Spontaneous expectoration of pulmonary metastases in a child with osteogenic sarcoma

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/148355/1/pbc27611.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/148355/2/pbc27611_am.pd

Isolated Limb Perfusion and External Beam Radiotherapy for Soft Tissue Sarcomas of the Extremity: Long-Term Effects on Normal Tissue According to the LENT-SOMA Scoring System

BACKGROUND: With the combined treatment procedure of isolated limb perfusion (ILP), delayed surgical resection and external beam radiotherapy (EBRT) for locally advanced soft tissue sarcomas (STS) of the extremities, limb salvage rates of more than 80% can be achieved. However, long-term damage to the healthy surrounding tissue cannot be prevented. We studied the late effects on the normal tissue using the LENT-SOMA scoring system. PATIENTS AND METHODS: A total of 32 patients-median age 47 (range 14-71) years-were treated for a locally advanced STS with ILP, surgical resection and often adjuvant 60-70 Gy EBRT. After a median follow-up of 88 (range 17-159) months, the patients were scored, using the LENT-SOMA scales, for the following late tissue damage: muscle/soft tissue, peripheral nerves, skin/subcutaneous tissue and vessels. RESULTS: According to the individual SOM parameters of the LENT-SOMA scales, 20 patients (63%) scored grade-3 toxicity on one or more separate items, reflecting severe symptoms with a negative impact on daily activities. Of these patients, 3 (9%) even scored grade-4 toxicity on some of the parameters, denoting irreversible functional damage necessitating major therapeutic intervention. CONCLUSIONS: In evaluating long-term morbidity after a combined treatment procedure for STS of the extremity, using modified LENT-SOMA scores, two-thirds of patients were found to have experienced serious late toxic effects

A comprehensive overview of radioguided surgery using gamma detection probe technology

The concept of radioguided surgery, which was first developed some 60 years ago, involves the use of a radiation detection probe system for the intraoperative detection of radionuclides. The use of gamma detection probe technology in radioguided surgery has tremendously expanded and has evolved into what is now considered an established discipline within the practice of surgery, revolutionizing the surgical management of many malignancies, including breast cancer, melanoma, and colorectal cancer, as well as the surgical management of parathyroid disease. The impact of radioguided surgery on the surgical management of cancer patients includes providing vital and real-time information to the surgeon regarding the location and extent of disease, as well as regarding the assessment of surgical resection margins. Additionally, it has allowed the surgeon to minimize the surgical invasiveness of many diagnostic and therapeutic procedures, while still maintaining maximum benefit to the cancer patient. In the current review, we have attempted to comprehensively evaluate the history, technical aspects, and clinical applications of radioguided surgery using gamma detection probe technology

Validation of the Signs of Inflammation in Children that can Kill (SICK) score for assessment of illness severity

Background The Signs of Inflammation in Children that can Kill (SICK) score has been developed in the search for a practical triage tool in settings with limited resources for immediate, noninvasive assessment of illness severity. Its seven parameters are heart rate, respiratory rate, systolic blood pressure, temperature, blood oxygen saturation (Sp02), capillary refill time (CRT), and level of consciousness. The SICK score also takes into account the age of the child. Objective To assess the validity of SICK scores for differentiating between high and low probabilities of death in children. Methods We performed a prospective evaluation of all children aged between one month to twelve years admitted to the Pediatric Emergency Care Unit at Prof. Dr. R.D. Kandou Hospital, Manado between October 2011 to January 2012. We calculated SICK scores at the time of presentation and assessed their correlation with subsequent in-hospital mortality using logis tic regression analysis. Results During the study period, we observed 230 patients, of whom 199 survived and 31 died. There were 134 males, of whom 117 survived and 17 died. The remaining 96 subjects were female, of whom 82 survived and 14 died. Logistic regression analysis revealed a significant relationship between SICK score and mortality (P< 0.001). With a probability of 0.5, we attained a cut off score of 4.74 points, with 96.8% sensitivity and 99.5% specificity for the prediction of mortality. Conclusion T he high SICK score is associated with higher probability of death. A cut off score of 4. 74 has high sensitivity and specificity for predicting the probability of death. The SICK score may be useful as a triage tool at the patient's initial presentation, particularly in settings with limited resources

Can pharmacokinetic monitoring improve clinical use of fluorouracil?

Fluorouracil is used clinically against a variety of solid tumours. It is a prodrug that undergoes a series of intracellular conversions to active cytotoxic species. There is wide interindividual variability in fluorouracil metabolism; furthermore, it has nonlinear kinetics that make it relatively more difficult to predict plasma concentrations after brief infusions compared with prolonged infusions. There is an increasing body of evidence that relates plasma fluorouracil concentrations to toxicity and effectiveness, and consequently there may be a definable mathematical relationship that describes a 'therapeutic window'. Dose nomograms and pharmacokinetic models based on limited sampling strategies have been developed, as have empirical dose escalation schedules based on multivariate analysis of the determinants of toxicity. The utility of these approaches should be tested in properly powered, prospective, randomised trials