Platelet RNA enables accurate detection of ovarian cancer: an intercontinental, biomarker identification study

Platelets are reprogrammed by cancer via a process called education, which favors cancer development. The transcriptional profile of tumor-educated platelets (TEPs) is skewed and therefore practicable for cancer detection. This intercontinental, hospital-based, diagnostic study included 761 treatment-naïve inpatients with histologically confirmed adnexal masses and 167 healthy controls from nine medical centers (China, n = 3; Netherlands, n = 5; Poland, n = 1) between September 2016 and May 2019. The main outcomes were the performance of TEPs and their combination with CA125 in two Chinese (VC1 and VC2) and the European (VC3) validation cohorts collectively and independently. Exploratory outcome was the value of TEPs in public pan-cancer platelet transcriptome datasets. The AUCs for TEPs in the combined validation cohort, VC1, VC2, and VC3 were 0.918 (95% CI 0.889-0.948), 0.923 (0.855-0.990), 0.918 (0.872-0.963), and 0.887 (0.813-0.960), respectively. Combination of TEPs and CA125 demonstrated an AUC of 0.922 (0.889-0.955) in the combined validation cohort; 0.955 (0.912-0.997) in VC1; 0.939 (0.901-0.977) in VC2; 0.917 (0.824-1.000) in VC3. For subgroup analysis, TEPs exhibited an AUC of 0.858, 0.859, and 0.920 to detect early-stage, borderline, non-epithelial diseases and 0.899 to discriminate ovarian cancer from endometriosis. TEPs had robustness, compatibility, and universality for preoperative diagnosis of ovarian cancer since it withstood validations in populations of different ethnicities, heterogeneous histological subtypes, and early-stage ovarian cancer. However, these observations warrant prospective validations in a larger population before clinical utilities.

Peroral cholangioscopy for the evaluation of bile duct stricture in hepatocellular carcinoma on a preoperative examination / Journal of Rural Medicine

Objective: Bile duct tumor thrombosis in hepatocellular carcinoma (HCC) is a relatively rare event with a poor prognosis. Furthermore, bile duct tumor thrombus in HCC may be misdiagnosed when only imaging modalities are used. The efficiency of peroral cholangioscopy (POCS) in evaluating bile duct lesions has been reported.Patients: We present three cases of HCC with bile duct strictures in which POCS was performed as a preoperative evaluation.Results: In these three cases, diagnosing whether the lesion was a bile duct tumor thrombus on CT and endoscopic retrograde cholangiopancreatography was difficult. We performed POCS in three cases and were able to diagnose the presence of bile duct tumor thrombus of HCC, including differentiation from extrinsic compression of the bile duct.Conclusion: POCS for HCC with bile duct features is useful for the preoperative diagnosis of bile duct tumor thrombus, especially in cases where the surgical procedure depends on the presence of bile duct tumor thrombus.

Epidemiological characteristics, diagnosis, treatment and prognosis of gallbladder cancer in China: a report of 6 159 cases / 中华消化外科杂志

Objective:To investigate the epidemiological characteristics, diagnosis, treat-ment and prognosis of gallbladder cancer in China from 2010 to 2017.Methods:The single disease retrospective registration cohort study was conducted. Based on the concept of the real world study, the clinicopathological data, from multicenter retrospective clinical data database of gallbladder cancer of Chinese Research Group of Gallbladder Cancer (CRGGC), of 6 159 patients with gallbladder cancer who were admitted to 42 hospitals from January 2010 to December 2017 were collected. Observation indicators: (1) case resources; (2) age and sex distribution; (3) diagnosis; (4) surgical treatment and prognosis; (5) multimodality therapy and prognosis. The follow-up data of the 42 hospitals were collected and analyzed by the CRGGC. The main outcome indicator was the overall survival time from date of operation for surgical patients or date of diagnosis for non-surgical patients to the end of outcome event or the last follow-up. Measurement data with normal distribu-tion were represented as Mean±SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M( Q1, Q3) or M(range), and com-parison between groups was conducted using the U test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test. Univariate analysis was performed using the Logistic forced regression model, and variables with P<0.1 in the univariate analysis were included for multivariate analysis. Multivariate analysis was performed using the Logistic stepwise regression model. The life table method was used to calculate survival rates and the Kaplan-Meier method was used to draw survival curves. Log-rank test was used for survival analysis. Results:(1) Case resources: of the 42 hospitals, there were 35 class A of tertiary hospitals and 7 class B of tertiary hospitals, 16 hospitals with high admission of gallbladder cancer and 26 hospitals with low admission of gallbladder cancer, respectively. Geographical distribution of the 42 hospitals: there were 9 hospitals in central China, 5 hospitals in northeast China, 22 hospitals in eastern China and 6 hospitals in western China. Geographical distribution of the 6 159 patients: there were 2 154 cases(34.973%) from central China, 705 cases(11.447%) from northeast China, 1 969 cases(31.969%) from eastern China and 1 331 cases(21.611%) from western China. The total average number of cases undergoing diagnosis and treatment in hospitals of the 6 159 patients was 18.3±4.5 per year, in which the average number of cases undergoing diagnosis and treatment in hospitals of 4 974 patients(80.760%) from hospitals with high admission of gallbladder cancer was 38.8±8.9 per year and the average number of cases undergoing diagnosis and treatment in hospitals of 1 185 patients(19.240%) from hospitals with low admission of gallbladder cancer was 5.7±1.9 per year. (2) Age and sex distribution: the age of 6 159 patients diagnosed as gallbladder cancer was 64(56,71) years, in which the age of 2 247 male patients(36.483%) diagnosed as gallbladder cancer was 64(58,71)years and the age of 3 912 female patients(63.517%) diagnosed as gallbladder cancer was 63(55,71)years. The sex ratio of female to male was 1.74:1. Of 6 159 patients, 3 886 cases(63.095%) were diagnosed as gallbladder cancer at 56 to 75 years old. There was a significant difference on age at diagnosis between male and female patients ( Z=-3.99, P<0.001). (3) Diagnosis: of 6 159 patients, 2 503 cases(40.640%) were initially diagnosed as gallbladder cancer and 3 656 cases(59.360%) were initially diagnosed as non-gallbladder cancer. There were 2 110 patients(34.259%) not undergoing surgical treatment, of which 200 cases(9.479%) were initially diagnosed as gallbladder cancer and 1 910 cases(90.521%) were initially diagnosed as non-gallbladder cancer. There were 4 049 patients(65.741%) undergoing surgical treatment, of which 2 303 cases(56.878%) were initially diagnosed as gallbladder cancer and 1 746 cases(43.122%) were initial diagnosed as non-gallbladder cancer. Of the 1 746 patients who were initially diagnosed as non-gallbladder cancer, there were 774 cases(19.116%) diagnosed as gallbladder cancer during operation and 972 cases(24.006%) diagnosed as gallbladder cancer after operation. Of 6 159 patients, there were 2 521 cases(40.932%), 2 335 cases(37.912%) and 1 114 cases(18.087%) undergoing ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) examination before initial diagnosis, respec-tively, and there were 3 259 cases(52.914%), 3 172 cases(51.502%) and 4 016 cases(65.205%) undergoing serum carcinoembryonic antigen, CA19-9 or CA125 examination before initially diagnosis, respectively. One patient may underwent multiple examinations. Results of univariate analysis showed that geographical distribution of hospitals (eastern China or western China), age ≥72 years, gallbladder cancer annual admission of hospitals, whether undergoing ultrasound, CT, MRI, serum carcinoembryonic antigen, CA19-9 or CA125 examination before initially diagnosis were related factors influencing initial diagnosis of gallbladder cancer patients ( odds ratio=1.45, 1.98, 0.69, 0.68, 2.43, 0.41, 1.63, 0.41, 0.39, 0.42, 95% confidence interval as 1.21-1.74, 1.64-2.40, 0.59-0.80, 0.60-0.78, 2.19-2.70, 0.37-0.45, 1.43-1.86, 0.37-0.45, 0.35-0.43, 0.38-0.47, P<0.05). Results of multivariate analysis showed that geographical distribution of hospitals (eastern China or western China), sex, age ≥72 years, gallbladder cancer annual admission of hospitals and cases undergoing ultrasound, CT, serum CA19-9 examination before initially diagnosis were indepen-dent influencing factors influencing initial diagnosis of gallbladder cancer patients ( odds ratio=1.36, 1.42, 0.89, 0.67, 1.85, 1.56, 1.57, 0.39, 95% confidence interval as 1.13-1.64, 1.16-1.73, 0.79-0.99, 0.57-0.78, 1.60-2.14, 1.38-1.77, 1.38-1.79, 0.35-0.43, P<0.05). (4) Surgical treatment and prognosis. Of the 4 049 patients undergoing surgical treatment, there were 2 447 cases(60.435%) with complete pathological staging data and follow-up data. Cases with pathological staging as stage 0, stage Ⅰ, stage Ⅱ, stage Ⅲa, stage Ⅲb, stage Ⅳa and stage Ⅳb were 85(3.474%), 201(8.214%), 71(2.902%), 890(36.371%), 382(15.611%), 33(1.348%) and 785(32.080%), respectively. The median follow-up time and median postoperative overall survival time of the 2 447 cases were 55.75 months (95% confidence interval as 52.78-58.35) and 23.46 months (95% confidence interval as 21.23-25.71), respectively. There was a significant difference in the overall survival between cases with pathological staging as stage 0, stage Ⅰ, stage Ⅱ, stage Ⅲa, stage Ⅲb, stage Ⅳa and stage Ⅳb ( χ2=512.47, P<0.001). Of the 4 049 patients undergoing surgical treatment, there were 2 988 cases(73.796%) with resectable tumor, 177 cases(4.371%) with unresectable tumor and 884 cases(21.833%) with tumor unassessable for resectabi-lity. Of the 2 988 cases with resectable tumor, there were 2 036 cases(68.139%) undergoing radical resection, 504 cases(16.867%) undergoing non-radical resection and 448 cases(14.994%) with operation unassessable for curative effect. Of the 2 447 cases with complete pathological staging data and follow-up data who underwent surgical treatment, there were 53 cases(2.166%) with unresectable tumor, 300 cases(12.260%) with resectable tumor and receiving non-radical resection, 1 441 cases(58.888%) with resectable tumor and receiving radical resection, 653 cases(26.686%) with resectable tumor and receiving operation unassessable for curative effect. There were 733 cases not undergoing surgical treatment with complete pathological staging data and follow-up data. There was a significant difference in the overall survival between cases not undergoing surgical treatment, cases undergoing surgical treatment for unresectable tumor, cases undergoing non-radical resection for resectable tumor and cases undergoing radical resection for resectable tumor ( χ2=121.04, P<0.001). (5) Multimodality therapy and prognosis: of 6 159 patients, there were 541 cases(8.784%) under-going postoperative adjuvant chemotherapy and advanced chemotherapy, 76 cases(1.234%) under-going radiotherapy. There were 1 170 advanced gallbladder cancer (pathological staging ≥stage Ⅲa) patients undergoing radical resection, including 126 cases(10.769%) with post-operative adjuvant chemotherapy and 1 044 cases(89.231%) without postoperative adjuvant chemo-therapy. There was no significant difference in the overall survival between cases with post-operative adjuvant chemotherapy and cases without postoperative adjuvant chemotherapy ( χ2=0.23, P=0.629). There were 658 patients with pathological staging as stage Ⅲa who underwent radical resection, including 66 cases(10.030%) with postoperative adjuvant chemotherapy and 592 cases(89.970%) without postoperative adjuvant chemotherapy. There was no significant difference in the overall survival between cases with postoperative adjuvant chemotherapy and cases without postoperative adjuvant chemotherapy ( χ2=0.05, P=0.817). There were 512 patients with pathological staging ≥stage Ⅲb who underwent radical resection, including 60 cases(11.719%) with postoperative adjuvant chemotherapy and 452 cases(88.281%) without postoperative adjuvant chemotherapy. There was no significant difference in the overall survival between cases with postoperative adjuvant chemo-therapy and cases without post-operative adjuvant chemo-therapy ( χ2=1.50, P=0.220). Conclusions:There are more women than men with gallbladder cancer in China and more than half of patients are diagnosed at the age of 56 to 75 years. Cases undergoing ultrasound, CT, serum CA19-9 examination before initial diagnosis are independent influencing factors influencing initial diagnosis of gallbladder cancer patients. Preoperative resectability evaluation can improve the therapy strategy and patient prognosis. Adjuvant chemotherapy for gallbladder cancer is not standardized and in low proportion in China.

Application of DCEGMRI and DWI in the preoperative diagnosis of breast cancer / 实用放射学杂志

Objective To explore the application of DCE-MRI and DWI in the preoperative diagnosis of breast cancer.Methods

Application of high frequency color Doppler ultrasonography combined with detections of serum FIB and CA199 in preoperative diagnosis of breast cancer / 中国医学装备

Objective: To investigate the application value of high frequency color Doppler flow imaging(CDFI)combined with serum fibrinogen(FIB)and sugar antigen 19-9(CA199)in the preoperative diagnosis of breast cancer.Methods: The clinical data of 226 patients with space occupying lesion of breast were analyzed retrospectively.According to the confirmed situation of postoperative pathological examination,they were divided into breast cancer group(158 cases)and breast disease group(68 cases).All patients received examination of preoperative CDFI and detections of preoperative serum FIB and CA199,and the values of single CDFI examination and it combined with detection of serum FIB and CA199 in preoperative diagnosis of breast cancer were compared.Results: In breast cancer group(158 patients),the ultrasonographic images of 146 patients showed the lumps were hypoechoic or weak echoes,irregular shape and uneven surface,and showed the change of lump appeared cauliflower shape,lobulated or crab foot shape.And the levels of serum FIB and CA199 of breast cancer group were significantly higher than those of breast disease group(t=6.821,t=20.061,P＜0.05),respectively.The sensitivity,negative predictive value and diagnostic coincidence rate of CDFI examination combined with detections of FIB and CA199 for diagnosis of breast cancer were 89.24％,79.76％and 92.04％,respectively.And these were significantly higher than those of single CDFI examination(x2=100.148,x2=37.666,x2=79.636,P＜0.05),respectively.Conclusion: The value of high frequency CDFI examination combined with serum FIB and CA199 in the preoperative diagnosis of breast cancer is significantly higher than that of single examination and single detection,and it has clinical application value.

Preoperative vestibular assessment protocol of cochlear implant surgery: an analytical descriptive study / Protocolo de avaliação vestibular pré-operatória da cirurgia de implante coclear: estudo descritivo analítico

Abstract Introduction: Cochlear implants are undeniably an effective method for the recovery of hearing function in patients with hearing loss. Objective: To describe the preoperative vestibular assessment protocol in subjects who will be submitted to cochlear implants. Methods: Our institutional protocol provides the vestibular diagnosis through six simple tests: Romberg and Fukuda tests, assessment for spontaneous nystagmus, Head Impulse Test, evaluation for Head Shaking Nystagmus and caloric test. Results: 21 patients were evaluated with a mean age of 42.75 ± 14.38 years. Only 28% of the sample had all normal test results. The presence of asymmetric vestibular information was documented through the caloric test in 32% of the sample and spontaneous nystagmus was an important clue for the diagnosis. Bilateral vestibular areflexia was present in four subjects, unilateral arreflexia in three and bilateral hyporeflexia in two. The Head Impulse Test was a significant indicator for the diagnosis of areflexia in the tested ear (p = 0.0001). The sensitized Romberg test using a foam pad was able to diagnose severe vestibular function impairment (p = 0.003). Conclusion: The six clinical tests were able to identify the presence or absence of vestibular function and function asymmetry between the ears of the same individual.

Resumo Introdução: Os implantes cocleares (IC) são indiscutivelmente um método eficaz de recuperação da função auditiva de pacientes surdos. Objetivo: Descrever o protocolo de avaliação vestibular pré-operatória em sujeitos que serão submetidos ao IC. Método: Nosso protocolo institucional prevê o diagnóstico vestibular por meio de seis testes simples: testes de Romberg e Fukuda, nistagmo espontâneo, Head Impulse Test, Head Shaking Nistagmus, prova calórica. Resultados: Foram avaliados 21 pacientes com média de 42,75 ± 14,38 anos. Apenas 28% da amostra apresentaram todos os testes normais. A presença de informação vestibular assimétrica foi documentada pela prova calórica em 32% da amostra e o nistagmo espontâneo mostrou-se pista importante para seu diagnóstico. A arreflexia vestibular bilateral foi diagnosticada em quatro sujeitos; arreflexia unilateral em três e hiporreflexia bilateral em dois. O Head Impulse Test mostrou-se indicador significante (p = 0,0001) para diagnosticar arreflexia da orelha testada. O teste de Romberg sensibilizado em almofada foi capaz de diagnosticar os comprometimentos severos da função vestibular (p = 0,003). Conclusão: Os seis testes clínicos foram capazes de identificar a presença ou não de função vestibular e assimetria da função entre as orelhas de um mesmo indivíduo.

Analysis of the clinicopathological characteristics and the clinical value of fine-needle aspiration biopsy for thyroid carcinoma / 临床外科杂志

Objective To analyze the clinicopathological characteristics of patients with benign thyroid nodules(BTN) and thyroid carcinoma(TC),and explore the clinical value of fine-needle aspiration biopsy (FNAB)in diagnosis of TC.Methods A retrospective analysis was conducted on the data of 2918 cases with thyroid carcinoma,who underwent surgery in the People's Hospital of Wuhan University between January 2011 and February 2015.Results Patients aged younger than 45 years old accounted for 26.23％ and 51.26％ in BTN group and CT group,respectively,and the difference between the two groups were statistically significant (P ＜ 0.05).Male patients accounted for 16.82％ and 20.15％ in BTN group and CT group,respectively,and the difference between the two groups were statistically significant (P ＜ 0.05).Patients with family history of thyroid related diseases accounted for 2.93％ and 3.70％ in BTN group and CT group,respectively,and there was no statistically significant difference between the two groups (P ＞ 0.05).Patients with solitary lesion accounted for 40.42％ and 47.95％ in BTN group and CT group,respectively,and the difference between the two groups were statistically significant(P ＜ 0.05).Af ter the application of FNAB,the percentage of the patients diagnosed with TC was increased by 4.83％ (P ＜ 0.05),and the diameter of nodular was increased by 4 cm (P ＜ 0.01).Conclusion Patients with TC have a characteristic of earlier onset age,higher proportion of male patients and lower incidence of multifocality compared with patients with BTN.There was no statistically significant difference between the TC group with family history of thyroid related diseases and the BTN group.The application of FNAB avoids of unnecessary surgeries on some BTN patients with small pathological diameter of nodule,it is important for preoperative diagnosis of thyroid nodules.

Intramuscular hemangioma in buccal cheek: a case report

Hemangioma is the most common benign tumor of a vascular origin, and is characterized by the abnormal proliferation of blood vessels. Intramuscular hemangioma (IMH) usually involves the skeletal muscles of the trunk or limbs, but rarely occurs in the head and neck region. This case report presents a patient with IMH showing multiple phleboliths in the buccal cheek. A 13-year-old boy was referred for the evaluation and management of painful swelling of the left cheek that had gradually increased in size over a 6 year duration. The examination revealed a palpable firm mass. Reddish-blue buccal mucosa color was observed with an aciniform shape. Preoperative magnetic resonance imaging (MRI) showed a vascular tumor in the left side adjacent to the buccinator and depressor orbicularis oris muscles. Surgical resection under general anesthesia was performed via the intraoral approach. The mass and phleboliths were extracted successfully. A histopathological examination confirmed the diagnosis of IMH. In conclusion, clinicians should be aware of the possibility of IMH in cases of a palpable mass with multiple nodules deep within the muscle in the buccal cheek. Among the several diagnostic tools, MRI provides essential information on the extent and surrounding anatomy of IMH.

Safety and diagnostic accuracy of preoperative endoscopic ultrasound-guided fine-needle aspiration for resectable pancreatic cancer / 中国内镜杂志

Objective To evaluate the safety and diagnostic accuracy of preoperative endoscopic ultrasound-guid﹣ed fine-needle aspiration in patients with pancreatic cancer. Methods 256 patients with pancreatic cancer from Jan﹣uary 2010 to December 2014, 82 were considered resectable on the basis of cross-sectional imaging findings. Of these patients, 54 underwent EUS-FNA before surgery (FNA+group) and 28 underwent surgery without preoperative EUS-FNA (FNA- group), the diagnosis result of EUS-FNA and the survival time of the two groups were observed. Results All 54 lesions were visible on EUS, and all 54 attempts at FNA were technically successful. The diagnostic accuracy according to cytology and histology findings was 94.44 % (51/54) and 88.89% (48/54), respectively, and the total accuracy was 94.44 % (51/54). Two patients developed mild pancreatitis and two hemorrhage after EUS-FNA but were successfully treated by conservative therapy. No severe complications occurred after EUS-FNA. In the FNA+and FNA- groups, the median relapse-free survival (RFS) was 282 and 265 d, respectively (P>0.05), and the median overall survival (OS) was 568 and 557 d, respectively (P>0.05). RFS and OS were therefore not inferior in the FNA+group. These data indicate that the usage of EUS-FNA did not influence RFS or OS, nor did it increase the risk of other complications. Conclusions Preoperative EUS-FNA is a safe and accurate diagnostic method.

Preoperative diagnosis and surgical treatment of anomalous origin of the left coronary artery from the pulmonary artery / 中国小儿急救医学

Objective To investigate the preoperative diagnosis,surgical treatment and results of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA).Methods We retrospectively analyzed the clinical data of 9 patients with ALCAPA who had undergone surgical treatment in Shanxi Children's Hospital from June 2010 to March 2014.Results There were 3 males and 6 females,aged from 4 months to 4 years old and 6 months,average age (1.14 ± 1.33)years,body weight from 5.6 to 18.0 kg,average weight(8.06 ± 3.99) kg.Echocardiography and spiral CT angiography were performed in all patients,one of which underwent cardiac catheter angiography.The cases of mitral regurgitation were mild in 2 cases,mild to moderate in 5 cases,and moderate to severe in 2 cases.Electrocardiogram showed abnormal Q wave,ST segment change and T wave inversion in lead Ⅰ,AVL and V4-6 in 9 cases.The X-ray sign was significant heart enlargement(C/T ratio 0.56-0.73,mean 0.61 ± 0.05).Echocardiography indicated ALCAPA,significant enlargement of left ventricle and decreased myocardial contractility(ejection fraction less than 50％).End diastolic diameter of left ventricle were more than 35 mm in 8 cases and aneurysm formation of left ventricular apex in 1 case.One case was confirmed ALCAPA by catheter angiography.Six cases had radioactive nuclide myocardial imaging,which showed different degree of myocardial infarction.All patients underwent reimplantation of left coronary artery into the aorta,mitral valvoplasty in 7 patients.One case died for low cardiac output syndrome.Others recovered and discharged.Postoperative complications included low cardiac output syndrome in 2 cases,pneumonia in 3 cases and supraventricular tachycardia in 1 case.During a followup of 3 months to 2 years,well development,good heart function,mitral valve regurgitation and ejection fraction improved in all case.Conclusion Echocardiography has important value in diagnosis of ALCAPA,which are confirmed by spiral CT angiography and catheter angiography.Preoperative nuclide examination for determinant of survival myocardium is helpful for surgery and prognosis.Reimplantation of left coronary artery into the aorta is the most ideal surgical procedure.

Utility of Discography as a Preoperative Diagnostic Tool for Intradural Lumbar Disc Herniation

Preoperative definitive diagnosis of intradural lumbar disc herniation (ILDH) is difficult despite the availability of various neuroradiological investigative tools. We present a case of ILDH diagnosed preoperatively by discography and computed tomography-discography (disco-CT).The patient was a 63-year-old man with acute excruciating right leg pain. Discography and disco-CT demonstrated leakage of the contrast medium into the intradural space. Based on these findings, a right L5 nerve root disturbance caused by ILDH was diagnosed. A right L5 hemi-laminectomy and a dorsal durotomy were performed. The herniated disc was carefully dissected and then completely removed. Three months after surgery, the patient had fully recovered. This report highlights the importance of making a definitive diagnosis of ILDH preoperatively for better surgical planning and improved clinical outcomes. Furthermore, discography and disco-CT are both useful preoperative diagnostic tools for the diagnosis of ILDH.

Frecuencia de diverticulo de Meckel en el diagnostico preoperatorio de la apendicitis aguda / Frequency of Meckel diverticulum in the pre-operative diagnosis of acute appendicitis

Introducción: La incidencia del Divertículo de Meckel es del 1-3% en la población general. Presentan complicaciones como hemorragia, perforación u obstrucción intestinal que en ocasiones simulan una apendicitis aguda. Objetivo: Determinar la frecuencia de esta enfermedad, en pacientes con diagnóstico pre-operatorio de apendicitis aguda, así como el tratamiento y morbimortalidad. Diseño: Estudio descriptivo, retrospectivo y observacional. Pacientes y metodo: Se revisaron 1552 fichas, de pacientes con diagnóstico pre-operatorio de apendicitis aguda, de las que se analizaron 14 casos de Divertículo de Meckel , que fueron el hallazgo quirúrgico, de marzo 2000 a febrero 2015. Resultados: n: 14 pacientes. Fueron del sexo masculino 13 pacientes y del femenino 1. La edad promedio de 27 años. El tiempo de evolución en promedio fue de 14,5 hs (5-24hs), el motivo de consulta fue el dolor abdominal, en todos los casos, los síntomas fueron el dolor en fosa ilíaca derecha y vómitos. Todos presentaron leucocitosis, en la intervención quirúrgica se constató perforación del divertículo en 8 casos, se realizó resección y anastomosis ileal termino-terminal, en 6 casos diverticulectomía. Se realizó la apendicectomía incidental en todos los pacientes. El estudio anatomopatológico informó divertículo de Meckel con áreas de mucosa gástrica heterotrópica. Tuvimos como complicación: 2 infecciones del sitio quirúrgico, una de ellas con evisceración grado I. El tiempo de internación estuvo comprendido entre 6 y 8 días. No tuvimos óbitos. Conclusiones: El Divertículo de Meckel presentó una frecuencia de 0,9%, de pacientes con diagnóstico pre - operatorio de apendicitis aguda, el tratamiento fué quirúrgico en todos los casos y la morbilidad del 14%.

Introduction: The incidence of Meckel’s diverticulum is 1-3% in the general population. There are complications such as hemorrhage, perforation or intestinal obstruction that sometimes simulate acute appendicitis. Objective: To determine the frequency of this disease, in patients with pre-operative diagnosis of acute appendicitis, as well mortality and morbidity. Design: Descriptive, retrospective and observational. Patients and method study: revised 1552 chips, of patients with a pre-operative diagnosis of acute appendicitis, of which analyzed is 14 cases of Meckel’s Diverticulum, which were the surgical finding, from March 2000 to February 2015. Results: n: 14 patients. 13 patients were male and female 1. The average age of 27 years. The time evolution in average was 14.5 hours (5-24 hs), the reason for consultation was abdominal pain, in all cases, the symptoms were pain in the right iliac fossa, and vomiting. All showed Leukocytosis, in surgery it was found in 8 cases diverticulum perforation, resection and end-terminal ileal anastomosis, in 6 cases Meckel. Incidental appendectomy was performed in all patients. The anatomopathologic study reported Meckel’s diverticulum with heterotropica gastric mucosa areas. We had as a complication: 2 infections in the surgical site, one with evisceration grade I. The time of internment was comprised between 6 and 8 days. We had no deaths. Conclusions: Meckel’s diverticulum presented a frequency of 0,9%, of patients with diagnostic pre - surgery for acute appendicitis, the treatment was surgical in all cases and morbidity of 14%.

Estudio del nivel de concordancia entre los diagnósticos prequirúrgico y artroscópico de lesiones meniscales asociadas a lesiones del ligamento cruzado anterior / Concordance between preoperatory diagnosis and arthroscopy findings of meniscal lesions associated to anterior cruciate ligament injury

Introducción: Las lesiones ligamentarias de la rodilla son comunes durante la segunda y tercera décadas de vida, su diagnóstico clínico es difícil ya que puede diferir con el diagnóstico definitivo. El objetivo es determinar la concordancia entre el diagnóstico preoperatorio-diagnóstico postoperatorio y entre la lesión meniscal sospechada-lesión meniscal encontrada, en pacientes con lesión del ligamento cruzado anterior. Material y métodos: Estudio transversal. En 29 pacientes con lesión del ligamento cruzado anterior a los cuales se realizó artroscopía. Las variables fueron edad, género, lado afectado, diagnóstico preoperatorio, diagnóstico postoperatorio, lesión meniscal sospechada, lesión meniscal encontrada. La estadística utilizada fue descriptiva, para la concordancia se usó índice de Kappa de Cohen. Resultados: Fueron 29 pacientes, 23 (79.3%) hombres y 6 (20.7%) mujeres, la edad promedio: 39.04 (15-50) ± 13.19 años, lado afectado derecho 69% e izquierdo 31%; el diagnóstico preoperatorio en 22 (75%) pacientes fue LLCA aislada, LLCA + menisco medial 6 (20.7%), LLCA + menisco lateral 1 (3.4%) y el diagnóstico artroscópico fue en 20 (68.96%) sin lesión meniscal, 7 (24.1%) lesión en menisco medial, 2 (6.9%) en menisco lateral, con una concordancia baja (Kappa 0.2), la concordancia diagnóstica preoperatoria intraobservador fue perfecta (Kappa 1.0); y la concordancia entre el diagnóstico de la lesión meniscal preoperatoria y de la lesión meniscal artroscópica fue baja (Kappa 0.2). Conclusiones: La concordancia entre el diagnóstico clínico-radiológico y el diagnóstico artroscópico en lesiones del LCA con asociación de lesión meniscal es baja, lo cual se tiene que tener en cuenta en la realización del diagnóstico inicial y en el tratamiento artroscópico de los pacientes.

Introduction: Ligament injuries of the knee joint are common during the second and third decades of life, clinical and radiological diagnosis presents difficulties since the surgical findings may differ significantly. The objective is to determine correlation between clinical-radiologic and arthroscopic diagnosis in patients with injury of the anterior cruciate ligament (ACL) and meniscal lesions. Material and methods: Cross-sectional study held in 29 patients with ACL injury associated to meniscal lesions treated arthroscopically. Variables were age, gender, affected side, preoperative and postoperative diagnosis, type and location of meniscal injury; descriptive statistics and Cohen Kappa for concordance were used. Results: There were 29 patients, 23 (79.3%) men and 6 (20.7%) women, mean age 39.04 (15-50) ± 13.19 years; right side was affected in 69% and left in 31%; 19% had not meniscal lesion, 17.2% had injury in anterior horn, 10.3% in posterior horn and 6.9% in the body. The concordance between preoperative and artroscopic diagnosis was: Kappa 0.2; intraboservador was Kappa 1.0; between suspected meniscal injury and arthroscopic findings was: Kappa 0.2. Conclusions: The concordance between the clinical-radiological and arthroscopic diagnosis in patients with ACL injuries and meniscal injury associated is low, which has to be considered in the initial review and the arthroscopic treatment of patients.

Diagnosis and treatment of primary appendiceal mucinous adenocarcinoma / 中华消化外科杂志

Appendiceal mucinous adenocarcinoma is a rare disease.The preoperative diagnosis is almostly impossible due to the lack of typical symptoms and inexperienced surgeons.One patient with appendiceal mucinous adenocarcinoma was diagnosed successfully at the 210th Hospital of Chinese PLA,who was misdiagnosed as with periappendiceal abscess by other hospitals.The result of intraoperative frozen pathological section confirmed appendiceal mucinous adenocarcinoma.And then the patient received extended resection and effective recovery.

The application value of EUS on preoperative diagnosis and clinical staging of esophageal cancer / 中国医学装备

Objective:To explore the application value of endoscopic ultrasonography (EUS) on preoperative diagnosis and clinical staging of esophageal cancer.Methods: In accordance with the international federation of tumor cancer alliance (UICC) and the United States (AJCC) (2003) TNM staging criteria, 45 cases of esophageal cancer patients confirmed by biopsy and gastroscope examination did preoperative diagnosis and clinical staging with EUS, and the results were compared with postoperative pathological staging results.Results: Fourty-five patients had esophageal EUS imaging characteristics, EUS on 45 cases of esophageal cancer patients with preoperative diagnostic accuracy rate was 100.0%; Clinical staging based on the result of postoperative histopathologic examination, preoperative EUS for esophageal T staging overall diagnostic accuracy was 82.2%, T1, T2, T3, T4 diagnostic accuracy respectively was 85.7%, 83.3%, 82.4% and 85.7%; The overall diagnostic accuracy was 77.8% for N staging, N0 and N1 stage diagnostic accuracy respectively was 80.0%, 76.0%.Conclusion: Accuracy rate of EUS on preoperative diagnosis of esophageal cancer is higher, accuracy rate of EUS on preoperative T and N staging of esophageal cancer is also high, it can be important basis of esophageal preoperative treatment selection and prognostic evaluation, and has higher clinical value.

Selection of mode of biopsy in histopathological diagnosis of Soft tissue sarcoma depending on diagnostic accuracy and feasibility: Debatable issue in modern era.

Background: Biopsy method of choice is a controversy issue for diagnosis of soft tissue sarcoma which are traditionally been managed by wide excision surgery and radiotherapy. Chemotherapy is reserved for advanced cases. Aims & Objective: The objective of study was to evaluate diagnostic accuracy of various modes of biopsy focusing on image guided core needle biopsy (CNB). Material and Methods: Current study includes 50 cases of soft tissue sarcoma from January 2010 to October 2012. The Mode of biopsies included image guided CNB, open and excision biopsy. Effective accuracy of each was determined by accuracy of biopsy to provide adequate tissue for histopathological and other special examinations like immunohistochemistry to reach final diagnosis. Results: Out of total 50 cases CNB was done in 13 cases, open biopsy in 2 cases and in 35 cases excision biopsy was done. CNB was adequate in 92.31 % cases and 7.69 % cases it was inadequate. Open and excision biopsy were 100 % adequate. Conclusion: Image guided CNB is very helpful in early diagnosis and shows high accuracy especially for high-grade sarcoma. It is less invasive compared to others and differentiate benign from malignant. It is handful when preoperative diagnosis is essential for planning pre-operative chemotherapy especially in patients with primarily inoperable, advanced tumour with compromised performance status or recurrent tumour. But it should be properly directed and representative of whole tumour and require full radiological correlation by experienced hands. Tumours with myxoid pattern, lipomatous tumours and low grade sarcomas encounters lower diagnostic accuracy on CNB.

Ultrasonido transvaginal para la detección preoperatoria de endometriosis profunda en pacientes con dolor pélvico crónico / Transvaginal ultrasonography for preoperative diagnosis of deep endometriosis in patients with chronic pelvic pain

Antecedentes: la endometriosis profunda (EP) es una enfermedad caracterizada por lesiones que penetran > 5 mm la superficie del peritoneo pélvico. Representa la forma más sintomática de la enfermedad y un importante desafío quirúrgico. La resonancia magnética, la ultrasonografía transrectal y la ultrasonografía transvaginal (USTV), se consideran métodos de diagnóstico adecuados, no obstante, este último ofrece ventajas de accesibilidad, costo-efectividad y tolerancia. Objetivo: implementar y determinar la capacidad de la USTV para detectar EP comparando los hallazgos con la laparoscopía. Métodos: estudio transversal de prueba diagnóstica que incluye 57 pacientes con sospecha de endometriosis e indicación quirúrgica. Se realizó la USTV, evaluando la presencia, localización, tamaño y grado de infiltración de la EP. Los resultados ecográficos se compararon con los hallazgos quirúrgicos e histológicos. Resultados: la EP se confirmó quirúrgica e histológicamente en 35/57 pacientes. Se identificó endometriosis ovárica (EO) y EP en la laparoscopía en 35 y 31 de las mujeres, respectivamente. Para el diagnóstico de la EP, la USTV tuvo una sensibilidad (S) de 94,3 por ciento, especificidad (E) 100 por ciento, valor predictivo positivo (VPP) de 100 por ciento, valor predictivo negativo (VPN) del 91,7 por ciento y un exactitud (Ex) de 96,5 por ciento. Para el diagnóstico EP sobre los ligamentos uterosacros, la S, E, VPP y VPN fue: 85,7 por ciento, 100 por ciento, 100 por ciento y 98 por ciento respectivamente. Para el diagnóstico de EP con compromiso intestinal, la S, E, VPP y VPN fue 100 por ciento. Conclusión: estos hallazgos muestran que USTV es un examen adecuado para la evaluación de la EP y confirma su importancia para definir una estrategia quirúrgica y consejería preoperatoria.

Background: deep endometriosis (DE) is defined arbitrarily as endometriosis infiltrating the peritoneum by >5 mm. Represents the most symptomatic disease and a major surgical challenge. Currently, MRI, transrectal ultrasonography and transvaginal ultrasonography (USTV), are considered appropriate diagnostic methods, however, the latter offers advantages in terms of accessibility, cost-effectiveness and tolerance. Objective: to implement and assess the ability of the USTV for detect DE having laparoscopy as the gold standard. Methods: cross-sectional diagnostic test study that included 57 patients with suspected endometriosis and surgical indication. USTV was performed by a single operator assessing the presence, location, size and degree of infiltration of the DE. The sonographic findings were compared with surgical and histological findings. Results: the DE was confirmed surgically and histologically in 35/57 patients. Ovarian endometriosis (OE) and DE were identified and at laparoscopy in 35 and 31 women, respectively. For the diagnosis of DE, the USTV had a sensitivity (S) of 94.3 percent, specificity (E) 100 percent, positive predictive value (PPV) of 100 percent, negative predictive value (NPV) of 91.7 percent and accuracy (A) of 96.5 percent. For diagnostic DE of the uterosacral ligaments, S, E, PPV and NPV were: 85.7 percent, 100 percent, 100 percent and 98 percent, respectively. For the diagnosis of DE with intestinal involvement, S, E, PPV and NPV was 100 percent. Conclusion: these findings show that USTV is adequate technique for the evaluation of the EP and confirms the importance to define a surgical strategy and preoperative counseling.

A Non-recurrent Laryngeal Nerve that was Unnoticed in a Preoperative Imaging Study: A Case Report / 대한내분비외과학회지

A non-recurrent laryngeal nerve is a rare nerve anomaly that is associated with a developmentally aberrant subclavian artery. During thyroidectomy,this aberrant nerve may become inadvertently damaged, causing permanent ipsilateral vocal cord paralysis. However, it is possible to predict the presence of a non-recurrent laryngeal nerve by preoperative diagnosis of an aberrant subclavian artery. We report a case of thyroid surgery associated with a right non-recurrent laryngeal nerve that was unnoticed preoperatively in a CT scan of the neck, but was encountered incidentally during the thyroidectomy. The preoperative CT scan showed a retroesophageal aberrant right subclavian artery, but it was unnoticed. The female patient underwent a total thyroidectomy with central compartment node dissection for a thyroid cancer. The recurrent laryngeal nerve on the left side was identified, as was the non-recurrent laryngeal nerve on the right side. Postoperatively, the patient had normal vocal cord function. It is possible to predict preoperatively a right non-recurrent laryngeal nerve by identifying an aberrant right subclavian artery on the CT scan of the neck, which likely enables prevention of vocal cord paralysis.

Preoperative assessment of cervical invasion in endometrial cancer:comparison of MRI and D&C / 中国癌症杂志

Background and purpose:A pre-surgery diagnosis of cervical invasion in endometrial cancer was usually determined by dilatations and curettage(D&C),so it could help in optimizing surgery,but the reliability of D&C still was controversial.This study was to compare MRI with D&C to estimate their accuracy for the diagnosis of cervical invasion in endometrial carcinoma respectively.Methods:34 endometrial cancer patients had been proved to have cervical invasion in endometrial cancer through examinations of either fractional dilatations and curettages(D&C),magnetic resonance imaging(MRI)before surgery or postoperative histopathologic examination.The results of D&C and MRI were compared with postoperative histopathologic examination,and the sensitivity,specificity were estimated for accuracy of cervical involvement in endometrial cancer.Results:21 of 34 patients were identified as having cervical invasion in endometrial cancer by histopathology after operation.D&C test matches 26.5% of them and MRI test matches 80%.The sensitivity was 35% vs.76.5% and the specificity 7.7% vs.100% for D&C and MRI methods respectively.All of them had significant statistical differences.Conclusions:MRI test is much better than D&C method for preoperative diagnosis of cervical invasion in endometrial carcinoma.