PDL therapy clears postirradiation telangiectasia of the breast and chest wall successfully with minimal adverse reactions, and can be recommended for patients distressed by this disorder.

Radiation synovectomy (RS) has been used to treat chronically inflamed joints refractory to treatment using conventional agents. In RS, the radioactive isotope is concentrated in the synovial membrane from the injected colloid suspension, where it exerts its activity. However, despite numerous reports confirming its safety and efficacy, this procedure is not widely practised. In the Singleton Hospital NHS Trust, yttrium(90) (Y(90)) RS has been practised since 1990 for refractory synovitis. In this study, we analyse the results of therapy and complications in 38 joints so treated. Doses of 10 mCi were used in the majority of patients. Most responses were apparent by 6 months following the procedure. Altogether, 68% of the treated joints showed satisfactory response at 3 years, with 29% having all symptoms under control beyond 3 years. In three patients, there was evidence of minor pigmentation at the injection site. Two patients had extravasation of the isotope and needle track ulcers, which were recorded as major toxicity. We find Y(90) radiosynovectomy to be safe, quick, and effective in the management of patients with refractory synovitis. The efficacy of RS should be tested in randomised clinical trials involving large numbers of patients.

Twenty‐five previously untreated patients with small cell carcinoma of the lung were treated with cyclophosphamide 160 to 200 mg/kg (with autologous bone marrow support) followed by radiotherapy (4000 cGy) to the primary site and mediastinum. No other treatment was given until relapse occurred. Nineteen patients were assessable at least 4 months after radiotherapy; of these, 15 (79%) developed radiologic evidence of fibrosis, which was symptomatic in 14 (74%). The time of onset of fibrosis was related to the volume of lung irradiated. A retrospective analysis was made of 20 consecutive patients treated with multiple‐drug chemotherapy and an identical radiotherapy regimen as part of a randomized trial. Radiologic and symptomatic fibrosis was one half as frequent (35%) as in the high‐dose cyclophosphamide group. Very high‐dose cyclophosphamide appears to sensitize the lung to radiotherapy and promotes the production of fibrosis.

Meningeal haemangiopericytoma (HPC) is a rare tumour often mistakenly reported as "vascular meningioma". Unlike meningiomas, HPC has a high rate of local recurrence and distant metastases, which may occur several years after initial treatment. We report a patient in whom a HPC was misdiagnosed as benign vascular meningioma and the patient discharged from follow-up. HPC was diagnosed 11 years later from biopsy of a skeletal metastasis. Histological review of the meningeal tumour confirmed the diagnosis of meningeal HPC. Meningeal HPCs resemble meningiomas clinically, radiologically and even light microscopically. As a result, they can be reported as atypical meningioma, as in this case. HPC's are more aggressive than typical meningiomas, with a high rate of recurrence and distant metastasis, often late in the course of the disease. Management of meningeal HPC differs from that of typical meningioma, with a need for post-operative radiotherapy and long-term follow-up.

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