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@#Objective To investigate the perioperative efficacy and safety of all-port robotic lobectomy versus thoracoscopic lobectomy in stageⅠA non-small cell lung cancer. Methods The clinical data of patients with stageⅠA non-small cell lung cancer who underwent lobectomy with lymph node dissection performed by the same operator in our center from June 2019 to June 2022 were retrospectively analyzed. The patients were divided into a robotic group and a thoracoscopic group according to different procedures. We compared the relevant indexes such as operation time, intraoperative bleeding, number of lymph node dissection stations, number of lymph node dissection, postoperative tube time, postoperative hospitalization time, closed chest drainage volume, postoperative pain, postoperative complications and hospitalization cost between the two groups. Results There were 83 patients in the robotic group, including 34 males and 49 females with a median age of 60.0 (53.0, 67.0) years, and 94 patients in the thoracoscopic group, including 36 males and 58 females with a median age of 60.5 (54.0, 65.3) years. There was no conversion to thoractomy or death in postoperative 90 days in both groups. No statistical difference was seen in the operation time, total postoperative drainage volume and postoperative complication rates between the two groups (P>0.05). Patients in the robotic group had less intraoperative bleeding (P<0.001), more lymph node dissection stations (P=0.002) and numbers (P=0.005), less postoperative pain (P=0.002), and shorter postoperative time with tubes (P=0.031) and hospital stay (P<0.001). However, the surgery was more expensive in the robotic group (P<0.001). Conclusion All-port robotic surgery is safe and effective for patients with early-stage non-small cell lung cancer with less intraoperative bleeding, more lymph node dissection, less postoperative pain, and shorter hospital stay compared with the thoracoscopic surgery.
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Objective:To explore the preoperative diagnostic value of endoscopic ultrasonography (EUS) for intraductal papillary mucinous neoplasms (IPMN).Methods:Data of 62 patients with IPMN confirmed by pathology who underwent EUS before surgery from 2008 to 2018 in Peking Union Medical College Hospital were analyzed. Characteristics that could distinguish low-grade dysplasia (LGD), high-grade dysplasia (HGD) and invasive carcinoma (IC) were explored. A scoring system based on EUS findings was established to determine the preoperative pathology of IPMN by using logistic model.Results:Of the 62 patients, 15 (24.2%) were diagnosed as having LGD, 20 (32.3%) HGD and 27 (43.5%) IC. Univariate analysis showed that the size of mural nodules and width of main pancreatic duct (MPD) were predictive factors for IPMN pathology. The possibility of higher pathological grading would increase 8% for every 1 mm increment in mural nodules. Multivariate analysis showed that only mural nodules≥5 mm ( OR=7.31, 95% CI : 2.49-21.40, P<0.001) was an independent risk factor to distinguish LGD, HGD and IC. Mural nodules≥5 mm, main pancreatic duct (MPD)≥10 mm and mural nodules <5 mm were assigned 2 points, 1 point and 1 point, respectively. The sensitivity, specificity, and area under receiver operator characteristic curve (AUC) of the EUS scoring system to distinguish benign and malignant IPMN were 0.830, 0.867, and 0.867, respectively. Conclusion:Preoperative EUS helps to distinguish LGD, HGD and IC. The size of mural nodules and the width of MPD are vital risk factors to distinguish benign and malignant IPMN.
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A 56-year-old female was admitted to Department of Gastroenterology at Peking Union Medical College Hospital with diarrhea for seven months, and abnormal liver function for six months. She had a history of type 1 diabetes. The main clinical manifestations were recurrent fatty diarrhea and abnormal liver function, accompanied by abdominal and retroperitoneal lymphadenopathy, elevated CA19-9 and CEA. Progressive impairment of hepatic synthetic function and shrinkage of liver developed in a short period of time. The pathology of liver biopsy suggested that nodular regeneration of hepatocytes was followed by hyperplasia of thin bile ducts after submassive necrosis. Intestinal mucosa biopsies were performed twice. The pathology showed that the intestinal villi were completely blunt, accompanied with crypt hyperplasia. Goblet cells disappeared with reduced mucin. Paneth cells were barely seen without intraepithelial infiltration of lymphocytes. Rifaximin was not effective, while glucocorticoids improved clinical situation. The diagnosis of autoimmune enteropathy was finally confirmed by multidisciplinary team including departments of gastroenterology, pathology, endocrinology, hematology, infectious diseases, and rheumatology. With the administration of glucocorticoid and sirolimus, diarrhea relieved and liver function returned to normal.
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Objective The subtypes of hepatocellular adenoma (HCA) were classified by immuno-histochemical study, and the clinicopathological characteristics of each subtype were analyzed. Methods From December 2003 to March 2018, 31 cases with HCA were retrieved from the archive files of the Depart-ment of Pathology, Peking Union Medical College Hospital, including 16 male patients and 15 female patients. The age ranged from 16 to 63 years. Hematoxylin and eosin ( HE) and immunohistochemical staining were performed with HCA samples. The subtypes were classified by immunohistochemical staining, and the clinicopathological characteristics of each subtype were analyzed. Results The HCA patients had no obvious and specific clinical symptoms, and most of them were diagnosed during the routine health checkup. All of the 31 patients were treated with surgery, and the complete resection was achieved in 26 cases. The adenomas were mainly in the right lobe of the liver (51. 6% , 16/31), and the solitary adenoma accounted for 54. 8% (17/31). 8 HCA were classified as H-HCA, 14 as I-HCA, 7 as β-HCA, and 2 as U-HCA by immunohistochemistry. H-HCA was characterized histologically by marked steatosis and lobulated contours, lacking L-FABP staining. I-HCA exhibited inflammatory infiltrate, telangiectasia, thickened arteries, more or less obvious ductular reaction, with the positive L-FABP/SAA/CRP staining. β-HCA all showed fibrous capsules, some of adenomas exhibited pseudoglandular structure and nodules in nodule. A strong homogeneous cytoplasmic overexpression of GS and nuclear β-catenin were observed in all β-HCA cases. The staining of SAA/CRP/GS was lacking in the U-HCA. Conclusions HCA is rare and difficult to diagnose in clinic. Final diagnosis relies on histological features, and immunohistochemical examinations need to be used for subtyping classification. Each of the four subtypes has characteristic pathological features.
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Objective To retrospectively analyze the clinical pathological features and treatment outcomes of primary non-Hodgkin'slymphoma (NHL) of the female reproductive system.Methods A retrospective analysis was performed on the clinical data of 28 patients with primary NHL of the female reproductive system who were admitted to our hospital from 1990 to 2016.The lymphomas were classified and staged based on the WHO histological classification and the Ann Arbor staging system,respectively.Of the 28 patients,18 (64％) underwent surgery,27 (96％) received chemotherapy,and 8 (29％) received radiotherapy.The Kaplan-Meier method was used to calculate survival rates.Results The 5-year follow-up rate was 86％.The median age was 56.5 years (13-80 years).The ovary was involved in 11 patients (39％).The lymphoma was staged as IVE in 18 patients (64％).The most common pathological type was diffuse large B-cell lymphoma.The median survival time was 23.5 months.The 1-,3-,and 5-year overall survival rates were 89％,74％,and 59％,respectively.Conclusions Primary NLH of the female reproductive system is an extremely rare neoplastic disorder with no typical clinical symptoms and mostly diagnosed in advanced stage.The combined treatment with surgery,chemotherapy,and radiotherapy plays an important role in the treatment of the disorder.
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Objective The type 1 autoimmune pancreatitis is gradually being recognized, but the type 2 AIP is still very rare in Asia.This paper summarizes the clinical characters of type-2 AIP patients in Peking Union Medical College Hospital.Methods From January 2001 to December 2016,all type 2 AIP hospitalized patients who met the ICDC were included in the study.The clinical data, laboratory results and imaging features of all patients were recorded, verified and follow-up.Results Six patients with type 2 AIP were included in the study.The ratio of men and women was 2/1, with an average age of 38.4 years.67.7% (4/6) patients have UC.37.7% (2/6) of patients were asymptomatic.Three patients were diagnosed by pathology.50% (3/6) of patients showed mass of pancreas, and 50% (3/6) of patients showed pancreatic enlargement.Conclusions The clinical manifestations of the type 2 AIP patients in Peking Union Medical College Hospital are the same as those in foreign countries.
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Objective To investigate treatment effects of levonorgestrel-releasing intrauterine system (LNG-IUS) for adenomyosis with menorrhea in a prospective study. Methods From December 2006 to December 2014, patients of symptomatic adenomyosis diagnosed by transvaginal ultrasound in outpatient or inpatient clinics of Peking Union Medical College Hospital were given the treatment of LNG-IUS. Before and after placement of LNG-IUS, all the patients′parameters were recorded prospectively, including scores of menstruation blood loss, carrying status of IUS, symptoms and scores of dysmenorrhea, biochemical indicators, physical parameters, menstruation patterns and adverse effects. Changes of pictorial chart scores of menstruation and distribution of anemia during follow-up were analyzed. Results Totally 1 100 women meets inclusion criteria, among which 618 cases (56.18%, 618/1 100) had severe menorrhea, with median follow-up period of 28 months (range 1-60 months), and accumulative carrying rate of 66% at 60 months follow-up. After placement of LNG-IUS, compared with baselines, pictorial chart scores and ratio of menorrhea had decreased significantly (all P0.05). Conclusions LNG-IUS is effective for adenomyosis of menorrhea. Improvement of menstruation blood loss is independent on patients characters, menstruation patterns or adverse effects.
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Objective To investigate treatment effects of levonorgestrel-releasing intrauterine system (LNG-IUS) for adenomyosis with severe dysmenorrhea in a prospective cohort study. Methods From December 2006 to December 2014, patients of symptomatic adenomyosis diagnosed by transvaginal ultrasound in outpatient or inpatient clinics of Peking Union Medical College Hospital were given the treatment of LNG-IUS. Before and after placement of LNG-IUS, all the patients′parameters were recorded prospectively, including symptoms and scores of dysmenorrhea, menstruation scores, biochemical indicators, physical parameters, carrying status of LNG-IUS, menstruation patterns and adverse effects. Changes of scores and patterns of pain during follow-up were analyzed. Results Totally 1 100 women meets inclusion criteria, among which 640 cases (58.18%, 640/1 100) had severe dysmeorrhea, with median follow-up period of 35 months (range 1-60 months), and accumulative carrying rate of 65% at 60 months follow-up. After placement of LNG-IUS, scores of pain and ratio of severe dysmenorrhea had decreased significantly compared with baselines (all P0.05). Conclusion LNG-IUS is effective for adenomyosis of severe dysmenorrhea. Improvement of pain is independent on patients characters, menstruation patterns or adverse effects.
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<p><b>OBJECTIVE</b>To study the clinicopathologic and immunohistochemical features, and the prognosis of intraductal papillary mucinous neoplasms (IPMN) of the pancreas.</p><p><b>METHODS</b>The clinical findings, morphologic features, immunophenotype and prognosis were investigated in 61 cases of IPMN.</p><p><b>RESULTS</b>Of these 61 cases, 33 were in the pancreatic head and 14 were in the body and tail, and 14 in the entire pancreas. The average patients' age was 61.8 years. The initial symptom was abdominal pain in 37 cases, and the tumors were detected at routine checkup in 14 cases. The imaging examination showed dilated ducts and/or cystic and solid masses. Grossly, 32 cases were multi-loculated cystic masses containing mucin and papillary areas; 13 cases were solid. Microscopically, the IPMN showed four patterns, including gastric-type (16 cases), intestinal-type (21 cases), pancreatobiliary-type (21 cases) and eosinophilic-type (3 cases). The IPMN cohort included 13, 13 and 6 IPMN with low, intermediate and high-grade dysplasia respectively, and 29 IPMN associated with invasive carcinoma. The IPMN associated carcinomas were mainly ductal adenocarcinoma (23/29, 79.3%), followed by colloid carcinoma (4/29, 13.8%) and undifferentiated carcinoma (2/29, 6.9%). Immunohistochemically, IPMN expressed MUC5AC (51/57, 89.4%), MUC2 (21/57, 36.8%), and MUC1 (13/46, 28.3%). The mean postoperative follow-up period was 32 months (range 12-112 months). Six of 61 patients were lost to follow-up. Overall 5-year survival rate was 76%. The 5-year survival rate of IPMN with low, intermediate or high-grade dysplasia was 100%, and recurrence was local in 3 patients. The 3-year survival rate of IPMN associated with invasive carcinoma was 55%. 12 of 13 patients died within 2 years after operation.</p><p><b>CONCLUSIONS</b>IPMN is a common cystic neoplasm of the pancreas located in the ducts. The pathologic types and classifications are clearly defined. MUC stains are helpful for the diagnosis and papillary typing. IPMN with invasive carcinoma was associated with significantly worse survival than IPMN with dysplasia.</p>
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Humans , Middle Aged , Adenocarcinoma, Mucinous , Diagnosis , Pathology , Carcinoma, Pancreatic Ductal , Diagnosis , Pathology , Mucins , Metabolism , Neoplasm Recurrence, Local , Pancreas , Pathology , Pancreatic Neoplasms , Diagnosis , Pathology , Prognosis , Survival RateABSTRACT
Objective To investigate the changes of mestruation patterns and adverse effects during the treatment of levonorgestrel-releasing intrauterine system (LNG-IUS) for symptomatic adenomyosis in a prospective cohort study. Methods From December, 2006 to December, 2014, patients of symptomatic adenomyosis diagnosed by transvaginal ultrasound in Peking Union Medical College Hospital were given LNG-IUS. Before and after placement of IUS, all patients′ parameters were recorded, including carrying status of IUS, symptoms and scores of dysmenorrhea, menstruation scores, biochemical indicators, physical parameters, menstruation patterns and adverse effects. Risk factors for changes of menstruation patterns and adverse effects, and their impact on treatment effects were analyzed. Results Totally 1 100 cases met inclusion criteria, with median age 36 years (range 20-44 years), median follow-up 35 months (range 1-108 months). During follow-up changes of menstruation patterns increased significantly with amenorrhea and shortened-menstruation being the most common manifestations. On 3, 6, 12, 24, 36, 48 and 60 months after the placement of LNG-IUS, 0, 5.8%(43/744), 6.9%(47/682), 10.1%(60/595), 17.3%(87/502), 27.2%(104/383) and 29.6%(82/277) patients achieved amenorrhea respectively (P12 months after placement, abdominal pain and body weight increasing ≥5 kg/year were the most common adverse effects. Changes of menstruation patterns, total and subclassifications of adverse effects were neither dependent on patient parameters, treatment modes and treatment effects, nor could predict future LNG-IUS carrying status (all P>0.05). After taking out of LNG-IUS, most changes of menstruation and adverse effects disappeared. Conclusions During the treatment of LNG-IUS for symptomatic adenomyosis, changes of menstruation patterns increase gradually with amenorrhea and shortened-menstruation being the most common manifestations, while adverse effects decrease significantly. Changes of menstruation patterns or adverse effects neither have any risk factor nor have impact on treatment effects.
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Objective_To study the significance of fascin protein expression in ductal intraepithelial neoplasia ( DIN) and invasive ductal carcinoma ( IDC) .Methods_Thirty cases of usual ductal hyperplasia ( UDH) , 30 ca-ses of flat epithelial atypia (FEA,DIN1a), 15 cases of atypical ductal hyperplasia (ADH,DIN1b), 2 cases of DCIS grade1(DIN1c),10 cases of DCIS grade2(DIN2)and 18 cases of DCIS grade3(DIN3)were immunohisto-chemically investigated using monoclonal antifascin antibody and compared with 120 cases of invasive ductal carci-noma (IDC).Results_Fascin protein expression was not found in normal breast tissue, UDH, FEA (DIN1a), ADH(DIN1b),DCIS grade1(DIN1c)and DCIS grade2(DIN2),but only seen in 2 of 18 cases of DCIS grade3 (DIN3)(11.1%), and 18 out of 120 cases of IDC (15%).Fascin protein expression was correlated with ER neg-ative( P<0.05) , PR negative( P<0.05) , tumor grade( P<0.05) and axillary lymph node status( P<0.05) , but not correlated with age,location,tumor sizeand HER2 expression.Conclusions_Fascin protein expression seems to be a late event, usually present in carcinoma.Targetting the fascin pathway may be a noval therapeutic strategy of mammary carcinoma.
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Objective The enhanced patterns of atherosclerotic plaque on dynamic contrastenhanced MRI have not been well studied. The aim of this study was to explore the patterns of plaque enhancement and their underlying mechanism by using dynamic contrast-enhanced MRI (DCE-MRI).Methods Atherosclerotic plaques were induced in the aorta of 12 New Zealand White rabbits by a combination of endothelial denudation and high-cholesterol diet. Ten to sixteen weeks after surgery, DCEMRI was performed with a fast spin echo T1 weighted sequence. Thirty-five phases of images were obtained at 71-second intervals. Gd-DTPA was injected coincident with the third scan via marginal ear vein. Specimens were harvested within 12 hours after imaging for HE staining and CD31 immunohistochemical staining which was used to highlight nco-vessels. Plaque enhancement patterns were studied and compared with histological findings. Signal intensity of each plaque section was normalized to pre-contrast signal intensity of psoas muscle, after which signal intensity versus time curve was drawn. Pearson correlation coefficient was used to reveal association between histological neo-vessel count and descriptive parameters derived from signal intensity versus time curve. Results Plaques were significantly enhanced by Gd-DTPA. Enhancement patterns could be described as fast-in and slow-out. Differences in patterns of enhancement were observed between tissues, with fibrous tissue enhanced more than lipid aggregation and leukocyte foci. Peak enhancement( 1. 05 ±0. 30) , initial slope(0. 82 ± 0. 28 ) and area under the curve at early phase(4.97 ± 1.67) derived from signal intensity-time curve had significant correlations with neo-vessel count( 117.7 ± 93. 3) ( r= 0. 553,0. 468, 0. 554 respectively, P ＜ 0. 05 ) . Conclusions The enhanced patterns of atherosclerotic plaque by Gd-DTPA were fast- in and slow-out. Neovascularization, increased endothelial permeability and extracellular matrix may be the reasons for plaque enhancement by Gd-DTPA. DCE-MRI has the potential to quantify the extent of neo-vasculature formation within plaques.
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Objective To improve the diagnosis and treatment quality of juxtaglomerular cell tumor of the kidney. Methods Three patients(2 females, 1 male) were diagnosed with juxtaglomerular cell tumor of kidney and underwent nephron-sparing surgery. Case 1 was female, 15 years old. She presented with hypertention of 245/135 mm Hg. The serum kalium was 2.5--3.0 mmol/L. Thelaboratory examination suggested that in decubitus and standing position, the plasma renin activity (PRA) was 2.2 and 3.5 μg · L-1 · h-1 , angiotensin Ⅱ (ATⅡ) was 181.2 and 481.4 ng/L; aldosterone(ALD) was 332.4 and 747.9 pmol/L, respectively. Dynamic enhanced CT scanning demonstrated a tumor with the diameter of 1.3 cm in right kidney. Case 2 was male, 39 years old. He presented with hypertention of 180/120 mm Hg. The serum kalium was 2. 7--3.0 mmol/L. In decubitus and standing position, PRAwas8.1 and 9.2 μg·L-1 · h-1, ATⅡ was 198.3 and 279.1 ng/L, ALD was 285.3 and 761.7 pmol/L, respectively. Dynamic enhanced CT scanning showed a tumor with the diameter of 1.2 cm in right kidney. Case 3 was female, 26 years old. She presented with hypertention of 210/120 mm Hg. The serum kalium was 4. 1 mmol/L. In decubitus and standing position, PRA was 0.1 and 0.3 μg · L-1·h-1 , ATⅡ 56.2 and 71.5 ng/L, ALD 321.3 and 421.1 pmol/L, respec tively. On dynamic enhanced CT scanning, a tumor with a diameter of 3.0era was located in left kidney. Results Partial nephrectomy was successfully performed in 3 patients, including 1 (case 2) retroperitoneal laparoscopic surgery. Pathologic examination revealed encapsulated tumors in all cases. Light microscopically, the tumor consisted of clusters of polygonal cells, and the cell had centrally located nuclei and slightly eosinophilic cytoplasm. Thick walled vessels were usually present. The tumors showed positive immunostaining for actin and CD34. Three patients were followed up for 23,4, 26 months respectively and all remained normotensive without any treatment. No recurrence or metastasis occurred. Conclusions Hypertention, increased PRA, secondary aldosteronism, hypokalemia are characteristics for juxtaglomerular cell tumor of the kidney. Dynamic enhanced CT scanning has high sensitivity. Partial nephrectomy or enucleation of tumor are both effective surgical treatment. Retroperitoneal laparoscopic surgery is safe and effective as well.
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The adoption of the system of multi-technical appraisals of malpractice means that the appraisals made each time, which constitute the key basis and evidence for the health administrative departments and the judicial organs to deal with medical disputes, are of legal validity as proof. By analyzing the causes of the differences in the appraisals of certain cases, the authors argue that a correct understanding of the definition of malpractice is the key to a correct determination of it; an appropriate application of the principle of allocating the burden of proof is the key link in the technical appraisal of malpractice; perfection of Regulations on Handling Malpractice, Standards for the Classification of Malpractices, and Temporary Provisions on the Technical Appraisal of Malpractice is the basis of correct and impartial appraisals; and a good grasp of the gist of rules and regulations and appraisal according to law is the guarantee for a correct determination of the nature of malpractices.