Limb salvage for extremity sarcoma in Ramathibodi Hospital.

From May 1986 to July 1991, a retrospective review of 27 patients treated with limb salvage surgery for extremity sarcomas, was evaluated by our team. There were 12 males and 15 females with a mean age of 22.7 years (ranging from, 9 to 53 years). The mean of the follow-up period was 27.6 months. (ranging from 6 to 62 months). Twenty-four patients had bone sarcomas which included 20 osteosarcomas, 3 chondrosarcomas and one adamantinoma. The locations of bone sarcomas were the proximal tibia (6 cases), distal femur (5 cases), proximal humerus (4 cases), proximal fibula (3 cases), scapula (3 cases), proximal femur (1 case), tibial shaft (1 case) and pelvis (1 case). The remaining three patients had malignant fibrous histiocytomas located in scapular, tibialis anterior muscle, and knee regions. In total there were 1 stage IA, 2 stage Ib, 1 stage IIA and 23 stage IIB. Twenty-four cases had wide excisions; two had marginal excisions and one radical excision. There were 17 bone reconstructions consisting of 11 allografts and 6 autografts. At the most recent follow-up examination, 74 per cent of the patients are alive and the overall disease free survival was 63 per cent. Local recurrences occurred in 11 per cent. The major complication rate was 3 per cent and the minor complication rate was 33 per cent. With respect to a functional outcome, 84 per cent of the patients achieved excellent or good results.(ABSTRACT TRUNCATED AT 250 WORDS)

Multidisciplinary "limb salvage" treatment of osteosarcoma.

Intraarterial plus systemic chemotherapy of cis-diamine dichloroplatinum-II and anthracycline together with preoperative radiation and "limb salvage" treatment have increased the chance of local control and facilitated the previous surgically nonresectable to be resectable. Among 30 cases of osteosarcoma from 1986-1989, aged 9-43 years old, 10 of the 17 cases (58.8%) are still alive with the mean disease free survival of 27.8 months. Late pulmonary metastases cause the need for future protocol for prophylactic lung therapy.

Human pythiosis associated with thalassemia hemoglobinopathy syndrome.

Pythium infection (pythiosis) in humans has not previously been described, even in areas endemic for animal pythiosis. We report five patients with a unique presentation of fungal arteritis. The medium- to large-sized arteries were involved, and in some cases this involvement led to gangrene of the limbs, aneurysm formation, and ultimately fatal arterial leakage. All five patients were farmers. All patients, with the possible exception of one who had hemoglobin typing performed after receiving a blood transfusion, had thalassemia hemoglobinopathy syndrome. Fungal isolation was difficult. Amphotericin B treatment seemed to be ineffective. Radical surgical removal of infected tissues and oral administration of a saturated solution of potassium iodide are proposed therapy. In the tropics, where Pythium is ubiquitous, one should actively look for this fungal infection in patients with unexplained arterial occlusion, especially in the case of patients with thalassemia hemoglobinopathy syndrome.