Poster Presentations

the pyogenic. is a of abscess in an otherwise healthy pregnant woman. Methods: A 40-year-old lady presented to the department Sunday with abdominal pain from right upper quadrant and across her pelvis. She was 37 weeks and the cervix was not open. An emergency caesarean section was ordered. Steps were taken to empty the bowels, but the pain persisted. 4 post-delivery, the in pain and with elevated c-reactive protein (CRP). The ultrasound discovered an abscess arising from the capsule of the liver tip of segment VI. Results: On CT, it was discovered that the abscess was in fact arising from a ruptured retrocaecal appendix. The caecum and appendix were in the right upper quadrant. A faecolith was present within the abscess and the abscess was approximately 200ml. Conclusion: This case demonstrates that subhepatic abscess is still to be found in the western world and can be caused by a ruptured appendix. aggressive nature and poor prognosis. Case presentation: A 57-year-old female presented for an ultrasound investigation of a growing palpable, hard mass within her left proximal medial thigh. The ultrasound revealed the mass correlated to a large, complex mixed cystic/solid vascular mass which appeared to involve the proximal long saphenous vein. Further investigation concluded that the mass was a leiomyosarcoma arising from the wall of the long saphenous vein. Despite surgery and chemotherapy the tumour eventually metastasised to the lungs. Conclusion: These tumours are technically difficult to differentiate with medical imaging as they can resemble venous thrombosis when very small. It is important that a patient history and relevant clinical information is obtained. If the venous thrombosis is not resolving with anticoagulant therapy a more sinister underlying process should be taken into consideration. Take home message: Leiomyosarcomas are aggressive tumours and because time sensitive, a diagnosis sooner rather than later is impera-tive to the final patient outcome. Results: 62 Conservative Multiple imaging showed stages analysed the of changes on in a cohort of the increase in the number of obese patients being scanned was responsible for increasing pain levels. Immobile patients, obstetric scans, performing mobile scans and increasing workload were also flagged as perceived risk factors for increased pain levels despite implementing ergonomic interventions in the workplace. No interventions were believed responsible for increased pain. Conclusion/Take home message: Evidence from this small study indicates that participatory ergonomics resulted in the identification of specific risks for WMSD in each sonography department in the WNSWLHD, allowing ergonomic changes to be tailored to the work-place, resulting in a safer environment for sonographers. interobserver rates among trainee Introduction: Juvenile polyposis syndrome (JPS) is an autosomal dom-inant condition where patients who have: more than five juvenile polyps in the colo-rectum; polyps throughout the gastrointestinal tract; or any number of polyps and a family history of the condition are considered to meet diagnostic criteria. While the majority of polyps are not malignant, patients are at an increased risk of develop-ing adenocarcinoma, and annual screening via colonoscopy is indi-cated from diagnosis. Methods: We describe the case of a nine-year-old boy who was hav-ing a routine surveillance ultrasound of their abdomen four years post Wilms tumour resection, in whom multiple polyps were incidentally identified in the colon. Results: Ultrasound revealed intraluminal soft tissue masses throughout the colon with heterogenous echotexture suggesting solid and cystic/necrotic components. These were further characterised for their relationship with the bowel wall and the presence of internal vascularity using Superb Microvascular Imaging (SMI). Colonoscopy was arranged and confirmed the presence of approximately 50 polyps confirming JPS. Written informed consent was obtained from the patient's parent for publication of this case. Conclusion: While not widely practised, sonography is capable of accurately identifying the presence of intestinal polyps. The presence of multiple polyps in children should raise the suspicion of JPS and appropriate follow-up and screening should be arranged. Take-home Message: Ultrasound is capable of identifying intestinal polyps in children, sonographers should be aware of their potential appearance and the clinical implications of multiple polyps in children given the increased risk of carcinoma in the JPS population. transducer has evolved significantly since the phenomena behind the science was first discovered in 1880. Improvements in transducer technology and design have seen progression in imaging from A-mode, B-mode, to 3D and 4D imaging. Methods: Historical and contemporary review of the construction and design of ultrasound transducers was undertaken. Capacitive micro-machined ultrasound transducers (CMUTs) are a revolutionary technology which utilises a change in capacitance to transmit and receive ultrasound waves. These transducers are constructed differently to traditional transducers and allow for larger bandwidths, high fre-quency operation and simpler electronic integration. Not only are CMUTs constructed differently, they also operate under different principles, which are described. Results: Ultrasound transducers are continually undergoing advance-ment but the basic design has remained relatively consistent, until the fabrication of capacitive micro-machined ultrasound transducers. Conclusion: The technology of ultrasound transducers is ever-evolv-ing with new concepts arising often, the latest of which are capacitive micro-machined ultrasound transducers. With such vast improvements in recent years, one can only imagine what will be accom-plished in diagnostic ultrasound in the future. if clinically hip of Introduction: Penile fractures occur when the erect penis is exposed to blunt trauma, commonly during traumatic coitus. The penile corpora which are thinned during engorgement “ pop ” under pressure. The case of a 37 year old male who presented with immediate pain, swelling and a bruise to the left side of the penis will be reviewed. Methods: Penile ultrasound imaging performed as per department protocol using the Philips EPIA 5G with a linear e18-4MHz transducer. B-mode and colour Doppler imaging techniques used for optimal image resolution. Results: Tunica albuginea of the left corpus cavernosum – defect seen at base of penis. Mixed echogenicity collection seen externally to the tunica albuginea, consistent with a haematoma appearance also noted. Further follow up with surgical notes revealed 2 areas of defect: ven-tral defects within the corpora bilaterally at the peno-scrotal junction. Conclusions: While MRI remains the gold standard imaging tool for penile pathology, ultrasound proves to be more available, reliable and more cost and time effective. Prompt diagnosis of penile fractures and surgical repair are crucial to maximise patient outcomes. This is achieved by quality scanning techniques, optimised images and thorough clinical assessment. Take Home Message: Penis fractures are not something scanned fre-quently in every day practice, however general knowledge of anatomy and scanning techniques are extremely important in aiding patient diagnosis and treatment. collected from late 2nd and early 3rd trimester scans. Anatomy was then identified and annotated. Images were documented. Results: A poster was created consisting of multiple ultrasound images to be used as a reference. Knowledge of the of the use by all sonographers, to expert, is FNA's when FNA full-capac-ity, cytology study at a tertiary ultrasound practice in Melbourne, Australia, including all women who underwent NIPT between November 2016 to January 2020. Results: During the study period, 10650 women attended the practice for NIPT. A high risk assessment for Trisomy 21 (T21), Trisomy 18 (T18), and Trisomy 13 (T13) were reported in 0.4% (42/10650), 0.05% (5/10650), and 0.06% (6/10650) of NIPT samples respectively. Majority of patients who received high risk assessments proceeded to have a detailed 12-13 week anatomy ultrasound. 38% of the T21 cohort had no structural abnormalities on ultrasound. 81%, (34/42) proceeded with diagnostic testing and all (34/34) were confirmed. In the high risk T18 cohort, 40% 2/5) demonstrated no abnormality on ultrasound. 50% (2/4) proceeded with diagnostic testing confirming the NIPT result. For T13 80% (4/5) demonstrated no ultrasound abnormality. 3/3 who proceeded with diagnostic testing received a normal outcome. role, especially for T13/T18 results, in guiding counselling and facili-tating decision making around testing options following a high risk assessment on NIPT. Results: a more echogenic and thicker placental portion. MCA PSV divergence peaked at 33 weeks GA with Twin A 0.63MoM and Twin B 1.4MoM, giving a difference of 0.77MoM. This difference did not meet Leiden criteria for TAPS, but recent research indicates that using an MCV PSV discordance greater than 0.5MoM would improve diagnosis of TAPS. At 34 weeks GA Twin A had diminished liver parenchymal echogenicity giving a “ starry sky ” pattern. Two, live male infants were delivered by caesarian section at 36 weeks and 4 days. A postnatal haemoglobin difference greater than 80g/L confirmed TAPS. Conclusion: This case study demonstrates changes in placental appearance, fetal liver echogenicity and diverging MCA PSV with advancing gestation age in a set of MCDA twins compromised by TAPS. Take home message: TTTS is not the only complication of MC twins. Use sequential plotting of MCA PSV to identify divergence. Subtle changes in the placenta and fetal liver appearances support an antenatal diagnosis of TAPS. treatment. Therefore, extended ultrasound imaging plays an important roletoseekthepredisposingcausesoftheclinicalsymptoms. Methods: Ultrasound lower limb DVT cases performed in our institu-tion were retrospectively collated and reviewed. Where available, correlation was made with Computed Tomography (CT) of the abdomen and pelvis, which was performed to delineate the extent of DVT and identify any predisposing causes. Correlation was also done with clinical symptoms and treatment outcomes. Results: DVT can be caused by extrinsic venous compression due to enlarged lymph nodes, May-Thurner syndrome or spinal pathologies such as spondylolisthesis and degenerative osteophytes. Imaging was extended proximally due to the presence of common femoral vein thrombosis to determine the proximal extent or when central disease is suspected. Differential diagnoses of DVT includes ruptured Baker's cyst, haematoma from muscle tear, thrombophlebitis and cellulitis. Conclusion: As ultrasound is usually the first line of imaging in suspected cases of lower limb DVT, knowledge of the various predisposing causes and differential diagnoses of DVT is essential to guide accurate diagnosis. In cases with positive ultrasound findings, further evaluation with extended ultrasound imaging is warranted. This would contribute to timely treatment and improved treatment outcomes. Take home messages: In the presence of extensive DVT, it is important to screen the abdomino-pelvic region to look for central cause of obstruction. In the absence of DVT, extended imaging to look for alternative aetiologies that explain the patient's symptom can add value to patient care. significant structural abnormality. Method: TTE with continuous ECG was performed by standard protocol. Findings included normal atrial and ventricular situs, normal biventricular function, concentric left ventricular hypertrophy and left atrial enlargement. A mildly stenotic (bicuspid) aortic valve and dilated ascending aorta were found - lesions most unlikely to cause syncope. Significantly, midway through the study, a 10-second period of ventricular standstill (VS) was captured: nine consecutive P waves occurred without ensuing QRS complexes. Results: During the 10 seconds of VS, the patient experienced pre-syncope. Additional images and measurements were acquired (with consent): no further arrhythmia occurred. Given the importance of the observation and symptoms, an electrophysiological study was performed the same day, and a dual-chamber pacemaker implanted. Conclusion: VS is a rare and potentially fatal cardiac arrhythmia. During VS, atrial activity is normal, but ventricular activity and cardiac output are zero, so pre-syncope and syncope commonly result. The recording of arrhythmias, VS or other, can be elusive: in this case both resting and 24-hour ECG failed to identify an abnormality. Fortu-nately, VS was captured during TTE, the finding was reported, and a pacemaker implanted to prevent future VS. Results: Thirty-four interviews were conducted

Methods: Patients less than 30 years of age with Ewing sarcoma metastatic at diagnosis and normal organ function were enrolled on P9457, a study of maximally intensi ed alkylator therapy administered without stem cell support. Cycles included alternating courses of ifosfamide, etoposide and vincristine, doxorubicin and cyclophosphamide. Amifostine was given to a randomized one-half of ____patients entered in the last half of the study. The dosage administered was 825 mg/m2 15 minutes prior to, and 3 hours after the beginning of each dose of ifosfamide or cyclophosphamide, with premedications and precautions as previously described. Days ANC <500/ul, platelets >50,000/ul and between cycles were analyzed at weeks 6, 12 and 18 of therapy. Results: There was no signi cant difference seen in the arithmetic mean number of days with platelet count < 50,000/ul: 31 with amifostine, 30 without amifostine (Wilcoxon rank sum test, pvalue: 0.38), the arithmetic mean number of days with absolute neutrophil count < 500/ul: with amifostine, 31 days, without amifostine, 30 days (WRS, p = 0.14), or the number of days until the next chemotherapy cycle: with amifostine: 30 days, without amifostine, 29 days (p= 0.45) Conclusions: In the dose and schedule used, amifostine did not provide myeloprotection from the toxicity of high dose alkylator therapy, and did not shorten the interval until the administration of the next chemotherapy cycle. Objectives: The expression of CD44 has been identi ed as prognostic factor in several malignant diseases. However, only few data exist correlating CD44 expression in soft tissue sarcoma with subsequent tumor progression or recurrence. The purpose of this study was to investigate the clinical signi cance of CD44s in adult soft tissue sarcoma (STS). Methods: Tumor specimens of 62 patients with STS were evaluated regarding CD44s expression using immunohistochemistry. The signi cance of the proposed prognostic indicators was evaluated in relation to survival and local recurrence. Results: Of 62 analyzed specimens, 49 tumors were CD44s positive compared to 13 CD44s negative tumors. Kaplan-Meier survival analysis indicated signi cantly better survival among patients whose tumor was CD44s positive (P = 0.015). Variables predictive of longer survival included resection quality (R0, P < 0.01) and tumor size (T1, P = 0.02). CD44s expression correlates with prognosis of soft tissue sarcomas. Conclusions: CD44s may play a pathogenetic role in tumor progression Determining the expression of CD44s in primary STS could be a valuable tool for selecting patients for further adjuvant treatment. Nevertheless, radical resection at initial surgery plays the pivotal role in soft tissue sarcoma treatment. Objectives: Irradiation of the growth plate during treatment of extremity sarcomas in pediatric patients often leads to undesirable late sequelae. Growth plate PTHrP has been reported to be downregulated following irradiation. The purpose of this project was to test the hypotheses that PTHrP rebounds as part of the normal response following growth plate irradiation and that a proven radioprotectant may act to enhance this PTHrP response. Methods: Sixty weanling 5 week Sprague-Dawley rats underwent right knee irradiation with single fraction 17.5 Gy while the left leg served as internal control. Twelve animals (half pretreated with amifostine) were euthanized at each of 0.5, 1, 2, 3, and 4 weeks. Immunohistochemical staining was performed and analyzed on tissue specimens for 3 animals per group per time for PTHrP, Bcl-2, Bax, caspase, TGF-beta and FGF-2. Results: Irradiated tissue demonstrated reduced staining for PTHrP early, but by 2 weeks after irradiation there was a notable return in PTHrP expression to at least control levels. This postirradiation PTHrP response was blunted rather than enhanced by amifostine. Amifostine showed its most dramatic effects in reducing Bax expression. Amifostine did not increase proliferative cytokines.

Conclusions:
The observed PTHrP response corresponds to improving growth plate morphology and growth rate, suggesting a role for PTHrP in response to growth plate irradiation. Amifostine appears to decrease apoptosis mediators. This suggests a potential role for complementary radioprotectants that increase or maintain the post-irradiation PTHrP levels, such as pentoxifylline, as a means of maximizing growth plate recovery following irradiation. Objectives: To evaluate the outcome for giant cell tumor of bone treated with radiation therapy, with or without surgical resection. Methods: A retrospective review of 25 consecutive patients with pathologically con rmed giant cell tumor of bone receiving radiation therapy.
Results: The anatomic distribution of lesions was as follows: cervical spine, 3; temporal bone, 1; thoracic or lumbar spine, 9; sacrum, 8; iliac, 1; and one each in the humerus, radius, and 1st metacarpal bone. Tumor size ranged from 2-20 cm (median, 9.5 cm). Twelve patients were referred with recurrent disease having undergone one or more prior surgical resections or had been heavily pretreated using chemo-embolization with subsequent recurrence. Fourteen patients were treated for gross disease, the remaining eleven were treated after gross total surgical resection. Objectives: Amifostine, a selective free-radical scavenger, is the only previously documented drug to achieve radioprotection of the growth plate, but its effect is incomplete. The aim of this pilot is to determine if any of four novel radioprotectant drugs other than amifostine can individually preserve the integrity of, or minimize damage to, physeal longitudinal growth during single radiation dose exposure in an animal model. Methods: Eighty-four weanling male Sprague-Dawley rats were randomized into 16 groups of 4-6 animals. All groups received single 17.5 Gy radiation exposure to the right knee with the left serving as control. Groups IA-C received pentoxifylline 50, 200, and 300 mg/kg. Groups IIA-B received selenium selenite 1.5 and 5 mg/kg. Groups IIIA-E received IL-1b 5, 15, 50, 125, and 500 mcg/kg. Groups IVA-E received misoprostol 0.1, 0.5, 1, 0, and 5 mg/kg. Group V received irradiation alone. At 6 weeks femoral and tibial lengths were measured and limb length percentage differences calculated between irradiated and unirradiated limbs. ANOVA was employed with alpha 0.05. Objectives: We describe three tumorigenic murine cell lines, which have a p53 de cient osteoblast-like cell as a common precursor.

Results
Methods: MMC2, p53-/-osteoblast-like cell line, was innoculated subcutaneously into athymic mice. Cells isolated from tumors were cultured in vitro. These cells were assayed for growth properties in vitro and tumorigenicity in nude mice . Expression of osteoblast-related genes were examined by Northern blotting.
Results: Tumors developed in 3 out of 8 sites, and polyclonal cell lines were established from each tumor, and designated as MMOS1, MMOS2 and MMOS3. Expression patterns of the osteoblast-related genes were correlated well with the features of the original tumors, ranging from an osteoblastic osteosarcoma (MMOS2) to tumors with scarce or no osteoid formation (MMOS1 and MMOS3). Properties as malignant cells also varied among the three cell lines. MMOS1, which showed the slowest growth in a low-serum condition, developed markedly larger tumors in vivo than the other two cell lines. MMOS3 showed the fastest growth in a low-serum condition and produced the largest number of colonies in soft agar, but did not develop lung metastases, whereas MMOS1 and MMOS2 developed lung metastases with a frequency of 30% and 50%. Because these three cell lines have a common precursor, the heterogeneity among them is clearly attributed to genetic alterations that took place during transformation process, and therefore these cell lines will be suitable materials to isolate the responsible genes.
In Objectives: Objective: It is well known that the retinoblastoma (Rb) gene plays an important role in the development of osteosarcoma. Precise sequential events after the inactivation of the Rb gene, however, remains to be investigated. Here we have performed in vitro transformation experiments using Rb-/-murine osteoblasts as a starting material.
Methods: Rb-/-osteoblast-like cells were isolated from long bone of neonatal chimeric mice composed of wild-type and Rb-/-cells, and using the ALP activity as an osteoblast marker, one clonal cell line (¢ RbOB1) was established.
Results: ¢ RbOB1 expressed several marker genes as osteoblast (type I collagen, osteocalcin, and cbfa1/runx2), and showed vigorous growth in vitro, but neither anchorage-independent growth nor in vivo tumorigenecity was observed. To inactivate the p53 gene in the ¢ RbOB1, p53DD, the truncated dominant-negative form of human p53 gene, was introduced by the retrovirus vector, and a clonal cell line expressing p53DD was established (¢ RbOB1p53DD). Induction of p53 gene by actinomycin D was observed in the ¢ RbOB1, but not in the ¢ RbOB1p53DD, suggesting that the wild-type p53 was inhibited in ¢ RbOB1 p53DD. However, neither anchorage-independent growth nor in vivo tumorigenecity was observed in the {?}RbOB1p53DD. Objectives: Chondromodulin-1(ChM1) is a glycoprotein that inhibits angiogenesis and the expression is restricted to cartilage and eye. In cartilageous tumors, the expression of ChM1 was observed only in benign lesions, suggesting the role of loss of ChM expression during the malignant transformation (Hayami, et al. FEBS letter, 2001). No information, so far, has demonstrated concerning the expression of ChM1 in osteosarcomas (OS), and here we report that some OS express the ChM1, which may relate to the origin of tumor cells. Methods: Using RT-PCR, the expression of mRNA of ChM1 in 26 cases of osteosarcoma tissues and 7 lines of osteosarcoma cell lines were analyzed. Results: The mRNA expression of the ChM1 was observed in 10 out of 26 OS, most of which were subclassi ed as chondroblastic OS. Among seven OS cell lines, the expression of ChM1 was observed in two, one of which was established from a chondroblastic OS.Tumors positive for the ChM1 expressed the type II and IX collagen, and aggrecan genes, as well as the osteocalcin genes, suggesting the bidirectional differentiation potential of these tumor cells. Treatment of ChM1 negative OS cell lines with 5azadeoxy-cytidine induced the expression of the ChM1 gene in two cell lines. Bisul te sequencing demonstrated the methylated CpG residues in the critical promoter lesion in these cell lines, which were not methylated in human normal cartilage cells.
Conclusions: These data suggest that some OSs stem from the mesenchymal cells with bidirectional potential, and epigenetic mechanisms may take a part in the process of cell fate determination. Objectives: As an adjunct to conventional grading in human liposarcomas, the possible prognostic value of the rate of tumor cell apoptosis and proliferation was investigated. Methods: 51 patients (female n=21, male n=30) with liposarcoma resected between 1988 and 2000 in our center were included in this study. Tumors were localised in the extremities (n=28), retroperitoneum (n=20) and trunk (n=3). Tumor margins were free (n=25) or showed residual microscopic (n=25) or macroscopic (n=1) disease. Multiple variables for each patient, including age, sex, tumor size, grading and numbers of apoptotic and proliferating cells were determined. Immunocytochemistry was performed for semiquantitative analysis of representative paraf n embedded tissue sections. Monoclonal antibodies targeted to proliferating cell nuclear antigen and apoptotic nuclei (Tunelassay) were utilised. The results were correlated with the postoperative course of these patients Results: The median survival time was 10.2 years. Multivariate analysis revealed a signi cant correlation between survival and grading, apoptosis and proliferation (p < 0.05 each).
Conclusions: These data indicate that in liposarcoma tumor cell apoptosis and proliferation are in addition to conventional grading of strong prognostic value in the assessment of disease-speci c survival. Objectives: Introduction Suspension of the humeral head from the clavicle after total scapular resection is compared to endoprosthetic scapular reconstruction. The surgical technique of endoprosthetic reconstruction and functional results are described. Patients: 23 patients with scapular tumors requiring total scapular resection were treated. Resection included 12 total scapulectomies and 11 en-bloc resections of the scapula and humeral head. Seven patients received endoprostheses. Four had prosthetic humeral heads suspended from the clavicle and 12 had suspension of the native humeral head. All patients were followed more than 2 years. Methods: Endoprosthetic Surgical Technique Patient selection was crucial. All peri-scapular muscles were tumor-free. Resection was usually performed using a posterior approach. Most highgrade scapula tumors were resected with the proximal humerus. Smaller than a natural scapula, the prosthesis facilitated soft-tissue reconstruction and was multiply fenestrated for myodesis. It was placed on the serratus anterior and covered by the rhomboids, trapezius and latissimus. A curved humeral head prosthesis was cemented into the humerus and connected to the scapular prosthesis using Gore-tex™.
Results: There were no deep wound infections, failures, or secondary amputations. Elbow range-of-motion and hand dexterity were similar. Patients with scapular endoprosthesis had better active abduction (60 -90 vs. 10 -20). Patients with endoprosthetic reconstruction had a more natural contour. 6 patients with scapular prostheses (86%) and 10 patients with humeral suspensions (62%) had a good-to-excellent functional outcome. Conclusions: Scapular endoprosthesis reconstruction is associated with better functional and cosmetic outcomes compared to simple humeral head suspension from the clavicle. Objectives: To identify the incidence of a cortical breech on the initial presentation X-rays of patients with distal femoral GCTs, and whether this lead to a higher rate of local recurrence of tumour and increase in severity of surgery.
Methods: A prospective database is kept of all patients seen in the unit, it contains data on over 10, 000 patients seen over 34 years. Using the database initial presentation X-rays on 54 patients with distal femoral GCTs were reviewed. The size of the tumour was estimated using a facility of the database, by measuring the largest dimensions of the tumour (depth, breadth & height). The volume of the distal femur was estimated using the same X-ray and computer programme. The X-rays were then carefully studied for evidence of a cortical breach on antero-posterior (AP) and lateral views. The records were also checked for evidence of subsequent locally recurrent disease and subsequent surgery.
Results: X-rays were reviewed on 54 patients (29 male, 25 female), range of 18-72 years. All patients had a biopsy proven GCT of the distal femur, X-rays (prior to biopsy) were reviewed. 34 (63%) patients with a cortical breech on X-ray. The mean tumour volume : distal femoral volumes (TV:DFV) was statistically greater between those patients with a cortical breach and those without, using ANOVA (p<0.0001). There were 13 patients with local recurrent disease but no statistical difference in subsequent local recurrence rates between the two patient groups.There was also no statistical differences between the number of operations for those who presented with a cortical breach or without.
There was no evidence that more radical surgery was required if a patient presented with a cortical breach.
Conclusions: The risk of cortical breech in patients with GCTs of the distal femur is dependant upon the tumour volume to distal femur volume ratio. If the ratio is above 54% then present with a cortical breech on X-ray is likely, (95% con dence interval), conversely if the ratio is less than 44 % then a cortical breach is unlikely. There is no evidence those patients with a cortical breach have a higher rate of local recurrence, an increased number of operations or more radical surgery. Average tumor size was 11.8 cm. 7/56 (12.5 %) reported minor wound complications. 25 (60%) had reports specifying margin depth in centimeters. 21 (84%) reported </= margins speci ed had (60%) patients LR Most "tumor-free". were remaining The focally-present. tumor (4%) 25 1 and margin to the from 0.5-cm/= 0.5 cm. Type III capsule formation correlated to 94.3% average necrosis (range 85%-99%), type II to 77% (range 50%-98%), type I to 34% (range 10-50%). Conclusions: Surgical margins are reported as being predictive of local recurrence after soft-tissue sarcoma resection. Presence of close or focally positive margins in this series did not correlate with local recurrence. A well-formed brous "capsule" tumor periphery and good chemotherapeutic response may contribute to improved local control. Objectives: The management of patients with GIST has been fundamentally altered by the introduction of Imatinib. Results in advanced disease have shown dramatic results for a previously untreatable condition with little major toxicity. The experience of patients may be complex and varied, including emotions stemming from unexpected renewed health and uncertainty associated with long term treatment with a new drug. The observations of a clinical trial nurse have identi ed particular patterns: a rst generation of patients diagnosed before Imatinib but who subsequently bene ted from it and a second generation offered treatment from the time of diagnosis or relapse. Methods: Illustrative case histories include 2 patients diagnosed before the introduction of Imatinib and had faced a terminal illness and 2 patients referred at diagnosis or at relapse speci cally for Imatinib. Results: Responses were partial remission in 2 and stable disease in 2. Both patients in the rst group had a good symptomatic response with only grade 1-2 toxicities. One stated that any side effect would be acceptable to achieve bene t. The other resumed full time work but remains anxious about how long the response may last. In the second group, one patient had multiple grade 1-2 toxicities similar to those of her disease causing constant fears of tumour re-growth. Another had no side effects but anxieties from living with a cancer still in situ. All exhibited anxiety despite the success of treatment. Conclusions: Health professionals caring for patents with GIST should recognise and acknowledge the additional issues faced by patients which accompany response to Imatinib.