Interventional Radiology for Treating Soft Tissue Sarcomas

The role of interventional radiology for soft tissue sarcomas is only occasionally addressed in the literature. However, different techniques such as embolization, selective chemotherapy, chemoembolization, and acrylic cement osteoplasty can be helpful with the primary tumor, recurrences, and metastases. This article discusses these techniques and their complications in treatment of soft tissue sarcomas.     

Hemodynamic effects of medical antishock trousers during mechanical ventilation

Purpose

To compare the hemodynamic effects of medical antishock trousers (MAST) inflation in mechanically ventilated patients with normal and poor left ventricular function.

Methods

Twelve patients requiring respiratory support were divided into two groups according to baseline transesophageal echocardiography (TEE) measurements: normal left ventricular dimensions and fractional area of contraction (FAC=61 ± 5%) (n=7) and dilated cardiomyopathy with reduced FAC (21 ± 1%) (n=5). All patients were studied when two successive levels of load (mild load by inflation of the leg compartment of MAST at 50 cmH₂O and high load by adding the abdominal compartment of MAST inflated at 30 cmH₂O) were applied. Global left ventricular systolic function was assessed on the TEE transgastric short-axis view. End-systolic wall stress (ESWS) was used as an indicator of left ventricular afterload.

Results

Total respiratory, lung and chest wall compliances were reduced by 48%, 51% and 27% respectively at the high load level (P < 0.05). Whereas no hemodynamic changes occurred at mild load, the high load level produced an increase in left ventricular afterload as evidenced by concomitant increases in diastolic arterial blood pressure (66 ± 6 to 79 ± 6 mmHg,P < 0.05) and ESWS (69 ± 12 to 74 ± 12 Kdyn·cm^?2·m^?2,P < 0.05). In patients with dilated cardiomyopathy, this increase in afterload impaired the left ventricular systolic function and end-systolic area increased (19.0 ± 2.5 to 21.4 ± 2.9 cm²·m^?2,P < 0.05) while FAC decreased (22 ± 2 to 16 ± 2%,P < 0.05). Left ventricular end-diastolic area remained unchanged during the study in both groups.

Conclusion

MAST inflation impairs respiratory mechanics and global left ventricular systolic function in cardiac patients without changes in left ventricular preload.     

Supine Bicycle Exercise Echocardiography: A Potent Immediately Available Tool for Detection and Localization of Myocardial Ischemia for the Initial Cardiologist

Background: Exercise echocardiography (EE) is being used increasingly as an investigative technique now that dynamic images can be captured digitally. Its equivalent reliability with scintigraphic methods has been demonstrated in a hospital setting. This study analyzes its impact on daily practice. Materials and Methods: Standardized progressive stress was produced by supine bicycle ergometry. Echocardiographic images of complete cardiac cycles were obtained in standard apical and parasternal short-axis views before, during, and after maximum effort, and digitized for simultaneous analysis of synchronized images at rest and during exercise. Two hundred sixteen patients (175 men and 41 women; mean age 58 ± 10 years) were studied. Results: Image quality was suboptimal in 4 cases. In the remaining 212 cases, ischemia was detected in 91 cases, and the test was negative in 114 cases and doubtful in 7 cases. Control by selective coronary angiography, as indicated by the clinical situation, was performed in 52 cases. In this particular group, EE showed 87% sensitivity, which is significantly higher than the 59% recorded for conventional exercise testing (P > 0.0001). Conclusions: EE by bicycle ergometer in the supine position is a valid, noninvasive investigative technique that can be used in an outpatient situation (feasibility 95%) since it is readily available. Its value appears to be greatest in cases in which exercise ECG is not conclusive. A negative result enables the initial cardiologist to reassure the patient immediately, which has been demonstrated in the literature to have favorable prognostic value.     

Morphological and quantitative study of spirochetes in the feces of normal and infected SPF pigs during the incubation period of swine dysentery.

Spirochetes found in feces of normal and infected pigs during the eight days preceding the onset of the clinical signs of swine dysentery have been studied using electron and phase contrast microscopy. According to their dimensions, diameter, length and pitch, three morphological groups have been described: small, intermediate and large spirochetes. On the basis of their axial filaments arrangement, eight types have been observed. Compared to the control pigs, there was no increase in the total number of spirochetes in infected pigs, except at day 6 before the onset of clinical signs. However, infected pigs have shown a wide spectrum of different morphological types of spirochetes in comparison to control, uninfected pigs, which showed only the type "1-2-1" spirochete of axial filaments arrangement. This last type was predominant in infected swine during the entire incubation period as compared to other spirochete types described.     

Phenotypic differences in survival to an experimental acute carbon monoxide intoxication

Male and female 45-day-old mice of two inbred (CBA and C57B1) and of one outbred (OF₁), SPF (specific pathogen free), strains, LD_12:12 (L = 150 lx) synchronized, were submitted to an acute carbon monoxide challenge giving an overall survival close to 50%. Under these conditions significantly (P < 0.001) less CBA survived than the two other strains. A sex-related significant (P < 0.001 difference was observed in OF₁. Strain survival differences are independent of body weights and of respiratory and displacement activity, but appear to be related to behavior reactions towards environmental stresses. These phenotypic differences are similar to previous findings obtained with these three strains of mice submitted to a 50% survival acute hypoxic hypoxia (M. Stupfel, A. Perramon, P. Merat, J. M. Faure, and H. Masse, 1979, Comp. Biochem. Physiol., 64A, 317–323).     

Cancer chemotherapy in the elderly: a series of 51 patients aged>70 years

Summary A total of 2,238 new cancer patients were treated in our institution in 1988; among the 423 (18.9%) who were>70 years old, 51 underwent chemotherapy. The median age was 75.8 years, and the Karnofsky performance status (KPS) was 70% for 40 patients. Malignancies were hematopoietic in 24 cases (47%) and digestive in 15 patients (29%), and 12 subjects (24%) had other types of cancers. The first chemotherapy course was given at the full dose to 23/51 (45.1%) patients. The drug dose was reduced for 28/51 (54.9%) patients, due in 25 cases to the subjects being>70 years old. Neither age, KPS, pretreatment assessment, nor cancer extent was correlated with the modifications made to the first cycle. An overall toxicity of grade 3+4 (WHO grading scale) was noted in 10 subjects (19.6%). Although these elderly patients were probably selected, analysis of their charts did not evidence an increase in chemotherapy toxicity, regardless of the dose they received.Presented at the EORTC Pharmacokinetics and Metabolism Group Meeting, Bordeaux, November 1990     

Light and Electron Microscopic Localization of the Neutral Metalloendopeptidase EC 3.4.24.16 in the Mesencephalon of the Rat

The topographic and cellular distribution of the neurotensin-hydrolysing neutral metalloendopeptidase 24.16 (EC 3.4.24.16) was examined by light and electron microscopic immunohistochemistry in adult rat mesencephalon. Light microscopic immunoradioautography revealed a ubiquitous distribution of the enzyme throughout the midbrain with a relative enrichment of grey matter areas including the substantia nigra, ventral tegmental area, interfascicular nucleus, interpeduncular nucleus, rostral and caudal linear raphe nuclei, central grey and superficial grey of the superior colliculus. Peroxidase - antiperoxidase immunocytochemistry revealed two distinct cellular patterns of immunostaining: (1) weakly labelled neuronal perikarya more or less uniformly distributed throughout the grey matter, and (2) intensely immunoreactive glial cells heterogeneously distributed across the mesencephalon. Areas exhibiting dense concentrations of endopeptidase 24.16-containing glial cells corresponded to those displaying enhanced immunoreactivity in immunoradioautographs, suggesting that a major proportion of brain endopeptidase 24.16 is associated with glia. Electron microscopic examination of the substantia nigra and ventral tegmental area confirmed the association of the enzyme with a subpopulation of neurons and allowed identification of labelled glial cells as protoplasmic astrocytes. In neurons, endopeptidase 24.16 immunoreactivity was distributed heterogeneously within the cytoplasm of perikarya, dendrites and axons. Reaction product was also characteristically associated with restricted zones of the plasma membrane and underlying neuroplasm. In astrocytes, endopeptidase 24.16 immunostaining was densely and uniformly distributed throughout the cytoplasm of cell bodies and processes. Many of these processes were in direct contact with endopeptidase 24.16-immunopositive neuronal elements. The present results demonstrate that within the midbrain, endopeptidase 24.16 is both intracytoplasmic and membrane-associated in neurons and predominantly intracytoplasmic in glia. The presence of a large number of immunostained elements within areas of the midbrain known to display high levels of neurotensin and/or neurotensin receptors, together with the demonstrated catabolic activity of the enzyme on neurotensin in vitro, is consistent with a role of endopeptidase 24.16 in the functional inactivation of endogenous neurotensin in this region of the brain.     

Screening protocol for MR imaging of the internal auditory canal

We have previously shown that 5 mm axial T1-weighted images following Gd-diethylenetriamine pentaacetic acid (DTPA) administration were sufficient as a screening examination of the internal auditory canal (IAC) and cerebellopontine angle cistern in 80% of cases with sensorineural hearing loss. In the remaining 20% of cases 3 mm slices were necessary for confirmation of the diagnosis. To reduce the number of cases requiring the additional examination, we have modified our protocol to include a coronal "scout" T1-weighted sequence followed by 5 mm axial sections angled through the IACs. Routine axial T2-weighted images of the posterior fossa were also obtained. One hundred eleven patients were studied with this protocol. In all but two of these the 5 mm sections unequivocally provided the diagnosis and in those two cases the coronal images confirmed the diagnosis suspected on the axial study. Three millimeter slices were not necessary in any patient. This three sequence, post-Gd-DTPA protocol, which requires only 12 min of scan time, is recommended as a screening protocol for IAC and cerebellopontine angle disease.