TSRH后路内固定系统治疗青少年特发性脊柱侧凸

目的　探讨应用 TSRH器械后路手术治疗青少年特发性脊柱侧凸的疗效。方法　对在 1997年 9月至 2 0 0 1年 9月行 TSRH后路手术治疗的 4 2例青少年特发性脊柱侧凸患者侧凸的矫正度、脊柱的平衡以及并发症等进行分析。结果　 King / 型患者胸弯的矫正率为 6 6 % ,King 型双弯患者胸弯矫正率为 5 0 % ,随访时矫正率丢失 8%～ 14 %。King 型患者腰弯的矫正率为 4 1% ,King 型患者腰弯的矫正率为 5 1% ,随访矫正率丢失接近 2 0 %。King / 型患者手术后躯体平衡迅速得到改善 (6 0 % ) ,而 King 型及 型躯体平衡改善不明显。在术前有明显的胸椎后凸减少 (小于 2 0°)患者中 ,术后可见胸椎后凸有部分改善。其余无明显改善。无神经并发症的发生 ,1例发生远端脱钩 ,1例患者在术后 15个月有延迟性的深部感染发生 ,深部培养为厌氧杆菌。结论　使用 TSRH器械可达到较满意的矢状位和冠状位的胸弯矫正 ,但需进一步努力去改善腰椎的钩子模式及外科技巧 ,从而达到和维持更好的腰弯矫正。     

Blue Lymphangitis of the Breast after Breast Cancer: Case Report

Carcinomatous lymphangitis accounts for 5% of all skin metastases, but blue lymphangitis of the breast has never been described. We report a case of blue lymphangitis of the breast in a patient 11 years after treatment for ipsilateral breast cancer that was in full remission. Breast examination and imaging showed no other abnormalities. Skin biopsy revealed a carcinomatous‐pigmented infiltration corresponding to melanoma metastasis, which helped highlight a primitive right flank injury. This case report emphasizes that a full body exam should always be performed with unusual presentation of breast cancer and reiterates the indispensable place of histology before any diagnosis.     

Modified ACDF Technique for the Treatment of Centrum Focal Ossification of the Posterior Longitudinal Ligament: A Case Report

Background

Anterior cervical discectomy fusion (ACDF) is a surgical procedure used to treat cervical spondylosis with anterior spinal cord compression. However, there are limitations to traditional ACDF and posterior indirect decompression when the anterior source lesion is in the center of the cervical vertebra.

Case Presentation

On June 8, 2022, our department treated a patient with cervical spondylotic myelopathy—whose high posterior longitudinal ligament (OPLL) occupied the central position of the vertebral body—with modified ACDF. The preoperative surgical plan was designed based on the relevant imaging data and assay index. Also, the visual analogue scale (VAS), Japanese Orthopaedic Association (JOA) scores, and imaging parameters of neck pain were recorded and compared. Postoperative imaging data showed that cervical curvature was recovered and spinal canal compression was relieved. The VAS score for neck pain decreased from 7 preoperatively to 1.5 at the last follow-up, while the JOA score increased from 10 preoperatively to 29 at the last follow-up. The volume of the spinal canal was restored. Simultaneously, the patient's extremity muscle strength improved and muscle tension decreased.

Conclusions

Modified ACDF may be an effective surgical method for resolving spinal cord compression in a specific location when bone mineral density is good. We can effectively avoid iatrogenic nerve injury and symptom recurrence by removing the vertebral body and the lesion directly.     

Microvascular Osteocutaneous Groin Flap in the Treatment of an Ununited Tibial Fracture with Chronic Osteitis: A Case Report

A 37-year-old man with an ununited tibial fracture combined with a significant skin defect underwent a microvascular transfer of an island osteocutaneous flap of groin skin and iliac crest bone. the bone component of the flap was shown to be a living transplant by the observation of brisk cancellous bone bleeding when the flap was isolated on its vascular stalk; by rapid fracture healing (weight-bearing 15 weeks postoperatively); and sequential bone scan investigations. Various aspects of the flap blood supply, particularly to bone, are discussed, and reference is made to the use of a more suitable vessel system.     

短节段C—D装置治疗胸腰椎骨折的探讨

１９９５年２月～１９９６年１月间，作者利用短节段Ｃｏｔｒｅｌ－Ｄｕｂｏｕｓｅｔ装置治疗胸腰椎不稳定性骨折１５例，骨折脱位复位达７３．３％，１２例伴有神经损伤者神经功能平均恢复１．２５级（Ｆｒａｎｋｅｌ分级）。作者认为Ｃ－Ｄ装置具有纵向撑开，横向固定、抗旋转、固定牢靠、手术操作简单、损伤脊髓的机会少等优点，是治疗胸腰椎骨折有效的装置之一。     

Breast Carcinoma in Childhood and Adolescence: Case Report and Review of the Literature

Secretory breast carcinoma is a rare tumor originally described in children and adolescent women with a characteristic morphology and a controversial choice of treatment. We report an additional case of a 4-year-old girl with a breast tumor diagnosed as a secretory carcinoma without involvement of the axillary lymph nodes. The therapy consisted of simple mastectomy and low axillary dissection. She presented with a local recurrence near the surgical scar 8 months later, and a wide elliptical excision of the scar and underlying tissue was performed with subsequent radiotherapy of the surgical bed. This tumor has a relatively benign behavior and rarely metastasizes. A literature review revealed only 22 cases of breast carcinoma in childhood and adolescence. ▪     

Microvascular Osteocutaneous Groin Flap in the Treatment of an Ununited Tibial Fracture with Chronic Osteitis: A Case Report

A 37-year-old man with an ununited tibial fracture combined with a significant skin defect underwent a microvascular transfer of an island osteocutaneous flap of groin skin and iliac crest bone. the bone component of the flap was shown to be a living transplant by the observation of brisk cancellous bone bleeding when the flap was isolated on its vascular stalk; by rapid fracture healing (weight-bearing 15 weeks postoperatively); and sequential bone scan investigations. Various aspects of the flap blood supply, particularly to bone, are discussed, and reference is made to the use of a more suitable vessel system.     

A Metastatic Ball Tumor in the Right Atrium Originating from Esophageal Cancer: Report of a Case

A metastatic ball tumor in the right atrium originating from esophageal cancer is extremely rare. A 53-year-old woman had two such tumors without any other types of metastasis. These tumors were associated with severe thrombocytopenia caused by the consumption of platelets. Even after repeated transfusions of platelets and fresh frozen plasma, the thrombocytopenia could not be controlled. Therefore, a surgical resection was performed to improve the thrombocytopenia and avoid sudden death due to a complete obstruction of the right ventricular outflow tract by the tumor. As the throm-bocytopenia did not recur postoperatively, the patient was discharged from hospital. She died, however, of multiple metastases with bilateral pleural effusions 5 months after the surgery.     

Basal Cell Carcinoma of the Nipple in a Male Patient: A Particular Case Report

Basal cell carcinoma (BCC) is a common skin cancer worldwide. However, BCC of the nipple and areola complex is rare. Men are more affected than women. Most of the cases were treated with simple excision. We report a case of BCC of the right nipple–areola complex in a 75‐year‐old man, treated with Mohs surgery and simple mastectomy.     

Ipsilateral Fixation and Reconstruction of the Cervical Spine after Resection of a Dumbbell Tumor Via a Unilateral Posterior Approach: A Case Report and Biomechanical Study

Objective

There is lack of an internal fixation following resection of a dumbbell tumor by hemi-laminectomy and facetectomy that achieves adequate stability with less trauma. Unilateral fixation and reconstruction (unilateral pedicle screw and contralateral lamina screw fixation combined with lateral mass reconstruction, UPS + CLS + LM) may be an ideal technique to address this problem. A biomechanical comparison and a case report were designed to evaluate its spinal stability and clinical effect.

Methods

Seven fresh-frozen human subcervical specimens were used for the biomechanical testing. The conditions tested were: (1) intact; (2) injured (single-level hemi-laminectomy and facetectomy); (3) unilateral pedicle screw (UPS) fixation; (4) UPS fixation combined with lateral mass (LM) reconstruction (UPS + LM); (5) UPS fixation and contralateral lamina screw fixation (UPS + CLS); (6) UPS + CLS + LM; (7) UPS fixation and contralateral transarticular screw fixation (UPS + CTAS); (8) bilateral pedicle screw (BPS) fixation. Range of motion (ROM) and neutral zone (NZ) were obtained at C5-C7 segment under eight conditions. In addition, we report the case of a patient with a C7-T1 dumbbell tumor that was treated by UPS + CLS + LM technique.

Results

Except left/right lateral bending and right axial rotation (all, p < 0.05), ROM of UPS + CLS + LM condition in other directions was similar to that of BPS condition (all, p > 0.05). There was no significant difference between UPS + CLS + LM and the UPS + CTAS condition in other directions of ROM (all, p > 0.05), except in left/right axial rotation (both, p < 0.05). Compared to UPS + CLS condition, left/right lateral bending ROM of UPS + CLS + LM condition were significantly reduced (both, p < 0.05). UPS + CLS + LM condition significantly reduced ROM in all directions compared to UPS and UPS + LM condition (all, p < 0.05). Similarly, except lateral bending (p < 0.05), there was no difference in NZ in other directions between UPS + CLS + LM and BPS condition (both, p > 0.05). There was no significant difference between UPS + CLS + LM and UPS + CTAS condition in NZ in all directions (all, p > 0.05). Axial rotation NZ of UPS + CLS + LM condition was significantly reduced compared to UPS + CLS condition (p < 0.05). Compared to UPS and UPS + LM condition, NZ of UPS + CLS + LM condition was significantly reduced in all directions (all, p < 0.05). The patient's imaging examination at 3 months postoperatively indicated that the internal fixation did not move and the graft bone was seen with fusion.

Conclusion

After resection of a dumbbell tumor in the cervical spine, UPS + CLS + LM technique is a reliable internal fixation method to provide sufficient immediate stability and promote postoperative bone fusion.     

Bilateral Orbital Metastases as the Presenting Finding in a Male Patient with Breast Cancer: A Case Report and Review of the Literature

Abstract: Breast cancer in men has traditionally been thought to be substantially different from that in women. As more becomes known about this relatively rare entity, the similarities between genders become more striking than the differences. Carcinoma of the male breast is an uncommon disease occurring in less than 1% of all breast cancers. Male breast carcinoma is staged similarly to female breast cancer using the American Joint Committee Clinical Staging System. As in women, axillary nodal status is the strongest predictor of outcome. Distant metastasis to bones, soft tissue, lungs, and liver have been widely reported in men with breast cancer. This case report provides a rather rare presentation of a man with breast carcinoma with bilateral orbital metastasis as an initial clinical presentation.     

Pleomorphic Liposarcoma of the Breast Mimicking Breast Abscess in a 19‐Year‐Old Postpartum Female: a Case Report and Review of the Literature

Abstract: Sarcomas of the breast constitutes <1% of primary malignant breast tumors. Liposarcoma of the breast represents 3–24% of the primary breast sarcomas. Liposarcoma can arise from pre‐existing benign lesions like fibroadenoma or from lipoid tissue in the breast. There are only few cases of liposarcoma of the breast in young females reported in the literature. Liposarcoma of the breast typically involves women with age after 50 years. In this article, we present a young woman with liposarcoma of the breast.     

Preoperative Systemic Treatment in BRCA-Positive Breast Cancer Patients: Case Report and Review of the Literature

BACKGROUND: In vitro and in vivo analyses have shown differences in chemosensitivity between breast cancers associated with BRCA1/2 mutations compared to sporadic variants. In the preoperative setting, the tumor response can be directly measured. Therefore, preoperative systemic treatment (PST) offers the opportunity to assess the chemosensitivity in vivo. However, there have been neither clear guidelines for mutation carriers in terms of choice of chemotherapy regimen nor recommendations how to proceed in case of an inadequate response to PST. CASE REPORT: Herein, we present the history of a 39-year-old woman with bilateral breast cancer who was tested positive for germ-line BRCA1 mutation while under PST. We performed a comprehensive literature review covering the MEDLINE database from 1992 to 2010 on published data regarding PST options for BRCA mutation carriers. CONCLUSIONS: If results of genetic testing are obtained during PST, individual therapy adaptations can be discussed with respect to mainly retrospective data of response to specific drugs. However, larger studies with longer follow-up are eagerly needed to draw firm conclusions before any specific treatment recommendations can be given for BRCA mutation carriers. PST is an ideal setting to evaluate such treatment options and to describe predictive markers that can help define subgroups that benefit most.     

新辅助化疗后腹腔镜辅助食管内翻拔脱术治疗颈段食管癌1例报告

本文报道2012年8月29日1例新辅助化疗后腹腔镜辅助食管内翻拔脱术治疗食管癌.患者男,58岁,吞咽困难进行性加重半年.经胃镜和活检病理诊断为颈段食管鳞状细胞癌.化疗3周期后,分期从T3N1M0降为T2N0M0,行腹腔镜辅助食管内翻拔脱术:腹腔镜下用超声刀游离胃、下段食管和膈食管裂孔,利用腔镜切割缝合器制成管状胃.同时,经颈部游离食管和清理颈部各组淋巴结.腹部悬吊,腹腔镜辅助食管内翻拔脱后,将管状胃牵至颈部,与食管残端吻合.手术时间2 h 50 min.术中出血量约210 ml.术后第7天进清流食,逐渐加量.术后第12天出院.住院期间未发生声嘶等并发症.术后病理:颈部各组淋巴结15枚,未见癌转移.术后3个月,酸反流4～6次/d,多在夜间.     

雄激素阻断治疗后前列腺腺癌转化为小细胞癌1例报告并文献复习

目的：探讨前列腺小细胞癌的临床、病理特征及诊治方法．方法：分析1例前列腺小细胞癌患者的临床资料：患者男．54岁。因“尿频、尿急、排尿困难1个月”入院。直肠指诊前列腺Ⅲ。大．质硬,表面不光滑。血PSA为175．08ng／ml。B超及MRI检查均提示前列腺癌．前列腺穿刺活检诊断为前列腺腺癌．行最大限度雄激素阻断治疗。9个月后症状加重,复查血PSA为7．4mg／ml。MRI提示前列腺腺癌,行前列腺电切术,病理检查为前列腺小细胞癌。免疫组织化学示CD56（＋）,NSE（＋）,CgA（-）．LCA（-）。遂以GP方案化疗：吉西他滨1800mg,DDP150mg,采用4周方案,一共行4个疗程。从第2个疗程开始同步局部放疗（3D-CRT。每次3Gy,总量60Gy）。结果：复查CT前列腺局部肿瘤消失,排尿通畅,但在随访的过程中。患者死于急性心肌梗死。结论：雄激素阻断治疗后,前列腺腺癌可能转化为小细胞癌,前列腺小细胞癌少见,恶性程度高,确诊需依靠临床及病理表现。强调早发现,早治疗。治疗以化疗为主,可辅以放疗,早期前列腺小细胞癌,也可行前列腺癌根治加化疗。     

Fetal Renal Insufficiency Following Trastuzumab Treatment for Breast Cancer in Pregnancy: Case Report und Review of the Current Literature

Some drugs are known for their fetal nephrotoxicity and should be avoided during pregnancy. We report on a pregnant woman suffering from breast cancer who received a weekly neoadjuvant trastuzumab (Herceptin^®) therapy from 15 weeks of gestation onward, in addition to a 3-weekly carboplatin/docetaxel chemotherapy. Fetal renal insufficiency with anhydramnios and missing visualization of the fetal bladder developed at 21 weeks. After discontinuation of trastuzumab and repeated instillation of amniotic fluid, the amount of amniotic fluid remained stable after 24 weeks of gestation. After caesarean section at 34 weeks because of fetal growth restriction, the renal function of the neonate was normal postnatally. In accordance with the current literature, our case shows a reversible adverse effect of trastuzumab on the fetal renal function and confirms the current recommendation that trastuzumab in pregnancy should be avoided. In pregnancies exposed to trastuzumab, treatment should be discontinued and the fetus should be closely monitored, with particular attention to the amniotic fluid and the fetal bladder volume, as these reflect fetal renal function.     

Incidence of Axillary Recurrence in 344 Sentinel Node Negative Breast Cancer Patients after Intermediate Follow-Up. A Prospective Study into the Accuracy of Sentinel Node Biopsy in Breast Cancer Patients

Sentinel lymph node biopsy (SLNB) has been validated in the treatment of breast carcinoma and is considered to stage the axilla adequately in this disease. However, long-term follow-up data are scarce. We evaluated the results of SLNB with respect to loco-regional failures in the axilla in SN-negative patients with invasive breast carcinoma and analysed their causal factors.

Between 1997 and May 2004, 656 patients without clinically palpable lymph nodes were included in our study. Data with regard to demographics, diagnostics, therapy and follow up were gathered prospectively from all patients. Patients treated after May 2004 were excluded from this study to permit at least one year of follow-up.

Out of the 656 patients, 344 patients with a negative sentinel lymph node biopsy did not undergo axillary dissection and were followed up clinically. Median follow up was 43 months. In 3 patients (0.9%) axillary recurrences developed. All three patients subsequently underwent a completion axillary dissection, chemotherapy and radiotherapy.

The low rate of clinical axillary recurrence after an intermediate follow up period suggests that a negative SN biopsy accurately reflects the nodal stage in patients with breast cancer.