This study investigates the potential of in vivo 31P magnetic resonance spectroscopy (MRS) to characterize musculoskeletal tumors and to determine preoperative levels of histological necrosis, which is an important clinical indicator of patient response. Pretherapy MRS was performed on 28 patients with large musculoskeletal tumors: 13 with osteosarcoma, 3 with chondrosarcoma, 5 with malignant fibrous histiocytoma, 1 with desmoid tumor, 1 with Ewing's, 2 with hemangioendothelioma, 1 with myxoid liposarcoma, 1 with synovial cell sarcoma, and 1 with rhabdomyosarcoma. Fifteen patients had follow-up MRS examinations after commencement of chemotherapy (mean of five/patient), eight of whom have now had surgery. Elevated levels of PMEs (P < 0.01), P(i) (P < 0.01), and PDEs (P < 0.02) as well as elevated tumor pH (P < 0.05) were observed in all patients. The synovial cell sarcoma was characterized by high levels of PMEs (> 20%) and low pH (pH 6.76). This contrasted with the spectra obtained from the malignant fibrous histiocytomas which had high levels of PDEs (17 +/- 5%). Reductions in PDE levels postchemotherapy were associated with a high degree of necrosis (> 90%) at surgery, while an increase in PDE levels was associated with a low level of histological necrosis. Likewise, reductions in the ratios PDE/NTP and PDE/PCr and an increase in P(i)/PDE were also associated with a high level of necrosis.
Recent work suggests that between 50 and 75% of small-cell lung cancer (SCLC) tumours have specific high-affinity binding sites for somatostatin. This study evaluated the potential role of the radiolabelled somatostatin analogue, [111In]pentetreotide, in the detection and staging of SCLC in patients prior to and after chemotherapy using scintigraphic imaging techniques. Thirteen patients were studied prior to chemotherapy. Following standard staging six patients had limited stage disease and seven extensive disease. [111In]pentetreotide imaging led to the detection of all primary sites of disease, including a primary site of disease not detectable with chest radiograph or computerised tomography (CT) of the thorax. Five of ten metastatic sites detected by standard staging were also imaged. Furthermore, a cerebellar metastasis was detected in a patient thought to have disease confined to the right hemithorax. This was subsequently confirmed with a CT brain scan. Following chemotherapy [111In]pentetreotide imaging detected residual intrathoracic disease in two of three patients with complete remissions by standard staging and in two patients who had had a partial response to chemotherapy. These results suggest that [111In]pentetreotide imaging may have a role to play in the clinical evaluation of patients with SCLC. Specifically, this technique may be of particular value in detecting residual intrathoracic disease in patients thought to be in complete remission by conventional staging methods.
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The results of a prospective randomised study in a series of 106 patients undergoing Charnley total hip arthroplasty are discussed. All were consecutive and no one was excluded on the grounds of previous medical history. Fifty-five received prophylactic Dextran while 51 acted as controls. A total of 867 separate studies were performed on these patients. Radionuclide venography was employed to detect deep vein thrombosis and perfusion lung scanning for pulmonary emboli. Eighteen per cent of the control patients and 27% of the Dextran patients developed deep vein thrombosis. Pulmonary emboli occurred in 16% of the patients in each group. The overall incidence of thromboembolic disease was 27% in the control and 36% in the Dextran group. A prophylactic effect of Dextran was not demonstrated.
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