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Objective:To compare outcomes between standardized and misdiagnosis and mistreatment of osteosarcoma.Methods:A retrospective analysis of patients with high-grade osteosarcoma who received appropriate surgical treatment and chemotherapy (299 cases, control group) and those who were misdiagnosed (benign or infective) and received mistreatment (23 cases, study group) between January 2009 and December 2021. Gender, age, first operation mode, recurrence time, recurrence interval, metastasis time, metastasis interval, total survival time (months), survival status in the two group and tumor site reoperation mode in the study group were statistically analyzed. Further, chi-square test was performed for comparison of the clinical between two groups. The survival analysis was performed using Kaplan-Meier test and Log-rank test.Results:All the 322 patients were followed up. In the control group, the average follow-up time was 42 months (1-137 months), the average age was 24 years (3-80 years), male 184 cases, female 115 cases, and limb salvage rate was 85.3% (255/299). Seven patients underwent amputation, and the amputation rate was 17.7% (44/299). The recurrence rate was 8.4% (25/299), the average recurrence interval was 22.8 months (7-36 months), and the metastasis rate was 28.1% (85/299), the average metastasis time was 32.7 months (0-58 months). In the study group, the average of follow-up time was 30 months (9-117 months), the average age was 36 years (5-67 years), 17 males and 6 females. Among them, eleven patients were treated with limb salvage in the second stage, and the limb salvage rate was 47.8% (11/23). Seven patients underwent amputation, and the amputation rate was 30.4% (7/23). The recurrence rate was 26.1% (6/23), the average recurrence interval was 11 months (1-42 months), and the metastasis rate was 43.4% (10/23), the average metastasis time was 20.3 months (1-44 months). The 5-year survival rate was 50.7% in the study group and 56.1% in the control group. There was no significant difference between the two groups (χ 2=0.09, P=0.760). Conclusion:The overall prognosis of patients with high-grade osteosarcoma who receive active treatment after mistreatment is similar to that of patients with standardized treatment, but the recurrence and metastasis rate is higher, the recurrence time is earlier, and the amputation rate is higher.
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Objective To investigate surgical method and effect on concealed penis in children after being mistaken for reshaping to provide the basis for clinical diagnosis and treatment.Methods The clinical data of 34 patients with concealed penis were analyzed retrospectively.All patients underwent surgical treatment of improving devine technique and transferred of the penile ventral flap.In the case,the congenital dartoic fascia dysplasia of penile shaft were resected and dennodesis of root of the penile were applied with transferred of the penile ventral flap to make up the defected skin of the back side for summary of surgical methods and techniques.Results Thirty four cases of children were successfully reshaped,and 27 cases were followed-up of 2 ～ 38 months.All 27 cases had normal penile development,results were satisfactory.Conclusions The surgical treatment can effectively treat concealed penis and the modified devine incision with transferred of the penile ventral flap is one of the ideal surgical treatment to correct the disease in children with simple,quick recovery,less complications,and beautiful appearance of penis with satisfactory efficacy.It is worth of clinical popularization and application.
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Objective: To compare the clinical characteristics and prognosis between the misdiagnosed and mistreated patients and the correctly diagnosed and treated patients with osteosarcoma. Methods: The clinical records of patients with osteosarcoma who received misdiagnosis and unplanned therapy (n = 30) and those who received correct diagnosis and therapy (n = 60) between January 2007 and February 2010 were retrospectively reviewed. The follow-up time was 6-60 months. The factors including gender, age, tumor location, Enneking's surgical staging, Karnofsky performance status score, pathological type, surgical procedure, tumor size, tumor necrosis rate, frequency of adjuvant chemotherapy, local recurrence rate, and lung metastasis rate were compared between the two groups. The two-year survival rate was calculated by Kaplan-Meier method. Results: No significant differences between the two groups were found in terms of gender, Enneking's surgical staging, Karnofsky performance status score, tumor location, pathological type, surgical procedure, frequency of adjuvant chemotherapy, time to local recurrence and time to lung metastasis (P > 0.05). The proportions of patients aged 30 years or more (46.7% vs 11.7%, P < 0.001), having a tumor's diameter of 10 cm or more (50.0% vs 23.3%, P = 0.011), and having tumor necrosis rate lower than 90.0% (80.0% vs 60.0%, P = 0.016) were significantly higher in the misdiagnosed and mistreated group than in the correctly diagnosed and treated group. The local recurrence rate (33.3% vs 10.0%, P = 0.006) and the lung metastasis rate (63.3% vs 43.3%, P = 0.037) in the misdiagnosed and mistreated group were also significantly higher than those in the correctly diagnosed and treated group. The median survival time and the two-year survival rates of the misdiagnosed and mistreated group and the correctly diagnosed and treated group were 25.5 (95% confidence interval: 7.1-58.9) months and 38.0 (95% confidence interval: 12.2-55.0) months, and 83.3% and 63.3%, respectively (P = 0.025; P = 0.036). Conclusion: The patients with osteosarcoma aged 30 years or more were more likely misdiagnosed as having benign diseases. Misdiagnosis and unplanned therapy for osteosarcoma can result in higher local recurrence rate and lung metastasis rate as well as a poor prognosis. Copyright © 2012 by TUMOR.
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Objective To summarize the reasons of mis-diagnosis and mis-treatment of autoimmune pancreatitis (AIP). Methods Clinical data of 17 patients with AIP,who were admitted to the hospital from May 2005 to July 2010 and experienced mis-diagnosis and mis-treatment, were retrospectively analyzed. Results The main clinical manifestations included epigastric pain (13 cases),progressive obstructive jaundice (12 cases), fever (6 cases) and weight loss (9 cases). Fifteen patients had extrapancreatic organ involvemnet, including allergic rhinitis, swelling of lymphoglandulae submaxillares, swelling of submaxillary gland, allergic asthma, rheumatoid arthritis, Sjogren syndrome, diabetes mellitus, primary sclerosing cholangitis and autoimmune hepatitis. Of these 17 cases, 11 cases presented with high serum globulin, 14 cases with high serum IgG, 13 cases with high serum γ-globulin, 13 cases with positive anti-nuclear antibody and 2 cases with positive anti-insulin IgG antibody. The abdominal imaging demonstrated that 15 patients had diffuse enlargement of the pancreas with diffuse or segmental narrowing of main pancreatic duct, narrowing of the intrapancreatic common bile duct, dilation of the proximal biliary duct and gallbladder enlargement. Focal enlargement of the pancreas was found in 2 cases. Thirteen cases were misdiagnosed as pancreatic carcinoma. Among them, 4 cases underwent pancreaticoduodenectomy and 7 cases underwent choledochojejunostomy. Two cases were misdiagnosed as end stage of cancer that lost therapeutic chance. Another 4 cases were misdiagnosed as chronic pancreatitis. Steroid therapy was administered in all patients with satisfactory response. All patients were followed-up for 15 months (ranged from 6 months to 45 months), and recurrence was found in 4 cases. Satisfactory response was found in patients treated with steroid for the second time. No pancreatic cancer was found in these patients in the follow up period. Conclusion The main causes of mis-diagnosis and mis-treatment of AIP may be contributed by difficulty in differentiating AIP from pancreatic carcinoma based on clinical manifestations and inadequate knowledge of AIP as well as insufficient attention to AIP in China.
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Objective To describe and analyze the misdiagnosis and mistreatment status of pulmonary alveolar proteinosis (PAP), especially cases with combination of severe infection. Method The misdiagnosis and mistreatment of 84 PAP patients and 6 cases with combination of severe infection before admitting to PUMCH was analyzed retrospectively. Results 66.7%(56/84) had experienced misdiagnosis before admission. 32.1% (27/84) were misdiagnosed with idiopathic interstitial pneumonia (IIP) and 14.3% (12/84) with pulmonary tuberculosis. 88.1%(74/84) had received anti-infection treatment, 33.3%(28/84) received eortieosteroids, and 19.0%(16/84) received anti-tuberculosis treatment. The percentage of the pa-tients who had taken the bronchoscopic examination outside the PUMCH was 53.6%(45/84). The PAP pa-tients diagnosis was established through bronchoscopic examination (including BAL and TBLB) in 86.9% (73/84) patients. There were 6 patients who had severe infection when PAP established. All of these 6 cases had been misdiagnosed with IIP and received corticosteroids treatment, 2 of whom died. Conclusions The misdiagnosis and mistreatment happens commonly in PAP patients. The misuse of corticosteroids makes some PAP cases get the severe infection. The image feature and the examination of bronchoscopy, BAL and TBLB are the key point in avoiding misdiagnosis. The administration of corticosteroids in uncertain patients should be avoided.
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OBJECTIVE To explore the clinic diagnosis and treatment of ectopic thyroid gland (ETG) of the neck.METHODS The clinical data of 10 cases with ETG who were misdiagnosis in out-patient clinic from 1999 to 2007 were analyzed,including 5 lumps of tongue base,3 thyroglossal duct cysts,1 epiglottic cyst,and 1 tumor in parapharyngeal space.RESULTS Four cases were not found normal thyroid gland at neck through preoperative ultrasonograph,3 cases were shown normal thyroid gland with ultrasonograph. Three cases have visulization in cervical part,but nonvisulization in normal thyroid gland position through radioactive isotope scanning.CONCLUSION The well understanding of ETG and the detailed preoperative examination of neck mass including ultrasonograph,CT,radioactive isotope scanning and fine needle aspiration biopsy,are keys to diagnosis and management of ETG.
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Objective To improve the diagnosis and management of solid-pseudopapillary tumor (SPT) of the pancreas. MethodsTwenty-two SPT patients were retrospectively reviewed and divided into two groups, misdiagnosed group and those with preoperatively correct diagnosis. ResultsAbout one half (46%) SPT cases were misdiagnosed preoperatively. With time SPT tends to invade its capsule resulting in impossibility of radical resection, and increased medical expenses. ConclusionsAlthough SPT is of low degree malignant, and the prognosis after surgical resection is satisfactory, misdiagnosis and preoperative misdiagnosis and inappropriate management still cost the patients increased expenses and inhospital stay.