The prognosis for patients with osteosarcoma who have received prior manipulative therapy

We evaluated the long-term outcome of patients with an osteosarcoma who had undergone prior manipulative therapy, a popular treatment in Asia, and investigated its effects on several prognostic factors. Of the 134 patients in this study, 70 (52%) patients had manipulative therapy and 64 (48%) did not. The age, location, and size of tumour were not significantly different between the groups. The five-year overall survival rate was 58% and 92% in the groups with and without manipulative therapy (p = 0.004). Both the primary and overall rates of lung metastasis were significantly higher in the manipulative group (primary: 32% vs 3%, p = 0.003; overall lung metastasis rate: 51.4% vs 18.8%, p < 0.001). Patients who had manipulative therapy had higher local recurrence rates in comparison to patients who did not (29% vs 6%, p = 0.011). The prognosis for patients with osteosarcoma who had manipulative therapy was significantly poorer than those who had not. Manipulative therapy was an independent factor for survival. This form of therapy may serve as a mechanism to accelerate the spread of tumour cells, and therefore must be avoided in order to improve the outcome for patients with an osteosarcoma.     

Assessing and preventing foot problems in older patients who have diabetes mellitus

The first component of prevention is patient education. The patient and those who provide care for the older diabetic must be fully informed of their problems, but understand the management process and be willing to make the lifestyle changes necessary to prevent complications. Evaluating patients to determine those diabetics who are at risk for foot problems, complication, ulceration, or potential amputation is the second component of prevention. This process must include continuing surveillance and management. Recognizing symptoms and signs of various systems with primary evaluative procedures permits the early identification of complications and secondary prevention of chronic disease. Because Medicare now provides footwear and orthotic coverage for at-risk diabetics as an adjunct to management, early screening, assessment, and detection are essential. The provision of significant patient education can then be added to complement professional education. We have attempted to provide a process for proper referral for care and management that can be employed by all health care providers involved in the evaluation of the patient who has diabetes.     

Fractures in patients who have myelomeningocele

Thirty-seven (20 per cent) of 186 children who had myelomeningocele whose records were reviewed had sustained a total of seventy-six fractures. The frequency with which the fractures occurred was related directly to the level of neurological involvement. Thirteen (41 per cent) of the patients who had involvement at the thoracic level, fifteen (36 per cent) who had involvement at the upper lumbar level, eight (10 per cent) who had involvement at the lower lumbar level, and one (3 per cent) who had involvement at the sacral level sustained fractures. Sixty-five (86 per cent) of the fractures occurred before the child was nine years old, fifty-eight (76 per cent) were judged to be secondary to the limb being in a cast, and seventy-four (97 per cent) involved the lower extremity. Eleven patients, all of whom had thoracic or upper lumbar involvement, sustained fractures of multiple extremities. All fractures of the lower extremity were distal to the level of neurological involvement; they occurred predominantly in the femur in patients who had thoracic involvement and in the tibia in patients who had lumbar involvement. All of the metaphyseal and diaphyseal fractures healed satisfactorily, whether they were treated by immobilization in a plaster cast or in a bulky Webril dressing, although there were fewer complications in the latter group. The seven fractures that involved the physeal plate were a major problem, as three (43 per cent) had delayed union and two (29 per cent) developed premature growth arrest.     

Non-constrained total shoulder replacement in patients who have rheumatoid arthritis and class-IV function

The results of twenty-four non-constrained total shoulder replacements that were done in twenty patients who had treatment of rheumatoid arthritis were retrospectively reviewed to determine how those results were affected by the severity of the disease. All of the patients had Class-IV functional capacity, and 92 per cent had Stage-III or IV rheumatoid progression. Nine (38 per cent) of the shoulders had a tear of the rotator cuff. The mean length of clinical follow-up was 4.5 years (range, two to ten years). Preoperatively, all of the patients had disabling pain and limited function. Postoperatively, twenty-two (92 per cent) of the patients had no appreciable pain, and eighteen (75 per cent) had no significant functional limitation (p less than 0.001). Active elevation improved by 88 per cent, and external and internal rotation also improved significantly. Motion, relief of pain, and functional improvement were not significantly greater in the patients who had an intact rotator cuff. Radiolucent lines developed around ten (42 per cent) of the glenoid prostheses, but only two of the prostheses were surrounded by a complete line and were thought to be loose. No revisions were done. We believe that a non-constrained total shoulder replacement affords excellent relief of pain, satisfactorily improves range of motion, and improves function in patients who have severe rheumatoid involvement of the shoulder. However, because motion and function are severely restricted preoperatively, the end-results are not comparable with those that have been reported for patients who have less severe rheumatoid disease.     

Subsequent tumor analysis of 36 patients who have received intravesical mitomycin C for superficial bladder cancer

We studied 36 patients with stages O and A (Tis, Ta and T1) bladder cancer who had received 8 weekly doses of 30 or 40 mg. mitomycin C as definitive therapy. Of this group 16 had failed thiotepa therapy and 13 had grade III tumors (6 multifocal carcinoma in situ). The complete response rate at 12 weeks was 45 per cent (negative biopsy and cytology), while an additional 33 per cent had a partial response. Response did not correlate with tumor grade or stage. Patients who had failed thiotepa therapy were less likely to have a complete response, although the over-all response rate was identical to patients who had either not received prior chemotherapy or were not clear thiotepa failures. Followup of these patients indicates that the complete responders were benefited by this regimen since the subsequent recurrence rate was reduced when compared prior to initiation of mitomycin C. Most of these patients received monthly maintenance therapy.     

HLA phenotypes in patients who have osteosarcoma

Human leukocyte antigen (HLA) phenotypes were studied in twenty Japanese patients who had typical osteosarcoma. The HLA-A11 phenotype was found in ten (50 per cent) of the twenty patients, compared with 16.6 per cent of 235 control subjects (chi square = 13.248; p less than 0.0005)--an odds ratio of 5.026. These data suggest that major histocompatibility complex-linked genes may determine susceptibility to osteosarcoma.     

Final height in children with chronic renal failure who have not received growth hormone

Final height (FH), growth velocity after 16 and 18 years of age, and factors predictive for FH were assessed in 60 patients (21-36 years old), whose chronic renal failure (CRF) started before the age of 16 years (28 girls and 32 boys). At 16 years of age, 22 had conservative treatment (CT, group A) and 38 end-stage renal failure [ESRF, group B, which includes 19 receiving hemodialysis (HD) and 19 with a functional renal transplant (RTx)]. None received recombinant human growth hormone (rhGH) treatment. FH was lower than in a normal population: 161.6+/-8 cm for males [-2.06+/-1.3 standard deviation score (SDS)] and 154.3+/-8.1 cm for females (-1.4+/-1.4 SDS). FH in group A (-1.15+/-1.4 SDS) was significantly higher than in group B (-2.1+/-1.3 SDS); 45% of all patients (56% of males and 23% of females) had a final height below -2 SDS (41% in group A and 47% in group B). FH was reached at 20.2+/-1.8 years in males and 18.8+/-2 years in females. A continuation of growth after 18 years of age was observed in 23 males (71.8%): +5.2 cm (+0.87 SDS) and in 14 females (50%): +1.75 cm (+0.3 SDS). However, this partial recovery concerned mainly patients with an important growth deficiency. A higher height at enrolment or at ESRF was significantly associated with a higher FH, whereas a longer period of ESRF had a significantly negative effect. In conclusion, all efforts should be made to diagnose CRF as early as possible and to try to improve growth before ESRF and RTx. Early institution of rhGH therapy should improve FH and improve the chance of achieving near-normal adult height in most patients.     

Follow-up of patients who have undergone ileogastrostomy

Patients who have had ileogastrostomy for the treatment of morbid obesity require close, long-term follow-up. From a prospective study of a large number of variables in 12 consecutive patients, and from experience with more than 200 patients who have undergone this procedure since 1982, a protocol has evolved. The authors outline the associated morbid conditions, operative complications and biochemical alterations that are important in the management of these patients.     

上腹部手术后行腹腔镜胆囊切除术的临床分析

目的探讨上腹部手术史患者行腹腔镜胆囊切除术（laparoscopic chole-cystectomy,LC）的可行性和手术特点。方法回顾分析53例上腹部手术史患者行LC的临床资料。结果53例中成功完成LC49例,中转开腹4例,患者均治愈,LC成功率92.5%。结论有上腹部手术史者行LC是安全可行的,术前的评估、气腹的建立、穿刺孔的选择、黏连的分离应予以注意。     

Total hip arthroplasty in patients who have sickle-cell hemoglobinopathy

Eleven patients who had a form of sickle-cell hemoglobinopathy had a total hip arthroplasty for avascular necrosis of the hip. Four patients had a revision and three had a resection arthroplasty. Four had a serious infection postoperatively. Both acute and late complications were numerous. We concluded that patients who have a sickle-cell hemoglobinopathy are at markedly increased risk for complications after total hip replacement arthroplasty, yet that over-all the results are favorable.     

Tumor invasion of muscular vessels predicts poor prognosis in patients with pancreatic ductal adenocarcinoma who have received neoadjuvant therapy and pancreaticoduodenectomy

Lymphovascular invasion (LVI) is a prognostic factor in many types of human malignancies, including pancreatic ductal adenocarcinoma (PDAC). However, the prognostic significance of LVI in patients with PDAC who have received neoadjuvant therapy and pancreaticoduodenectomy is unclear. In this study, we analyzed LVI in 212 patients who had received neoadjuvant chemoradiation and subsequent pancreaticoduodenectomy at our institution between January 1999 and December 2007. LVI was present in 61.8% (131/212) of the patients. Of the 131 patients who were positive for LVI, 67 (31.6%) had tumor invasion into lymphovascular spaces without muscle layer (nonmuscular lymphovascular spaces), and 64 (30.2%) had tumor invasion into muscular vessels. Tumor invasion into muscular vessels correlated with higher frequencies of positive resection margin, lymph node metastasis, and locoregional/distant recurrence. Patients with tumor invasion into muscular vessels had significantly shorter disease-free survival and overall survival than did patients who had no LVI or who had tumor invasion of nonmuscular lymphovascular spaces (P<0.01). Tumor invasion into muscular vessels is an independent prognostic factor in patients with PDAC who have received neoadjuvant therapies. Our results showed that tumor invasion into muscular vessels plays an important role in the progression of PDAC and in predicting prognosis in this group of patients.