Frank Ahlhelm

Synovial Sarcoma Diagnosed after a Sports Injury

Only 1% of all neoplasms are soft tissue sarcomas. One of the most common soft tissue sarcomas in adolescents and young adults is the synovial sarcoma (13%), which is most likely to occur in patients between 15 and 40 years of age, a time when many people are active in sports as their favorite spare-time activity. Localization of this soft tissue tumor is an important criterion for the diagnosis of a synovial sarcoma because the extremities, and especially the lower extremity, are mostly affected. Apart from the high-risk sarcomas, most sarcomas are characterized by slow growth. Subfascial synovial sarcomas may be clinically inapparent or may be accidentally detected in association with a sports injury. An exact history regarding the mode of injury may be helpful for the physician considering the diagnosis of a soft tissue sarcoma. Whenever the clinical findings are inadequate regarding the mode of injury, the physician should take into account the differential diagnosis of a malignancy.

Physical training During intrahepatic chemotherapy

OBJECTIVE To evaluate the role of strength and endurance training for the muscular, cardiac, respiratory, and immune systems and the quality of life (QOL) during intrahepatic chemotherapy (folinic acid, 5-fluorouracil). DESIGN Single case. SETTING Teaching hospital in Germany. PARTICIPANT An elderly athlete with liver metastasis after resection of a carcinoma of the rectum (pT3, N0, M-liver, G2). INTERVENTION Strength and endurance training during chemotherapy. MAIN OUTCOME MEASURES During the intervals between training cycles (14d), beginning in postoperative week 6, a strength and endurance training regimen was performed twice weekly for 13 weeks, with an intensity of 40% to 60% of the maximum postoperative individual power and endurance. Before and after chemotherapy, we checked echocardiograms, resting and exercise electrocardiograms, lung function, natural killer (NK) cells, and the Gastrointestinal Quality of Life Index (GIQLI) scores. RESULTS The increase in strength was between 0% and 144%. The improvement in endurance expressed by reduction of heart rate and lactate concentration was 10% and 21.5%, respectively. Lung function also improved with regard to forced expiratory volume in 1 second (12.9%), forced vital capacity (11.3%), and inspiratory vital capacity (11.4%). The relative count of the NK cells increased to 27.2%. An improvement in the GIQLI was observed from 109 points (pathologic) to 129 points. CONCLUSION Strength and endurance training was associated with an increase of physical strength and endurance with positive influence on illness-related QOL. Postoperative physical exercise during regional chemotherapy is beneficial.