Post-irradiation angiosarcoma of bone.

Radiation therapy is extensively used for treatment of malignancies, but angiosarcomas occurring in an irradiated area are uncommon. We report a rare case of high-grade epithelioid angiosarcoma of upper end of right humerus in a 67-year-old male occurring ten years following irradiation for giant cell tumor of the same anatomical site. The patient presented with progressive painful swelling over right shoulder and his X-ray showed erosion of medial cortex with lytic areas at upper end of humerus. He underwent excision of affected part of humerus followed by cemented hemiarthroplasty and bone grafting. After initial histopathological diagnostic dilemma the final report was given as post-radiation angiosarcoma. Disease recurred at the end of one-year follow-up period where upon he underwent wide resection with prosthesis replacement. He received four cycles of combination chemotherapy with doxorubicin and ifosfamide and currently is free of recurrence after six months follow-up.

Cervical screening by visual inspection with acetic acid (VIA) is well accepted by women--results from a community-based study in rural India.

OBJECTIVE: Among the low cost alternative screening tests Visual Inspection after Acetic Acid Application (VIA) has been found to be most promising. The objective of the present study was to evaluate the safety and acceptability of VIA done by health workers among rural Indian women. We also evaluated the level of women's satisfaction with the screening program. METHODS:Women residing in a defined geographic area were offered cervical screening using VIA by trained health workers. Women testing positive were colposcoped by a medical officer at the same sitting. Based on the feedback from a few focus group discussions a structured questionnaire was designed to interview the women after screening. A total of 498 women were selected randomly from the screened women for interview by a social worker. Besides enquiring about any discomfort they faced during or within seven days after screening, the women were also asked to indicate their level of satisfaction with the service. Their opinions to improve the quality of service were also sought. RESULTS: Most women reported no pain or only slight discomfort during screening (94.2%). The most common complaint after screening was vaginal discharge (12%). A burning sensation in the vagina was experienced by some of the women (5.8%). These complaints were mild and short-lasting in majority of cases. Most of the women were satisfied with the screening service (94.6% selected the top three of a six-point response scale) and 97% said they would recommend the test to others. The most common reasons for dissatisfaction with screening were discomfort during or after screening, long waiting time and failure to get treatment for other medical problems. CONCLUSION: VIA by trained health workers followed by colposcopy at the same sitting is an acceptable screening algorithm for Indian women. A VIA based screening program has to be integrated to the existing primary health care facility in developing countries.