Report card on tobacco use in Mississippi, 2009.

Mississippians are failing in their health status particularly as it relates to tobacco use. According to the Behavioral Risk Factor Surveillance System, 2008, 22.7% of Mississippi adults are current smokers compared to 18.4% of U.S. adults. This gives Mississippi a ranking of seventh among the states and the District of Columbia. Considering that smoking is the leading cause of preventable death, change must occur in our state. Resources necessary to combat the problem of tobacco use in Mississippi are available, but it is important that tobacco users are aware of their availability and how to access those resources. Physicians can positively impact the tobacco use statistics by counseling their tobacco dependent patients on the need for cessation and what counseling and pharmacotherapy resources are available to help the patient break his or her addiction.

Lung cancer and radiofrequency ablation.

Radiofrequency (RF) ablation is a recently developed technique for image-guided local destruction of selected tumors. Because the lung is a common site for cancer and usually has substantial functional reserve, RF ablation of lung cancers is an attractive option for minimally invasive treatment. The primary goal of the present review is to describe the natural history, staging systems, and conventional therapies for primary and secondary treatment of lung cancer, as well as the results of RF ablation in animal models and in humans for pulmonary applications, to clarify the appropriate role and limitations of this technology. The secondary goals are to review the principles of how RF works and to describe RF ablation techniques to familiarize interventionalists who may consider incorporating this technology into their practice and inform diagnostic radiologists of expected imaging findings and clinicians of their patients' anticipated courses and outcomes.

CASE REPORTS: malignant fibrous histiocytoma of bone arising in chronic osteomyelitis.

This case report shows the importance of frozen section and/or permanent section pathology for diagnosis of tumorous conditions in patients with chronic osteomyelitis. According to published reports, a coincidence of malignant fibrous histiocytoma of bone and post-fracture osteomyelitis has occurred in only four patients. Our report details the treatment of 51-year-old man with a fracture 15 years previously and subsequent chronic osteomyelitis of the left distal femur. The original treatment was open reduction and casting. Fifteen years after the injury, the patient presented to the emergency room with increasing pain, erythema, swelling, and increased purulent discharge from the distal femur. Irrigation and debridement was done, but no frozen section or permanent pathology specimens were obtained. The left distal femur was radically resected for treatment of osteomyelitis. Histologic samples of the specimen revealed malignant fibrous histiocytoma of bone. A metastatic workup was negative. Subsequently, the left hip was disarticulated for wide resection of the tumor. One of two inguinal lymph nodes removed at that time was positive for malignant fibrous histiocytoma. The patient had additional chemotherapy. He was still alive 27 months after the operation.

Management of women who present with T4 breast cancer.

The purpose of this study was to review the clinical presentation and outcome of women who present with large or locally invasive (T4) breast carcinoma. This retrospective study was conducted at the University of Mississippi Medical Center, a state tertiary care referral institution. One hundred twenty-nine women between the ages of 28 and 85 years (mean, 55 years) presented with T4 breast carcinoma. Follow-up was available for 128 women. Only 23 women have survived (18%), 5 of whom (21.7%) have metastatic disease. Mean survival for those who died was 21.6 months, compared to 76.3 months for survivors. Survival was not influenced by tumor characteristics (P > 0.5), but was strongly influenced by nodal status (P < 0.001) and by the presence of metastases at the time of diagnosis (P < 0.001). Survival was strongly related to mode of therapy (P < 0.01), but this was principally related to very high mortality rates in women who received no therapy (100%), surgery only (92.3%), or chemotherapy only (95%). The best survival was seen in women who received chemotherapy prior to surgery (40%); their survival was superior to that of women treated initially by surgery, followed by chemotherapy (16.3%, P = 0.04). However, when women who presented with metastatic disease were excluded, survival was not different between these two groups (P = 0.18). Despite public education efforts and the wide availability of screening programs for breast carcinoma, many women still present with locally advanced disease. Outcome can be favorable in the absence of node involvement or metastatic disease, even in the presence of large, fungating tumors. Multimodality therapy gives the best results, but early surgery may be required for progression of disease during chemotherapy or because of extensive ulceration at initial presentation.

Phase II trial of amonafide in central nervous system tumors: a Southwest Oncology Group study.

Amonafide 300 mg/M2 was administered intravenously on a daily x 5 schedule to 27 eligible patients with recurrent or progressive central nervous system tumors. There were no objective responses. The most common toxicities were gastrointestinal, hematologic and neurologic. Further study of amonafide in patients with central nervous system malignancies is not indicated.