Adjuvant chemotherapy for stage D1 adenocarcinoma of prostate

In a series of 112 patients undergoing pelvic lymphadenectomy for clinically localized prostate cancer, 37 were found to have pelvic lymph node metastases. After prostatic irradiation, these 37 patients were divided into groups receiving adjunctive chemotherapy versus no additional treatment. The patients were followed for a period ranging from twelve to sixty-five months for evidence of disease progression. Of the 12 patients administered chemotherapy, disease progression was documented in 4 (average time to progression was fifteen months). In contrast, of the 25 patients receiving no additional treatment, 12 exhibited evidence of gross metastatic disease within an average interval of 11.6 months. One death has been recorded in the chemotherapy group at twenty-nine months after diagnosis; 4 deaths have occurred in patients receiving no systemic therapy (average time to death was eighteen months).     

Pancreatogastrostomy: an ideal complement to pancreatic head resection with preservation of the pylorus in the treatment of chronic pancreatitis

We have reported our experience with pancreatoduodenectomy with preservation of the pylorus performed in 37 patients for the treatment of chronic pancreatitis and its complications. The remaining pancreatic tail duct was occluded in 12 patients without anastomosis. Eight complications were observed and reoperation was necessary in two patients. Three complications and one reoperation occurred in the 25 patients who underwent pancreatogastrostomy. There was no operative mortality in the 37 patients. Six to 30 months postoperatively, 23 patients were free of complaints, the average weight gain was 7.6 kg, and so far no marginal ulcers have developed. Technically, pancreatogastrostomy is easy and complications may be identified early. According to our results, this type of anastomosis is the most favorable so far and is particularly suitable for the significant reduction of complications and deaths related to partial pancreatoduodenectomy.     

两种不同术式治疗多节段脊髓型颈椎病的比较

目的探讨两种不同的颈椎前路减压植骨融合术治疗多节段脊髓型颈椎病的疗效。方法37例多节段脊髓型颈椎病患者中,22例行前路椎体次全切除减压钛网内植骨钛板内固定术,15例行分节段颈椎间盘切除、减压＋PEEK-cage内植骨椎间融合术。对两种术式疗效及融合率进行统计分析。结果37例均获随访,时间10～31（18±4.25）个月,两组植骨均融合且无椎间盘退变及椎间高度丢失。两术式疗效及融合率比较差异无显著性（P〉0.05）。结论颈前路减压植骨内固定治疗多节段脊髓型颈椎病,可取得满意效果,应根据患者病理特点,选择恰当的术式。     

Doxorubicin chemotherapy in the treatment of soft-tissue sarcoma. Combined results of two randomized trials

In 1978, there were initiated two independent randomized, prospective trials of adjuvant doxorubicin hydrochloride (Adriamycin) following primary therapy for soft-tissue sarcoma. The virtual identity of these two protocols permits their combination for analysis. A total of 75 patients (42 men, 33 women) with soft-tissue sarcoma (stages IIB to IVA) were randomized, after receiving optimal regional therapy, to receive either doxorubicin hydrochloride (450 mg/m2) (37 patients) or observation (38 patients). Follow-up has ranged from 16 to 80 months (median, 49 months). Twenty-five patients (33%) died, and two patients receiving doxorubicin developed cardiotoxicity. No significant differences in local control, metastasis-free survival, disease-free survival, and overall survival were observed for the two treatment arms. Despite temporary prolongation of disease-free survival with doxorubicin in some subgroups, we conclude that there is no advantage to the use of adjuvant doxorubicin in the treatment of soft-tissue sarcoma.     

颈椎前路低切迹钛板系统的研制和初步临床应用

目的对自行研制的颈椎前路低切迹钛板系统(anterior cervical low-profile plate system，ACLPS)进行临床应用评价。方法颈椎前路低切迹钛板系统由医用钛合金材料制成，组件包括钛板、锁固片、固定螺钉及挽救螺钉，切迹低平、锁固简捷、规格多样，并以松质骨螺纹自攻螺钉单皮质固定为特点。临床应用治疗颈椎疾患37例，男23例，女14例；年龄35—74岁，平均50．7岁。颈椎病8例，颈椎间盘突出症12例，颈椎骨折和(或)脱位伴截瘫14例，颈椎转移性肿瘤伴截瘫3例。均行颈前路减压、植骨融合及ACLPS内固定术。单间隙融合22例，双间隙15例。单纯自体髂骨块植骨29例40个间隙，结合椎间融合器植骨8例12个间隙。钛板固定椎体最高为C，，最低达T1。结果37例均获随访，随访时间6—12个月，平均9．6个月。全部病例术后均无颈部异物感，舒适度满意。未发生切口感染、血肿、窒息、神经损伤、硬脊膜破裂及脑脊液漏、切口渗液不愈合等现象。全部病例均获骨性融合，根据JOA评分术后总有效率94．6％，优良率83．8％。术后影像学资料显示无植骨块脱出或塌陷、椎间高度明显丢失、钛板或螺钉断裂、螺钉松动脱落及钛板螺钉整体松动等并发症。结论ACLPS具有较高的强度和紧固能力，能够提供较好的生物力学稳定作用，且操作简便，可以满足颈椎前路固定的需要。     

Use of TARA hemiarthroplasty in advanced osteonecrosis

The results of 25 TARA hemiarthroplasty procedures performed on 21 patients with radiographically documented Ficat stages III and IV osteonecrosis are reported. The average patient age at the time of surgery was 37.6 years (range, 22-55 years). The average length of follow-up study was 37 months (range, 25-60 months). Preoperative Harris hip scores averaged 51 points (range, 22-69 points). Postoperative scores averaged 90 points (range, 66-100 points). Good or excellent results were obtained in 22 of 25 hips. There were no cases of infection or component dislocation. Three component revisions were performed in two patients. Four patients required removal of trochanteric wires and one patient had excision of heterotopic ossification. This procedure appears to offer selected young patients with advanced femoral head osteonecrosis a very satisfactory initial result, while preserving many options for subsequent revision procedures.     

Clinical and pathological findings of BRCA1/2 associated breast cancer

It is not known if the behaviour of hereditary breast cancer (HBC) differs from that of sporadic breast cancer (BC). The aim of the present study was to analyze clinical-pathological characteristics in patients with BRCA1/2-mutation associated to BC. These data could be useful in the management of HBC. This study includes 17 patients with BC in whom a germ-line BRCA1/2-mutation was diagnosed. The patients were from 10 different families, and four patients had no family history of BC or ovarian cancer (OC). The study of mutations was with the protein truncation test (exon 11 for BRCA1, exons 10 and 11 for BRCA2) and sequencing (the rest of exons). At diagnosis the mean age was 37 years (28-54). Only 3/17 patients presented with involvement of axillary nodes; no patient was diagnosed with metastatic disease. All cases were infiltrating ductal carcinoma; two of them were medullary carcinoma. Histological grade was available in 13/17 cases, with grade III being the most frequent (12/13). Hormonal receptors were negative in 8/10 patients. The mean follow-up was 129 months (23-223). There were three local recurrences at 17, 108 and 151 months; and two distant relapses at 15 months (complete remission) and 92 months. There were three diagnosed contralateral BC. Hereditary breast cancer has malignant pathological features, but the clinical behaviour may be less aggressive than sporadic breast cancer in the same age group.     

陈旧性踝关节骨折手术治疗的远期疗效分析

目的：对陈旧性踝关节骨折手术治疗的远期疗效进行分析，确定恰当的治疗方案。方法：对46例陈旧性踝关节骨折患施行手术治疗，37例行切开复位内固定，9例行踝关节融合术，应用AOFAS评分系统进行评分。结果：随访26－121个月，平均87个月。远期疗效良好，骨折全部愈合，无痛可负重，但延迟1－3个月手术AOFAS评分术后较术前明显提高，延迟三个月以上术后较术前无明显提高。结论：延迟1－3个月手术的踝关节骨折如踝穴恢复完整并获得解剖复位或接近解剖复位宜行关节切开复位内固定术；否则宜行关节融合术。延迟三个月以上手术的骨折，由于软骨和软组织发生退变，难以获得解剖复位，宜行关节融合术。     

空心钉治疗跟骨骨折疗效分析

目的探讨空心钉治疗跟骨骨折的临床疗效。方法对75例跟骨骨折患者中38例(45足)用空心钉治疗,37例(45足)用钢板内固定治疗。记录两组患者的手术时间、术中出血量、骨折愈合时间及术后功能,对两种疗效进行对比。结果 75例患者均获得随访,时间6～18(10.32±2.18)个月。空心钉组优良率为93.33%,钢板组优良率为91.11%,两组疗效差异无统计学意义(P>0.05)。与钢板组比较,空心钉组的手术时间和术中出血量明显缩短或者减少,差异有统计学意义(P<0.01);而骨折愈合时间、Bhler角、Gissane角、跟骨距骨宽度和踝关节活动范围两组差异无统计学意义(P>0.05);两组并发症发生率差异无统计学意义(P>0.05)。结论空心钉治疗跟骨骨折能有效防止关节面复位后再塌陷及骨折端再移位,手术简便、手术创伤小,是治疗跟骨骨折较理想的一种方法。     

阿托品在无水乙醇注射治疗腋臭中的作用

目的探讨阿托品在无水乙醇注射法治疗腋臭中的作用及对远期效果的影响。方法将应用无水乙醇皮下注射治疗腋臭的72例患者随机分为A组（使用阿托品）和B组（不使用阿托品）,其中A组37例,B组35例。分别于治疗后1、3、6个月观察腋臭治疗效果。结果以残余气味最终疗效达到0级为标准,A组有效率为83．78％,B组有效率为82．86％,两组对比差异无统计学意义。结论阿托品对于注射法治疗腋臭的远期疗效没有影响,无水乙醇注射法治疗腋臭的配方不必加入阿托品。     

Results of treatment of infected humeral nonunions: the Mayo Clinic experience

Between 1987 and 2001, 15 infected humeral nonunions were treated of which nine were distal, four were proximal, and two were midshaft. One patient was lost to followup. The remaining 14 patients were followed up for a mean of 37 months (range, 8-156 months). All patients were treated with debridement and intravenous antibiotics. Ten patients had surgical attempts at achieving bony union: external fixation (four patients), plating (two patients), external fixation and plating (two patients), tension band wiring (one patient), and bone grafting with shoulder spica casting (one patient). Three patients were treated definitively with a functional brace because of low functional demands and one patient had resection arthroplasty followed by delayed total elbow arthroplasty. Of the 10 nonunions treated with surgical attempts at achieving bony union, only seven healed. None of those nonunions in patients treated with a functional brace healed. At final followup, 12 of 14 patients had minimal or no pain and two patients had moderate pain, both with ununited fractures. Complications included one seroma and two cases of posttraumatic elbow stiffness for which the patients required capsular release. This study documents the challenges in achieving bony union in the infected humeral nonunion in contradistinction to the predictable union rates reported for aseptic humeral nonunions. Although pain relief was predictable in most patients, functional results generally were poor and bony union was difficult to obtain.     

Amiodarone-associated thyrotoxicosis (AAT): experience with surgical management

Amiodarone (Cordarone), a benzofuran derivative containing two atoms of iodine per molecule (37% of molecular weight), has recently been released in the United States for the management of refractory cardiac arrhythmias. While it was still under investigation, 529 patients were managed with this drug at the Mayo Clinic between 1981 and 1986; eight of them (1.5%) had thyrotoxicosis 12 to 37 months (median, 28 months) after initiation of treatment. Low 24-hour iodine-131 uptake (less than 4%) and recognized refractoriness to thionamide treatment precluded the use of radioablation or antithyroid drugs. Cessation of the amiodarone treatment was considered undesirable from a cardiac standpoint. Near-total thyroidectomies were undertaken in six patients, and rapid correction of hyperthyroidism followed. There were no intraoperative or postoperative arrhythmias. The median postoperative hospital stay was 4.3 days (range, 2 to 13 days). Subsequently, all patients required thyroid hormone replacement. Near-total thyroidectomy has proved a safe and effective treatment for amiodarone-associated thyrotoxicosis in patients who required drug continuation.     

Use of the internal mammary artery as a free graft with reimplantation of the proximal end onto the ascending aorta. Apropos of 39 cases]

From January 1987 to January 1991, 104 patients received bilateral internal mammary artery grafts and 39 of them had coronary bypass with a free graft implanted on the ascending aorta. There were 35 men, with a mean age of 57.35 years (range 41 to 70 years). 87% of them had stable angina, and 23 had preoperative myocardial infarction. The left ventricular function was good in 77 per cent of cases. 23 patients had three vessel disease (61.5%), 13 two vessel diseases (30.7%), 2 one vessel disease (5.12%) and one a left main coronary stenosis. Left internal mammary artery was used in two patients on the left descending artery and the right internal mammary artery was used in 37 patients: 15 on the circumflex, 15 on the right coronary, 4 on the LDA and 3 on the diagonal artery. Five patients had one graft, 32 two grafts and one three grafts (bilateral mammary and saphenous vein). Hospital mortality was 2.56% (1 patient) and there were 2 late deaths (5.12%). There were 5 perioperative myocardial infractions (12.8%) and no sternal infections. The mean follow up is 21 months (range 3 to 46 months). At follow-up, 34 patients (87.2%) were asymptomatic, and there were no myocardial infarctions. Postoperative angiography in 8 patients (mean postoperative time 2.5 months) showed that all the grafts were patent. This analysis demonstrates that free IMA graft has a low operative risk and provides excellent long term functional improvement and survival.     

Cytoreductive hepatic surgery for neuroendocrine tumors.

We retrospectively reviewed 37 patients who underwent hepatic resection between 1970 and 1989 to evaluate the role of cytoreductive hepatic surgery in patients with metastatic neuroendocrine tumors (carcinoid, 24; islet cell, 13). Seventeen resections were curative (no gross residual tumor); nine patients had symptomatic endocrinopathies and seven patients had symptoms caused by the primary tumor. Eight of nine patients with symptomatic endorcrinopathies obtained complete relief of symptoms; five are alive with no evidence of disease at 2 to 82 months (mean, 26 months). Six of seven patients with symptoms caused by the primary tumor obtained complete relief; five are alive with no evidence of disease at 5 to 28 months (mean, 14 months). One symptom-free patient underwent curative hepatic resection 5 years after abdominoperineal resection for a rectal carcinoid. Twenty resections were palliative (gross residual tumor); 16 patients had symptomatic endocrinopathies and 4 patients had symptoms caused by the primary tumor. Eight of 16 patients with symptomatic endocrinopathies obtained complete relief; five are alive at 2 to 30 months (mean, 11 months), with a mean duration of complete relief of 6 months (3 to 12 months). All four patients who underwent resection for symptoms caused by the primary tumor obtained complete relief; two are alive and symptom free at 10 and 101 months. Our experience suggests that curative surgery should be considered in all patients with completely resectable metastatic disease and that palliative surgery, despite the short duration of complete relief, should be considered in selected patients because it delays and may reduce the subsequent need for medical therapy.     

Long-term follow-up of the Senning operation for transposition of the great arteries in children under 3 months of age

Twenty-six patients aged 6 days to 3 months (mean 57 days) underwent a Senning procedure for transposition of the great arteries. Twenty-two had intact ventricular septum and four had a small ventricular septal defect. They were followed up for 1 month to 8 years (mean 4 years). There were no late deaths. At late examination, 25 patients were asymptomatic and there was no clinical or echographic evidence of caval or pulmonary venous obstruction. Growth was normal in all but two patients. Neurologic assessment was abnormal in eight patients. The electrocardiogram showed sinus rhythm in 22 patients and asymptomatic arrhythmias in four. Twenty-three patients underwent cardiac catheterization and angiographic studies 2 to 72 months postoperatively (mean 15 months), which demonstrated effective left and right atrial contraction. An atrial shunt was noted in one patient and a ventricular shunt in one. Two infants (8%) had a residual left ventricular outflow tract obstruction (gradients of 26 and 37 mm Hg). Two had mild superior vena caval obstruction (gradients of 4 and 5 mm Hg). We conclude that the Senning procedure can be performed in early infancy with good results and a low incidence of late complications.     

Placard-shaped in situ vaginal wall sling for the treatment of stress urinary incontinence

PURPOSE: To evaluate the efficacy of a simple and economic procedure using a placard-shaped in situ anterior vaginal wall sling for the treatment of stress urinary incontinence, with or without cystocele repair. METHODS: From July 2003 to July 2004, 14 female patients (mean age 45.21 years, range 37-57) were operated upon because of stress urinary incontinence (SUI) with the placard-shaped in situ anterior vaginal wall sling technique. The average follow-up period was 11 months (range 4-14.5 months). Twelve patients were operated primarily with this technique and only two patients had undergone previous surgeries for the treatment of SUI (one patient had had two previous surgeries and the other had had one previous surgery). In all patients urethral hypermobility or/and bladder prolapse were observed. Filling cystometry showed sufficient bladder capacity with no detrusor overactivity. RESULTS: No urinary retention was observed in any patient in the postoperative period. While 11 patients have 100% cure of incontinence, three patients started leakage of urine after 1-2 months after the operation (one patient had been operated upon twice before (and who was diabetic and obese) and two patients were primarily repaired by our technique). In two patients, suprapubic tenderness and redness were observed, and were treated by oral antibiotic and anti-inflammatory drugs. CONCLUSION: The placard technique is simple, cost-effective and has low incidence of urinary retention in the post-operative period. The success rate seems to be satisfactory and it can be applicable to patients who are primary cases of SUI with average body mass index. Yet longer term follow up and larger number of patients are needed before final conclusion can be drawn.     

雄激素受体在乳腺癌患者预后中的价值

目的 以淋巴结转移及c-erbB2表达情况作为病例分组依据,探讨雄激素受体(AR)在乳腺癌预后中的价值.方法 回顾性分析2003年1月至6月连续收治的原发性女性乳腺癌患者184例,收集其临床资料,采用免疫组化方法检测化疗前乳腺癌组织的雌激素受体(ER)、孕激素受体(PR)、AR、c-erbB2蛋白表达,以淋巴结状况及c-erbB2蛋白表达情况分组,探讨AR表达与淋巴结状况、c-erbB2蛋白表达的关系及AR对生存率的影响.结果 184例均获随访5年以上,随访率100%.全组淋巴结转移率为45.1%,5年远处转移率为16.9%,5年生存率为86.4%.将184例分为淋巴结阴性及受累两组,x2检验表明AR表达情况与淋巴结状况低度相关(P＜0.05,r,=-0.236),淋巴结阳性者AR表达率低.Kaplan-Meier分析表明在淋巴结阴性组,AR表达对预后分析无影响;在淋巴结受累组,AR阳性组5年生存率及中位生存时间均优于阴性组(89.3%比67.3%和56个月比37个月).将184例分为c-erbB2表达阴性及阳性两组,同样发现在c-erbB2表达阴性组,AR表达对预后无影响;在c-erbB2表达阳性组,AR阳性组5年生存率及中位生存时间均优于阴性组(80.0%比57.1%和57个月比37个月).结论 在预后相对较差的淋巴结受累及c-erbB2表达阳性的患者中,AR表达对进一步分析预后有一定价值,AR表达阳性者预后好于阴性病例.     

Dorsal (AO/ASIF) pi-plate osteosynthesis in the treatment of distal intraarticular radius fractures

The results and complications using the dorsal 2.4 mm 2.7 mm (AO/ASIF) pi-plate for the treatment of distal radius fractures were evaluated in a prospective study of 42 patients followed up clinically and radiologically and seven patients followed up with telephone call and radiological follow-up for an average time of 12.1 (range 4-32) months in a group of 50 patients with intraarticular distal radial fractures treated consecutively using this method. Twelve complications occurred in 10 patients including two extensor tendon ruptures, two transient cases of CRPS Type 1 (Reflex Sympathetic Dystrophy, Algodystrophy), two instances of screw loosening, three cases of posttraumatic carpal tunnel syndrome and three permanent sensory irritations on the dorsum of the hands. Using the AO score, there were 37 successful and 12 tolerable results, with no unsatisfactory outcomes. Using the NYOWR scale, there were 17 very good and 25 good results, with no satisfactory or poor outcomes. These results suggest that this osteosynthesis provides adequate fixation of comminuted distal intraarticular radius fractures with a reasonable incidence of complications.     

Bacillus Calmette-Guerin: Is monthly maintenance an option for transitional cell carcinoma of the bladder?

Purpose: Recently, a Southwest Oncology Group study (SWOG 8507) demonstrated increased efficacy for a bacillus Calmette-Guerin (BCG) maintenance (mtce) program (3 weekly treatments at 3 months, 6 months, and every 6 months thereafter for 3 years) following 6 weekly instillations with BCG as compared to no mtce (“6+3” protocol). The remarkable results from the mtce arm were unfortunately accompanied by grade 3 or 4 toxicity in 26%. In fact; only 16% of the patients in the maintenance arm received BCG at each of the 7 prescribed courses. Herein, we report on a series of 37 patients with high risk (rapidly recurring grade 2 or 3) Ta, T1 transitional cell carcinoma (TCC) or carcinoma in situ (TIS) of the bladder who received 6 weekly BCG treatments followed by monthly mtce for one year. Patients and Methods: This was a prospective, non-randomized trial of 37 patients with high risk superficial transitional cell carcinoma (TCC) who received one or two 6-week induction courses of intravesical Tice BCG, followed by monthly mtce for 12 months. Entry criteria were identical to those of SWOG 8507. The mean follow-up interval was 40.7 months. Results: Twenty eight of thirty-seven patients (75.7%) remained free of disease recurrence at a median of 40.7 (range 13–101) months. Only one patient progressed to muscle invasive disease. Only 1 of 37 (2.7%) patient experienced grade 3/4 toxicity. Conclusion: In this single institution, monthly maintenance protocol, freedom from recurrence was significant with dramatically less grade 3 or 4 toxicity than reported in SWOG 8507.     

保留后瓣及瓣下结构的二尖瓣置换术临床分析

目的总结保留二尖瓣后瓣及瓣下结构二尖瓣置换术(MVR)的经验,评价其临床效果。方法回顾性分析首都医科大学北京安贞医院2006年1月至2011年3月行MVR患者1 035例的临床资料,其中男562例,女473例;年龄37～78(53.84±13.13)岁。风湿性心脏瓣膜病712例,退行性瓣膜病323例;二尖瓣狭窄为主389例,二尖瓣关闭不全为主646例;均排除冠状动脉疾病。不保留后瓣及瓣下结构的MVR(不保留组)457例,保留后瓣及瓣下结构的MVR(保留组)578例,两组患者术前情况差异无统计学意义。分析比较两组患者手术后并发症、死亡率,以及左心室大小与功能。结果不保留组与保留组患者的死亡率(2.63%vs.1.21%,P=0.091)及并发症发生率(8.53%vs.7.44%,P=0.519)差异无统计学意义,但不保留组左心室破裂发生率高于保留组(1.09%vs.0.00%,P=0.012);术后6个月心脏超声心动图提示左心室舒张期末内径(LVEDD)较术前缩小,但两组差异无统计学意义;两组患者左心室射血分数(LVEF)均较术前提高,保留组中二尖瓣关闭不全为主患者的LVEF优于不保留组(56.00%±3.47%vs.53.00%±3.13%,P=0.000),两组二尖瓣狭窄为主的患者中LVEF差异无统计学意义(57.00%±5.58%vs.56.00%±4.79%,P=0.066)。结论保留二尖瓣后瓣及瓣下结构的MVR安全有效,可以减少术后左心室破裂的发生并改善术后心功能。