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Percutaneous fine-needle aspiration biopsy of pancreatic masses was performed in 34 patients. Biopsies were performed with a 22 or 23-gage, spinal-type needle under fluoroscopic guidance. Correct results were obtained in 73% of the patients including 21 patients with pancreatic carcinoma. No complications occurred. The primary indication for aspiration biopsy was to document the presence of malignancy and avoid a diagnostic laparotomy in patients considered to be unresectable.

Summary Transcatheter therapy for arteriocapillary gastrointestinal bleeding is often an effective form of treatment. The choice of transcatheter therapy (ie, vasoconstrictor or occlusive) often is dependent on the etiology and location of bleeding. Vasopressin is a generally safe form of treatment which is often successful in treating bleeding secondary to gastritis, Mallory-Weiss mucosal tears, and diverticular disease. It is less effective in treating bleeding peptic ulcers, neoplastic bleeding, or bleeding when clotting abnormalities exist. Occlusive therapy is an effective alternate form of therapy in selected circumstances. Ischemic complications from vasoconstrictor and embolic therapy may occur and require appropriate caution and discretion with their use.

Abstract: Intraarterial infusion of cis-platinum was evaluated in 14 patients with primary osteosarcoma because the method delivers a higher dose to the neoplasm without increasing systemic toxicity. The tumor response was evaluated by clinical examination, conventional radiography, angiography, and histopathologic examination. Eight (57%) of the 14 patients responded. Among the eight responders, four patients with medullary osteosarcoma of the extremities were treated by limb salvage operation followed by insertion of an endoprosthesis to preserve limb function. The responders are all alive with a median follow-up period of 17.5 months; six of them have no evaluable disease. The six failures died of disease after median survival of 6.5 months. Intraarterial cis-platinum infusion proved to be an effective approach in treating osteosarcoma and created the opportunity for limb salvage.

• Eleven patients were diagnosed as having lumbosacral plexopathy at M. D. Anderson Hospital, Houston, from August 1981 through July 1982. Four causes were documented: plexopathy secondary to metastatic disease (six cases); radiation-induced plexopathy (two cases); plexopathy secondary to intra-arterial chemotherapy (two cases); and plexopathy as the result of a second primary tumor (one case). Patients with plexopathies secondary to tumor or irradiation complained of pain in the ipsilateral lower extremity. Computed tomography of the pelvis was the most accurate method of documenting tumor in the region of the lumbosacral plexus. Radiation therapy records of patients with cervical carcinoma were reviewed with respect to positioning of intracavitary radium, which was thought to be responsible for the development of radiation-induced plexopathies. Radiation therapy and/or systemic chemotherapy provided relief of pain and improvement of neurologic deficits in three patients with metastatic involvement.

Ultrasound and computed tomography (CT) guided percutaneous needle biopsy of soft tissue lesions was performed in 39 patients. A correct diagnosis was obtained in 35 of 42 biopsies, with an overall accuracy rate of 83%. No false-positive diagnoses were obtained, and no complications related to the procedure were encountered. The value of this technique in the management of selected patients with soft tissue masses is detailed.

Fifty patients with eosinophilic granuloma of bone were reviewed. Thirty-one lesions were in the head and neck, 24 in the extremities, seven in the pelvis, and five in the ribs. The lesions were lytic with ill-defined margins, endosteal erosion, and solid periosteal reaction. The diagnoses were obtained by surgical biopsy in 36 patients and by percutaneous biopsy in 14. Twenty-six lesions were treated with radiotherapy, 14 by surgery, and nine by surgery and radiotherapy. The last 14 cases have been treated by percutaneous injection of methylprednisolone sodium succinate into the lesion. Healing was obtained in every lesion. There were no complications.

Two patients who received radiation therapy to the thorax and who developed recurrent spontaneous pneumothoraces are presented. Patients with recurrent pneumothoraces secondary to radiation have not been described previously. Pleural changes secondary to radiation may contribute significantly to the complicated clinical course of these patients.

When fine-needle aspiration biopsy is combined with bipedal lymphangiography, the presence of nodal metastases can be determined histologically without an open surgical procedure. Thirty-five patients with carcinoma of the prostate who had “positive” or “suspicious” lymphangiograms underwent fine-needle aspiration biopsy of the involved node. The diagnosis of metastatic disease was confirmed cytologically in 10 of 20 patients with “definitely positive” x-ray films and 9 of 15 patients with “suspicious” x-ray films. Over-all, nodal metastases were confirmed cytologically without surgical exploration in 19 of 36 patients (54%). No complications were encountered.