Treatment and outcome of radiation-induced soft-tissue sarcomas at a specialist institution.

BACKGROUND: Radiation-induced sarcoma (RIS) is a rare late complication of therapeutic irradiation with a reputation for aggressive pathology and poor outcome. METHODS: We retrospectively reviewed histopathological features, surgery and outcome in 67 patients with RIS treated between 1990 and 2005 at a single tertiary referral center. RESULTS: Previous breast cancer was the most common indication for radiotherapy. The median interval from irradiation to development of RIS of was 11 years (3-36 years). Median tumour size was 7 cm with 56% classified as high grade, 31% intermediate grade and 13% low grade. The commonest histology was leiomyosarcoma. The only relationship for histology with site was for angiosarcoma (n=9), all of which developed on the chest wall/breast after irradiation for breast cancer. Of 67 patients, 34 underwent potentially curative surgery, and microscopically clear margins were achieved in 75% of cases. Pedicled or free tissue transfer was required in 12 patients and abdominal or chest wall mesh reconstructions were required in 8 patients. No patient received adjuvant radiotherapy but 7 received adjuvant/neoadjuvant chemotherapy. Median follow up is 53 months. Median sarcoma specific survival was 54 months (2- & 5-year survival: 75% & 45%). The local relapse rate was 65%. Negative histopathological margins were a significant predictor of sarcoma specific survival (HR 3.0 95% CI 1.1-8.6 p=0.04). Grade and size of tumour approached, but did not attain significance. CONCLUSION: RIS is a biologically aggressive tumour with high rates of local relapse despite aggressive attempts at curative surgery.

Osteosarcoma metastasising to the duodenum and pancreas.

The incidence of metastatic osteosarcoma is increasing because of improved results following multi-agent chemotherapy and resection of the primary tumour. Metastases occur most commonly in the lungs, whereas bowel metastases are rare. We describe a 25-year-old female who presented with melaena six years after successful resection of an osteosarcoma of her right femur, and one year after resection of a solitary pulmonary metastasis. Imaging revealed a lesion arising within both the duodenum and the pancreas for which a Whipple's pancreatoduodenectomy was carried out, achieving complete resection. Histological examination confirmed the diagnosis of metastatic osteosarcoma. We believe this is only the second such case reported. At 11 months post-operatively she had no detectable disease. Although rare, osteosarcoma can metastasise to the intestine. The surgeon must be aware of this complication, and that bowel metastases are potentially resectable.

Phencyclidine abuse in New Orleans: medical, forensic, and laboratory aspects.

A one year study of phencyclidine abuse in New Orleans showed that 90% of the cases cannot be detected by routine laboratory methods. Fifty percent of all cases showed evidence of police intervention. Initial impressions covered a wide range of psychiatric and clinical diagnoses. Recurring psychiatric problems due to the presence of the drug would indicate observation for a period of at least 72 hours. Patterns of PCP abuse cross racial and ethnic boundaries and are found uniformly in all population groups.

Comparison of serum theophylline concentrations measured by high pressure liquid chromatography and quantitative enzyme-multiplied immunoassay technique.

Safe, effective theophylline therapy depends on the rapid determination of serum theophylline concentrations. Two rapid methods that require less than 0.1 ml of serum are high pressure liquid chromatography (HPLC) and quantitative enzyme-multiplied immunoassay technique (EMIT). A comparison of these two methods was carried out using 117 serum samples routinely collected from asthmatic patients in Charity Hospital of Louisiana at New Orleans. After determination by the EMIT method, specimens were analyzed by HPLC in a different laboratory. Mean serum theophylline concentrations in 100 specimens containing more than trace concentrations were 14.5 mcg/ml by the EMIT method, compared with 12.1 mcg/ml by HPLC. The paired t test showed this to be a highly significant difference (p less than 0.0005). Whichever method of determination of theophylline concentration is used, frequent validation of results by comparison with those of other laboratories seems indicated.