Prognostic value of liver function after radical excision in patients with intrahepatic cholangiocarcinoma / 第二军医大学学报

Objective To analyze the prognostic factors influencing the survival of patients with intrahepatic cholangiocarcinoma (ICC) after radical excision. Methods The clinical data of ICC patients who were treated with radical excision from March 2009 to March 2014 in our hospital were retrospectively analyzed. A total of 32 clinical or laboratory findings were selected , and the risk factors influencing the survival of ICC patients after radical excision were analyzed by univariate analysis and Cox regression model. Results Ultimately 189 patients were included in this study. Multivariate analysis showed that tumor size , number of intrahepatic tumors , lymph node metastasis , pre-operation serum CA19-9 and .-glutamyl transferase levels , one-day postoperative total bilirubin and five-day postoperative alanine aminotransferase levels were the independent prognostic factors for the survival of ICC patients after radical excision (P<0.05). Conclusion The one-day postoperative total bilirubin and five-day postoperative alanine aminotransferase may be used to predict the prognosis of ICC patient after radical resection. Preoperative and postoperative liver supporting treatment , minimizing liver trauma during operation , and improving the nutritional status can improve the prognosis of ICC patients.

Pilonidal Cysts Occurring in the Sacrococcygeal Region and that were Misdiagnosed as a Simple Abscess / 대한정형외과학회잡지

A pilonidal cyst is known to be a recurrent infectious disease in the sacrococcygeal region and it usually affects adolescents and adults. It is often misdiagnosed as a simple abscess or a sebaceous cyst, so there are many patients with pilonidal cysts who have gone through several operations. Although many treatments for this malady have been reported, the principle treatment for pilonidal cysts is radical excision. We report here on two cases of pilonidal cyst and the patients were misdiagnosed as having a simple abscess. We planned to perform incision and drainage, but the lesions were finally diagnosed as pilonidal cysts and so we performed radical excision for the treatment. We also review the medical literature on abscesses that occur in the sacrococcygeal region in early adulthood.

External Oblique Myocutaneous Flap for Reconstruction of Large Chest-Wall Defects following Resection of Advanced Breast Cancer

PURPOSE: Major chest wall reconstruction following radical excision of advanced breast cancer is remained a challenging treatment of oncoplastic surgeons. The aims of this study are to introduce a method of external oblique myocutaneous flap (EOMCF) and evaluate the effect of large chest wall reconstruction using external oblique myocutaneous flap. METHODS: A retrospective review of 17 patients who underwent chest wall reconstruction with external oblique myocutaneous flap from January of 2007 through May of 2008 was performed. The upper edge of external oblique myocutaneous flap was lower margin of defect. The medial edge was mid-line of abdomen by umbilicus, vertically along the linea alba. The lower edge was a lateral transverse line at the level of umbilicus. The flap was rotated clockwise in the left side chest wall defects and counterclockwise in the right. RESULTS: The mean chest wall defect was 360.8+/-137.8 cm2 and the mean flap size was 591.1+/-136.2 cm2. The mean reconstruction time was 41.5+/-7.9 min and patients were discharged on 8.8+/-1.2 postoperative day (mean). Three patients had superficial skin loss (<5%) and this lesions are healed with conservative therapy. CONCLUSION: We propose that the external oblique myocutaneous flap may be a safe and feasible method for reconstruction of large chest wall defects after radical mastectomy including all breast skin.

Management with Radical Excision in Squamous Cell Carcinoma of the Lacrimal Sac

PURPOSE: Squamous cell carcinoma of the lacrimal sac is rare and there is high rate of recurrence after dacryocystectomy. We report successful radical excision of the tumor for the purpose of reducing the recurrence and improving the survival rate. METHODS: A 48-year-old man who had a history of epiphora and medial canthal mass for one year was referred to our clinic. CT scan showed a mass on the lacrimal fossa but there was no evidence of bony destruction or local invasion. We confirmed that the excised mass was squamous cell carcinoma of the lacrimal sac by frozen section. So, radical excision including bony and mucous nasolacrimal duct (NLD), inferior turbinate, and medial maxilla was performed through lateral rhinotomy. RESULTS: Ten months later, there was skin defect and medial canthal deformity. So we corrected the deformity with a forehead free flap and the result was cosmetically acceptable. There was no evidence of recurrence or distant metastasis for one- year follow- up period. CONCLUSIONS: Despite its high recurrence rate, we can reduce the recurrence and mortality rate of squamous cell carcinoma of the lacrimal sac with radical excision including bony and mucous NLD, inferior turbinate, and medial maxilla.

Tuberculous Spondylitis in a Hemodialysis Patient / 대한신장학회잡지

Patients undergoing maintenance dialysis show an increased susceptibility to tuberculosis because host immunity is decreased secondary to malnutrition, impaired cellular immunity, acidosis and etc. Extrapulmonary tuberculosis is more prevalent in patients with end stage renal disease than in normal subjects. Among the extrapulmonary tuberculosis in patients receiving hemodialysis, the diagnosis of tuberculous spondylitis is difficult because the symptoms are non specific and attributable to uremia, and the appearance of plain radiographs is often normal during the early phase of the disease. We experienced a case of tuberculous spondylitis in a hemodialysis patient. A 55 years old female admitted with fever, weight loss and back pain. Conventional radiograph of T-spine showed no definite abnormal finding. However, chest CT revealed heterogeneously enhancing soft tissue around the T8 vertebral body and T-spine MRI showed compatible finding to tuberculous spondylitis. She received radical excision of involved vertebra and confirmed tuberculous spondylitis with histologic finding from a surgical specimen. Following the administration of anti-tuberculosis medication(isoniazid, rifampin, pyraziamide, ethambutol) and radical excision, patient's symptom and sign were improved. The patient is maintaining dialysis with anti-tuberculosis medication for 5 months.

Laparoscopic Cholangiotomy for Radical Excision of Upper Cholangiocarcinoma / 中国微创外科杂志

Objective To evaluate the feasibility of laparoscopic cholangiotomy for radical excision of upper cholangiocarcinoma. Methods Four trocars were placed at the umbilical area, right upper and lower abdomen, and below the xiphoid. A 3 cm incision was made at the left upper abdomen for Roux-en-Y jejunojejunostomy. The gallbladder, inferior segment of the left medial liver, and the middle-upper segment of the bile duct were resected. And then the tumor and the adjacent 1 cm bile duct were excised. Afterwards, the proper hepatic artery, portal vein, and the surrounding connective tissues and lymph nodes were removed. Finally, the bile-jejunum Roux-en-Y anastomosis was performed. Results The hepatic duct bifurcation was involved by the cholangiocarcinoma in all the 4 cases. The diameter of the tumor was 1-1.5 cm. The resection of the inferior segment of the left medial liver and middle and upper segments of the bile duct, and dissection of the lymph nodes at the hepatic porta were completed successfully. The operation was accomplished in all the cases with an operation time of 270, 255, 270, and 230 mins, and the intraoperative blood loss was 500, 400, 300, and 400 ml, respectively. Postoperative pathological examination showed highly differentiated adenocarcinoma in all the cases. Cases 2 and 3 developed bile leakage after the operation and were cured 20 or 15 days later. In all the cases, the jaundice disappeared after the operation. Their appetite recovered, and the body weight was increased by 3, 3.5, 2, and 2 kg, respectively. Conclusions Upper cholangiocarcinoma can be radically excised by using laparoscopy. The resection of cholangiocarcinoma and part of liver tissues, dissection of surrounding connective tissues and lymph nodes, and bile duct reconstruction can be accomplished under a laparoscope. Thus,we consider that laparoscopic cholangiotomy is feasible for radical excision of upper cholangiocarcinoma.

Complete Removal of Giant Craniophanyngioma by Drainage Through the Ommaya Reservior

Craniopharyngioma is one of the most challenging, Frustrating, and humbling benign intracranial tumors of childhood. Its behavior is a clinical malignancy even though it is benign tumor in microscopically. There is no single treatment of craniopharyngioma and there must be a plan customized for eacg patient. This decision may, be made from diagnostic studies alone, but in most cases exploration of the tumor and the testing of its adherence to its surroundings will be the only thorough and fair way to determine whether it can be totally excised or not. So the choice of treatment is "individualize". We experienced one case of giant cystic craniopharyngioma and performed combined operaion whih were percutaneous intermittent drainage of cystic fluid through Ommaya reservoir and following microsurgical radial excision. There was no complication and marked intellectual and psychological improvement until todays for 20 months.

Sucessful Treatment of A Giant Craniopharyngioma:Combined Preoperative Stereotactic Cyst Drainage and Microsurgical Radical Excision: A Technical Note

Even though the craniopharyngioma was benign neoplasm pathologically, actually it is a clinical malignancy because its troublesome, harzardous and difficult surgical excision with high surgical mortality, morbidity and also high recurrency, especially in cases of giant sized tumor which diameter was over the 3 cm. The authors present a technical note of a giant craniopharyngioma which was mixed tumor of huge sized cystic portion and calcified solid portion in 10 years old female patient, and its diameter was 9 cm. The surgical technique of complete radical excision of tumor was staged combined method as initial percutaneous gradual drainage of cystic fluid by EVD system which was placed by stereotactic method and followed by successful radical extirpation of remaining cyst wall and solid mass by pterional-trans-sylvian microsurgical approach. There was no complication during and post-operatively.

Metastatic Alveolar Soft Part Sarcoma

A case of metastatic alveolar soft part sarcoma is presented with clincal, pathological and radiological features. Alveolar soft part sarcoma is a rare soft-tissue neoplasm that is malignant and invariably fatal. It was first described and named by Christopherson, et al. in 1952. Since 1952 numerous examples of this tumor have been reported and have been studied with the electron microscope, but there is still considerable uncertainty as to the exact histogenesis of the tumor. Most cases occur in young females involving the lower extrimities especially in the right side. The most initial presenting symptom is a slowgrowing painless mass and the principal metastatic sites are the lungs, followed by the brain and skeleton. Cerebral metastasis, in fact, may be the first manifestation of the disease. Treatment is radical surgical excision but radiotherapy and chemotherapy are less effective. We present the reported case of metastatic alveolar soft pat sarcoma with electron microscopic findings.