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Objective:To investigate the clinical features and prognosis of patients with pancreatic metastasis from clear cell renal cell carcinoma(CCRCC).Methods:From Jan 2000 to May 2020, the clinical data of patients pathologically diagnosed as CCRCC with pancreatic metastasis and admitted in Cancer Institute and Hospital of Tianjin Medical University were analyzed retrospectively. The gender, age, metastasis time, relapse time, metastatic sites, numbers of metastatic lesions and whether metastatic pancreatic lesions should be surgerically removed were recorded and the influencing factors were analyzed.Results:Among the 20 patients, there were 12 males and 8 females. The median age of diagnosis was 50 years. There were 12 patients(60%) of left renal carcinoma and 8 patients(40%)of the other side. 12 cases(60%) had single pancreatic metastatic lesion and the other 8 cases(40%) had multiple metastatic lesions. Seven patients(35%) had other organs metastasis besides pancreatic metastasis. Two patients(10%) had simultaneous pancreatic metastasis and renal cancer, and the other eighteen patients(90%) had pancreatic metachronous metastasis after being diagnosed as renal cancer. The median time from the diagnosis of CCRCC to pancreatic metastasis was 102 months. Thirteen patients(65%)had recurrences within 10 years and the other seven patients(35%)had recurrences after 10 years. Pancreatectomy was performed in nine patients(45%) and targeted therapy was conducted in thirteen patients. The mean follow-up was 122.9 months (1-256 months). Three patients (15%) died and 17 patients (85%) survived. The median overall survival was 75.9 months, and the 5 year-survival rate was 66.7%. Simultaneous metastasis and extra-pancreatic metastasis were prognostic factors in patients with CCRCC with pancreatic metastasis.Conclusions:Pancreatic metastases from renal clear cell carcinoma were rare, but the prognosis was good, especially in patients with only pancreatic metastases several years after renal carcinoma was diagnosed.
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Objective To study risk factors of newly developed nonalcoholic fatty liver disease (NAFLD) in patients after pancreaticoduodenectomy (PD) and the effect on prognosis.Methods Date of patients undergoing PD surgery at Pancreatic Department,Tianjin Cancer Hospital were collected from Jan 2016 to Dec 2016.Patients were divided into two groups according to occurrence of NAFL Devents.Results There were 22 patients in NAFLD group (group Ⅰ) and 47 patients in non NAFLD group(group Ⅱ).All patients were followed up till the end of 2017.Multi-factor analysis showed that extraintestinal drainage of pancreatic juice (OR =18.118,95％ CI 2.968-114.455,P =0.002) and dissected lymph node number over 30 (OR =8.424,95％ CI 2.272-31.232,P =0.001) were independent factors associated with NAFLD in patients after PD.Survival analysis showed no statistically significance for median progression-free survival (12.7 months in group Ⅰ vs.13.9 months in group Ⅱ,P =0.99) and median overall survival (mOS) (15.4 months in group Ⅰ vs.17.7 months in group Ⅱ,P =0.09).Conclusions Extraintestinal drainage of pancreatic juice and lymph node clearance over 30 are independent risk factors for new NAFLD in PD patients.The effect of new NAFLD on PFS and OS is not statistically significant.
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Objective To compare the clinical value of different electroencephalogram (EEG) in the diagnosis of temporal lobe epilepsy.Methods A total of 123 patients in Taizhou Central Hospital received routine EEG , dynamic EEG,routine sphenoidal electrode examination ,and long sphenoidal electrode examination.The the detection rate of epileptic waves in EEG , awake and sleep phases of patients with temporal lobe epilepsy were compared . Results The detection rate of epileptiform wave by the routine EEG was 52.63%,which by the dynamic EEG was 61.11%,and there was no statistically significant difference (P＞0.05).The detection rate of epileptiform wave by the long range sphenoidal electrode EEG was 63.64%,which was higher than that by the conventional sphenoidal electrode EEG(22.22%)(χ2＝8.776,P＜0.05).The detection rate of epileptiform wave in the sleep period EEG in temporal lobe epilepsy was 51.35%,which was higher than that in the awake period (29.73%),and the difference was statistically significant ( χ2＝5.739, P ＜0.05).Conclusion Different types of EEG have their respective advantages in diagnosis of temporal lobe epilepsy ,sphenoidal electrodes and sleep induced temporal lobe epilepsy can significantly improve the detection rate of abnormal EEG ,has important clinical value in the diagnosis of temporal lobe epilepsy.
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Objective To study the clinical experience on pancreaticoduodenectomy (PD) in thepast three years from a single operation group at the Cancer Institute and Hospital of Tianjin Medical Universiy.Methods The clinical data of 118 patients who underwent PD from January 2015 to December 2017 were collected and analyzed retrospectively.Results Of the 118 patients who underwent PDs,102 underwent open pancreaticoduodenectomy (OPD) (86.4％),and 16 laparoscopic pancreaticoduodenectomy (LPD) (13.6％).There were 54.2％ males with a age of (56.0±12.0) years (39.83％ over 60 years).Malignancy was confirmed by pathology in 73.7％ (87/118 patients).The operative time was (324.0±95.6) minutes.Intraoperative blood loss was (192.8±97.5) ml and R0 resection was achieved in all patients.The postoperative complication rate was 46.6％ (55/118).The median postoperative hospital stay was (19.9±9.5) days.There was no perioperative mortality.The operation time of LPD was significantly longer than OPD,but there was no significant difference in intraoperative bleeding,lymph node clearance,postoperative complication rate and postoperative hospital stay (P＞0.05).Conclusions PD is safe and feasible.The postoperative complication rate was relatively high but all patients were discharged from hospital after appropriate treatment.Compared with OPD,LPD is a better alternative for patients.