结节病易误诊,据王洪武等~([1])收集国内18篇关于此病误诊的文献,误诊率高达63.2%,当然有误诊就会有误治,如孙永昌等~([2])报道26例结节病在影像学检查诊断的第一印象中拟诊结核5例,其中就有2例完成规范的抗结核治疗,为此应引起临床对本病诊治的重视。

Sarcoidosis

PURPOSE: To define prognostic factors for response and long-term outcome for a wide spectrum of osteosarcomas, extending well beyond those of the typical young patient with seemingly localized extremity disease. PATIENTS AND METHODS: A total of 1,702 consecutive newly diagnosed patients with high-grade osteosarcoma of the trunk or limbs registered into the neoadjuvant studies of the Cooperative Osteosarcoma Study Group before July 1998 were entered into an analysis of demographic, tumor-related, and treatment-related variables, response, and survival. The intended therapeutic strategy included preoperative and postoperative chemotherapy with multiple agents as well as surgery of all operable lesions. RESULTS: Axial tumor site, male sex, and a long history of symptoms were associated with poor response to chemotherapy in univariate and multivariate analysis. Actuarial 10-year overall and event-free survival rates were 59.8% and 48.9%. Among the variables assessable at diagnosis, patient age (actuarial 10-y...

Prognostic Factors in High-Grade Osteosarcoma of the Extremities or Trunk: An Analysis of 1,702 Patients Treated on Neoadjuvant Cooperative Osteosarcoma Study Group Protocols

https://behandelaar.pijnbijkanker.nl/sites/behandelaar.pijnbijkanker.nl/files/publicaties/van%20den%20Beuken%20et%20al.%20Prevalence%20cancer%20pain.%20Ann%20Oncol%202007.pdf

Prevalence of pain in patients with cancer: a systematic review of the past 40 years

Nasopharyngeal carcinoma (NPC) has a unique and complex etiology that is not completely understood. Although NPC is rare in most populations, it is a leading form of cancer in a few well-defined populations, including natives of southern China, Southeast Asia, the Arctic, and the Middle East/North Africa. The distinctive racial/ethnic and geographic distribution of NPC worldwide suggests that both environmental factors and genetic traits contribute to its development. This review aims to summarize the current knowledge regarding the epidemiology of NPC and to propose new avenues of research that could help illuminate the causes and ultimately the prevention of this remarkable disease. Well-established risk factors for NPC include elevated antibody titers against the Epstein-Barr virus, consumption of salt-preserved fish, a family history of NPC, and certain human leukocyte antigen class I genotypes. Consumption of other preserved foods, tobacco smoking, and a history of chronic respiratory tract conditions may be associated with elevated NPC risk, whereas consumption of fresh fruits and vegetables and other human leukocyte antigen genotypes may be associated with decreased risk. Evidence for a causal role of various inhalants, herbal medicines, and occupational exposures is inconsistent. Other than dietary modification, no concrete preventive measures for NPC exist. Given the unresolved gaps in understanding of NPC, there is a clear need for large-scale, population-based molecular epidemiologic studies to elucidate how environmental, viral, and genetic factors interact in both the development and the prevention of this disease.

https://cebp.aacrjournals.org/content/cebp/15/10/1765.full.pdf

The enigmatic epidemiology of nasopharyngeal carcinoma.

Epidemiology of nasopharyngeal carcinoma.

The records of 66 patients with osteosarcoma of the jaw were reviewed. The ages of the 42 males and 24 females ranged from 12 to 79 years (mean, 34.2 years). Swelling and pain, the most frequent presenting complaints, were noted an average of three months before the patient was seen by a physician. Fifty-one percent of the lesions involved the maxilla and 49% involved the mandible. The most common sites of involvement were the body of the mandible and the alveolar ridge of the maxilla. Radiologically, most of the lesions in the maxilla were osteoblastic (50%), whereas most of those in the mandible were osteolytic (43%). Chondroblastic osteosarcoma was the most frequent histologic type (48%) and was associated with the best survival rate (47%). Treatment included radical and local surgery with radiotherapy, chemotherapy, or various combinations. The recurrence rate for all treatment modalities was 70%. Patients treated by initial radical surgery had the best survival (80%). Survival decreased to 27% with local surgery. Of the 43 (65%) patients who died, most died with uncontrolled local disease; only four patients had documented distant metastasis, which involved lung, cervical lymph nodes, spinal column, and brain.

Osteosarcoma of the jaw.

From 1933 through 1962 thirty-three patients who had nasal lymphoreticular lesions previously diagnosed as lymphoma were seen at the Mayo Clinic. Of the thirty-three patients twenty-three were men and ten were women. Their ages ranged from twenty-five to seventysix years and 70 per cent were more than forty years of age. The most frequent complaints were progressive nasal obstruction and nasal, facial, or orbital swelling. The nasal involvement was bilateral in 27 per cent of the cases. Cell types of twenty-four lesions were those of typical lymphoma and those of nine lesions had a polymorphocellular composition. The growths exhibiting typical lymphoma cell types more often grossly tumorous and symptomatically of shorter duration, while the polymorphic type was more frequently ulcerative and had longer prodromata of nasal symptomatology in many cases. Radiotherapy was the treatment of choice. The five year survival rate in the thirty-three cases was 56.7 per cent and the ten year survival rate, 34.8 per cent. Patients having stage I lesions without extension to neighboring sinuses, orbit, or pharynx did much better than those with this extension or patients with stage II involvement. The most striking feature of our study was that the five year survival rate of the twenty-four patients with typical lymphoma in stage I was 41.2 per cent with an over-all survival rate of 38.1 per cent while all nine patients with polymorphic lesions survived five or more years. A relationship may exist between these nine polymorphic lesions and certain lesions reported as lethal midline granuloma, although polymorphic reticulosis is suggested as a more descriptive morphologic term.

Primary lymphoma of the nose including a relationship to lethal midline granuloma.

In 142 patients with primary nasopharyngeal cancer encountered at the Mayo Clinic in the years 1950 through 1960, sex, age, site of primary tumor, presenting symptoms, or duration of symptoms did not seem to bear any relationship to the ultimate salvageability of these patients. The ratio of males to females was 2.4:1. The 5 year survival rate was 29 per cent for males and 33 per cent for females. Seventy-one per cent of the patients and 75 per cent of the 5 year survivors were in the age period 40 through 69 years. None of 10 patients less than 20 years of age and only 2 of 10 aged 70 years or more survived 5 years. Site of the primary tumor in the nasopharynx did not seem to carry a prognostic implication : the 5 year survival rate was 37 per cent for lateral wall lesions, 29 per cent for vault lesions, 37 per cent for combined lateral-wall and vault lesions, 14 per cent for lesions of the anterior vault and posterior nares, 30 per cent for posterior wall lesions, and 18 per cent for extensive lesions f...

Cancer of the nasopharynx: 142 patients treated in the 11 year period 1950-1960.

In the past, the recurrence rate of tumors of the parotid gland has been exceedingly high. This fact is surprising, since approximately 80% of parotid tumors are considered to be benign. Kirklin and associates, 1 reviewing all parotid tumors treated at the Mayo Clinic from 1907 through 1944, found a recurrence rate of 32% in 30 years. Malignant lesions of this gland represent 20% to 35% of all parotid tumors. 1-3 The poor results in the treatment of parotid tumors stem largely from inadequate removal of the primary lesion. The two most important reasons for this are fear of injuring the facial nerve and lack of knowledge of the technique in dissecting the nerve from parotid tissue. 4,5 Therefore, about eight years ago, we instituted a more aggressive approach to the treatment of lesions of the parotid gland. Most benign tumors since 1951 have been removed by subtotal (superficial) parotidectomy

Surgical management of parotid lesions. Review of seven hundred sixty cases.

Summary All young males with nasal obstruction or nose-bleed (or both) should be suspected of having juvenile angiofibroma. This awareness, as well as a good physical examination and history taking, is essential. Plain roentgenograms of the sinus, with submentovertical views, and tomograms should be sufficient adjuncts for diagnosis. Knowledge of the point of origin in the posterior nasal cavity and the natural history of extension of the tumor into the nasal cavity, nasopharynx, sphenoid sinus, pterygomaxillary and infratemporal fossae, and cranial cavity is essential in planning treatment. Angiography for diagnostic purposes should be used only in unusual circumstances. The use of hormones, cryotherapy, carotid ligation, or hypotensive anesthesia probably will not be of any help in controlling hemorrhage at operation. Our experience with patients who have received irradiation and who still had the angiofibroma—with the ever present risk of irradiation [ 15 ] in the preadult patient—has caused us to be skeptical of this modality as a primary form of treatment. However, the radiotherapist is a member of the team managing the treatment of patients with this most difficult tumor. (Figure 9.) All operations presently used to obtain surgical exposure of the angiofibroma and its extension may be inadequate when the tumor bleeds excessively on manipulation. We believe-lateral rhinotomy, in one procedure, allows the surgeon to expose the extensions of the tumor and to remove the tumor from its point of origin in the posterior nasal cavity without disturbing facial growth or causing facial deformity. Intracranial extension indicates advanced disease and is not unusual [ 13, 16 ]. We have successfully removed angiofibromas involving the middle fossa, but four of our patients who died had evidence of intracranial angiofibroma.

Kenneth D. Devine

Papers

Osteosarcoma of the jaw.

Primary lymphoma of the nose including a relationship to lethal midline granuloma.

Cancer of the nasopharynx: 142 patients treated in the 11 year period 1950-1960.

Surgical management of parotid lesions. Review of seven hundred sixty cases.

Juvenile angiofibroma. Review of 120 cases.