Clinical outcomes of endoscopic submucosal dissection for large colorectal tumors / 中华消化内镜杂志

Objective:To evaluate the outcome of endoscopic submucosal dissection (ESD) of colorectal tumors, and to analyze the factors affecting the therapeutic efficacy of ESD.Methods:Clinical data of patients with colorectal tumors who were treated with ESD in Department of Gastroenterology in Beijing Hospital from November 2016 to December 2019 were reviewed. A total of 82 patients with pathologically confirmed colorectal adenoma or carcinoma of diameter ≥20 mm were included. The clinical features, ESD and pathological outcomes of the patients were analyzed.Results:All 82 lesions were single, with the mean diameter of 29.72±10.74 mm. Lesions were divided into the laterally spreading tumors (LST), mainly located in the ascending colon and ileocecal region (47.8%, 22 / 46) and the protruding colorectal tumors, mainly located in the left colon, 52.8% (19 / 36) of which were located in the sigmoid colon. The overall resection rate was 81.7%(67/82) and the curative resection rate was 72.0%(59/82). The incidences of bleeding and perforation were 2.4%(2/82) and 1.2%(1/82), respectively. The curative resection rates [91.4%(32/35), 63.6%(7/11) and 55.6%(20/36), P=0.003] and surgical operation rates [8.6%(3/35), 18.2%(2/11) and 36.1%(13/36), P=0.010] of LST-G, LST-NG and protruding colorectal tumors were significantly different. Multivariate regression analysis showed that protruding colorectal tumor ( OR=3.396, 95% CI: 1.014-11.374, P=0.047) and submucosal severe fibrosis (F2 type) ( OR=5.508, 95% CI: 2.216-13.692, P=0.001) were independent risk factors for non-curative ESD resection of colorectal tumors. Conclusion:ESD is effective and safe for colorectal tumors of diameter ≥ 20 mm. However, there are some differences in the rate of submucosal invasion and treatment outcome among different types of lesions. The risk factors for non-curative resection are protruding tumors and severe submucosal fibrosis.

Omohyoid muscle syndrome

Omohyoid muscle syndrome is a rare cause of a bulging lateral neck mass that occurs on swallowing that often a worrisome observation because of the concern of malignancy and cosmetic deformity. The first case has been documented on 1969. A 12 years old male came to Surgical Oncology Outpatient Clinic with chief complaint a protruding right lateral neck mass during swallowing. He noticed this complaint since three months prior. He had no previous history of medical illness. He had history of multiple chokehold trauma when playing with his friend 6 months ago. He had no symptoms besides the mass occurring on his right neck. The patient went through the cervical radiograph and neck ultrasonography examination. There were inconclusive results. The patient was informed that the implication of these findings was strictly cosmetic and did not pose any risk of long-term consequence. Corrective cosmetic surgery was recommended as an option if he was concerned about the cosmetic appearance and conservative management was recommended to observe any pain or dysphagia he might experience in the near future. He denied surgery and did not seek further care for his condition. Omohyoid muscle syndrome is a rare condition that might occur after trauma such as chokehold to the neck. Imaging on this syndrome quite challenging especially when there were no other symptoms experienced. If it is proven to be strictly cosmetic, most patients will choose to have a conservative therapy.

Clinical Outcome of Endoscopic Submucosal Dissection for Large Protruding Colorectal Tumor / 胃肠病学

Background: Endoscopic submucosal dissection (ESD) is the first choice for treating laterally spreading colorectal tumor. However, the effect of ESD on large protruding colorectal tumor is not ideal. Aims: To evaluate the features of large protruding colorectal tumor and the clinical outcome of ESD. Methods: The clinical data of 36 patients with protruding colorectal tumor with diameter ≥20 mm that undergone ESD from November 2016 to December 2019 at Beijing Hospital were retrospectively analyzed. The clinical, endoscopic, surgical and pathological features were summarized, and the risk factors of ESD were analyzed. Results: The average diameter of 36 lesions was (25.44±5.57) mm. All lesions were located in left hemicolon. The percentage of en bloc resection was 75.0%, and the percentage of R0 resection was 72.2%. ESD procedure was discontinued in 5 patients (13.9%) and were converted to surgery. The rate of curative resection was 55.6%. Non-curative resection was found in 11 patients, and of them 7 patients accepted surgery later. The overall rate of surgery was 33.3%. The en bloc resection rate (0 vs. 87.1%, P=0.003) and R0 resection rate (20.0% vs. 80.6%, P=0.008) were significantly decreased in muscle-retracting sign group than in non-muscle-retracting sign group. There were significant differences in en bloc resection rate, R0 resection rate and curative resection rate among the non-submucosal fibrosis (F0), mild fibrosis (F1) and severe fibrosis (F2) groups (P<0.001, P=0.000, P=0.010). Conclusions: The ESD procedure of large protruding colorectal tumors ≥20 mm is technically difficult. The rates of the en bloc resection and R0 resection are low, and the curative resection rate is even more lower. Muscle-retracting sign, severe submucosal fibrosis are the important factors that affecting the outcome of ESD operation.

Comparison between transmission technique and MBT straight wire technique in correction of protruding in adults / 中华医学美学美容杂志

Objective To evaluate the curative effect by using transmission straight wire appliance in treatment of adult patients with protruding,to compare with MBT straight wire technique,and to discuss their similarities and differences.Methods Totally 40 protruding patients were assigned into two groups randomly:the transmission straight wire technique group were treated with transmission straight wire appliance,and the MBT straight wire technique group were treated with MBT appliance together with extraoral arch or screw implant anchorage.Cephalometric measurements were compared before and after treatment.Results Average period of treatment was (19 ±4) months for transmission group and (23 ± 4) months for MBT group.The difference was statistically significant (P＜0.05).After treatment,U1/SN,U1/NA,U1-NA,L1/NB,L1-NB,U1-AP,L1-AP,UL-EP,LL-EP were significantly reduced for both patients groups (P＜0.01).U1/L1,nasolabial angle and z angle were increased for both groups (P＜0.05).MP/SN increased by 1.93°(P＜0.05)for transmission group vs.0.81° (P＞0.05) for MBT group.There was no statistically significant difference between the two groups (P＞0.05) except MP/SN (P＜0.05).However,the retraction of anterior teeth in transmission group was greater than that of MBT group,and U1/NA changed (-20.95±8.79)° in transmission group vs.(-16.00 ± 6.52)° in MBT group.Conclusions Both techniques can achieve satisfactory results for protruding cases.The transmission technology can improve soft tissue profile quicker,but anterior teeth have excessive vertical trend,where attention should be paid to control torque on anterior teeth.

Change of the facial profile in patients with protruding by fixed appliance and micro-implant / 中华医学美学美容杂志

Objective To examine the effects of fixed appliance and micro-implant on the improvement of facial profile in patients with protruding.Methods 30 protruding cases were treated by fixed appliance and micro-implant.Cephalometric data before and after treatment were measured and analyzed to assess the effects.Results The upper incisors were retracted 6.5 mm.The upper lip was retracted 3.8 mm.The lower incisors were retracted 5.8 mm.The lower lip was retracted 5.6 mm.UL-E was retracted 3.21 mm.LL-E was retracted 3.67 mm.NLA was changed from 86.7°to 103.7°.The U1-SN,U1-Y,L1-MP,L1-Y,UL-Y,LL-Y,UL-E,LL-E,and NLA demonstrated significant differences between pre-and post-treatment.Conclusions Fixed appliance and micro-implant might retract the anterior teeth and lead to an improvement of facial profile.

Cutaneous Schwannoma Presented as a Pedunculated Protruding Mass

Schwannoma is a benign neoplasm of the nerve sheath origin. It arises from the nerve sheath of large peripheral or cranial nerves and occurs at the level of the subcutaneous fat layer or deeper layer. Cutaneous schwannoma occurs more superficially and usually presents as a solitary dermal or subcutaneous nodule. We describe a case of cutaneous schwannoma that presented as an erythematous pedunculated protruding mass on the left flank of a 19-year-old female. It was clinically diagnosed as a granuloma pyogenicum. Shaving biopsy was conducted and histological examination revealed an encapsulated tumor mass containing dense, spindle-shaped cells whose nuclei are arranged back to back representing Verocay body, and a diagnosis of schwannoma was made. This is an unusual case of cutaneous schwannoma that presented as a pedunculated protruding mass.

Comparison of distribution of single nucleotide polymorphism in normal mandible and protruding mandible / 重庆医科大学学报

Objective:To study the differences of growth hormone recepto(rGHR)gene between normal mandible(control group)and protruding mandible(study group)in molecular level by comparing the gene's nucleotide sequences.Methods:In our study,we selected 100 individuals with protruding mandibles and 87 individuals with normal mandibles by the study criterions,diagnosed in Affiliated Stomatological Hospital of Chongqing Medical University during 2005～2006.5 ml venous blood was withdraw and the genomic DNA was isolated from the whole blood cells with the use of a DNA Blood Kit.PCR amplification was performed by a standard protocol to increase and sequence the aim gene in normal and protruding individuals.And then we compared the acquired gene sequences with the published ones in NCBI(national center for biotechnology information)database,finally found the positions of single nucleotide polymorphism(SNP)in exon 10 of GHR gene and calculated the allele frequency and genotype frequency in study and control groups by SPSS10.0.Results:One SNP position(including study and control groups)was found in our study and his nucleotide code was 1673.In this SNP position,there were two alleles(AC)and three genotypes(AC,AA and CC).The allele frequency and distributions of genotype had a significant difference by ?2 calculation in 0.01 level.Conclusion:Differences in sequences of growth hormone receptor gene exist in individuals with protruding mandibles and individuals with normal mandibles.

Clinical Experience in Treating Lumbar Compressed Fracture / 浙江中医药大学学报

[Objective]To discuss the methods selection for lumbar compressed fracture.[Method]137 cases were respectively treated with non-operation,AF nail,Z-Plate steel board internal fixation and protruding formation behind centrum.[Result]All were cured in 10~14w,(12?0.6)w in average;the pain VAS score,Frankel score,Cobb’s angle,the height of front and back edge of centrum were all relieved a lot after treatment,without operation sequela or marked loss of injured vertebra.[Conclusion]The methods shall be selected for lumbar compressed fracture under compressing degree,bone occupation degree in lumbar tube,nerve injure degree,stability of spine structure or fracture dislocation,etc.The stable fracture shall rest in bed with cushion under back.

A Clinical Study of Protruding Lesions That Arise at the Scar of an Endoscopic Mucosal Resection for an Early Gastric Carcinoma and a Gastric Flat Adenoma

PURPOSE: Several studies of an endoscopic mucosal resection (EMR) have been reported, but reports about benign protruding lesions that arise at the scar of EMR for early gastric cancer (EGC) or a gastric adenoma are rare. The purpose of this study was to elucidate endoscopic and histological characteristics of benign protruding lesions which arise at the scar of an EMR for EGC and a gastric flat adenoma. MATENRIALS AND METHODS: In 101 lesions (73 gastric flat adenomas and 28 EGCs) from 96 patients, 16 lesions developed new protruding lesions that arose at the scar of the EMR. We retrospectively analyzed the endoscopic findings of initial and protruding lesions, and several other clinical factors (H. pylori infection, eradication therapy, and proton pump inhibitor (PPI) or H2-blocker use). RESULTS: 1. The mean duration until detection of the protruding lesion was 8.9 months (1.5~7). Protruding lesions arose at the scar of the EMR in 1 of 28 EGCs (3.6%) and from 15 of 73 gastric flat adenomas (20.5%). All of the patients were men. 2. With respect to the endoscopic findings, the shapes of the protruding lesions were as follows: 10 Yamada (Y) I, 4 Y-II, 1 Y-III, and 1 flat lesion. Histological examination of the protruding lesions revealed regenerating hyperplasia in 5 lesions, intestinal metaplasia in 5, and both in 6. 3. The incidence of these lesions was higher in cases of tubular adenomas with focal high-grade dysplasia than in cases of tubular adenomas without dysplasia (p<0.05). 4. The incidence of H. pylori infection was higher in patients (81.7%) who developed a protruding lesion than in those (51.8%) who did not develop (p=0.029); also, the incidence of use of PPI was higher in those patients (p=0.045). However, eradication therapy for H. pylori and duration of use of PPI or H2-blocker showed no difference between groups. CONCLUSION: It may be possible that the potential hyperplasia that may reside in normal mucosa surrounding EGC or a gastric adenoma might awaken during the healing process of the EMR ulcer and develop to benign protruding lesions. And, H. pylori and PPI might also be related to the development of the protruding lesions.