骨外骨软骨瘤

骨外骨软骨瘤 (或软组织骨软骨瘤 )是指发生在骨以外软组织中与骨骼及骨膜无关联的良性肿瘤性骨软骨组织。软组织中成软骨、成骨性良性肿瘤较少 ,其中以软组织软骨瘤为多 ,其次为软组织骨瘤。在各种肿瘤专著中 ,不少有这两种疾病的专门章节 ,唯独不见骨外骨软骨瘤 ,可见其病理学地位和定义尚不明确。本病罕见 ,三十年代Ａｌｐｅｒｓ首先报道了起源于硬脑膜的颅内骨软骨瘤 ,Ｎｅｕｍａｒｋ则报告位于舌组织内的骨软骨瘤。八十年代初报告的有所增加[1～ 2 ] 。国内胡圣光首先报告 1例大网膜骨软骨瘤[3 ] 。八十年代后报告逐渐增加[4～ 6] 。这…     

自体骨与同种异体骨植骨治疗骨巨细胞瘤临床对比观察

目的总结同种异体骨与自体骨移植在骨巨细胞瘤刮除植骨治疗中的临床效果。方法回顾性分析1997年1月至2002年12月,30例用同种异体辐照骨与自体骨(3例加骨水泥)充填修复骨巨细胞瘤刮除后遗留的局限性缺损病人的病历资料。结果随访时间2.5～9年,植骨全部愈合,功能恢复正常,复发3例。结论术前准确评估,术中彻底清除对降低肿瘤复发率有重要作用;同种异体骨移植具有良好的组织相容性和成骨活性,与自体骨移植疗效相当,是骨巨细胞瘤刮除术后骨缺损的较理想的修复材料。     

骨质量与骨量

骨强度同时反映骨量与骨质量的完整性。骨强度由骨材料、构筑、力学性能及骨量共同构成。骨质量能解释一些单纯用骨量或骨密度（BMD）不能解释的问题，诸如在正常BMD仍发生骨折；给予抗骨吸收制剂后，虽只有小的面积骨密度（aB—MD）变化也能减少骨折风险；应用氟化物虽能增加脊柱BMD，但并不能减少脊柱骨折风险；骨折风险早在BMD最大变化之前即可出现等。     

骨感染

医用硫酸钙人工骨在脊柱结核手术中的应用;一期病灶清除同种异体骨移植治疗胸腰椎结核;不典型脊柱结构的临床特点与诊疗体会;手术治疗脊柱结核伴截瘫的疗效分析;抗感染活性骨治疗开放性骨损伤;腓动脉穿支远端蒂腓肠神经岛状筋膜肌皮瓣修复足踝骨髓炎创面;     

骨感染

一期病椎切除内固定治疗胸腰椎结核;前路一期病灶清除植骨内固定治疗腰椎跳跃性结核。     

骨感染

化脓性膝关节炎伴有邻近骨髓炎的治疗;CR、CT、MRI在脊柱结核诊断中的临床价值     

骨替代物

骨缺损时需进行骨修复,修复材料即为骨替代物。骨替代物的作用为填充骨缺损和起力学支撑作用。骨替代物的基本成分包括：无机成分钙磷化合物和具有促进骨代谢的有机成分如骨基质蛋白和各种骨生长因子。骨材料的选择标准有：组织相容性、生物安全性、符合不同需要的机械强度、可降解性、利于骨再生的三维空间结构（孔隙率、孔径尺寸与形状）、与再生相适应的降解速度等。     

骨感染

骨科感染创面病原菌菌谱分析；布鲁杆菌病性脊椎炎的临床影像学表现及外科治疗；经皮自体骨髓移植治疗感染性骨折愈合不良；脊柱包虫病的诊断治疗及误诊原因分析.     

骨感染

混合式单臂外固定架骨延长术治疗感染性骨不连;罕见的小儿股骨干浆细胞性骨髓炎一例;急性化脓性膝关节炎的关节镜治疗;累及膝关节的骨端骨髓炎的治疗;相隔单椎体跳跃性椎体结核的手术治疗;     

Efficacy of conservative treatment modalities used in epistaxis

Objective

To assess the efficacy of conservative modalities in the management of epistaxis.

Study design

Prospective case studies.

Setting

Rural medical college hospital.

Patients

Indoor and outdoor patients with epistaxis.

lntervention

Conservative(non surgical) management techniques in epistaxis.

Results

Chemical cauterization was successful in 72.07% cases, anterior nasal packing in 84.5% and posterior nasal packing in 95.6% cases.

Conclusion

Out of 300 cases of epistaxis included in the study (except for one case that required internal maxillary artery ligation). all cases were treated successfully with conservative treatment alongwith treating the underlying pathology causing epistaxis.     

Results of intravenous steroid injection on reduction of postoperative edema in rhinoplasty

Objective

To determine the efficacy of intravenous dexamethasone in reducing postrhinoplasty edema.

Design

A prospective, randomized clinical trial with placebo control.

Setting

Department of Otorhinolaryngology, Al-Sabah and Zain Hospital, Kuwait.

Subject

Eighty-four patients (male = 28; female = 56) aged between 20 and 40 years, undergoing open rhinoplasty with hump removal and bilateral lateral osteotomies were enrolled in this study.

Intervention

Patients were randomized to receive two doses of 10 mg of dexamethasone intravenously or placebo, first dose during surgery and second dose 12 hours after surgery.

Main outcome measures

Patients were evaluated postoperatively at 24 hours, days 2, 5, 7 and 10 for periorbital edema.

Results

10 mg of dexamethasone given intravenously during rhinoplasty and a second dose 12 hours after surgery, reduced postoperative periorbital edema significantly.

Conclusion

This study showed a statistically significant benefit of dexamethasone over placebo in reducing periorbital edema after rhinoplasty. No complications were attributed to the administration of dexamethasone.     

Diagnostic significance of nasal eosinophilia in allergic rhinitis

Background

Nasal eosinophilia is one of the potential tests for substantiating the diagnosis of allergic rhinitis.

Objective

The aim was to establish the validity of nasal eosinophilia in allergic rhinitis, to study it's various clinical correlates and interpret it in context of skin sensitivity pattern.

Study Design

Prospective cased study.

Setting

Hospital based.

Patients

The patients were selected on the basis of history and clinical examination and were from the Himalayan region.

Intervention

Diagnostic.

Methods

The patients and the equal number of controls, were subjected to nasal smear for eosinophilia and intra-dermal skin tests to various allergeus.

Results

Overall, eighty percent of nasal smears were positive in various degrees among the cases. Around eighty-eight percent of cases showed both smear and skin test positivity, thereby signifying a high degree of harmony among them and further validating and confirming the diagnosis of allergic rhinitis.

Conclusion

Nasal eosinophilia was found to be a useful diagnostic test in allergic rhinitis, with a moderately high sensitivity and a high specificity.     

The role of neuropathology in the management of progressive glioblastoma

Question

1. What are the most important diagnostic considerations in reporting progressive glioblastoma?

Target population

These recommendations apply to adults with progressive glioblastoma

Recommendations

Level III

For patients who undergo biopsy or neurosurgical resection at the time of radiologic or clinical progression, it is recommended that the pathologist report the presence and extent of progressive neoplasm as well as the presence and extent of necrosis within the pathologic material examined. Furthermore, to ensure the proper interpretation of progressive glioblastoma, it is recommended that the pathologist take into account the patient’s previous diagnosis and treatment, as well as the current clinical and neuroimaging features that have led to a second biopsy or resection.

Question

2. What techniques and ancillary studies are most useful in separating malignant progression from treatment effect?

Target population

These recommendations apply to adults with progressive glioblastoma

Recommendations

Level III

In the setting of prior radiation and chemotherapy, it is recommended to adhere to strict histologic criteria for microvascular proliferation and necrosis in order to establish a diagnosis of a glioblastoma. Immunohistochemistry and genetic studies are selectively recommended for distinguishing neoplastic cells from atypical reactive cells in progressive glioblastoma.     

Metabolic iodine and tumours

Purpose

Purpose of the work is to highlight a possible connection between metabolic iodine and natural tumour control.

Method

Method adopted is to use information available in the literature.

Result

Result indicated a means of the purpose being attained.

Conclusion

Conclusion drawn is that a tumour control method derives from the relationship studied.

     

Societal preference values for advanced melanoma health states in the United Kingdom and Australia

Background:

No studies measure preference-based utilities in advanced melanoma that capture both intended clinical response and unintended toxicities associated with treatment.

Methods:

Using standard gamble, utilities were elicited from 140 respondents in the United Kingdom and Australia for 13 health states.

Results:

Preferences decreased with reduced treatment responsiveness and with increasing toxicity.

Conclusions:

These general population utilities can be incorporated into treatment-specific cost-effectiveness evaluations.     

Cancers et environnement : explorer les comportements de recherche et les sources d’information des personnes atteintes et non atteintes d’un cancer

Aim

To explore information-seeking behaviors on links between cancers and environment.

Method

Focus groups and individual semi-structured interviews realized, respectively, with individuals without and with personal cancer experience.

Results

The majority of respondents reported informationscanning behaviors. Only half cancer patients searched for information regarding the links between cancers and environment.

Conclusion

Little information is sought on links between cancers and environment.

     

Intratympanic dexamethasone application in Meniere's disease—Is it superior to conventional therapy?

Objective

To compare the efficacy of conventional medical treatment versus transtympanic dexamethasone application into middle ear as treatment modality in Meniere's disease.

Study Design

Prospective randomized study.

Setting

Tertiary referral centre.

Method

Forty patients of Meniere's disease were treated, 20 by conventional method and 20 by transtympanic dexamethasone applications.

Intervention

Theraputic.

Results

Vertigo control of 85% achieved in study group when compared to 80% in control group, 15% of patients had hearing improvement in study group while 10% had hearing improvement in control group. Aural fullness and tinnitus control were identical in both groups.

Conclusions

Both modalities of therapy were found to have almost equal efficacy, with Intra tympanic steroid (ITS) therapy having an edge over conventional therapy in cases with severe attacks and shorter duration of symptoms.     

EBV-associated gastric carcinoma in high- and low-incidence areas for nasopharyngeal carcinoma

Background:

Approximately 10% of gastric carcinomas are associated with Epstein–Barr virus (EBV). The Inuit in Greenland have a high incidence of EBV-associated nasopharyngeal carcinoma.

Methods:

We conducted a population-based case–control study comparing gastric carcinomas in Greenland and in Denmark.

Results:

The prevalence rate of EBV-associated gastric carcinomas was 8.5% in both populations.

Conclusion:

The findings of this study argue against a general susceptibility to EBV-associated carcinomas among the Inuit.     

Anterior external bony ear canal bulge

Objective

To study the prevalence of anterior external bony ear canal bulge.

Methods

Hundred patients each of the sexes among three races in Malaysia were studied with an otoscope and microscope.

Results

Anterior external ear canal wall bulge is seen in 34% of the Malays, 32% of the Chinese and 29.5% of the Indians

Conclusion

In about one third of the population in Malaysia an anterior canal wall bulge is seen.