Myelodysplastic syndrome as a complication of neo-adjuvant triple M chemotherapy and radiotherapy.

Cases of myelodysplastic syndrome occurring after multi-drug chemotherapy are rare; they are more often associated with the use of alkylating agents. We report the case history of a patient with myelodyspasia occurring after neoadjuvant methotrexate, mitoxantrone and mitomycin C (triple M) chemotherapy with subsequent radiotherapy for locally advanced breast cancer. Cytogenetic analysis of a bone marrow biopsy confirmed the typical chromosomal abnormalities associated with therapy related myelodysplasia. Few treatments for this disorder have been found to be of value. The aetiology, incidence and management options are briefly discussed.

Interstitial photodynamic therapy. Clinical experience with diffusing fibres in the treatment of cutaneous and subcutaneous tumours.

Interstitial photodynamic therapy has a number of potential advantages over superficial treatment. We have treated 50 subcutaneous and cutaneous tumours interstitially, in nine patients. An additional 22 tumours in the same patients, were treated by superficial PDT. Patients received 1.5-2.0 mg kg-1 of polyhaematoporphyrin and 72 h later underwent treatment using a copper vapour dye laser producing red light at 630 nm. All interstitial treatments were delivered using cylindrical diffusing fibres and a wide range of light doses (5-1500 J cm-3). The complete response rate for all tumours treated interstitially was 52%, rising to 81% in those patients who received 2.0 mg kg-1 PHP and light doses in excess of 500 J cm-3. The overall incidence of skin necrosis was 32% and was 79% in those treated with light doses of greater than 500 J cm-3. The incidence of skin necrosis with interstitial PDT is lower than that seen with superficial photodynamic therapy but higher volumetric light doses are required to produce tumour complete responses. All treatments were well tolerated and volumes of tumour up to 60 cm3 were successfully treated. The penetration depth of 630 nm light in human breast cancer tissue was determined as 4 mm. Little true tumour tissue selectivity was detected by analysis of porphyrin levels in biopsy material.

The spontaneous regression of lymphoma in AIDS.

Non-Hodgkin's lymphomas are an increasing problem in the AIDS population. They are generally aggressive, high-grade lymphomas and more commonly present at extranodal sites, particularly the central nervous system. Although chemo- and radiosensitive, the duration of response is generally short lived. Spontaneous remission of non-Hodgkin's lymphomas has been reported in immunocompetent individuals, but has not been reported in HIV disease. We would like to report the first such case.

In vivo measurement of the optical interaction coefficients of human tumours at 630 nm.

The light distribution within a treatment volume is determined by the source geometry (e.g. superficial or interstitial illumination) and the optical interaction coefficients of the irradiated tissue. We have measured the energy fluence rate at various points within tumours undergoing irradiation with 630 nm light for photodynamic therapy for several source geometries. The relative positions of source and detector fibres were determined using CT scanning techniques. The results of the measurements were then applied to solutions of the diffusion theory which allowed the determination of the absorption coefficient (sigma a = 30.5 +/- 16 m-1), the reduced scattering coefficient (sigma' s = 941 +/- 735 m-1), the effective attenuation coefficient (sigma eff = 261 +/- 49 m-1) and the build-up coefficient which relates surface irradiance to the energy fluence rate at depth (k = 1.6 +/- 0.6). Knowledge of these coefficients allows the transmission of light through tissue to be predicted and hence the optical dosimetry of subsequent treatments to be planned more effectively.

An unusual case of angiosarcoma.

A case of angiosarcoma arising in an arm affected by chronic lymphoedema and treated initially by intraarterial cytotoxic perfusion chemotherapy and radiotherapy is described. The patient is still alive twenty years after presentation. This represents the longest reported survival for this condition.

The incidence of amyloidosis complicating inflammatory bowel disease. A prospective survey of 177 patients.

Three cases of secondary amyloidosis are reported, two in patients who had unequivocal Crohn's disease and one in whom the clinical course was that of Crohn's disease, but with histologic findings that were more suggestive of ulcerative colitis. All had evidence of renal failure. A prospective study of 177 patients with inflammatory bowel disease of greater than five years' duration was carried out in an attempt to establish the incidence of secondary amyloidosis, using rectal biopsy and simple renal function tests. No new cases were found. Neither was there evidence of renal failure due to other conditions. In the absence of renal dysfunction, a search for secondary amyloidosis probably is not justified.

Secondary amyloidosis of the gastrointestinal tract: an electron microscopic study.

Biopsy specimens of the gastric antrum, duodenum, and rectum from three patients with secondary amyloidosis were examined by electron microscopy in an attempt to determine the ultrastructural distribution of amyloid filaments and to identify any secondary changes in the covering mucosal epithelial cells. The characteristic amyloid filaments were seen in the walls of submucosal arterioles and mucosal capillaries deposited within the basal lamina surrounding the endothelial cells. Filaments were also sometimes seen within the muscularis mucosa. the overlying gastric and rectal epithelial cells appeared normal, but numerous curved bacilli were seen in close contact with the microvilli of the surface epithelial gastric cells. Duodenal columnar absorptive cells were vacuolated and contained prominent lysosomes. These changes are probably degenerative and may explain, at least in part, the development of malabsorption in some patients with intestinal amyloidosis.

Low-dose 131I in treatment of Graves' disease.

One hundred and sixty-four patients with Graves' disease were treated with low-dose radioiodine (2 mCi), with a mean follow up of 4 1/2 years. At this time 74 (45%) were euthyroid having had a single dose, with a total of 131 (80%) being controlled with one or more doses. Three (2%) were still toxic but their mean follow up was only 3 years. Thirty (18%) were rendered hypothyroid, two-thirds of these after a single dose of 2 mCi 131I. The one-year incidence of hypothyroidism was 6%, with an incidence at 6 years of 20%. Previous surgery, medical treatment and thyroid antibody status appeared to have no influence on the outcome.

Metabolic acidosis induced by carbonic anhydrase inhibitors and salicylates in patients with normal renal function.

Two young patients with unimpaired renal and hepatic function were found to have developed metabolic acidosis after treatment for glaucoma and joint pain with a combination of salicylates and carbonic anhydrase inhibitors in normal doses. Carbonic anhydrase inhibitors appear to interact with salicylates to produce serious metabolic acidosis in patients without the predisposing factors generally considered to constitute risks. It is recommended that treatment combining salicylates and carbonic anhydrase inhibitors is either kept to a minimum or avoided.