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A total of 1 789 patients with gastric cancer underwent radical gastrectomy in our hospital from September 2015 to August 2017, internal hernia (IH) developed in 7 cases with a incidence rate of 0.4%. The general condition, the symptoms, imaging findings, treatment methods and prognosis as well as the types of digestive tract reconstruction of patients were retrospective analyzed. There were 4 cases of Petersen′s hernia, 2 cases of jejuno-jejuno mesenteric hernia and 1 case of diaphragm hernia. All patients developed mechanical obstruction. Imaging examination showed mesenteric vessels overriding sign and double whirl sign. Six patients recovered smoothly, 1 patient gave up treatment due to extensive small bowel infarction. It is indicated that the formation of abnormal channels in the abdominal cavity after radical gastrectomy may lead to IH. The mesenteric vessels overriding sign and the double whirl sign are the unique imaging findings of IH after radical gastrectomy. Closing the abnormal channel can prevent the occurrence of IH after gastrectomy.
ABSTRACT
A total of 1 789 patients with gastric cancer underwent radical gastrectomy in our hospital from September 2015 to August 2017,internal hernia (IH) developed in 7 cases with a incidence rate of 0.4％.The general condition,the symptoms,imaging findings,treatment methods and prognosis as well as the types of digestive tract reconstruction of patients were retrospective analyzed.There were 4 cases of Petersen's hernia,2 cases of jejuno-jejuno mesenteric hernia and 1 case of diaphragm hernia.All patients developed mechanical obstruction.Imaging examination showed mesenteric vessels overriding sign and double whirl sign.Six patients recovered smoothly,1 patient gave up treatment due to extensive small bowel infarction.It is indicated that the formation of abnormal channels in the abdominal cavity after radical gastrectomy may lead to IH.The mesenteric vessels overriding sign and the double whirl sign are the unique imaging findings of IH after radical gastrectomy.Closing the abnormal channel can prevent the occurrence of IH after gastrectomy.
ABSTRACT
Surgery alone for the adenocarcinoma of the esophagogastric junction (AEG) often gives unsatisfactory results, with a poor prognosis.At present, there is no unified therapeutic regimen specifically for AEG.Neoadjuvant therapy includes neoadjuvant radiotherapy, chemotherapy and chemoradiotherapy, but the applications and effects of them for AEG are still controversial.
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ObjectivesTo explore the clinical presentation, diagnosis and treatment of hemophagocytic syndrome (HLH) in children.MethodsThe clinical data from 11 hospitalized pediatric patients with HLH were collected and retrospectively analyzed from 2009 to 2013.ResultsIn 11 pediatric patients with HLH, 6 patients were Epstein-Barr virus associated-HLH, 1 patient was T-cell lymphoma associated-HLH, 2 patients had unknown reason, 2 patients had mutations in the UNC13D gene coding sequence, c.2459C>T/p.A832V (alanine to valine mutation) and c.3067C>T/p.R1023C (arginine to cysteine mutation) respectively. In 11 patients, 6 patients were improved after treatment and 5 patients were died.ConclusionsThe HLH in chil-dren lacks speciifc clinical presentation and progresses rapidly. It should be diagnosed and treated in time.
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In numerous digestive reconstruction techniques after proximal gastrectomy for tumor of the gastroesophageal junction,widely used methods are esophagogastrostomy,esophagogastric tube reconstruction and jejunalinterposition reconstruction.More studies have been focused on jejunalinterposition reconstruction in recent years,from which a variety of modified reconstructions derive.In clinical practice,a flexible choice is needed according to the actual situation of patients.
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Objective To investigate the effect of the second resection for unsuspected gallbladder carcinoma discovered after cholecystectomy.Methods A retrospective clincopathological analysis was conducted for 45 cases of unsuspected gallbladder carcinoma receiving second operation at our hospital from January 2000 to December 2010.Result Of the 45 cases with unsuspected gallbladder carcinoma (33 pT2,12 pT3 ),40 cases received second radical reeection of the liver bed with lymph dissection; the remaining 5 cases received palliative operation.Amongst 45 patients lymph metastasis (4 pT2,6 pT3 ) was found in 10 cases,liver metastasis ( 2 pT2,1 pT3 ) in 3,parietal seeding in 1 ( pT3 ) and distant metastasis ( pT2 ) in one.The 5 patients receiving palliative operation died in 3 ～ 8 months and 40 patients receiving the radical operation achieved long-term survival ( 40.4 ± 2.7 months) after the operation.The effect of second operation which was done within 4 weeks after the first cholecystectomy was better than that of the operation done beyond 4 weeks ( survival time 37.1 ± 2.2 vs 22.4 ± 5.8months).Conclusions Radical resection for unsuspected gallbladder carcinoma discovered after the initial cholecystectomy helps improve prognosis and prolong patients survival time.
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Objective To investigate the predictive factors and prognosis of early intrahepatic recurrence after curative resection of hepatocellular carcinoma(HCC).Methods Clinicopathological dats of 184 HCC patients with intrahepatic recurrence after curative resection were collected.Thirteen clinicopathological factors and prognosis after recurrence were retrospectively analyzed. Results Univariate analysis showed that preoperative scrota alpha-fetoprotein(AFP)>100 ng/ml,tumour size>5 cm,venous invasion and intra-operative blood transfusion were predictive factors of early intrahepatic recurrence,and selum albumin<35 g/L was marginally predictive factor.Multivariate analysis showed that serum AFP>100 ng/ml,tumour size>5 cm and venous invasion were independent predictive factots of early intrahepatic recurrence.The survival of patients suffering from early recurrence was significantly shorter than those with late recurrence.with median survival period of 12 mos vs 18 mos(P=0.012).Conclusion Serum AFP,tumour size and venous invasion were independent predictive factors of early intrahepatic recurrence in HCC patients after radical resection of the primary tumor.Early intrahepatic recurrence implies poor prognosis.
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ObjectiveTo summarize the experience of managing portal hypertension( PHT) complicated with hyperthyroidism. Methods5 patients with hyperthyroidism complicated PHT were performed with splenectomy plus pericardial devascularization after preoperative management, and the experience of pre- and postoperative management was summarized. Results1 patient occurred postoperative thyroid crisis and was cured with tranquilizing, prenisone and sodium iodide;the other 4 went through perioperation safely. The preoperative WBC,RBC,Hb and Pt were(2.018±0.536)×109/L,(2.97±0.42)×1012/L,(87±15.6)g/L and (38.4±13.24)×109/L, respectively, which rose to (6.54±0.398)×109/L, (3.636±0.387)×1012/L, (108.6±9.633)g/L and (240.4±84.54)×109 /L, respectively after operation. WBC and platelets of all patients reached normal level postoperatively. ConclusionProper perioperative management ensures that patients with hyperthyroidism complicated PHT survive the splenectomy plus pericardial devascularization, which renders opportunity for treating hyperthyroidism with medicine or surgery.
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AIM: To investigate the levels of mRNA, protein of glucosylceramide synthase (GCS) and caspase 3 in the drug resistance induced by doxorubicin in human gallbladder carcinoma cell line GBC-SD, the effect of ceramide metabolism in this process was examined. METHODS: Human gallbladder carcinoma cell line GBC-SD was treated by doxorubicin at concentration of 200 ?g/L for 12 weeks (named GBC-SD12). Cytotoxicity, mRNA and protein of GCS were measured on 1st week, 4th week and 12th week by MTT assays, RT-PCR or Western blotting. The levels of caspase 3 were measured by spectrofluorometry. RESULTS: A 3.8-fold increase in drug resistance to doxorubicin in GBC-SD12 was observed. Up-regulation of GCS mRNA and protein were also detected in GBC-SD12 (P