Ethmoid adenocarcinomas: retrospective study of 76 patients

From the retrospective study of 76 adenocarcinomas of the ethmoid sinuses, results were expressed in two terms: the morbidity related to surgery and the oncologic outcome. This case study extends between 1975 and 2000. It includes 71 men and 5 women, with an average of 61 years. 81% of them works in wood dust, with a mean duration of exposure of 26 years. The diagnosis of adenocarcinoma is realized in the three months after the first signs, essentially rhinologicals, next neurologicals and ophthalmologicals. The majority of tumors were classified as T3N0M0, i.e. 57.89%. The treatment of this tumors is surgical: 34.2% surgical only and 59.2% with radiotherapy. The transfacial approach (paralateronasal and degloving) and the combined surgery are respectively performed in 36 patients and 35 patients. 23.2% patients had a local recurrence, and 10% developed cervical nodes and systemic metastasis. Survival rate based on the Kaplan-Meier actuarial method is 82% at 3 years, 80% at 5 years, 72% at 10 years. The prognosis of ethmoidal cancer is strictly correlated to local control. Local recurrence is statistically more likely in patients with involvement of the dura, brain and sphenoid sinus. With the analysis of the carcinologics results, we discuss the therapeutics indications of the adenocarcinomas and a new classification. Taking in account the involvement of the dura, sphenoid and orbit. We did not find any statistical differences between T3 patients treated by combined approach (n = 13) or by transfacial approach (n = 15).     

The Effects of Laparoscopic Adjustable Gastric Banding on the Proximal Pouch and the Esophagus

Background: Pouch development is a potentially serious problem following gastric banding, and re-operation is often demanded to maintain long-term function of the lap band. Laparoscopic gastric banding was performed with two different calibrations of the pouch. Within a period of 12 months, postoperative pouch behavior with regard to volume and shape was evaluated retrospectively, as were changes in the distal esophagus. Methods: The pouches of 14 patients with intraperitoneal band positioning were calibrated at 25 ml. The volumes of 54 patients operated by a suprabursal technique were set at 15 ml. We performed three radiological examinations and calculated the volumes using the ellipsoid formula d1 x d2 x d3 x π/6. Four morphologically different pouch types have been observed: regular, concentric, eccentric-medial and eccentric-lateral. The ϕ-angle corresponds to the angle between the spinal column and the gastric band. Results: In the first group, the pouch volume increased from 21.2 ml ± 21.2 to 87.9 ml ± 64.6 (p=0.006) and the BMI fell from 47.1 kg/m² ± 8.4 to 38.1 kg/m² ± 7.0 (p=0.001). The pouch volume of the second group increased from 10.4 ml ± 5.8 to 38.8 ml ± 29.1 (p<0.001), and the BMI reduced from 48.4 kg/m² ± 6.9 to 39.3 kg/m² ± 6.7 (p<0.001). If the ϕ-angle is smaller than 4°,the pouch is of the eccentric-medial type. Conclusions: The transbursal operative technique is responsible for the development of the eccentric-medial pouch. If the anterior sero-muscular fixative sutures tear, an eccentric-lateral pouch results. All pouch types are affected by changes at the pouch-esophageal junction and by pathological developments in the distal and middle oesophagus.     

肝细胞癌切除术后复发行二次手术切除疗效研究

目的 评估二次肝切除手术（RHR）治疗切除术后复发型肝细胞癌（HCC）病人的安全性和有效性。方法 回顾性分析2007年1月至2011年12月第二军医大学东方肝胆外科医院HCC术后首次复发未行任何治疗的175例行RHR的病人临床资料,统计长期存活率并行预后相关因素分析。结果 RHR后严重并发症的发生率为7.4%,1、3、5年总存活率和无瘤存活率分别为92%、71%、51%和为75%、43%、36%。高龄（>65岁）、首发肿瘤巴塞罗那（BCLC）分期B期、肿瘤出现微血管侵犯、肿瘤直径和肿瘤包膜不完整是影响RHR后总存活率的风险因素。结论 RHR的适应证应严格掌握,经筛选可行者,其安全性较高且疗效理想。高龄（>65岁）、首发肿瘤BCLC分期B期、肿瘤出现微血管侵犯、肿瘤直径和肿瘤包膜不完整的HCC病人RHR后预后相对较差,考虑可否缩短随访时间或联合其他治疗。     

Primary malignant melanoma of the esophagus

Primary malignant melanoma of the esophagus is a rare but aggressive tumor that accounts for less than 0.1-0.2% of all esophageal malignancies. The aim of this study was to report a case of primary malignant melanoma of the esophagus in a 72-year-old woman. The diagnosis was histologically proven, but the patient died despite extensive surgical resection.     

应用二维斑点追踪成像技术监测急性淋巴细胞白血病柔红霉素化疗患儿左室扭转功能探讨

探讨应用二维斑点追踪成像技术监测柔红霉素化疗对急性淋巴细胞白血病（急淋）患儿左心室短轴心肌扭转功能的影响,分析心脏功能损伤与柔红霉素不同累积剂量的关系。方法　研究对象为2007年1月至2009年12月深圳市儿童医院诊断的急淋患儿60例,均接受柔红霉素化疗,按治疗程序分为A组（化疗前）、B组（柔红霉素化疗累积剂量达120 mg/m2）和C组（柔红霉素化疗累积剂量达240 mg/m2）。对照组为同期体检正常儿童60名。检测每组常规超声心动图指标左室射血分数（EF）、二尖瓣口舒张期血流比值（E/A）,并应用超声二维斑点追踪成像技术（two-dimensional speckle tracking imaging,2DSI）检测对照组及A、B、C组的左室短轴基底段和心尖段的心肌节段收缩期峰值旋转度,计算左室心肌收缩期峰值扭转角度。结果　心率、EF、二尖瓣口舒张期E/A比值在对照组、A、B、C各组间比较,差别无统计学意义（P > 0.05）。A、B组与对照组比较,基底段和心尖段的峰值旋转角度差异无统计学意义（P > 0.05）;C组与对照组比较心尖段峰值旋转角度,差异无统计学意义（P > 0.05）; C组与对照组、A组、B组比较,基底段峰值旋转角度差异有统计学意义（F＝5.23, P < 0.05）。A、B组与对照组比较,左室扭转角度差异无统计学意义（P > 0.05）,但C组小于对照组、A组、B组,差异有统计学意义（F＝4.51, P < 0.05）。结论　急淋患儿柔红霉素化疗累积剂量达120 mg/m2时未发现心脏扭转功能损伤,当达到240 mg/m2时,心脏扭转功能出现显著损伤,2DSI可无创性定量监测患儿心脏功能的变化,对临床评价柔红霉素的心脏毒性、预防化疗后遗症的发生有重要意义。