Long-Term Locoregional Vascular Morbidity After Isolated Limb Perfusion and External-Beam Radiotherapy for Soft Tissue Sarcoma of the Extremity

Background: Isolated limb perfusion (ILP) with tumor necrosis factor alpha (TNF-alpha) and melphalan, followed by delayed surgical resection and adjuvant external-beam radiotherapy is a limb salvage treatment strategy for locally advanced soft tissue sarcomas. The long-term vascular side effects of this combined procedure were evaluated. Methods: Thirty-two patients were treated for a locally advanced sarcoma of the upper (n = 5) or lower limb (n = 27). All patients underwent a noninvasive vascular work-up. Results: Five patients underwent a leg amputation, in two cases due to critical leg ischemia 10 years after ILP. With a median follow-up of 88 (range, 17-159) months, none of the patients with a salvaged lower leg (n = 22) experienced peripheral arterial occlusive disease. Ankle-brachial index (ABI) measurements in the involved leg (median, 1.02; range, .50-1.20) showed a significant decrease compared with the contralateral leg (median, 1.09; range, .91-1.36, P = .001). Pulsatility index (PI) was decreased in the treated leg in 17 of 22 patients at the femoral level (median, 6.30; range, 2.1-23.9 vs. median, 7.35; range, 4.8-21.9; P = .011) and in 19 of 20 patients at popliteal level (median, 8.35; range, 0-21.4 vs. median, 10.95; range, 8.0-32.6; P <.0005). In patients with follow-up of > 5 years, there was more often a decrease in ABI (P = .024) and PI at femoral level (P = .011). Conclusions: ILP followed by resection and external-beam radiotherapy can lead to major late vascular morbidity that requires amputation. Objective measurements show a time-related decrease of ABI and femoral PI in the treated extremity

Lipid-F1 nucleohistone interactions.

High concentrations of phospholipids determine destabilization of F1 histone-DNA complex at the weight ratios, histone:DNA, 0.8:1 and 1:1, but low concentrations cause only negligible destabilization. Cholesterol at high weight ratios has little effect on nucleohistone stability. Only linolenic acid of the fatty acids used reproduces similar changes in the thermal stability of F1 histone-DNA complex as phospholipids. The type of interaction of phospholipids with the F1 histone-DNA complex is analyzed, and the involvement of phospholipids in DNA replication in vivo is discussed

Lipid--DNA interactions. II. Phospholipids, cholesterol, glycerophosphorylcholine, spingosine and fatty acids.

High concentrations of lecitin, phosphadylethanolamine, phosphatidyl-serine, cholesterol and lauric acid have a destabilizing effect on the DNA helix. On the contrary, lower concentrations of the same lipids produce stabilization on DNA. The stabilizing and destabilizing effects with sphingomyelin components can be mainly attributed to sphingosine and lignocerin acid components, whwreas glycerophosphorycholine probably has a minimal effect. The saturated long-chain fatty acids were capable of having a moderate destabilizing effect on DNA; however, the unsaturated fatty acids were found to be generally more stabilizing in nature. The type of bonding within the lipid-DNA interaction has been investigated and the existence of a lipid-DNA complex in vivo has been considered

Effect of phospholipids on the activity of DNA polymerase I from E.coli.

Sphingomyelin, phosphatidylethanolamine and lecithin at concentrations which destabilize the DNA helix enhance the DNA polymerase activity, but sphingosine and phosphatidylserine have only a moderate effect. MgCl2 was shown to modify the action of sphingomyelin on the DNA polymerase activity. The role of phospholipids in the DNA replicating process was analyzed