The efficacy of neoadjuvant and adjuvant chemotherapy has been clearly established in the treatment of osteosarcoma; however, the most active regimen remains to be identified. This prospective study evaluated the efficacy and toxicity of a dose-intense ifosfamide, doxorubicin, and cisplatin-based neoadjuvant regimen in adults with osteosarcoma. We prospectively treated 20 patients with osteogenic sarcoma with two cycles of ifosfamide/doxorubicin followed by two cycles of doxorubicin/cisplatin every 2 weeks. Surgical specimens were analyzed for percent tumor necrosis. Patients who demonstrated a "good response" (GR) to chemotherapy received the same combination postoperatively at a lower dose rate. Patients who demonstrated a "poor response" (PR) received four cycles of high-dose methotrexate alternating with two cycles of ifosfamide/etoposide and two cycles of cisplatin/etoposide after the surgery. Neoadjuvant chemotherapy was well tolerated with moderate hematologic toxicity. Twelve of 19 evaluable patients (63%) were treated according to the GR arm and 7 according to the PR arm. At median follow-up of 5.5 years, disease-free survival (DFS) and overall survival (OS) are 68% and 74%, respectively. Patients treated on the GR arm had DFS and OS of 75% and 83%, respectively, whereas patients on the PR arm had DFS and OS of 57%. Intensive neoadjuvant chemotherapy is effective and moderately well tolerated in patients with de novo osteosarcoma. The outcome data suggest that lack of a near complete response to preoperative chemotherapy reflects inherent biologic resistance to chemotherapy and hence a poor prognosis.

In contrast to studies observing thyroid dysfunction in the setting of high lead exposure and related clinical poisoning, our findings weigh against a significant physiologic effect on thyroid function at lower levels (< 60 microg/dl) of occupational lead exposure.

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This paper works from a Jungian perspective to explore the unconscious dynamics of an authoritarian cultural complex at work in public schools in the United States. The paper exposes two areas of what Jung called the shadow archetype: the historical narrative of child labor during the industrial revolution as a traumatic societal event; and mythic images of the Greek Father-gods who buried, ate, or imprisoned their children. The working hypothesis of the paper is that the trauma of child labor operates as a social force, an unconscious archetypal pattern of authority and exploitation that is imaged and illuminated by the mythic narratives of the Greek Father-gods. Using depth psychological concepts and methods, the paper reveals how these repressed traumas create unconscious cultural attitudes that view children as commodities whose innate value and potential are sacrificed to feed the nation’s economic power and growth rather than leading out the potential within each student. Kristeva’s theories of abjection and subject in process provide psychoanalytic insights into how authoritarian cultural attitudes toward the education of children enslave students in a mandated instructive process that inflicts a kind of violence upon them. In conclusion, the paper suggests that the current system of education calibrated to standardized testing needs to broaden significantly to include transformative educative processes encompassing learning through the body, senses, feeling, intuition, and imagination.