Treatment of Chronic Radiation Intestinal Injury by Ileostomy Combined with Perioperative Nutrition Support Therapy / 肠外与肠内营养

Objective: To review the application of ileostomy combined with perioperative nutrition support therapy in the treatment of chronic radiation intestinal injury. Methods: The clinical data of patients with chronic radiation intestinal injury who received ileostomy combined with perioperative nutrition support therapy in the department of general surgery, Nanjing General Hospital of Nanjing Military Command from January 2012 to December 2016 were retrospectively analyzed. The short-term complications and perioperative nutrition process were recorded, and the long-term prognoses were followed up. Results: Forty-six patients were included in the study. The overall postoperative complication rate was 36. 96％. All the patients restored total enteral nutrition at the time of discharge (18±15) days. There was no post-operative mortality. Thirty-six patients were followed up (follow-up rate of 78. 26％), and the follow-up time was (25 ± 17) months. Tumor recurrence was occurred in 7 patients (19. 44％) during follow-up and 6 deaths (16. 67％). All of the 30 (83. 33％) survived patients maintained total enteral feeding, 27 of whom (75％) returned to normal diet. Twenty-one patients (58. 33％) underwent a second staging ostomy surgery in our hospital and recovered well. Conclusion: For selected patients with chronic radiation intestinal injury, ileostomy combined with perioperative nutrition support therapy could effectively restore intestinal patency and total enteral nutrition, and reduce the mortality.

Analysis of surgical treatment of soft tissue sarcomas of the adductor compartment / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To review the outcomes and complications of 21 consecutive patients with soft tissue sarcomas of the adductor compartment treated in our hospital from July 2006 to March 2012.</p><p><b>METHODS</b>Medical records of 21 patients who underwent resection of soft tissue sarcomas of the adductor compartment were reviewed. Eight of the patients had primary operation, other eight had secondary radical excision, and five were admitted for tumor recurrence after operation in local hospitals. Six cases used gracilis or sartorius muscle to fill the cavity after removal of adductor muscle group. Fifteen patients underwent adjuvant treatment including radiotherapy and/or chemotherapy.</p><p><b>RESULTS</b>Seven patients (33.3%) developed wound complications. Five required further surgery and two received dressing changes. All the patients were followed up for 3 to 60 months. During the follow-up period, no tumor recurrence was found in all the patients, only one case had multiple bone and pulmonary metastases, and two cases died (one for pulmonary metastasis at 11 months after surgery, and the other died of heart disease at 36 months post operation).</p><p><b>CONCLUSIONS</b>Good local control rate can be achieved in patients with soft tissue sarcomas of the adductor compartment by using adductor muscle group resection, but it carries a relatively high rate of wound complications requiring proper management.</p>

Damage control surgery for pancreatic injuries after blunt abdominal trauma / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize the management of pancreatic injuries after blunt abdominal trauma.</p><p><b>METHODS</b>The clinical data of 42 patients with blunt pancreatic injury admitted from January 2001 to December 2010 was analyzed retrospectively. There were 38 male and 4 female patients, aging from 13 to 65 years with a mean of 31 years. The organ injury scaling of Committee of the American Association for the Surgery of Trauma (AAST grade): grade I in 3 patients, grade II in 12 patients, grade III in 9 patients, grade IV in 13 patients and grade V in 5 patients. The mean injury severity score was 27 ± 21. Patients above AAST grade II underwent peritoneal drainage and "three neostomy" (gastrostomy, jejunostomy and gallbladder) according to damage control theory.</p><p><b>RESULTS</b>Thirty-eight patients got abdominal CT scanning with a positive rate of 79.9% (30/38). Forty patients underwent surgical procedures, and 2 patients with non-operative management. The surgical procedures include peritoneal drainage and "three neostomy" in 32 patients, pancreas suture or pancreatic tail resection in 6 patients, pancreatoduodenectomy or caudal pancreaticojejunostomy in 2 patients. Forty patients (95.2%) survived, 2 patients (4.8%) died and 16 patients (38.1%) had complications such as pancreatic fistula,pulmonary infection.</p><p><b>CONCLUSIONS</b>Abdominal CT scanning will benefit the preoperative diagnosis of blunt pancreatic trauma. Although the survival rate of patients with blunt pancreatic trauma might be improved by using the damage control surgery, the management of damage control surgery also needs to be modified because of the high rate of complications.</p>

Value of intraoperative electron radiation therapy in the treatment of malignant bone or soft tissue tumors around the joints / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the value of intraoperative radiation therapy with electrons (ELIOT) in treatment of malignant bone or soft tissue tumors around the joints.</p><p><b>METHODS</b>From October 2008 to April 2012, nineteen patients with malignant bone or soft tissue tumors around the joints were treated with ELIOT. The tumors were located around the knee joint in 8 patients, around the hip joint in 6 patients, around the elbow joint in 4 patients and around the shoulder joint in one patient. All of the patients underwent limb salvage surgeries. R0 resections were performed in 18 patients, while R1 resection was performed in one patient. The doses of intraoperative radiation ranged from 10 Gy to 22 Gy. The median dose was 19 Gy. More than one ELIOT fields were used in 10 patients because of the large tumor size.</p><p><b>RESULTS</b>Seven patients suffered wound complications. No grade ≥ 3 acute toxicities were observed. One patient developed radiation ulcer and arterial fistula 15 months after surgery and ELIOT, and resulted in amputation finally (grade 4 late toxicity). The mean Musculoskeletal Tumor Society (MSTS) 93 score was 26.26 ± 4.04 (87.5% ± 13.5%), with excellent to good extremity functions in 18 patients (94.7%). Four patients had local recurrences. The estimated locoregional control rates at 1, 2, and 3 years were 81.9%, 73.7%, and 73.7%, respectively. Seven patients died of the diseases. The estimated overall survivals of the entire group of patients at 1, 2, and 3 years were 76.3%, 61.2%, and 51.0%, respectively.</p><p><b>CONCLUSIONS</b>ELIOT is a safe and well-tolerable technique and could be widely used for patients with malignant bone or soft tissue tumors around the joints with acceptable rates of acute and late toxicity. There is positive significance for controlling the tumor local recurrence, preserving the joint function and improving survival quality.</p>

Expression of AC133 and EpCAM in human pulmonary adenocarcinoma and isolation of their double positive cells / 第二军医大学学报

Objective: To determine the expression of AC133 and EpCAM in human pulmonary adenocarcinoma by dual immunofluorescent labeling technique and to isolate AC133+ EpCAM+ cells by flow cytometry, so as to provide a basis for further investigation of human pulmonary adenocarcinoma stem cells. Methods: The human lung adenocarcinoma tissues were obtained and subjected to cryosection and dual immunofluorescent staining. AC133+ EpCAM+ cells in human pulmonary adenocarcinoma were identified by using laser confocal microscopy. The fresh adenocarcinoma tissues were prepared into single cell suspension with the collagen and red blood cell removed. AC133 and EpCAM were used to label cells and the AC133+ EpCAM+ cells were isolated by flow cytometry. ResuIts:AC133+ EpCAM + cells were found in human pulmonary adenocarcinoma and they could be isolated by flow cytometry. Conclusion:The existence of AC133+ EpCAM+ cells has been confirmed in the lung adenocarcinoma tissues; the double positive cells can be isolated by flow cytometry, which provides a basis for further investigation of lung cancer stem cells.

Clinical features and prognosis of alveolar soft part sarcoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the clinical feature, suitable treatment and prognosis of alveolar soft part sarcoma.</p><p><b>METHODS</b>The clinical data of 58 such patients treated at our hospital from 1967 to 2006 were retrospectively analyzed. Fifty-three patients except 6 with distant metastasis underwent surgical resection including 33 extensive resection and 19 local resection. Furthermore, 19 patients received postoperative adjuvant radiotherapy or chemotherapy.</p><p><b>RESULTS</b>Eleven of 50 patients who underwent complete resection developed local recurrence. Thirty-One (53.4%) was found to have lung metastasis. The overall 3-, 5-, 10-year survival rate was 89.5%, 74.1% and 57.7%, respectively. The median survival time of the patients was 125 months. The 3-, 5-, 10-year survival rate was 100.0%, 81.6% and 65.3% for female patients, but it was 79.6%, 67.2% and 49.7% for male patients, respectively.</p><p><b>CONCLUSION</b>Alveolar soft part sarcoma usually grows slowly. Though local recurrence is rarely seen, distant metastasis is frequently observed. Lung is the most common organ of metastasis. However, survival can still be long even with lung metastasis. To achieve microscopically complete resection is quite critical to localized alveolar soft part sarcoma. No survival advantage was observed when adding adjuvant radiotherapy and/or chemotherapy. The phenomena of female patient or patient with X chromosome translocation showing better prognosis than the male or other patients needs further investigation.</p>

Clinical curative effect of bilateral total knee arthroplasty in one-stage procedure / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the perioperative and early-term efficacy of bilateral total knee arthroplasty (BTKA) in one-stage procedure.</p><p><b>METHODS</b>Totally 93 patients operated with BTKA in one-stage procedure from 2003 June to 2005 June were followed up and the curative effect was determined with Hospital for Special Surgery knee-rating system (HSS). The complications were then analyzed.</p><p><b>RESULTS</b>The mean postoperative HSS score was 89. 6 (55 approximately 96 scores) and the excellence/good rate reached 95. 7% (excellent in 74 cases, good in 15 cases, moderate in 2 cases, and poor in 2 cases). Except for the muscle power, the pain, joint function, range of joint movement (ROM) , deformity, and stability were significantly improved after operation (P < 0. 05). The average ROM of knee was improved to 99. 8 (75-135 ) degrees after operation from 88.9 (25-110) degrees before operation (P < 0. 01). Complications included deep vein thrombosis (n = 2) , incision fat liquidation (n = 2) , deep infection ( n = 1) , urinary infection ( n = 1) , and peroneal nerve palsy (n = 1). No death was documented.</p><p><b>CONCLUSION</b>Bilateral total knee arthroplasty in one-stage procedure under secure conditions can be performed with good outcomes in selected patients without a definite increase in perioperative risk.</p>

Reoperative treatment of lumbar disc herniation / 中国医学科学院学报

<p><b>OBJECTIVE</b>To explore the causes, methods and outcomes of reoperative treatment after lumbar disc surgery.</p><p><b>METHODS</b>Nine hundred and twenty eight patients with lumbar disc herniation were treated surgically from January 1995 to January 2004, of whom 43 patients (4.6%) underwent reoperation due to persistent pain or recurrence of symptoms. Forty patients were followed up from 3 months to 84 months (mean 30 months).</p><p><b>RESULTS</b>According to Macnab's criteria, outcomes were excellent in 11 cases (27.5%), good in 16 cases (40%), fair in 8 cases (20%), and poor in 5 cases (12.5%).</p><p><b>CONCLUSIONS</b>The major causes of reoperation after lumbar disc surgery included incomplete removal of herniating discs and recurrent disc herniation of primary interspace, secondary lumbar canal stenosis, and adhesion of nerve roots. Prior to primary surgical treatment of lumbar disc herniation, operative indications must be strictly accurate, surgical methods should be correctly selected, and improved and refined surgical skills should be guaranteed. Satisfactory outcomes can be gained with reoperation for patients who still requiring treatment.</p>