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Objective:To study the effect of early nursing intervention to prevent lymphedema of upper limb after breast cancer surgery and its effect on postoperative quality of life.Methods:Between July 2018 and March 2020, one hundred and seventeen cases of breast cancer, all female, admitted to department of thyroid and breast surgery, the affiliated Zhongshan hospital of Dalian University, were underwent modified radical mastectomy with axillary lymph node dissection. Fifty-eight cases were included in the control group whereas fifty-nine cases were in the intervention group. The control group received conventional nursing, the intervention group added early care intervention measures on the basis of conventional nursing. Follow-ups were carried out monthly in a period of 9 months post-surgery. The incidence and grade of lymphedema were compared between the two groups.Results:The incidences of lymphedema at 1,3,9 months after surgery were 8.5% (5/59), 8.5% (5/59), 10.2% (6/59) in the intervention group, which were lower than 31.0% (18/58), 36.2% (21/58), 43.1% (25/58) in the control group. Statistics showed significant difference between the two groups ( χ2 value was 9.425, 13.041, 16.289, P<0.05). The incidence of mild, moderate, and severe lymphedema were statistically different between the two groups ( χ2 value was 10.350, 12.078, 17.422, P<0.05). Follow-up for the quality of life was assessed using a 5-dimension evaluation method, including physical status, social/family status, emotional status, functional status and additional attention. One month follow-up showed 20.36±1.80, 20.03±1.68, 34.63±3.52, 15.86±1.96, 19.81±1.04 in the intervention group, all higher than the control group 17.03±1.36, 17.10±1.46, 19.38±1.51, 10.91±1.22, 18.36±1.21. Three-month follow-up showed 23.56±2.72, 23.73±2.20, 39.93±4.17, 20.31±3.04, 26.37±2.23 in the intervention group, higher than those of the control group 20.90±2.14, 19.12±2.63, 25.79±3.59, 13.97±2.67, 21.02±2.50. Nine month follow-up showed 27.44±2.01, 25.80±1.85, 40.88±3.72, 21.02±2.78, 27.02±2.45 in the intervention group, which were high than the control group 19.93±1.66, 20.67±1.46, 19.38±2.29, 16.33±2.65, 22.29±2.52. The difference between the two groups were statistically significant ( t value was 8.691-34.383, P<0.05). Conclusions:Early nursing intervention could prevent lymphedema of upper limb after breast cancer surgery, delay the progress of lymphedema, reduce the incidence and grade of lymphedema, and promote the rehabilitation of patients' affected limbs, improve quality of Life of patients, which is worthy of clinical application.
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Objective To explore the differential value of clinical features and MRI in differentiating idiopathic granulomatous mastitis(IGM) and non-mass enhancement of breast cancer.Methods The clinical features and MRI findings of 45 cases of IGM and 57 cases of non-mass enhancement of breast cancer were analyzed retrospectively in the study.All patients were examined by routine MR scan and additional DCE and DWI scan.The difference of clinical and MRI features in 2 groups was analyzed by χ2 test.One-way ANOVA was employed to compare the ADC values between different sites of IGM and breast cancer.Results There was statistical significance between IGM and breast cancer in age at onset, enhancement pat-tern, mastalgia, nipple retraction, and thicken skin (P<0.01).The abscess area of IGM showed ob-viously hyperintensity on DWI, the non-abscess area showed hyperintensity.The lesion of the non-mass enhancement of breast cancer showed hyperintensity.There was statistical significance of ADC value between the lesion of the non-mass enhancement of breast cancer and the non-abscess area of IGM(P<0.01).Conclusion Clinical and MRI features have a certain value in the identification of IGM and non-mass enhancement of breast cancer.
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Objective To observe the change of MR perfusion value in patients with hepatocellular carcinoma (HCC) before and after transcatheter arterial chemoembolization (TACE). Methods A total of 22 patients with HCC underwent MR perfusion weighted imaging (MR PWI) before TACE and 3-10 days after TACE. The mean time to enhance (MTE), negative enhancement integral (NEI), time to peak (TTP) and maximum slope of decrease (MSD) before and after TACE were acquired and compared. Results The time intension curve (TIC) of HCC region was observed to descend rapidly before TACE, while descended slowly after TACE. The value of MTE and TTP after TACE were lower than those before TACE (P0.05). Conclusion MR PWI is a very sensitive imaging technique that be used to monitor blood flow changes of HCC before and after TACE and evaluate efficacy of TACE.
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Objective To investigate the value of MR perfusion imaging in early detection of findings following arterial chemoembolization of hepatocellular carcinoma Methods Twenty eight consecutive patients with pathologically-confirmed HCC were evaluated. All patients underwent MR perfusion imaging at pre-TACE and 3 to 10 days after TACE. The negative enhancement integral (NEI) ,the time to peak(TTP) ,the maximum slope of decrease (MSD) , the signal enhance ratio (SER) were acquired from MRI software FuncTool 2. 5.36a Version. Statistical analysis using SPSS 14, least significant difference test (t test) were utilized. Results The time intensive curve of tumor was observed to descend rapidly to reach the peak at pre-TACE studies, whereas it descended slowly to reach the peak on post TACE studies. The Value of TTP and SER prior to TACE were(51.2 ± 10. 3) s, 60. 6 ± 36. 3 respectively, and post TACE (43.7 ± 12. 0)s, 41.2 ±27. 5 respectively. The values of TTP and SER post TACE were lower than those prior to TACE (P ＜ 0. 05). The value of NEI prior to TACE was 108.7 ± 58.9, and after TACE 149. 6 ±80. 1 and there was statistically significant difference (P ＜0. 05). The Value of MSD post TACE were lower than those prior to TACE, but there was no statistical significance (P ＞ 0. 05). Conclusion PWI is a very sensitive imaging technique that can be used to monitor early dynamic changes of HCC following TACE.
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The articles concerning intensive effect and progress of interventional therapy for hepatocellular carcinoma (HCC) recurrence were comprehensively reviewed. Along with unceasing abundance of all interventional methods (including transcatheter arterial chemoemblization (TACE),percutaneous dehydrated ethanol injection,radio frequency ablation,percutaneous microwave therapy,argon-helium cryoablation,high-intensity focused ultrasound and radionuclide interventional therapy,etc),combined interven-tional therapies mainly TACE were increasingly appreciated in postoperative HCC recurrence,but still have to be further standardized. With further emerging and maturing of new technologies,such as antiangiogenesis,gene therapy and targeted therapy on HCC metastatic and recurrence specific cycle; the effect of combined therapy will be further promoted. Interventional therapy will play an important role in the prevention and treatment of postoperative HCC recurrence in the foreseen furture.
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The interventional therapy of chemoembolization is the first management of choice in treating unresectable hepatic carcinomas but with some side effects including liver function damage and bone marrow restraints which may affect the patients'life expectancy and living quality in the long run.The advancement of the combination of interventional treatment with Chinese drugs in managing liver carcinomas is a special presentation by the auther for further recommondation.
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Objective To evaluate the imaging findings and its pathologic basis of intrahepatic peripheral cholangiocarcinoma(IHPCC).Methods 25 patients with pathologically proven IHPCC were reviewed retrospectively.B-ultrasonic scanning (BUS) was performed in allpatients.CT(including conventional unenhanced and enhanced scan) was done in 21 patients.11 patients received MRI with dynamicscannings.9 patients underwent digital subtraction angiography(DSA).Results 15 patients were hypoecho and 10 patients were brieflyhyperecho or hyperecho in BUS, homogeneous or heterogeneous. On unenhanced CT, the lesions were of low density with ill-definedborder. The lesions were low intensity on T1WI and moderately high intensity with low intensity in central area on T2WI . Dynamic CT and MRI showed gradually enhancement from the periphery toward the center of the lesion in most patients. Focal dilatation and calculus of the intrahepatic bile ducts around the tumor could be seen and retraction of liver capsule could also be seen in imaging appearance of IHPCC. On selective DSA ,the lesions were resemble to the tumors with rare blood vessels ,on superselective DSA, tumor vascular plexus were tiny and like “flocculus” in arterial period, obvious staining with ill-defined during parenchymal phase in 9 patients. Pathologically,tumor vessels were rare, these were plenty of interstitial fibrous tissue between tumor cells. Conclusion The imaging features of intrahepatic peripheral cholangiocarcinoma are of certain characteristic.