Lokalrezidive von Weichteilsarkomen an Extremitäten und Rumpf

Soft tissue sarcomas (STS) tend to recur locally. In a series of 140 patients operated on during the past two decades with STS of the extremities and trunk, prognostic factors influencing local recurrence were determined. Statistical significance was evaluated for the quality of surgical resection (P<0.001), regional positive lymph nodes (P=0.03), and adjuvant radiotherapy (P=0.01) [for resection without wide margins (R1) and low-grade (G3) tumors]. In 1988, the surgical procedure was standardized. After 1987, local recurrence decreased significantly (P < 0.001). In subfascial tumors, local recurrence occurred far less in cases of compartmental resection than with wide excision. These data indicate that the course of patients with STS can be beneficially influenced by optimal therapy. Resection with wide margins in all three dimensions is the aim of sarcoma surgery. Postoperative radiation therapy is indicated in the case of R1 resection.

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Lokalrezidive von Weichteilsarkomen an Extremitäten und Rumpf

Zusammenfassung Weichteilsarkome neigen zur Ausbildung von Lokalrezidiven. In einer Studie von 140 Patienten der letzten 20 Jahre mit Sarkomen an Extremitäten und Rumpf wurde untersucht, welche Faktoren das Auftreten von Lokalrezidiven beeinflussen. Statistische Signifikanz ergab sick fur die Qualität der chirurgischen Re sektion (R) (p<0,001), den regionalen Lymphknotenstatus (p=0,03) sowie eine adjuvante Strahlentherapie (p=0,01) [bei marginal resezierten (RI), niedrig differenzierten (G3) Tumoren]. 1988 wurde das chirurgische Vorgehen standardisiert. In der Zeit danach traten signifikant weniger Rezidive auf als davor (p < 0,001). Bei subfaszialer Lage traten Rezidive nach Kompartmentresektion wesentlich seltener auf als nach weiter Resektion. Der Krankheitsverlauf von Weichteilsarkomen ist also durchaus therapeutisch beeinflußbar. Ein dreidimensional weiter Sicherheitsabstand ist das entscheidende Therapieziel, eine Bestrahlung in R1-Situationen indiziert.

     

红景天素抗肿瘤作用的研究

本研究通过体外培养５种人癌细胞（肝癌、胃癌、肺癌、Ｈｅｌａ细胞和咽癌）和小鼠移植性肿瘤实验，证明了红景天素可明显抑制３种癌细胞的生长增殖，可提高荷瘤小鼠的存活率，延长其生存期，抑瘤率在５０％以上。结果提示红景天素对体外培养３种癌细胞和小鼠Ｓ１８０。细胞均有一定的抑制作用。     

Sarcomas of head and neck — A 10 yrs experience

38 cases of sarcoma of head and neck region were analysed in a retrospective way in relation to age, anatomic location, histological, clinical profile, and surgical approaches. Compared to other types of head and neck neoplasms, such as squamous cell carcinoma, soft tissue sarcomas have low rates of regional metastases. However the biological behaviour of soft tissue sarcoma is more aggressive specially in paediatric age group. In the present series, CT scan was considered as the primary modality of investigation. Surgery generally has been recommended as the primary method of treatment for achieving local control, except in those high-grade tumours arising in sites not amenable to resection. 3-year and 5-year survival rates in this present series 50% and 31.6% respectively.     

蜗牛卵液对小鼠S_(180)肉瘤的抑制作用

[目的 ]探讨蜗牛卵液对小鼠S180 肉瘤的抑制作用 .[方法 ]按标准方法给 4 0只小鼠接种S180肉瘤细胞后 ,随机分成 4个组 ,即对照组 :每日灌胃生理盐水 10mL/kg ;实验 1组 :每日灌胃蜗牛卵液1 5 g/kg ;实验 2组 :每日灌胃蜗牛卵液 3 0 g/kg ;实验 3组 :每日灌胃蜗牛卵液 3 8g/kg ;连续 8d后 ,观察肿瘤质量变化及胸腺 (脾脏 )指数 .[结果 ]每日 1 5 ,3 0 ,3 8g/kg的蜗牛卵液对小鼠S180 肉瘤的生长抑制率分别为 38 2 % ,4 0 5 % ,5 4 4 % ,实验 3组的肿瘤抑制率高于对照组 ,两组间有显著性差异 ;实验2组和实验 3组的胸腺 (脾脏 )指数低于对照组 ,与对照组相比较亦有显著性差异 .[结论 ]蜗牛卵液对小鼠S180 肉瘤有抑制作用 .     

RETROPERITONEAL SCHWANNOMA: A CASE SERIES AND REVIEW

Schwannomas account for only a small percentage of retroperitoneal tumours. Presentation is typically varied and non-specific and pre-operative diagnosis is difficult. Herein are described five cases of retroperitoneal schwannoma. Presentation was varied, ranging from abdominal pain, abdominal mass, obstructed labour or an incidental finding. All patients had either an abdominal computed tomography scan and/or ultrasound performed. Pre-operative biopsy either by fine needle aspiration (in one patient) or core biopsy in two patients was unhelpful. In four patients with smaller tumours, complete excision was possible with no apparent long-term morbidity and no clinical evidence of recurrent tumour with follow up from 3.5 months to 11 years. For the largest tumour, complete surgical excision was not attempted as it would have entailed significant morbidity.     

艾滋病相关卡波西肉瘤32例尸检材料病理学研究

目的：概况艾滋病相关卡产波西肉瘤（ＫＳ）病理特征，并探讨其两全是学分型、来源与性质。方法：所有病例均按常规尸检及制片，光镜观察，并复习资料。结果：ＫＳ累及皮肤２３例，呼吸系统２０例，消化道１７例，淋巴结１２例，２６例为播散性。肿瘤肉眼表现为斑型和结节型，镜下主要同增生的血管和梭形细胞构成。并常见胶原分、淋这扩张、嗜性小体、炎细胞浸浸、出血及含铁务黄素沉积等特征性病变。结论：ＫＳ是一种颇具特征的病变     

THE SURGICAL MANAGEMENT OF OSSEOUS CRANIAL BASE TUMOURS IN CHILDREN

Background : Osseous cranial base tumours in children present as a diverse collection of both benign and malignant pathologies. Concerns raised by the difficulty in accurate diagnosis and local recurrence of benign lesions and by the long-term sequelae of radiotherapy for malignant cranial tumours (marked local growth disturbances, pituitary dysfunction, visual disturbances, late new tumour induction) prompted an evaluation of surgical resection of cranial base tumours in children, with specific regard to safety, efficacy and aesthetic result. Methods : A retrospective review was performed of 10 consecutive children presenting with tumours either arising from or eroding into bone of the cranial base who were managed by surgical resection in a 10-year period from 1986 to 1996. The patients demonstrated a great variation in both presentation and pathology. All underwent surgical resection of tumour with reconstruction where indicated. Results : There were no postoperative complications or mortality. All patients remained clinically free of disease at follow-up, which ranged from 17 months to 9 years (mean 6 years and 4 months). Conclusion : The aggressive surgical resection and craniofacial reconstruction of cranial base tumours in the paediatric population offers a safe and efficacious mode of treatment that obviates problems of diagnosis and local recurrence for benign lesions and of the long-term sequelae of radiotherapy for malignant lesions.     

Advantages of using the midline incision right retroperitoneal approach for abdominal aortic aneurysm repair

This study was conducted to compare the midline incision right retroperitoneal approach for repairing abdominal aortic aneurysms (AAA) with the transperitoneal approach. The intra- and postoperative course of 15 patients who underwent AAA repair using the transperitoneal approach between 1987 and 1991 and another 15 patients who underwent AAA repair using the retroperitoneal approach between 1991 and 1994 were evaluated. The incidence of postoperative wound complications was also assessed. There was no operative or hospital death in either group. Although a significantly longer interval was required from the incision to the aortic clamp using the extraperitoneal method, there were no statistical differences in the aortic clamping time, total operation time, or blood loss between the two groups. On the other hand, there was a statistically significant improvement in bowel function and a significant reduction in the length of postoperative hospitalization following the extraperitoneal procedure. Furthermore, no wound complications such as those associated with the left flank incision developed after the extraperitoneal procedure. Thus, we recommend the midline incision right retroperitoneal approach for AAA as it does not involve muscle division and is associated with fewer complications.     

Laparoscopic partial nephrectomy for a renal tumor with tumor-feeding artery ligation: Left renal cell carcinoma in the posterior mid zone

The most serious problem regarding a laparoscopic partial nephrectomy is how to perform bloodless excision without causing renal ischemia in a limited working space. We report the case of a 65-year-old man with left small renal cell carcinoma in the posterior mid zone who underwent a laparoscopic partial nephrectomy through a retroperitoneal approach by carrying out the ligation of the tumor-feeding artery, but without clamping the renal pedicle. Both preoperative abdominal computed tomography (CT) and intraoperative ultrasonography revealed the tumor to be fully encapsulated. The tumor-feeding artery could be exposed by dissection from the renal hilum and, after an arterial ligation, tumor resection with a safety margin was smoothly performed with minimal bleeding. Postoperatively, CT revealed a limited defect of the renal parenchyma and excretory pyelography showed no urine leakage or urinary tract obstruction. The preoperative and postoperative creatinine levels were 0.66 and 0.69 mg/dL, respectively. As a result, a tumor-feeding artery ligation with a laparoscopic partial nephrectomy for left renal cell carcinoma in the posterior mid zone is considered to be an effective surgical modality which avoids renal ischemia and pelvic heat injury.     

Liver Transplantation for Primary or Metastatic Sarcoma to the Liver

Sarcoma is generally a rare disease in the US, with poor survival in patients with both primary angiosarcoma and metastatic disease from sarcoma and GIST. In order to determine if liver transplantation for sarcoma is a realistic option, we examined records of all patients in the US component of the Israel Penn International Transplant Tumor Registry were reviewed. Those patients with liver failure from primary or metastatic liver sarcoma were evaluated. Patient outcome analysis was then performed. Patient and tumor demographics were reviewed as well as patient survival after transplantation. 19 patients are identified having received liver transplantation after treatment for sarcoma of the liver, 6 patients with primary hepatic sarcoma and 13 patients with metastatic sarcoma of the liver. Recurrence was almost universal in 18 of 19 patients (95%) after a median interval of 6 months. Survival for the group as a whole was 47% for 1-year, 15% for 3-years and 5% for 5-years. Given the early recurrence of tumor and meager 1-year survival outcome, liver transplantation is a poor therapeutic choice for patients with either primary or metastatic liver sarcoma, including high-grade leiomyosarcoma (GIST) regardless of primary site or primary therapy.