Scapulectomy for malignant tumor: Function and shoulder strength in five patients

Function and muscular strength were studied in five patients who had undergone either total or subtotal scapulectomy for malignant tumor. We found a striking difference in the functional impairment between the two patients with total and the three patients with subtotal scapulectomy. The latter three patients were able to handle light objects with their hands over their heads, and reached or nearly reached the horizontal plane in flexion and abduction of the shoulder. The two patients with total scapulectomy had a flexion and abduction range between 40 and 50 degrees. The mean isometric muscle strength in flexion relative to the non-operated side was 17 and 37 per cent for patients with total and subtotal scapulectomy, respectively, and the abduction strength 14 and 44 per cent, respectively. After scapulectomy, a reasonably good function can be expected, especially if it is possible to preserve the glenoid fossa and/or the acromion.     

Scapulectomy for malignant tumor: Function and shoulder strength in five patients

Function and muscular strength were studied in five patients who had undergone either total or subtotal scapulectomy for malignant tumor. We found a striking difference in the functional impairment between the two patients with total and the three patients with subtotal scapulectomy. The latter three patients were able to handle light objects with their hands over their heads, and reached or nearly reached the horizontal plane in flexion and abduction of the shoulder. The two patients with total scapulectomy had a flexion and abduction range between 40 and 50 degrees. The mean isometric muscle strength in flexion relative to the non-operated side was 17 and 37 per cent for patients with total and subtotal scapulectomy, respectively, and the abduction strength 14 and 44 per cent, respectively. After scapulectomy, a reasonably good function can be expected, especially if it is possible to preserve the glenoid fossa and/or the acromion.     

Superficial angiomyxomas with and without epithelial components. Report of 30 tumors in 28 patients

This paper describes 30 uncommon dermal and subcutaneous angiomyxoid tumors in 28 patients whose ages ranged from 4 to 78 years (mean, 39 years). There were 16 male patients and 12 female patients. Tumor size varied from 0.5 to 9 cm, with the majority measuring 1-5 cm. Eleven tumors (37%) were located on the trunk, ten (33%) on the lower extremity, five (17%) on the head or neck, and four (13%) on the arm. Microscopically, there were moderately to sparsely cellular angiomyxoid nodules with scattered small vessels. Nine tumors had an epidermal component that took the form of a keratin-filled cyst or epithelial strands. The angiomyxoid components of all 30 tumors were morphologically similar. Electron microscopy showed fibroblastic stromal cells, proteoglycan matrix, and collagen fibers. The S-100 protein stain was negative in two tumors, and the vimentin stain was positive in stromal cells in one tumor. Follow-up information obtained for 20 of the 28 patients included data on eight tumors with epithelial components. Five (63%) of those eight tumors recurred once; three had not recurred, and one patient developed a new and separate purely angiomyxoid tumor. Three (23%) of 13 tumors without epithelial components recurred. None recurred more than once, and none metastasized. We suspect that superficial angiomyxoma, cutaneous focal mucinosis, trichogenic myxoma, trichogenic adnexal tumors, trichodiscoma, myxoid perifollicular fibromas, trichofolliculomas and fibrofolliculomas, the Carney complex, NAME and LAMB syndromes are all closely related. We also believe that the solitary superficial angiomyxoma with no epithelial elements is the most common manifestation of these myxoid tumors.     

Magnetic resonance imaging of pelvic tumors in men. Preliminary results in a series of 28 patients

The authors conducted a retrospective evaluation of the diagnostic value of nuclear magnetic resonance in comparison with other imaging techniques in a series of 28 pelvic tumours, with the exclusion of gastrointestinal tumours. The positive diagnosis of the lesion was obtained in every case. The variation of the signal provided information concerning the tissues, while the sections in three planes, the spontaneous visibility of the vessels and the very good natural contrast related to the presence of fat which gives a high signal, facilitated staging of the tumour.     

Pulmonary valve replacement with a mechanical prosthesis. Promising results of 28 procedures in patients with congenital heart disease.

OBJECTIVE: Pulmonary valve replacement is performed increasingly late after correction of Tetralogy of Fallot. Most reports deal with pulmonary allografts as the valvar substitute of choice, although late deterioration and reoperation(s) are the rule. Mechanical valves are scarcely reported and if so only because of complications. Although life-long anticoagulation therapy is indicated for mechanical prostheses, the chance of subsequent re-operations can be expected to be low. We report the results of 28 mechanical valve replacements in the pulmonary position. METHODS: A mechanical valve was implanted in 27 of 79 patients indicated for pulmonary valve replacement. Tetralogy of Fallot was the most common basic lesion. The results and follow-up were reviewed retrospectively, where death and re-operation were primary end points. Routine outpatient follow-up, including trans-thoracic echocardiography, was performed. RESULTS: Twenty-eight pulmonary valve implantations were done in 27 patients. Thirty-day hospital mortality was 1/28 (3.6%), because of a cerebro-vascular accident. One patient died late (2.8 years postoperatively). Median age was 33 years and the median interval between primary repair and insertion of the prosthesis was 26 years. Freedom from re-operation at 1 year was 100%. One valve had to be replaced 14 years after implantation because of malfunction due to ingrowth of endomyocardial fibrosis. No thrombo-embolic events were observed. CONCLUSIONS: Our series do not confirm the bad reputation of mechanical valvar prostheses in the pulmonary position. On the contrary they perform well and result in a much lower re-operation rate than can be expected and in fact is reported after allograft usage. No thrombo-embolic complications were noted. In our experience pulmonary mechanical valve prostheses do well.     

Complications of leg lengthening. 46 procedures in 28 patients

The results and complications of 46 leg-lengthening procedures in 28 consecutive patients were analyzed retrospectively. There were 24 femoral and 22 tibial lengthenings, performed for short stature (5 patients) and limb-length discrepancy (23 patients). Three methods were used: diaphyseal osteotomy, metaphyseal corticotomy, and distraction physiolysis. In the second group a satisfactory result was obtained more often and a lower complication rate was observed. The overall complication rate was high: 45 substantial problems occurred. We conclude that leg lengthening is difficult, requiring good preoperative examination and planning, and should be carried out only in specialized centers.     

Scapulectomy with latissimus dorsi musculocutaneous flap in the treatment of sarcoma of the upper back

We present a patient in whom scapulectomy was performed to treat a huge malignant fibrous hystiocytoma of the back. Computed tomographic examination showed the tumor to have invaded the musculature of the upper back and about the scapula. To achieve adequate surgical excision, a major portion of the skin and soft tissue of the upper back was excised in conjunction with subtotal scapulectomy. The defect, with exposed vertebral spines and transected scapula, was covered with an ipsilateral latissimus dorsi musculocutaneous flap. Now, four years postoperatively, the patient has no evidence of recurrent disease and has good use of his arm. Total or partial excision of the scapula is rarely performed and poses unique problems. As our case demonstrates, scapulectomy (combined with musculocutaneous flap) is well tolerated, and surgeons should not be discouraged from using it when appropriate.     

腹腔镜胆囊切除兼行其他手术28例经验

目的探讨腹腔镜联合手术的适应证和优越性。方法回顾性分析28例腹腔镜联合手术的临床资料。结果28例腹腔镜联合手术均获得成功。手术时间65~132min,平均手术时间76min,术后3~7d出院。无并发症。结论腹腔镜联合手术可安全、有效地治疗多种腹部疾病,显著减少病人的痛苦和费用,体现了微创技术的优越性,值得推广。     

肾皮质感染28例报告

目的:总结10年来28例肾皮质感染的诊治经验。方法:采用IVU检查12例,CT扫描20例,全部行B超检查,14例行脓液培养均获确诊。按病灶中央有无液化分为非脓肿组(A组)和脓肿组(B组),A组15例给予单纯抗生素治疗,B组13例行抗生素加经皮肾穿刺引流(或置管引流)治疗。结果:A组中治愈14例,配合经皮穿刺治愈1例。B组治愈11例,2例改行手术后痊愈。18例获得3个月～1年随访,无复发。结论:在肾皮质感染的影像学检查中,B超较CT更具实用价值。治疗上应按病理阶段采用不同的治疗方法,当形成肾脓肿时,抗生素加经皮肾穿刺引流疗效较好。     

Our results with percutaneous nephrolithotomy. Report of 61 cases

Between January 1990 and December 1997, 61 patients with renal calculi underwent percutaneous nepholithotomy. In the immediate postoperative period, 49 renal units (80.3%) were stone-free. At three months, our overall success rate was 91.8% after spontaneous elimination of non-significant residual calculi (< 3 mm). Complications were observed in 9.8% (six cases); hemorrhage and sepsis were the major complications. Percutaneous nephrolithotomy is an effective, safe and reliable alternative to the open operation.