ABSTRACT
Objective: To explore the clinicopathological characteristics and prognostic factors of patients with ovarian metastasis from gastric cancer. Methods: We retrospectively analyzed the clinical data and treatment strategies of 83 patients with metastatic ovarian tumors treated at PLA General Hospital between January 2006 and December 2017. Univariate analysis using the Log-rank test and multivariate analysis using the Cox proportional-hazards model were used to identify the prognostic factors. Results: The median diam-eter of the metastatic ovarian tumors was 7.1 (1.0-24.0) cm. Of these patients, 36 (43.4%) had unilateral metastasis and 47 (56.6%) had bilateral metastasis; 35 (42.2%) patients had peritoneal metastasis. All patients received chemotherapy, including 57 (68.7%) pa-tients who underwent combined-modality resection of the metastatic tumors and 22 patients (26.5%) who received hyperthermic in-traperitoneal chemotherapy. Of these patients, 74 (89.1%) were followed up, with a median survival time of 15 [95% confidence inter-val (CI): 12.5-17.5] months. The 1-year, 3-year, and 5-year overall survival rates were 71.1%, 6.5%, and 0, respectively. Univariate analy-sis showed that risk factors including≥6 metastatic lymph nodes, metastasectomy, synchronous ovarian metastasis, peritoneal carcino-matosis, estrogen receptor (ER) positivity, and high levels of serum carcinoembryonic antigen and cancer antigen-125 (CA125) might af-fect the prognosis (P<0.05). Multivariate analysis showed that metastasectomy, synchronous ovarian metastasis, combined peritoneal carcinomatosis, and ER positivity were independent factors affecting prognosis (P<0.05). Conclusions: We found that the presence of synchronous ovarian metastasis or combined peritoneal carcinomatosis indicated a poor prognosis; in contrast, ER-positivity predicted a better prognosis than ER-negativity. Metastasectomy may prolong the survival of patients.
ABSTRACT
Objective To investigate the efficacy and safety of indocyanine green fluorescence imaging in the lymph node dissection of radical thyroidectomy.Methods Radical thyroidectomy was performed using indocyanine green fluorescence imaging technology for two patients at the Department of General Surgery of Chinese People's Liberation Army (PLA) General Hospital in July 2018.Indocyanine green was injected into the thyroid glands after bilateral thyroid glands were exposed during operation.Bilateral total thyroidectomy plus central lymph node dissection was performed in case 1,and bilateral total thyroidectomy plus central area and left lateral area(area Ⅱ a,Ⅲ,Ⅳ) lymph node dissection was performed in case 2.Both operations were performed under the guidance of real-time fluorescence imaging system.The total number of lymph nodes detected,the number of small lymph nodes (diameter less than 3 mm),the level of parathyroid hormone(PTH),the incidence of complications such as hypocalcemia,hoarseness and short-term recurrence were observed.Results After excitation by the near-infrared light of the fluorescence detector probe,the display showed that the parathyroid gland and surrounding tissues were not visualized,and the thyroid glands and lymph nodes were brightly illuminated.The number of lymph nodes dissected in the central region of the two patients was 20 (13 with diameter less than 3 mm) and 10(6 with diameter less than 3 mm),respectively.For case 2,13 lymph nodes were dissected in the left lateral area (area Ⅱ a,Ⅲ,Ⅳ),and 8 lymph nodes with diameter less than 3 mm were dissected.There were no complications such as hypocalcemia and hoarseness after operation.The levels of parathyroid hormone and serum calcium were normal on the first day and 3 months after operation.There was no recurrence or metastasis of the tumors by ultrasonography 3 months after operation.Conclusion Indocyanine green fluorescence real-time imaging technology can help to identify lymph nodes specifically during radical thyroidectomy,and can achieve real-time dynamic imaging,which can make lymph node dissection more thorough and can be used as a new method for lymph node tracing in thyroid cancer surgery.
ABSTRACT
<p><b>OBJECTIVE</b>To investigate and compare the clinicopathological characteristics of gastric stump cancer(GSC) and the recurrent of gastric cancer (RGC) following radical gastrectomy, and to evaluate survival prognosis.</p><p><b>METHODS</b>A retrospective cohort study was performed on clinicopathological and survival data of patients with GSC (n=31) and with RGC (n=105) following radical gastrectomy at the Chinese People's Liberation Army General Hospital between January 1992 and August 2017. GSC was defined as cancer occured in remnant stomach ≥10 years after radical gastrectomy, while RGC was defined as <10 years. Patients of both groups received radical resection or palliative operation with tumor resection and had complete clinicopathological data regarding the first operation and gastric stump operation. T-test was used to compare quantitative data between the two groups, and Pearson χ test was used to compare qualitative data between the two groups. Kaplan-Meier method was applied to draw survival curves and log-rank test to assess survival differences.</p><p><b>RESULTS</b>Of the 136 enrolled patients, 113 were male and 23 were female. In the first operation, compared with RGC group, in GSC group, the Borrmann type and histological differentiation were more better [Borrmann I(: 11/31 (35.5%) vs. 5/105 (4.8%), χ=23.003, P=0.001; the high differentiation: 15/31 (48.4%) vs. 1/105 (1.0%), χ=57.137, P=0.001]; the tumor diameter was smaller [<4 cm: 28/31(90.3%) vs. 56/105(53.3%), χ=14.045, P=0.001]; the pT stage [pT1: 12/31 (38.7%) vs. 3/105 (2.9%), χ=50.373, P=0.001], pN stage [pN0: 28/31 (90.3%) vs. 19/105 (18.1%), χ=55.722, P=0.001] and pTNM staging [I(: 26/31 (83.9%) vs. 11/105 (10.5%), χ=66.688, P=0.001] were earlier. Most of the GSC occurred at non-anastomotic sites, while the recurrence mostly occurred at anastomotic sites [51.6%(16/31) vs. 61.9%(65/105), χ=7.520, P=0.023]. Compared with RGC group, GSC group had better histological differentiation [high differentiation: 5/31 (16.1%) vs. 2/105(1.9%), χ=10.029, P=0.007]. There was more histological type change between the first and the second operation in GSC group than that in RGC group[48.4%(15/31) vs. 26.7%(28/105), χ=5.222, P=0.022]. The overall survival time of GSC group was significantly longer than that of RGC group [mean: (161.0±18.6) months vs. (50.8±27.6) months, respectively, Log-rank: 76.818, P=0.001]. The survival time after the second surgery of GSC group was longer than that of RGC group [mean: (30.7±18.4) months vs. (20.5±15.0) months, P=0.003]. In the subgroup analysis of all the 136 patients according to histological type change between the two surgeries (unchanged 93 patients, changed 43 patients), compared with unchanged group, the overall survival time of changed group was longer [mean: (99.6±56.5) months vs. (72.1±58.1) months, P=0.008].</p><p><b>CONCLUSIONS</b>GSC patients have better histological differentiation and earlier clinical stage of primary gastric cancer, and longer survival time compared with RGC patients. The histological type change between two operations may be used as a new factor to define GSC.</p>
Subject(s)
Female , Humans , Male , Gastrectomy , Gastric Stump , Pathology , General Surgery , Neoplasm Recurrence, Local , Neoplasm Staging , Prognosis , Retrospective Studies , Stomach Neoplasms , General Surgery , Survival RateABSTRACT
Bartter′s syndrome(BS) is a rare renal tubular diseases and an autosomal recessive hereditary disease. The characteristic findings are hypokalemia, metabolic alkalosis, and raised serum renin and aldosterone levels. Combination of metabolic syndrome with Bartter′s syndrome has not been reported so far. Here in, we report a case in order to call attention to the diagnosis and treatment of typical Bartter′s syndrome combined with metabolic syndrome.
ABSTRACT
Objective To evaluate the efficacy of manually controlled jet ventilation with Manujet Ⅲ apparatus (VBM Co, Germany) for removal of airway foreign body in children. Methods One hundred and twenty ASA Ⅰ or Ⅱ children aged 10 months-12 yr, weighing 8-35 kg undergoing removal of airway foreign body were randomly divided into 3 groups (n=40 each) : group Ⅰ spontaneous respiration (SR) ; group Ⅱ intermittentpositive pressure ventilation through the short side tube of the rigid bronchoscope (IPPV) and group Ⅲ manually controlled jet ventilation with Manujet Ⅲ (JV). Anesthesia was induced with methylprednisolone 2 mg/kg, propofol 2 mg/kg and γ-OH 70 mg/kg in group SR (Ⅰ) and with methylprednisolone 2 mg/kg, propofol 4-5 mg/kg, fentanyl 1.5 μg/kg and succinylcholine 2 mg/kg in group IPPV and JV (Ⅱ,Ⅲ). The bronchescope insertion condition, the occurrence of hypoxia during and after operation, body movement during operation, the rate of successful removal of the foreign body, the duration of operation, anesthesia emergence time and perioperative side effects were recorded. Resulls The rate of good bronchescope insertion condition and successful removal of airway foreign body were significantly higher, the rate of hypoxia during and after operation, body movement, breath holding and restlessness were significantly lower and duration of operation and anesthesia emergence time were significantly shorter in group IPPV and JV than in group SR (P<0.05). The rate of intraoperative hypoxia was significantly lower in group JV than in group IPPV (P<0.05). Conclusion Jet ventilation with Manujet Ⅲ can reduce the occurrence of hypoxia during removal of airway foreign body in children and does not interfere with the operation.
ABSTRACT
Objective To observe the changes in serum High Sensitive C-reactive Protein(hs-CRP)in newly dignosed type 2 diabetic patients after treament with short-term intensive insulin aspart and investigate the relationship of inflammatory factors with insulin resistant.Methods30 newly dignosed ty 2 diabetic were treated by 14 d intensive aspart treament,the levels of fasting plasma glucose(FPG),2hours postprandial glucose(2hPG),insulin and C-peptide,hs-CRP,the mean area under the curve(AUC)of insulin and C-peptide,insulin resistance index(HOMA-A),insulin secretion index(HOMA-B)were compared before and after transient intensive nsulin aspart treament.ResultsAfter the treament,FPG,2hPG,hs-CRP and HOMA-A were significantly decreased(P