Reconstruction using a frozen autograft for a skull and humeral lesion of synchronous multicentric osteosarcoma after undergoing successful neoadjuvant chemotherapy: a case report and review of the literature

Comprehensive conservative treatment for multiple metastases of skull osteosarcoma: A case report

Background

Skull osteosarcoma is relatively rare, and it is difficult to be diagnosed according to medical history and imaging examination due to the complex structure and diverse components of the brain. Consequently, there is only a limited number of patients who can undergo neoadjuvant chemotherapy before the operation. Although neoadjuvant chemotherapy plays an important role in the treatment of osteosarcoma, there is still a "bottleneck" in the current treatment method which when pulmonary metastasis occurs, or surgical treatment is not Enneking appropriate. Under such circumstances, the choice of treatment can be an issue.

Case

A 16-year-old male patient with multiple metastases of skull osteosarcoma was reported. The patient suffered not only tinnitus and hearing loss in the right ear but also right facial paralysis and headache. The preoperative brain MRI showed a tumor in the right cerebellopontine angle (CPA) area. He underwent skull tumor resection at another hospital in November 2018, during which process the biopsy revealed epithelioid osteoblastoma-like osteosarcoma. The patient had supplemental radiotherapy 1 month after surgery because of tumor recurrence. 32 months afterward, pulmonary metastases and multiple bone metastases were found. Then the patient underwent multiple conservative treatments which include Denosumab, Anlotinib, and DIA (cisplatin + ifosfamide + doxorubicin) chemotherapy at our hospital. After a series of 6 cycles of treatment, the patient can walk without aid. Lactate dehydrogenase (LDH) and Alkaline phosphatase (AKP) returned to a normal level. Fluorodeoxyglucose (FDG) metabolism in all bone metastases decreased to normal except for the ones in the proximal left femur, and the FDG metabolism in the left femur is significantly lower than that before treatment. Multiple bone metastases showed different extents of high-density calcification, and the volume of the local bone metastases has been reduced significantly. The patient's condition stayed stable at latest follow-up.

Conclusion

We found that multiple conservative treatments, which include Denosumab, Anlotinib and DIA chemotherapy, can improve patients' life quality, and help avoid further osteolytic destruction for patients with skull osteosarcoma and multiple metastases. Its specific mechanism and scope of the application still need to be further studied.

Effects of Nursing Intervention Based on Health Belief Model on Self-Perceived Burden, Drug Compliance, and Quality of Life of Renal Transplant Recipients

Objective

To explore the effects of nursing intervention based on health belief model (HBM) on self-perceived burden, drug compliance, and quality of life of renal transplant recipients.

Methods

Sixty patients with renal transplantation treated in our hospital from February 2019 to July 2021 were enrolled. The patients were randomly assigned to control group and study group. The former received routine nursing and the latter received nursing intervention based on HBM.

Results

The nursing satisfaction in the study group was higher compared to the control group (P < 0.05). Secondly, we compared the scores of self-burdens. Before nursing, they exhibited no significant difference (P > 0.05); after nursing, they decreased. Moreover, the physical burden, economic burden, and emotional burden of the study group were lower compared to the control group (P < 0.05). In terms of drug compliance, the rates of no missed medication, noncontinuous missed medication, timely medication, dose-by-dose medication, and non-self-stopping medication in the study group were higher compared to the control group (P < 0.05). The scores of SAS and SDS exhibited no significant difference before nursing (P > 0.05). After nursing, they decreased. Furthermore, the scores of SAS and SDS of the study group were lower compared to the control group (P < 0.05). The self-management ability exhibited no significant difference before nursing (P > 0.05); after nursing, it increased. Moreover, the self-management ability of the study group at discharge and 1 month, 3 months, and 6 months after discharge was higher compared to the control group (P < 0.05). Finally, we compared the scores of quality of life. Before nursing, there was no significant difference (P > 0.05). The scores of physiological function, psychological function, social function, and health self-cognition in the study group were lower compared to the control group (P < 0.05).

Conclusion

The nursing intervention based on HBM can enhance the medication compliance of renal transplant recipients, and the intervention effect is long-lasting. Meanwhile, it can effectively enhance the negative emotion of patients, reduce the burden of self-feeling, promote the quality of life, strengthen the self-management of patients, and facilitate the prognosis.

Malignant fibrous histiocytoma of the bone in a traumatic amputation stump: A case report and review of the literature

BACKGROUND

Malignant fibrous histiocytoma (MFH) is one of the most common soft tissue sarcomas among adults. It is characterized by large size, high grade, and biological aggressiveness. There are many reports of MFH after local stimulation, such as bone fracture, implants, and chronic osteomyelitis. In this paper, we report a patient who developed MFH 6 years after amputation, suggesting that wound healing and mechanical force play a role in the local stimulation of this disease.

CASE SUMMARY

A 66-year-old man complained of persistent pain in his residual mid-thigh. He had undergone amputation surgery due to a traffic accident 6 years prior. Physical examination showed tenderness but no abnormalities in appearance. X-ray radiographs and magnetic resonance imaging supported the diagnosis of a tumor, and a biopsy confirmed that the lesion was MFH. The patient received neoadjuvant chemotherapy and left hip disarticulation. During the 6-mo follow-up, there were no symptoms of recurrence.

CONCLUSION

Postsurgery MFH has been reported before, and many studies have attributed it to the biological effects of implants. Our case report shows that this disease can develop without an implant and thus highlights the importance of local stimulation. The wound-healing process and mechanical force can both promote this tumor, but whether they directly cause MFH needs further investigation.