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Leiomyosarcomas constitute 1% to 2% of all gastrointestinal stromal tumors. Presenting symptoms and endoscopic findings are nonspecific, and the diagnosis frequently is made incidentally during laparotomy for another indication. Seventeen cases of small bowel leiomyosarcoma were found by means of the pathology database at the Massachusetts General Hospital from 1952 to 1993. Clinical presentation, pathologic findings, and tumor recurrence were studied. The mean follow-up was 7.9 years. The average age was 48 years. Fourteen patients were female, three were male, and one could not be determined. Two patients did not have any symptoms. Five patients had nonspecific gastrointestinal symptoms, including weight loss (n = 2), weakness (n = 1), and diarrhea (n = 2). Ten patients underwent surgery, including nine exploratory laparotomies and one laparoscopic resection. Localized disease was found at initial operation in three patients. Two patients underwent resections. Both patients died of metastatic disease despite treatment. Five patients had distant metastases at initial diagnosis. Three of the four patients with localized disease who received postoperative irradiation (median dose, 3000 cGy; range, 2300-4000 cGy) are alive without evidence of recurrence of disease. One patient died after 21 months of progressive disease. Two patients with disseminated disease died after 12 and 23 months of progressive disease, respectively. Small bowel leiomyosarcomas usually present in the fifth decade of life, with nonspecific gastrointestinal symptoms. In the absence of symptoms, these tumors are unlikely to be diagnosed. Up to 30% of patients with disseminated disease have metastases at the time of initial diagnosis. Endoscopic resection is recommended for suspicious lesions. Radiotherapy may be useful in carefully selected patients with localized disease.Functional outcomes and costs of cochlear implantation in children.
To assess the long-term benefits of cochlear implants in children. Prospective cohort study. Tertiary care centre. Thirty-six children implanted between 1993 and 1997 at the Department of Audiology and Phoniatrics at the Turku University Hospital. The Auditory Speech Perception Test and the N
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