Diagnosis and one stage surgical treatment of lower thoracic ossification of ligamentum flavum combined with lumbar spinal stenosis

Objective To study the diagnosis and treatment of lower thoracic ossification of ligamentum flavum(OLF) combined with lumbar spinal stenosis.Methods Retrospective analysis was carried out on 11 cases of lower thoracic OLF combined with

Ultrasonographic Evaluation of Osteosarcomas

The ultrasonographic appearances of osteosarcomas and the roles of ultrasonography in the diagnosis and surgical staging of osteosarcomas were investigated. A comparative study was performed on 45 cases of osteosarcomas by ultrasonography and radiography. Bony changes, periosteal reaction and soft tissue mass were evaluated for each lesion. The results showed that ultrasonography revealed a solid mass around bone in 42 patients, bone destruction in 24 patients and periosteal reaction in 16 patients. Plain radiographs showed bony changes in 44 patients and no bony change in remaining one patient, shadowing of soft tissue swelling in 30 patients, and pulmonary metastases in 3 patients. Surgical biopsy and pathological examination confirmed osteosarcoma in all 45 patients. Soft tissue mass was confirmed in 42 patients surgically. The diagnostic accuracy of soft tissue masses by ultrasonography and radiography was 100 % （42/42） and 71.4 % （30/42）, respectively. The positive rate of ultrasonography and radiography in displaying bony changes was 53.3 % （24/45） and 97,8 % （44/45）, respectively. In conclusion, in the detection of soft tissue mass of osteosarcoma, ultrasonography is superior to radiography, and in displaying bony changes of osteosarcomas, radiography is superior to ultrasonography. So it may come to a conclusion that plain radiography combined with ultrasonography can completely display the bony and soft tissue lesion of osteosarcomas.

Is surgical axillary staging necessary in women with T1 breast cancer who are treated with breast-conserving therapy?

Background:In the post-Z0011 trial era,the need to perform surgical axillary staging for early-stage breast cancer patients,who are treated with breast-conserving therapy(BCT),is being questioned.We conducted a retrospective cohort study using the Surveillance,Epidemiology,and End Results(SEER)database to evaluate the safety of waiving surgical axillary staging in patients with T1 breast cancer treated with BCT.Methods:A total of 166,615 eligible patients diagnosed between 2000 and 2012 were divided into staging(sentinel lymph node biopsy or axillary lymph node dissection)and non-staging(no lymph node examined or only needle aspiration biopsy of lymph nodes)groups.Propensity score matching(PSM)was performed to balance disparities between the two groups.Multivariate analysis with the Cox proportional hazards model was used to assess factors related to breast cancer-specific survival(BCSS).Results:Although the tumor size at time of presentation was decreasing over years,the rate of surgical axillary stag-ing increased from 93.3%to 96.9%.The 5-year BCSS rates of the whole cohort(before PSM)and matched cohort(after PSM)were 98.0%and 97.5%.Within the matched cohort,the BCSS was significantly longer in the staging group than in the non-staging group(P<0.001).However,surgical axillary staging did not benefit patients who were 50-79 years old,had tumor size<1 cm,histological grade I disease,or favorable histological types(tubular/mucinous/papillary)in stratified analyses(P>0.05).Race,marital status,hormone receptors,and chemotherapy were not associated with the favorable impact of surgical axillary staging on BCSS(P>0.05).Conclusion:Although surgical axillary staging remains important for T1 breast cancer patients treated with BCT,it might be unnecessary for patients with old age,small tumor,grade I disease,or favorable histological types.