Tumors of the Appendix and Colon

This collective review includes all available case reports of smooth muscle (stromal) tumors of the appendix and large intestine in the world literature. When compiling this review, we endeavored to examine cumulative as well as recently collected data on both benign and malignant smooth muscle tumors spanning the period 1875 to 1996. In total, there were reports of 331 leiomyomas (LMs) and 263 leiomyosarcomas (LMSs). The peak age of incidence of LM was 30 to 39 years, and the peak age of incidence of LMSs was 50 to 59 years. The female/male ratio was slightly higher for LM, and the male/female ratio was higher for LMS. The descending colon and sigmoid colon were the most common sites of both benign and malignant smooth muscle tumors. The growth of LMs most often occurred extraluminally, whereas LMSs tended to grow within the lumen of the colon. With both tumor types pain was the most frequent presenting complaint, followed less commonly by complaints of a palpable mass or gastrointestinal bleeding. LMSs tended to be larger at diagnosis than LMs, though the duration of symptoms for both types of tumor was most often reported to be between 1 month and 1 year. Finally, LMSs were found to metastasize most commonly to the liver, with metastatic disease reported in 43% of all cases.     

Malignant Odontogenic Tumors: An Update on Selected Tumors

This is an update on selected odontogenic malignancies. The article deals with aspects of recognized odontogenic carcinomas, odontogenic sarcoma and a yet unrecognized entity, sclerosing odontogenic carcinoma. Odontogenic malignancies are exceedingly rare, complicating a thorough understanding of the biologic behavior, reproducible standardized diagnostic criteria, appropriate classification and clinical management. Without the knowledge of the tumor’s biologic behavior, adequate clinical management is difficult and patient outcomes uncertain. The histopathologic features are emphasized as well as the more recent biomarker findings. These recent advances may facilitate further understanding of this group of malignancies and provide useful stratification to guide patient management.     

Longitudinal Spread of Intraneurally Injected Local Anesthetics: An Experimental Study of the Initial Neural Distribution Following Intraneural Injections

Unexpected spinal anesthesia, occurring after peripheral nerve blocks close to the spine, may be caused by a centripetal spread of the local anesthetic along the injected nerve to the spinal cord. In order to analyze the pathway of such a spread, a radioactive local anesthetic mixed with a fluorescent dye was injected into different compartments of the rabbit sciatic nerve, and the early distribution of these tracers was studied by scintillation counting and fluorescence microscopy. Epineurial (extrafascicular) injections were of low injection pressure (25–60 mmHg) (3.3–7.9 kPa) and limited spread, while endoneurial (intrafascicular) injections reached higher pressures (300–750 mmHg) (39.9–99.7 kPa) and caused a rapid spread over long distances within the fascicle. The sacral plexus seemed difficult to pass. However, 20% of endoneurial injections reached the spinal cord, where the injectate primarily spread in the thin subpial space.
Our experimental findings suggest that intraneural injections of local anesthetics are responsible for the reported cases of unexpected spinal anesthesia due to inadvertent intrafascicular spread. Although intrafascicular injections are rarely made, we recommend that intraneural injections of local anesthetics or other solutions close to the spine should be avoided, as they may cause unexpected spinal anesthesia or lesion of the cord.     

The Influence of Freezing on the Maximum Torque Capacity of Long Bones: An Experimental Study on Dogs

The strength of bone has often been measured in previously frozen samples and the freezing and thawing effect on the strength properties has been considered negligible. By means of a specially constructed torsion machine and a new method for fixing the test bone into the machine, previously frozen bones have been compared to fresh controls. The previously frozen samples were significantly weaker, with an average difference of -4.6 per cent.     

结肠绒毛状腺瘤X线诊断的价值

目的研究X线表现在结肠绒毛状腺瘤诊断上的应用价值。方法回顾性分析26例经手术和病理证实的结肠绒毛状腺瘤的X线表现。所有病例均行低张双对比灌肠造影。结果该组患者中,病变主要位于直肠、乙状结肠占73.1%。绒毛状腺瘤X线主要征象:所有病例均显示,腔内突出的肿块充盈缺损(100%),肿块表面不规则分叶,结节状隆起及细网状结构。3例肿块表面可见溃疡。结论结肠绒毛状腺瘤,特别是地毯型及菜花型在X线钡灌肠造影中有较特异的表现,X线表现反映了结肠绒毛状腺瘤的病理特点,X线钡灌肠造影检查是诊断结肠绒毛状腺瘤重要而有效的手段。     

A Brief Course of Colon Preparation with Oral Antibiotics

P < 0.05). The surgical site infection rate was 18% in group 1 and 13% in group 2. Organisms isolated from the sites of postoperative infections were not identical with those from the peritoneal fluid. This relatively brief course preparation minimized the emergence of resistant strains. However, in spite of the colonic bacterial burden and the intraoperative inoculation in the patients with mechanical cleansing alone, their incidence of subsequent infections was comparable to that of patients who were administered oral antibiotics provided that the prophylactic antibiotic was administered for 3 days after surgery. (Received for publication on Nov. 16, 1998; accepted on July 13, 1999)     

Parasternal Intrapleural Colon Interposition: An Alternative Pathway for the Colon Graft

A new pathway for the placement of the interposed colon in esophagocolonoplasty is described. In a patient with a peptic stricture and a history of previous coronary artery bypass operation and multiple thoracotomies, the interposed colon was placed in the parasternal right intrapleural space successfully. This avoided a thoracotomy as well as the areas of adhesion. Technical details are described.     

透明质酸钠对硬膜外疤痕中胶原代谢影响的实验研究

目的：探讨透明质酸钠对硬膜外疤痕中胶原成分影响。方法：采用兔非相邻节段椎板切除模型,分透明质酸钠组和生理盐水组,２、４、８周取材作透射电镜、ＥＬＩＳＡ和免疫组化分析。结果：透明质酸钠组成纤维细胞分泌功能较差,胶原纤维蔬松,且Ｉ／Ⅲ胶原含量比低于对照组。４、８周透明质酸钠组Ｉ期胶原染色较浅,各时期透明质酸钠组Ⅲ型胶原染色均较深。结论：透明质酸钠能提高伤口中疤痕Ⅲ型胶原含量,提示其能减少硬膜外疤痕形成     

Minilaparotomy Approach for the Resection of Laterally Spreading Tumors of the Colon

Purpose We report our experience of using the minimally invasive minilaparotomy approach to resect colonic laterally spreading tumors (LSTs) that could not be removed by colonoscopic snare polypectomy.Methods We prospectively examined 17 patients who underwent a minilaparotomy, defined as an incision less than 7cm long, between 1997 and 2001, for a collective 19 colonic LSTs.Results Complete en bloc resection of the LSTs was successfully performed in all 17 patients. The resections included colotomy and polypectomy in four patients (four LSTs), limited colectomy in seven patients (nine LSTs), and colectomy with regional lymph node dissection in six patients (six LSTs). There was no mortality or morbidity. The mean ± standard deviation (SD) length of the minilaparotomy was 6.7 (±0.8) cm, and the mean (±SD) operating time and blood loss were 139 (±39) min and 27 (±15) ml, respectively. Histology revealed 2 adenomas, 16 Tis carcinomas, and 1 T1 carcinoma. None of the patients had lymph node metastasis or positive resection margins. There have been no signs of tumor recurrence after a median follow-up period of 30.4 months.Conclusions The minilaparotomy approach is appropriate for resecting LSTs that cannot be removed by colonoscopic snare polypectomy, and provides a minimally invasive alternative to conventional laparotomy.     

移位乙状结肠对阑尾切除手术的影响(附5例报告)

自1998年1月～2000年4月,于625例阑尾切除手术中发现伴有乙状结肠移位致右下腹的解剖变异共5例,占同期阑尾切除术的08%,现报道如下。1　临床资料11　一般资料本组共5例,男4例,女1例。年龄18～46岁。发病至手术时间1～3天。全组病例都具有转移性右下腹痛或右下腹痛病史。合并体温升高2例;合并胃肠道症状4例;既往有“阑尾炎”发作史者1例。结合体检右下腹麦氏点固定性压痛及反跳痛;血象及中性白细胞百分比均升高,术前均明确诊断“阑尾炎”。无肝、肾、心、肺功能障碍。12　手术方法及结果全组病例均先由工作2～4年的外科医师担任术者,由于对右…     

Myoepithelial Tumors: An Update

Primary myoepithelial neoplasms of soft tissue are uncommon, and have been increasingly characterized by clinicopathologic and genetic means. Tumors are classified as mixed tumor/chondroid syringoma, myoepithelioma, and myoepithelial carcinoma, and they share morphologic, immunophenotypic, and genetic features with their salivary gland counterparts. However, soft tissue myoepithelial tumors are classified as malignant based on the presence of cytologic atypia, in contrast to the criterion of invasive growth in salivary gland sites. This review discusses the clinicopathologic and morphologic characteristics, distinct variants, and currently known genetic alterations of myoepithelial neoplasms of soft tissue, skin, and bone.