Germ cell tumor in the hypothalamo-neurohypophysial region: clinical features and treatment

Twenty-one patients with germ cell tumors (17 germinomas and 4 teratomas) involving the hypothalamic-neurohypophysial (HN) region were reviewed retrospectively. Eleven patients were males and 10 females, and their ages ranged from 7 to 45 years (average 18.5 years). Diabetes insipidus was the initial and the most prominent symptom in most germinomas; in teratomas the most prominent symptom was visual disturbance. Fifteen patients with germinomas were treated by radiotherapy, and 4 with teratomas were treated by surgical resection alone. Two recent germinoma patients with extensive CSF dissemination were treated with systemic chemotherapy consisting of anticancer platinum drugs and etoposide, which resulted in a complete disappearance of the tumors. Patients with germinoma treated after the introduction of CT scanning had a greatly improved mortality rate, and their actual survival rate was 87.5% over 10 years. On the basis of this review, the authors consider that diagnosis at an early stage of the disease and chemotherapy, which can be an effective therapeuric alternative to radiation therapy, may improve not only the mortality rate but also the quality of life of patients with HN germ cell tumors.     

Ascending cluster pinning of the humerus inserted through the deltoid tuberosity

Summary Goal of Surgery Stable internal fixation of extraarticular proximal humeral fractures. Indications Extraarticular fractures angulated more than 30° which can be reduced closely or through a small incision. Epiphysiolysis. Fracture-dislocation of the humeral head. Contraindications Pathological fractures. Four part fractures. Segmental fractures of the humerus. Positioning and Anaesthesia Supine; the affected shoulder overhanging the edge of the table and supported by a radiolucent board. General or regional anaesthesia. Surgical Technique Closed pinning of two part and certain three part fractures of the proximal humerus being displaced, unstable, and mainly at the metaphyseal level. Introduction of Kirschner wires through a diaphyseal window and advancement into the proximal fragments after reduction which is controlled by image intensification. Postoperative Management Temporary immobilization in a sling. Passive and active assisted movements after a few days. Active movements after 2 weeks. Removal of wires after 3 months. Possible Complications Fracture of the humerus at the site of the cortical window. Injury to the radial nerve. Results 32 patients, mean age 49 years, 30 two part fractures and 2 three part fractures. Number of Kirschner wires used: 3 to 6, mean 4. Two out of 3 patients complained of pain at the site of wire insertion. All fractures consolidated. No avascular necrosis nor infection. Complications: Partial loss of internal fixation in 3 patients. One fracture of the humeral shaft. Sympathetic reflex dystrophy in 3 patients. Half of the patients had a normal range of motion. Time of follow-up: 6 to 24 (mean 10) months. Division of Orthopaedics and Traumatology, Purpan Hospital, Toulouse, France.     

尺骨头进针固定尺骨的解剖及临床应用研究

目的 :报道尺骨头进针固定尺骨骨折的解剖基础及其临床应用效果。方法 :观察 7具 1 4侧成人上肢标本 ,测量尺骨茎突的长度。以尺侧腕伸肌腱沟内缘 2mm尺骨茎突远端以上 1 5mm处为进针点 ,测量该点到尺神经手背支的距离、该点在前后两侧到尺骨头环状关节面的距离。以该点进针模拟手术并试用于临床。结果 :①尺骨茎突长为 (6 .0± 1 .2 )mm ;②进针点与尺神经手背支距离为 (1 4 .1± 3 .8)mm ;③进针点在前后两侧到尺骨头环状关节面的距离分别为 (1 6 .7± 0 .7)mm、(1 6 .6± 1 .1 )mm ,配对t检验比较两者差异 (P >0 .0 5) ;④术后随访未见严重并发症。结论 :自尺骨头背侧进针能避免传统的从尺骨鹰嘴进针的并发症 ,且钢针尾部不影响前臂的旋转运动和腕关节活动     

A comparative morphological and immunohistochemical study of testicular seminomas and intracranial germinomas

A series of 10 classical testicular seminomas and 10 intracranial germinomas were reviewed and examined using immunohistochemical techniques. In particular, the staining profiles of the tumour cells and the nature of the mononuclear cell infiltrate at the two sites were studied and compared. The tumour cells in eight of the 10 intracranial germinomas and nine of the 10 seminomas exhibited positive staining with placental alkaline phosphatase. Only one intracranial germinoma showed evidence of human chorionic gonadotrophin expression. Tumour cells in all cases at both sites were negative for cytokeratin and vimentin. The lymphocytic infiltrate in both the testicular and intracranial tumours was similar, comprising T-cells and B-cells, the former predominantly. The presence of macrophages and granulomas in tumours at both sites was noted. These findings confirm the high degree of similarity of germinomas of intracranial and testicular origin, and support the hypothesis of a common derivation. We could find no evidence of differentiation of tumour cells at either site.     

Low-grade fibrosarcoma of the proximal humerus

We present the clinical, radiographical and pathological features of low-grade fibrosarcoma of the left proximal humerus in a 23-year-old man in whom it was necessary to distinguish the tumor from desmoplastic fibroma, malignant fibrous histiocytoma and intramedullary well-differentiated osteosarcoma. The patient presented with a 10-day history of pain in his left upper arm sustained when trying to break his fall with his left hand when slipping in the street. Plain radiography revealed an expanding multilobular osteolytic lesion from the proximal metaphysis to the diaphysis of his left humerus, accompanied by a pathological fracture at the distal portion of the lesion. Open biopsy of the lesion was performed twice; however, a conclusive diagnosis could not be obtained. The patient underwent wide excision and prosthetic replacement of the left proximal humerus. Histologically, the resected tumor was composed of both cellular areas and hypocellular areas. Cellular areas revealed a proliferation of bundles of uniform fibroblastic spindle-shaped cells with minimal cellular atypia, mixed with abundant intercellular collagenization. Mitotic figures were occasionally seen. Hypocellular areas showed myxoid features with loose bundles of collagen fibers. The patient demonstrates no evidence of disease 42 months after surgery. It is important to detect the scant atypical cells for the differential diagnosis of low-grade fibrosarcoma and desmoplastic fibroma of bone.     

股骨近端防旋髓内钉治疗骨质疏松性股骨转子间骨折内固定失败的影响因素

目的探讨股骨近端防旋髓内钉治疗骨质疏松性股骨转子间骨折内固定失败的影响因素。方法选取采用防旋髓内钉治疗的骨质疏松性股骨转子间骨折患者60例,采用单因素和多因素Logistic回归分析探讨内固定失败的影响因素。结果单因素分析显示,失败组和成功组的尖顶距TAD、 AO分型、外壁分型、术前Singh指数、应用唑来膦酸占比、合并呼吸内科疾病占比比较,差异有统计学意义(P <0.05)。多因素分析显示,内固定失败的影响因素包括尖顶距TAD、 AO分型、外壁分型、术前Singh指数、应用唑来膦酸、合并呼吸内科疾病。结论股骨近端防旋髓内钉治疗骨质疏松性股骨转子间骨折内固定失败的影响因素较多,临床中针对性进行预防和干预,对降低内固定失败率有重要价值。     

尖头梅花髓内针与带锁髓内针治疗胫腓骨骨折比较

目的　比较改良的尖头梅花针与带锁髓内针治疗胫腓骨干骨折的临床综合疗效 ,正确选取内固定物。方法　分别用改良的尖头梅花针与带锁髓内钉内固定治疗胫腓骨干骨折 74例 ,比较两组的综合疗效。结果　改良梅花针组 48例 ,轻度外旋畸形 2例 ,无骨不愈合 ,平均骨折愈合时间 3.5个月 ,平均手术时间 40 mim ,住院费用 30 0 0元 (人民币 ) ,优良率93.75 % ;带锁髓内钉组 2 1例 ,发生骨延期愈合 2例 ,平均骨折愈合时间 5个月 ,平均手术时间 6 0 mim ,住院费用 5 5 0 0元(人民币 ) ,优良率 95 .2 4%。除胫骨远端下 1/ 3或严重的粉碎性骨折外 ,两组疗效无明显差异 (P >0 .0 5 )。结论　改良尖梅花针内固定操作简单、价格低廉、疗效确切 ,仍有较高的临床使用价值 ;带锁髓内钉能满足胫骨各种类型的骨折 ,扩大了髓内固定的适应症 ,随着成本的降低 ,已逐渐成为治疗胫腓骨骨折髓内固定的方向。     

逆向交锁髓内钉治疗股骨髁上骨折

目的探讨逆向交锁髓内钉在股骨髁上骨折中的应用价值.方法采用静力型交锁技术对16例股骨髁上骨折病例行经髁逆向交锁髓内钉治疗,其中陈旧性骨折6例,4例患者同期行植骨术.对伴有膝关节僵硬的病例,术中采用手法或(和)手术松解膝关节,术后辅以持续被动活动.结果随访8～36个月,骨折均愈合.愈合时间新鲜骨折2.5～5个月,平均3.5个月;陈旧性骨折7～11个月,平均8个月.结论逆向交锁髓内钉是治疗股骨髁上骨折的良好方法之一,其提供的力学固定有利于骨折愈合和膝关节功能的康复.     

带锁髓内钉治疗股骨、胫腓骨骨折14例临床分析

目的　观察小切口骨折复位带锁髓内钉治疗股骨、胫腓骨骨折的临床疗效。方法　对 14例 (股骨干6例、胫骨干 5例、胫腓骨 3例 )采用带锁髓内钉固定。结果　随访 12例 ,平均 10 .5个月 ,骨折全部愈合 ,平均愈合时间胫腓骨为 11周、股骨为 18周。结论　小切口骨折复位带锁髓内钉治疗股骨、胫腓骨骨折是一种有效的内固定的方法。