Malignancies in the acquired immunodeficiency syndrome

Aside from opportunistic infections, several neoplasms have been identified as part of the spectrum of acquired immunodeficiency syndrome (AIDS) as defined by the Centers for Disease Control. Kaposi's sarcoma (KS) was the first such neoplasm to be recognized within the spectrum of AIDS. Although the classic form of Kaposi's sarcoma had been well recognized prior to the epidemic of AIDS, it was quite distinct from the illness that was seen in its "epidemic" form in young homosexual males. In this setting, Kaposi's sarcoma is an aggressive disease, with extensive involvement of skin and mucous membranes, early dissemination to lymph nodes, impressive development of extreme lymphedema, even in the absence of bulky adenopathy, and rapid spread to visceral organs, including lungs and gastrointestinal tract, among others. Although rapid clinical progression and short median survival have been the rule, a spectrum of disease has been seen such that some patients have survived for many years with disease limited to the skin. Certain clinical and laboratory features, such as presence of unexplained fever, night sweats, weight loss ("B" symptoms), or significant T-4-lymphocytopenia, have been identified as indicators of poor prognosis. Various therapeutic interventions have been employed in epidemic KS, and although partial and complete remissions have occurred, no regimen yet reported has significantly improved the survival of treated patients. High-dose recombinant alpha interferon has produced response rates in approximately 30% of treated patients, although toxicity has been observed in approximately 30% as well. Likewise, vinblastine has produced similar response rates with no evidence of long-term efficacy or "cure." Aside from Kaposi's sarcoma, lymphoma primary to the central nervous system was recognized early in the AIDS epidemic as a criterion for inclusion within AIDS in patients less than sixty years of age. Several years after the initial reports of disease, it became apparent that specific types of systemic lymphoma were also quite extraordinary, and the definition of AIDS was amended in June 1985 to include high-grade B-cell lymphomas in individuals who had positive serology or virology for the human immunodeficiency virus (HIV). The AIDS-related lymphomas are characteristic, both pathologically and clinically. The vast majority of these cases have been high-grade B-lymphoid tumors of either immunoblastic or small-non-cleaved type (also known as "undifferentiated," Burkitt, or Burkitt-like).(ABSTRACT TRUNCATED AT 400 WORDS)     

Surgical stabilization of pathological neoplastic fractures

The most important factor to consider in deciding between treatment options in the management of metastatic bone disease is the level of the patient's dysfunction and pain. Severe dysfunction or pain demands a treatment that predictably leads to a quick resumption of the painless activities of daily living. A treatment that predictably will restore function in months may seem reasonable in patients with a normal remaining life span, but is untenable if those months represent a high percentage of remaining life span, as they do in metastatic disease afflicted patients. The treating physician needs also to understand the basis for the patient's dysfunction. A destroyed joint will not return to painless function even if the metastasis responsible is totally eliminated. A bone that has lost its structural integrity, even though not grossly fractured, will not support weight bearing for months even if the metastasis is eliminated. Control of the metastatic tumor does not always equate with return to function. Treatment options in the management of metastatic bone disease are not mutually exclusive. In many patients treatment options are combined. Surgical stabilization may best return the patient's function while he is being treated postoperatively with radiotherapy or chemotherapy for good neoplasm control. Neoplasm control should not be such an overriding concern that function is not addressed. Function can almost always be returned to the patient, but neoplasm "cure" is rarely achieved in this group of patients. It is a reasonable goal to avoid allowing bone metastasis to progress to pathological fracture. Routine periodic examinations and bone scans should commonly alert the treating physician to the presence of metastatic bone disease well before fracture occurs. Pathological fracture narrows the range of treatment options, mitigates against full functional restoration, demands a rehabilitation hiatus, and acutely frightens the patient who does not have time to participate fully in treatment decisions. An impending pathological fracture can be treated with surgery, radiotherapy, chemotherapy, or hormonal manipulation. The options are basically operative or nonoperative. Lesions that predictably will fracture short term, involve joints, or will cause catastrophic consequences if fracture occurs should be strongly considered for surgical stabilization. Other factors to consider are the location of the metastasis, the primary tumor, and the expected response to nonoperative therapy. The patient becomes a surgical candidate for the above reasons and not because of any estimated life span.(ABSTRACT TRUNCATED AT 400 WORDS)     

Soft tissue sarcomas of the extremity

In 1955, in a series of abstracts entitled "A Half Century of Effort to Control Cancer," Pack and Ariel wrote, "in each individual case, there is a constant battle of judgement between the wisdom of more radical amputation and the need for preservation of that important functional part." This dilemma remains with us today. In his paper on the histogenesis of tumors, Stout, relating to the philosophy of treatment, wrote that "the best chance of curing malignant tumors of the soft tissues lies in the hands of the therapist who makes the first attempt." Pack's words are as true today as they were in 1955, and although limb salvage is possible for many patients with soft tissue sarcomas, preservation of an extremity at the risk of patient survival is not a feasible option. Most efforts at less than amputative surgery must entail multimodality therapy. Although there are some reports of success with single-agent therapy, such as surgery alone, the majority of successful, nonamputative series include surgery with radiation and/or chemotherapy. It must be emphasized that an extremely important aspect of the treatment of these patients is the judgment and evaluation by the primary physician. Therefore it is extremely important that the primary physician be familiar with the many factors involved in prognosis, both in terms of local control and of systemic illness, in order for the patient to be informed of treatment options. If this is not possible, the patient should be referred to a center that is involved in active research protocols or treatments. Although rare, the soft tissue sarcomas remain among the most difficult to treat, even though over the years there has been significant progress in diagnosis, classification, and successful local control. Patient survival is based on a multitude of factors that include the histogenesis of the tumor, its grade, size, anatomical location, the surgical procedure performed, the use of preoperative or postoperative radiation, and the clinical stage of the disease--whether it is primary or metastatic. In time, it is probable that additional factors will be found.     

颅内静脉窦血栓形成的临床研究

研究背景颅内静脉窦血栓形成是一种特殊类型的脑血管疾病,其病因及诱发因素复杂多样、临床表现各异,易被误诊或漏诊。该病具有较高的病残率和病死率,如何提高诊断与治疗水平一直是临床研究的热点问题,本文旨在探讨颅内静脉窦血栓形成不同治疗方法的安全性及有效性。方法回顾分析52例颅内静脉窦血栓形成患者的临床资料,并根据临床症状与体征、腰椎穿刺脑脊液压力和影像学表现分为轻症和重症组,分别接受全身抗凝联合静脉溶栓、血管内溶栓或锥颅上矢状窦溶栓治疗,同时辅助华法林口服6～12个月。术后通过磁共振静脉血管造影术观察静脉窦形态。结果轻症组27例患者接受全身抗凝药物联合静脉溶栓治疗,14例痊愈、9例好转、4例无效;重症组25例患者中22例经全身抗凝药物联合血管内溶栓治疗后18例痊愈、3例好转、1例死亡,余3例行锥颅上矢状窦溶栓治疗,均痊愈。共随访6～60个月(平均36个月),无一例复发。结论根据患者病情轻重程度,针对临床分型选择不同方法治疗颅内静脉窦血栓安全有效。     

股骨近端锁定加压钢板治疗股骨转子间骨折

目的 探讨股骨近端锁定加压钢板（LCP）内固定治疗股骨转子间骨折的临床疗效.方法 采用股骨近端LCP治疗23例股骨转子间骨折的患者.随访观察骨折愈合时间,按Harris评分标准评价疗效.结果 23例均获随访,时间6~12（9±1.4）个月.骨折愈合时间14~20（17±1.7）周.髋关节Harris评分：优13例,良9例,一般1例.结论 股骨近端LCP内固定治疗股骨转子间骨折创伤小、出血少、对骨膜影响小,符合解剖形态,临床疗效满意.     

寰枢椎椎弓根螺钉固定治疗齿状突骨折并寰枢关节脱位

目的探讨寰枢椎椎弓根螺钉固定在对治疗齿突骨折合并寰枢关节脱位患者的疗效。方法筛选从2006年11月至2012年9月在我院就诊治疗的21例齿突骨折合并寰枢关节脱位患者,且均是本地居民,在手术前对21例患者进行日本骨科协会(JOA)评分标准进行评分,得分8¹4分,平均分(10.6±1.4)分,在治疗出院后随访时再次进行评分并和术前水平对比。结果对21例患者实施寰枢椎椎弓根螺钉固定术,术后患者均完全复位,且无神经根、脊髓损伤情况,在术后10个月时对患者进行随访调查并复查X线,发现固定情况良好,无松动等情况发生,同时JOA评分1414分,平均分(10.6±1.4)分,在治疗出院后随访时再次进行评分并和术前水平对比。结果对21例患者实施寰枢椎椎弓根螺钉固定术,术后患者均完全复位,且无神经根、脊髓损伤情况,在术后10个月时对患者进行随访调查并复查X线,发现固定情况良好,无松动等情况发生,同时JOA评分14¹7分,平均得分为(15.5±1.2)分。和患者入院时的评分结果对比提升明显(P<0.05),有统计学意义。结论寰枢椎椎弓根螺钉固定术很好的解决了齿突骨折合并寰枢关节脱位患者的困扰,能长期维持颅颈区稳定性,具有一定创新性。     

四川省城乡居民糖尿病流行特征

目的了解四川省城乡居民糖尿病患病情况,为防治提供科学依据。方法采用多阶段整群随机抽样方法,以户为单位在四川省抽取6个县区3240户共4641名居民,通过检测血糖和询问病史方法进行糖尿病患病率调查。结果3岁以上居民糖尿病患病率为2.2%,标化率为2.6%;18岁以上成人糖尿病患病率为4.0%,标化率为3.4%;城市18岁以上成人患病率8.8%,标化率为6.2%,农村成人患病率为1.1%,标化率为1.0%,城市高于农村(u=7.04,P<0.01);糖尿病患病率随着年龄的增长而增高,55岁以上居民糖尿病患病率达15%以上。结论四川省抽样调查地区糖尿病患病率高于全国2002年同期调查的平均水平,城市高于农村。应针对不同地区及不同人群糖尿病患病率特点,制定适宜的防治措施。     

Postirradiation neoplasia: A symposium

It is impossible to prove that radiation given for benign conditions in infancy and childhood is an etiologic factor in the subsequent development of carcinoma in the head and neck area. Nevertheless, the suggestive evidence is quite impressive and the information from many sources correlates well. There are some conflicting reports but, in general, it can be said that very high doses of radiation are less likely to be carcinogenic than lesser amounts. Very small doses of radiation are probably not carcinogenic either. In general, the younger the patient at the time of exposure to radiation, the greater is the risk of subsequent development of carcinoma. The breast seems to be an exception, however, as it is more sensitive to radiation carcinogenesis between the ages of 10 and 35. Chronic low doses of radiation seem to be more carcinogenic in humans. The latent interval between irradiation and the appearance of carcinoma in most sites averages about 30 years; leukemia tends to occur 5–8 years after irradiation. The atomic bomb data are confusing. Up to 30% of the Hiroshima bomb radiation consisted of neutrons, whereas the neutron radiation of the Nagasaki bomb was very low. The higher incidence of breast cancer associated with the former type of irradiation may be related to the higher carcinogenicity of neutrons. On the other hand, the lower normal incidence of breast carcinoma in Japanese women may be a modifying factor of RBE of radiation in tumor induction.Irradiation for malignant tumors in all parts of the body, although an exceedingly valuable addition to the cancer therapy armamentarium, probably predisposes to the later development of irradiation carcinoma in the long-term survivors. This becomes increasingly important as more children and young adults with malignant tumors are clinically cured of their original malignant tumor with multimodal therapy including irradiation.The risk of carcinogenesis in radiation-treated patients never disappears. These patients should be followed carefully for life.