Renal mucinous tubular and spindle cell carcinoma combined with multiple bone metastasis: a case report and literature review / 北京大学学报(医学版)

Mucinous tubular and spindle cell carcinoma (MTSCC) is a rare sub-type of renal cell carcinoma (RCC). It has been considered to be a kind of "indolent" tumor with low-grade fashion, weak invasive capacity and relatively favorable prognosis. However, in the current case, a 3.7 cm×2.8 cm spherical mass with contrast enhancement was found in the left kidney incidentally by computed tomography (CT) in a 60-year-old male patient. A lesion in the right humerus (2.1 cm×1.6 cm×3.1 cm) was found at the same time without any symptoms or sign of pathological fracture by magnetic resonance (MR) imaging. Further positron emission tomography (PET)/CT scan which was ordered immediately after admission suggested multiple bone destruction including skull, pelvis, sternum, right humerus and femur, left scapula, multiple vertebrae and libs. Pathological examination after radical nephrectomy and palliative resection with internal fixation of the lesion in the right humerus indicated that both renal (3.0 cm×3.0 cm×2.5 cm) and bone lesions were MTSCC with the features of high-grade ovoid epithelioid cells, cord-like spindle cells and mucinous matrix under light microscope. The diagnosis of renal MTSCC concurrent with multiple bone metastasis was made. This case report suggested the necessity of general evaluation, especially bone scan for possible distant metastasis, as MTSCC might present unexpected advanced behaviors without any orthopedic symptoms. The behavior of bone metastasis might be associated with male and elderly age. MTSCC has similar enhancement features to papillary RCC on CT scan. As results, attentions are needed to differentiate MTSCC from papillary RCC as they both tend to show lesser enhancement degrees than cortex. Rather than exhibiting a dedifferentiating appearance, the pathological characteristics of bone metastasis lesion were close to those of primary renal lesion. The reason of distant metastasis to the bone remained unclear, negative expression of cytokeratin (CK) 7 might be attributed to. Though immunotherapy, chemotherapy and target therapy could all be methods for systematic therapies, procedures to remove renal lesions and prevent skeletal related events are still highly recommended.

Expressiona of c-Jun and collagens I and III in cultured human skin fibroblasts are affected by infrared ray radiation / 南方医科大学学报

<p><b>OBJECTIVE</b>To observe the effect of solar infrared ray (IR) radiation on the expressions of c-Jun and collagens I and III in cultured human skin fibroblasts (HSFs) and explore the molecular mechanism by which IR radiation causes aging of the skin.</p><p><b>METHODS</b>Primarily cultured HSFs exposed to IR radiation were examined for changes of the cell viability with MTT assay. The mRNA and protein expressions of c-Jun and collagens I and III was detected with real-time quantitative PCR and immunocytochemistry.</p><p><b>RESULTS</b>MTT assay showed that IR irradiation caused inhibition of cell proliferation compared with the control cells. The mRNA and protein expression of collagen I was decreased significantly by IR irradiation with the increase of the irradiation dose (P<0.01). HSFs irradiated by IR for 12 h showed a dose-dependent reduction of the expression of collagen type III mRNA and protein (P<0.05, P<0.01), but the expression increased dose-dependently in response to IR exposure for 24 h (P<0.05 or 0.01). IR irradiation enhanced the mRNA and protein expression of c-Jun in a dose-dependence manner (P<0.05 or 0.01).</p><p><b>CONCLUSIONS</b>IR irradiation can increase the expression of c-Jun, inhibit the expression of collagen I, and cause disturbance in collagen III expression in human skin fibroblasts, which may be one of the mechanism of IR radiation to initiate and promote skin photoaging.</p>

Surgical classification and therapeutic strategy for metastases of proximal femur / 中华外科杂志

<p><b>OBJECTIVE</b>To establish a surgical classification system for metastases of proximal femur and discuss the therapeutic strategy with retrospective analysis and literature review.</p><p><b>METHODS</b>The data of 99 patients who underwent a total of 102 operations for femoral metastatic lesions from January 2003 to December 2011 was analyzed. There were 50 males and 49 females, and the median age was 56 years (range 15-87 years). The most common diagnosis was lung cancer (30 cases), followed by breast cancer (17 cases). All femoral lesions were divided into 4 types (I-IV) with different anatomic site and biomechanic characteristic. The patients with various surgical reconstruction mode and postoperative follow-up data were recorded.</p><p><b>RESULT</b>There were 65 side who received widely or marginal resection and 37 side who received intralesional resection. The patients were operated with bipolar hip prosthesis (n = 3), ordinary total hip replacement (THR) (n = 10), bipolar tumor prosthesis (n = 48), THR with tumor prosthesis (n = 8), intramedullary nailing (n = 21), and plate/screw (n = 12). The estimated survival for the 99 patients was 10.3 months. Type I, II, III and IV patients with postoperative American Society of bone and soft tissue tumors-93 rating were 86.5%, 77.3%, 81.3% and 69.1%. Patients with type IV were worse compared with the other 3 groups (t = 4.763, P = 0.031). The 10 operations were followed by complications of any kind. Complication rate of patients with type IV were 3/12, and it was significantly higher than the other 3 groups of patients (χ(2) = 4.018, P = 0.045).</p><p><b>CONCLUSIONS</b>The classifications and corresponsive surgical methods for upper femur metastases had some superiority in hinting prognosis and guiding treatment.</p>

Surgical management and prognostic factors in patients with spinal metastatic tumors / 中华外科杂志

<p><b>OBJECTIVE</b>To identify the survival prognostic factors and clinical outcome of the patients with spinal metastatic tumors and to discuss the surgical treatment strategy of spinal metastatic tumors.</p><p><b>METHODS</b>The patients with spinal metastatic tumors who received surgeries during January 2003 to June 2012 were enrolled. The survival was analyzed by Kaplan-Meier survival curve. The prognostic factors, divided into patient-related factors, tumor-related factors and therapy-related factors, were analyzed univariately and multivariately by Cox comparative hazard model.</p><p><b>RESULTS</b>There were 453 patients were enrolled in research including 263 male and 190 female patients with an average age of (56 ± 13) years (10-86 years). The median postoperative survival was 9 months. Local recurrences and peri-operative complications were found in 78 (17.2%) and 72 (15.9%) patients, respectively. Univariate analysis showed the significant prognostic factors for postoperative survival included poor preoperative general condition (χ(2) = 4.16), severe preoperative neurologic deficit(χ(2) = 10.23), not receiving bisphosphonate therapy(χ(2) = 10.47), short disease-free interval before spinal metastasis (χ(2) = 23.31), spinal metastasis as the first manifestation (χ(2) = 10.94), rapid-growth primary tumor(χ(2) = 15.45), visceral metastasis (χ(2) = 4.10), not receiving postoperative radiotherapy(χ(2) = 18.10) and not receiving post-operative sensitive systemic therapy(χ(2) = 11.20) (P < 0.05). Multivariate analysis showed the independent prognostic factors include severe preoperative neurologic deficit (P = 0.012, 95%CI: 1.11-2.30), short disease-free interval before spinal metastasis (P = 0.023, 95%CI:1.05-1.83), rapid-growth primary tumor (P = 0.000, 95%CI:1.74-3.06), visceral metastasis (P = 0.008, 95%CI: 1.08-1.68), not receiving postoperative radiotherapy (P = 0.000, 95%CI:1.38-2.35) and not receiving post-operative sensitive systemic therapy (P = 0.045, 95%CI:1.01-1.58).</p><p><b>CONCLUSION</b>The prognostic factors for survival are useful for determining the indication of operation and improving survival and clinical outcome for patients with spinal metastatic tumors.</p>

An analysis of prognostic factors for malignant fibrous histiocytoma of bone / 中华外科杂志

<p><b>OBJECTIVE</b>To study the risk factors related to the survival rate, recurrence and metastasis of malignant fibrous histiocytoma of bone.</p><p><b>METHODS</b>From July 1997 and July 2010, 56 patients with malignant fibrous histiocytoma of bone were treated. Univariate and multivariate analysis were performed to determine the probable risk factors including gender, age, tumor location, tumor size and so on.</p><p><b>RESULTS</b>Forty-four cases were followed up ranged from 2 weeks to 78 months (medium 33.3). The 5-year overall survival rate was 50.1%, local recurrence rate 40.9% with a median time of 12 months (3 to 60 months) and metastatic rate 27.5% (11/40) with a median time of 6.5 months (2 to 23 months). Univariate analysis indicated that gender, condition of presentation (primary case or recurrence case), tumor location, surgical margin and surgical stage were significantly related to survival rate (P < 0.05), and tumor location and surgical margin were related to local recurrence rate (P < 0.05), and important vessel or nerve invasion was related to metastatic rate (P < 0.05). Multivariate analysis showed that surgical margin and surgical stage were independent risk factors for survival rate, of which surgical margin was the independent risk factor for recurrence rate.</p><p><b>CONCLUSIONS</b>Surgical margin and surgical stage are independent risk factors for survival rate, of which surgical margin is the independent risk factor for recurrence rate.</p>

Evaluation of prognostic factors for synovial sarcoma / 中华外科杂志

<p><b>OBJECTIVE</b>To determine the independent prognostic factors of primary synovial sarcoma.</p><p><b>METHODS</b>The clinical data of 52 patients followed up from 66 patients with synovial sarcoma treated between September 1997 and September 2008 was analyzed retrospectively. There were 28 male and 24 female patients aged from 11 to 71 years old. Three and five-year overall survival (OS), recurrence rate and 9 prognostic factors were analyzed in this study. Univariate and multivariate analysis were performed to determine the prognostic factors of OS.</p><p><b>RESULTS</b>Fifty-two patients were followed up with the follow-up time ranged from 6 to 88 months (median 32 months). The 3-, 5-year overall survival rate and local recurrence rate were 52.8%, 30.3% and 32.7% respectively. Univariate showed tumor size < 5 cm, tumor located at extremities, adequate surgical margin and radical resection combined with radiotherapy had better survival rate (P < 0.05). Multivariate analysis demonstrated that tumor size, primary site and adequate surgical margin were independent prognostic factors for OS. Patients received radical resection combined with radiotherapy have longer median relapse time (25 months) compared with marginal resection combined with radiotherapy (18 months) and single radical resection (12 months). Thirty-five (67%) patients were treated with chemotherapy and seventeen (33%) patients received no chemotherapy for the primary tumor. Treatment with chemotherapy was not associated with an improved OS (P = 0.52).</p><p><b>CONCLUSIONS</b>The independent prognostic factors of synovial sarcoma are tumor size, primary site and adequate surgical margin. Doxorubicin and ifosfamide based chemotherapy was not associated with an improved OS in patients with synovial sarcoma. Radical resection combined with radiotherapy can best control local condition.</p>

Ewing's sarcoma of bone:treatment results and prognostic factors / 中华外科杂志

<p><b>OBJECTIVE</b>To determine the prognostic factors from the view of clinic and pathology.</p><p><b>METHODS</b>A retrospective analysis was performed on a data set of 78 patients with Ewing's sarcoma treated at Peking University People's Hospital Musculoskeletal tumor center between July 1998 and July 2007. Five-year overall survival (OS), recurrence rate and prognostic factors were analyzed in this study. Univariate and multivariate analysis were performed to determine the prognostic factors for OS.</p><p><b>RESULTS</b>Fifty-three cases were followed up, follow-up time ranged from 8.0 to 101.0 months (median 37.6 months). The 5-year overall survival rate and local recurrence rate were 33.7% and 20.8% respectively. Univariate showed age < 20 years, metastases free at diagnosis, tumor located at extremities, tumor size < 10 cm, adequate surgical margin had better survival rate (all P < 0.05). Multivariate analysis demonstrated that metastases at diagnosis, primary site and tumor size were independent prognostic factors for OS.</p><p><b>CONCLUSION</b>The independent prognostic factors Ewing's sarcoma are metastases at diagnosis, primary site, tumor size.</p>

The survival and functional outcome of primary bone sarcomas in distal lower extremity / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze the oncological and functional outcome of limb salvage in this location.</p><p><b>METHODS</b>From November 2003 to January 2010, 20 patients with primary malignant bone tumors of the distal lower extremity were treated. There were 15 male and 5 female, the mean age was 20 years. Among 14 patients with malignant distal tibial sarcoma, 11 patients had ankle arthrodesis reconstructed by using allograft (7 patients) or autografts (4 patients), the other 3 patients underwent below-knee amputation. Three patients with osteosarcoma of distal fibula reconstructed with ipsilateral fibular head, 3 patients with calcaneus osteosarcoma underwent total calcanectomy and reconstructed with fibular segment and iliac crest. The mean follow-up was 36.4 months.</p><p><b>RESULTS</b>Five of 7 (71.4%) patients with allograft reconstruction were associated with delayed wound healing, however, only 1 of 10 patients with autograft had this problem (P = 0.036). One local recurrence was observed, 2 osteosarcoma patients died of disseminated disease. The estimated 2-year and 5-year overall survival for the patients with malignant tibial sarcomas were 92.9% and 79.6% respectively, for the patients with distal tibial high-grade osteosarcoma were 87.5% and 70.0% respectively. The mean functional MSTS score was 82% for limb salvage patients.</p><p><b>CONCLUSIONS</b>The survival of patients with primary malignant bone tumor of distal lower extremity seems to be better than that of other sites. Limb salvage can provide satisfactory local control and functional results.</p>

Reconstruction of bony defect after resection of malignant pelvic tumor involvement of sacrum / 中华外科杂志

<p><b>OBJECTIVES</b>To review the patients with malignant pelvic tumors involving sacrum treated surgically and to discuss the methods of resection of tumors and reconstruction of defects.</p><p><b>METHODS</b>Nineteen patients with malignant pelvic tumors involving the sacrum were treated surgically in People's Hospital between July 1999 and July 2007. The series comprised 12 males and 7 females. Five patients were diagnosed with chondrosarcoma, 4 with Ewing sarcoma, 4 with osteosarcoma, 1 with malignant fibrohistiocytoma (MFH), 1 with giant cell tumor (GCT), and 4 with metastatic bone tumors. Acetabulum was preserved after resection of the iliac and sacral tumor and reconstructed with screw and rod system in 10 patients. Among this 10 patients, 5 of them were also done bone graft. Acetabulum was not preserved after resection of the iliac and sacral tumor and the defect was reconstructed with modular hemipelvic prosthesis in 9 patients.</p><p><b>RESULTS</b>Oncology result: 7 patients (7/19, 36.9%) had local relapse, including of 2 osteosarcoma, 2 chondrosarcoma, 2 Ewing sarcoma and 1 metastatic tumor. Two of 4 osteosarcoma, 2 of 4 Ewing sarcoma, 1 of 5 chondrosarcoma and 1 MFH patients died of lung metastasis. Two patients with metastatic lung cancer died of the disease 1 year after surgery. One patient with kidney carcinoma and 1 with thyroid carcinoma alive without of disease. Functional result: 8 patients with acetabular reconstruction after resection of pelvic and sacral tumors could walk with a cane 2 months after surgery. Average ISOLS function score was 20, including good in 3, fair in 5 and poor in 1 patient. One of the patient with modular hemipelvic prosthetic reconstruction occurred dislocation treated with 1 month after surgery and experienced open reduction. Hemipelvic prosthesis was took out in 1 patient because of the deep infection.</p><p><b>CONCLUSIONS</b>For patients with acetabulum preserved after resection of the iliac and sacral tumor, reconstructed with screw and rod system combining with bone graft is an ideal method for restoration. Bone graft with resected femoral head and neck on residual sacrum and modular hemipelvic prosthetic reconstruction after resection of the pelvic tumor involving of the secrum is a good choose.</p>

Total elbow arthroplasty after resection of tumors at the elbow / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the effects and complications of the total elbow arthroplasty after the resection of the peri-elbow tumor.</p><p><b>METHODS</b>Between June 1998 to June 2007, 19 patients underwent total elbow arthroplasty after resection of tumors at the authors department, which involved 13 males and 6 females, including 6 patients with metastatic tumor, 1 with giant cell tumor of bone (GCT), 2 with malignant fibrous histiocytoma (MFH), 4 with osteosarcoma, 3 with Ewing sarcoma, l with lymphoma, 1 with synovial sarcoma, and 1 with desmoid fibroma of the bone. The age of patients ranged from 15 to 71 years (mean 43 years).</p><p><b>LOCATION</b>distal humerus in 9 cases, proximal ulna in 5 and the tumor involving both distal humerus and proximal ulna in 5 patients.</p><p><b>RESULTS</b>Patients were evaluated according to the Mayo Elbow Performance Score. Pain scores decreased from a mean of 3.6 to 2.0. Mean arc of elbow motion from extention to flexion improved from 30 to 80 (range, 55 - 105). Fourteen elbows had excellent or good result (14/19, 77.8%), and 4 elbows had a poor result (22.2%). There was no wound infection or other complication after surgery. During the following up time, 2 patients with metastatic lung cancer, 1 with metastatic rectal cancer and 1 with ovarian cancer died in 2 years after surgery. Two Ewing sarcoma, 1 MFH and 1 osteosarcoma patients occurred lung metastasis (4/18, 22.2%), and two patients had local recurrence (11.1%). Three patients occurred complication during the following time (3/18, 16.7%), the stem of humerus prosthesis came out of channel in 1 case 5 years after surgery, the stem of ulna prosthesis came out of channel in 1 case 4 years after surgery, and both cases did revision surgery. The stem loosening was in 1 humerus prosthesis 4 years after surgery.</p><p><b>CONCLUSIONS</b>The results show that total elbow arthroplasty after resection of tumors can decrease the pain, and improve the function substantially. For metastatic tumors, this technique also can be used if there is no other good option.</p>

Resection and reconstruction of upper thoracic tumor by high transthoracic approach / 中华外科杂志

<p><b>OBJECTIVES</b>To define the role of high transthoracic approach in the treatment of cervicothoracic and high thoracic tumor, and analyze the problem encountered during tumor resection and reconstruction of this technique and oncological results of patients who received this type of surgery.</p><p><b>METHODS</b>Twenty-one patients with cervicothoracic and high thoracic tumor (T(1 - 4)) were treated with high transthoracic approach. This series included metastatic tumor 11 patients, eosinophilic granuloma of bone 2 patients, osteosarcoma 1 patient, Ewing's sarcoma 2 patients, chondrosarcoma 2 patients, giant cell tumor 2 patients, lymphoma 1 patient. High transthoracic approach was applied to these patients for tumor resection and spinal cord decompression. Reconstruction method included artificial vertebrae implantation or bone graft implantation combined with anterior internal fixation.</p><p><b>RESULTS</b>Chest-back pain of all patients relieved significantly after operation. Paraplegia of 3 patients was improved from grade A to grade D according to Frankel grading system, the other 2 patients recovered completely. Pulmonary infection and pulmonary atelectasis occurred in 2 patients; cerebrospinal fluid leakage happened in 1 patient; thoracic aorta rupture happened in 1 patient. The follow-up period was 11 - 58 months, 9 patients died, including 7 patients with metastatic cancer, 1 patient with Ewing's sarcoma, 1 patient with osteosarcoma.</p><p><b>CONCLUSIONS</b>High transthoracic approach is a satisfactory method in dealing with the lesion of cervicothoracic and high thoracic vertebrae, especially with the lesion involving the vertebrae and single vertebral arch. The thoracic canal can be decompressed effectively by this approach.</p>

Prognostic factors for 72 patients with osteosarcoma of the extremity treated with neoadjuvant chemotherapy / 中华外科杂志

<p><b>OBJECTIVE</b>To determine the prognostic factors that influence survival of patients with non-metastatic, high-grade osteosarcoma of the extremities.</p><p><b>METHODS</b>The data of 72 patients treated between June 2003 and June 2007, was retrospectively evaluated in relation to many factors including gender, age, etc.</p><p><b>RESULTS</b>Tumor necrosis was significantly related to gender, tumor volume change, tumor margin and T2 signal intensity of the extraosseous component of bone sarcomas. Multivariate analysis, tumor necrosis was only related to tumor volume change. Upon multivariate analysis, good histologic response was related to the outcome of patients.</p><p><b>CONCLUSIONS</b>Event free survival is related to the tumor necrosis, the level of alkaline phosphatase and the change of T2 signal of the extraosseous component. Tumor necrosis is related to the volume change after preoperative chemotherapy. These factors must be considered when deciding risk-adapted treatments for patients with osteosarcoma.</p>

The clinical outcome of proximal fibular osteosarcoma with en-bloc resection / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the local recurrence and 5-year survival of proximal fibular osteosarcoma.</p><p><b>METHODS</b>From October 1997 to July 2005, 12 patients with proximal fibular osteosarcoma were treated. There were 9 males and 3 females. The mean age at diagnosis was 16 (9-23) years old. Histopathological diagnosis were obtained by trut-cut biopsy, Enneking surgical stages of 12 lesions were as follows: 11 grade II B and 1 grade III. Induction chemotherapy was applied to all patients except one who left the hospital after the biopsy. Of 11 patients, 8 were performed Malawer type I resection, and 3 type II. All patients continued to get postoperative chemotherapy.</p><p><b>RESULTS</b>Regular follow-up was applied. Only 1 patient was found local recurrence one year after operation and received re-resection, the others did not. Four patients died of lung metastases, including the one who did not get treated, one stage III and two II B patients. The range of follow up was 6 to 117 months. The evaluated 5 year disease-free survival of 11 patients who got treated was 72.7% by using Kaplan Meier survival analysis.</p><p><b>CONCLUSIONS</b>The local recurrence is low, and 5 year disease-free survival is acceptable, in accordance with present point that marginal resection may not impact survival for fibular osteosarcoma. No knee instability is found in this group after great care is taken for proper reconstruction of lateral collateral ligament and reinsertion of biceps femoris tendon on the lateral condyle of tibia.</p>

Limb salvage surgery for osteosarcoma around the knee in children and adolescent patients / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss the reconstruction methods and treatment effects of osteosarcoma around the knee in skeletal immature children and adolescent patients.</p><p><b>METHODS</b>Between October 1996 and December 2005, 89 children and adolescent patients with osteosarcoma around the knee received limb salvage surgery. The average age was 13 years old. Tumor involved distal femur in 52 cases, proximal tibia in 36 cases, and both parts in one patient. Different limb salvage methods, including tumor recycle bone reimplantation (n = 20), partial endoprosthesis (n = 19) and total knee megaprosthesis replacement (n = 50) were chosen according to both the age of the patient and the skeletal. Expandable and special designed pediatric prosthesis some times might also be considered.</p><p><b>RESULTS</b>After average follow up of 42 months, 4 cases of local recurrence and 11 of metastasis occurred in tumor recycle bone group; 1 case of local recurrence and 4 of metastasis in partial endoprosthesis group; another 4 cases of local recurrence and 9 patients died of disease in total knee megaprosthesis group. The five-year survival rate was 47.1%, 71.7% and 68.2% in 3 groups respectively. There were 3 deep infections in all the cases, 2 subluxations and 1 amputation after operation for limb ischemia in partial endoprosthesis group. The average functional score of MSTS 93 was 21.43 point, 23.40 point and 25.32 point; and the average leg length discrepancy was 5.48, 4.50 and 3.12 cm in 3 groups respectively.</p><p><b>CONCLUSIONS</b>Partial-joint prosthesis or other methods which can avoid injury of the opposite epiphysis should be used to decrease the possibility of limb length discrepancy and ease the following revised arthroplasty. For patient with almost mature skeletal, total knee megaprosthesis may be a proper choice for better function result.</p>

Clinical evaluation of hemofiltration without anticoagulation in critically ill patients at high risk of bleeding / 中国医学科学院学报

<p><b>OBJECTIVE</b>To explore the safety and therapeutic efficacy of hemofiltration without anticoagulation in critically ill patients at high risk of bleeding.</p><p><b>METHODS</b>We retrospectively analyzed 41 patients undergoing bedside hemofiltration in the Intensive Care Unit of PUMC Hospital from December 2005 to December 2006. The hemofiltration cases with or without anticoagulation were compared.</p><p><b>RESULTS</b>Totally 224 hemofiltration circuits were performed in these 41 patients, including 114 (50.89%) circuits without anticoagulation in 27 patients at high risk of bleeding and 110 (49.11%) with anticoagulation by heparin. The circuit life of hemofiltration without anticoagulation was (13.21 +/- 9.73) hours (3-55 hours), and that of hemofiltration with anticoagulation was (28. 35 +/- 26.43) hours (9-126) hours (P < 0.01). The circuit life had no correlation with prothrombin time (PT), activitated partial thromboplastin time (APTT), fibrinogen (Fbg), and platelet count (PLT) levels before the therapy (P > 0.05). The levels of blood creatinine, blood urea nitrogen, potassium, and pH value significantly improved after both therapies (P < 0.05). Urea reduction rates were (38.4 +/- 26.7)% and (24.3 +/- 13.2)% in hemofiltration with and without anticoagulation, respectively. The levels of Fbg and PLT significantly decreased after therapy in both groups (P < 0.01). PT and APTT did not change in hemofiltration without anticoagulation (P > 0.05), while APTIT was prolonged in hemofiltration with heparin (P < 0.01). Of the 21 patients who initially received hemofiltration with heparin, 7 patients turned to hemofiltration without anticoagulation for hemorrhagic complications. Seventeen (41.5%) of 41 patients died during hospital stay, but none of them died of complications of hemofiltration.</p><p><b>CONCLUSIONS</b>Hemofiltration without anticoagulation reduces bleeding risks and achieves an acceptable circuit life. The strategy can be applied as an alternative to critically ill patients at high risks of bleeding who need continuous blood purification.</p>

The surgical palliation of operation combined with vertebroplasty for multiple spinal neoplasm / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss the effect and complication of spinal operation combined with vertebroplasty in treating for multiple spinal neoplasm.</p><p><b>METHODS</b>During the last two years, 20 patients (13 male and 7 female) with multiple spinal neoplasm including metastases, multiple myeloma and lymphoma were treated by operation combined with vertebroplasty, 2 vertebral body segments were involved in 5 cases, 3 to 4 vertebral body segments were involved in 11 cases, more than 5 segments were involved in other 4 cases. Neurological function deficit and severe pain were seen in all the cases. Patients were evaluated by Tomita prognostic scoring system before the operation; The average point was 7.2 (from 3 to 9 points).</p><p><b>RESULTS</b>The pain relief rate was 85% (17/20), and neurological recovery was found in 10 out of 12 patients who had neurological deficit. According to the system of Frankel and neurological function, 1 patient recovered from grade B to grade C after the operation, and there was no change in another patients who was evaluated as grade A before the operation. The main complication of vertebroplasty was leakage of PMMA. Six patients had leakage of PMMA into adjacent structures in this series.</p><p><b>CONCLUSIONS</b>Better results of pain relief and neurological function recovery and living quality can be achieved by surgical palliation of operation combined with vertebroplasty for multiple spinal neoplasm.</p>

Surgery for multiple myeloma of the bone / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the indication, approach and results of the surgical treatment of multiple myeloma.</p><p><b>METHODS</b>The authors reported 29 surgically-treated patients with solitary or multiple myeloma of the bone between January 1997 and January 2002. There are 17 males and 12 females with average age of 59.5 years (range 38 - 76 years). The primary tumour localizations were: vertebral column in 9, rib in1, humerus in 2, proximal femur in 2, femur shaft in 3, pelvis in 6, sacrum in 6. The 29 patients had undergone the following surgical procedures: vertebral tumours were excited through the anterior or posterior approach, combined with a stabilizing procedure in 7 cases. Tumors on thoracic spine were resected using anterior approach. 4 endoprotheses of replacement were performed, indnding two on proximal femur, one on humerus, and one on pelvis. The pathologic fracture was fixated by internal fixation. Neurological impairment was evaluated according to Frankel system. The study evaluated the complications, neurologic function improvement, life quality, and survival after the surgical treatment.</p><p><b>RESULTS</b>The pain was relieved in all cases and the neurological function was improved after the surgery. Local recurrence were found in three cases during the follow-up time.</p><p><b>CONCLUSION</b>The symptom of the patients can be relieved by the surgery. Our experience suggests that surgical interruption on multiple myeloma in some cases may be rewarding.</p>

Resection and reconstruction for primary pelvic tumors around acetabular / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss the resection of tumors, reconstruction of defects and the postoperative complications.</p><p><b>METHODS</b>Thirty-one patients with tumors around acetabular were treated surgically in People's Hospital between July 1997 and July 2003. The series comprised 19 males and 12 females. Twelve patients were diagnosed with chondrosarcoma, 1 with Ewing sarcoma, 3 with osteosarcoma, 1 with lymphoma, 1 with carcinosarcoma, 1 with malignant fibrohistiocytoma (MFH), 2 with myeloma, 9 with giant cell tumor (GCT), 1 with aneurysmal bone cyst. Among 31 patients with peri-acetabular tumors, 8 were reconstructed with hemi-pelvic prosthesis, 7 with saddle prosthesis, 6 with cauterized tumor bone and total hip arthroplasty, 10 with total hip replacement after curettage of lesion and cemented.</p><p><b>RESULTS</b>Among 21 patients who underwent tumor resection and reconstruction in region II, 6 had local relapse. Two of 3 patients with osteosarcoma were dead. Five of 12 patients with chondrosarcoma were free of disease. Twenty-one patients with acetabular reconstruction after resection of lesions in region II could sit and stand normally and walked with a cane, several of which even had normal gait.</p><p><b>CONCLUSION</b>Allograft or pelvic prosthesis can be used to reconstruct the acetabulum after resection of tumors. We must pay more attention on the following points in the surgical treatment of periacetabular tumors: (1) Extensively resect tumors as far as possible; (2) Be acquainted with advantages and disadvantages of different reconstructive methods of acetabulum to prevent the complications; (3) The reconstructed acetabulum is unstable, so the patients must stand with a cane to protect the reconstructed hip joint; (4) Prevent wound necrosis and infection; (5) Surgical treatment of pelvic tumors would easily result in poor wound healing especially in the patients receiving chemotherapy or radiotherapy because of extensive soft tissue stripping. The destroyed soft tissue caused by chemotherapy or radiotherapy may increase the great tissue tension after implantation of allograft. And the factors of poor blood supply and hematoma in the wound theoretically increase the chance of infection.</p>

The surgical management of sacral tumors / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the way of sacral tumors surgical treatment.</p><p><b>METHODS</b>This retrospective study included 119 cases of sacral tumors surgically treated from July, 1996 to December, 2001. The age of patients ranged from 18 to 80 years (mean 57 years), including of 72 male and 47 female. Out of the patients, there were 52 chordomas, 16 giant cell tumor, 5 neurofibroma, 23 metastases tumors, 9 myeloma, 2 osteoblastomas, 5 aneurysmal bone cysts, 3 osteosarcomas, 4 chondrosarcomas. Posterior approach and combined anterior-posterior approach were used in 83 and 36 cases respectively. Twenty-nine patients had received surgical management at least once and 16 of them had received radiation therapy before came to our department.</p><p><b>RESULTS</b>Three patients died on the complication around the surgery. Most of the patients with metastases tumor or multiple myeloma died 1 to 3 years after the surgery. Out of three osteosarcoma patients, 2 died and one alive with tumor. Three chondrosarcoma patients died, and one alive with tumor. Out of 52 chordoma patients, 3 patients had died of metastatic chordoma, 3 patients died of many times recurrence. Among the other 46 patients who were stay alive, 31 were free from disease with average follow-up time of 42 months. In the patients whose sacral nerve roots had been reserved bilaterally at and above S(3) level, the sphincter muscle function of bladder and bowl was good. While the function of sphincter muscle impaired in 2 patients with nerve roots reserved only at and above S(1) level. To manage these 2 patients, indwelling bladder catheters were used, but colostomy had not been performed.</p><p><b>CONCLUSIONS</b>Complete resection of tumor (radical surgery when possible) is the most effective way to manage sacral tumors. Postoperative adjuvant radiation therapy can reduce the tumor recurrence rate, but it also can cause troubles that would hinder further surgical managements. Even if the tumor is relatively huge and the upper resection margin is as high as at S(1) or S(2) level, the tumor can be removed successfully by posterior approach and the postoperative complications could be accepted. To the patients with aneurysmal cyst or giant cell tumor on sacrum, for control bleeding purpose, anterior approach should be performed to ligate the bilateral internal iliac artery.</p>