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Objective Aggressive fibromatosis is a rare kind of soft tissue tumor and was evaluated by few large studies. This study was to evaluate the clinical characteristics and identify the prognostic factors of this disease. Methods One hundred and forty-two patients with aggressive fibromatosis treated from January 1983 to August 2009 in Tianjin Medical University Cancer Hospital were retrospectively reviewed.The prognostic value of clinical and treatment factors was analyzed. Univariate analysis was performed with Log-rank test and Multivariate analysis was performed with Cox regression model. Results The follow-up rate is 93.7% and the median follow up time was 54 months (range,6 -208 months). Sixty-three patients had a minimum follow up time of 5 years and 6 patients had a minimum follow up time of 10 years. The male/female ratio was 1/1.84. The disease was most popular in women aged from 18 to 35 years old. The disease frequently occurred in the trunk (55.6%) and extremity (31.7%). All patients received surgery,and 46 received radiotherapy. The 5-year and 10-year local recurrence rates were 24. 4% and 31.1%,respectively. The 5-year and 10-year overall survival rates were both 99. 3%. Univariate analysis revealed that factors correlated with local recurrence were tumor size ( χ2 = 4. 37, P = 0. 037 ) and margin status (χ2 = 12. 36,P =0. 002). Multivariate analysis revealed that margin status was an independent risk factor (RR = 2. 219; χ2 = 9. 47,P = 0. 002) and radiotherapy was an independent protective factor ( RR = 0. 360;χ2 = 4. 95, P = 0. 026 ) for disease recurrence. When radiotherapy was delivered, the 10-year local recurrence rate decreased from 70. 1% to 20. 7% in patients with positive margin ( χ2 = 4. 22, P = 0. 040 )and decreased from 19.8% to 10.4% (χ2= 0.90, P= 0.344) in patients with negative margin.Conclusions Radical resection is the mainstay of treatment for aggressive fibromatosis. Postoperative radiotherapy can reduce the recurrent rate for patients with positive margin. In patients with negative margin,the role of radiotherapy should to be further evaluated in large clinical trials.
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Objective To analyze the clinical characteristics and the prognostic factors of carcinomatous meningitis(CM). Methods 63 patients with CM treated in Tianjin Medical University Cancer Institute and Hospital from 1998 to 2008 were reviewed retrospectively. The correlations between clinical characteristics, treatment modalities and the prognosis of CM were analyzed. The common primary site was lung cancer(65%)and breast cancer(13%). All the patients were underwent MRI scan and 29 of the patients received lumbar puncture. Fifty-one patients received whole brain radiotherapy, systemic and/or intrathecal chemotherapy. The other 12 patients only received supportive care. Kaplan-Meier method and Log-rank test were used for survival analysis. Results All patients died by the end of follow-up. The follow-up rate was 95%. The number of patients who undergone 1-,2 years follow-up were 59 and 56. The median survival time was 2. 2 months(range :0. 1 -24. 4 months)for the entire group. The clinical stage and the control status of the primary disease were strongly correlated with survival(x2 = 6. 68, P = 0. 036)and(x2 = 7.04, P = 0. 008). The median survival time was 3.0 months(range: 1.0 - 24. 4 months)in patients who received ≥30 Gy whole brain irradiation, while only 1.8 months(range:0. 1-14. 2 months)in those who did not receive radiotherapy(x2 =5.54,P =0. 019). The median survival time of radiotherapy ± chemotherapy group, chemotherapy only group and supportive treatment only group were 3.0 months (range :0. 5 - 24. 4 months), 2. 2 months(range :0. 3 - 14. 2 months)and 1. 2 months(range :0. 1 - 4.5 months), respectively(x2 = 9. 32, P = 0. 009). Conclusions The prognosis of CM is very poor. The clinical stage before the diagnosis of CM and the control status of primary disease and were significantly correlated with survival. Sufficient whole brain irradiation dose may prolong survival and worth further study in a large sample study.
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Carcinomatous meningitis (CM) represents a devastating metastatic complication of malignant tumour, and the incident of CM is increasing in recent years. The diagnosis is made by both cerebrospinal fluid by lumbar puncture and radiological investigation, mainly magnetic resonance imaging. The therapeutic management of CM includes intrathecal administration of chemotherapy, radiotherapy, surgery and palliative care, but the treatment of CM remains controversial Individualized treatment and combined modality therapy are recommended at present, and the utilization of targeted drug may increase therapeutic effect of CM.
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Objective To investigate the relationship of microembolic signals (MESs) between the degree of symptomatic carotid artery stenosis, ultrasonic characteristics of plaques, peak systolic velocity at the stenotic site and risk factors for stroke. Methods A total of 52 patients with symptomatic carotid artery stenosis were enrolled. MESs of bilateral middle cerebral arteries were monitored and detected by carotid color Doppler flow imaging. Results The positive rate of MESs on the symptomatic sides was significantly higher than that on the asymptomatic sides (28. 8% vs. 4. 5%, P < 0. 05). The positive rate was not significantly correlated with the degree of stenosis, ultrasonic characteristics of plaques, peak systolic velocity on the stenotic sides, and risk factors for stroke. Conclusions MESs mainly occurred on the symptomatic sides of carotid artery stenosis, and they were more closely correlated with unstable plaques.
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The mechanism of development of thymomas associated with myasthenia gravis(MG) is not completely clear. It is not hard to make diagnosis of thymomas associated with MG via clinical manifestation,radiological investigation and laboratory examination, however, the treatment of thymomas associated with MG remains controversial and there is no straightforward guidelines in the literatures. Most scholars think surgery is the first choice to treat thymomas associated with MG, but for those who are not suitable for surgery, radiotherapy and chemotherapy would be considered to be their choice combined with anti-cholinesterase and steroidsdrugs therapy.
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Since 1990, the microembolic monitoring technology has been widely used in clinical practice and some progress has been made. This article reviews the new advances achieved in recent years, the problems facing and the direction of new development for microembolic monitoring in clinical research.