I型神经纤维瘤病七例报告

探讨I型神经纤维瘤病的临床特征及整形外科治疗方法。回顾分析1989年1月～2003年12月收治的7例I型神经纤维瘤病的临床资料。1例分次切除＋植皮手术，1例采用部分瘤体皮肤回植，皮片成活好。2例采用预置扩张器＋二期皮瓣修复手术，效果好。其余3例在四肢者，采用邻近皮瓣或岛状皮瓣修复。随访1-3年无复发。按整形外科原则利用合适的组织移植是治疗I型神经纤维瘤病较好的外科方法。     

原发肾淋巴瘤五例报道并文献复习

回顾分析5例原发肾淋巴瘤(primary renal lymphoma,PRL)的临床病理资料,男4例,女1例;中位年龄36岁,最初所有病例均误诊为肾癌,4例为B细胞来源,中位随访时间为38个月,中位生存期为38个月(4~112个月)。回顾性分析的结果表明,PRL是一种罕见的结外恶性淋巴瘤,以成人发病为主,男性占优势,易误诊为肾癌,病理类型多为B细胞来源的非霍奇金淋巴瘤,综合治疗是取得长期生存的最佳治疗方式。     

原发肾淋巴瘤五例报道并文献复习

回顾分析5例原发肾淋巴瘤（primary renal lymphoma,PRL）的临床病理资料,男4例,女1例;中位年龄36岁,最初所有病例均误诊为肾癌,4例为B细胞来源,中位随访时间为38个月,中位生存期为38个月（4～112个月）.回顾性分析的结果表明,PRL是一种罕见的结外恶性淋巴瘤,以成人发病为主,男性占优势,易误诊为肾癌,病理类型多为B细胞来源的非霍奇金淋巴瘤,综合治疗是取得长期生存的最佳治疗方式.     

“蚌壳状”截骨术治疗股骨干骨折术后畸形愈合再骨折一例报道

临床资料患者,男,61岁,35年前因右股骨干骨折在外院手术治疗,术后于当地医院复查提示股骨骨折畸形愈合,内固定存留,患者长期跛行。入院前16天患者在路边走路时滑倒摔伤,当即感右大腿疼痛,被急送往当地县医院行X线检查提示:右股骨干骨质续性中断,右股骨骨折内固定术后。     

A comparison of the result of a three-part study with the rights of cancer patients presented in public reports, laws and regulations

People diagnosed with cancer often state that they are left to their own resources after receiving their diagnosis and possibly receiving treatment at a hospital. In all likelihood, most of those afflicted with cancer will require follow-up care. The Norwegian Cancer Plan of 1997 proposed that more should be done for people afflicted with cancer. With these factors as the starting point, a three-part study with use of interviews and questionnaires was conducted to identify and evaluate the scope of follow-up care in one Norwegian county with 26 municipalities in a sparsely populated region. This article examines consequences of the sickness for those afflicted. Next, the article discusses who is responsible for organizing follow-up care, and the related official reports, laws and regulations. The article also discusses the results of a three-part study that sought to identify those components of follow-up care that worked effectively and those that did not, with the aim of drafting a follow-up care programme.     

肺血管内大B细胞淋巴瘤一例分析并文献复习

为了探讨血管内大B细胞淋巴瘤(IVLBCL)的临床和病理特点,分析1例IVLBCL的临床特征和病理资料,用形态学方法和免疫组化染色进行研究。系统分析国内公开报道24例IVLBCL临床表现及诊断特点。本例临床表现以呼吸系统症状为主,肿瘤通过肺活检发现,镜下表现瘤细胞仅位于小血管腔内,瘤细胞大,核仁明显。瘤细胞表达淋巴细胞标记LCA(+),CD20(+),CD79a(+),CD3(-),CD45RO(-),血管内皮CD31(+),CD34(+)。初步研究结果提示,我国IVLBCL具有自身特点,该瘤是一种罕见的结外弥漫性大B细胞淋巴瘤,诊断只能依靠病理检查确诊,发热气喘等呼吸系统症状具有提示作用。该瘤具有高度恶性和高度侵袭性,预后很差,早期诊断具有重要意义。     

Medication errors involving oral chemotherapy

BACKGROUND:

Given the expanding use of oral chemotherapies, the authors set out to examine errors in the prescribing, dispensing, administration, and monitoring of these drugs.

METHODS:

Reports were collected of oral chemotherapy‐associated medication errors from a medical literature and Internet search and review of reports to the Medication Errors Reporting Program and MEDMARX. The authors solicited incident reports from 14 comprehensive cancer centers, and also collected incident reports, pharmacy interventions, and prompted clinician reports from their own center. They classified the type of incident, severity, stage in the medication use process, and type of medication error. They examined the yield of the various reporting methods to identify oral chemotherapy‐related medication errors.

RESULTS:

The authors identified 99 adverse drug events, 322 near misses, and 87 medical errors with low risk of harm. Of the 99 adverse drug events, 20 were serious or life‐threatening, 52 were significant, and 25 were minor. The most common medication errors involved wrong dose (38.8%), wrong drug (13.6%), wrong number of days supplied (11.0%), and missed dose (10.0%). The majority of errors resulted in a near miss; however, 39.3% of reports involving the wrong number of days supplied resulted in adverse drug events. Incidents derived from the literature search and hospital incident reporting system included a larger percentage of adverse drug events (73.1% and 58.8%, respectively) compared with other sources.

CONCLUSIONS:

Ensuring oral chemotherapy safety requires improvements in the way these drugs are ordered, dispensed, administered, and monitored. Cancer 2010. © 2010 American Cancer Society.     

食管癌术后并发胸胃穿孔3例分析

目的探讨食管癌术后并发胸腔胃穿孔（胸胃穿孔）的病因、诊断、治疗和预防。方法回顾性分析食管癌手术279例术后并发胸胃穿孔3例。结果手术治疗均获成功,术后未再发生瘘。结论食管癌术后并发胸胃穿孔的原因常与手术操作技术相关,术后早期发生,宜尽早二次开胸手术修补,效果满意。     

头皮血管内皮细胞瘤一例报告及文献复习

为了探讨头皮血管内皮细胞瘤的发病机制及综合治疗,分析1例头皮血管内皮细胞瘤患者的临床表现及治疗并回顾分析相关文献。患者接受了病变扩大切除手术治疗,术后给予放化疗。3个月后局部复发,14个月后死于肺转移。复习82例头皮血管内皮细胞瘤患者临床资料,75.6%的患者进行了手术治疗,其中48.8%的患者进行了术后化疗/放疗,26.8%的患者只进行了手术切除。初步研究结果提示,头皮血管内皮细胞瘤是一种少见的、具有侵袭性生长的恶性病变,其最适治疗方法为手术切除加广泛的放疗,但局部复发及远处再发的可能性较高。化疗可能起到短期缓解的作用。     

卵巢环状小管性索瘤2例报道并文献复习

报道2例罕见的卵巢环状小管性索瘤(SCTAT),讨论该瘤的临床病理特征。通过临床和随访资料复习、光镜组织学检查和免疫组化染色,对2例SCTAT的临床和病理学特征进行研究并复习文献。临床表现均为月经紊乱和腹部包块。病理检查2例均为单侧卵巢肿块,最大径分别为29cm和9cm,镜下肿瘤均由简单和复杂的环状小管组成,瘤细胞α-抑制素( ),其中1例有盆腔和腹股沟淋巴结转移且于2年内复发并死亡。回顾分析显示,SCTAT在1994年1月1日~2004年12月31日我国文献(清华同方:中国医院数字图书馆、CHKD期刊全文数据库。并列图书馆查阅及后参考文献核实病例无重复)中共有79例报道,包括我们的2例共约81例,但有Peutz-Jegher’s综合征(PJS)肿瘤仅1例,远低于国外报道。无PJS的肿瘤中约22.5%为恶性,较国外报道相近。初步研究结果显示,与PJS无关的SCTAT中约1/5有恶性生物学行为。α-抑制素是SCTAT首选的免疫标记物。     

Available resources and challenges for the clinical annotation of somatic variations

Next‐generation sequencing (NGS) has become an important tool for identifying clinically relevant variants in both inherited disorders and oncology. Variants annotation that enables the creation of meaningful clinical reports often requires mining multiple publicly available databases. There are a number of such resources that have been designed to catalog and mine a plethora of germline variants or mutations. However, when analyzing tumor specimens in clinical settings, one may need to use different or ancillary resources that are specific for somatic variants or actionable mutations that may have clinical or treatment implications. The purpose of this review is to recapitulate the state of the art of somatic variation databases, which can aid in the clinical interpretation of NGS‐based assays in oncology. In addition, the current need for collating various annotation sources into one‐stop solutions to facilitate faster query execution and better integration into existing laboratory information systems are discussed. Cancer (Cancer Cytopathol) 2014;122:730–736 . © 2014 The Authors. Cancer Cytopathology published by Wiley Periodicals, Inc. on behalf of American Cancer Society.     

Ten years of disease-free survival between two diagnoses of small-cell lung cancer

Small-cell lung carcinoma (SCLC) represents one-fifth of all cases of bronchopulmonary cancer and has a 5-yr survival of 2-4%. Long-term survivors of SCLC are at risk for developing second primary aerodigestive tumors. We report a case of a long-term survivor who had a 10-yr disease-free survival between two diagnoses of SCLC. A literature review identified four case reports and seven review series with a total of 26 cases of 5-yr disease-free survivors of SCLC who developed a second SCLC. A total of 4574 patients were reported in the review series. Five-year disease-free survival was documented in 139 of 4574 patients. Twenty-two (15.8%) of those developed a second SCLC over the next 7 yr of follow up, with an averaged annual incidence equal to fivefold that of the general population. Earlier reports of a slow radiographic doubling time for some cases of SCLC suggests that survivors of SCLC may still develop a recurrent SCLC following 12 yr of disease-free follow up. It remains difficult to ascertain whether a second SCLC is a recurrence or a second primary tumor in the absence of a preneoplastic lesion for SCLC. New genetic markers may hold the answer. They may also help screen high-risk patients including survivors of SCLC.