Nineteen chondrosarcomas are reported arising in proximal phalanges or metacarpal bones of the hand mainly in elderly patients, predominantly women. The usual clinical presentation was of a progressively painful large tumour, often arising in a dormant lesion near the metacarpo-phalangeal joint. Radiologically most showed some bone expansion with a poorly defined area of destruction and a considerable soft-tissue swelling. Histologically, malignancy was usually obvious, but confusion might arise from the inclusion of bland areas of chondromatous tissue that probably represented the original lesion. Four tumours, initially curetted and grafted, recurred locally and necessitated amputation of the digit or ray. Amputation was the primary treatment for fourteen other tumours and was curative except in one patient who eventually needed amputation through the forearm for a large second recurrence. One tumour was satisfactorily controlled by excision of the affected phalanx. None of these nineteen tumours is known to have metastasised. Correct treatment implies a carefully considered balance between conservation of function and complete removal of all tumour tissue.
Early results from this anecdotal series are encouraging and a prospective study to determine the application of the PTBO in patients with neuropathic and neuropathic/ischaemic tissue loss is planned.
Dextran 70 is widely used as a plasma expander for patients in circulatory collapse, a condition which could mask a superimposed anaphylactic shock or make physical signs difficult to interpret. If the administration of intravenous dextran leads to a further drop in blood pressure in a patient in collapse, increasing the rate of infusion may have disastrous effects.It therefore seems advisable to avoid using dextran 70 in patients with a history of allergy or bronchial asthma. A doctor should be present during the first 200 ml of a dextran 70 infusion, and if an untoward reaction appears dextran should be discontinued. A separate infusion of saline should be running simultaneously at a speed determined by the degree of shock. For the first 15 minutes the dextran infusion should be at the rate of 10 drops/min, and cardiorespiratory resuscitation drugs, equipment, and personnel should be immediately available.We are greatly indebted to Mr S Bender for his guidance in reporting the above cases. Association, 1968, 204, 824. 3Fothergill, R, and Heaney, G A, British Medical Journal, 1976, 2, 1502 Michelson, E, New England Journal of Medicine, 1968, 278, 552. s Ring, J, and Messmer, K, Lancet, 1977, 1, 466 She induced vomiting soon after taking the tablets, and gastric lavage was carried out on admission.She was drowsy and complained of a dry mouth. Blood pressure was 115/95 mm Hg and pulse rate 90 beats/min. The electrocardiogram (ECG) on admission showed first-degree heart block (P-R interval 0 28 seconds). Serial ECG tracings showed that she remained in first-degree block until 14 hours after ingesting the tablets. For the next two hours the block was variable, and by 16 hours after ingestion she had spontaneously reverted to normal rhythm (P-R interval=0 l8 seconds). An ECG recorded a year previously at a routine outpatient visit was normal.Blood was removed at intervals for drug estimation by Organon Laboratories Ltd, and the results are shown in the table. The peak serum concentration was four times the therapeutically desirable level. Peak level during normal treatment with 20 mg thrice daily is 100-120 sggl. CommentThe cardiotoxic effects of tricyclic antidepressants in cases of selfpoisoning have been well documented,2 and even therapeutic doses of these drugs affect intracardiac conduction.3 Recently new antidepressants with a tetracyclic structure have been marketed, which are claimed to have no cardiotoxic effects at normal doses. Animal studies have shown that effects are dose related and that a proportionately higher dose of mianserin hydrochloride is required to cause arrhythmias than with tricyclic antidepressants.In our patient the effect on the conducting tiEsue of the heart seemed to be dose related, in that conduction returned to normal when the blood concentrations descended to the therapeutic range. Only the P-R interval was abnormal in this patient. The We describe here our experience with 10 patients. Patients, methods, and resultsThe series consisted of seven men and three women aged 44 to...
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