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Cholecystic adenomyosis is a common benign lesion of the biliary system. Recently, cholecystic adenomyosis has been diagnosed to harbour an incidental gallbladder cancer (IGBC) on intraoperative or postoperative pathological examinations. In this article, we reviewed 586 patients who were treated at Zhongshan Hospital, Fudan University with a preoperative diagnosis of cholecystic adenomyosis, and found 5 patients with IGBC diagnosed by pathological examinations. We described the clinical characteristics, imaging features and pathological findings of these 5 cases. We further reviewed the relevant medical literatures to provide a comprehensive view on IGBC of adenomyosis origin.
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Objective@#To analyze the clinical effect of low molecular weight heparin calcium(LMWH) combined with aspirin in preventing portal venous thrombosis (PVT) after devascularization.@*Methods@#Retrospective cohort study was carried out. A total of 61 patients with portal hypertension in Zhongshan Hospital affiliated to Fudan University from December 2014 to April 2017 were included in the study, including 43 males and 18 females, aged 24~74 years. According to anticoagulation methods, the patients were divided into treatment group (31 cases of LMWH combined with aspirin) and control group (30 cases of aspirin). Splenectomy and pericardial devascularization or combined devascularization were performed in both groups. Platelet count, prothrombin time, Child-Pugh score, PVT status and surgical complications were observed after surgery.@*Results@#There were no significant differences for platelet count and prothrombin time between the two groups after 7, 14, 30, 60 and 90 days (P>0.05). Child-Pugh scores at 3, 7, 14, 30, 60 and 90 d after operation of the two groups showed no significant differences (P>0.05). Seven days after the operation, PVT in the treatment group and control group was 7 (22.6%) and 7 (23.3%), respectively. Thirty days after the operation, PVT was detected in 8 patients (25.8%) in the treatment group and 15 patients (50.0%) in the control group. Sixty days after the operation, 6 patients (19.4%) had PVT in the treatment group and 13 patients (43.3%) in the control group. PVT was detected in 4 patients (12.9%) in the treatment group and 12 patients (40.0%) in the control group 90 days after operation. The incidence of PVT in the 30, 60 and 90 days after surgery was lower than that in the control group, with significant difference (P<0.05), and the degree of thrombosis was relatively mild. There were 6 cases (20.0%) of complications in the control group and 6 cases (19.4%) in the treatment group, there were no significant differences between the two groups (P>0.05).@*Conclusion@#LMWH combined with aspirin is safe and effective in preventing PVT after devascularization.
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Objective To analyze the clinical effect of low molecular weight heparin calcium (LMWH) combined with aspirin in preventing portal venous thrombosis (PVT) after devascularization.Methods Retrospective cohort study was carried out.A total of 61 patients with portal hypertension in Zhongshan Hospital affiliated to Fudan University from December 2014 to April 2017 were included in the study,including 43 males and 18 females,aged 24 ～ 74 years.According to anticoagulation methods,the patients were divided into treatment group (31 cases of LMWH combined with aspirin) and control group (30 cases of aspirin).Splenectomy and pericardial devascularization or combined devascularization were performed in both groups.Platelet count,prothrombin time,Child-Pugh score,PVT status and surgical complications were observed after surgery.Results There were no significant differences for platelet count and prothrombin time between the two groups after 7,14,30,60 and 90 days (P ＞ 0.05).Child-Pugh scores at 3,7,14,30,60 and 90 d after operation of the two groups showed no significant differences (P ＞0.05).Seven days after the operation,PVT in the treatment group and control group was 7 (22.6％) and 7 (23.3％),respectively.Thirty days after the operation,PVT was detected in 8 patients (25.8％) in the treatment group and 15 patients (50.0％) in the control group.Sixty days after the operation,6 patients (19.4％) had PVT in the treatment group and 13 patients (43.3％) in the control group.PVT was detected in 4 patients (12.9％) in the treatment group and 12 patients (40.0％) in the control group 90 days after operation.The incidence of PVT in the 30,60 and 90 days after surgery was lower than that in the control group,with significant difference (P ＜ 0.05),and the degree of thrombosis was relatively mild.There were 6 cases (20.0％) of complications in the control group and 6 cases (19.4％) in the treatment group,there were no significant differences between the two groups (P ＞ 0.05).Conclusion LMWH combinedwith aspirin is safe and effective in preventing PVT after devascularization.
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Objective To study the use of preoperative indocyanine green retention test at 15 minutes (ICG R15) in the prediction of liver functional reserve in patients with hilar cholangiocarcinoma (HCCA).Methods The clinical data of 62 patients with HCCA treated in our department from March 2016 to March 2018 was reviewed.The relationship between preoperative ICG R15 and postoperative hepatic insufficiency was analyzed.The relationship between preoperative ICG R15 and Child-Pugh scoring was also studied.Univariate analysis was used to evaluate the risk factors of postoperative liver dysfunction.Logistic regression was used to assess the independent risk factors of postoperative liver dysfunction.The regression equation between independent risk factors and postoperative liver dysfunction was established.Results Among the 62 patients,ICG R15 was less than 10.0％ in 26 patients,between 10.0％ and 19.0％ in 17 patients,between 20.0％ and 29.0％ in 9 patients,between 30.0％ and 39.0％ in 5 patients,and over 40.0％ in 5 patients.There were 29 patients with a Child-Pugh A grading and 33 patients with a Child-Pugh B grading in the preoperative evaluation of liver function.The Wilcoxon W rank sum test was used to compare the preoperative ICG R15 in patients with Child-Pugh grading A and B separately.The ICG R15 in Child-Pugh grading A patients was significantly lower than those in Child-Pugh B grading patients (P ＜0.05).There were no significant differences in age,gender,history of previous liver diseases,duration of operation,and intraoperative blood loss (P ＞ 0.05) between the normal liver function group and the liver dysfunction group.However,there was a significant difference in the preoperative ICG R15 and preoperative bilirubin levels (P ＜ 0.05) between the two groups.The preoperative ICG R15 and preoperative bilirubin levels were significant risk factors of postoperative hepatic insufficiency.Regression analysis suggested that preoperative ICG R15 level was an independent risk factor of postoperative hepatic insufficiency (P ＜ 0.05).A regression equation:logit(P) =0.185 × preoperative ICG R15-3.152 could be constructed.Conclusions ICG R15 is an ideal clinical indicator for evaluation of preoperative liver functional reserve in patients with HCCA.It predicted the recovery of postoperative liver function.
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Objective To explore the characteristics and influencing factors of depressive symptoms among the only-child-lost persons.Methods A total of 841 only-child-lost persons and 674 controls conforming to entering group condition were selected.The difference of SDS score between the two groups and the demographic characteristics distribution differences of depression severity in only-child-lost persons were compared and the influencing factors were analyzed.Results The SDS score had statistical difference between the only-child-lost persons group and control group(P＜0.05),and was correlated to the only-child-lost years and no physical disease;the proportion of mild to moderate depression in the only-child-lost persons of the low cultural level,somatic diseases and middle income level groups was significantly higher than that in the other groups;the only-child-lost persons with low income level,age≤60 years old and high educational level had a higher proportion of severe depression;the Logistic regression analysis showed that the educational level had a significant influence on the depression onset among the only-child-lost persons,the difference was statistically significant(P＜0.05).Conclusion The characteristics of depressive symptoms among the only-child-lost persons are related to their demographic characteristics.
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Objective To study the living quality and mental health status in losing-single-child family couples .Methods A total of 841 losing-single-child family couples and 674 family couples with children alive conforming to the entering group condition were random sampled from the three districts of Chongqing main city .The on-site survey was performed by using the general condi-tion questionnaire ,90 Symptom Checklist (SCL-90) ,Self-rating Anxiety Scale (SAS ) ,Self- rating Depression Scale (SDS ) ,Social Support Rating Scale (SSRS) ,Memorial University of Newfoundland Scale of Happiness (MUNSH) and WHO Quality of Life Scale (WHOQOL-BREF) Chinese version .Results There were no differences in gender ,age and culture between the losing-single-child family couples group and family couples with children alive group (P>0 .05);the SCL-90 total score and each factor score , SAS and SDS score in the losing-single-child family couples group were significantly higher than those in family couples with chil-dren alive group(P<0 .05) ,the SSRS score ,MUNSH score and WHOQOL-BREF Chinese version evaluation score were signifi-cantly lower than those in the family couples with children alive group(P<0 .05);the multivariate regression analysis showed that the four regression equations in the social relation field ,environment field ,depression factors and total happiness had statistical sig-nificance (P<0 .05) .Conclusion The living quality ,mental health status and subjective well-being in the losing-single-child family couples are significantly affected ,timely psychological crisis intervention and persistent psychological support and mental health ed-ucation should be give them to improve their psychological health status ,increase the living quality and subjective well-being .
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Pancreatic sinistral portal hypertension is a localized kind of portal hypertension that usually occurs as a result of the splenic vein obstruction caused by pancreatic diseases.Furthermore,it is also an important cause of upper gastrointestinal hemorrhage.Management in clinical practice should be directed at the sinistral portal hypertension and primary pancreatic diseases.
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Objective To promote the diagnostic accuracy of intrapancreatic accessory spleen (IPAS).Methods The clinical data of 10 cases of IPAS admitted in Fudan University Zhongshan Hospital from Apr 2005 to Dec 2013 were retrospectively analyzed.Results There were ten cases of IPAS confirmed pathologically.Only 1 of the ten cases was diagnosed correctly and definitely with IPAS preoperatively.The other 9 cases were misdiagnosed with benign or malignant pancreatic tumors,including nonfunctional neuroendocrine neoplasms in 5 cases,pancreatic neuroendocrine cancers in 3 and pancreatic intraductal adenocarcinoma in one.All the nine misdiagnosed patients has no specific symptoms or laboratory indexes.All the IPASs located in the tail of the pancreas with the mean diameter (1.3 ±0.2) cm(0.8-2.5 cm).7 cases of IPAS show strikingly similar dynamic enhancement to the spleen on the CT scans and/or MRI.Accessory spleen around the splenic hilum was found in five cases.Conclusions Morphological study plays an important role in the diagnosis and IPAS carries parallel dynamic enhancement to the spleen on CT scans and/or MRI.IPAS should be considered as a differential diagnosis while the lesion is no more than 2.5 cm in diameter and when other accessory spleens were shown around the splenic hilum.
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Objective To investigate the clinical outcomes of alprostadil in prevention of portal vein thrombosis after splenectomy and devascularization.Methods 113 patients with PHT who were treated with prophylactic alprostadil after splenectomy and devascularization procedures from May 2009 to Apr 2013 were included into the treatment group.112 conservative patients with PHT who were treated with traditional prophylactic anticoagulants after the same operations before May 2009 were included as the control group.The postoperative complication rates,mortality,postoperative drainage volume from the abdominal cavity,blood platelet counts,prothrombin time,liver function,Child-Pugh's scores and portal vein thrombosis rates between the two groups were compared.Results When compared with the control group,the postoperative complication rate and mortality in the alprostadil group were not increased,while the postoperative drainage volume from the abdominal cavity was significantly reduced.The increase in blood platelet counts and prothrombin time were similar in the 2 groups.Furthermore,the extent of hepatic dysfunction on the 3rd and 7th after operation was significantly decreased.On short term follow-up,color droppler ultrasonography showed the portal vein thrombosis rate of the treatment group was significantly lower than the control group,with less extensive degree of thrombosis in the treatment group.Conclusion Alprostadil is a safe and effective anticoagulant which provided better prevention of portal vein thrombosis after splenectomy combined with devascularization.
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Objective To investigate the clinical features,diagnosis and prognosis of solid pseudopapillary tumor of the pancreas(SPTP). Method The clinical data of SPTP cases that underwent surgical resection with a definitive histological diagnosis in Zhong Shan Hospital from 1999 to 2007 were retrospectively analyzed.Result There were 42 SPTP cases undergoing surgery in this period,including 37 females and 5 males:mean age was 37.6 years.Tumors located in the pancreatic head in 18 cases and in the body or tail in 24 cases.The most common symptom was abdominal discomfort(n=20),palpable mass (n=8).Preoperative diagnostic accuracy of MRI and CT were 93%and 31.8%,respectively.Ten cases underwent pancreaticoduodenectomy,20 cases received distal pancreatectomy,3 cases did spleen-preserving distal pancreatectomy.Tumors were simply enucleated in 8 cases.Average diameter of the tumors was 6.1 cm,34 lesions were solid,6 were solid-cystic,2 were cystic.The overall perioperative morbidity was 38.1%,10 cases developed postoperative pancreatic fistula.The mean follow-up time was 38.6 months.Except three cases that were lost to follow-up,all the other cases were alive.Four cases(2 cases had had tumor enucleation,2 had had distal pancreatectomy)developed hepatic metastases on 70、110、41、3 months after first surgery,respectively.A transarterial chemoembolization was employed in three cases,while right hemihepatectomy was performed in one case. Conclusion SPTP is an indolent tumor with low-grade biological aggressiveness.Patients had a favorable outcome after surgical treatment,but enucleation should be avoided.Patients with liver metastasis may benefit from chemoembolization and liver resection.
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Objective To observe the therapeutic effects of comprehensive rehabilitation treatment in patients with chronic renal failure (CRF). Methods Fifty patients with CRF were randomly and equally divided into a rehabilitation group and a control group. Those in the rehabilitation group were intervened with comprehensive rehabilitation protocol including regular counseling, health education and adequate aerobic exercise in addition to routine medications, while those in the control group with the routine medications only. The therapeutic effects were evaluated by means of Symptom Check List- 90(SCL- 90) and the questionnaire about quality of life (QOL) for patients with CRF, as well as such biochemical parameters as SCr, BUN, Ccr, DBP and SBP before and after treatment. Results Compared with those in the control group, the physiological capability and other relevant parameters of QOL in the rehabilitation group were significantly improved after one year of comprehensive rehabilitation, while SBP and DBP significantly decreased. There was no statistically significant changes of the concentrations of Scr, Bun, and Ccr. Conclusion Comprehensive rehabilitation intervention is superior to routine drug therapy in terms of improving the physiological capability, decreasing the BP and improving the QOL of the CRF patients.
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Objective To investigate the biological features and treatment of pancreatic adenosquamous carcinoma. Methods A retrospective clinical analysis was conducted in 6 cases of pancreatic adenosquamous carcinoma treated in our hospital from 1995 to 2005. The clinical features, imaging findings, therapy and pathology were analyzed. Results Pancreatic adenosquamous carcinoma was found in 3 men and 3 women with a mean age of 51. 8?10. 8 years. Tumor was located in the head of the pancreas in 4 patients, body in 1 and tail in 1. Three cases received pancreaticoduodenectomy, two did distal pancreatectomy and splenectomy, one underwent palliative operation. The mean size of the tumor was 5. 2 cm ? 4. 1 cm ? 3. 0 cm, pathologically primary tumor and the liver metastasis were mixture of adenocarcinoma and squamous cell carcinoma. Tumor invaded the duodenal wall and common bile duct in 3 cases, portal vein was invaded in 1 case. Neural invasion was present in 4 cases. Lymphatic invasion was found in 3 cases. Postoperative mean survival time was 6. 7 months after the operation with patients finally dying of tumor recurrence and liver metastasis. Conclusions Pancreatic adenosquamous carcinoma is characterized by the mixture of adenomatous and squamous cell element with aggressive biological behavior. The prognosis of this tumor is poor demanding early diagnosis and proper surgical treatment.
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Objective To construct MUC1-VNTR DNA vaccine pancreatic cancer. Methods The recombinant gene of VNTR was synthesized and cloned into MCS in the pcDNA3. 1/Myc-his ( + ) A vector. pcDNA3. 1-VNTR/Myc-his( + ) A was injected twice into C57BL/6( H-2b)female mice (V group, n = 15). Mice inoculated with either the empty plasmid vector ( D group, n = 15 ) or 0. 9% NaCl ( NS group, n, = 15) were used as control. Two weeks later, both humoral and cellular immunity of the mice were studied. Results The recombinant plasmid pcDNA3. 1 -VNTR/Myc-his ( + ) A encoded the whole exact translation frame region of the pcDNA3. 1/Myc-his ( + ) A vector and the recombinant gene of human VNTR. The transfected COS7 cells expressed transgene products at 48 hours after transfection. Intramuscular delivery of the recombinant plasmid into C57BL/6 mice resulted in more efficient induction of CTL lysis specific against VNTR polypeptide than the D group and the NS group (P