Recurrent Low- to Intermediate-Grade Chondrosarcoma of the Thumb with Lung Metastases: An Objective Response to Trofosfamide

BACKGROUND

Low- to intermediate-grade chondrosarcoma is usually a slow-growing and highly chemotherapyresistant tumor type.

CASE REPORT

The 76-year-old female patient presented with low- to intermediate-grade chondrosarcoma of the distal phalanx of the right thumb in 1993 and was treated with an excision of the carpometacarpal joint. Approximately 10 years later, the patient presented with recurrent local disease at the trapezoid bone, which was resected. Eight months later she presented with local recurrence at the carpal joint and lung metastases. Subsequently she was treated chemotherapeutically with pegylated liposomal doxorubicin as part of a clinical trial. Due to tumor progression after 2 cycles, she was switched to oral trofosfamide (150 mg daily). A follow-up CT scan after 8 months demonstrated a partial remission that was confirmed by a second scan after 9 months of treatment. The treatment was well tolerated. After 18 months of continued treatment, she was still in remission and on trofosfamide.

CONCLUSION

Trofosfamide at a daily dose of 150 mg may be effective in low- to intermediate-grade chondrosarcoma.

Use of an interactive game to increase food acceptance--a pilot study

BACKGROUND

Techniques to improve food selection in healthy children with long standing food refusal are limited. The use of educational games has been successful in getting children to increase knowledge in healthy eating, but it is uncertain whether this translates into behaviour change. Therefore the purpose of this study was to test the use of an interactive food game to increase food acceptance in healthy-weight school-age children with chronic food refusal.

METHODS

Children attended an outpatient clinic and played an interactive game with a therapist and one parent during which non-preferred foods were consumed. Weekly recording of food consumption occurred with diet analysis by a Registered Dietitian three times during a 1-year time span.

RESULTS

The children increased their repertoire of foods and had a more balanced intake. The changes in intake were incorporated into their daily meal patterns in the home setting and were maintained for 1 year.

CONCLUSIONS

An interactive food game is a successful tool for increasing food variety in healthy children with chronic food refusal. As this report included only three subjects, the results will be used for subsequent work on this topic.

Validating a practical approach to determine weight control in obese children and adolescents

OBJECTIVE

To study the usefulness of a mathematical index for assessing changes in body composition of obese children and adolescents who undergo a weight control program.

DESIGN

A short-term longitudinal (mean of 19 months) cohort study.

SUBJECTS

Sixty-seven obese children and adolescents (38 M, 29 F, age 6-16 (mean 11)y) who took part in a clinic-based weight control program.

MEASUREMENTS

Percentage body fat was assessed at the start of the program by underwater weighing (UWW) and by bioelectrical impedance (BIA). Response to the program was assessed by a mathematical index (MI), based on observed and expected changes in height and weight, and by changes in percentage fat as measured by BIA.

RESULTS

Adiposity, as assessed by BIA at the start of the program, was highly correlated to that obtained by UWW (r = 0.96 for fat-free mass). Changes in the MI over the program were correlated fairly well (r = -0.81, SEE = 3.57 kg) with changes in percentage fat as assessed by BIA.

CONCLUSION

Using change in BIA as criterion, the MI is valid for assessing changes in percentage body fat of obese children and adolescents over time. This index is of use to clinicians who lack body composition equipment and need a quick method to analyze the effectiveness of a weight control program in obese children and adolescents.

Effectiveness of outreach to homeless substance abusers

Substance abuse is a frequent and complicating feature of homelessness. Barriers to service access have prevented homeless individuals from receiving substance abuse care. Outreach to homeless persons is a mechanism for identifying homeless substance abusers and engaging them in treatment. This study describes a program of substance abuse treatment conducted by a medical care provider for homeless persons in Baltimore, Maryland and compares characteristics of outreach recipients to those of walk-in clients. The study also examines the differences in drug abuse pathology and selected treatment outcomes among homeless and non-homeless clients and the extent to which homeless persons are unidentified in the drug abuse treatment reporting system of the state. Homelessness is about 5.5 times more prevalent in the clientele of drug abuse treatment programs than is reflected in the statewide substance abuse management information system of Maryland. Composite scores on the Addiction Severity Index for homeless individuals are significantly higher (reflecting more serious problems) on every measure in the interview, compared to non-homeless individuals. Except for residential treatment settings, homeless persons demonstrate a shorter length-of-stay in substance abuse treatment than housed clients. Our outreach effort successfully located its targets. Outreach clients reported significantly higher levels of substance abuse than walk-in clients. In addition 42.3% of outreach contacts became service recipients. These findings indicate that outreach can be a successful method of targeting and engaging a segment of homeless substance abusers who are otherwise difficult to engage in treatment.

Characterization of oligosaccharides on methylcholanthrene-induced murine oncofetal antigen using biotinylated lectins

Biotinylated lectins were used to characterize oligosaccharide chains of the minute amounts of the 44 kD membrane-bound oncofetal antigen (OFA) derived from murine MCA 1315 tumor cells. Lectins of known sugar specificity were used to detect oligosaccharides on glycoprotein which had been previously separated electrophoretically on sodium dodecyl sulfate polyacrylamide gels (SDS-PAGE) and blotted onto nitrocellulose (NC). Oligosaccharide reactivity with biotinlylated lectins was also analyzed after glycosidase treatment of the NC blotted OFA. Results indicate MCA 1315 derived OFA possesses N-glycosylated oligosaccharide chains which are high in mannose. This result is in agreement with the high mannose glycosylation of OFA derived from 13-day mouse fetuses.

The laboratory test justified. An effective means to reduce routine laboratory testing

In an attempt to reduce clinical laboratory testing, a strategy was designed for a clinician-oriented restriction policy imposed on the laboratory test-ordering mechanism. The program examined the requirement of a written justification to accompany test requests. Directed justification, where specified conditions were required for test performance, was applied to the prothrombin and partial thromboplastin times and resulted in a mean reduction of 44% (P less than 0.001) in these tests; a nonspecific justification directive for leukocyte differentials, where any clinical condition listed generated the test, reduced differentials 35% (P less than 0.001). The justification policy then was extended more broadly and applied on a trial basis to general medical wards. Although no review was made on validity of listed test rationalizations, the justification process alone significantly reduced four common laboratory tests from 28% (BUN/creatinine) to 45% (electrolytes); significant reductions were not seen in less frequently ordered tests. The authors concluded that the most common clinical laboratory tests may be reduced by demanding that the clinician perform a clerical justification when requesting these tests. This mild restrictive policy in the ordering process allows the clinician to maintain responsibility over laboratory testing, while effectively reducing laboratory volume.

Metabolic and EEG changes during transcendental meditation: an explanation

Two experiments were conducted to measure the oxygen uptake (Experiment II) and the carbon dioxide production (Experiment I) during transcendental meditation. A control group of non-meditators and a few meditators listening to music was used for both experiments. In Experiment I, a controlled group of fasting meditators was also included. A drop in oxygen consumption and carbon dioxide production, found by previous authors during transcendental meditation, was confirmed. It was, however, possible to show that these drops were physiologically of small significance, and were of the magnitude to be expected from muscle relaxation. EEG recordings were taken during Experiment II in the meditating group. The EEG results showed transcendental meditation to be a method of holding the mediator's level of consciousness at stage 'onset' sleep. No evidence could be found to suggest that meditation produced a hypometabolic state beyond that produced by muscle relaxation and there was no evidence that the EEG changes were different from those observed in stage 'onset' sleep. No support was found for the idea that transcendental meditation is a fourth stage of consciousness.

Infected Traumatic Epidermoid Cysts, the Result of Rubbing by an Artificial Limb

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