Primary Intracranial Sarcomas, Myxoid Meningeal Sarcoma - a Case Report and Literature Review.

BACKGROUND: Primary intracranial sarcoma is a rare disease. Due to the scarcity of evidence from randomized clinical trials, we follow the treatment guidelines of their extracranial counterparts or those published in case reports, while taking into consideration the specificity of radiotherapy within the brain, and the limit imposed on chemotherapy by the blood brain barrier. Nevertheless, surgery remains the golden standard of treatment for primary tumours, and also for recurrence. Even though there are usually narrow margins achieved in brain compared with the extracranial sarcomas. Despite significant effort, prognosis remains dismal. CASE: We present a 69-year old woman who was investigated for psychoorganic syndrome and paresis of the left hand. Magnetic resonance imaging revealed a tumour expansion in her frontal lobe with collateral oedema. Surgical resection was indicated. Histology of the specimen suggested a myxoid meningeal sarcoma. Early disease recurrence 4 months after primary resection was treated by reresection and 50 Gy of adjuvant radiotherapy to the tumour bed. Similarly, another recurrence 19 months after the second surgery was treated using the same approach. Systemic treatment has not been indicated so far. At this time, the patient is without evidence of any disease recurrence and continues with regular follow-up. CONCLUSION: Myxoid meningeal sarcoma represents a rare disease with a high risk of recurrence. Unfortunately, there is no clear recommendation for treatment algorithm. The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers.

[Internal mammary lymph nodes in early stage breast cancer]. / Vnitrní mamární uzliny u casného karcinomu prsu.

Internal mammary nodes (IMN) in early stage breast cancer are a still unresolved issue. Their involvement has a crucial impact on the staging as well as prognosis of the breast cancer patients. The reported incidence of IMN drainage in the process of detecting the axillary sentinel node is about 20% depending on the tracer application technique. However, the IMN drainage itself apparently has no effect on the prognosis even when the nodes are left without biopsy or radiotherapy. The major predictive factor for the presence of metastases in IMN is the presence of metastases in axillary lymph nodes. Studies evaluating adjuvant IMN radiotherapy have shown inconsistent outcomes. The generally accepted trend towards less extensive locoregional procedures in breast cancer treatment will apparently affect the IMN, as well, given that new systemic treatment will probably compensate for uncertainties in IMN management.Key words: breast cancer internal mammary nodes radiotherapy.

[Infusion mixtures--study of clinical practice in Austria]. / Infusionsmischungen--Untersuchung der Praxis in Osterreich.

Options in parenteral therapy increasingly require administration of several medications simultaneously. Very little is known about the compatibility and pharmacological stability of such mixtures. We investigated how widespread this practice is, which carrier solutions are most commonly used, and whether specific medication mixtures ('cocktails') or constant formulations for TPN are applied. Upon our request, physicians and nursing staff of 54 general hospital wards (19 surgical, 18 internal medicine, 17 intensive care) in 17 Austrian hospitals recorded the parenteral admixtures for one week under the supervision of a hospital pharmacist. We found that: 1. Admixing is commonly practiced in all wards. In all but one of the wards two or even more medications are added into one single infusion. 2. Carrier solutions were: Dextrose/fructose (87% of the wards), electrolytes (90%), amino acids (40%), fat emulsions (26%), colloids (14.8%), albumin (5.5%) and Solcoseryl (5.5%). 3. Fixed combinations for i.v. therapy are practiced in 70% of the wards (mostly analgetics with corticosteroids or vitamins) 4. In almost half of the units constant formulations for TPN exist (46%). Only few of the combinations named have been investigated or tested for stability. The compatibility of most of the admixtures is unknown, while a few are clearly incompatible. Admixtures to one of the carrier solutions (Solcoseryl) are known to have caused serious complications before. For several admixtures, conflicting data about compatibility were found in the literature. The theoretical basis for incompatibilities is discussed together with some typical examples. Also some rules for admixtures are given. Questions concerning the compatibility of simultaneous parenteral drug applications are too specific to be answered for most physicians. Advice and counseling on this subject should become a new task for clinical pharmacists.