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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 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.
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Objective:To explore influence of probucol combined atorvastatin on blood viscosity ,transcranial Doppler (TCD) indexes and carotid plaque stability in patients with large artery‐derived cerebral infarction .Methods :A total of 100 patients with large artery‐derived cerebral infarction treated in our hospital from Apr 2014 to Apr 2016 were selected .According to random number table ,patients were randomly and equally divided into atorvastatin group (received atorvastatin based on routine treatment ) and combined treatment group (received probucol based on atorv‐astatin group) ,both groups were treated for six months .Related indexes before and after treatment were compared between two groups .Results :Compared with atorvastatin group after treatment ,there were significant reductions in levels of TC ,TG and LDL‐C ,and significant rise in HDL‐C level (P<0.01 all);significant reductions in whole blood high shear viscosity [(6.23 ± 0.38) mPa/s vs .(4.20 ± 0.42) mPa/s] ,whole blood low shear viscosity [(21.17 ± 5.83) mPa/s vs .(18.10 ± 4.44) mPa/s] ,plasma viscosity [ (2.10 ± 0.45) mPa/s vs .(1.72 ± 0.34) mPa/s] and fibrinogen (Fg) level [(4.35 ± 1.36) g/L vs .(3.30 ± 1.38) g/L] ,P<0.01 all;significant rise in systolic blood flow velocity (Vs) [left :(87.43 ± 14.56) cm/s vs .(95.45 ± 18.37) cm/s]and mean blood flow velocity (Vm) [left :(60.89 ± 16.03) cm/s vs .(75.38 ± 19.36) cm/s]of left and right MCA ,significant reduction in pulsatility index(PI) [(0.85 ± 0.22) vs .(0.75 ± 0.12)] , P<0.05 or <0.01;significant reductions in unstable plaque score [(4.93 ± 0.40) scores vs .(4.12 ± 0.35) scores]and recurrence rate of cerebral infarction (16.00% vs .2.00% ) in combined treatment group ,respectiely P=0.001 ,0.014. Conclusion:Probucol combined atorvastatin can significantly reduce blood viscosity ,significantly improve hemodynamics in patients with large artery‐derived cerebral infarction .Its an‐ti‐atherosclerosis effect is obvious ,therefore it can be used to prevent or reduce recurrence of cerebral infarction .
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Objective To observe the effects of doxazosin on the expression of type Ⅰ and type Ⅲ collagen fiber in autoantibodies against α1-adrenergic receptors (α1-AA) positive diabetic rats,and to investigate the protective mechanism of doxazosin on cardiomyopathy of diabetic rats.Methods After establishment of diabetes model with streptozocin,diabetic rats were randomly divided into diabetic group (group A,n =10),doxazosin treated group (group B,n =10),α1-AA mediated group (group C,n =8),α1-AA plus doxazosin treated group (group D,n =8).Group C and group D were injected α1-AA (100 μg/100 g) by caudal vein at 0,4,8,12,and 16 weeks.Doxazosin (0.36 mg · kg-1 · d-1) was administered by lavage for 16 weeks in group B and group D,and other groups were given the same volume of saline every day.Expressions of type Ⅰ and type Ⅲ collagen fibers in myocardium of left ventricle were detected by immunohistochemical staining.Pathological changes in the myocardium were observed by both light and electron microscopes.Changes in collagen fiber in myocardium were detected by Van Gieson staining.Results Among various groups,there was no significant difference in blood glucose levels (P ＞ 0.05).After the intervention of doxazosin,body weight in group B and group D was greater than that of group A and group C (P＜0.05 or P＜0.01).Expression of type Ⅰ and type Ⅲ collagen fibers in myocardium in group D was lower than that in group C (P＜0.05).Expression of type Ⅰ and type Ⅲ collagen fibers in group B was lower than that in group A (P＜0.05) as well.Myocardial pathological changes in group C were most serious,showing reduced mitochondrial,vacuolar degeneration,and interstitial collagen hyperplasia.Cardiomyopathy in group D and group B was less marked as compared with that in group C and group A,respectively.Myocardial collagen fiber in group C was significantly increased and showed poor alignment.Compared with group C,myocardial collagen deposition in group D was obviously reduced.Conclusions Doxazosin may suppress type Ⅰ and type Ⅲ collagen expressions in myocardium of α1-AA mediated diabetic rats,resulting in alleviation of myocardial fibrosis and protection of myocardium in diabetic rats.