伽玛刀治疗脑血管瘤（附10例报告）

目的:研究伽玛刀治疗脑血管瘤的疗效.方法:从2002年2月-2007年7月,伽玛刀治疗脑血管瘤10例,男5例,女5例,其中海绵状血管瘤6例, 动静脉畸形3例, 未定型1例.血管瘤最大3cm×3cm,最小1.5cm×1cm.伽玛刀最大计量45Gy,最小20Gy.结果:全部病例随访满3年,血管闭塞8例(8/10),无出血者.患者症状随治疗时间延长逐渐消失.结论:伽玛刀治疗脑血管瘤安全、有效.其治疗效果与脑血管瘤的部位、体积、照射剂量密切相关.     

Survival patterns in treated cases of carcinoma larynx in North India: A 10-year follow-up study

Carcinoma of larynx is a common disease in North Indian population. It is seen commonly in smokers and alcoholics. It poses a serious health problem due to its tendency to cause airway obstruction and to make the patient aphonic if total larynxgectomy is done for curing this cancer. We conducted a retrospective analysis in 690 cases of carcinoma larynx presenting to Nehru Hospital, Postgraduate Institute of Medical Education and Research, Chandigarh. Various aspects of this disease like predisposing factors, patterns of spread, histological types, various treatment modalities, their complications and response of this disease to these therapeutic options were studied in detail.     

Testicular seminoma. A study of 103 cases treated at UCLA

The records of all patients treated at UCLA with stage I through stage III testicular seminoma, diagnosed in 1956-1983, were reviewed. Histologic subtype, therapeutic protocol, survival, and the incidence of subsequent primary malignancies are examined in this presentation. The 10 year cause-specific survival is 93% for stage I and 70% for stage II patients. Of the four patients initially seen with stage III disease, three have achieved long-term disease-free survival after combined irradiation and chemotherapy. Irradiation of the whole pelvis was not associated with improved control for those patients with previous pelvic surgery. Four patients complained of gynecomastia after therapy, and since none of these patients had elevated human chorionic gonadotropin levels, the gynecomastia was attributed to gonadal failure.     

A clinicopathological study of recurrent gastric cancer cases treated by a resection of the remnant stomach

Seventeen cases of a recurrent gastric cancer that were treated by a resection of the remnant stomach have been studied retrospectively. For first management 12 cases were given a Billroth 2 procedure, 4 cases a Billroth 1 procedure and 1 case a fundectomy. For the recurrent cancer, 13 cases were given a total resection of the gastric remnant and 4 cases a partial resection. The overall mortality rate was 12% and the survival rate was 58% at 1 year, and 8% at 5 years. We thus have concluded that a resection of the remnant stomach should be carried cut in cases of a recurrent gastric cancer whenever possible.     

肿瘤细胞丰富的霍奇金淋巴瘤10例临床病理分析

  目的　研究肿瘤细胞丰富的霍奇金淋巴瘤（NCRHL）的临床特征、病理特点、免疫表型及EB病毒感染情况,以提高对NCRHL的认识和诊断水平。方法　收集10例NCRHL,应用光学显微镜观察、免疫组织化学方法及原位杂交技术,结合临床资料分析,对10例NCRHL进行临床病理、免疫表型和EB病毒感染的研究。结果　NCRHL多见于青年人,中位年龄25.5岁,男女比为1∶2.3,常伴浅表淋巴结及纵隔肿大。可有B症状（6例）、皮肤瘙痒（5例）、贫血（1例）等临床表现。淋巴结结构破坏,瘤细胞数量增多为其突出表现,并且瘤细胞形态多样（霍奇金细胞样、陷窝细胞样、干尸细胞样、间变细胞、奇异核细胞、多核巨细胞样细胞等）,背景中的炎性细胞无明显减少,多数病例没有明显纤维化,也不形成纤维条带围绕的硬化结节,50 %病例有灶状坏死。肿瘤组织表现为灶片状、坏死肉芽肿样和弥散状生长方式。免疫表型：所有检测的病例表达CD30和PAX5,不表达LCA、CD3和CD20,仅有2例（20 %）表达CD15;6例行EB病毒编码的小RNA（EBER）检测,均为阴性。10例患者中,8例获得随访,其中1例死亡,1例复发,其余6例化疗后均完全缓解。结论　NCRHL以肿瘤细胞数量增多为主要形态学特征,呈灶片状、坏死肉芽肿样和弥散状生长方式,无EBER表达,部分病例治疗方案效果不理想,有待探索新的治疗方案。     

Chondromyxoid fibromas: a study of 10 cases

Chondromyxoid fibroma (CMF) can be confused with a malignant tumor because of its potential for recurrence and occasional nuclear atypia. This study of 10 cases of CMF comprises 6 men and 4 women, with a mean age of 24.3 years. Tibia was the preferred site of involvement. The histology showed lobulated chondromyxoid matrix with peripheral fibrosis. Two cases had local recurrences following intralesional excision. The study emphasizes that despite nuclear atypia and recurrences, CMF is a benign disease.     

BP素联合化疗对60例恶性肿瘤患者的临床观察

目的本研究观察大剂量牛胰抗癌免疫核糖核酸(以下简称BP素吉林敖东药业集团生产)联合化疗对恶性肿瘤患者近期疗效的影响及对其T细胞亚群的影响.方法60例患者,采用单盲随机分为化疗加BP组(实验组)和单独化疗组(对照组),实验组于化疗同时每日静点BP素100mg,连续静点90天(一个疗程)后检测T细胞亚群的变化,观察近期疗效,观察血白细胞的变化,并通过Karnofsky评分了解患者的生活质量.结果(1)实验组化疗后CD3、CD4和CD56(Nk)的阳性率及CD4/CD8的比值均明显高于本组化疗前和对照组化疗后水平.(2)实验组近期疗效的有效率为62.9%,对照组近期疗效的有效率为40%,二者相比有显著性差异.(3)实验组化疗后Karnofsky评分明显高于本组化疗前和对照组化疗后.(4)实验组化疗后的白细胞下降例数及程度均明显低于对照组,差异有显著性.结论(1)大剂量BP素可显著提高肿瘤化疗病人机体的免疫功能.(2)实验组用BP素治疗后患者食欲增加,生活质量明显改善.(3)化疗联合BP素治疗,疗效更佳,并能减少化疗毒副反应及保护骨髓功能.     

Gastric cancer treated by hematoporphyrin derivative(HPD)-laser--histopathological study of 10 gastrectomy specimens

10 patients with gastric carcinoma treated by HPD-laser preoperatively are reported. The gastric lesions were irradiated with laser beam delivered by a quartz fibre through the fiberoptic gastroscope 48-72 hours after intravenous injection of HPD (5.0 mg/kg) about 2 weeks before operation. In the resected specimens, the histological changes following HPD-laser therapy were studied. The cancer cells in the irradiated areas showed degeneration and necrosis in varying degrees. Because of the fact that the light spots were small and the penetration not deep enough, the cancer cells beyond the irradiated area and those infiltrating more deeply or beyond the gastric wall did not show any evident changes while metastatic cancers in the lymph nodes showed no changes at all. These facts may suggest that the HPD-laser therapy should not be used as the main therapeutic method to replace operation, radiotherapy or chemotherapy for gastric cancers in either advanced or early stage.     

Secondary carcinoma of testis--a clinicopathologic study of 10 cases

Ten cases of metastatic carcinomas to the testis are recorded in the last 17 years from Tata Memorial Hospital (TMH). There were two from kidney and four each from prostate and gastrointestinal tract carcinomas. The age of the patients ranged from 40 to 82 years with a mean of 57 years. The disease was unilateral in eight cases and bilateral in two. The testicular mass preceded the symptomatology of the primary lesion in a single case. The disease was an incidental finding in three prostatic carcinomas, where bilateral orchidectomy was performed as a therapeutic procedure. Hydrocele was associated in three cases. Grossly the tumour deposits were nodular or diffuse. Microscopically involvement of the interstitial parenchyma, with sparing of the tubular structures of the testis, epididymis and retetestis and special stains for mucin were helpful in the diagnosis. Lymphatic emboli were present in six cases and vascular emboli in three. The spermatic cord was involved in two cases.     

Oncoplastic surgery with omental flap reconstruction: a study of 200 cases

Background

There are several small case series on use of a laparoscopically harvested omental flap (LHOF) for breast reconstruction. However, the long-term oncological safety and clinical benefits of the LHOF remain uncertain, especially in use of the flap in oncoplastic breast surgery.

Study design

A retrospective chart review was performed for 200 patients who underwent oncoplastic breast surgery using a LHOF at our institution from April 2002 to March 2016. Laparoscopy-associated complications, local recurrence, and cosmetic outcomes were evaluated.

Results

Most of the patients underwent partial breast reconstruction immediately after breast-conserving surgery (BCS). The success rate of laparoscopic harvesting of the omental flap was 99.5%. The rate of complications was 12.0% and laparoscopy-associated complications occurred in four cases (2.0%). The rate of a positive margin was 6.5%. Two cases (1.0%) had local recurrence during a median follow-up period of 90 months. In 24 patients (12.0%), the volume of the flap was insufficient. When applied to total reconstruction, volume insufficiency occurred in 32.6% of patients. Cosmetic outcomes were mostly satisfactory. Approximately 80% of patients were rated as good or excellent by evaluation using a 4-point scale and Breast Cancer Conservative Treatment cosmetic results (BCCT.core) software. Donor-site scars were negligible, as in laparoscopic cholecystectomy.

Conclusions

The LHOF has minimal donor-site morbidity and deformity, and oncological safety is promising. There is a limit to the adaptable volume, but the LHOF is an attractive option in partial breast reconstruction after BCS.

     

A study of complete responders in cases of metastatic breast cancer treated with combination chemotherapy

Twenty-eight patients with a metastatic breast cancer who have achieved a complete remission from a combination chemotherapy that included doxorubicin have been analyzed to ascertain the factors which affect the duration of the response and the survival time. The median duration of a complete remission was 26 months. Relapses occurred in 17 patients (61%), of which the median duration of the response was 18 months and 71% of the relapses occurred at the sites of the prior dominant disease. Most of the patients suffered a relapse while they were receiving maintenance chemotherapy. The number of metastasized organs were one or two in 89% of the patients. The dominant sites of the disease were mainly the visceral (61%) and soft tissue (29%), and the duration of survival was found to be longer in patients with a visceral metastasis. In the group of patients who experienced a recurrence 2 years or more after their operation showed a statistically longer remission and survival time than those who experienced a recurrence within 2 years. The duration of survival from the start of chemotherapy was 45.5 months for complete responders and 21 months for partial responders. This difference was statistically significant (p less than 0.001), though no difference was found between partial responders and "no-change" patients (18.5 months). The tendency towards a relapse at the site of the initial involvement and while receiving maintenance therapy suggests that the majority of patients with a metastatic breast cancer who achieved a complete remission with this combination chemotherapy still have a substantial subclinical residual tumor. Maintenance treatment should be investigated to ascertain the procedures and duration of therapy. Thus, these results have indicated that it is necessary to achieve a complete remission in order to obtain a long term survival.     

51例乳腺癌患者术后游离腹壁皮瓣乳房重建的临床分析

背景与目的:随着乳腺癌患者预后的不断改善,全乳切除后接受乳房重建手术的患者比例正逐年增高。腹部游离皮瓣是目前应用最多的自体组织乳房重建方法。本研究旨在探讨游离腹壁皮瓣乳房重建在临床实践中的应用价值。方法:对2006年6月—2011年11月在复旦大学附属肿瘤医院接受游离腹壁皮瓣乳房重建的51例乳腺癌患者进行回顾性分析。在51例患者(1例患者为双乳重建,手术计52例次)中,行游离的横行腹直肌(free transverse rectus abdominis myocutaneous,F-TRAM)手术1例次,保留肌肉的F-TRAM19例次,DIEP 32例次。结果:手术成功49例(96.1%)。受区血管的选择:胸廓内血管42例次(80.8%);胸外侧血管1例次(1.9%);肩胛下血管9例次(17.3%)。穿支平均数量为2.31支(1～4支),平均手术时间为8.1 h(4.6～12 h),平均住院时间为20 d(10～39 d),术后平均住院时间为11 d(4～22 d)。在Ⅰ期重建的40例患者中(包括1例双侧Ⅰ期乳房重建),术后化疗有23例(57.5%),其手术距离首次化疗时间为15.6 d(7～33 d)。乳房重建术后乳头重建患者13例(25.5%)。随访1.2～38.5个月,中位随访7.5个月。全部皮瓣坏死2例(3.92%),皮瓣感染1例(1.96%),皮瓣下血肿1例(1.96%),部分脂肪坏死8例(15.69%),腹部并发症3例(5.88%)。患者总体满意度为8.5分。结论:游离腹壁乳房重建有较好的临床应用价值。血供佳,皮瓣组织量大,可以满足大部分患者的需求。术后供区并发症较少,患者对重建形体的满意度较高。但该术式需要较高的手术技巧、先进的手术设备及护理团队的配合。     

Uncommon variants of cervical carcinoma treated with radical irradiation. A clinicopathologic study of 66 cases

Although certain histologic types are uncommon in cervical carcinoma, these tumors as a group comprise almost one in five patients. The present study throws some light on the therapeutic approaches that are appropriate. From 1968 through 1978, 396 patients with carcinoma of the cervix were treated primarily with radiation therapy, at the University of Virginia Medical Center. The treatment policy remained consistent throughout the study interval. Diagnostic pathologic material was reviewed and uniformly classified in 365 cases (92.2%). Over 80% were invasive keratinizing or nonkeratinizing squamous cell carcinoma. There were 66 patients with uncommon histologic types including 24 adenocarcinomas (6.6%), 13 adenosquamous carcinomas (3.6%), 10 small cell carcinomas (2.7%), 6 papillary squamous carcinomas (1.6%), 5 glassy cell carcinomas (1.4%), and 8 miscellaneous types (2.2%). These 66 patients form the basis for this report. Five-year survival rates and causes of failure are presented along with management recommendations.     

Spinal carcinomatous metastases. Retrospective study of 67 surgically treated cases

A series of 67 surgically treated spinal carcinomatous metastases is reviewed in order to establish the role played by surgery in the management of such a disease. The authors compare the results achieved in two groups of patients treated with a different therapeutic approach: either surgery alone or surgery associated with other therapies (mainly radiotherapy). On this basis, although no ideal treatment for spinal epidural metastases can be established, the authors suggest decompressive laminectomy as a first choice approach in the treatment of patients bearing a scarcely radiosensitive spinal metastasis with a rapidly deteriorating motor function. Address for offprints: Massimiliano Boccardo, M.D., Department of Neurological Surgery, Ente Ospedaliero Ospedali Galliera-via Volta, 8 - 16128 Genova, Italia.