Extramedullary hematopoiesis is encountered in some severe anemic conditions. Very rarely it may cause neurologic symptoms, leading to spinal cord or cauda equina compression. Two patients with thalassemia who developed neurologic complications are described. Diagnosis was based on clinical findings, CT scan and magnetic-resonance imaging (MRI). The two patients responded successfully to irradiation and blood transfusion. The prognosis is excellent, if recognized at an early stage. Our experience supports the role of radiation therapy as standard treatment for this complication.
Heterotopic ossification, or the appearance of ectopic bone in para-articular soft tissues after surgery, immobilization, or trauma, complicates the surgical and physiatric management of injured joints. The chief symptoms of heterotopic ossification are joint and muscle pain and a compromised range of motion. Current therapies for prevention or treatment of heterotopic ossification include surgery, physical therapy, radiation therapy, and medical management. Unlike heterotopic ossification of the hip, heterotopic ossification of the elbow has not been extensively investigated, leaving its optimal management ill-defined. To remedy this deficiency, we review risk factors, clinical anatomy, physical findings, proposed mechanisms, and current practice for treatment and prevention of heterotopic ossification. We then consider and draw conclusions from four cases of elbow injury treated at our institutions (three complicated by heterotopic ossification) in which treatment included surgery, radiation therapy, physical therapy, and medical therapy. We summarize our institutional practices and conclude with a call for a randomized clinical trial to better define optimal management of heterotopic ossification of the elbow.
A retrospective study of 51 patients treated for primary gastric lymphoma was made to evaluate the influence of clinicopathologic features and the method of treatment on survival. The lymphocytic type of tumor showed a higher survival rate than the histiocytic type. Tumors that involved only the gastric wall resulted in a five-year survival rate of 62%, as compared with 50% for tumors that involved also the adjacent gastric lymph nodes, and 25% for those involving the distant gastric lymph nodes. Treatment by subtotal, total, or extended forms of gastric resection without postoperative radiation gave a five-year survival rate of 33%. Resection followed by radiation yielded a higher survival rate of 67%. The best results were obtained in 13 patients who received higher doses of radiation: 11 (85%) survived five or more years. One-third of the patients developed manifestations of systemic malignant lymphoma after curative therapy. These observations suggest a planned multimodal therapeutic program for this disease.3RIMARY GASTRIC LYMPHOMA represents 1 to 5% of fall gastric cancers'-3 and is anatomically the most common type of extranodal lymphoma.4'5 Prior to the popular use of fiberoptic gastroscopy, most of these tumors were treated with a presumed diagnosis of carcinoma until pathologic examination of the resected tumor. Today, endoscopic biopsy and cytologic or histopathologic examination can reveal the diagnosis before surgical intervention in most cases. This permits a planned approach to treatment that is different from that of gastric adenocarcinoma and may include surgical resection, radiation therapy, and chemotherapy. The individual roles of these modalities of therapy are, however, often debated. There is much disagreement and controversy regarding the efficacy of surgical resection alone, the optimal extent of resection and the curative value of radiotherapy and chemotherapy. The relative rarity of the condition and its confusion with pseudolymphoma6'7 during the earlier part of the century have prevented a detailed understanding of its natural history, making it difficult to render intelligent recommendations on treatment. We report here a retrospective study of 51 patients treated over a 27-year period at Memorial Sloan-Kettering Cancer Center.
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