Preliminary clinical experience of transrectal ultrasonography in early rectal cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the accuracy of transrectal ultrasonography (TRUS) in the assessment of the invasion depth of rectal cancer, and analyze the value of TRUS in diagnosis of early rectal cancer.</p><p><b>METHODS</b>TRUS was performed preoperatively in 163 patients with rectal cancer, and the results was compared with the postoperative pathological findings according to TNM staging. The early rectal cancer was diagnosed if the lesion was limited to mucosa and submucosa. The tumor located in mucosa was defined as mucosal cancer, while as submucosal cancer when the tumor invading into submucosa. Sixteen cases were confirmed as early cancer by pathology after the operation. No patients received chemotherapy and radiotherapy before operation.</p><p><b>RESULTS</b>The sensitivity of TRUS in the staging of the early rectal cancer was 87.5% (14/16), specificity was 98.6% (145/147), and the positive predictive value was 87.5% (14/16). The sensitivity of TRUS in predicting mucosal and submucosal cancer was 85.7% (6/7) and 66.7% (6/9), respectively. Sixteen patients with early rectal cancer were examined before and after filling rectum with water. After filling rectum, all tumors were visualized clearly, while 14 tumors were correctly diagnosed as early rectal cancer. Before filling rectum, only 6 tumors were visualized clearly, and 3 tumors were staged correctly. The ultrasonographic appearance of early rectal cancer manifested in two kinds: protruded and ulcerative, and most were protruded (81.6%).</p><p><b>CONCLUSIONS</b>TRUS is a valuable imaging examination for diagnosis of early rectal cancer preoperatively. Visualization rate and diagnostic accuracy of early rectal cancer are improved dramatically after filling rectum with water.</p>

Intraperitoneal hemorrhage during and after percutaneous radiofrequency ablation of hepatic tumors: reasons and management / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Intraperitoneal hemorrhage is one of the most common complications of radiofrequency (RF) ablation of hepatic tumors. This study was designed to investigate the reason and management of intraperitoneal hemorrhage occurred during or after percutaneous RF ablation of hepatic tumors.</p><p><b>METHODS</b>Three hundred and fifty-six patients with hepatic tumors have been treated at 592 procedures of ultrasound guided RF ablation. Intraperitoneal hemorrhage occurred in 5 patients (0.8%). The reasons and management of intraperitoneal hemorrhage in these 5 cases were retrospectively analyzed.</p><p><b>RESULTS</b>Two patients with liver metastasis and one hepatocellular carcinoma (HCC) patient suffered from hemorrhage during the RF treatment. Two patients with recurrent HCC after surgery developed hemorrhage 20 minutes or 4 hours after RF treatment. One case of hemorrhage was due to the inappropriate electrode positioning induced liver laceration while treating a 1 cm liver metastasis near the liver capsule. One was due to the injury of a small vessel by the RF needle in another liver metastasis patient. Three cases were due to tumor rupture with two cases induced by cough or position change after treating large protruding HCC lesions. Four (80%) of the 5 cases of hemorrhage were rapidly identified by ultrasound. The causes and sites of bleeding during the RF treatment in three cases were confirmed through ultrasound, which were successfully treated using RF coagulation to achieve hemostasis of the bleeding site. Two patients with post-ablation hemorrhage recovered in one hour and 24 hours, respectively after given blood transfusion and other conservative measures. No surgical intervention was required. Two patients died of wide spread metastasis 23 - 36 months afterwards and the other three patients have lived for 18 - 25 months to date.</p><p><b>CONCLUSIONS</b>It is important to perform close monitoring during and after RF ablation in order to identify intraperitoneal hemorrhage in time. RF ablation of the bleeding sites was a simple and effective management when the bleeding site could be confirmed by ultrasound. The hemorrhage due to the rupture of large and protruding liver tumors could be serious and should be considered as contraindication for RF treatment.</p>