儿童骨肉瘤患者保留骨骺的灭活再植术(英文)

目的探讨在有效大剂量化疗前提下的保留骨骺灭活再植术的可行性。方法自1999年开始在 MMIA 方案(由甲氨喋呤、异环磷酰胺、阿霉素组成)的有效大剂量化疗保护下对2例儿童骨肉瘤患者行保留骨骺的灭活再植术。术前严格遵循新辅助化疗的原则,行2个疗程的 MMIA 化疗。化疗后患者疼痛消失,肿块缩小,AKP、LDH明显下降,X 线片及 MR 示左股骨下端病变局限,边缘清晰,硬化及骨化明显,骨骺未受侵蚀。术后继续应用2疗程化疗。结果 2例患者术后切口均一期愈合。随访分别为3年和4年,无复发和转移,肢体功能恢复理想。结论保留骨骺的灭活再植术是治疗儿童骨肉瘤的一种新方法,其在不增加局部复发率的前提下避免术后双侧肢体不等长,并改善了术后患者的肢体功能。但严格掌握手术适应证是至关重要的,否则将导致灾难性后果。     

保留骨骺灭活再植术治疗儿童股骨远端骨肉瘤的远期疗效

目的探讨保留骨骺灭活再植术的远期临床疗效及并发症的治疗。方法回顾10年间随访超过5年的5例股骨远端骨肉瘤患者,男1例,女4例。平均年龄9．2岁。MR分型：I型3例,II型2例。1例合并病理骨折。治疗方法均采用术前化疗2疗程＋保留骨骺灭活再植手术＋术后化疗。结果5例患者平均随访82个月（60～126个月）。无复发、转移和死亡。3例发生灭活骨骨折,均再次行植骨内固定术,再次术后半年骨愈合良好。患膝屈曲≥110°3例,90°1例,70°1例。双下肢等长1例,患肢短缩〈2cm3例,8cm1例。肢体功能评分为13～30分,平均25．6分。结论保留骨骺的灭活再植术是一种可行的手术方法,可有满意的临床疗效。关节活动受限和灭活骨骨折是该手术的最常见远期并发症。     

肢体骨肉瘤瘤段灭活再植的术后并发症

目的：分析骨肉瘤患接受瘤段灭活再植的术后并发症，评价该术式的临床价值。方法：1986年11月到1989年7月，39例肢体骨肉瘤患行瘤段灭活再植术，平均随访43．5个月。瘤段灭活方法为液态氮冷冻24例，^60Co照射13例，煮沸2例。结果：（1）29名患发生了41例次的术后并发症，发生率为74．4％。11名患因术后感染、肿瘤局部复发等原因而截肢。术后总评优良率为41．0％。（2）瘤段灭活再植术后主要并发症的发生率：肿瘤局部复发33．3％，术后感染15．4％，皮瓣坏死7．7％，骨折25．6％，骨不连10．3％。结论：采用液态氮冷冻、^60Co照射、煮沸等方法行瘤段灭活再植，术后并发症发生率高，患肢体功能较差。     

保留关节的瘤段切除酒精灭活再植术治疗股骨远端骨肉瘤的临床疗效

目的：探讨保留关节的瘤段切除酒精灭活骨再植术治疗股骨远端骨肉瘤的临床疗效,分析常见并发症的发生原因并提出治疗策略。方法2004年1月至2011年5月,采用保留关节的瘤段切除酒精灭活再植术治疗股骨远端骨肉瘤10例。男7例,女3例;年龄15～24岁,平均20.1岁,中位年龄21岁;左股骨下段6例,右股骨下段4例;Enneking分期II B期9例,III期1例;术后疗效评价采用MSTS功能评分和ISOLS复合移植物影像评分。结果10例术后切口均I期愈合。随访12～110个月,平均随访34个月,1例13个月局部复发并全身多发转移而死亡。3例分别于术后9、12、24个月因全身多处转移而死亡。3例患者（30％）于术后2～9个月因灭活骨骨折而行切开复位、植骨、环抱器内固定术,1例于术后半年死亡;1例术后4个月骨折处愈合,再次术后48个月无异常。另1例再次术后13个月再次出现骨折而行切开复位、植骨、钢板内固定术,术后半年骨愈合良好,随访12个月出现关节不稳及膝关节屈曲受限。ISOLS影像评分28～34分,平均31分（87%）;MSTS肢体功能评分19～28分,平均23分（77%）。结论在严格掌握适应证的前提下,应用保留关节的酒精灭活再植术治疗股骨远端干骺端骨肉瘤是一种可行的手术方式,具有保留关节的重要结构、瘤段骨与宿主骨匹配良好、无排异反应等优点。灭活骨骨折是该手术最常见的并发症,灭活骨自身骨质改变和内固定方式选择不当是导致骨折发生的主要原因。应用钢板内固定及延长外固定时间是降低灭活骨骨折的有效措施。     

骨肉瘤侵蚀骨骺的影像学研究

目的探讨影像学对确定骨肉瘤侵袭骺板累及骨骺的诊断价值。方法采用X线平片、CT、MRI三种影像学检查方法,观察骺板及骨骺侵及的敏感性和特异性。结果本组23例骨肉瘤骺板受累元一例幸免。在本组病例中,MRI发现两种类型的骺板及骨骺侵及,一类为中心型呈锥状或不规则型突破骺板侵入骨骺,另一类边缘型从骺板侧方由边缘向中心扩展侵入骨骺;MRI的敏感性为100%;X线平片敏感性为69.2%、特异性为100%。结论MRI可直接反映组织内化学成分的变化,因此,在确定骨肉瘤侵袭骺板及骨骺的敏感性和特异性方面是最佳的检查手段。     

常温下对骨肉瘤真空干燥灭活的探讨*

目的：分析常温下对骨肉瘤组织进行真空干燥灭活的可行性。方法：体内实验对VX2 肿瘤块进行真空干燥处理及冰水复水后,行体内种植,确定灭活处理的安全时间。体外实验对骨肉瘤组织进行真空干燥灭活,测定脱水率,观察肿瘤组织形态学改变,检测肿瘤组织ATP 酶活性;检测兔骨、肌腱进行真空灭活处理后生物力学强度的变化。结果：常温下VX2 肿瘤真空干燥灭活的安全时间为60min;骨肉瘤组织接受真空干燥灭活后,明显皱缩,内部呈多孔状,脱水率达93.98% ,镜下见细胞明显变小,结构破坏,透射电镜下见肿瘤细胞膜破坏,细胞器崩解,染色体分解;肿瘤组织的ATP 酶活性明显较对照组降低;骨、肌腱的生物力学强度并未发生明显下降。结论：室温下真空干燥处理60min,对骨、肌腱力学强度无明显影响,却可以使骨及软组织肿瘤内肿瘤细胞完全灭活。     

儿童及青少年保留骨骺的保肢手术临床研究

Objective  

The aim of the study was to analyze the clinical features of limb salvage surgery with epiphyseal preservation in children and adolescents, and to evaluate the recurrence rate, metastasis, complications, and the joint functional results after tumor resection.     

选择性个案化疗与瘤段骨超声灭活再植治疗骨肉瘤—临床前瞻性随？…

为实施手术前后多种有效药物的个案化疗，并增加瘤段灭活的彻底性。缩短其术中灭活时间，本文进行了选择性个案化疗与瘤段骨超声灭活再植治疗骨肉瘤临床前瞻性随机对照研究。结果表明，观察组瘤段骨术中灭活时间明显缩短，随访期内无瘤生存率高于对照组」手术前后固定方案化疗加常规酒精灭活再植术；经Ｘ＾２检验Ｐ〈０．０５」。     

骨肉瘤瘤段灭活方法

骨肉瘤是一种最常见的恶性骨肿瘤,恶性程度高,且容易复发和转移,死亡率高,致残率高,70年代以来,随着新辅助化疗在临床的开展,患者的保肢率和生存率都大幅度提高,文献报道目前5年生存率最高能达到79%。当前骨肉瘤的治疗主要以保肢术结合大剂量化疗为主。其中保肢术又以3种方法最多，即肿瘤切除灭活再植、人工假体置换及同种异体骨移植，国外主要以后两种方法为主，我国由于骨库不多且因经济等各方面的原因，     

选择性个案化疗与瘤段骨超声灭活再植治疗骨肉瘤——临床前瞻性随机对照研究

为实施手术前后多种有效药物的个案化疗，并增加瘤段骨灭活的彻底性，缩短其术中灭活时间，本文进行了选择性个案化疗与瘤段骨超声灭活再植治疗骨肉瘤临床前瞻性随机对照研究。结果表明，观察组瘤段骨术中灭活时间明显缩短（约２０分钟），随访期内（２．５年）无瘤生存率（６５．０％）高于对照组［手术前后固定方案化疗加常规酒精灭活再植术（３３．３％）；经χ２检验Ｐ＜０．０５］。其术后合并症、局部复发及转移或死亡的发生率较对照组减低，但无统计学差异（Ｐ＞０．０５）；术后患肢功能评定结果两组间无差异。提示选择性个案化疗与瘤段骨超声灭活再植术是一种方法简便、疗效较好、经济节俭的骨肉瘤保肢综合治疗的有效方法之一。     

10例骨旁骨肉瘤的诊断与治疗

目的:总结骨旁骨肉瘤的临床特点,诊断方法和治疗经验。方法:全部病例采用手术治疗,瘤段切除、人工假体植入7例,肿瘤局部切除(半皮质切除)自体或异体骨移植2例,截肢1例。结果:随访4.6～29年,无局部复发。结论:骨旁骨肉瘤为低度恶性肿瘤,广泛切除是治愈肿瘤的前提,个体化的手术方式是尽可能多地保留患肢功能的保证。出现肺转移可结合化疗和积极手术治疗,预后仍然较好。     

Association of Metastasis with Clinicopathological Data in Mexican Patients with Osteosarcoma,Giant Cell Tumor of Bone and Chondrosarcoma

Background: Bone tumors are neoplasias with a high overall mortality; one of the main factors that reduce survival is their high capacity to develop metastases. It has been reported that finding lung metastases at diagnosis of osteosarcoma (OS), chondrosarcoma (CS) and giant cell tumor of bone (GCTb) is quite common. In this study, we inquire the relationship of metastases caused by these tumors with different clinical and pathological aspects, in order to guide medical personnel in the diagnosis and opportune treatment of metastases or micro metastases. Materials and Methods: We collected data of 384 patients with clinical, radiological and histopathological diagnosis of OS, GCTb and CS that attended the National Rehabilitation Institute (INR) during 2006 to 2014. Chi-square and Fisher’s exact tests were performed for data analysis. Results: In the three tumor types, the presence of metastases at diagnosis was variable (p=0.0001). Frequency of metastases was 36.7%, 31.7% and 13.2% for OS, CS and GCTb respectively. The average age had no significant difference (p>0.05) in relation to metastases, even so, patients with OS and GCTb and metastases, were older while patients with CS and metastases were younger, in comparison to patients without metastases. Males had a higher frequency of metastases (68.2%, p = 0.09) in contrast to CS and GCTb, in which the metastases was more frequent in women with 51.9% (p = 0.44) and 57.9% (p = 0.56) respectively. Broadly, metastasis was associated with primary tumors located in the femur (44.4%), followed by the tibia (15.6%); metastases was more frequent when primary tumor of GCTb and OS were in the same bones, but were located in the hip (26.3%) for CS. Conclusions: The frequency of metastases in OS, GCTb and CS is high in our population and is determined by different clinicopathological variables related to the kind of tumor. Further studies are needed in order to evaluate metastases subsequent to diagnosis and associations with survival and clinicopathological factors , as well as to determine the sensitivity and specificity of current methods of detection.     

骨肉瘤的远处骨转移(附5例报告)

目的：探讨骨肉瘤远处骨转移的临床表现，诊治过程及预后情况．方法：对我科1993年6月～1999年9月收治的5例骨肉痛发生远处骨转移患者进行回顾性分析总结结果：5例中3例为多发骨转移灶，2例为单发骨转移灶：4例合并肺转移，1例合并淋巴结、心包转移．经随访4～36个月，平均15.4个月，4例死亡，1例生存，结论：骨肉瘤的远处骨转移均为超关节的血行转移，两处以上骨转移灶者的生存期低于单发骨转移灶者，合并其它脏器转移者预后更差化疗加适宜的手术是治疗此类患者较有效的方法。     

Treatment of Gancyclovir Resistant Cytomegalovirus with Foscarnet: a Report of Two Cases Occurring After Bone Marrow Transplantation

Cytomegalovirus (CMV) infection is common in patients who undergo allogeneic bone marrow transplantation. Gancyclovir is useful in treating CMV infections. Resistance to gancyclovir is rare and has, thus far, not been reported in the setting of BMT. Two patients with CMV infections unresponsive to gancyclovir were successfully treated with foscarnet. 10-15% of CMV infections are resistant initially or develop resistance to gancyclovir. Both patients had an adequate trial of gancyclovir and resistance developed over time. While we did not document resistance in the laboratory there was dramatic clinical improvement with foscarnet.     

Candida Meningitis in Children: Report of Two Cases

Abstract

Candida meningitis is rare in children. However reports have been increasing recently. We report two cases of meningitis caused by Candida species. The first case was a term male infant who was admitted at 14 days of age with the diagnosis of possible sepsis. He had received multiple courses of antibiotics without improvement. Later his cerebrospinal fluid (CSF) culture grew Candida tropicalis. The damage done by the infection was severe and the patient died.

The second case was a 2-month old girl who was born at 34 weeks of gestation. She was admitted to the Neonatal Intensive Care Unit (NICU) and given antibiotics as prophylaxis. Despite this she developed recurrent episodes of fever that required multiple courses of antibiotics. After discharging her, she continued to have fever. Upon investigation, her blood and CSF grew Candida albicans. She was treated and responded to therapy.     

儿童非霍奇金淋巴瘤96例临床分析

回顾分析了１９８６ 年４ 月至１９９８ 年４ 月住院治疗的９６ 例儿童非霍奇金淋巴瘤（ＮＨＬ） 的临床资料。第１ 阶段（１９８６年４ 月至１９９０ 年１２ 月） ,共２９ 例,采用ＣＯＰ、ＣＨＯＰ、ＣＯＭＰ方案治疗６～８ 个周期,有中枢神经侵犯者给予ＭＴＸ、ＤＸＭ 鞘内注射,每周１ 次。第２ 阶段（１９９１ 年１ 月至１９９８ 年４ 月）,共６７ 例,采用ＣＨＯＰ、ＣＨＯＰ加ＶＰ１６ 治疗８～１２ 个周期,后改用ＣＴＸ＋ＶＣＲ 巩固治疗共１ ．５ ａ 至２ ａ,临床Ⅳ期或病理分类恶性度高者常规鞘内注射ＭＴＸ１２ ．５ ｍｇ／ｍ２（ 最大量１２ ．５ ｍｇ） ,ＤＸＭ５ ｍｇ,每周１ 次,连续４ 次,有中枢神经侵犯者,每周２ 次,待脑脊液转阴后改为每周１ 次。结果表明,儿童ＮＨＬ 多见于男性年长儿,高发年龄６～１３ 岁,Ⅲ、Ⅳ期患儿所占比例高（６７．７％） ,易侵犯骨髓（３３．３ ％） 及中枢神经（１３ ．５％ ）,初诊到确诊时间平均为７３ ｄ,最长达１ａ 。第１ 阶段疗效为：ＣＲ３７ ．９％ ,５ａ 生存率为２０ ．０％ 。第２ 阶段疗效为：ＣＲ６２．７ ％ ,５ ａ 生存率４９ ．４％ 。Ⅰ、Ⅱ与Ⅲ、Ⅳ期的５ ａ 生存率分别为８５ ．５％ 和９．８ ％ ,有显著差异（Ｐ     

骨外骨肉瘤病理特征与鉴别诊断4例报道并文献复习

目的 探讨骨外骨肉瘤（extraskeletal osteosarcoma, EOS）的临床病理特征、免疫表型及病理诊断与鉴别诊断要点。方法 收集4例EOS,对其临床、病理组织学及免疫表型进行观察并复习相关文献。结果 4例患者均为成年男性,平均年龄35.5岁。主要表现为无痛性或有触痛性软组织肿块。3例发生于下肢,1例发生于上肢。2例为肌纤维母细胞型EOS,1例为小细胞型EOS,1例为恶性纤维组织细胞型EOS。病理检查：(1)肉眼观见瘤体最大径平均为4cm,切面灰白,质软质脆,界限清楚。(2)镜检:肌纤维母细胞型EOS呈小叶状结构,细胞呈梭形或卵圆形。小细胞型EOS瘤细胞形态一致,弥漫分布。恶性纤维组织细胞型EOS瘤细胞多形性,伴多核巨细胞。（3）免疫组织化学：4例均表达Vim,OC,1例表达OCT。4例均不表达S100、desmin、CD34、NSE及SMA。结论 EOS是一种罕见的软组织肿瘤,其诊断主要依靠组织病理学特征,免疫组织化学标记可帮助诊断和鉴别诊断。     

Simple Bone Cysts: Report of Two Unusual Cases

Two cases of unusual, simple bone cyst are reported. One involving the left mid-radius in an eight year-old boy and the other, post-traumatic, involving the left tibia in a three-and-a-half year-old girl.