Experience with wound complications after surgery for sacral tumors.

PURPOSE: The aim of this article is to summarize our experience in treating sacral wound complications after sacrectomy. We focus, in particular, on factors associated with wound complications, including surgical site infection (SSI) and wound dehiscence. METHODS: The definition of SSI devised by Horgan et al. was applied. Wound dehiscence was defined as a wound showing breakdown in the absence of clinical signs meeting the diagnostic standard for SSI. Between September 1997 and August 2009, 387 patients with a sacral tumor underwent sacrectomy performed by the same team of surgeons and were followed up for ≥ 12 months. Potential risk factors were evaluated for univariate associations with SSI and wound complications. Multivariable conditional logistic regression was used to identify the combined effects of several risk factors. RESULTS: Of the 387 wounds studied, 274 healed uneventfully, and 113 (29.2 %) broke down because of infection or dehiscence. Fifty-one (13.2 %) patients developed a postoperative SSI, and 62 (16.0 %) patients developed wound dehiscence. Gram-negative bacteria grew in 45 cultures (91.8 %) and included 38 cases of Escherichia coli. Previous radiation, rectum rupture, longer duration of surgery, and cerebrospinal fluid leakage were significantly associated with increased likelihood of developing an SSI. Previous radiation, rectum rupture, age <40 years, history of diabetes mellitus, maximum tumor diameter ≥ 10 cm, and instrumentation used were risk factors for wound complications. CONCLUSIONS: The incidence of wound complications is not so high at a musculoskeletal tumor center with surgeons experienced in treating sacral tumors. Controlling for these risk factors when possible may improve clinical outcomes.

The changing epidemiology of paediatric brain tumours: a review from the Hospital for Sick Children.

PURPOSE: This study examines the changing epidemiology of paediatric brain tumours over the past three decades (1980-2008) in a single institution, SickKids, Toronto, Canada. METHODS: We classified 1,866 surgical pathology cases of brain tumours in children under the age of 19 according to the World Health Organization 2007 consensus and analysed them by gender, histological tumour type, age distribution and decade. RESULTS: Males showed a slightly higher predominance with 56.8% of cases overall. The main histological tumour types were low-grade (I/II) astrocytomas (26.4%), medulloblastoma (10.6%), anaplastic astrocytoma/glioblastoma multiforme (7.1%) and ependymoma (7.0%). Over three decades, an increasing proportion of certain tumour types, including pilocytic astrocytoma, atypical teratoma/rhabdoid tumours and neuronal/mixed neuronal-glial tumours was seen. CONCLUSIONS: Our results are consistent with those published with similar methodologies in other countries. Any changes in the epidemiology of childhood central nervous system tumours over the past three decades may be attributed in part to changing classification systems, improved imaging technologies and developments in epilepsy surgery; however, continued surveillance remains important.

gp130RB13-6-positive neural progenitor cells are susceptible to the oncogenic effect of ethylnitrosourea in pre-natal rat brain.

Proliferation-competent rat brain precursor cells of glial lineages are thought to preferentially undergo malignant transformation after transplacental exposure to ethylnitrosourea (EtNU). We recently have reported that monoclonal antibody (mAb) RB13-6 recognizes a developmentally regulated 130 kDa cell surface glycoprotein (gp130RB13-6) transiently expressed by a small subpopulation of glial progenitor cells in pre-natal rat brain. The expression of gp130RB13-6 has now been analysed immunocytochemically in malignant gliomas induced on day 15, 18 or 21 of gestation and in long-term cultures of fetal brain cells (FBC) isolated after in vivo-exposure to EtNU on day 18 of gestation. Malignant gliomas induced at different gestational stages contained varying proportions of gp130RB13-6-positive cells, whereas a subpopulation of proliferative neural progenitor cells exhibiting sustained gp130RB13-6 expression persisted in long-term FBC cultures after 3 months. This subpopulation, which was not selected for in control cultures of FBC derived from buffer-treated rats, gave rise to malignant cell lines after a period of time similar to the latency period required for glioma development in vivo. These data suggest that gp130RB13-6-positive cells of the immature rat nervous system may represent a subset of neural progenitor cells particularly susceptible to the oncogenic effect of EtNU.

Tumores do mediastino em crianças / Mediastinal tumors in children

Os tumores do mediatino em crianças apresentam algumas peculiaridades qye divergem dos adultos. O mediatino pode ser dividido em três compartimentos, o anterior, o médio e o posterior onde as lesöes se agrupam de modo preferencial. Os sintomas apresentados pelas crianças abaixo de dois anos de idade säo muito mais graves do que acima desta idade, salientado-se a compressäo traqueal em 78% dos casos. A incidência dos tumores mediatinais corresponde a 0.02% de todas as admissöes nos hospitais terciários. Quase 70% de todos os tumores nas crianças estäo representados por tumores do tipo neurogênico (35%), linfoma (20% e cisto enterógeno (13%). Um novo tipo de tumor (Askin) foi descrito recentemente e localizado no mediatino posterior. Foram descritos os estadiamentos da doença de Hodgkin e näo Hodgkin, bem como as formas de tratamento pela quimioterapia e radioterapia. Foi dada ênfase especial aos tumores do mediastino posterior, especialmente o neuroblastoma, cuja incidência no mediastino é de 20%, enquanto 70%, localiza-se no retroperítônio e 5% na pelvis. A classificaçäo mais adotada deste tipo de tumor é a de Evans. O prognóstico desta patologia no estágio I é excelente (100%), no estágio II (82%), estágio III (27,5%), estágio IV (15%) e estágio IVs, (80%)

[A clinicopathological study of mediastinal tumors].

One hundred and fifty-eight cases of mediastinal tumors have been studied clinicopathologically, based on patients of Nagasaki University Hospital from 1961 to 1984. Of these tumors, 29.7% were thymic tumors, 23.4% neurogenic tumors, and 21.5% were germ cell tumors, the frequencies of which reflected the same tendency as other such reports in Japan. Thirty-three cases were malignant tumors. Among them, thymomas were the most common (48.5%) as Wada et al. have reported. Extrathoracic metastases have observed in 2 thymomas. Thymomas associated with myasthenia gravis were seen in 6 cases in which 5 patients are still alive.

Incidence of malignant disease in childhood: a 24-year review of the Manchester Children's Tumour Registry data.

The Manchester Children's Tumour Registry data for the period 1954-1977 have been analysed. The overall incidence of malignant disease in children aged 0-14 years in the north-west of England is estimated to be 100 per million person-years. The most common disease group is leukaemia, which forms about one third of the total number of cases. Among solid tumours, by far the most common presenting site is the central nervous system, representing nearly a quarter of all neoplasms. Wilms' tumour, neuroblastoma and soft-tissue sarcomas comprise approximately 5%, 6.5% and 6% respectively of the total. The tumours most frequently seen in adults (e.g. carcinoma of colon, lung and breast) are extremely rare in childhood. A significant excess of males was seen in acute lymphoid leukaemia, non-Hodgkin's lymphoma, Hodgkin's disease, medulloblastoma and hepatoblastoma. A female excess was found among germ-cell tumours. During the study period significant increases in incidence were seen among acute lymphoid leukaemia and epithelial tumours, and an increase in germ cell tumours approached significance.

Occurrence of nervous-tissue tumors in cattle, horses, cats and dogs.

From 11 North American veterinary university hospitals and clinics, 248 animals were a confirmed diagnosis of nervous-tissue tumor were identified; 7 tumors were found in cattle, 28 in horses, 14 in cats, 199 in dogs, and none in other species. Tumors were divided for analysis into three categories-glial, meningeal, and peripheral nerve. In cattle and horses, all tumors involved peripheral nerves, the risk of which, in horses, reached a plateau at 4-6 years of age and remained constant thereafter. In cats, the tumors were equally distributed among the three tumor categories whereas, in dogs, twice as many glial tumors as meningeal and peripheral nerve tumors were found. The risk for glial tumors in dogs reached a peak at 10-14 years of age, for meningeal at 7-9 years, and for peripheral nerve at 2-3 and 7-9 years. Three canine breeds-English bulldog, boxer, and Boston terrier-had an excessive rish of glial tumors. Except for an excess of skin tumors in dogs with peripheral nerve tumors, there was no unusual occurrence with second primary neoplasms for any species. There was no detectable predisposition by sex for any of the categories of nervous-tissue tumors among any of the four species. The role of genetic abnormalities associated with nervous-tissue tumors and other etiologic factors (e.g., chronic hypoxia) may be clarified by further studies involving canine breeds of "bulldog" ancestry.

Malignant lymphomas of African children.

Clinical, pathologic, and epidemiologic observations of malignant tumors of children in sub-Sahara Africa suggest alternative theories of causation, and give insight into environmental influences that may play a large role in the etiology and form of malignant lymphatic tumors and cerebral neoplasms of infants.