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Laparoscopic pancreaticoduodenectomy is an important surgical undertaking, mostly used for benign and malignant tumors in the pancreatic head and periampullary region. The postoperative pancreatic fistula is the main factor to cause death after pancreaticoduodenectomy, and pancreaticojejunostomy is an independent risk factor for pancreatic fistula. In order to reduce the incidence of pancreatic fistula, surgeons have proposed dozens of pancreaticojejunostomy, but so far there are no randomized trials proved which method of pancreaticojejunostomy is better than the others. This article reviews the methods and characteristics of different pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy.
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Objective@#To analyze the epidemiological history, clinical manifestations, treatment and the short-term prognosis of 31 cases of 2019 novel coronavirus(2019-nCoV) infection in children from six provinces (autonomous region) in northern China.@*Methods@#A retrospective analysis of the epidemiological history, clinical symptoms, signs, laboratory examinations, chest imaging, treatment and the short-term prognosis of 31 cases of 2019-nCoV was conducted. The patients were diagnosed between January 25th, 2020 and February 21st, 2020 in 21 hospitals in 17 cities of six provinces(autonomous region) of Shaanxi, Gansu, Ningxia, Hebei, Henan and Shandong.@*Results@#The age of the 31 children with 2019-nCoV infection was 7 years and 1 month (6 months -17 years). Nine cases (29%) were imported cases. Other 21 cases (68%) had contact with confirmed infected adults. One case (3%) had contact with asymptomatic returnees from Wuhan. Among the 31 children, 28 patients (90%) were family cluster cases. The clinical types were asymptomatic type in 4 cases (13%), mild type in 13 cases (42%), and common type in 14 cases (45%). No severe or critical type existed. The most common symptom was fever (n=20, 65%), including 1 case of high fever, 9 cases of moderate fever, 10 cases of low fever. Fever lasted from 1 day to 9 days. The fever of fifteen cases lasted for ≤3 d, while in other 5 cases lasted > 3 d. Other symptoms included cough (n=14, 45%), fatigue (n=3, 10%) and diarrhea (n=3, 9%). Pharyngalgia, runny nose, dizziness, headache and vomiting were rare. In the early stage, the total leukocytes count in peripheral blood decreased in 2 cases (6%), the lymphocytes count decreased in 2 cases (6%), and the platelet count increased in 2 cases (6%).Elevation of C-reactive protein (10%, 3/30), erythrocyte sedimentation rate(19%,4/21), procalcitonin(4%,1/28), liver enzyme(22%, 6/27) and muscle enzyme (15%, 4/27) occurred in different proportions. Renal function and blood glucose were normal. There were abnormal chest CT changes in 14 cases, including 9 cases with patchy ground glass opacities and nodules, mostly located in the lower lobe of both lungs near the pleural area. After receiving supportive treatment, the viral nucleic acid turned negative in 25 cases within 7-23 days. Among them, 24 children (77%) recovered and were discharged from hospital. No death occurred.@*Conclusions@#In this case series, 2019-nCoV infections in children from six provinces (autonomous region) in northern China are mainly caused by close family contact. Clinical types are asymptomatic, mild and common types. Clinical manifestations and laboratory examination results are nonspecific. Close contact history of epidemiology, nucleic acid detection and chest imaging are important bases for diagnosis. After general treatment, the short-term prognosis is good.
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Objective To investigate the MRI features of Fukuyama-type congenital muscular dystrophy(FCMD) in Chinese.Methods The MRI and clinical data of 3 patients with FCMD which had been diagnosed by gene analysis were retrospectively analyzed.Two females and one male were included in this study,and they underwent MR examination at 0.5,2.3,5.0 years old respectively.The main clinical manifestations were muscular hypotonia and severe developmental delay.Abnormalities on MR images were analyzed and recorded by two experienced radiologists.Results Unlayerdpoly microgyria involved in frontal lobes,numerous intraparenchymal cysts at the peripheral hemispheres and prolonged T1 and T2 signal in the white matter were found in all the 3 cases.Disorganized cerebellar folia,lissencephaly of cerebral cortices,flattened pons were detected in 2 cases.Cystic region of white matter incerebral cortices and enlarged fourth ventricle could be seen in one case.Conclusion There are typical MR imaging featuresof FCMD,and preliminary diagnosis can be made by the combination with clinical symptoms and biochemical analysis.
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Objective To observe the virology response after the treatment of chronic hepatitis C by polyethylene glycol interferon in combination with ribavirin and the etiological characteristics of chronic hepatitis C.Methods A retrospective analysis of chronic hepatitis C infection route,hepatitis C virus(of hepatitis C virus,HCV)load and its gene typing of 120 patients in our hospital from August 2009 to July 2012.And the patients were given pegylated interferon (PEG-IFN-2a),or ordinary interferon (IFNα) alone or in combination with ribavifin.HCV-RNA load and liver function were monitored before and after 4,12,24,36,48 weeks.Results Blood transfusion was the main way of HCV infection(71/120).109 cases (90.8％) patients with serum HCV-RNA load between 5.0 ～ 7.0 logl0 copies/ml.76 patients were made HCV viral genetics testing,test results,65 cases of HCV-RNA 1b type,2 cases of HCV-RNA 1c type,HCV-RNA 2a type and HCV-RNA 6a type and HCV-RNA type 3b was 3 cases,especially.The application of PEG-IFN-2a of the two groups was significantly better than the application of IFNα of the two groups(P ＜ 0.05).Conclusion Chronic hepatitis C is mainly to infected by blood transfusion.HCV-RNA load between 5.0 ～ 7.0 log10 copies/ml.88.2％ of the cases of genotype 1(most of which is type 1b).PEG-IFN-2a combined with ribavirin combined with individualized treatment can effectively improve SVR rates.
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Objective To quantitatively analyze and testify the diagnostic value of combined MRS and DWI for prostate cancer based on sextant localization.Methods Patients who underwent prostate MR examinations in our hospital had MRS and DWI scanning in addition to conventional MRI.The(choline+creatine)/citrate(CC/C)value in each measurable voxel and the minimal ADC value(ADC_(mini))in each sextant were measured.Taking CC/C of no less than 0.911 as the cutoff value for prostate cancer,the ratios of positive voxel(PVR)in sextants were calculated.The selected patients were divided into 2 groups according to the date of examination,for the quantitative analysis and the verification respectively.Group 1 was from Feb,2006 to Dec,2006,and group 2 from Jan,2007 to Jul,2007.The diagnostic efficacy of PVR,ADC_(mini) and their combination was tested by ROC analysis.Results There were 40 patients in group 1 and group 2 respectively for the linear discrimination of the cluster analysis,including 20 patients with prostate cancer and 20 patients without prostate cancer.The linear discrimination equation calculated from group 1 was 'D=3.264×ADC_(mini)-0.205×PVR-4.407'.The areas under curve(Az)of ROC for PVR,ADC_(mini) and D were 0.769,0.910 and 0.909,respectively.In group 2,the Az of ROC for PVR,ADC_(mini) and D were 0.838,0.912 and 0.915,respectively.There were no statistical difference between ADC_(mini)-alone and D in both groups(X~2=0.32 and 1.50,P＞0.05).Conclusions Quantitative prostate DWI had higher diagnostic value than MRS.The combined use of MRS and DWI was not superior to the DWI-alone in the diagnostic efficacy of prostate cancer.
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Objective To evaluate the therapeutic effect of endocrine for prostate cancer with bone metastases with MR diffusion-weighted imaging (DWI). Methods Forty patients with bone metastases from prostate cancer were examined with DWI. Seventeen patients underwent endocrine therapy were recruited as the test group, the other 23 were regarded as the control group. There was no relapse of the metastases according to clinical diagnosis in the test group. DWI sequences were based on steady-state free precession with b value (800 s/mm~2). After identifying the metastasis according to the T1WI and T2WI, ROIs were marked at the metastases, normal muscle, normal bone and bladder on DWI, and the ADC values of the ROIs were calculated respectively. Non-parameter two independent samples test was applicated to compare the ADC values of the metastases between the two groups.Results ADC values of the bone metastases were (1.10±0.50)×10~(-3)mm~2/s in the test group and (1.12±0.30) ×10~-3mm~2/s in the control group (P>0.05).Conclusion MR DWI shows no help in evaluating the therapeutic effect of endocrine for prostate cancer with bone metastases.
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Objective To study the changes of the apparent diffusion coefficient (ADC) values and the association with serum prostate specific antigen (PSA) in prostate cancer patients. Methods Diffusion-weighted echo-planar imaging (EPI) sequences were performed in 47 patients with biopsy proved locally confined prostate cancer,age ranged from 56 to 86 years.t-PSA range,f-PSA range and F/T range in serum of all patients were 1.41-603.16 ng/ml,0.10-12.29 ng/ml and 0.01-0.36,respectively.The patients'clinical staging were 2 cases of stage A,18 cases of stage B and 27 cases of stage C,among which 1 cases were well differentiated (Gleason 2-4), 23 were moderately differentiated (Gleason 5-7) and 23 were poorly differentiated(Gleason 8-10),respectively.Images were obtained with a diffusion factor of 800 s/mm2.According to the pathological results obtained by ultrasound guided systemic biopsy,the locations of the prostate cancerous region were marked as one or more of the sextants.The ADC values of every region and whole gland were measured and analyzed with ROC curve.Correlations between the ADC and t-PSA,f-PSA,F/T ratios were analyzed.Results Acceptable images for ADC measurement were obtained in all cases.The mean ADC values of cancerous and noncancerous regions in 47 prostate patients were(1.29±0.28)×10-3mm2/s and (1.78+0.32)×10-3mm2/s and significant difference was noted in ADC values between cancerous and noncancerous regions(t=13.58,P＜0.01).Negative correlation was found between the ADC values and t-PSA,f-PSA,(γ=-0.353,P＜0.01;γ=-O.401.P＜0.01).There were no significant associations between the ADC values and F/T(γ=-0.123,P＞0.05). Conclusions The ADC values in cancerous regions were negatively correlated with t-PSA,f-PSA. Measurement of ADCs,combined with serum PSA,might be useful to accurate location and preoperative assessment of tumor.
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Objective To evaluate the diagnostic efficacy of MRS in prostate cancer based on sextant localization. Methods There were 110 patients, 54 patients with pathologically confirmed prostate cancer and 56 patients confirmed non-prostate cancer proved by ultrasound guided systemic biopsy. The (choline + creatine)/citrate (CC/C) value in each voxel and ratio of positive voxel (PVR) in sextant localization were measured. The ROC analysis was used to evaluate the diagnostic efficacy of CC/C in single voxel and PVR in sextant localization. Results There are 1673 and 2426 voxel in prostate cancer and non-prostate cancer respectively. The median of CC/C in cancer sextants was 2. 137; the median of CC/C in noncancer sextants was 0. 600. The difference of these two groups was statistically significant (Z = -41.7, P < 0. 01 ). The diagnostic sensitivity was 81.4% ( 1362/1673 ), the specificity was 83.1% (2018/2426), and the accuracy was 82.4% [ (1362+2018)/4099] for prostatic cancer with the cutoff point 0. 911 of the CC/C value. The median of PVR in cancer sextants and noncancer sextants were 1 and 0 respectively, the difference of PVR was statistically significant (Z = -11.7,P < 0.01 ). The diagnostic sensitivity was 77. 5% (148/191), the specificity was 76. 9% (247/321), and the accuracy was 77. 1% [ ( 148 + 247 )/ 512] for prostatic cancer with the cutoff point 0. 519 of the PVR. Conclusion Detecting the cutoff point of the CC/C value in single voxel and the PVR in sextant localization may be valuable in the diagnosis of prostate cancer.
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ObjectiveTo determine if the three-dimensional proton magnetic resonance spectroscopic(MRS) imaging helps in diagnosing metastasis ofprostate cancer(Pca).MethodsSixty-five patients with biopsy proven Pca were recruited and divided into two groups:group 1 with metastasis(bone and/or lymph node metastasis)(n=34)and Group 2 without metastasis(n=31).Voxels were placed on cancerous area in peripheral zone and the ratios of(Cho+Cre)/Cit were measured.The mean ratio in each patient was calculated and ROC curve was drawn to determine the optimal operating point(OOP)for the prediction of Pca metastasis by the metabolite ratio.ResultsThe mean ratio of(Cho+Cre)/Cit in cancerous area of Pca without metastasis was 1.3 ±0.5,whereas that of Pca with metastasis was 2.2±0.6.Statistically significant difference existed between the two groups(t=6.38,P＜0.05).According to the ROC analysis,the OOP was determined and interpreted at 1.53 with higher sensitivity and specificity.If Pca with metastasis was predicted as whose the mean ratio of(Cho+Cre)/Cit in cancerous area larger than 1.53,the sensitivity,specificity and accuracy for metastasis determination were 94.12%(32/34),67.74%(21/31),and 81.54%(53/65)respectively.Conclusion MRS may be a useful noninvasive method to predict the metastasis of Pca.
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Objective:To evaluate the variation of clinical data and referred purpose of prostate magnetic resonance(MR) examination in the past 12 years in Peking University First Hospital.Methods:One thousand and sixty-six patients underwent prostate MR examination(1 296 exams) from May 1992 to Sept.2004.The clinical data of the patients were retrospectively analyzed.The number of patients was counted and three groups were classified(diagnosing group,staging group and follow-up group) according to the purpose of prostate MR examination per year.For the diagnosing group, the clinical data of patient's age,symptom,level of serum prostate specific antigen(PSA),and the result of ultrasound or digital rectal examination(DRE) were evaluated.Results:(1)The number of patients increased year by year in the past 12 years,and the majority of the increased patients required differential diagnosis.(2) Diagnosing group: the percentage of patients with the symptom of BPH increased year by year.The average level of serum PSA dropped and the percentage of patients with elevated PSA or with nodules detected by ultrasound or DRE referred for detection of prostate cancer or with the symptom of metastasis decreased.Conclusion:With the widespread screening of prostate cancer,more patients of early prostate carcinoma and non-tumoral lesion in prostate gland are examined by MR imaging.
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Objective To investigate the changes of apparent diffusion coefficient(ADC) values after endocrinotherapy in cancerous and noncancerous regions of prostate peripheral zone.Methods 28 patients with prostate cancer proved by pathology were retrospectively evaluated in this study.The prostate peripheral zone was divided into two regions(cancerous and noncancerous regions).All patients were examined by single-shot diffusion-weighted echo-planar imaging before and after 3~6 months endocrinotherapy.ADC values of noncancerous and cancerous regions in peripheral zone were calculated and statistical analysis was performed on the data by applying either paired or independent t-test.Results Before treatment, the average ADC values in noncancerous ( n=107 ) and cancerous ( n=61 ) regions were (2.21?0.61)?10-3 mm2/s and (1.65?0.46)?10-3mm2/s, respectively, and statistic significant difference could be detected between them (t=4.36, P=0.039, independent t-test). After 3~6 months treatment, the ADC values in noncancerous and cancerous regions decreased to(1.33?0.48)?10-3 mm2/s and (1.28?0.53)?10-3mm2/s, respectively, significantly lower than those before treatment(t=5.28, P=0.024 and t=7.39, P=0.015, paired t-test),but no significant difference between noncancerous and cancerous regions was detected after endocrinotherapy (t=0.58, P=0.639, independent t-test). Conclusion After endocrinotherapy, the ADC value of cancerous and noncancerous prostate tissues both decreased. This change was more significant in noncancerous tissue and the difference of ADC values between them diminished after endocrinotherapy.
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Objective To quantitatively analyze the ADC values of different types of benign prostatic hyperplasia(BPH) comparatively with ADC values of prostatic carcinoma(Pca).Methods Seventeen cases of BPH(mean age 69.1 years?4.3 years,ranged from 62 to 77 years) underwent transurethral resection of prostate(TURP) were scanned with the sequence of DWI.DWI(b-values = 0 s/mm2and 800 s/mm2) was performed at 1.5-T system.The hyperplasia tissues resected from central gland were divided into two types pathologically: glandular BPH and stromal BPH.According to the pathological results,ROIs were placed on central gland and the ADC values of two types of BPH were measured.In addition,fifteen patients with biopsy-proved Pca were evaluated and the ADC values of Pca regions were measured.Results The mean ADC values of glandular BPH,stromal BPH and Pca were(1.80?0.20)?10-3 mm2/s,(1.56?0.18)?10-3 mm2/s and(1.27?0.21)?10-3 mm2/s,respectively.Statistically significant difference(F=47.366,P
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0.05) except the patient’s age(P=0.00).Conclusion Follow-up of patients with non-tumoral lesions in prostate gland with MR imaging usually does not give useful informations in addition to the first MR examination.
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Objective To investigate MRI characteristics of recurrent prostate cancer after endocrinotherapy.Methods Recurrent prostate cancer after endocrinotherapy was diagnosed clinically in 10 cases.MRI examinations were performed before and after recurrence of tumors.T_2 signal intensity and morphological changes of the prostate,involvement of pelvic tissues,metastasis of bone and lymph metastasiswere analyzed.Results The prostates enlarged in 7 patients after recurrence and maintained the same size in the other three.The pelvictissues,including seminal vesicle,bladder,rectal and obturator internus,were involved in 7 patients after recurrence.Metastasis of bone and lymph node progressed in 7 and 9 patients,respectively,but T_2 signal differences were unremarkable between recurrent regions and otherregions.Conclusion MRI examination can provide sufficient radiologic information in the diagnosis of recurrence of prostate cancer afterendocrinotherapy.
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40 years, old group) without prostate diseases, underwent MRI and MRS examinations. The peripheral zone (PZ) and central gland (CG) of the prostate were distinctly demonstrated on MRI, the right and left side of PZ and CG were divided into bottom, middle and tip regions,totally 12 samples were obtained from each case. The levels of (Cho+Cre)/Cit ratios were calculated on the basis of the MRS metabolic map. Results ①The mean level of (Cho+Cre)/Cit ratios in PZs and CGs of different regions in young group and old group was not significantly different. Statistically significant variation of the (Cho+Cre)/Cit ratio in PZs and CGs in the two groups was detected. ②The mean level of (Cho+Cre)/Cit ratios of PZs between young group and old group was not significantly different. Only Statistically significant variation of (Cho+Cre)/Cit ratios in CGs between two groups was detected. Conclusion The normal levels of prostatic metabolites fluctuate dramatically among individuals. There is metabolic difference between the peripheral and central zone and that of young and old group.
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Objective To evaluate three-dimensional reconstruction of MRI images in diagnosis and therapy of prostate cancer. Methods Twenty-eight patients with proven prostate cancers were recruited in this study. Seventeen of them were diagnosed as having prostate cancer according to the ultrasound guided systemic biopsy. Their MR examinations showed fourteen lesions in the peripheral zone and three in the central gland of the prostate. The other eleven patients underwent MR examination after a period of treatment, including endocrinetherapy and brachytherapy. Using endorectal coil, a series of T2-weighted images were acquired on the axial plane. These source images were processed by 3D-Doctor software to reconstruct into three-dimensional images. Results In the fourteen patients with peripheral zone cancer, reconstruction images could display the 3D regions of cancer and the involvement of capsular. The outspread of central gland and the compression of peripheral zone in patients with central gland cancer could be revealed in the same way. The volumetric changes of the lesion and the prostate after endocrinetherapy could also be perceived through these 3D images. Similarly, radioactive seeds were revealed in a spatial manner that could be easily evaluated. Conclusion Three-dimensional reconstruction images were obtained in all patients. They were able to provide stereotyped information about the lesions and their surrounding tissues. MRI three-dimensional reconstruction can be an adjunctive tool in the evaluation of prostate lesions.
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0.05,Friedman Test).When b-value increased from 300 s/mm2 up to 500 s/mm2 and 800 s/mm2,the decreased rates of ADC value were 14% and 21% respectively in carcinous regions,5% and 11% respectively in non-carcinous regions respectively.Conclusion The ADC values are different when b-values changed in both prostatic non-carcinous and carcinous regions,but the difference of ADC between the non-carcinous and carcinous tissues seems to be stable in spite of the change of b-value(range 300-800 s/mm2).
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50 years old).DWI was done on a 1.5-T system using single-shot diffusion-weighted echo-planar imaging(b-values = 0,300,500 and 800 s/mm~2).ADC maps were calculated using the manufacturer's software.ROIs placed on peripheral zone contained,average,thirty pixels.Results When b-value was 300 s/mm~2,the ADC of peripheral zone in junior,middle-age and senior group were(2.03?0.29)?10~(-3) mm~2/s,(2.37?0.33)?10~(-3) mm~2/s,(2.75?0.29)?10~(-3) mm~2/s,respectively,and statistically significant different(F=36.66,P
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Objective To investigate the diagnostic efficacy of MRI and bone scintigraphy in the detection of bone metastasis from prostate cancer.Methods One hundred and eighty-three patients suspected of prostate cancer were recruited in this study.All the patients were examined by pelvic MRI and bone scintigraphy.According to the integragted clinical diagnosis,the patients were categorized as metastastic group and non-metastatic group.SPSS 11.0 was used to analyze the data.Results Bone metastasis were identified in 37 of the 183 patients.In the 24 patients whose MRI results demonstrated bone metastasis,all of them were convinced of bone metastasis(24/24,100%).In the 159 patients whose MRI results revealed no bone metastasis,only 4 of them(4/159,2.52%)were detected bone metastasis by bone scintigraphy.The sensitivity,specificity and accuracy of MRI in the detection of bone metastasis was 78.38%,87.0% and 85.25%,respectively.The sensitivity,specificity and accuracy of bone scintigrapy in the detection of bone metastasis was 94.59%,62.33% and 68.85%,respectively.The specificity and accuracy of MRI in the prediction of bone metastasis were higher than that of bone scintigraphy(? 2=23.458,P=0.000;? 2=13.906,P=0.000),whereas the sensitivity of bone scintigraphy in the detection of bone metastasis was higher than that of MRI(? 2=4.163,P=0.041).Conclusion With the negative findings of the pelvic MRI,the probability of bone metastasis diagnosed by bone scintigraphy was fairly low.So even with the limitation range of the pelvic MRI examination,it is useful in the prediction of bone metastasis from prostate cancer.