胸中段食管癌放疗放射范围对预后的影响分析

目的：探讨胸中段食管癌放疗放射范围对预后的影响。方法：本次临床观察选取94例我院2011年1月至2012年1月间收治的胸中段食管癌放疗患者为研究对象,回顾分析患者的放射治疗范围以及其预后情况。结果：全部94例胸中段食管癌放疗患者均接受18个月的随访,其中,73例淋巴结转移,22例血循转移,4例血循和淋巴结均转移,10例局部复发。结论：本次医学研究结果证实,胸中段食管癌患者临床治疗效果和预后情况会在一定程度上受其放射范围的影响,进而巩固治疗效果,降低患者临床死亡率和复发率。     

乳腺癌围手术期抗菌药物应用的临床研究

目的探讨乳腺癌围手术期不使用抗菌药物对患者术后手术部位感染(SSI)的影响。方法回顾性分析2011年1月-2012年12月甲状腺乳腺外科收治的乳腺癌手术患者411例,将其分为对照组202例、研究组209例,对照组围手术期预防性使用抗菌药物,研究组围手术期不使用抗菌药物,观察两组患者SSI发生率,并对SSI发生及相关因素进行分析,数据采用SPSS13.0统计软件进行处理。结果 411例乳腺癌手术患者术后发生SSI2例,发生率为0.48%,对照组患者SSI发生率0.49%,研究组为0.48%,两组比较差异无统计学意义,证实乳腺癌术后SSI与是否应用抗菌药物无关;两组SSI患者在糖尿病、新辅助化疗、高龄等相关因素方面比较,差异无统计学意义;进一步分析发现,2例SSI均与术后皮下血肿及皮瓣坏死有关。结论乳腺癌术后SSI发生率与年龄、肥胖、糖尿病、术后创面血肿及血清肿等高危因素有关,与预防性使用抗菌药物无关,乳腺癌围手术期不使用抗菌药物并不增加SSI发生率,同时可以减少医疗费用,可以避免使用抗菌药物带来二次感染、耐药等问题,值得临床推广应用。     

Therapeutic nipple-sparing mastectomy: trends based on a national cancer database

Background

Current reports on nipple-sparing mastectomy (NSM) are limited to single-institution series. We use the National Cancer Institute's Surveillance, Epidemiology, and End Results database to report on the national experience with NSM.

Methods

Population-level deidentified data were extracted from the Surveillance, Epidemiology, and End Results database. All female breast cancer patients treated with NSM from 2005 to 2009 were included. Case analysis was performed with respect to demographic and oncologic characteristics.

Results

Four hundred forty-nine patients underwent therapeutic NSM; this number increased from 66 patients in 2005 to 133 in 2009. Patients were distributed across 16 regions, although nearly 50% were from a region of California. Tumor diameter was <2 cm in 224 patients (50%). Lymph nodes were positive in 59 patients (13%), while radiation was delivered to 74 patients (16%).

Conclusions

NSM use has been increasing over the past several years. A majority of patients have tumor size <2 cm, although the number of patients with tumor size ≥2 cm has increased over time. Further population-based studies of NSM may benefit from collection of oncologic data such as tumor-to-nipple distance and tumor location.     

Breast-specific gamma imaging is a cost effective and efficacious imaging modality when compared with MRI

Background

Both MRI and breast-specific gamma imaging are tools for surgical planning in newly diagnosed breast cancer. Breast-specific gamma imaging (BSGI) is used less frequently although it is of similar utility and lower cost. We compared the diagnostic and cost efficacy of BSGI with MRI.

Methods

Retrospective review of 1,480 BSGIs was performed in a community breast health center, 539 had a new diagnosis of cancer, 75 patients having both MRI and BSGI performed within 2 months of each other. Institutional charges for BSGI ($850) and MRI ($3,381) were noted.

Results

BSGI had a sensitivity of 92%, specificity of 73%, positive predictive value of 78%, and negative predictive value of 90%. This compared favorably with MRI that had sensitivity of 89%, specificity 54%, positive predictive value 67%, and negative predictive value 83%. The accuracy of BSGI was higher at 82% vs MRI at 72%. Total cost of MRI imaging was $253,575 vs BSGI at $63,750.

Conclusions

BSGI is a cost-effective and accurate imaging study for further evaluation of dense breast tissue and new diagnosis of cancer.     

Minimal invasive para-rectus approach for limited open reduction and percutaneous fixation of displaced acetabular fractures

Introduction

Minimal invasive fixation has been reported as an alternative option for treatment of acetabular fractures to avoid blood loss and complications of extensive approaches. Closed reduction and percutaneous lag screw fixation can be done in minimally displaced acetabular fractures. Open reduction is indicated, if there is wide displacement. In this study, we report the use of a mini-open anterior approach to manipulate and reduce anteriorly displaced transverse acetabular fractures combined with percutaneous lag screw fixation.

Methods

This report included eight patients. All had anterior displaced simple transverse acetabular fractures. An oblique mini-incision was made above and medial to the mid-inguinal point, and lateral to the lateral border of rectus abdominis muscle. The external abdominal oblique aponeurosis was incised along its fibres. The arched fibres of internal abdominal oblique were displaced medially above the inguinal ligament to expose and incise the fascia transversalis. Care was taken to avoid injury of ilioinguinal nerve, inferior epigastric vessels, and spermatic cord. The external iliac vessels were palpated and protected laterally. A blunt long bone impactor was introduced through this small incision to manipulate and reduce the fracture under fluoroscopic control. Fluoroscopic guided percutaneous lag screw fixation was done in all patients.

Results

The average time to operation was 4 days. Average blood loss was 110 mL. Operative time averaged 95 min. Maximum fracture displacement averaged 10 mm preoperatively and 1.3 mm postoperatively. According to Matta score, anatomical reduction of the fracture was achieved in five patients and imperfect in three. Follow up averaged 27 months. Wound healing occurred without complications and fracture union was achieved without secondary displacement in all patients. Average time to fracture healing was 14 weeks. According to the modified Merle d’Aubigné score, functional outcome was good to excellent in all patients.

Discussion and conclusion

Limited open reduction can solve the problem of fracture reduction, which is the main concern in minimal invasive fixation of acetabular fractures. It may help the inclusion of displaced acetabular fractures for percutaneous lag screw fixation. This mini-para-rectus approach has the advantages of minimal soft tissue dissection with the possible anatomical reduction of simple transverse displaced acetabular fractures.     

The expression and significance of dishevelled in human glioma

Background

The proto-oncogene dishevelled (Dvl) is a critical component of the Wnt/β-catenin signaling pathway, and its elevated expression in various tumor types is associated with malignancy. However, a role for Dvl in glioma has not been explored.

Materials and methods

To determine whether Dvl expression is elevated in human glioma, we examined the protein levels in 67 human glioma samples and 3 normal brain specimens by Western blotting and immunohistochemistry. To investigate a possible association of Dvl with the malignant phenotype in glioma, the correlation of the Dvl immunoreactivity score (IRS) with β-catenin IRS, the tumor proliferation index (PI), and tumor invasion index (II) were determined for each sample.

Results

The Dvl IRS, β-catenin IRS, PI, and II increased significantly with the pathologic grade of glioma (P <0.001) with average scores of 3.46 ± 3.45, 3.92 ± 3.28, 30.93 ± 17.92, and 20.43 ± 11.79, respectively. Furthermore, the PI and II were significantly higher for the Dvl-positive group than the Dvl-negative group (P <0.001). Correlation analysis demonstrated that β-catenin IRS, PI, and II were positively correlated with Dvl IRS.

Conclusions

Dvl overexpression may contribute to the malignant proliferation and invasion of human glioma.     

Margin index: a useful tool for the breast surgeon?

Background

In breast conservation surgery (BCS) for breast cancer, the appropriate surgical margin is controversial. Margin index, a mathematical relationship between tumor size and closest margin, has been shown to be predictive of the probability of residual cancer after BCS for early stage breast cancer. We applied this tool to the same population of patients at our institution to evaluate its ability to predict residual disease after BCS.

Methods

We retrospectively reviewed a prospectively maintained database of women undergoing BCS between 1980 and 2010 at the University of Pennsylvania. A total of 246 women underwent re-excision because of close margins. Average margin index between groups with and without residual disease in the re-excision specimen was compared using the Student t-test. A receiver operating curve was created using logistic regression to assess the overall diagnostic ability of the margin index on the presence or absence of residual disease.

Results

Of patients who underwent re-excision, 29% of patients had residual disease. We analyzed several cutoff values for margin index, but none proved to be significant predictors of residual disease. Average margin index was significantly higher for patients without residual disease compared with patients with residual invasive cancer but not for patients with residual ductal carcinoma in situ.

Conclusions

In women undergoing BCS for early stage breast cancer at our institution, margin index was not predictive of the presence of residual cancer on re-excision. We hypothesize that the predictive ability of a margin index is likely limited by several factors including the presence of ductal carcinoma in situ and the location and extent of the close margin.     

乳腺癌改良根治术保留肋间臂神经文献分析

目的探讨保留肋间臂神经与切除肋间臂神经在乳腺癌改良根治术中的临床意义,为制定临床合理的个体化手术方案提供证据.方法： 制定原始文献的纳入标准、排除标准及检索策略,搜索关于保留肋间臂神经在乳腺癌改良根治术中的价值和意义方面的临床随机对照试验.检索日期由2000年1月—2012年2月.按cochrane系统评价方法,评价所纳入研究的文献质量,并提取有效数据后采用RevMan5.0软件进行Meta分析.结果纳入12项研究,共计1146例患者.结果： 保留肋间神经可以明显减轻患者上臂内侧感觉功能（随访1个月,3个月,12个月OR1=0.15,95%CI：0.10～0.21;OR3=0.06,95%CI：0.03～0.10; OR12=0.07,95%CI：0.03～0.16））,保留肋间臂神经手术时间较切除肋间臂神经在乳腺癌改良根治所用的时间略延长（MD=6.75,95%CI：3.88～9.26）;随访1～3年乳腺癌局部复发率两种术式术中出血量、清除淋巴结数、术后肩关节运动障碍及皮下积液切除ICBN与保留ICBN均没有明显的差异.结论： 保留肋间臂神经可以明显减轻乳腺癌改良根治术后患侧上臂内侧感觉功能障碍、延长手术时间但对乳腺癌复发率没有明显影响.     

胶质瘤患者肿瘤组织和血浆中MMP-9的表达及意义

目的探讨胶质瘤患者肿瘤组织和血浆中基质金属蛋白酶-9(MMP-9)的表达、两者之间的关系及意义。方法收集40例胶质瘤患者病理标本、患者术前血浆及临床资料,分成高度恶性组和低度恶性组。10例因重度颅脑损伤而行内减压手术切除的脑组织和患者术前血浆,作为对照组。运用免疫组织化学染色法对胶质瘤组织标本中MMP-9表达进行半定量分析。运用酶联免疫吸附测定法检测血浆中总MMP-9浓度。结果 MMP-9在正常脑组织中无表达,高度恶性组瘤组织中MMP-9的表达显著高于低度恶性组(P=0.027)和对照组(P=0.000)。各级别胶质瘤组MMP-9血浆浓度均显著高于对照组(P0.001)。瘤组织MMP-9强阳性表达组血浆MMP-9浓度显著高于阴性组(P=0.022)和弱阳性组(P=0.048),血浆MMP-9浓度与相应肿瘤组织MMP-9的表达水平呈正相关(rs=0.530,P=0.000)。结论瘤组织MMP-9表达与胶质瘤恶性程度呈正相关,其高表达可能与胶质瘤的侵袭转移有关;胶质瘤患者血浆MMP-9浓度一定程度上反映出瘤组织中MMP-9表达水平。     

保留肋骨间神经和胸前神经入路对乳腺癌术后并发症及预后的影响

目的 :探讨保留肋骨间神经、胸前神经入路对乳腺癌患者术后并发症及预后的影响。方法:选取2011年1月—2013年1月收治的128例I~Ⅱ期乳腺癌患者为研究对象,根据手术方式将患者分为观察组及对照组各64例,观察组患者采用经胸大肌前入路保留肋骨间神经、胸前神经及胸小肌,对照组采用经胸大肌后方入路不保留肋骨间神经及胸小肌,对比分析2组患者手术情况。术后对患者随访1年,观察并发症发生情况,并采用肿瘤生存质量量表(Q O L)对患者生存质量进行评价。结果:观察组患者手术时间、术中出血量、引流时间、总引流量、平均住院时间均少于对照组(P0.05)。随访1年,观察组皮瓣坏死、皮下积液、蜂窝织炎、胸大肌萎缩、腋窝感觉障碍及上臂内侧感染障碍发生率均低于对照组,差异有统计学意义(P0.05)。观察组术后食欲、睡眠、自理能力、心理能力、疾病认识以及总生存质量评分均高于对照组,差异有统计学意义(P0.05)。结论:保留肋间臂神经及胸前神经的乳腺癌改良手术能减少患者术中创伤,降低患者术后并发症发生率,提高患者术后生存质量。