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Objective:To investigate the diagnosis and treatment of multicentric Castleman disease (MCD).Methods:The diagnosis and treatment of one MCD patient admitted in Hangzhou First People's Hospital in July 2020 was analyzed and related literatures were reviewed.Results:The patient was a 55-year-old male with anemia, elevated globulin levels and IgG4 > 10 g/L, and enlarged lymph nodes. He was undiagnosed for 7 years. Lymph node biopsy revealed a large number of polyclonal plasma cell hyperplasia, and the ratio of IgG4/IgG was less than 0.40; the serum interleukin (IL)-6 was more than 6 000 pg/ml and then he was eventually diagnosed as MCD (plasma cell type). Rituximab + cyclophosphamide + dexamethasone (RCD) regimen was not effective, and it was changed to anti-IL-6 receptor antibody tocilizumab for 2 courses and then the patient obtained good results.Conclusions:Castleman disease is a rare disease with a poor prognosis. It has high heterogeneity and is easy to be misdiagnosed clinically. The diagnosis requires pathological examination. IL-6 is considered to be closely related to the onset of Castleman disease and has become an effective target for treatment.
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Objective To evaluate enhanced recovery after surgery (ERAS) in the treatment of cholecystolithiasis complicated with extra hepaticbile duct stones by laparoscopy and choledochoscopy.Methods Patients were divided into ERAS and control groups according to the inclusion and exclusion criteria.Patients in ERAS group received perioperative management according to enhanced recovery rehabilitation program.Clinical and laboratory results were compared between the two groups.Results 46 patients were enrolled into ERAS group and 40 patients into control group.The ERAS group had shorter time of first postoperative exhaust,first postoperative oral intake,getting out of bed,removal of abdominal drainage tube,postoperative hospital stay (respectively t =-3.658,-15.552,-8.864,-6.673,-6.036,all P ＜ 0.05),less pain in 6,12,24 and 48 hours after operation (F =8.284,P =0.000),and lower complication rate (x2 =4.172,P =0.043),lower C-reactive protein (CRP) level from pre-operation to postoperative day 1,3 and 5 (F =6.692,P =0.013),higher level of prealbumin (PA) from preoperation to postoperative day 1,3 and 5 (F =21.191,P =0.000),lower hospitalization costs (t =-0.592,P =0.004).Conclusion The application of ERAS in the treatment of cholecystolithiasis complicated with extrahepatic bile duct stones by laparoscopy combined with choledochoscopy is conducive to rapid postoperative recovery of patients.
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Objective To investigate the effects of aspirin on the morphology and wall structure of the intracranial aneurysm induced by hemodynamics.Methods Twenty-six SD rats were randomly divided into three groups:a control group,a model group,and an aspirin group.The right common carotid artery,left external carotid artery,and pterygopalatine artery were ligated in order to change the hemodynamics of left internal carotid artery.After 3-month induction,the anterior communicating artery complex were harvested after heart perfusion.The aneurysm-like structure was observed using a scanning electron microscope and was graded.The changes of elastic hyer and smooth muscle cells in the tunica media were detected by pathological examination.Results Aneurysm-like remodeling was observed both in the model group and in the aspirin group,and there was no statistical differences in morphological grade between the 2 groups (P =0.054).Pathological examination showed the folds or loss of the internal elastic lamina and thinned media smooth muscle layer both in the model group and in the aspirin group.The length of thinned media in the model group was significantly higher than that in the aspirin group (173.50 ± 17.62 μm vs.153.50 ± 12.04 μ,m;t=2.964,P=0.008).Conclusions Aspirin can slow down the pathological remodeling of intracranial aneurysm wall,but it cannot completely inhibit the formation of intracranial aneurysm.
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To retrospectively analyze the prognostic significance of plasma Epstein -Barr virus (EBV) DNA in 122 patients with diffuse large B cell lymphoma (DLBCL).Plasma EBV DNA positivity was related to advanced disease stage ( P =0.030 ) , B symptoms ( P =0.004 ) and elevated serum lactic dehydrogenase (LDH) (P=0.001).Furthermore, univariate analysis indicated that plasma EBV DNA level was associated with worse overall survival (OS) (HR=0.223, 95%CI 0.096-0.518, P<0.001) and worse progression free survival (PFS) (HR =4.417, 95%CI 1.911 -10.208, P <0.001), whereas multivariate analysis showed plasma EBV DNA as a probable independent prognostic factor of clinical outcome(HR=0.409, 95%CI 0.166-1.008, P=0.052).
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Objective To investigate the influence of different pancreaticojejunostomy on the incidence of postoperative pancreatic (PF) fistula in pancreaticoduodenectomy (PD).Methods The clinical data of 343 patients undergoing radical PD from January 2011 to December 2015 were collected.343 patients were divided into 3 groups,including 124 cases of continuous lamellar duct-to-mucosa pancreaticojejunostomy (CL-DMP) (group A),111 cases of invaginated pancreaticojejunostomy (group B) and 108 cases of binding pancreaticojejunostomy (group C).The rates of postoperative PF and related complications,length of postoperative hospital stay,perioperative mortality and hospitalization costs were compared between the 3 groups.Results There was no statistical difference in the size of pancreatic duct between the 3 groups (P ＞ 0.05).The postoperative PF incidence of group A was 4.84％,significantly lower than 13.51％ in group B and 15.74％ in group C,respectively (P ＜0.05).The anastomosis took less time and postoperative hospital stay was shorter in group A than that in the other 2 groups (P ＜0.05).Conclusion CL-DMP is time-saving,safe and effective method of pancreaticojejunostomy during the process of pancreaticoduodenectomy.
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Objective To investigate the influence of different pancreaticojejunostomy on the incidence of postoperative pancreatic (PF) fistula in pancreaticoduodenectomy (PD).Methods The clinical data of 343 patients undergoing radical PD from January 2011 to December 2015 were collected.343 patients were divided into 3 groups,including 124 cases of continuous lamellar duct-to-mucosa pancreaticojejunostomy (CL-DMP) (group A),111 cases of invaginated pancreaticojejunostomy (group B) and 108 cases of binding pancreaticojejunostomy (group C).The rates of postoperative PF and related complications,length of postoperative hospital stay,perioperative mortality and hospitalization costs were compared between the 3 groups.Results There was no statistical difference in the size of pancreatic duct between the 3 groups (P ＞ 0.05).The postoperative PF incidence of group A was 4.84％,significantly lower than 13.51％ in group B and 15.74％ in group C,respectively (P ＜0.05).The anastomosis took less time and postoperative hospital stay was shorter in group A than that in the other 2 groups (P ＜0.05).Conclusion CL-DMP is time-saving,safe and effective method of pancreaticojejunostomy during the process of pancreaticoduodenectomy.
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Objective To improve the understanding of clinician' treatment of pregnancy with acute lymphoblastic leukemia. Method To analyze tretrospectively the diagnosis and treatment process of 1 case with acute lymphoblastic leukemia from December 13, 2016, and discuss the selection of the timing of termination of pregnancy. Results The patient was a 28 years old female. She was dignosed for acute lymphocytic leukemia in the third trimester. She bore a healthy baby boy in caesarean section after a dexamethasone treatment for two days. Then she recevied a series of standard chemotherapy. But she suffered a cerebral hemorrhage during treatment, and surgical pathology made a definite dignosis of central nervous system leukemia.Finally, She was out of danger after rescue. Conclusion Postoperative chemotherapy is a feasible option for the treatment of acute leukemia after the termination of pregnancy.
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Objective To study carbon nanoparticles lymphatic tracer to guide surgery for gallbladder cancer.Methods 120 patients with gallbladder cancer were randomized into two groups:the experimental group (n =60) and the control group (n =60).For the experimental group,0.1 ml carbon nanoparticles was injected at 4 ～ 6 locations subserosally around the cancerous site intraoperatively.Stained lymph nodes were used as markers to guide lymphadenectomy.The resected specimens were carefully dissected,and then the lymph nodes were studied according to their positions by histopathological examinations.Results Various degrees of stained lymph nodes were seen in the specimens.In the experimental group,the number of lymph nodes (12.0 ± 3.8),and metastatic lymph nodes (6.3 ± 3.3) per patient were obviously higher than those in the control group (9.2 ± 3.6、4.4 ± 2.8),respectively,(P ＜ 0.05).There were significant differences (P ＜ 0.05) in postoperative disease-free survival and overall survival.Conclusions Intraoperative injection of carbon nanoparticles enhanced lymph node clearance and increased the number of lymph nodes and metastatic lymph nodes dissected,which helped to guide pathological staging.There were significant improvements in disease-free survival and overall survival of these patients with gallbladder cancer after surgery.
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Objective To investigate and analyze the experience of planting and maintaining implantable venous access ports(IVAP) in management of post-operative breast cancer patients. Methods Breast cancer pa-tients receiving IVAP after surgery from Mar. 2011 to Jun. 2014 were retrospectively analyzed. The relative com-plications were documented and summarized during implanting operation. Results 468 patients received IVAP, among whom 451 patients underwent piercing implantation via right internal jugular vein, 15 patients underwent piercing implantation via right subclavian vein, and 2 patients underwent piercing implantation via left internal jugular vein. The mean cathe tering leng th was 12.8 cm for patients receiving IVAP via right internal jugular vein, ranging from 12 to 15 cm. Thereinto, 30(6.4%) patients experienced shot-term complications including 16 cases of puncture difficulty, 5 cases of accidental arterial puncture, 2 cases of extravasation, 2 cases of blood aspiration dif-ficulty and 5 cases of arrhythmia. Three cases had long-term complications as the following:one case of catheter-re-lated infection, one case of catheter lost, and one case of incision rupture. Conclusions IVAP is a safe and effec-tive intravenous infusion device. It is crucial to choose individualized implanting access and length by professional surgical team.
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In medical clinical practice, physicians need to acquire the image and text information of the patient. All the information will be of benefit for physicians to diagnose disease, improve clinical treatment, and do research work. But the information is distributed in different systems, such as medical image information in PACS (Picture Archiving and Communication System) and text records in HIS (Hospital Information System). Today many hospitals are suffering from lack of an integrated system with PACS and HIS. This paper compares PACS with HIS and puts forward a distributed integration method of integrating the PACS and HIS with the prevailing WWW technology. In such a method, the image and the text information are regarded as the common object and the operation whereon as the object operation. Thus the method integrates the PACS with HIS effectively and implements the information resources sharing with the use of web technology.
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Redes de Comunicación de Computadores , Sistemas de Información en Hospital , Sistemas de Información Radiológica , Diseño de SoftwareRESUMEN
For acquisition of the gene chip information, how to correctly locate the probe dots in the chip's scanning image is the base of the chip information processing. Here we present a new approach for locating the probe dots in the gene chip image. First, a medialness function, which is good at detection of circle area with radius given in advance, is used for calculating the medialness map in which the center of circle sample area of the gene chip image is disclosed prominently. Then, a method to locate the probe dots center is given based on the medialness map and the 2D space configuration of the probe dots. The experiments show that the new approach correctly locates the probe dots while against noise affection robustly.