A Surgical Case of Sarcomas with BCOR Genetic Alternations Invading the Heart through the Pulmonary Veins / 日本心臓血管外科学会雑誌

Sarcomas with BCOR genetic alternations, formerly treated as Ewing-like sarcomas, are malignant tumors with a poor prognosis. They have been classified under the category of undifferentiated small round cell sarcomas of bone and soft tissue since 2020. There are only a few reports on surgical treatment for these sarcomas, as they are extremely rare, and no specific treatment has been established. Among them, there have been no reports on the treatment of patients with intracardiac invasion. We report herein the case of intracardiac invasion of a rare sarcomas with BCOR genetic alternations. The patient is a 14-year-old girl who presented to the hospital with a chief complaint of left upper arm pain. Computed tomography (CT) showed tumors in the left axilla and left thoracic cavity, and after biopsies of each, we diagnosed the patient with sarcomas with BCOR genetic alternations. Although chemotherapy was planned, echocardiography revealed a mobile tumor in the left atrium, we decided to perform surgical procedure before chemotherapy to reduce the risk of embolism and sudden death. The tumor invaded directly the left upper pulmonary vein and extended into the left atrium. Since right lung metastasis was suspected, we considered the en bloc tumor resection while preserving the left lung. However it was difficult because the tumor invaded into the vicinity of the lower lobe bronchus. Concerned about extracardiac seeding, we resected the tumor as much as possible intravascularly. Although there was residual tumor, chemotherapy was started immediately after surgery, and the tumor has shrunk in size. We are planning to remove the entire tumor after several courses of chemotherapy.

Clinical application of 3D visualization and mixed reality technique in surgical resection of renal tumor / 中华泌尿外科杂志

Objective:To investigate the clinical feasibility and effectiveness of 3D visualization and mixed reality technique in the partial nephrectomy of renal tumor, and to evaluate its role in the communication between doctors and patients.Methods:82 patients with renal tumors confirmed by imaging examination including 33 patients in our hospital and 49 patients admitted to the Beijing Cancer Hospital from June 2018 to December 2020, all of whom were single tumors without local or distant metastasis, and in line with the indications of endoscopic partial nephrectomy, but without other systemic serious diseases. These patients were randomly divided into observation group (n=41) and control group (n=41). Both groups were scanned with 64-slice spiral CT before operation, while the CT images in the observation group were generated by DICOM data, modeled by three-dimensional reconstruction software and uploaded to mixed reality glasses for the preoperative planning, doctor-patient communication and intraoperative guidance. In this study, 82 patients underwent laparoscopic partial nephrectomy. Questionnaires and scales were used to compare the awareness of disease and/or satisfaction with 3D visual images between the two groups. The intraoperative time of tumor detection, operative time, renal heat ischemia time and intraoperative blood loss in 2 groups were recorded to evaluate preoperative planning and intraoperative guidance. In addition, the recovery time of gastrointestinal function, indwelling time of urinary catheter, indwelling time of drainage tube in operation area, length of hospital stays after surgery and pathological type, as well as serum creatinine level and glomerular filtration rate (GFR) value in patients at 6 months after operation were used to evaluate the postoperative recovery.Results:Before surgery, the concentrations of serum creatinine in patients with the observation group and control group were (66.8±17.5) μmol/L and (70.5±13.7) μmol/L, and the GFR were (40.8±7.6) ml/min and (38.9±6.8) ml/min, respectively. All the 82 cases were operated successfully. The number of correct responses of patients in the observation group and control group about basic kidney physiology, kidney anatomy and surgical plan was (5 vs.4), (2 vs.1), (7 vs.4), the difference among which was statistically significant ( P<0.05). In the observation group, the points of patients in understanding their own kidney, disease, specific surgical plan, and risk of surgical complications were 9.5±1.61, 9.3±0.84, 9.7±0.53, and 8.5±2.21 respectively. The tumor detection time was (35.2±5.6) min, the operation time was (100.2±20.1) min, and the renal warm ischemia time was (22.7±8.6) min in the observation group, which was significantly shorter than that in the control group (43.2±6.7) min, (123.2±23.50) min, (33.2±7.8) min. However, there was no significant difference in the amount of bleeding (103.2±22.8 ml vs.112.5±19.5 ml), postoperative recovery time of gastrointestinal function (1.7±0.8 d vs.1.8±1.2 d), indwelling time of urinary catheter (3.9±1.6 d vs.4.2±1.0 d), indwelling time of drainage tube in operation area (4.6±1.3 d vs.4.9±1.7 d), length of hospital stays (6.9±1.5 d vs.7.2±1.3 d), pathological type, and the changes of serum creatinine (10.1±19.0 vs.9.6±11.3) and the amplitude of GRF (19.4±9.5 vs.18.5±10.7) fluctuation in the affected side 6 months after operation (19.4±9.5 vs.18.5±10.7) ( P>0.05). Conclusions:The application of 3D visualization and mixed reality technology in preoperative planning and intraoperative guidance of partial nephrectomy could improve patients' cognitive understanding of renal anatomy, tumor characteristics and surgical operation, and make doctor-patient communication smoother. It can reduce the risk of surgery to a certain extent, reduce the renal heat ischemia and the operation time, and remove the tumor more accurately.

Outcomes of surgical treatment of 29 patients with stages Ⅱ-Ⅲ bisphosphonate-related osteonecrosis of the jaw / 口腔疾病防治

Objective@# To examine the outcome of surgical treatment in patients with stages Ⅱ-Ⅲ bisphosphonate-related osteonecrosis of the jaw. @*Methods@#Twenty-nine patients with bisphosphonate-related osteonecrosis of the jaw were examined. The patients were followed up for more than 6 months, and the treatment outcome was reviewed. @*Results@# After curettage of local lesions, 19 out of the 21 patients were cured, and 2 were relieved of symptoms. Six patients underwent subtotal resection of the maxilla, and the symptoms disappeared completely after the surgery. Two patients underwent partial resection of the mandible and recovered.@*Conclusion@#Surgical debridement is an effective measure for the treatment of patients with bisphosphonate-related osteonecrosis of the jaw in stages Ⅱ-Ⅲ. In most cases, curettage of local lesions via the intraoral approach can completely remove sequestrum and inflammatory granulomatous tissue. Subtotal maxillary resection or partial mandible resection is performed when the bone death reaches the level of the maxillary sinus floor or continues to the mandible. By timely surgical intervention, the bone lesion is removed to maintain the sterile, active bone microenvironment locally.

Application of KeyPort access to transanal endoscopic mircrosurgery / 中华胃肠外科杂志

Objective@#To explore the effectiveness of KeyPort access in transanal endoscopic mircrosurgery (TEM).@*Methods@#A descriptive case series study was performed. Clinicopathological data of 20 patients undergoing KeyPort access TEM in Beijing Chaoyang Hospital of Capital Medical University from December 2016 to April 2018 were collected and analyzed retrospectively. Procedure of KeyPort access TEM: general anesthesia or combined spinal epidural anesthesia (CSEA); lithotomy or prone jack-knife position; anal dilation; placement of the KeyPortaccess; connection of TEM pneumoperitoneum device, light source and imaging equipment; placement of 5 mm dedicated endoscope; insufflation of CO2 with pressure of 1.6-2.0 kPa (12-15 mmHg); after rinsing the intestinal lumen, circular resection marginlabeled by the needle-shaped electrocautery;electric coagulation or ultrasonic knife used to perform a full-thickness resection with a 0.5 cm-1 cm margin along the marking line. Indications of KeyPort access TEM: (1) benign large sessile polyps which were difficult to resect under colonoscopy; (2) submucosal lesions with diameter <2 cm; (3) Tis and T1 stage rectal carcinoma without lymph node metastasis; (4) palliative resection of T2 stage rectal carcinoma without lymph node metastasis. Contraindications: (1) accompanying serious diseases without the tolerance of anesthesia and operation; (2) distance from lesion to anal verge >20 cm.@*Results@#There were 10 males and 10 females with age of (63±15) years old and BMI of (24.5±3.3) kg/m2. The diameter of the lesions was (2.0±1.3) cm, and the distance from lesion to anal verge was (6.2±2.2) cm. One patient had 3 lesions at different positions in rectum with diameters of 0.5 cm, 0.5 cm, and 1 cm, respectively. All operations were accomplished through the KeyPort access TEM and no case was transferred to other methods. The duration of surgery was 75 (30-220) minutes; intraoperative blood loss was 10 (0-30) ml. Two patients with rectal anterior wall lesions underwent full-thickness resection of the intestine wall reaching the peritoneal reflex with penetration into the peritonealcavity, and received suture closure immediately. For the patient with 3 rectal lesions, the 1.0 cm lesion received a full-thickness resection and the other 2 lesions received submucosal resection. No postoperative complication occurred. Postoperative pathology showed that there were 1 case of chronic inflammatory lesion, 4 cases of benign tumor, 3 cases of carcinoma in situ, 4 cases of neuroendocrine tumor, 6 cases of pT1 rectal cancer, 2 cases of pT2 rectal cancer (both invading the superficial muscle layer). The median hospital stay was 6 (3-7) days. The postoperative follow-up was (7.2±3.8) months. No postoperative complication or recurrence was observed.@*Conclusion@#TEM with KeyPort access is safe, rapid and effective in the treatment of rectal tumors.

Treatment of Palmer Class 1A Triangular Fibrocartilage Complex Injuries with Arthroscopic Partial Resection

PURPOSE: We reported the clinical results of Palmer class 1A triangular fibrocartilage complex (TFCC) injuries treated with arthroscopic partial resection. METHODS: This study included eighteen patients with Palmer class 1A TFCC injury. The results of arthroscopic partial resection were analyzed based on the preoperative and postoperative evaluation of visual analogue scale pain scale, range of motion, grip strength, Mayo wrist score, ulna grind test, ulna stress test and ulnocarpal tenderness. RESULTS: According to the Mayo wrist score, the results were excellent in 10 patients, good in 4, fair in 2, and poor in 2. There was no correlation among the worker's compensation, interval from injury to surgery, age and the treatment results. Patients with complication and scapholunate interosseous ligament tears had a poor clinical outcome. CONCLUSION: The arthroscopic TFCC partial resection is considered as an useful and effective treatment in Palmer class 1A TFCC injuries.

End-to-end anastomosis of esophagus after partial resection for early cervical esophageal carcinoma / 中华胸心血管外科杂志

Objective To investigate the feasibility of treatment mode of end-to-end anastomosis of esophagus(EAS) af ter partial resection for early-stage cervical esophageal carcinoma(ECEA).Methods 7 patients were substantially confirmed as squsmous cell carcinoma of cervical esophagus by endoscopy,the nearest distance of the lesion from the incisors was 17cm,and the furthest was 20 cm,the maximum extent was 2.5 cm,and the minimum was 1 cm.None of them with longitudinal muscularis invasion.Confirmed by PET/CT or chest enhancement CT examination preoperatively,intrathoracic and cervical lymphatic metastasis was excluded,cT1 -2 N0 M0.Incisal margin length was not less than 1 cm,the maximum was 5 cm and the minimum was 3 cm.Meanwhile,the cervical lymph node should be dissected,and the average number was 6.43 per case.After surgery,all the patients were fixed by plaster slab to release the tension of anastomosis.Postoperative adjuvant radiotherapy or chemotherapy was received.Results None of the patients had severe postoperative complications,and the average hospital stay was 14.5 days.All the patients are alive,the longest follow-up lasts for 3 years and 4 months,all of them can take normal food,without anastomotic stenosis.Conclusion Treatment mode of EAS after partial resection for ECEA significantly decrease the operative damage,apparently improve the patient's quality of life(QOL),so that the patients can better receive adjuvant treatment subsequently; it is a feasible and effective method for cervical esophageal carcinoma at the early stage.

Management of main hepatic vein injury in hepatectomy for hepatic neoplasm of segment Ⅷ / 中华肝胆外科杂志

Objective To summarize the experience in management of main hepatic vein injury due to hepatectomy for hepatic neoplasm of segment Ⅷ. Methods Clinical data of 64 patients suffering from main hepatic vein injury due to hepatectomy of hepatic neoplasm of segment Ⅷ in our hospital from October 1996 to October 2008 were retrospectively analyzed. Results Both the main trunks of the middle and right hepatic vein were injured in 34 patients, single right hepatic vein in 13 and middle hepatic vein in 17. In these patients with hepatic vein injury, the main trunk of the hepatic vein was repaired in 39, vessels ligated in 12 and direct liver wound surfaces sutured in 12. The hepatectomy and hemostasis were successfully performed during operation in all patients. After operation, 3 patients had active bleeding and 2 patients were reoperated on to sew up the bleeding points by wadding with the gelatin sponge and discharged after rehabilitation. One patient gave up treatment and was discharged automatically. Conclusion Main hepatic vein injury in hepatectomy of hepatic neoplasm of segment Ⅷ can be managed effectively by hepatic vein repair, hepatic vein ligation and suture of the liver section that can be chosen to control the bleeding of hepatic vein injury according to the actual conditions.

TFCC Injury Associated with the Triquetral Dorsal Chip Fracture

PURPOSE: To evaluate the usefulness of wrist arthroscopic examination in patient with persistent pain after the triquetral dorsal chip fracture and also to determine its relationship with TFCC injury in the triquetral dorsal chip fracture patient manifesting persistent pain. MATERIALS AND METHODS: This study is based on six cases presenting persistent pain in the ulnar aspect after the triqeutral posterior cord fracture that were treated conservatively. Wrist arthroscopy was carried out for all six cases. All were preoperatively and postoperatively evaluated using VAS pain scale, grip power, ulnar grind test, Kleinman shearing test and lunotriquetral ballottment test. RESULTS: Preoperatively, ulnar grind test yielded positive results in all six cases, Kleiman shearing test proved positive in three cases and lunotriquetral ballottment test yielded positive result in one case. In the arthroscopic findings, synovitis and TFCC injury were detected in all cases, and based on Palmer classification of TFCC injury, type IA was determined in five cases and type ID in one case. Arthroscopic TFCC partial resection and synovectomy were carried out. VAS pain scale improved from an average 8 points preoperatively to 3 points postoperatively. The difference of grip power between the normal and the other side improved from average of 15 lb preoperatively to 5 lb postoperatively. Based on postoperatively physical examination at 6 weeks, all cases yielded negative results in the ulnar grind test and Kleiman shearing test. CONCLUSION: We think that TFCC injury is one of the causes of persistent pain after triquetral dorsal chip fracture. We recommend an arthroscopic TFCC partial resection as a valuable treatment option.

A Case of Giant Colonic Lipoma Showing Spontaneous Resolution after Endoscopic Partial Resection / 대한소화기학회지

Generally, colon lipoma is mildly symptomatic or asymptomatic. However, sometimes it may present with symptoms, such as pain, constipation, obstruction, or bleeding and may be the leading point for intussusception, particularly in large size (>20 mm). Giant colon lipoma may warrant the removal to exclude confusion with other lesions that have a malignant potential and to control symptoms. Currently, surgical resection should be considered for giant lipoma more than 20 mm in diameter due to the high risk of perforation or bleeding, especially when the lesion is broadly-based. We report here a case of spontaneous resolution acquired after endoscopic partial resection for the symptomatic giant colon lipoma with broad-base requiring surgery.

Clinical Experience of Partial Resection of Desmoid Tumor and Perforated Small Bowel for Unresectable Desmoid Tumor with Small Bowel Perforation after IPAA for FAP

A complicated unresectable desmoid tumor is a life threatening disease. An unresectable desmoid tumor with perforation of the small bowel, was experience at my institute. In this case, the desmoid tumor had invaded major vessels, so that complete resection of the tumor would necessitate resection of most of the small bowel. A desmoid tumor with perforation of the small bowel following ileal pouch anal anastomosis for familial adenomatous polyposis is rare. If the patent had not undergone the operation, they would not have survived. Also, had the tumor with a perforated bowel been completely, resected, they also would not have survived. Therefore, a partial resection of the desmoid tumor and perforated small bowel was performed, with a good result. It is not necessary to abort such an operation, with potentially fatal consequences, due to an unresectable desmoid tumor with a perforated small bowel. Herein, this case is reported with a review of the literature.

Partial Resection of the Sternocleidomastoid Muscle for the Congenital Muscular Torticollis / 대한척추외과학회지

STUDY DESIGN: This is a retrospective study determining the surgical result of the partial resection of the sternocleidomastoid (SCM) muscle for the congenital muscular torticollis. OBJECTIVES: To evaluate the efficacy of the partial resection of the sternocleidomastoid muscle for the correction of the congenital muscular torticollis. MATERIALS AND METHODS: We reviewed 19 patients who were treated by the partial resection of the sternocleidomastoid muscle from 1990 to 1997. The mean age at the time of the operation was 8 year 3 months. Each patient was examined the range of the motion of the neck for the functional results by the modified Ling's criteria, and the tilt of the head, facial asymmetry, presence of the lateral band, loss of the sternomastoid column and quality of the scar for the cosmetic results by the modified Ling's criteria. The over-all cosmetic and functional results were analyzed by the criteria similar to those described by Canale et al. RESULTS: Functionally, 5 patients (26.3%) were excellent, 10 (52.6%) good, 2 (10.5%) fair, and 2 (10.5%) poor. Cosmetically, 7 patients (30.8%) were excellent, 9 (47.4%) good, 1 (5.3%) fair, and 2 (10.5%) poor. The complication was one lymphatic leakage. Seven of 8 patients were good and one patient was fair under the age of 5. Six of 7 patients were good and one patient was poor between the age of 6 and 10. Two of 4 patients were good and two patients were poor over the age of 11. CONCLUSION: The partial resection of sternocleidomastoid muscle for the congenital muscular torticollis would be recommendable, because it is a simple, safe procedure and usually produces satisfactory results. All partial rescetion of the sternal and clavicular head of the sternocleidomastoid muscle may prevent the unsatisfactory cosmetic result which is lateral band due to the clavicular head of the sternocleidomastoid muscle. The good results were achieved in case of under the age 10 years.