Small-cell osteosarcoma

Six cases of small-cell osteosarcoma, a tumor that resembles Ewing's sarcoma but produces osteoid matrix, are presented. The patients were young (6-31 years of age) and presented with symptoms of pain and/or swelling of 1-10 months duration. The lesions demonstrated a wide variation in radiographic appearance. Histologically, the tumors were composed of small, round cells that produced variable amounts of osteoid. In three cases chondroid was also present. Two of the six patients were treated with surgery alone and four received radiation and either single- or multiple-agent adjuvant chemotherapy. The two patients who received radiation and multiple-agent adjuvant chemotherapy have no evidence of disease at four and ten years after diagnosis. Recognition of this tumor as distinct from Ewing's sarcoma and from other forms of osteosarcoma is important to determine the incidence, clinical features, and optimal therapy for this tumor.

Ultrasonic evaluation of therapeutic response in tumors: its values and implications

Not only may ultrasound demonstrate the presence of a tumor mass at various sites in the abdomen, but it may also be useful in measuring the size of the mass. The rate of tumor growth or regression was followed by ultrasound in 28 patients with ovarian carcinoma undergoing chemotherapy. The ability of ultrasound to make precise measurements of tumor size is discussed, and the value of these measurements is explored. This quantification may be valuable in the assessment of therapeutic response in pelvic cancer, and the technique may be applicable to other intra-abdominal mass lesions.

The first rib as the cause of a "pulmonary nodule" on chest computed tomography

A protuberance arising from the first rib may simulate a pulmonary nodule on computed tomography of the chest. The typical location of this density should suggest its true nature, which may be confirmed by a frontal chest radiograph.

Evaluation of bupivacaine nerve blocks in the modification of pain and pulmonary function changes after thoracotomy

Thirty-one patients undergoing thoracotomy were prospectively randomized to receive (1) no nerve blocks (n = 12), (2) placement of percutaneous catheters for intermittent nerve blocks with bupivacaine (Marcaine) (n = 10), or (3) bupivacaine nerve blocks intraoperatively (n = 8). One patient refused postoperative evaluation and was not included in this study. All patients received similar preoperative, intraoperative, and postoperative medications. Comparison of preoperative and postoperative arterial blood gases, assessments of pain and alertness, and chest roentgenograms showed no statistical advantage for any group. Analgesic requirements and pulmonary functions (functional residual capacity, tidal volume, minute ventilation peak flow, or forced expiratory volume) did not differ among the groups. Statistically significant differences were seen in mean respiratory rate and forced vital capacity. These differences, however, indicate that bupivacaine either by intraoperative use or by intermittent percutaneous administration did not improve postoperative increases in respiratory rate or decreases in forced vital capacity.

The displaced crus: a sign for distinguishing between pleural fluid and ascites on computed tomography

Fluid collections in the lower pleural cavity and upper abdominal cavity may sometimes appear similar on computed tomography. Lateral displacement of the diaphragmatic crus and interposition of fluid between the crus and vertebral column indicate an intrapleural component. Demonstration of fluid anterior to the crus establishes an intraperitoneal component. Medial location of the posterior recess of the fluid collection and the intercostal bulging of its lateral margin suggest a pleural effusion.

Radionuclide determination of cardiac chamber flow/volume characteristics

The flow/volume characteristics of an externally monitored radionuclide dilution curve may contain valuable information about specific cardiac chamber abnormalities. a simplified method of obtaining this flow/volume ratio on a standard scintillation camera is presented. Preliminary clinical application to right-sided cardiac lesions has been undertaken. The implications of flow/volume variation with time are discussed.