Prospective randomized evaluation of adjuvant chemotherapy in adults with soft tissue sarcomas of the extremities

Sixty-five patients with high-grade soft tissue sarcomas of the extremities were treated in a prospective randomized trial evaluating the efficacy of adjuvant chemotherapy with doxorubicin, cyclophosphamide, and high-dose methotrexate. Local therapy was administered using either amputation or wide local resection plus radiation therapy and the chemotherapy was begun in the immediate postoperative period. Actuarial analysis with median follow-up of 653 days revealed an advantage in continuous disease-free and overall survival in the patient group receiving chemotherapy (P = 0.0008 and P = 0.04, respectively, one-sided Mantel-Haenszel test). The continuous disease-free survival at three years is 92% in the chemotherapy group compared to 60% in the no chemotherapy group. Overall survival is 95% and 74% in these two patient groups. Fifty-eight percent of patients had limb-sparing surgery plus radiation therapy and 42% underwent amputation. In both treatment subgroups analyzed separately, chemotherapy resulted in an improvement in disease-free survival compared to randomized controls not receiving chemotherapy (P = 0.006 and P = 0.04 for groups receiving amputation and limb sparing, respectively). There were no local failures in the patients receiving chemotherapy and two local failures in the no chemotherapy group. The results of this trial confirm the historically controlled pilot trial performed in 26 patients between 1975 and 1977. A current update of the patients in the pilot trial, with a minimum four-year follow-up, reveals an improvement in disease-free and overall survival due to chemotherapy (P less than 0.002). Analysis of the previous pilot trial indicates that only few recurrences are seen beyond three years. Thus, it appears that adjuvant chemotherapy should be a part of the treatment adult patients with soft tissue sarcomas of the extremities.

An assessment of the sensitivity of 3 bleeding time techniques

The sensitivity of 3 bleeding time techniques to an aspirin-induced defect of platelet function has been assessed in 35 normal volunteers. A carefully standardised Ivy technique was compared with 2 commercial devices for a template bleeding time, the Simplate II and the Thrombolette. The standardised Ivy and the Simplate II were found to have a similar sensitivity; the Thrombolette tended to be less sensitive but the difference was not significant.

Kinetic studies of mouse brain transketolase

The activity of transketolase in mouse brain was 5.7 nmol/min/mg protein measured by an enzyme-coupled spectrophotometric assay. The apparent Km for ribose-5-phosphate was 330 microM, for D-xylulose-5-phosphate was 120 microM, and for thiamine pyrophosphate was 7 microM. However, thiamine pyrophosphate remained tightly bound to transketolase in homogenates in which it dissociated completely from another thiamine pyrophosphate-dependent enzyme, the pyruvate dehydrogenase complex. These data suggest that loss of transketolase activity is likely to be a later consequence of thiamine deficiency in mammalian brain than is decreased activity of pyruvate dehydrogenase complex.

The treatment of soft-tissue sarcomas of the extremities: prospective randomized evaluations of (1) limb-sparing surgery plus radiation therapy compared with amputation and (2) the role of adjuvant chemotherapy

Between May 1975 and April 1981, 43 adult patients with high-grade soft tissue sarcomas of the extremities were prospectively randomized to receive either amputation at or above the joint proximal to the tumor, including all involved muscle groups, or to receive a limb-sparing resection plus adjuvant radiation therapy. The limb-sparing resection group received wide local excision followed by 5000 rads to the entire anatomic area at risk for local spread and 6000 to 7000 rads to the tumor bed. Both randomization groups received postoperative chemotherapy with doxorubicin (maximum cumulative dose 550 mg/m2), cyclophosphamide, and high-dose methotrexate. Twenty-seven patients randomized to receive limb-sparing resection and radiotherapy, and 16 received amputation (randomization was 2:1). There were four local recurrences in the limb-sparing group and none in the amputation group (p1 = 0.06 generalized Wilcoxon test). However, there were no differences in disease-free survival rates (71% and 78% at five years; p2 = 0.75) or overall survival rates (83% and 88% at five years; p2 = 0.99) between the limb-sparing group and the amputation treatment groups. Multivariate analysis indicated that the only correlate of local recurrence was the final margin of resection. Patients with positive margins of resection had a higher likelihood of local recurrence compared with those with negative margins (p1 less than 0.0001) even when postoperative radiotherapy was used. A simultaneous prospective randomized study of postoperative chemotherapy in 65 patients with high-grade soft-tissue sarcomas of the extremities revealed a marked advantage in patients receiving chemotherapy compared with those without chemotherapy in three-year continuous disease-free (92% vs. 60%; p1 = 0.0008) and overall survival (95% vs. 74%; p1 = 0.04). Thus limb-sparing surgery, radiation therapy, and adjuvant chemotherapy appear capable of successfully treating the great majority of adult patients with soft tissue sarcomas of the extremity.

Image detection and enhancement

An optimal filtering approach is taken to the problem of detecting and enhancing a photographic image immersed in background or noise. The minimum mean square error criterion is shown to be not relevant to the optical employment of the Wiener filter. It is shown theoretically and demonstrated by simulation that, even without information about the background, a knowledge of the target spectrum alone makes it possible to find and display such a target without distortion while eliminating all uncorrelated background, despite the fact that target and background spectra actually overlap, and virtually without regard to noise level.

Effect of nutritional and enzymatic methionine deprivation upon human normal and malignant cells in tissue culture

Human embryonic lung fibroblasts (F-136-35-56) capable of growing in medium containing DL-homocysteine instead of L-methionine and human acute lymphoblastic leukemia cells (CCRF-HSB-2) with absolute methionine requirement exhibited dose-dependent growth inhibition when semipurified L-methionine-degrading enzyme (L-methioninase, EC 4.4.1.11) was added to the tissue cultures. When D-homocystine was added to the cultures together with L-methioninase (0.1 units/ml, which completely degraded the available L-methionine in tissue culture), the F-136-35-56 cells continued to grow whereas the CCRF-HSB-2 cells were completely inhibited. In mixed cultures of the two cell lines with added L-methioninase + D-homocystine or L-methioninase + L-homocysteine thiolactone, the normal fibroblasts grew and synthesized DNA vigorously, whereas the lymphocytic malignant cells lost their viability completely and died within 3 to 4 days.

"Hand gym" for patients with arthritic hand disabilities: preliminary report

To improve function and to delay the tendency toward deformities of the rheumatoid arthritic hand, a new device was evaluated which enables patients to perform range of motion and isometric exercises in their home. Eighteen patients (35 hands) exercised daily for four months. Strength and range of motion showed statistically significant gains. Grip strength increased in 28 hands, volar pinch in 22 hands, lateral pinch in 21 hands. Of 140 PIP joints, 77% increased in range, indicating loosening of intrinsic muscles. Improvement in hand function was reported by most of the patients.

Alkaline phosphatase. Possible induction by cyclic AMP after cholera enterotoxin administration

The present studies were undertaken to determine the role, if any, of cyclic 3',5'-adenosine monophosphate (cyclic AMP) as a chemical inducer of rat liver alkaline phosphatase. Cholera enterotoxin, given intravenously to rats, led to a rapid rise in the activity of hepatic adenyl cyclase that was 7(1/2) times greater than control values in 6 h. Cyclic AMP levels were also significantly increased above control values while the activity of cyclic nucleotide phosphodiesterase was unchanged. Hepatic alkaline phosphatase activity was increased 5(1/2) times above control in 12 h, but its rise followed that of adenyl cyclase and cyclic AMP by several hours. Cycloheximide inhibited the rise of hepatic alkaline phosphatase but not that of adenyl cyclase. The administration of glucagon, a known stimulator of hepatic adenyl cyclase, and of dibutyryl cyclic AMP, led to similar striking increases in hepatic alkaline phosphatase activity. This alkaline phosphatase increase was blocked by the prior administration of cycloheximide. Bile duct ligation, a known stimulator of hepatic alkaline phosphatase activity, failed to produce any significant changes in adenyl cyclase or cyclic AMP. Concomitant treatment of rats with bile duct ligation and cholera enterotoxin or bile duct ligation and glucagon, had no additive effect on the increase in hepatic alkaline phosphatase activity, although the increase occurred earlier. These results suggest that: (a) cyclic AMP may act as an inducer of hepatic alkaline phosphatase: (b) the stimulation of hepatic alkaline phosphatase by cholera enterotoxin is mediated by cyclic AMP; (c) the rise in hepatic alkaline phosphatase following bile duct ligation is not mediated by cyclic AMP; (d) the same alkaline phosphatase in rat liver may be induced by two (or more) mechanisms, only one of which requires cyclic AMP.

A case of ophthalmic neonatorum with disseminated gonococcal dermatitis and gonorrhoea

Ophthalmia neonatorum with disseminated gonococcal dermatitis and gonorrhoea is a rare condition. A neonate of 22 days from a poor socioeconomic condition presented with purulent discharge from eye and vagina and eye for last 18 days and skin lesions for 5 days. The baby as born through vaginal delivery. Gram staining of eye and vaginal discharge revealed gram-negative intracellular diplococcices visualized microscopically inside polymorph nuclear cells. Neonate was diagnosed as a case of ophthalmia neonatorum with disseminated gonococcal dermatitis and gonorrhoea. Neonate was treated with inj. Ceftroaxone 250mg daily intravenously with antibacterial eye drop. On 2nd day, sign symptoms disappear and on 4th day patient was cured. Key words: Ophthalmia neonatum; conorrhoea; disseminated gonococcal dermatitis; HIV. DOI: http://dx.doi.org/10.3329/bjms.v10i4.9507 BJMS 2011; 10(4): 299-301

Fourier analysis and nonlinear optical systems

The modulation transfer function is based on Fourier techniques which imply the validity of the principle of superposition. This is clearly violated in the nonlinear film development process. A pseudotransfer function is defined to represent an artificial linear filter which, if it replaced the actual optical and photographic process, would result in precisely the same image as would be produced by the real system. The significance of such a function in a statistical approach and the results of a typical calculation are presented for purpose of illustration.