Special Exception Research Articles

SHOULD A COMPANY’S DIGNITY BE PROTECTED UNDER SECTION 10 OF THE CONSTITUTION? THE QUESTION IN Reddell v Mineral Sands Resources (Pty) Limited [2022] ZACC 38

In Reddell v Mineral Sands Resources (Pty) Ltd ([2022] ZACC 38) (Reddell), the Constitutional Court considered whether section 10 of the Constitution of the Republic of South Africa, 1996 (the Constitution), as read with section 8(4), should be interpreted to protect the dignity of juristic persons (in this case, mining companies). The majority and minority judgments arrived at conflicting decisions on the point. Unterhalter AJ, for the minority, held that juristic persons should be protected under section 10, while Majiedt J, for the majority, held otherwise. The majority also developed the common law of defamation to limit the circumstances in which a juristic person may succeed in a claim for general damages for non-patrimonial loss.The authors make two claims. First, it is argued that the minority judgment correctly interpreted the nature and purpose of section 10 (the guarantee of human dignity) when read with section 8(4) of the Constitution, which provides that juristic persons are entitled to bear the rights in the Bill of Rights as required by the nature of the right and the nature of the juristic person in issue. It is asserted that the two sections can be interpreted to entitle companies to rely on section 10 of the Constitution to protect their right to dignity, encompassing their good name and reputation. Secondly, it is argued that the majority’s development of the common law of defamation – to create a special exception for cases where a juristic person sues for general damages – was unnecessary, and has created legal uncertainty.The case note proceeds as follows. First, the authors introduce the facts of the case, and then explore the ratione decidendi of both judgments. Secondly, the note addresses the ambit and scope of human dignity as a constitutional right, followed by the applicable principles governing constitutional interpretation, including the role of the heading of a statutory provision. This is followed by a discussion of the law of defamation concerning whether a juristic person can claim damages for an infringement to its reputation under the actio iniuriarum. The legal position prior to the judgment in Reddell is compared to that which now applies. Finally, the decision is evaluated with reference both to the reasoning used by the majority and minority respectively and the significance of the outcome of the case for our law.A detailed discussion of the constitutionality of awarding general damages to corporations for defamation on the basis that such claims unjustifiably limit section 16 of the Constitution (the right to freedom of expression) falls outside the scope of this case note.

Points of inflection of special eigenvalue functions as indicators of stiffness maxima/minima of proportionally loaded structures

The stiffness of a proportionally loaded structure may continuously increase or decrease. As a special exception, it may be constant. On the other hand, an initially stiffening (softening) structure may turn into a softening (stiffening) structure. At the load level of such a change the stiffness of the structure attains an extreme value. The task of this work is to present mathematical conditions for these load levels. Lack of them represents a void in the pertinent literature. The practical significance of the aforementioned changes is the one of indicators of the mechanical behavior to be expected after their occurrence. The second and the last author have recently presented a condition for the load level at which the stiffness of a proportionally loaded structure becomes a minimum value. It is given as d2(ℜ(χ1(λ)))/dλ2=0, representing the condition for a point of inflection of the real part of a complex eigenvalue function χ1(λ), where λ denotes a dimensionless load parameter. The underlying linear eigenvalue problem has two indefinite coefficient matrices, which is a necessary condition for complex regions of eigenvalue functions. These matrices are established with hybrid elements, available in a commercial finite element program. In the present work, d2(χ1(λ))/dλ2=0 is shown to be the condition for the load level at which the stiffness of a proportionally loaded structure attains a maximum value. The eigenvalue function concerned has no complex region. It is also shown that the displacement elements, which are the basis for their extension to the employed hybrid elements, are unable to indicate the load level at an extreme value of the stiffness.

Recurrent Medulloblastoma: Complete Response and > than 21 Years and Five Months Overall Survival in a One-Year and SevenMonth-Old Male Treated with Antineoplastons

Medulloblastomas arise in the posterior fossa, primarily in the region of the fourth ventricle. Recurrent medulloblastomas are high-risk and have a bad prognosis. Objectives: the case of a male child with recurrent, disseminated medulloblastoma is presented to detail the efficacy of ANP therapy (Antineoplaston A10 {Atengenal} and Antineoplaston AS2-1 {Astugenal}) in the treatment of high-risk medulloblastoma. This child was treated at the Burzynski Clinic (BC), as a Special Exception, according to Protocol BT-12, “Phase II Study of Antineoplastons A10 and AS2-1 in Children with Primitive Neuroectodermal Tumors”, with intravenous (IV) ANP therapy via a subclavian catheter and infusion pump. Tumor response was measured by sequential magnetic resonance imaging (MRI) of the brain with gadolinium enhancement. Findings: This child initially underwent tumor resection, placement of ventricular shunts, and chemotherapy, all performed elsewhere. Baseline MRI at the BC revealed recurrent, disseminated, and enhancing disease measuring 9.10 cm2 in total. IV ANP therapy began in March 2001 and ended in December 2002 after a complete response (CR) was achieved based on MRI criteria. Subsequently, the child received oral Antineoplastons as maintenance therapy, which were discontinued after eight months. At last follow-up, > 21 years and eight months since diagnosis and > 21 years and five months since the start of IV ANP therapy, the patient was well and showing no evidence of tumor recurrence. Conclusions: The utilization of ANP therapy to cure a patient with recurrent medulloblastoma is presented. We conclude that ANP therapy is an attractive therapeutic option for children with medulloblastoma

특정건축물 정리에 관한 특별조치법의 개선방안에 관한 소고

The “Legalizing Specific Building by Special Measure Act” (abbreviated as the “Specific Building Legalization”) is a temporary law that allows for the legalization of small residential violating buildings under specific conditions through using approval. The “Specific Building Legalization” mandates on-site investigations to determine whether a building qualifies as a specific building, even if the investigators are not experts in the fields of construction, safety, and machinery. To ensure professional and safe using approval, it is necessary to address the issues of lax on-site inspections by introducing a system involving engineers in specialized fields and specialized civil servants. One of the concerns is related to the setback regulation from north side of the building to secure sunlight, which could unintentionally lead to illegal expansion through the formation of verandas. This setback regulation from north side needs to be reconsidered to avoid potential violations of legal fairness. Additionally, the law provides an exemption from the obligation to create an additional parking lot when the building's area increases at the time of using approval under the “Specific Building Legalization” through the 'Special Exception for Establishment of Attached Parking Lot.' Instead of granting special exemptions for parking lots, an alternative plan should be developed to maintain legal fairness. Upon the enforcement of the “Specific Building Legalization”, there should be a plan to increase awareness and establish an application support system to prevent exclusion from the designation of specific buildings due to lack of recognition or ignorance of the law. Furthermore, there is a need to prevent the proliferation of residential violating buildings, especially right before the law comes into effect, by excluding recently constructed buildings that have been using approved for less than two years from being considered as specific buildings. Despite being a temporary law, building owners, contractors, and executors seem to expect repeated enforcement and continue constructing small residential violating buildings. To address this issue, continuous additional enforcement of the “Specific Building Legalization” should be prevented, and administrative penalties for violating buildings built after the enforcement should be strengthened. The scope of punishment should also be expanded to include constructors and implementers. Overall, refining and addressing these concerns will be crucial to ensuring the effective and fair implementation of the “Specific Building Legalization” while promoting safety and compliance with building regulations.

Characteristics and Issues of the Three Systems Related to the "Special Exception System of the Parking Law" for Walkable Cities

本研究の目的は、「駐車場法特例制度」に関連する3つの制度を導入している各自治体の主体、目的、整備手段の適用状況を整理し、「駐車場法特例制度」の特徴や課題を明らかにすることである。ヒアリング調査をもとに、3つの制度それぞれの策定プロセス、計画・運用の主体、策定の目的、整備手段などを整理し、各制度の特徴や課題を明らかにします。その上で、3つのシステムを比較し、Walkable Citiesのための今後の駐車場集約化を提案する。

A Study on the Economic Ripple Effect Analysis and Development Plan of the establishment of a Blockchain Digital Asset Exchange for the Creation of a Financial Innovation Ecosystem: Fousing on Busan Metropolitan City

Purpose - This study examines how much economic ripple effect occurs by investing Busan Metropolitan City in construction and operation costs with a budget of 75 billion won to establish a Digital Asset Exchange. In addition, to the study presents a development plan through the establishment of an exchange.
 Design/Methodology/Approach - In order to analyze the economic ripple effect for the establishment of a digital exchange in the Busan, we intend to utilize the 2015 regional industry association table announced by the Bank of Korea. Through this study, we derive the production inducement effect, the value-added inducement effect, the import inducement effect, and the employment inducement effect, and examine how much output is induced with an input of 75 billion.
 Findings - With the Busan budget of 75 billion, the economic ripple effect showed more than 100 billion and more than 1,000 jobs in the short term.
 Research Implications - As a development plan, first, a special regulatory exception should be requested. Second, it is necessary to establish operational governance. Third, it is necessary to divide the scope of investors and investment targets into two stages from an asset point of view, implement them step by step and accumulate know-how.
 Research Implications - Detail.

A 25-year-female with Diffuse Intrinsic Pontine Glioma Surviving for More than Nine Years Following Treatment with Antineoplastons

Rationale: Diffuse intrinsic pontine glioma (DIPG) is a lethal brain tumor and leading cause of brain tumor–related death in children. Over the past few decades, clinical trials have shown no improvement in outcome. Most DIPGs occur in the pediatric population. Adult brainstem gliomas are rare, constitute less than 2% of adult gliomas, and show a slight male predominance. The case of this 25-year-old female is presented to detail and discuss the use of Antineoplastons A10 (Atengenal) and AS2-1 (Astugenal) in the treatment of DIPG that persisted despite radiation therapy (RT) and temozolomide. Objectives: The patient described was treated at the Burzynski Clinic (BC), as a special exception, according to the phase II protocol, BT-09, which utilized Antineoplastons A10 and AS2-1 (ANP therapy) in the treatment of brain tumors. The delivery of ANP therapy was via a subclavian catheter and infusion pump. Tumor response to therapy was measured by sequential magnetic resonance imaging (MRI) of the brain. Overall Survival (OS) and Adverse Events (AES) were also documented. Findings: At her presentation to the BC, the patient complained of diplopia, left-sided weakness, and difficulty walking. On physical exam, she was alert and orientated. Her cranial nerves were intact. There was weakness of the left-sided extremities. Deep tendon reflexes were equal bilaterally with down-going toes bilaterally. Reports of the original brain MRIs in Argentina suggested a DIPG with extension to the medulla and cerebellum. In addition, tumor biopsy confirmed a grade 3 astrocytoma. Following radiation therapy (RT) and temozolomide in Argentina, the patient was treated at BC for persistent disease with ANP therapy. Sequential MRI imaging of the residual tumor, which was non-enhancing, showed no change in size during therapy. However, the patient did achieve resolution of her neurologic signs and symptoms and has survived more than nine years since first being seen at BC. Correspondence with the patient on September 9, 2021 indicated she was feeling fine, had a healthy child, and was enjoying life. Conclusions: We have presented here the case of an adult female with a DIPG who had resolution of signs and symptoms and survived more than nine years after ANP therapy. For patients with DIPG (or other high-grade astrocytoma), who do not qualify for/refuse RT or show persistent or progressive disease following RT and/or chemotherapy, ANP therapy is an effective therapeutic option. In collaboration with the FDA confirmatory Phase II and Phase III studies have been developed.

ACQUISITION OF AGRICULTURAL REAL ESTATE BY LEGAL PERSON OF CHURCHES AND OTHER RELIGIOUS ORGANIZATIONS IN THE CONTEXT OF THE ACT ON THE FORMATION OF AGRICULTURAL SYSTEM

Act on the Formation of Agricultural System introduced the general principle according to which agricultural real estate can be purchased only by individual farmers. However, there are exceptions, including the possibility of purchasing agricultural real estate by legal person of churches and other religious organizations. The purpose of the article is to establish the scope of this special exception and the reasons for its introduction. The author concludes that the binding regulation, due to its wide scope, may raise doubts. The article proposes de lege ferenda changes that would enable the purchase of agricultural real estate by legal person of churches and other religious organizations in such a way that the freedom of religion could be protected and regulatory proceedings could be carried out, while at the same time it could fulfil the objectives of the Act on the Formation of Agricultural System.

Operation Varsity Blues and the NCAA’s Special Admission Exception

“Operation Varsity Blues,” the university admissions scandal and ensuing federal investigation, made national news and captivated the public. Fascination with the scandal could have stemmed from the involvement of celebrities such as Lori Loughlin and Felicity Huffman and/or the sheer ridiculousness of the scheme, in which wealthy and prominent families paid exorbitant amounts of money to secure their childrens’ admission to elite universities. Others may have closely followed the resulting legal proceedings that included federal criminal charges like racketeering against 50 individuals and civil lawsuits against elite universities and celebrities with one suit seeking $500 billion in damages. Lawmakers’ attempts at preventing future university admissions scandals legislatively may have also caused curiosity.
 This article, though, explores the scandal’s intricate ties to college athletics and seeks to determine the most effective and practical means to mitigate the likelihood of a future similar admissions scandal. More specifically, the article explores how head coaches and an athletics administrator used their positions at academically elite universities to exploit a little-known NCAA rule permitting universities to use more lenient admissions standards for incoming student-athletes. Scheme participants falsely indicated dozens of applicants were incoming student-athletes in order to trigger the less rigorous standards and secure admission to elite universities. The criminal proceedings resulting from the scandal have yielded relatively light sentences for involved coaches, and civil suits against universities have been unsuccessful. California attempted to address the scandal legislatively, but, as this article explains, its reform package contains holes that fail to address many of the scheme’s key components.
 The article concludes that the NCAA, as opposed to lawmakers, the legal system, or individual universities, is in the best position to prevent, or mitigate the likelihood of, a future university admissions scheme like Operation Varsity Blues. Doing so would require only eliminating a single NCAA rule that is inconsistent with myriad other NCAA rules and principles and has resulted in decades of poor academic results.

A Proposal for 'Rebalancing' To Deal With 'National Security' Trade Restrictions

Over its first two years, the Trump administration has aggressively reshaped U.S. trade policy. One of its most controversial initiatives is the expansive use of “national security” to justify imposing tariffs and quotas. Section 232 of the Trade Act of 1962 gives the president authority to restrict imports on this basis after an investigation by the Commerce Department, and the administration has already done so for steel and aluminum and is now threatening similar actions on automobiles. The World Trade Organization (WTO) has a special exception for such measures, so there is at least an argument that they are permitted under international law. However, the administration has taken what was previously considered a narrow and exceptional remedy and broadened it to serve as a more general tool to protect domestic industries. This paper argues that WTO dispute settlement cannot easily resolve disputes of this kind, and suggests an alternative mechanism to handle these issues. Instead of litigation, a “rebalancing” process like the one used in the context of “safeguard” tariffs and quotas should be utilized for national security measures. Safeguards are a political safety valve that allow the trading system to pursue broad-based liberalization by providing the flexibility to protect domestic industries under certain conditions (ideally, by offering compensatory liberalization elsewhere). By adopting a similar political arrangement for national security trade restrictions, the overall balance in the system can be preserved, permanent damage to the WTO dispute system avoided, and a potentially destructive loophole kept closed.

A trip project for more demanding clientele involving the climb on Matterhorn

Abstract Tourism is one of the areas which is constantly making progress. While 10 years ago tourists enjoyed a holiday by the sea in a beautiful resort with even more beautiful weather and clean beach, eventually winter holiday in the ski resort with regularly adjusted slope, enough snow and comfortable accommodation, today it is different. Based on a survey among the clients of the Slovak travel agency it was found out that the clients are interested in the trip involving the climb on the Matterhorn mountain which has not been offered in the proposition yet. Travel agency together with the specialized academic workplace processed the trip project for more demanding clientele to this less common destination, this means on Matterhorn mountain, accompanied by the mountain guides. This way the travel agency gained a competitive advantage because no other Slovak travel agency organizes a tour of this type. It has to be considered the safety of the participants of the trip and wind conditions in the final destination. The profit margin was established at 45%. Under the term „ demanding clientele” we mean the clients who do not long for a stay at the seaside but on the contrary they love to increase adrenaline and are not afraid to test their abilities in extreme situations. There is a competition not only among the individual travel agencies but due to access to information via the Internet there are more and more tourists who are able to arrange a demanding sightseeing trip to various countries themselves. The special exception is mountain tourism and climbing which is demanding for the accompanying services – providing mounting guides, transport of the backpacks in hilly terrain. Climbing is the risky sport, it is necessary to have a secure professional accompaniment.

Il Ruolo della donna nell’Islam

The problem of a woman’s role in an Islamic world evokes today a lot of emotions in the context, on one hand, of bigger and bigger sensibility of the world on the equality of rights of sex, and on the other wider presence of Muslim communities in cultures which are traditionally strange or directly reluctant to Islam.The author stipulates that her article is not an attempt of judging a woman’s position in an Islamic world, but only a presentation how a woman’s role in shown by the Quran and Islamic traditions in the womb of Muslim communities which have different tints dictated by legal or mental interpretations. Contemporary legislation of Islamic states has a fundamental place in the article.A figure of a woman appears in the text of Quran very often, even more often than in the Bible. However, a woman in the Quran appears rather as an impersonal form, without any specific name, and rather as an area of certain rules used towards her. A special exception is Blessed virgin, the Mother of Jesus whose name is repeated in the Quran more often than in Gospels. Muhammad appreciated a woman’s value when he took her situation into consideration in times contemporary to him. He gave her what she did not have in that tribal culture of Arabic people e.g. equality in nature to a man, right to succeed, recognition of birth of a daughter as God’s blessing.However, taking into consideration appropriate texts of the Quran showing a woman as a creature having her own dignity, created like a man by God, as well as texts of different traditions, or contemporary sharias, one thing cannot be given to a woman – the equality of rights.It is visible in many facts presented in the article, for example: religious admissibility, legal polygamy and its actual existence, practically a woman cannot take the first step to divorce, a woman cannot marry a non-Muslim, factual “belonging” of children to a father, and not to a father and mother, different levels of impossibility of gaining education depending on local legislation or customs, inequality in inheritance with relation to a man, value of a woman not as an independent subject, but only in relations to a figure of a man whose a daughter, a wife, a sister she is. The author of the article indicates, that although a woman cannot in practice even dream of things which are naturally vested to a man, she has an actual influence on a family life, society or even all state organisms. A woman’s situation changes depending on a country, interpretation of Koranic texts coming from the Quran and many other influences which take place in contemporary Islamic states. However, folk traditions have an important influence on a woman’s situation, if not dominant, but also mentality, usually strong human’s convictions which do not always go in harmony with current legislation of a given Muslim country.Thereby, the article analyses a woman’s situation in individual countries and explains the main nature of the greatest problems which appear in non-Muslim countries in which a Muslim woman tries to live. It is connected with a loudly discussed issue of putting hijab on, circumcision of women and other problems.Finally, the problem of Islamic feminism appears together with famous figures of women as well as attempts of introducing something like women’s right in Islamic countries as for example in Morocco. The article tries in a scientifically honest way to show the figure of the woman in the Islamic world, and also debunk many stereotypes and for this reason the article appears to be precious for a non-Muslim reader.

Give Me Your Tired, Your Poor, Your Pregnant

Since a majority of Supreme Court justices created the abortion right in 1973, a troubling pattern has emerged: The Supreme Court has come to ignore—and even nullify—longstanding precedent and legal doctrines in the name of preserving and expanding the abortion right. And with a Supreme Court majority that is blithe to manipulate any doctrine or principle—no matter how deeply rooted in U.S. legal tradition—in the name of expansive abortion rights, it should come as no surprise that lower courts are following suit. Most recently, the D.C. Circuit fired up the “ad hoc nullification machine,” but this time, its victim of choice was the constitutional distinction between citizenship and alien status. In Garza v. Hargan, the D.C. Circuit—sitting en banc—pronounced, for the first time, that the Constitution guarantees the right to an abortion on demand to unlawfully present aliens. The Supreme Court has long held, however, that the scope of constitutional rights accorded to unlawful aliens is limited. Rather than confront this inconvenient precedent, the D.C. Circuit entirely ignored the antecedent question of whether unlawfully present aliens are entitled to the Fifth Amendment abortion right. Instead, the court simply assumed that they are. This holding is wrong for two reasons. First, by effectively deciding that an unlawful immigrant minor, in federal custody, whose only contact with the United States was her detention at the U.S. border, was entitled to the full scope of Fifth Amendment rights, the D.C. Circuit ignored Supreme Court precedent mandating that a person must have “developed substantial connections with the country” before being accorded constitutional protections. Second, by carving out this special exception for the abortion right, the court prioritized that right over all other constitutional protections.

To admit, or not to admit? An exploratory study of graduation rates of “special-admit” student-athletes within the “Power 5” conferences

ABSTRACTAccording to the National Collegiate Athletic Association (NCAA) manual, a student-athlete may be admitted to a university under special exception to the normal entrance requirements. Currently, the NCAA does not require data to track the outcomes of specially admitted student-athletes. Pragmatism, within the context of education, warrants regular evaluation of policies and procedures to see if they are achieving the desired purposes, and subsequently making changes to reflect values and beliefs as needed. The purpose of this quantitative study was to gain a pragmatic understanding of educational outcomes associated with specially admitted student-athletes within the “Power 5” conference institutions. Findings show the majority of student-athlete special admits (51%) graduated within six years from their initial institution while 6.06% were dismissed for academic reasons. Furthermore, student-athletes within the “Power 5” conference institutions graduated at a higher rate (68%) than Division I student-athletes (67%) and all Division I students (65%).

(423) - Transplantation in Adults with Congenital Heart Disease: A Special Exception

(423) - Transplantation in Adults with Congenital Heart Disease: A Special Exception

What are the Correct Results for the Special Values of the Operands of the Power Operation?

Language standards such as C99 and C11, as well as the IEEE Standard for Floating-Point Arithmetic 754 (IEEE Std 754-2008) specify the expected behavior of binary and decimal floating-point arithmetic in computer-programming environments and the handling of special values and exception conditions. Many researchers focus on verifying the compliance of implementations for binary and decimal floating-point operations with these standards. In this article, we are concerned with the special values of the operands of the power function Z = X Y . We study how the standards define the correct results for this operation, propose a mathematically justified definition for the correct results of the power function on the occurrence of these special values as its operands, test how different software implementations for the power function deal with these special values, and classify the behavior of different programming languages from the viewpoint of how much they conform to the standards and our proposed mathematical definition. We present inconsistencies between the implementations and the standards, and discuss incompatibilities between different versions of the same software.

A Field Guide to Cancellation of Debt Income

The United States is awash in a sea of debt. In the midst of the most severe recession since the Great Depression, loan delinquencies and charge-offs are at levels heretofore unknown in the modern financial era. Every loan charge-off and mortgage foreclosure has tax consequences. While the creditor most often claims a bad debt deduction or business related loss, the debtor generally must recognize gross income and pay income taxes on an amount roughly equal to the creditor’s loss, unless a special exception applies to exclude the debt relief from income. This article deals with the tax consequences to the debtor of the discharge of a debt for less than full payment. It first explain the origins and rationale for the rule, now codified in § 61(a)(12), that requires the inclusion of '[i]ncome from discharge of indebtedness.' The article then examines the various events that trigger recognition of income under § 61(a)(12). Following that discussion, the article deals with the manner in which the amount of income from discharge of indebtedness is computed. This part of the article also discusses the tax consequences to a business entity that issues an equity interests to a creditor to satisfy a debt. Finally, the article explores the myriad of statutory rules in §108 that permit nonrecognition income from discharge of indebtedness under particular circumstances, and the various ancillary consequences that follow from nonrecognition. Throughout, the article explores the relationship of income from discharge of indebtedness to realization of gain from the transfer of property to satisfy a debt by contrasting the tax consequences of transfers of property to discharge a debt with the consequences of discharge of a debt for less than full payment.

Application of the Charter to universities’ limitation of expression

This paper, which originated in a constitutional symposium series in honour of Justice Marie Deschamps, analyzes the move toward the possibility of applying the Canadian Charter of Rights and Freedoms to universities' restrictions on expression. The paper traces the pertinent case law on Charter application and argues that this case law now properly leads to Charter application in the context of university restrictions on expression. It considers the possibility of universities warranting a special exception based on academic freedom and argues that the contemporary tendency of universities to restrict expression actually means that Charter application can help to protect university values of expression and academic freedom from universities themselves.

AT-28 * LONG-TERM SURVIVAL (OVER 15 YEARS) OF PATHOLOGICALLY CONFIRMED RECURRENT GLIOBLASTOMA MULTIFORME: A CASE REPORT

Recurrent GBM carries poor prognosis with no standard therapy available. A 46-year-old Caucasian female underwent a partial resection of the tumor revealing a pathologic diagnosis of GBM. The patient then received radiation therapy (RT) at the dose of 5940 cGy over a six-week duration. After four months, she underwent a Gamma Knife procedure. Seven months later, she developed recurrence and underwent a second partial tumor resection. The pathology diagnosis again confirmed GBM. Magnetic resonance imaging (MRI) performed within one month revealed a recurrent tumor. A month later, treatment with IV infusions of antineoplastons A10 and AS2-1 (ANP) was initiated based on Special Exception into Protocol BT-20. During the baseline evaluation, the patient complained of marked weakness, short memory loss, frequent aura, loss of coordination, nausea, dizziness, difficulty walking, and speech problems. The dosage of A10 was gradually increased to 10.44 g/kg/d and AS2-1 to 0.17 g/kg/d. IV ANP was discontinued after 18.5 months due to complete response (CR). The only adverse event possibly related to the treatment was grade 1 skin rash, which resolved spontaneously. After stopping treatment with IV ANP, the patient started taking ANP A10 and AS2-1 orally (0.14 g/kg/d each). All treatments were discontinued after 31 months. The patient made a substantial recovery; she was able to walk without assistance and made progress in speech therapy. The baseline MRI revealed a right temporal enhancing lesion of 1.5 cm x 1.3 cm. Beginning fourteen months after the treatment start (10/14/1999), the MRI images showed a CR. Currently the patient is free from tumor recurrence, but had experienced some deterioration of her mental capacity due to chronic post-radiation toxicity. Her overall survival and progression-free survival is over 15 years.

Long-term Survival (>13 Years) in a Child With Recurrent Diffuse Pontine Gliosarcoma

Pediatric gliosarcoma (GS) is a rare variant of glioblastoma multiforme. The authors describe the case of an unusual pontine location of GS in a 9-year-old boy who was initially diagnosed with low-grade astrocytoma (LGA) that was successfully controlled for 4 years. Subsequently, his brain tumor transformed into a GS. Prior treatment of his LGA included subtotal tumor resection 3 times, standard radiation therapy, and Gamma Knife procedure twice. His LGA was also treated with a standard chemotherapy regimen of carboplatin and vincristine, and his GS with subtotal resection, high-dose cyclophosphamide, and thiotepa with stem cell rescue and temozolomide. Unfortunately, he developed disseminated disease with multiple lesions and leptomeningeal involvement including a tumor occupying 80% of the pons. Upon presentation at our clinic, he had rapidly progressing disease. He received treatment with antineoplastons (ANP) A10 and AS2-1 for 6 years and 10 months under special exception to our phase II protocol BT-22. During his treatment with ANP his tumor stabilized, then decreased, and, ultimately, did not show any metabolic activity. The patient’s response was evaluated by magnetic resonance imaging and positron emission tomography scans. His pathology diagnosis was confirmed by external neuropathologists, and his response to the treatment was determined by central radiology review. He experienced the following treatment-related, reversible toxicities with ANP: fatigue, xerostomia and urinary frequency (grade 1), diarrhea, incontinence and urine color change (grade 2), and grade 4 hypernatremia. His condition continued to improve after treatment with ANP and, currently, he complains only of residual neurological deficit from his previous surgery. He achieved a complete response, and his overall and progression-free survival is in excess of 13 years. This report indicates that it is possible to obtain long-term survival of a child with a highly aggressive recurrent GS with diffuse pontine involvement with a currently available investigational treatment.