OBJECTIVE To analyze the indications for revision surgery after limb salvage procedure of malignant bone tumor and summarize the experiences in revision surgery. METHODS From January 1994 to December 1997, 8 cases were re-operated after primary limb salvage procedure. The average survival period with no-tumor occurrence was 8 years. The common causes for the revision were traumatic osteoarthritis, fracture, and bone resorption. The main difficulties in revision were soft tissue contracture and limb discrepancy from limb shortening. RESULTS In this study, there was total hip replacement in 1 case, large segmental allograft for reconstruction of distal femur in 3 cases, total knee replacement upon composite of previously transplanted allograft in 3 cases, removing of intramedullary nail and re-internally fixed with intramedullary nail in 1 cases. The isotopic bone scan before the revision showed active bone metabolism in all 4 transplanted segmental allograft. The pathologic study of the transplanted allograft after revision confirmed new bone formation in allograft. The revision procedure reduced the pain, and improved the limb function. CONCLUSION The main causes of revision surgery after limb salvage procedure of malignant bone tumor are fracture of transplanted allograft segment or devitalized tumor segment, and poor function of the affected joint. Constrained knee prostheses with rotating hinges or semi-constrained ball-axis resurfacing knee prostheses improve the function of knee joint postoperatively.
Objective To evaluate the efficacy of transposition of the medial gastracnemius muscle flap in the limbsalvage operation of the proximal tibial tumors. Methods From January 2001 to September 2005, 13 patients (8 males,5 females; aged 14-57 years, averaged 29.7 years) suffering from the proximal tibial tumors were treated with a limbsalvage operation. Among them, there were 4 patients with osteosarcoma, 6 with malignant fibrous histocytoma, 1 with malignant giant cell tumor, 1 with synovial sarcoma, and 1 with Ewing’s sarcoma. According to the Enneking staging system, 1 case was in Stage ⅠB, 9 in Stage ⅡA, and 3 in Stage ⅡB. One or two cycles of neo-adjuvant chemotherapy were used to each of the patients before operation. All of the patients underwent the medial head of the gastrocnemius muscle flap transposition to reconstruct the soft tissues after resection of the tumors and reconstruction of the bone defect by prothesis or bone-graft or the two methods combined. Results The follow-up for 7-47 months (average, 19.2 months) in all the patients revealed that. there was no flap necrosis, no skin necrosis at the incision margins, and no infection or fracture of the implanted bone. The patient with malignant fibrous histocytoma died of systemic metastasis 20 monthsafter operation. The patient with Ewing’s sarcoma had a local tumor recurrence 18 months after operation; though treated with the focal cleaning and the bone cement filling, the patient still developed lung metastasis of the tumor 26 months after operation. The patient with osteosarcoma underwent amputation 12 months after operation because of the tumor recurrence. According to the function assessment by the Mankin system, there were 6 patients who had an excellent result, 4 had a good result, and 3 had a poor result, with a satisfaction rate of 77%. Conclusion The flap transposition of the medial head of the gastrocnemius muscle can reconstruct the soft tissue defect, decrease the local complication rate and improve the clinical outcome of the limb salvage for the proximal tibia malignant tumor.
Objective To investigate the diagnosis and treatment methods of primary cardiac malignant tumors，so as to improve its’ level of diagnosis and treatment. Methods From April 2004 to June 2008, 19 patients with primary cardiac malignant tumors were diagnosed and treated in the department of cardiac surgery in this hospital. Male 11, Female 8.Age of the patients was 40.7±12.1 years(17-64 years). Preoperative diagnosis were occupying lesion in cardiac, malignant tumors were possible. Complete resections of malignant tumors were achieved by cardiopulmonary bypass (CPB) in 3 cases, and partially resected in 1 case, heart transplantation was performed in 1 case, only biopsies were performed in 5 cases. 9 cases (47.4%) lost the chances of operative treatments. Results There were no operative and hospitalstay deaths. Hospital stay was 10±7 d（9-15 d）, all patients were safely discharged from hospital. Two cases suffered from postoperative pericardial effusions，and high temperature happened in 1 patient, these 3 cases recovered by puncture and symptomatic treatment. The pathological diagnosis: leiomyosarcoma in 1case, malignant mesothelioma in 1 case and hemangioendothelial sarcoma in 8 cases. 14 cases (73.7%) were followed up from 1 to 38 months, 14 cases died of tumor recurrence or metastasis, the mortality was 73.7%, 5 cases (26.3%) were failed to be followed up. Conclusion The prognosis of patient with primary cardiac malignant tumor is still poor. Earlier diagnosis and complete surgical removal of the tumor as soon as possible may improve the patients’qualities of lives.
Objective To observe the toxic and side effects during the continuous hyperthermic peritoneal perfusion chemotherapy (CHPPC).Methods Abdominal paracentesis and catheterization were performed under ultrasound guidance, then CHPPC was carried out, which was in temperature of 42-44 ℃ for 1 h. The changes of body temperature, heart rate, blood pressure, saturation of blood oxygen and respiratory frequency were recorded in 109 patients during and after perfusion, meanwhile symptoms and physical signs of abdominal region and system status such as abdominal tenderness, rebound tenderness were observed. Results There were no significant differences of body temperature, heart rate, blood pressure, saturation of blood oxygen or respiratory frequency between before and after perfusion (Pgt;0.05). There were 25 patients with abdominal pain, but in which only 3 patients with symptoms of acute abdomen, 26 patients with gastrointestinal symptoms, 20 patients with myelosuppression, and others (22 cases) with aches of puncture position which were released by symptomatic treatment. Conclusion There are less toxic and side effect and better tolerance in patients with CHPPC application 1 month after operation.
Objective To retrospectively analyze the morbidity, mortality, epidemiologic trends and distribution characteristic of top-three malignant tumors in Chengdu from 1990 to 2010, and to be aware of the incidence risk factors, and types and syn-position of main tumors, so as to provide evidence for the policy-making of tumor prevention and control. Methods ICD-10 coding method was used to categorize diseases and analyze the morbidity and mortality of malignant tumors seen in different ages, genders, areas and types, based on the surveillance data in Chengdu collected since 1990. Results The morbidity reports of top-three malignant tumors in Chengdu from 1999 to 2010 were lung cancer, liver cancer and colorectal cancer, the same as the mortality reports from 1999 to 2005, But the mortality of gastric cancer exceeded that of colorectal cancer and ranked as the third from 2005 to 2010. The mortality of top-three malignant tumors in male patients was higher than those in female patients. No difference was observed between urban and rural areas. The mortality of main malignant tumors rose along with the age growth. Conclusion Lung cancer, liver cancer and gastric cancer have become the main malignant tumors threatening Chengdu civilians, and their morbidity and mortality are rising yearly, which suggests that the prevention and control measures such as early diagnosis and treatment should be implemented aiming directly at those main tumors.
From 1987 to 1993, 12 cases of primary gastric malignant lymphoma (PGML) were hospitalized. The incidence of PGML was 1.9% of gastric malignancies during the same period. There were 5 cases in stage Ⅰ, 4 in stage Ⅱ, 1 in stage Ⅲ, and 2 in stage Ⅳ. The preoperative diagnosis of PGML was difficult because the incidence of PGML is low, the symptoms are nonspecific, and the radiologic and fibrogastroscopic character were very similar to those of gastric carcinoma and peptic ulcer disease. The surgical treatment of PGML is disccused.
Objective To assess the methodological quality of clinical studies using Shen-Mai injection as an adjunct therapy to tumor chemotherapy and to evaluate its efficacy and safety. Methods A comprehensive search strategy was designed to identify all randomized controlled trials (RCT) comparing Shen-Mai injection plus routine chemotherapy versus routine chemotherapy alone by searching for the CBMdisc (issue 3) and TCMLRS database (1981-2001). The methodological quality of the trials was assessed by two reviewers independently for which a meta analysis was perfermed. Results Thirteen RCTs met the inclusion criteria. methodological quality was poor (all the trials included were level C). Compared with the control group, the combined outcome of Shen-Mai injection increased the effect of chemotherapy (OR 1.73 95%CI 1.27 to 2.34, P＝0.000 4), reduced the side effect of bone marrow inhibition (OR 0.29, 95%CI 0.16 to 0.52, P＝0.000 04) in WBC counting and (OR 0.11, 95%CI 0.02 to 0.49, P＝0.004 in PLT count. And Shen-Mai injection relieved the symptoms of nausea and vomiting (OR 0.26, 95%CI 0.16 to 0.43, Plt;0.000 01). Conclusions The methodological quality of the trails using Shen-Mai injection should be improved. Based on the results of the review and the meta-analysis, Shen-Mai injection may have positive effects on chemotherapy in patients with malignant tumor, although the evidence is weak. No serious adverse events are reported. Further well-designed clinical trials should be performed.
After freatment of prosthesis replacement for 12 malignant tumer of the proximal humoral werereported. The operation were performed after the indications and methods of treatment had beendefined. All of the 12 cases were followed-up, in the average of 8 yeare. On functional evaluation , 8cases had satisfactory result , but per in 1 cases and 3 cases died from recurrence or metastasis withinfive years. The indieation of the procthetic replantation, the complications, and revision weredisecused.
Objectives To systematically review the efficacy and safety of Yangzhengxiaoji capsule combined with chemotherapy for malignant digestive tract tumor. Methods CNKI, WanFang Data, PubMed, EMbase, SinoMed and The Cochrane Library databases were searched online to collect randomized controlled trials (RCTs) of Yangzhengxiaoji capsule combined with chemotherapy for malignant tumor of digestive tract from inception to November 20th, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was then performed using ReMan 5.3 software. Resluts A total of 15 RCTs were included. The results of meta-analysis showed that: compared with the chemotherapy alone, Yangzhengxiaoji capsule combined with chemotherapy could significantly improve the disease control rate (RR=1.26, 95%CI 1.07 to 1.49, P<0.000 01), the clinical efficacy of TCM syndrome (RR=1.71, 95%CI 1.50 to 1.96,P<0.000 01), and the quality of life scores of patients (RR=1.44, 95%CI 1.13 to 1.82,P=0.003). The combination therapy could also improve the immune function of patients and reduce the incidence of adverse reactions. Conclusions Current evidence shows that chemotherapy combined with Yangzhengxiaoji capsule is superior to chemotherapy alone for disease control of malignant tumor of digestive tract, clinical efficacy of TCM syndrome, the quality of life, and improving immune function. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
Objective To investigate the epidemiological characteristics of malignant tumor deaths in the registered population of Zhuhai city. Methods A retrospective survey of death from malignant tumor during 2004 and 2005 was performed in the registered population of Zhuhai city. This was based on the retrospective protocol of the third national survey of death cause. The mortality of main malignant tumor and cause of deaths were analyzed. Results During 2004 to 2005, the mean crude mortality and age-specific standardized mortality of malignant tumor were 90.3/100 000 and 97.2/100 000, respectively. Malignant tumor death was the most common cause of death in Zhuhai city, accounting for 21.8% of all deaths. The standardized mortalities in males and females were 119.7/100,000 and 71.6/100,000, respectively. The standardized rate in the male population was significantly higher than that of the female population (u=10.3, Plt;0.01). The mortality of malignant tumor tended to increase with age. The top five causes of malignant tumor deaths were lung cancer, liver cancer, colorectal cancer, nasopharyngeal cancer and gastric cancer. Their standardized mortalities were 20.9, 18.0, 8.7, 8.2, 8.1/100,000, respectively. Conclusion The mortality of mal ignant tumors has showed an increasing trend in Zhuhai city, with the main tumors being lung cancer, liver cancer, colorectal cancer, nasopharyngeal cancer and gastric cancer. Malignant tumor has become a common and frequently-occurring disease with a major impact on the life and health of people in Zhuhai city.