Cerebral oxygenation assessed by near-infrared spectroscopy in the sitting and prone positions during posterior fossa surgery: a prospective, randomized clinical study

Abstract Objectives: Sitting position (SP) or prone position (PP) are used for posterior fossa surgery. The SP induced reduction in cerebral blood flow and cerebral oxygen saturation (rSO2) has been shown in shoulder surgeries, but there is not enough data in intracranial tumor surgery. Studies showed that PP is safe in terms of cerebral oxygen saturation in patients undergoing spinal surgery. Our hypothesis is that the SP may improve cerebral oxygenation in the patients with intracranial pathologies due to reduction in intracranial pressure. Therefore, we compared the effects of the SP and PP on rSO2 in patients undergoing posterior fossa tumor surgery. Methods: Data were collected patients undergoing posterior fossa surgery, 20 patients in SP compared to 21 patients in PP. The rSO2 was assessed using INVOS monitor. Heart rate (HR), mean arterial pressure (MAP), EtCO2, BIS, and bilateral rSO2 were recorded preoperatively, and at 5, 8, and 11 minutes after the intubation and every 3 minutes after patient positioning until the initial surgical incision. Results: Cerebral oxygenation slowly reduced in both the sitting and prone position patients following the positioning (p < 0.002), without any difference between the groups. The HR and MAP were lower in the sitting SP after positioning compared to the PP. Conclusion: Neurosurgery in the SP and PP is associated with slight reduction in cerebral oxygenation. We speculate that if we rise the lower limit of MAP, we might have showed the beneficial effect of the SP on rSO2.

Tumor de células granulares: a propósito de un caso / Granulle cell tumor: a case report

RESUMEN Fundamento: el mioblastoma de células granulares también conocido como tumor de Abrikossoff es una neoplasia benigna de rara frecuencia formada por células de aspecto granular. Objetivo: exponer aspectos clínicos del mioblastoma de células granulares. Presentación del caso: se reportó el caso de un paciente masculino de raza negra, 50 años de edad, que fue remitido de la Atención Primaria con impresión clínica de fibroma lingual, al examen bucal se observó lesión ovoide de 3 cm de diámetro en el dorso de la lengua, asintomática, firme, hipocoloreada, consistencia dura y bordes precisos. Se realizó exéresis mediante biopsia escisional. El diagnóstico histopatológico determinó mioblastoma de células granulares. Conclusiones: tanto las características clínicas como histológicas del tumor de células granulares son muy semejantes a otras neoplasias malignas que se asientan en la lengua como el carcinoma epidermoide por tanto su diagnóstico constituye un reto para el estomatólogo.

ABSTRACT Background: granular cell tumor known as Abrikossoff´s tumor is a benign neoplasm of rare incidence formed by cell of granular aspects. Objective: to expose clinical aspects of granular cell tumor. Case report: a clinical case is reported of a 50 years-old black male patient. He was remitted of Primary Health Service with diagnostic impression of tongue's fibroma, in the oral exam was detected an oval lesion of 3cm of diameter on dorsum of the tongue, asymptomatic, firm consistency, and well defined. The lesion was removed by excision biopsy. The histological-pathological study determined a granular cell tumor. Conclusions: both the clinical and histological characteristics of the granular cell tumor are very similar to other malignant neoplasm that settle on the tongue such as epidermoid cell carcinoma therefore its diagnosis constitutes a challenge for the dentistry.

Application of enhanced recovery after surgery in abdominal tumor surgery / 中国肿瘤临床

Enhanced recovery after surgery (ERAS) represents a transformation to the evidence-based medicine paradigm in perioperative treatment. ERAS aims to reduce recovery time, postoperative complications, and healthcare costs. Here, we review the development and principal components of ERAS along with its application in abdominal tumor surgery. The benefits and feasibility of the ERAS protocol have been demonstrated in clinical practice, particularly in relation to colorectal surgery.

Prognostic value of primary tumor surgery in seminoma patients with distant metastasis at diagnosis: a population-based study / 亚洲男科学杂志(英文版)

The aims of this study were to determine the prognostic value of primary tumor surgery and identify optimal candidates for such surgery among patients with seminoma and distant metastasis at diagnosis. We identified 521 patients with seminoma and distant metastasis at diagnosis between 2004 and 2014 from the Surveillance, Epidemiology, and End Results database. Among these patients, 434 had undergone surgery, whereas 87 had not. The prognostic value of primary tumor surgery was assessed by Kaplan-Meier methods, log-rank analyses, and multivariate Cox's proportional hazards model. Survival curves and forest plots were also plotted. Survival analysis indicated that patients who underwent surgery had a better 5-year overall survival and cancer-specific survival than those who did not. Multivariate analyses demonstrated that primary tumor surgery is an independent prognostic factor for overall survival and cancer-specific survival, along with age at diagnosis, M stage, and marital status. In addition, primary tumor surgery still had considerable prognostic value in the subgroup of patients with lymph node metastasis. Further, forest plots demonstrated that patients with M1a stage, N1 or N2-3 stage, and a younger age at diagnosis (<60 years) may benefit from primary tumor surgery. In conclusion, our findings indicate that primary tumor surgery is correlated with improved survival in patients with seminoma and distant metastasis. Furthermore, primary tumor surgery is an independent prognostic indicator for patients with seminoma and distant metastasis.

Tumor de células granulares intratiroideo / Intra-thyroid granular cell tumor

RESUMEN Fundamento: los tumores de células granulares son lesiones benignas infrecuentes de crecimiento lento que pueden aparecer en cualquier sitio del organismo. La región de cabeza y cuello incluye las localizaciones más frecuentes (entre el 30 y el 50 % de todos los tumores de este tipo, hasta los del sistema nervioso central). Objetivo: presentar un caso de tumor de células granulares intratiroideo. Caso clínico: se presenta el caso de una paciente femenina de 37 años de edad con enfermedad nodular de la glándula tiroides de crecimiento lento con escasa sintomatología, con confirmación histológica tumor de células de la granulosa. Al examen físico se identificó aumento de volumen en la región anterolateral del cuello, en relación con el lóbulo derecho de la glándula tiroidea, que correspondía con lesión tumoral de 3 cm, mal delimitada, adherida a planos profundos, no dolorosa a la palpación. En la ecografía se observó: lóbulo derecho del tiroides de 4,3 cm x 1,2 cm x 1,4 cm, no homogéneo con lesión nodular de 2,8 x 1,4 cm mal delimitada, de bordes irregulares. Se realizó biopsia transoperatoria que se reportó como positiva de células neoplásicas malignas, sin embargo, el estudio histológico extemporáneo reveló un tumor benigno de células granulares intratiroideo. El tratamiento quirúrgico es curativo en este caso. Conclusiones: el diagnóstico de tumor de células granulares intratiroideo benigno, se presenta con las características de una lesión tumoral maligna, debe tenerse en cuenta en el diagnóstico diferencial de los tumores de la glándula tiroides.

ABSTRACT Background: the granular cells tumors are uncommon benign lesions of slow growth that can appear in any place of the organism. The head and neck region includes the most frequent localizations (between the 30 and 50% of all the tumors of this type, including those of the central nervous system). Objective: to present a case of intra-thyroid granular cell tumor. Clinical case: a case of a 37 year-old female patient with nodular illness of the thyroid of slow growth with scarce symptoms, with histologic confirmation of granular cells tumor is presented. To the physical exam, an increase of volume was identified in the anterolateral region of the neck, in connection with the right lobe of the thyroid gland that corresponded with a tumoral lesion of 3cm approximately, not well defined, stuck to deep planes, not painful to the palpation. In the echography, it was observed: right lobe of the thyroid of 4.3 cm x 1.2cm x 1.4 cm, not homogeneous with a nodular lesion of 2.8 x 1.4 cm not well defined, of irregular borders. During the surgery, a frozen section was examined and reported as positive of malignancy, however, the untimely histologic study revealed a benign intra-thyroid granular cell tumor. The surgical treatment is healing in this case. Conclusions: the diagnosis of intra-thyroid benign granular cell tumor is presented with the characteristics of a malign tumor, it should be kept in mind in the differential diagnosis of the tumors of the thyroid.

Bronchial carcinoid tumors: second primary neoplasms and outcomes of surgical treatment / Tumores carcinoides brônquicos: segunda neoplasia primária e desfechos do tratamento cirúrgico

ABSTRACT Objective: To analyze determinants of prognosis in patients with bronchial carcinoid tumors treated surgically and the potential concomitance of such tumors with second primary neoplasms. Methods: This was a retrospective analysis of 51 bronchial carcinoid tumors treated surgically between 2007 and 2016. Disease-free survival (DFS) was calculated by the Kaplan-Meier method, and determinants of prognosis were evaluated. Primary neoplasms that were concomitant with the bronchial carcinoid tumors were identified by reviewing patient charts. Results: The median age was 51.2 years, 58.8% of the patients were female, and 52.9% were asymptomatic. The most common histology was typical carcinoid (in 80.4%). Five-year DFS was 89.8%. Ki-67 expression was determined in 27 patients, and five-year DFS was better among the patients in whom Ki-67 expression was ≤ 5% than among those in whom it was > 5% (100% vs. 47.6%; p = 0.01). Concomitant primary neoplasms were observed in 14 (27.4%) of the 51 cases. Among the concomitant primary neoplasms that were malignant, the most common was lung adenocarcinoma, which was observed in 3 cases. Concomitant primary neoplasms were more common in patients who were asymptomatic and in those with small tumors. Conclusions: Surgical resection is the mainstay treatment of bronchopulmonary carcinoid tumors and confers a good prognosis. Bronchial carcinoid tumors are likely to be accompanied by second primary neoplasms.

RESUMO Objetivo: Analisar os determinantes do prognóstico em pacientes com tumores carcinoides brônquicos tratados cirurgicamente e possível segunda neoplasia primária concomitante. Métodos: Trata-se de uma análise retrospectiva de 51 tumores carcinoides brônquicos tratados cirurgicamente entre 2007 e 2016. A sobrevida livre de doença (SLD) foi calculada pelo método de Kaplan-Meier, e os determinantes do prognóstico foram avaliados. As neoplasias primárias concomitantes aos tumores carcinoides brônquicos foram identificadas por meio da análise dos prontuários dos pacientes. Resultados: A mediana de idade foi de 51,2 anos, 58,8% dos pacientes eram do sexo feminino e 52,9% eram assintomáticos. A classificação histológica mais comum foi carcinoide típico (em 80,4%). A SLD em cinco anos foi de 89,8%. A expressão de Ki-67 foi determinada em 27 pacientes, e a SLD em cinco anos foi melhor nos pacientes nos quais a expressão de Ki-67 foi ≤ 5% do que naqueles nos quais a expressão de Ki-67 foi > 5% (100% vs. 47,6%; p = 0,01). Neoplasias primárias concomitantes foram observadas em 14 (27,4%) dos 51 casos. Entre as neoplasias primárias malignas concomitantes, a mais comum foi o adenocarcinoma pulmonar, observado em 3 casos. Neoplasias primárias concomitantes foram mais comuns em pacientes assintomáticos e naqueles com tumores pequenos. Conclusões: A resseção cirúrgica é o principal tratamento de tumores carcinoides broncopulmonares e propicia um bom prognóstico. É provável que tumores carcinoides brônquicos se relacionem com segunda neoplasia primária.

Progress of reconstruction in bone tumor surgery / 中国修复重建外科杂志

Bone tumor surgery involves tumor resection and subsequent reconstruction. With the development of surgical technique and new material, there is a great step toward bone and joint reconstruction in bone tumor surgery. Generally speaking, there are two major reconstructive methods including bio-reconstruction and mechanical reconstruction. In addition, three-dimensional printed prosthesis has been widely applied in the field of bone tumor surgery. The short-term result is encouraged; however, long-term results and related complications are seldom reported.

Effect of acute non-isovolemic hemodilution in combination with tranexamic acid on cycle function blood gas and electrolytes with brain tumor surgery / 实用医学杂志

Objective To investigate the effect of acute non-isovolemic hemodilution in combination with tranexamic acid on cycle function blood gas and electrolytes with brain tumor surgery. Methods Forty-two patients undergoing brain tumor were randomly divided into two groups. Patients in group A received ANIH plus tranexamic acid , while patients in group B received ANIH alone. Collected blood was transfused before the end of surgery. HR、CVP、MAP,hemoglubin, blood gas and plasma electrolytes were respectively recorded before ANIH(T1), at 0 min (T1) and 1 h (T2) after ANIH, and at the end of operation (T4). Results There were no significant changes in HR, CVP, MAP. At T2, T3, T4, Hb, Hct in both two groups lower than those at T1(P <0.05); at T4, Hb, Hct in group A were higher than those in group B. There were no significant changes in pH , PaO2, PaCO2, BE between the both two groups. There were no significant changes in Na +, Cl-, Ca2+and K+between the both two groups. Conclusion ANIH has little effect on the cycle function and blood gas electrolyte. ANIH in combination with TA has a section blood effect. It can be used in the brain tumor operation with TA security.

Estratégias em reconstruções de tórax pós-ressecções extensas de tumores de mama localmente avançados: uma série de 11 casos / Strategies for chest reconstruction following extensive resection of locally advanced breast tumors: an 11-case series

INTRODUÇÃO: O câncer de mama representa um dos maiores responsáveis pela mortalidade feminina no Brasil. Os tumores de mama localmente avançados são classificados como estádio III, pois comprometem a mama em toda ou quase toda sua extensão e/ou linfonodos regionais sem apresentar metástase à distância. O tratamento cirúrgico desses tumores avançados consiste na realização de mastectomia radical modificada, que inclui esvaziamento axilar e grandes ressecções cutâneas, levando a grandes defeitos na caixa torácica, necessitando de complexas reconstruções. MÉTODO: Foi realizado um estudo clínico retrospectivo, no período de janeiro de 2006 a março de 2014, de uma série de 11 casos diagnosticados com tumores de mama localmente avançados. RESULTADOS: Foram realizados 3 retalhos fasciocutâneos, 2 enxertos de pele e 6 reconstruções com retalhos musculares para a reconstrução da caixa torácica após a resseção de tumores avançados da mama. Observouse uma cobertura eficaz dos extensos defeitos em tórax. CONCLUSÃO: O tratamento cirúrgico agressivo é viável nestes tumores; diferentes técnicas para a reconstrução do tórax são possíveis; cada caso deve ser avaliado individualmente, devendo ser realizado o reparo que possibilite um menor trauma cirúrgico e menor morbidade, de forma a não retardar o tratamento adjuvante nestes pacientes. As reconstruções apresentadas foram consideradas seguras, os resultados obtidos foram satisfatórios e de acordo com a literatura.

INTRODUCTION: Breast cancer is a major cause of mortality among women in Brazil. Locally advanced breast tumors are classified as stage III because they compromise the breast tissue in all or almost all of its extensions and regional lymph nodes, without distant metastases. Surgical treatment of these advanced tumors includes modified radical mastectomy, which involves axillary dissection and large skin resection, leading to major defects in the chest cavity that require complex reconstruction. METHOD: A retrospective clinical study including a series of 11 cases diagnosed with locally advanced breast tumors was performed from January 2006 to March 2014. RESULTS: The chest cavity reconstruction methods performed after resection of advanced breast tumors included three fasciocutaneous flaps, two skin grafts, and six reconstructions with muscle flaps. These procedures resulted in effective coverage of extensive chest defects. CONCLUSION: Aggressive surgical treatment is feasible in these tumors; although numerous reconstruction options are available, individual case assessment is necessary to determine the optimal technique to reduce surgical trauma and lower morbidity in order to avoid delays in adjuvant treatment in these patients. The reconstructions were safe, with satisfactory results similar to those reported in the literature.

Resultados de la cirugía de los somatotropinomas por acceso transnasal endoscópico usando la técnica de neuronavegación / Results of somatotropinoma surgery through endoscopic transnasal approach using the neuronavigation technique

Introducción: El tratamiento de elección para los tumores hipofisarios productores de hormona de crecimiento es la cirugía. El por ciento de recurrencia es elevado, pero, en gran medida, está en relación con la experiencia de los cirujanos, la técnica empleada y el trabajo multidisciplinario. Desde el año 2011 se constituyó un equipo multidisciplinario para guiar la conducta y el seguimiento de estos pacientes, que serían intervenidos empleando la técnica endoscópica con neuronavegación. Objetivo: describir los resultados de la cirugía de los adenomas hipofisarios productores de hormona de crecimiento con la técnica de neuronavegación. Métodos: estudio descriptivo que incluyó la revisión de las historias clínicas de 18 pacientes con tumores hipofisarios productores de la hormona de crecimiento, evaluados y remitidos para tratamiento quirúrgico endoscópico con neuronavegación. Las variables analizadas fueron: la edad, el sexo, la prueba de tolerancia a la glucosa para medir hormona de crecimiento antes y 7 días después de la cirugía, las características del tumor, las complicaciones posquirúrgicas y la evolución. Resultados: de los 18 casos, 66,6 por ciento eran del sexo masculino. El 33,4 por ciento tenía un tumor con crecimiento hacia el suelo de la silla turca, y las complicaciones posquirúrgicas fueron mínimas: el 16,7 por ciento presentó una diabetes insípida transitoria, e igual porcentaje una fístula de líquido cefalorraquídeo. En el 55 por ciento se identificó la remisión bioquímica a la semana de la intervención. Conclusiones: la cirugía de tumores hipofisarios productores de hormona de crecimiento empleando la técnica endoscópica con neuronavegador ofrece ventajas para los pacientes, con una evolución satisfactoria desde el punto de vista clínico y bioquímico, así como una baja frecuencia de complicaciones(AU)

Introduction: Treatment of choice for growth hormone-producing hypophysial tumors is surgery. The recurrence percentage is high but, to a great extent, is related to the surgeon´s experience, the surgical technique and the multidisciplinary work. Since 2011, a multidisciplinary team was created to guide the behavior and the follow-up of these patients who would be operated on by using the endoscopic technique based on the neuronavigation. Objective: to describe the results of the growth hormone-producing hypophysial adenomas surgery by using the neuronavigation technique. Methods: a descriptive study that included checking of the medical records of 18 patients diagnosed with growth hormone-producing hypophysial tumors and referred for endoscopic surgical treatment through neuronavigation. The analyzed variables were age, sex, tolerance test for glucose to measure growth hormone before and 7 days after surgery, the characteristics of the tumor, the postsurgical complications and the progress. Results: of this group of 18 patients, 66.6 percent were males 33.4 percent had tumors growing into the floor of the Turkish saddle and the postsurgical complications were minimal: 16.7 percent presented with transient diabetes insipidus and the same percentage had a cerebrospinal fluid fistula. Biochemical remission was detected in 55 percent of patients one week after the surgery. Conclusions: growth hormone-producing hypophysial tumors surgery using the endoscopic technique with neuronavigator provides advantages for patients, with satisfactory recovery from the clinical and biochemical viewpoint as well as low frequency of complications(AU)

The effect of dexmedetomidine on amino acid in cerebro-spinal fluid of patients undergoing intracranial tumor surgery / 临床麻醉学杂志

Objective To investigate the effect of dexmedetomidine on excitatory aminoacid (EAA)and inhibition of amino acid(IAA)in cerebro-spinal fluid(CSF)of patients undergoing in-tracranial tumor surgery,and to explore the cerebral protective mechanism of dexmedetomidine in neurosurgery.Methods Sixty patients aged 18-64 years old,ASA Ⅰ or Ⅱ,weighing 50-90 kg un-dergoing elective intracranial tumor surgery were randomly divided into dexmedetomidine group (group D)and control group(group C).Dexmedetomidine 1 μg/kg was infused before anesthesia in-duction for more than 10 minutes and pumped continously with 0.2-0.7 μg·kg-1·h-1 in group D, while in group C midazolam 0.03-0.05 mg/kg was injected followed by intermittent administration of 0.03-0.05 mg/kg.BIS value was maintained between 40-50.MAP and HR was recorded at the time points before induction(T0 ),dura mater incision(T1 ),tumor resection(T2 ),at the end of the surgery (T3 ).And we collected CSF at T0 ,T3 ,6 hours after the surgery(T4 ),12 hours after the surgery (T5 ),24 hours after the surgery(T6 ),then the concentrations of EAA and IAA were determined with high-performance liquid chromatography (HPLC)at T0 ,T3 ,T4 ,T5 and T6 .Results The MAP and HR in group D at T1-T3 were much lower than that in T0 and in group C(P <0.05).Compared with T0 ,the Glu and Asp in CSF significantly increased in group C at T3-T6 and were much higher than those in group D (P < 0.05 ),GABA was significantly decreased and much lower than group D(P <0.05).Compared with T0 ,the Glu and Asp in group D at T3-T5 were increased and GABA was decreased, but without statistic significance. At T6 , the values recovered to the level at T0 . Conclusion Dexmedetomidine can be used to maintain hemodynamic stability in intracranial tumor surgery,and may play a role in cerebral protection through inhibiting expression of Glu and Asp (EAA).

Growth hormone treatment for hypopituitarism after sellar tumor operation / 中华内分泌外科杂志

Objective To investigate the effect of growth hormone replacement therapy on life quality of patients with growth hormone deficiency after sellar tumor surgery.Methods The data of 13 patients undergoing sellar tumor resection and suffering postoperative hypopituitarism from Jun.2009 to Dec.2010.were collected.Each of them was given daily 0.5 units growth hormone (about 0.17 mg) as replacement therapy.The life quality of patients at different time points was evaluated with QoL-GDHA scale.SPSS 17.0 software was used for statistical analysis.Results 1,3,and 6 months after treatment,QoL-GDHA score of the patients was 3.91± 2.29,3.38 + 2.43,and 3.23 + 2.28 repectively,significantly lower than before ( 8.69 ± 2.66).The difference had statistical significance (P ＜0.05 ).Conclusion Growth hormone replacement therapy can significantly improve the life quality of patients with hypopituitarism after sellar tumor surgery.

An Experience of Autologous Blood Transfusion and Blood Management in Brain Tumor Surgery / 대한수혈학회지

BACKGROUND: Allogeneic blood transfusion has risks from transfusion-transmitted pathogens. Blood management programs are widely used for cardiovascular or orthopedic surgery, but there have been few studies that have focused on blood conservation during brain tumor resection surgery. The purpose of this study was to evaluate the benefits of blood management for brain tumor surgery. METHODS: A total of 26 patients undergoing brain tumor resection surgery were included in the study. Thirteen patients with meningiomas, 10 patients with malignant gliomas and 3 patients with other tumors were included. The surgical blood loss was estimated by preoperative imaging studies, and the tumors that could be operated with minimal bleeding were excluded. Preoperative autologous donation (PAD) was done when the expected amount of surgical bleeding surpassed 300 mL. Preoperative embolization was performed in the patients with meningiomas whenever it was technically feasible. Six percent hydroxyethyl starch 130/0.4 (Voluven) was administered during anesthesia for expanding the blood volume and we performed meticulous surgical techniques for minimizing the blood loss. RESULTS: The amount of bleeding was less than 300 mL in 69.2% of the patients. Preoperative autologous blood was donated by 10 patents and 20% of the PAD units were discarded. Five patients with meningimas received preoperative embolization. None of the patients, except for one patient who had massive bleeding of 7,000 mL, were transfused allogeneic blood. Eighty one percent of the patients received Voluven without complications. CONCLUSION: Multiple strategies that include preoperative embolization, proper surgical techniques for minimizing blood loss, PAD and hydroxyehtyl starch could effectively decrease the amount of allogenic blood transfused during brain tumor resection surgery.

Dermatofibrosarcoma protuberans de cuero cabelludo / Dermatofibrosarcoma protuberans of scalp

El Dermatofibrosarcoma Protuberans (DFSP), es una tumoración poco frecuente, representa del 2 al 6 por ciento de todos los sarcomas de tejido blandos, se considera de origen dérmico. Se caracteriza por ser de una malignidad intermedia, con poca potencialidad metastásica aun que lo puede hacer tardíamente en el desarrollo de la enfermedad, es de crecimiento por lo general lento, localmente agresivo y con altos índices de recurrencia luego de los tratamientos. Mayormente afecta pacientes entre los 20 y 50 años aunque se han descrito casos en niños y ancianos, como es este caso. Se presenta el caso de un paciente de 91 años de edad, con una tumoración localizada en cuero cabelludo, el procedimiento quirúrgico de extirpación el para estudio histopatológico de toda la masa tumoral, que permitió efectuar el diagnóstico de Dermatofibrosarcoma Protuberans. Se discute aspectos clínicos, diagnósticos y terapéuticos de este caso.

Dermatofibrosarcoma Protuberans (DFSP) is a rare tumor, accounts for 2 to 6 per cent of all soft tissue sarcomas, it is considered of dermal origin. It is characterized as intermediate malignancy with low metastaic potencial, it can do even late in the development of the disease, is usually slow growing, locally aggressive with high recurrence rates after treatment. Mainly affects patients between 20 and 50 years although cases, have been reported in children and the elderly, as in this case. A case of a patient 91 years old with a tumor located on the scalp, the surgical procedure of removal for histopathological study of the whole tumor mass, allowed the diagnosis of dermatofibrosarcoma protuberans. We discuss clinical, Diagnostic and therapeutic in this case.

Perioperative nursing of patients receiving colorectal tumor surgery under peritoneoscope / 中国实用护理杂志

Objective To discuss the perioperative nursing method for patients receiving colorec-tal tumor surgery under peritoneoscope. Methods Using the nursing procedure, through appraisal of patients' health situation→listing the nursing diagnosis or the nursing questions→formulation of nursing plan→ implementation of nursing plan→appraisal of the expected effect, combination of the surgical nursing's characteristic, to practice the idea of "the perfect person health and concern", cooperation with medical and nursing team, we provided a complete treatment and nursing plan for 38 patients receiving colorectal tumor surgery under peritoneoscope. Results 38 patients made satisfactory results with no surgery complications. The average in-hospital time was 9 days. Conclusions This technology has slight wound,light hemorrhage,slight draw-off, less pain, short exposure time of intestine, fast recovery of intestine function and early food intake. Systematic and intact perioperative nursing can improve the nursing quality and the success rate and reduce the complications so that the patients can live through the surgery safely.

The malignant tumor of appendix / 中国普通外科杂志

From 1952 to 1990, 21 cases of malignant tumor of the appendix, including 14 cases of carcinoid tumor of appendix, 4 cases of appendix adenocarcinoma, 2 cases of appendix lymposarcoma and 1 case of appendix cystocarcinoma, were treated in the Affiliated Hospital of Wannan Medical College Among these 21 patients, 16 underwent appendectomy alone, 5 underwent appendectomy first and a right hemicolectomy was performed on later All of the 21 patients were followed up for 5～10 years,the survival rate was 90 5% and 90 5% respectively So if a malignant tumor of the appendix was suspected, a biopsy during operation should be done to determine the pathological type If the diagnosis was clear, the choice of operation mode must be made according to the size and the pathological type of the tumor In selective patient, a right hemicolectomy must be performed on

An Analysis of Major Complications after Brain Tumor Surgery

The ocurrence of complications after brain tumor surgery often lead to death. To decrease the incidence of complications, it is desirable to identify patients at risk as early as possible prior to surgery. It can be achieved by determining preoperatively those factors known to be of prognostic relevance in the development of such postoperative complications. The prognostic factors may be differ considerably depending on the population studied but the homogeneous population studied in this analysis may help to contribute to the reference guide in identifying those factors. Authors have retrospectively analysed the major complications developed after performing on 150 brain tumor surgeries during last five years to identify the prognostic factors.