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There are few studies about the treatment of metastatic castration-resistant prostate cancer (mCRPC) with darolutamide. This paper reports a case that an 83-year-old patient complained of dysuria. His initial diagnosis was metastatic hormone sensitive prostate cancer(mHSPC). Androgen deprivation therapy (ADT) plus bicalutamide was performed. Re-examination of bone scan after half a year revealed that there were more than two new bone metastases, which was considered entering mCRPC. Due to the patient’s advanced age, post medical history of epilepsy, type 2 diabetes and cardiac radiofrequency ablation, long-term use of phenobarbital and repaglinide, the therapy was changed to ADT plus darolutamide to avoid drug contraindications. Re-examination of bone scan after 10 months revealed decreased metabolism in some metastases, and tPSA declined continuously.
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Objective:To observe the effects of self-made Qingyuan Shenghua decoction on coagulation dysfunction in patients with sepsis, and to explore its possible mechanism.Methods:Eighty patients with sepsis and coagulation dysfunction admitted to the department of critical care medicine of Chengdu First People's Hospital from March 2018 to April 2020 were enrolled. The patients were divided into control group and observation group according to random number table method, with 40 cases in each group. Patients in both groups received basic treatment for sepsis. On this basis, the observation group was administrated with self-made Qingyuan Shenghua decoction, one dose a day, 100 mL in the morning and 100 mL in the evening; the control group was given the same amount of normal saline. Both groups were treated for 7 days. Prothrombin time (PT), activated partial thromboplastin time (APTT), international normalized ratio (INR), fibrinogen (Fib), D-dimer, platelet count (PLT), white blood cell count (WBC), C-reactive protein (CRP), and procalcitonin (PCT) were measured before and after treatment, and acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) and sequential organ failure assessment (SOFA) were calculated. The length of intensive care unit (ICU) stay, the incidence of multiple organ dysfunction syndrome (MODS) and 28-day mortality was recorded.Results:The indexes of coagulation function and inflammation in the two groups were significantly improved after treatment, the improvement of various indexes in the observation group were better than those in the control group [PT (s): 16.01±1.08 vs. 19.21±1.38, APTT (s): 55.33±15.29 vs. 79.41±12.69, INR: 1.30±0.21 vs. 1.65±0.22, Fib (g/L): 2.87±0.89 vs. 5.44±1.13, D-dimer (mg/L): 2.56±1.67 vs. 6.41±2.42, PLT (×10 9/L): 125.79±18.51 vs. 95.46±18.50, WBC (×10 9/L): 7.50±0.78 vs. 12.75±4.09, CRP (mg/L): 21.27±9.32 vs. 65.44±13.40, PCT (μg/L): 1.15±0.58 vs. 6.31±1.29], and the differences were statistically significant (all P < 0.05). After treatment, APACHEⅡ and SOFA scores in the two groups decreased significantly compared with those before treatment, and the decrease in the observation group were more obvious than those in the control group (APACHEⅡ score: 10.29±1.86 vs. 15.35±2.06, SOFA score: 5.51±1.08 vs. 7.65±1.58, both P < 0.05). The length of ICU stay was shortened in the observation group than that in the control group (days: 12.22±9.48 vs. 20.22±15.35, P < 0.05). The incidence of MODS [35.0% (14/40) vs. 47.5% (19/40)] and the 28-day mortality [45.0% (18/40) vs. 47.5% (19/40)] was lower than that of the control group, but there was no statistical difference (both P > 0.05). Conclusion:Self-made Qingyuan Shenghua decoction can effectively improve the prognosis of patients with coagulation dysfunction and sepsis, and its mechanism may be related to inhibition of inflammatory reaction and improvement of coagulation function.
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Objective:To compare the outcomes of low-dose-rate prostate brachytherapy (BT) and radical prostatectomy (RP) in patients with T 1c-T 3a prostate cancer. Methods:A group of 745 patients with T 1c-T 3a prostate cancer between January 2010 and August 2017 at Peking Union Medical College Hospital were identified. The records of these patients, who were followed up for a minimum of 2 years, were reviewed. 384 cases received BT. Their characters included age(72.1±6.6), tPSA (12.4±6.1) ng/ml, prostate volume (33.6±13.8) ml, Gleason grade group (2.0±1.2). In this group, T 1c-T 2a stage was diagnosed in 189 cases, T 2b-T 2c stage in 182 cases and T 3a stage in 13 cases.361 cases received RP. Their characters included age(65.7±6.2), tPSA(12.6±6.4) ng/ml, prostate volume (37.2±17.8) ml, Gleason grade group (1.9±1.2). In this group, T 1c-T 2a stage was diagnosed in 177 cases, T 2b-T 2c stage in 170 cases and T 3a stage in 14 cases.The log-rank test compared survival rates between the two modalities, and Cox regression identified factors associated with bRFS. Results:Median follow-up was 60 months. Kaplan-Meier analysis did not show any statistically significant differences in terms of cRFS( P=0.321), cancer specific survival (CSS, P=0.643) and overall survival (OS, P=0.565) rate between the two groups. BT was associated with improved bRFS compared to RP( P=0.018). Risk of biochemical recurrence was significantly lower with BT compared with RP in the patients with a biopsy Gleason grade group 2 and 3 ( P=0.008), or prostate volume ≤35 ml ( P=0.027), or tPSA ≤10 ng/ml ( P=0.013), or the clinical T stages of T 2b and T 2C( P=0.031), or in the intermediate-risk group according to NCCN risk classification ( P=0.003). On multivariate analysis of all 745 patients, age≤ 70 and T stage≥T 2b was associated with significantly shorter bRFS. Conclusions:BT produced equivalent cRFS, CSS and OS compared to RP, while it was associated with improved bRFS. BT On multivariate analysis of all 745 patients, age≤ 70 and T stage≥T 2b was associated with significantly lower bRFS.
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Objective To evaluate the diagnostic value of template-guided transperineal prostate biopsy (TTPB) by comparing biopsy-derived pathological results with findings from radical prostatectomy (RP) specimens.Methods From April 2013 to December 2015,patients who were diagnosed prostate cancer by transperineal template-guided 11-region prostate biopsy were enrolled in our study,and underwent laparoscopic RP.All whole-mount slices were reconstructed via a three-dimensional prostate model.Pathological features of the biopsy and RP specimens were compared.Detection rate of index lesions,overall sensitivity and specificity of TTPB,Gleason scores (GSs) in comparisons of biopsy and RP specimens were analyzed.Results One hundred and three patients were enrolled in our study,and the mean age was (65 ± 6)years.The median serum PSA was 11.7 ng/ml(IQR 7.2-19.1 ng/ml).The Gleason score ranged from 6 to 9.The clinical stage was T1c-T3a and the median prostate volume was 33.0 ml(IQR 26.0-43.0 ml).Eighty-nine of the 103 index lesions (86.4％) were detected by biopsy.The median volume was 1.2 ml (IQR 0.5-3.3 ml) and the mean maximum tumor length was (0.6 ± 0.4)cm.The overall sensitivity and specificity of the transperineal prostate biopsies were 53.3％ and 94.2％,respectively.RP-derived GSs were unchanged,upgraded and downgraded relative to the corresponding biopsy-derived GSs in 75 (72.8％),24 (23.3％) and 4 (3.9％) patients,respectively.Conclusions Stematic transperineal template-guided prostate biopsy could detect most of the index lesions.This biopsy approach was less able to determine tumour focal positioning and could only serve as a reference for guiding focal therapy.
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Objective To detect the efficacy of trimodality treatment combining transurethral resection of bladder tumor (TURBT), chemotherapy and radiotherapy for locally muscle-invasive bladder cancer.Methods From November 2007 to June 2013, 107 local muscle-invasive bladder cancer cases were treated by TURBT.Thirty-six cases ( group A) underwent the bladder-sparing trimodality treatment, aged from 42 to 88 years.Seventy -one cases (group B) underwent radical cystectomy,aged from 38 to 77 years.In group A, there were 19 cases of T2 , 13 cases of T3 , and 4 cases of T4a.Among those patients, 11 patients underwent gemcitabine/cisplatin ( GC ) systemic chemotherapy regimen, 15 patients underwent gemcitabine/cisplatin ( GC ) intrailliac artery chemotherapy regimen, and 10 patients underwent taxane/carboplatin ( TC) systemic chemotherapy regimen.In group B, there were 38 cases of T2 , 27 cases of T3 , 6 cases of T4a.The progress-free survival after 2 years was compared with the only radical cystectomy, and the efficacy among the three chemotherapy regimens was also evaluated.Results There is no statistical difference in age and tumor stage between the two groups.In group A, patients were followed up from 3 to 79 months, and 2 years′progress-free survival was 78.9%(15 cases) in T2 , 46.2%(6 cases) in T3 , and 0 in T4a.In group A, organ-sparing 2 years′progress-free survival was 58.3%, and 6 metastasis (16.7%) and 11 local relapse ( 30.6%) were detected during the follow-up period.In group B, patients were followed up from 2 to 65 months, and 2 years′progress-free survival was 76.3%in T2(29 cases), 55.6%(15 cases) in T3, and 16.7% (1 case) in T4a.Of all the patients in group B, 2 years′progress-free survival was 63.4%, and 22 metastasis ( 31.0%) and 16 local relapse ( 22.5%) were found during the follow-up period.There′s no statistical difference on 2 years′progress-free survival between the two groups, and the efficacy among the three chemotherapy regimens.Conclusions Two years′progress-free survival of bladder-preserving trimodality treatment was similar to that of radical cystectomy for local muscle-invasive bladder cancer.In term of treatment efficacy, stage T2 was much better than T3 and T4a .Each kind of chemotherapy regimen in trimodality treatment was equally effective.
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Objective To retrospectively analyze the clinical data of 3 middle-aged and elderly cases with inflammatory myofibroblastic tumor (IMT) of the kidney,in order to improve its diagnosis and treatment.Methods The records of 3 patients who were diagnosed as IMT of the kidney by pathology in our hospital from Jan 2005 to Jun 2014 were reviewed to identify the characteristics including age,gender,clinical manifestation,tumor imaging and pathological features,treatment and prognosis.Results The mean age of the patients was 60 years.One patient underwent partial nephrectorny,1 patient underwent radical nephrectomy,and another patient received nephroureterectomy with bladder cuff excision.Patients were followed up for 8 months to 10 years,and no tumor recurrence was found.Conclusions IMT of the kidney is the tumor of low malignant potential with a good prognosis.Surgery is the first choice for the diagnosis and treatment.
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<p><b>OBJECTIVE</b>To evaluate the outcomes of permanent brachytherapy combined with maximal androgen blockade (MAB) in local intermediated-risk prostate cancer.</p><p><b>METHODS</b>From December 2003 to December 2009, 307 patients of local prostate cancer were treated with brachytherapy, 98 cases of intermediated-risk were followed-up for 5 years and data were recorded, aged from 58 to 84 years, average 74 years. Serum PSA was 0.4-19.0 µg/L, average 11.2 µg/L, clinical TNM stage was T1cN0M0-T2bN0M0. Gleason score 4-7, 6.7 in average. Prostate volume ranged from 14 to 65 ml, average 32.1 ml. All the 98 patients underwent permanent brachytherapy combined with MAB. Biochemical recurrence rate, biochemical-free survival, tumor-specific survival, overall survival, salvage therapy and complications were analyzed.</p><p><b>RESULTS</b>Followed up for 5 years, 19 cases had biochemical recurrence, median recurrence period: 36 months. One patient died of prostate cancer 45 months after brachytherapy of all 7 patients died in 5 years. Five-years biochemical-free recurrence rate: 80.6%, overall survival: 92.9%, tumor-specific survival: 98.9%, biochemical-free survival: 79.3%. Low-urinary tract and rectal irritation symptoms occurred in 75 cases(76.5%). Urinary retention occurred in 7 cases (7.1%) with catheterization duration less than 1 week, no surgical operation were performed. Seeds immigration to lung in 2 cases. No serious complications occurred.</p><p><b>CONCLUSION</b>In local intermediated-risk prostate cancer patients, permanent brachytherapy combined with short-term MAB can be an effective treatment with few complications.</p>
Subject(s)
Aged , Aged, 80 and over , Humans , Male , Middle Aged , Androgen Antagonists , Therapeutic Uses , Brachytherapy , Combined Modality Therapy , Neoplasm Recurrence, Local , Prostate-Specific Antigen , Blood , Prostatic Neoplasms , Drug Therapy , Radiotherapy , Treatment OutcomeABSTRACT
<p><b>OBJECTIVE</b>To assess the clinical features of transperineal prostate biopsy in patients age ≤50 years.</p><p><b>METHODS</b>The clinical data of 124 patients ≤ 50 years old were retrieved retrospectively in Peking Union Medical College Hospital between January 2005 and September 2014. The age of patients were 14 to 50 years (mean age 43.6 years), and their prostatic specific antigen(PSA) levels were fluctuated in a range of 0.01 to 579.00 µg/L (mean 15.5 µg/L). Twenty patients were abnormal in digital rectal examination (DRE). All the patients were underwent transperineal prostate biopsy using an 11-region template.</p><p><b>RESULTS</b>Prostate cancer was detected in 14 of 124 patients (11.3%). The prostate cancer detection rates in groups with PSA 0-4.0, >4.0-10.0, >10.0-20.0, >20.0-50.0, and >50.0 µg/L were 0, 6.2% (4/65), 13.3% (4/30), 1/5, and 5/5, respectively. Non-adenocarcinoma prostate malignancy (NAPM) was detected in 7 of 124 patients (5.6%), and their PSA levels were fluctuated in a range of 0 to 4.0 µg/L. Four patients were abnormal in DRE and 5 patients were abnormal in radiological examination.</p><p><b>CONCLUSION</b>The positive rate of transperineal prostate biopsy in patients age≤50 years is low, and rigorous screening before prostate biopsy is necessary. The men with DRE or radiological abnormalities but normal PSA should be wary of NAPM.</p>
Subject(s)
Adolescent , Adult , Humans , Male , Middle Aged , Young Adult , Beijing , Biopsy , Methods , Early Detection of Cancer , Prostate-Specific Antigen , Blood , Prostatic Neoplasms , DiagnosisABSTRACT
<p><b>OBJECTIVE</b>To evaluate the outcomes of T3a prostate cancer treated by permanent interstitial brachytherapy combined with external radiotherapy and hormone therapy, and analyse the influence of preoperative factors on prognosis.</p><p><b>METHODS</b>From January 2003 to December 2008, 38 pactients with T3a prostate cancer aged from 48 to 81 years (mean: 71 years) were enrolled, with serum prostate specific antigen (PSA) levels ranged from 10.000 to 99.800 µg/L (mean: 56.300 µg/L), Gleason score from 5 to 9 (mean: 7.6) and percentage of positive biopsy cores from 10.0% to 100% (mean: 65.3%). All patients were treated by permanent interstitial brachytherapy combined with external radiotherapy and hormone therapy. Survival curves were calculated using the Kaplan-Meier method. The predictive factors including patient's age, prostate volume, serum pre-treatment PSA, Gleason score and percentage of positive biopsy cores were used for univariate analysis on biochemical failure-free, distant metastasis-free and overall survival.</p><p><b>RESULTS</b>The mean follow-up was 69 months (range: 9-109 months).Nineteen patients experienced biochemical failure. The average biochemical failure time was 13.4 months (range: 1-40 months). There were 13 patients developed as distant metastatic prostate cancer since average 19.7 months (range: 1-70 months) after brachytherapy. Of all patients, 9 died of prostate cancer recurrence, while 6 passed away because of other reasons, with an average of 52.2 months (range: 9.0- 98.5 months). The 5-year biochemical failure-free survival (BFFS), distant metastasis free survival (DMFS), cancer specific survival (CSS) and overall survival (OS) rate were 44.1%, 68.6%, 82.4 and 75.8%, respectively. Twenty-nine patients experienced grade 1-2 gastrointestinal toxicity and 18 patients experienced grade 1-2 genitourinary toxicity. In univariate analysis, the percentage of positive biopsy cores was significantly correlated with BFFS (χ(2) = 17.240, P = 0.000), DMFS (χ(2) = 18.641, P = 0.000) and OS (χ(2) = 8.970, P = 0.003); the Gleason score was significantly correlated with DMFS (χ(2) = 12.484, P = 0.000) and OS (χ(2) = 6.575, P = 0.010); and patient's age was significantly correlated with OS (χ(2) = 5.179, P = 0.023).</p><p><b>CONCLUSIONS</b>Permanent interstitial brachytherapy combined with external radiotherapy and hormone therapy is alternative for T3a prostate cancer. The percentage of positive biopsy cores is correlated with BFFS, DMFS and OS.</p>
Subject(s)
Aged , Aged, 80 and over , Humans , Male , Middle Aged , Brachytherapy , Methods , Combined Modality Therapy , Hormones , Therapeutic Uses , Neoplasm Recurrence, Local , Prognosis , Prostate-Specific Antigen , Blood , Prostatic Neoplasms , Drug Therapy , Mortality , Radiotherapy , Radiotherapy , Methods , Survival Rate , Treatment OutcomeABSTRACT
Objective To estimate the diagnostic significance and indication of repeated prostate biopsy in patients with persistently abnormal serum PSA.Methods From Jan 2004 to Sep 2011,90 patients with persistently abnormal serum PSA levels underwent transperineal ultrasound guided template prostate biopsy.They were diagnosed as benign lesions (BPH 66/90,PIN 10/90,ASAP 14/90)by previous first biopsies.The ages were 43 to 86 years old (mean age 71),and their PSA levels were fluctuated in a range of 3.1 to 168.0 μg/L (mean 17.6 μg/L),26 patients were abnormal in digital rectal examination (DRE).Results According to the repeated biopsies,it was divided into three groups including benign group (57/90),PIN or ASAP group (5/90) and PCa group (28/90).21.2％ patients were confirmed as PCa (14/66) in BPH group,while 60％ (6/10) patients in PIN group and 57.1％ (8/14) patients in ASAP group were confirmed as PCa.There were significant differences in BPH group compared with PIN or ASAP group (P＜0.05).The mean prostate volume (PV) was (65.9±22.6) ml in benign group and (50.4±20.8) mlin PCa group,while abnormal DRE were foundin 7/41 in benign group and 5/9 in PCa group.There was significant differences in PV and DRE between the two groups (P＜0.05).There were no significant differences in age,PSA,PSAD,PV or DRE between PIN and ASAP group (P＞0.05).Conclusions Repeated biopsy can improve the diagnosis of PCa in patients with persistently abnormal serum PSA.Smaller PV or abnormal DRE in the patients who were diagnosed as BPH by previous first biopsies may strongly need repeated biopsies,while in the patients who were diagnosed as PIN/ASAP by previous first biopsies,repeated biopsies were required despite any age,PSA,PSAD,PV or DRE.
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Objective To analyze the risk factors for perioperative mortality in children after total correction of tetralogy of Fallot (TOF),in order to provide better operation and decrease the mortality rate.Methods We enrolled 191 TOF patients including 142 males and 49 females at Chengdu Cardiovascular Hospital between Jan 2003 and Dec 2010.The age ranged from 4 months to 12 years.Preoperative,perioperative and postoperative clinical data of all patients were corrected and the risk factors for mortality after total correction of TOF were analyzed.Results Among all the 191 cases,6 cases death (3.14％) occurred in early postoperative,the main causes of death were postoperative infection with multiple organ failure (3 cases),low cardiac output syndrome (2 cases),cerebral complications (1 cases).Among them,2 children (6.67％,2/30) died in age≤6 months,1 child (1.41％,1/71)died in age ranged from 6 months to 3 years,3 children (3.33％,3/90) died in age ranged from 3 years to 12 years.The results of logistic regression and model selection indicated that age ≤ 6 months (OR =4.606,95 ％ CI 1.811 ～ 11.719,P ＜ 0.05),percutaneous oxygen saturation ＜ 70％ before operation (OR =0.982,95％ CI 0.501 ～ 1.932,P ＜ 0.01),Nakata index ＜140 mm2/m2(OR =16.960,95％ CI 1.414 ～ 150.390,P ＜ 0.01),cardiopulmonary bypass time ＞ 150 min (OR =4.398,95 ％ CI 2.091 ～ 9.216,P ＜ 0.01) and multiple organ failure (OR =4.872,95 ％ CI 2.583 ～9.192,P ＜0.05)were risk factors for early postoperative death after total correction of TOF.Conclusion Postoperative mortality in children after total correction of TOF can be predicted by risk factors of age,percutaneous oxygen saturation,Nakata index,cardiopulmonary bypass time,and multiple organ failure.
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Objective To analyze the risk factors associated with multiple organ dysfunction syndrome (MODS) in children after cardiopulmonary bypass (CPB).Methods Between Jan 2001 and Dec 2010,1 899 patients undergoing open heart surgery were reviewed retrospectively according to the presence or absence of MODS.Univariate and multivariate logistic regression analysis were used to identify the risk factors.Results Thirty-five patients (1.84％) developed MODS,the mortality for MODS was 51.43％ (18/35).Univariate risk factors included complex congenital heart disease,perioperative unexpected events,CPB time,aortic cross-clamping time,mechanical ventilation time,and postoperative spsis.Multivariate logistic regression analysis identified that complex congenital heart disease,perioperative unexpected events,CPB time ＞ 180 min,postoperative spsis were risk factors.Conclusion The results suggest that the patients with MODS risk factors described above need more careful peri and post operative surveillance and preventive management.
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Objective To report outcomes of patients with PSA ≥ 30 μg/L with initial negative transperineal template-guided saturation biopsy (TTSB). Methods From 2003 to 2010,a total of 1824 patients underwent transperineal saturation biopsies with the prostate template at the Peking Union Medical College Hospital.44 of them had initial negative biopsy with PSA ≥ 30 μg/L were reviewed in this study.The mean age was 68 years old (range,51 to 80).The mean biopsy cores were 28.7 (range,11 to 44).The median PSA level was 40 μg/L (range,30 to 128),and the median prostate volume was 73 ml (range,30 to 190).They were divided into four groups:TURP group,chronic prostatitis group,repeat biopsy group and miscellaneous group. Results Patients were followed up for a mean of 49 months (range,12 to 91).All patients of TURP group (15 cases) were identified as prostatic hyperplasia by postoperative pathology.2 of them had a second TTSB for PSA ＞ 10 μg/L after TURP,which were negative.5 patients of chronic prostatitis group had a declining PSA level after antibiotic therapy for 3 to 4 weeks.One patient took a second biopsy,which was identified as prostatitis.All patients of repeat biopsy group (18 cases) showed no significant decrease in PSA level during follow-up and undertook biopsies 2 to 4 times,6 of which were proved to be prostate cancer.All patients of the miscellaneous group (6 cases) had a declining PSA and didn't take a second biopsy. Conclusions Close follow-up and regular PSA testing for patients who had a high PSA level with initial negative biopsy would be help to avoid both false negative of prostate cancer and unnecessary biopsy.
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Objective To investigate the influence of intensive insulin therapy on the short-term prognosis in children after cardiac surgery.Methods A total of 320 children including 192 males and 128 females who underwent cardiac surgery were enrolled in this study from Jan 2009 to Dec 2010 at the cardiac surgery department of Chengdu cardiovascular hospital.The age of these children ranged from 3 months to 12years old.According to insulin administration time and blood glucose control level,they were randomly divided into two groups.In group A,there were 165 patients who received continuous insulin infusion to maintain postoperative gloucose levels between 4.4 and 6.1 mmol/L,while 155 patients in group B received insulin infusion when their glucose levels were higher than 11.1 mmol/L to control the levels between 6.1 and 11.1 mmol/L.Then the postoperative complications and blood glucose controlling were compared and analyzed.Results A total of 320 children were enrolled,and 4 800 recorded data were analyzed.The mean blood glucose level was (5.58 ±0.54) mmol/L in group A and (7.73 ±0.85) mmol/L in group B (P ＜0.01 ),and both of them were controlled within the target range.The incidence of hypoglycemia ( ＜3.3 mmor/L) was 1.65％ (38/2310)in group A and 1.04％ (26/2490) in group B.The incidence of severe hypoglycemia ( ＜2.2 mmol/L) was 0.13 ％ ( 3/2 310 ) in group A and 0.08 ％ ( 2/2 490 ) in group B.The incidences of hypoglycemia and severe hypoglycemia were significantly increased in group A compared to group B ( P ＜0.01 ).The incidence of infection in group A was lower than that in group B [3.03％ (5/165) vs 9.68％ (15/155),P ＜0.05],but there was no significant difference between the two groups in the incidences of malignant arrhythmia,circulation failure or shock,multiple organ dysfunctive syndrome and mortality.Conclusion Intensive insulin therapy can't improve the short-term prognosis in children after cardiac surgery.
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Objective To improve the recognization of bilateral adrenal tumors from different tissues and to discuss the treatment.Methods One case of bilateral adrenal tumors from different tissues:pheochromocytoma in one side and adrenocortical adenoma in the other side was reported and the data of syptoms,physical features,auxillary examination,diagnosis and treatment were retrospectively reviewed.Results The patient was diagnosed as adrenocorticotropic hormone (ACTH) -independent Cushing's syndrome in other hospital and received laparoscopic adrenalectomy for right adrenal tumor.During the operation the blood pressure fluctuated seriously and was even more than 200 mm Hg.The pathological report showed the mass was pheochromocytoma.After the operation,the patient's clinical manifcstation was not changed.Half a year later the lab test showed blood ACTH was still less than 5 pg/ml,24 h urinary-free cortisol (UFC) was 571.32 μg,and 24 h urinary catecholamines (U CA) was:noradrenalin (NE) 22.80 μg,epinephrine (E) 2.55 μg,dopamine (DA) 92.92 μg.CT detected a mass in left adrenal gland.The patient received laparoscopic adrenalectomy for left adrenal tumor after being transferred to Peking Union Medical College Hospital.The tumor was proved as adrenocortical adenoma by postoperational pathology.One week after the operation,the 24 h UFC was 56.2 μg.Conclusions Bilateral adrenal tumors from different tissues are very rare in clinic.Adrenalectomy for tumors from both sides and remaining the normal adrenal glands are recommended.
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Objective To analyze the risk factors for ventilator-associated pneumonia(VAP)in children after cardiopulmonary bypass(CPB).Methods Between January 2003 and June 2010,116 consecu tive cases receiving postoperative ventilation for more than 48 hours were included in this study.The patients were assigned into a VAP group(n =57)and non-YAP group(n =59).Univariate and multivariate logistic regression analysis were used to identify the risk factors.Results The overall incidence of VAP was 4.18％(57/1 365).The mortality of VAP was 26.32％(15/57).Univariate risk factors included severe pulmonary hypertension,CPB time,aortic cross-clamping time,secondary CPB support,plasma albumin,low ratio of ar terial oxygen tension to inspired oxygen fraction(PaO2/FiO2),mechanical ventilation time,the volume of postoperative drainage per kilogram of body weight,re-intubations,tracheotomy,gastric tube retention,pre vention of stress ulcer.Multivariate logistic regression analysis showed that risk factors included CPB time≥150 min,mechanical veritilation time ≥4 d,the volume of postoperative drainage per kilogram of body weight ≥ 18 ml and tracheotomy.A total of 90 pathogens were obtained by sputum culture in 57 VAP patients.There were 54 cases(60.0％)gram negative bacilli,32 cases(35.6％)of gram positive bacilli and 4 cases (4.4％)of eumycetes.Conclusion These results suggest that the patients with risk factors described above need more careful and postoperative surveillance and management.
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Objective To evaluate the effects of inhaled nitric oxide (iNO) in management of postoperative pulmonary hypertension in the patients with congenital heart disease. Methods Thirty-two children with refractory pulmonary hypertension or pulmonary hypertensive crisis after open heart operations for congenital heart disease were treated with iNO. The changes of hemodynamics were observed. Results In iNO therapy group,the mean pulmonary artery pressure(mPAP) decreased from (38.0 ±3.2) mm Hg to (28.0 ±2.1) mm Hg,pulmonary vascular resistance (PVR) decreased from (62.2 ±6.7) kPa/(L·S) to (49.9 ±5.6) kPa/(L·S) ,PaO2/FiO2increased from (67.0 ±30. 1 ) mm Hg to (92. 6 ±25.0) mm Hg,and arterial oxygen saturation increased from 0. 78 ±0. 14 to 0. 84 ±0. 09 respectively. No toxic side effect was observed.Conclusion iNO is effective, safe to reduce pulmonary hypertension. It may play an important role in the treatment of postoperative pulmonary hypertension or pulmonary hypertensive crisis in the patients with congenital heart disease.
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Objective To evaluate the effects of inhaled nitric oxide(INO) in the early period after Fontan operation. Methods Twenty children receiving INO [(10 ～ 25) × 10 -6] after fight heart bypass for congenital heart disease were evaluated. The changes of hemodynamic and respiratory parameters were observed at two different intervals. The levels of methemoglobin (MetHb)and nitrogen dioxide(NO2)were monitored. Results In INO therapy group,CVP decreased from (20.8±4.8) mm Hg to (14.3±1.8) mm Hg,TPG decreased from (16.3 ±3.0) mm Hg to (8.8±2. 1) mm Hg,PaO2/FiO2 increased from (70.3±16.9) mm Hg to (120.5 ±14.0) mm Hg,and arterial oxygen saturation increased from 0. 78 ±0. 14 to 0. 91 ±0. 09 ,blood lactic acid level decreased from (3.98 ± 0. 86) mmol/L to (1.29 ± 1.60) mmol/L. No toxic side effect was observed. Conclusion INO has no significant long-term effect on patients after Fontan operation, but it can improve respiratory function, and reduce the incidence of low cardiac output syndrome and high cava pressure caused by reactive elevation of pulmonary vascular resistance in the early postoperative period after Fontan operation.
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Objective To investigate the clinical feature and treatment of adenomyomatosis of the gallbladder(GBA).Methods Thirty-three cases of GBA admitted from 1992 to 2007 were reviewed retrospectively and their clinical characters were sununarized. Results These cases were divided into three types grossly:14 cages of diffuse type,10 cases of segmental type and 9 Cages of localized type.Cholelithiasis wag associated in 21 cases and 11 cases with cholecystitis.Main clinical presentations included pain in the upper abdomen,discomfort after meal,nausea and vomit.Preoperative correct diagnosis was achieved in only six cases.Twenty-eight patients underwent laparoscopic cholecystectomy and three did open cholecystectomy.Concomirant exploration of common bile duct with T tube drainage and resection of liver ansioma was performed in one each.Adenomyomatosis of the gallbladder was diagnosed by pathologic examination in all cases. Condusions Due to the high rate of combination with cholelithiasis and cholecystitis,GBA has no specific clinical manifestations.The preoperative diagnosis lies on radiological examinations.Cholecystectomy is an appropriate treatment as adenomyomatesis of the gallbladder has a malignant potential.