No abstract

Intratumoral angiogenesis quantified by microvessel density (MVD) has been shown to be a strong prognostic indicator in a number of malignant tumors. Its association with prognosis in bone sarcomas has been subject to less extensive research. The aim of this study was to investigate prognostic significance of angiogenesis in osteosarcoma. Thirty-nine patients with osteosarcoma were included in a retrospective immunohistochemical study. Sections from diagnostic biopsies were immunostained using anti-von Willebrand factor antibody and microvessels were counted at 400 x magnification on 3 microscopic fields per patient. MVD was correlated with overall and disease-free survival by Kaplan-Meier and log-rank analysis. Correlation between clinicopathological variables and the degree of angiogenesis was tested using a chi 2 test. Significant statistical difference was found regarding overall survival and disease-free survival between patients with high (> 32.3 vessels/field) and low (< or = 32.3 vessels/field) microvessel counts (log-rank test p = .0196 and p = .0147, respectively). The rate of metastasis was significantly higher in patients with high microvessel counts (p = .042). These findings strongly suggest that angiogenesis quantified by microvessel density is predictive of metastasis and poor prognosis in osteosarcoma.

Growth hormone (GH) responses to sleep, insulin hypoglycaemia and arginine infusion. A few children with no apparent cause for their short stature, continue to grow poorly despite normal GH responses (>15mU/L) to pharmacological stimuli. It has been suggested that their GH secretion during sleep may more accurately reflect their true GH reserve. We have compared sleep related GH secretion (GH-Sleep) with GH responses to insulin hypoglycaemia (GH-I) and arginine infusion (GH-Arg.) in 19 children referred to our Growth Clinic. Blood was withdrawn continuously through an indwelling thromboresistant catheter (Cormed SL-65 Continuous Blood Withdrawal Pump) and divided into 15 minute aliquots, throughout approximately 5 hours of EEG monitored sleep. The following morning an, insulin hypoglycaemia/arginine infusion test was performed. GH was measured by radioiuununoassay. 2 patients had normal GH-Arg. responses but GH-Sleep peaks less than 15mU/~. Correlation coefficients, r, for peak serum GH levels were :for GH-I & GH-Sleep 0.55 (p<0.02), GH-Arg. & GH-Sleep 0.52 (p<0.02) and GH-I & GH-Arg. 0.56 (p <0.02). We conclude that sleep studies of GH reserve are indicated only when the results of stimulation tests are inconsistent with clinical findings.

No abstract

The relief of obstruction alone is frequently not sufficient to ensure renal salvage in giant hydronephrosis. We report on our experience with plication of the renal calyces used as an adjunct to dismembered pyeloplasty in patients with giant hydronephrosis. We describe the operative technique and outcomes in ten children after a follow-up period of six months. Ten patients (six girls and four boys) with a mean age of 8.1 years (range 2-14 years) with giant hydronephrosis caused by primary ureteropelvic junction obstruction underwent a dismembered pyeloplasty followed by plication of the dilated renal calyces. The preoperative evaluation included an excretory urography, ultrasonography, 99mTc-DMSA and 99mTc-DTPA scans. The same tests were repeated six months after the operation to evaluate the outcomes. There were no intraoperative or postoperative complications. Excretory urography and ultrasonography performed six months after the operation demonstrated a significant improvement of the morphology of the operated kidneys. The kidneys shrunk in diameter from a mean of 149.5 mm (range 89-224 mm) to 93.6 mm (range 68-121 mm) and the mean diameter of the calyces was reduced from 26.9 mm (range 15-42 mm) to 14.7 mm (range 10-24 mm). Renal 99mTc-DTPA scans showed improved perfusion and renal function after surgery, with the mean elimination rate decreasing from 22.41 min (range 17.84 - 28.22 min) to 11.7 min (range 8.16-13.76 mm). 99mTc-DMSA scans demonstrated no new scars and no deterioration of renal parenchyma after surgery. We believe that plication of the renal calyces is the method of choice to be used as an adjunct to the Anderson-Hynes pyeloplasty in the treatment of paediatric patients with giant hydronephrosis.