Treatment Strategy of Leukopenia After Chemotherapy with Traditional Chinese Medicine from the Generation and Transmission of Defense Qi / 中医杂志

By analysing the similarity between defense qi and leukocytes in terms of function， site of action， and circadian rhythm， it is proposed that in traditional Chinese medicine （TCM）， the pathogenesis of leukopenia is defense qi deficiency. By analyzing the relevant discussions on the generation and transmission of defense qi in TCM classics， it is believed that the original qi in lower jiao （焦） is the source of defense qi， while the water and grain qi in middle jiao enriches defense qi， and the upper jiao transmits and distributes defense qi to the whole body. Therefore， when treating leukopenia after chemotherapy with TCM， Guilu Erxian Gelatin （龟鹿二仙胶） and Yougui Pill （右归丸） are often used to tonify the kidney and supplement essence， and moxibustion at Guanyuan （CV 4） and Qihai （CV 6） is usually accompanied to replenish the original qi in lower jiao and enrich the source of defense qi. Guipi Decoction （归脾汤）， Buzhong Yiqi Decoction （补中益气汤）， Shenling Baizhu Powder （参苓白术散）， and Sijunzi Decoction （四君子汤） are often suggested to strengthen spleen and replenish qi， in combination with moxibustion at Zhongwan （CV 12） and Zusanli （ST 36） to transport the spleen and stomach in the middle jiao to enrich the defense qi. Modified Guizhi Decoction （桂枝汤） to harmonize nutrient and defensive aspects is often used， and moxibustion at Dazhui （GV 14） and Feishu （BL 13） or scraping is added to dredge the striae and interstice in the upper jiao and promote transmission and dissemination of the defense qi. Considering the whole process of generation and distribution of defense qi， it is suggested to choose the most appropriate treatment modality flexibly， and combine internal treatment with external treatment， in order to provide ideas for the treatment of leukopenia in tumour patients.

Zarzio Ameliorates Non-alcoholic Fatty Liver Induced By a High Fat Diet in a Rat Experimental Model: A Histological and Immunohistochemical Study

SUMMARY: The therapeutic effect of a granulocyte-colony stimulating factor (G-CSF) biosimilar drug, zarzio, on non-alcoholic fatty liver disease (NAFLD) in a rat model was investigated in this study. Thirty-two rats were randomly divided into four groups. Groups I and II were fed a standard laboratory diet, whereas groups III and IV were fed a high fat diet (HFD) for 14 weeks. After 12 weeks of feeding, groups I and III were administered normal saline, and groups II and IV were intraperitoneally administered zarzio (200 mg/kg/day) for two consecutive weeks. Hematoxylin-eosin (H&E) staining was used to assess hepatic and pancreatic morphology in all groups, oil red O (ORO) staining for lipid accumulation, Masson's staining for fibrosis, and immunohistochemistry assay for hepatic protein expression of insulin receptor substrate 1 (IRS1), nuclear factor erythroid 2-related factor 2 (Nrf2), tumour necrosis factor alpha (TNF-α) and pancreatic caspase-3. The NAFLD rats (group III) developed hepatic steatosis with increased lipid accumulation, perisinusoidal fibrosis, upregulated IRS1, TNF-α (all P<0.05) without a significant increase in Nrf2 protein expression compared with normal control. In comparison, model rats treated with zarzio (group IV) showed significant rejuvenation of the hepatic architecture, reduction of fat accumulation, and fibrosis. This was accompanied by the upregulation of Nrf2, downregulation of IRS1 and TNF-α protein expression (all P<0.05). No correlation was detected between NAFLD and non-alcoholic fatty pancreas disease (NAFPD). However, the pancreatic β-cells in group III showed increased caspase-3 expression, which was decreased (P<0.05) in group IV. In conclusion, zarzio ameliorates NAFLD by improving the antioxidant capacity of liver cells, reducing hepatic IRS1, TNF-α protein expression and pancreatic β-cells apoptosis, suggesting that zarzio could be used as a potential therapy for NAFLD.

En este estudio se investigó el efecto terapéutico de un fármaco biosimilar del factor estimulante de colonias de granulocitos (G-CSF), zarzio, sobre la enfermedaddel hígado graso no alcohólico (NAFLD) en un modelo de rata. Treinta y dos ratas se dividieron aleatoriamente en cuatro grupos. Los grupos I y II fueron alimentados con una dieta estándar de laboratorio, mientras que los grupos III y IV fueron alimentados con una dieta alta en grasas (HFD) durante 14 semanas. Después de 12 semanas de alimentación, a los grupos I y III se les administró solución salina normal, y a los grupos II y IV se les administró zarzio por vía intraperitoneal (200 mg/kg/ día) durante dos semanas consecutivas. Se utilizó tinción de hematoxilina-eosina (H&E) para evaluar la morfología hepática y pancreática en todos los grupos, tinción con rojo aceite O (ORO) para la acumulación de lípidos, tinción de Masson para la fibrosis y ensayo de inmunohistoquímica para la expresión de la proteína hepática del sustrato 1 del receptor de insulina (IRS1), factor nuclear eritroide 2 relacionado con el factor 2 (Nrf2), factor de necrosis tumoral alfa (TNF-α) y caspasa-3 pancreática. Las ratas NAFLD (grupo III) desarrollaron esteatosis hepática con aumento de la acumulación de lípidos, fibrosis perisinusoidal, IRS1 y TNF-α regulados positivamente (todos P <0,05) sin un aumento significativo en la expresión de la proteína Nrf2 en comparación con el control normal. En comparación, las ratas modelo tratadas con zarzio (grupo IV) mostraron un rejuvenecimiento significativo de la arquitectura hepática, una reducción de la acumulación de grasa y fibrosis. Esto estuvo acompañado por la regulación positiva de Nrf2, la regulación negativa de la expresión de la proteína IRS1 y TNF-α (todas P <0,05). No se detectó correlación entre NAFLD y la enfermedad del páncreas graso no alcohólico (NAFPD). Sin embargo, las células β pancreáticas en el grupo III mostraron una mayor expresión de caspasa-3, que disminuyó (P <0,05) en el grupo IV. En conclusión, zarzio mejora la NAFLD al mejorar la capacidad antioxidante de las células hepáticas, reduciendo el IRS1 hepático, la expresión de la proteína TNF-α y la apoptosis de las células β pancreáticas, lo que sugiere que zarzio podría usarse como una terapia potencial para la NAFLD.

Maxillary Lipofibromatosis in a pediatric patient. Case report

This report discusses a rare case of a soft palate deformity in a young girl due to lipofibromatosis (LPF). This rare benign pediatric soft tissue tumour usually arises in the distal extremities. We believe this case represents the first report of lipofibromatosis involving only the maxillary bone.

Evolução da mortalidade por neoplasias entre os anos de 2010 a 2020 no Brasil segundo sexo e localização primária do tumor / Evolution of mortality from neoplasms between the years 2010 to 2020 in Brazil according to gender and primary location of the tumour

Introdução: o câncer é um grave problema de saúde pública, considerado a segunda causa de óbitos no Brasil. Devido à sua relevância, é indispensável um controle eficiente dos casos através do acompanhamento da taxa de mortalidade. Dessa forma, o trabalho analisou a evolução da mortalidade por câncer para as localizações primárias mais frequentes, segundo sexo, durante o período de 2010 a 2020. Metodologia: trata-se de um estudo observacional descritivo, no qual os dados foram obtidos através do Atlas On-line de Mortalidade por Câncer. Os dados colhidos correspondem ao número de óbitos estratificados por tipo de câncer mais frequente, por ano estudado e por sexo, além das taxas de mortalidade específica bruta e a taxa de mortalidade ajustada por idade para o sexo masculino e feminino, para cada tipo de câncer em estudo, considerando a população padrão mundial, sendo avaliado por regressão linear a significância da tendência temporal. Resultados: no Brasil, no período de 2010 a 2020, as neoplasias mais frequentes em mulheres foram câncer de mama, câncer nos brônquios e pulmões, câncer no colo do útero, câncer no cólon e no pâncreas e em homens foram brônquios e pulmões, câncer de próstata, câncer de estômago, de esôfago e no fígado e vias biliares, sendo observado uma tendência crescente na taxa de mortalidade em mulheres e decrescente na taxa de mortalidade em homens. Conclusão: os resultados demonstram um possível comprometimento com a notificação durante o período de pandemia por Covid-19 e um possível rastreamento ainda deficiente de câncer na população masculina.

Introduction: cancer is a severe public health problem, considered the second cause of death in Brazil. Due to its relevance, efficient control of cases by monitoring the mortality rate is essential. Thus, the work analysed the evolution of cancer mortality for the most frequent primary locations, according to sex, from 2010 to 2020. Methodology: this is a descriptive observational study in which data were obtained through the Atlas Online Cancer Mortality Report. The data collected correspond to the number of deaths stratified by the most frequent type of cancer, by year studied and by sex, in addition to the crude specific mortality rates and the age-adjusted mortality rate for males and females, for each type of cancer. Understudy, considering the standard world population, the significance of the temporal trend is evaluated by linear regression. Results: in Brazil, from 2010 to 2020, the most frequent neoplasms in women were breast cancer, bronchial and lung cancer, cervical cancer, colon and pancreas cancer and in men, they were bronchial and lung cancer, cancer prostate, stomach, oesophagal and liver and biliary tract cancer, with an increasing trend in the mortality rate in women and a decreasing trend in the mortality rate in men. Conclusion: the results demonstrate a possible compromise with notification during the Covid-19 pandemic and a possible still poor screening of cancer in the male population.

Peripheral squamous odontogenic tumor associated with an impacted mandibular third molar: A case report

Introduction: Squamous odontogenic tumor is a benign but locally infiltrative, epithelial odontogenic tumor. This case report presents a case of a peripheral variant of squamous odontogenic tumor. Case Presentation: A 29-year-old male patient presented with pain in the left posterior mandible region for one month. Radiographic examination revealed an impacted left mandibular third molar with no other abnormalities. Management and Prognosis: The impacted tooth was removed under local anaesthesia. Histopathological examination of the abnormally thick pericoronal tissue, covering the impacted tooth revealed islands of bland squamous epithelium in a background of mature fibrous connective tissue. The prognosis was good with no signs of recurrence after one year of follow- up. Conclusion: Squamous odontogenic tumor should be considered in the differential diagnosis of pericoronal pathoses, although it is rare in this location.

Giant Eyelid Eccrine Hidrocystoma: A Case Report

Aims: To report a case of a rare giant eyelid eccrine hidrocystoma confirmed on histopathological examination and successful surgical excision with no recurrence.Presentation of Case: A young male presented with a mass over his eyelid which was gradually increasing in size, leading to drooping of the upper eyelid with no other associated symptoms. The mass 20x15x10 mm was present over the upper lid, non-mobile, non-tender, and firm. On the CT scan, a well-defined round to oval hypodense cystic mass was seen to be originating from the left upper eyelid. The cyst was excised and sent for histopathological analysis. The histological appearance of cystic spaces lined by cuboidal epithelium and containing mucinous fluid was suggestive of eccrine hidrocystoma. There was no recurrence till 2 months of follow-up.Conclusion: Eccrine hidrocystomas are 1-6 mm in size, generally 4 mm, and cysts larger than 10 mm are rare. Larger cysts have been described as “giant eccrine hidrocystoma.” Giant eyelid eccrine hidrocystoma is an unusual condition of the eyelid that must be considered in the differential diagnosis of eyelid tumours. They can be managed by complete surgical excision although recurrences are found to be common.

SEBACEOMA : A RARE CASE REPORT CLINICALLY DIAGNOSED AS PLEOMORPHIC ADENOMA.

Sebaceoma is a benign tumour of epidermal appendages with sebaceous differentiation also known as sebaceous epithelioma .We report a case of a 31 year old male presented with an exophytic mass on the posterior side of right ear lobule. Histopathology revealed rippled pattern sebeceoma comprising of cells arranged in sheets, cohesive nests and islands mostly comprising of basaloid cells (>50%)with mature sebocytes interspersed in between. The sebocytes appeared as clear cells , some cells multivacuolated with central indented nuclei. The rippled pattern sebeceoma is a histological variant and is seen predominantly in males in the head, neck and face region.The immunohistochemistry markers Epithelial Membrane Antigen (EMA) was focally positive along with Pan-Cytokeratin being strongly positive and diffuse which were con?rmatory for the disgnosis.

Small cell neuroendocrine carcinoma with primary orbital involvement – The unseen, and a review of literature

Neuroendocrine neoplasms are derived from the epithelial lineages mainly of respiratory tract, with predominant neuroendocrine differentiation. There are only a handful of documented cases of paranasal small cell neuroendocrine carcinomas (SNEC) with primary orbital involvement. Here, the authors describe a 33-year-old male patient with rapidly progressive swelling of the right lower lid with proptosis since 4 weeks. On contrast-MRI orbit, an ill-defined multilobulated mass measuring 3.6 × 3.1 cm with intense homogenous enhancement was seen in the right retrobulbar space involving the right ethmoid sinus. On incisional biopsy, a poorly differentiated mass containing numerous small round blue cells and scanty intervening stroma with prominent necrosis and apoptosis was seen. Immunohistochemistry was strongly positive for synaptophysin. He was diagnosed as a case of SNEC and received chemotherapy, with good response till date of 9 months of follow up. The authors present a literature review and describe challenges in management of a primary orbital SNEC.

Histopathological-spectrum-of-brain-lesions-in-patients-attending-to-rims-ranchi—a-retrospective-study

Background- The CNS space occupying lesions cause grave life-threatening outcomes irrespective of their nature as they grow in a confined space and are present close to vital structures Hence, it is of great importance to establish the accurate diagnosis for proper and timely neurosurgical intervention Tumours of central nervous system (CNS) are reported to be less than 2 % of all malignancies. In India, CNS tumours constitute about 1.9 % of all tumours. - AMethod retrospective study carried out in RIMS hospital for all the brain tissue specimen that have come for the histopathological examination, for a duration of one year (February2021 - January2022) among 78 cases of CNS lesions collected from archives of Department of Pathology. Astrocytoma was the most common entity followed by Meningioma whileResults- 2.56% cases were metastatic in this study sample. The present study helps to provide informationConclusion- regarding the disease burden in our area. This study attempts to categorise various CNS neoplasms as per recent WHO classification (2016) which has not only diagnostic implication but also has significant prognosis and predictive value

STUDY OF MENINGIOMAS WITH HISTOPATHOLOGICAL AND RADIOLOGICAL CORRELATION

Background: Meningiomas are tumours originating from meningothelial cells. They are commonly located at intracranial, intraspinal or occasionally ectopic site. They show histological diversity and are categorized into three grades by WHO 2007 Classi?cation. This grading helps in predicting their behaviour and deciding treatment strategy. To study the frequency, clinical details, histological typing and grading of 50 cases of Aims and Objective: meningiomas. To evaluate diagnostic accuracy of radio-imaging and there correlation with histopathological diagnosis is made Total 50 cases of histopathologically con?rmed cases of meningiomas were studied with above mentioned Methods: aims and objectives. Analysis of histological features, typing and grading of all cases were done. Meningioma are the Result: most common extra-axial tumour. Obvious female predominance was observed. The most common histological subtype was meningothelial followed by ?broblastic. In all cases radiological diagnosis correlated with histopathological diagnosis Conclusion: Meningiomas are slow growing extra-axial tumours majority being intracranial, benign grade I followed by grade II and rarely grade III neoplasms occurring most commonly in elderly females

Research progress of tumor immunomodulation strategies based on nanodrug delivery system / 中国药科大学学报

@#Tumor immunotherapy is a therapeutic modality that uses immunological principles and methods to activate and enhance the body''s immune system to generate immune response for the removal of tumour cells. Many new immunotherapeutic agents have demonstrated effective anti-tumour capabilities, yet their clinical use is challenging due to the complex mechanisms of tumour immune escape. Meanwhile, these drugs would accumulate in different tissues and organs in the human body and be unable to achieve precise and specific targeting therapeutic effects, resulting in serious immune-related adverse effects, which greatly hinders the clinical potential of immunotherapy.Nanodrug delivery systems can deliver immunotherapeutic drugs to target tissues or specific immune cells precisely, thereby enhancing immune effects and reducing side effects.This paper reviews the research progress of nanodrug delivery systems in tumour immunotherapy in recent years based on the regulatory mechanism of the anti-tumour immune response, with a prospect of the challenges and development in this field.

Embarazo y tumor anexial: tratamiento laparoscópico con minilaparotomía. Reporte de caso y revisión bibliográfica / Pregnancy and annexal mass; laparoscopic with minilaparotomy management. Case report and literature review

Resumen ANTECEDENTES: Los tumores anexiales durante el embarazo requieren una conducta terapéutica segura para la madre y el feto, por lo que el obstetra debe tener claro cuándo la opción quirúrgica es la indicada y cuál la menos agresiva para la madre y el feto. Describir la implementación de la laparoscopia con minilaparotomía en un caso de tumor anexial en el embarazo puede contribuir a conocer las ventajas y desventajas de la estrategia quirúrgica de estos casos. CASO CLÍNICO: Paciente de 29 años, 70 kg de peso, talla de 1.61 m e IMC 27 en curso de las 16 semanas de embarazo, que acudió al servicio de Urgencias debido a un dolor abdominal. Ante la persistencia del síntoma se estableció el diagnóstico de síndrome doloroso abdominal, secundario a un tumor anexial gigante. Se programó para una laparoscopia diagnóstica y operatoria con minilaparotomía. Se dio de alta del hospital a las 24 horas posteriores a la cirugía y el embarazo finalizó a las 39 semanas. METODOLOGÍA: Búsqueda retrospectiva de artículos publicados durante los últimos diez años e indizados en la base de PubMed con los MeSH: adnexal masses pregnancy, adnexal masses pregnancy and laparoscopic surgery. RESULTADOS: Se incluyeron 34 artículos de revisión, 8 reportes de caso y un editorial, estos últimos 9 se consideraron cuando proveyeron información relevante para el conocimiento de una técnica quirúrgica. Se eliminaron los artículos en los que se utilizó cirugía asistida por robot o técnica con uso de orificios naturales (NOTES), revisiones que fueran exclusivas de patología oncológica, así como casos en niñas, al no disponer de esta tecnología en nuestro medio o no estar en etapa reproductiva, podría incurrirse en un riesgo de transferencia. Así mismo, se eliminaron los artículos sin explicación de las ventajas de la técnica propuesta. CONCLUSIÓN: En pacientes embarazadas con tumor anexial gigante, la laparoscopia con minilaparotomía es una opción de tratamiento segura para el feto y la madre. Con esta técnica se consigue una rápida recuperación, disminución de los riesgos de lesión uterina, pronta reintegración a la vida cotidiana y un buen desenlace cosmético.

Abstract BACKGROUND: Adnexal tumors during pregnancy require safe therapeutic behavior for the mother and the fetus, so the obstetrician must be clear when the surgical option is indicated and within the approach which would be less aggressive for the fetal-maternal binomial. Describing the implementation of laparoscopy with mini laparotomy in a case of adnexal tumor in pregnancy can contribute to understanding the advantages and disadvantages of the surgical strategy in these cases. CLINICAL CASE: Patient aged 29 years, weight 70 kg, height 1.61 m and BMI 27 in the course of 16 weeks of pregnancy, who attended the emergency department due to abdominal pain. Given the persistence of the symptom, a diagnosis of painful abdominal syndrome secondary to a giant adnexal tumour was established. She was scheduled for diagnostic and operative laparoscopy with mini-laparotomy. She was discharged from hospital 24 hours after surgery and the pregnancy ended at 39 weeks. METHODOLOGY: A literature search of the last 10 years was performed in Pubmed under the MeSH terms: adnexal masses pregnancy, adnexal masses pregnancy and laparoscopic surgery. RESULTS: Thirty-four review articles, eight case reports and one editorial were included, the latter nine were considered when they provided information relevant to the knowledge of a surgical technique. We eliminated articles in which robot-assisted surgery or a technique using natural orifices (NOTES) was used, reviews that were exclusive to oncological pathology, as well as cases in girls, as this technology was not available in our environment or they were not in the reproductive stage, which could incur a risk of transfer. Likewise, articles that did not explain the advantages of the proposed technique were eliminated. CONCLUSION: In pregnant patients with giant adnexal tumours, laparoscopy with mini-laparotomy is a safe treatment option for the foetus and the mother. This technique achieves a rapid recovery, reduced risk of uterine injury, early reintegration into daily life and a good cosmetic outcome.

Synchronous Primary Parosteal Osteosarcoma and Primary Mediastinal Germ Cell Tumour with Atypical Mycobacterial Infection – A Rare Phenomenon: A Case Report

@#Mediastinal germ cell tumours are a rare group of extragonadal germ cell tumours with less than 5% prevalence of all germ cell tumours. Primary mediastinal germ cell tumours themselves account for 16-36% of the extragonadal germ cell tumours. Along the spectrum of osteosarcoma, parosteal osteosarcoma is a welldifferentiated surface osteosarcoma with a prevalence of 4% of all osteosarcoma. As such synchronous primary parosteal osteosarcoma and primary mediastinal germ cell tumour are exceedingly rare. This leads to complexity in determining the most appropriate chemotherapy for two different types of tumours and its potential side effects of reduced immunity leading to potential secondary infection. Here we report a case of a 16-year-old boy who presented with synchronous primary osteosarcoma and primary mediastinal germ cell tumour, complicated with atypical mycobacterial infection post-operatively. Additionally, we discuss our choice of chemotherapy and the management of the atypical mycobacterial infection.

The Efficacy of Bisphosphonate in the Treatment of Giant Cell Tumour of the Bone: A Systematic Review and MetaAnalysis

@#Introduction: Anti-osteoclastic mechanism of Bisphosphonate (BP) is crucial to treat Giant Cell Tumour of the Bone (GCTB), however no established guidelines of its use have been published. This systematic review and metaanalysis is the first to summarise recent clinical studies on the subject. Materials and methods: A systematic search was performed based on PRISMA guidelines for clinical trials of BP administration in GCTB. Baseline data including BP regimen, dose and timing was summarised. The primary outcomes assessed were recurrence rate, metastases, survival rate, functional outcome, clinical outcome, radiological outcome, and adverse effect. Results: We identified 8 articles from 2008-2020. Most studies administer 4mg of Zoledronic acid post-operatively, with five studies mentioning pre-operative administration and six studies describing post-operative administration. There was a total of 181 GCTB cases analysed in this study. The BP group presented lower recurrence rate than control group (three studies; Odds Ratio [OR] 0.15; 95% Confidence Interval [CI], 0.05 – 0.43; p<0.05; heterogeneity, I2=0%). As for survival rate, BP group is comparable to control group (two studies; OR 1.67; 95% CI, 0.06 – 48.46; p=0.77; heterogeneity, I2=65%). Conclusion: Bisphosphonate therapy offers satisfactory recurrence rate, functional outcome, clinical outcome, radiological outcome, survival rate and metastases rate in patients with GCTB, with minimal adverse effects. Pre- and post-operative administration of bisphosphonates in combination might be the most beneficial in minimalising the recurrence rate.

Prediction of Responses of Patients with Hepatocellular Carcinoma to Anti-PD-1 Immunotherapy by T-cell Invigoration to Tumour Burden Ratio / 肿瘤防治研究

Objective To explore the predictive value of T cell activation in peripheral blood of patients with hepatocellular carcinoma(HCC) after anti PD-1 therapy and its ratio to tumor burden on the efficacy of immunotherapy. Methods Serum specimens were obtained before and after treatment from 85 patients with HCC who received anti-PD-1 treatment. Indicators such as cell subpopulations and T cell activation were detected by flow cytometry. Combined with imaging analysis, cutoff value was obtained by X-tile software. Survival analysis was used to evaluate patients' outcomes. Results The maximum fold change of Ki-67+/PD-1+/CD8+ T cells in treatment cycles and the tumor burden determined by imaging were associated with prognoses. The ratio of T cell Ki-67+/PD-1+/CD8+ expression to tumor burden ratio greater than 0.6 at the first cycle of anti-PD-1 immunotherapy was associated with improvements in progression-free survival and overall survival (P < 0.05). Conclusion The ratio of activationa in T cells in peripheral blood after immunotherapy to the tumor burden may be related to the clinical efficacy of anti-PD-1 immunotherapy for HCC.

Anatomy of rectus femoris muscle flap and anterolateral thigh muscle flap and their application in reconstruction of postoperative defects of oral malignant tumour / 中华显微外科杂志

Objective:To investigate the anatomy of rectus femoris muscle flap and the anterolateral thigh muscle flap and their clinical application in reconstruction of large soft tissue defects after the removal of oral malignant tumour.Methods:From December 2006 to June 2009, 8 specimens of Chinese adult cadavers fixed in 10% formaldehyde were dissected to perform anatomy of anterolateral thigh region at the School of Basic Medical Sciences, Kunming Medical University. Anatomical images were analysed using Image-Pro Plus 6.0. Then, a retrospective study was performed on 19 patients who had postoperative defects after oral malignant tumour surgery and the defects were reconstructed with the rectus femoris muscle flap and the anterolateral thigh muscle flap from March 2020 to July 2022 at the Department of Oral and Maxillofacial Surgery, Affiliated Stomatology Hospital, Kunming Medical University. The postoperative defects of the 19 patients ranged from 3.0 cm×6.0 cm to 5.0 cm×10.0 cm. Ten rectus femoris muscle flaps, 8 anterolateral thigh muscle flaps and 1 combined rectus femoris muscle flap and anterolateral thigh muscle flap were used. The muscular flaps sized from 4.0 cm × 8.0 cm to 6.0 cm × 11.0 cm. Regular postoperative outpatient follow-ups were conducted.Results:The lengths of vessels of the harvested rectus femoris muscle flap and anterolateral thigh muscle flap were 63.4 mm± 12.9 mm and 112.5 mm± 19.6 mm, respectively. The starting outer diameters of the lateral circumflex thigh artery, the oblique branch of the lateral circumflex thigh artery and the descending branch of the lateral circumflex thigh artery were 2.92 mm±0.72 mm, 1.88 mm±0.23 mm and 2.29 mm±0.43 mm, respectively. Postoperative follow-up lasted for 7 to 32 months, with 17.5 months in average. Seventeen flaps were completely survived and the rectus femoris muscle flap was completely mucosalised 5 weeks after surgery. However, 2 rectus femoris muscle flaps had necrosis of which one was changed to a tongue flap reconstruction and the other encountered flap necrosis during postoperative radiotherapy and healed after debridement and dressing changes. There was no postoperative complication in the donor sites. Other than the 2 patients, all other 17 patients had satisfactory clinical outcomes.Conclusion:Both of the starting outer diameters and length of vessels of the femoris muscle flap and the anterolateral thigh muscle flap meet the requirements for reconstruction of maxillofacial defects, and both muscular flaps are simple to prepare, in good reconstructive results with few complication, as well as an excellent outcome. They are feasible approaches for reconstruction of large soft tissue defects left after the removal of an oral malignant tumour.

Efficacy analysis of Allium ureteral stent in semisupine-lithotomy position for treatment of pelvic tumour-induced ureteral stricture / 中华泌尿外科杂志

Objective:To investigate the efficacy and safety of semisupine-lithotomy position placement of Allium ureteral stent to treat ureteral stricture caused by pelvic tumours.Methods:The clinical data of 29 patients who received Allium ureteral stent(URS) placement for ureteral stricture in Sun Yat-sen Memorial Hospital, Sun Yat-sen University between April 2020 and March 2022 were retrospectively analyzed. There were 3 males and 26 females, with the median age of 56(54, 61) years old. All patients had a pathology confirmation of carcinoma before the treatment, including 26 patients with gynaecological tumours, two with urinary system tumours, and one with rectal carcinoma. A preoperative imaging examination confirmed the diagnosis of ureteral stricture. There were 15 patients with unilateral and 14 with bilateral stenosis, median stenosis length was 3.6(2.0, 4.9)cm. Preoperative median urine white blood cell count was 62(21, 354) U/L, median serum creatinine (SCR) was 170.0(85.5, 273.5) μmol/L, and renal pelvis separation was (32.98±6.64) mm. The median time of long-term indwelling double J (D-J)ureteral stent before surgery was 12.0 (6.5, 35.5) months. Seven patients had mild hydronephrosis, 18 had moderate hydronephrosis, and four had severe hydronephrosis. In all patients, Allium URS were placed in the way of the semisupine-lithotomy position (Galdakao-modified supine Valdivia position). Anterograde flexible ureteroscope was inserted into the percutaneous nephrostomy channel, and the retrogradel rigid ureteroscope were advanced simultaneously, looking for location of strictures. Allium URS were inserted retrogradely with transureteroscope when the two ureteroscope were connected. Perioperative conditions and postoperative follow-up for the last examination of SCR, renal pelvis width under ultrasound, and plain abdominal film (KUB). Allium URS patency and complications, hydronephrosis and renal function were evaluated.Results:A total of 61 Allium URS were successfully placed. Seven patients were placed in stages, and 18 patients were placed in series with multiple stents. The mean follow-up period was (12.1±5.8) months. At last follow-up, median SCR was 124.0(81.5, 193.0)μmol/L and renal pelvis separation was(14.96±5.18)mm, which were significantly decreased compared with preoperative(all P<0.01). There were 24 cases of hydronephrosis disappeared and 5 cases of mild hydronephrosis in the last follow-up. Postoperative follow-up, urinary tract infection occurred in 3 patients after operation, such as hematuria and fever within one week, and the symptoms were relieved after anti-infective and symptomatic treatment. One case had mild urine leakage, and 4 patients had occasional low back pain, which may be related to the activity. One case occurred stent displacement due to stent migration to the bladder after eight months, the URS was replaced and a D-J stent was inserted .The patency rate was 96.6%(28/29). Conclusions:Allium URS was placed in the semisupine-lithotomy position for treating pelvic tumour-induced ureteral stricture, with low incidence of complications, high patency and good curative effect.

Placental Site Trophoblastic Tumour – A Rare Cause of Uncontrollable Post - Operative Hemorrhage in Obstetric Cases

Placental site trophoblastic tumour (PSTT) is a rare variant of gestational trophoblastic disease developing from intermediate trophoblasts. PSTTs are incredibly rare tumours with 1 in 100000 pregnancies and only about 200 cases reported till date with mortality reaching up to 25% in undiagnosed c ases. We present the case of a 37year old female, gravida 4 para 3, presenting with uncontrollable post caesarean haemorrhage for which she underwent subtotal hysterectomy. Histopathological examination revealed Placental site trophoblastic tumour. Placent al site trophoblastic tumour, being a rare entity, pose difficulties in its early diagnosis. Delayed diagnosis can lead to distant metastases, thus worsening the prognosis.

A RARE CASE REPORT OF GLOMUS TUMOUR OVER MARGIN OF LOWER LID OF LEFT EYE

Introduction: Glomus tumours are rare, benign tumours of vascular origin, arising from the glomus body. Glomus tumours are neoplasms of mesenchyme derived from glomus bodies. Glomus tumours present as a purple or pink vascular lesion that can be confused with a vascular neoplasm such as hemangioma. In this case we are reporting a rare presentation of glomus tumour over lower lid. A 10 year old female child presented with lesion over left lower Case Report: lid since 3 months which was painless and progressive. On examination a 0.3x0.3 cm subcutaneous pink non encapsulated mass is seen over medial canthus of left eye. Mass was excised and subjected to histopathological examination which confirmed the diagnosis of glomus cell tumour(glomangioma). Postoperative period was uneventful with no recurrence for last 6months. Conclusion: All excised eyelid lesions should undergo detailed Histopathological evaluation and glomus tumour should be considered as one of the differential diagnosis in patients presenting with eyelid mass

A Rare Case of Yolk Sac Tumour in Postmenopausal Lady

Epithelial tumours are the most common ovarian neoplasm in postmenopausal age group. Yolk sac tumour is a type of germ cell tumour which is common in younger age group. Occurrence of such tumour in postmenopausal women is extremely rare and not more than 55 cases have been reported so far in English literature. Often in such cases an association with benign or malignant epithelial tumours have been described. We report a strange case of Yolk sac tumour in a 57 year old postmenopausal lady who presented to us with chief complaints of abdominal distension and early satiety. She underwent exploratory laparotomy with presumed diagnosis of carcinoma ovary. Upon exploration she had extensive disease with peritoneal nodules and metastatic deposits over small bowel mesentery. Debulking surgery in form of total abdominal hysterectomy with bilateral oophorectomy, infracolic omentectomy and stripping of anterior peritoneum was done. Postoperative histopathological examination showed presence of high grade adeno carcinoma of left ovary with omental metastasis. On immunohistochemistry cells were immunoreactive for cytokeratin, Glypican 3, SALL 4 and negative for EMA,CK-7,CK-20,PAX8 and OCT 4.The clinical picture was consistent for Yolk Sac tumour. Postoperatively she was planned for chemotherapy with BEP. Her pulmonary function testing was suggestive of severe restrictive disease. She received one cycle of EP. One month later she developed ascites and melena and succumbed to her disease