Case report: Leukemia cutis as the first manifestation of chronic neutrophilic leukemia in a 6-year-old girl.

Chronic neutrophilic leukemia (CNL) is a rare BCR-ABL negative myeloproliferative neoplasm that usually affects older adults with a poor prognosis. Leukemia cutis is an extramedullary manifestation of leukemia and may be misdiagnosed by dermatologists. Here, we describe a case of CNL in a 6-year-old Chinese girl with leukemia cutis as the first manifestation. Her skin rashes failed to attract the attention of dermatologists in early stages. The diagnosis was confirmed by peripheral smear, bone marrow studies, genomic analysis and skin biopsy.

Radiation Exposure Reduction in Ultrasound-Guided Transforaminal Percutaneous Endoscopic Lumbar Discectomy for Lumbar Disc Herniation: A Randomized Controlled Trial.

BACKGROUND: Transforaminal percutaneous endoscopic lumbar discectomy (TF-PELD) is a minimally invasive technique with high radiation exposure. The purpose of this study was to compare radiation exposure of ultrasound-guided TF-PELD with fluoroscopy-guided TF-PELD. METHODS: In this prospective randomized controlled clinical trial, 60 patients with lumbar disc herniation were enrolled and randomly assigned to 2 groups (30 cases in each group): the ultrasound-guided group or the fluoroscopy-guided group. The radiation exposure, fluoroscopy time, and visual analog scale score were recorded. The number of possible operations per year within the yearly occupational exposure limit (OEL) was calculated. We also recorded the adverse events to evaluate the safety of ultrasound-guided TF-PELD. RESULTS: In 30 patients from the ultrasound-guided group, the lumbar disc structure was clearly visible under ultrasound guidance. The effective dose to surgeons and radiation dose to patients were 1.7 ± 0.4 and 25.2 ± 4.9 µSv in the ultrasound-guided group and 9.0 ± 2.5 and 127.4 ± 27.1 µSv in the fluoroscopy-guided group (P < 0.05), respectively. The fluoroscopy time was 2.6 ± 0.5 seconds in the ultrasound-guided group and 127.3 ± 29.5 seconds in the fluoroscopy-guided group (P < 0.05). A surgeon with shielding devices could treat 5556 cases per year in the fluoroscopy-guided group before exceeding the OEL for whole-body radiation, whereas they could treat 29,412 cases in the ultrasound-guided group. No difference between groups was detected in postoperative visual analog scale score (P > 0.58). No serious adverse event was found in any patient. CONCLUSIONS: Ultrasound-guided TF-PELD could decrease radiation exposure to surgeons and patients, without serious adverse events. It seems to be an acceptable alternative to fluoroscopy-guided TF-PELD.

[Treatment of thoracic vertebrae tumor with posterior total vertebral resection and internal fixation].

OBJECTIVE: To evaluate the clinical outcome of posterior total vertebral resection in treating thoracic vertebrae tumor in order to provide a safe and effective method in rebuilding spine stability. METHODS: From 2002.1 to 2007.12, 18 patients with thoracic spine tumor underwent posterior total vertebral resection and internal fixation. Among the patients, 10 patients were male and 8 patients were female, ranging in age from 45 to 78 years, with an average of 56 years. The course of the diseases ranged from 2 to 13 months. After the operation, the tumor reccurence was monitored by X-ray, and the tumor markers were detected. RESULTS: All the patients were followed up for a period ranging from 12 to 60 months, averaged 29 months. All the patients showed a postoperative neurologic improvement, as well as showed radiographic evidence of solid fusion in the follow-up examinations during 3 to 9 months, with an average of (8 +/- 1.4) months. CONCLUSION: Posterior total vertebral resection for the treatment of thoracic spine tumor is safe and effective.