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We reported a case of fetus with right atrial isomerism diagnosed by ultrasound prenatally. Right atrial isomerism was suspected based on several kinds of abnormalities detected at 24 gestational weeks by ultrasound imaging, such as levocardia complicated by complex cardiovascular malformations (double outlet of right ventricle, atrioventricular septal defect, pulmonary artery dysplasia, bilateral superior vena cava and infracardiac total anomalous pulmonary venous drainage), abnormal right-sided stomach bubble, midline liver, suspicious absence of the spleen, juxtaposition of the abdominal aorta and the inferior vena cava to the left side, and mirror-image right bronchia. Autopsy confirmed all of the prenatal diagnosis with an additional finding of splenic dysplasia. Right atrial isomerism should be considered when ultrasound findings indicate complex cardiovascular malformations. Given the high mortality rate of right atrium isomerism, prenatal diagnosis is of great importance.
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The Japanese Society for Cancer of the Colon and Rectum (JSCCR) published the guidelines 2019 for the treatment of colorectal cancer in March 2019. The new edition expanded the indications of endoscopic treatment, enriched the follow-up recommendations after endoscopic resection of early colorectal cancer, supplemented the indications of ISR and added the recommendations of lymph node recurrence and peritoneal recurrence. In the new edition, the adjuvant and palliative chemotherapy schemes were revised and patients with first-line chemotherapy were divided into three categories as follows: appropriate for intensive systemic therapy (fit), inappropriate for intensive systemic therapy (vulnerable), and inappropriate for systemic therapy (frail). The new edition of guidelines can also provide references to the doctors of colorectal cancer in our country. This article intends to interpret the essentials of this new edition.
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Cor triatriatum sinister (CTS) is characterized by the presence of a fibromuscular membrane dividing the left atrium into two chambers. The postero-superior and proximal chamber of CTS receives blood from four pulmonary veins, whereas the antero-inferior and distal chamber (true left atrium) connects to mitral valve and left atrial appendage (LAA). CTS can be classified into two types, complete and partial CTS. We reported a case of fetal autopsy-confirmed complete CTS that had been misdiagnosed as atresia of the common pulmonary vein on prenatal ultrasound. At 25 gestational weeks, fetal sonography revealed that the pulmonary venous angle on the top of the left atrium disappeared and no vertical vein was found around the common pulmonary venous cava formed by bilateral pulmonary veins. Thus, atresia of the common pulmonary venous cava was considered. Fetal autopsy after induction further confirmed the case was complete CTS.
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Cor triatriatum sinister (CTS) is characterized by the presence of a fibromuscular membrane dividing the left atrium into two chambers. The postero-superior and proximal chamber of CTS receives blood from four pulmonary veins, whereas the antero-inferior and distal chamber (true left atrium) connects to mitral valve and left atrial appendage (LAA). CTS can be classified into two types, complete and partial CTS. We reported a case of fetal autopsy-confirmed complete CTS that had been misdiagnosed as atresia of the common pulmonary vein on prenatal ultrasound. At 25 gestational weeks, fetal sonography revealed that the pulmonary venous angle on the top of the left atrium disappeared and no vertical vein was found around the common pulmonary venous cava formed by bilateral pulmonary veins. Thus, atresia of the common pulmonary venous cava was considered. Fetal autopsy after induction further confirmed the case was complete CTS.
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Malignant acute abdomen is an acute abdominal disease caused by abdominal and extra-abdominal malignant tumors or secondary to various treatments for tumors, and belongs to the category of oncologic emergencies. Malignant acute abdomen includes perforation, bowel obstruction, infection and bleeding, etc. Most of the malignant acute abdomen is urgent and critical. The postoperative morbidity and mortality of these patients are high. The treatment strategy should ideally be discussed by a multidisciplinary team, which is often infeasible in the emergent setting. Surgery should be the main measures to improve survival and quality of life, but the risk of death should be fully evaluated before surgery to determine whether the surgery can benefit patients. In addition, the timing of surgery depends mostly on the surgeon. This article explores the treatment of malignant acute abdomen from the perspective of surgical oncology.
Assuntos
Humanos , Abdome Agudo , Terapêutica , Neoplasias Abdominais , Terapêutica , Oncologistas , Equipe de Assistência ao Paciente , Qualidade de VidaRESUMO
We reported a case of trisomy 18 with Abernethy malformation diagnosed by prenatal ultrasound, which was confirmed by chromosome karyotyping after cordocentesis and fetal autopsy. At 24 gestational weeks, fetal sonography revealed a fetus with multiple malformations (cleft lip/cleft palate of left side, left radial dysplasia, hooked hands, bilateral pes valgus, ventricular septal defect, and congenital extrahepatic portocaval shunt), which was diagnosed as trisomy 18 syndrome with Abernethy malformation. The fetus's karyotype was 47, XX+18.
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There are two major stage classification systems for gastric cancer: the tumor-node-metastasis (TNM) staging by the International Union against Cancer (UICC)/the American Joint Committee on Cancer(AJCC) and the Japanese Classification of Gastric Carcinoma by the Japanese Gastric Cancer Association(JGCA). The evolution of these two systems showed the advancement of gastric cancer treatment. The independence of TNM and JGCA staging system is not conducive to global communication and cooperation. The integration of 2010 Japan's 14th edition of the General Rules for Gastric Cancer Study and the 7th edition of UICC/AJCC TNM staging formed an internationally unified clinical staging system. TNM staging determined by the N factor according to the number of lymph node metastasis more accurately stratified the survival curves of different stages. On January 1, 2018, the 8th edition of the TNM staging system for gastric cancer was officially implemented. The 8th edition of TNM staging provided a new definition of the staging criteria for esophagogastric junction cancer. On the basis of a single staging system, clinical TNM staging(cTNM) and neoadjuvant treatment staging (ypTNM) were added. N3a and N3b were seperately staged, and adjustments were made to the histological grading. A comprehensive treatment plan was determined by accurate clinical staging in the model of multidisciplinary diagnosis and treatment for gastric cancer. Comprehensive application of endoscopic ultrasonography (EUS), multi-slice spiral CT(MDCT), positron computed tomography combined with CT(PET-CT), and staging laparoscopy can improve the accuracy of preoperative staging of gastric cancer. The emergence of ypTNM staging is a highlight of the 8th edition of the staging, but due to insufficient case data for cTNM and ypTNM staging, the staging criteria are relatively broad, and more data validation, refinement and revision are required in the future. The 8th edition system is superior to the 7th edition system in terms of homogeneity, discriminatory ability, and monotonicity of gradients for Chinese patients with gastric cancer. The new version of the staging can guide clinicians to develop treatment plans more rationally, evaluate the treatment more scientifically, and assess the prognosis more accurately. New lymph node staging methods such as metastatic rate(rN), log odds of positive lymph nodes (LODDS), and a new staging system based on the anatomical range of lymph node metastasis can also better predict the prognosis of patients. At present, molecular type of gastric cancer has little significance for prognosis guidance, and may be rewritten or supplemented with TNM staging of gastric cancer in the future. This article discusses the history, current status and research progress of gastric cancer staging.
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Objective To investigate the risk factors for malignant middle cerebral artery infarction (MMI) in different age groups.Methods Patients with middle cerebral artery infarction were analyzed retrospectively.They were divided into a young and middle-aged group (＜ 60 years) and an elderly group (≥60 years).The demography and vascular risk factors,stroke etiologies,baseline blood pressure,drug use before onset and common blood test results in patients with MMI and non-MMI were compared in general cases and each age group.Multivariate logistic regression analysis was used to determine the independent risk factors for MMI.ResultsA total of 912 patients with middle cerebral artery infarction were enrolled,including 299 females (32.79％) and 613 males (67.21％);401 young and middle-aged patients (43.97％) and 511 elderly patients (56.03％);159 patients in the MMI group (17.43％),and 753 (82.57％) in the non-MMI group.Multivariable logistic regression analysis showed that hypertension (odds ratio [OR]6.962,95％ confidence interval [CI] 1.349-35.934;P=0.021) and NIHSS score (OR 1.551,95％ CI 1.384-1.737;P ＜0.001) were the independent risk factors for MMI.Subgroup analysis showed that NIHSS score (OR 1.402,95％ CI 1.239-1.588;P＜0.001) was an independent risk factor for MMI in young and middle-aged patients;hypertension (OR 10.752,95％ CI 1.213-95.295;P =0.033),diastolic blood pressure (OR 1.080,95％ CI 1.002-1.164;P=0.044),and NIHSS score (OR 1.504,95％ CI 1.281-1.765;P＜ 0.001) were the independent risk factor for MMI in the elderly patients,while systolic blood pressure (OR 0.938,95％ CI 0.893-0.986;P =0.011) was an independent protective factor.Conclusions The baseline NIHSS score was an independent risk factor for MMI in each age group.Hypertension and diastolic blood pressure were the independent risk factors for MMI in the elderly patients,while systolic pressure was an independent protective factor.Therefore,timely NIHSS assessment and appropriate hypertension management had important significance for the prevention and treatment of MMI.
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Objective:To develop a catalytic system for the asymmetric Morita-Baylis-Hillman ( MBH) reaction of conjugated ni-troalkene with activated aldehyde, and screen out the chiral catalysts with high activity and enantioselectivity. Methods: Totally 21 chiral organocatalysts were applied in the asymmetric MBH reaction ofβ-nitrostyrene with ethyl glyoxylate, and the ee value was deter-mined by chiral HPLC. The effects of temperature, solvent and substrate ratio on the catalytic reaction were investigated. Results: In the presence of cinchona alkaloid catalyst (DHQ)2AQN, β-nitrostyrene reacted with ethyl glyoxylate in toluene at 0℃ affording the MBH adduct in 60% yield with good enantioselectivity (up to 56.9% ee). Conclusion: The bis-cinchona alkaloids with aromatic bridging group are the efficient catalysts for the asymmetric MBH reaction ofβ-nitrostyrene with ethyl glyoxylate, and moderate isolated yield and enantioselectivity are obtained.
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Gastric cancer is one of the most common types of cancer worldwide. In China, approximately 42%of new cancer cas-es are documented. However, the prognosis of advanced gastric cancer remains poor because of high recurrence and metastatic rates. In gastric cancer patients with peritoneal metastasis, malignant bowel obstruction (MBO) is often detected. Many of these patients endure excruciating pain because of ineffective diagnosis and treatment. In recent years, the symptoms of many patients with MBO have been effectively relieved after somatostatin and other drugs have been administered. Other patients with MBO have been provided the chance to undergo chemotherapy, and their survival time has been prolonged. Hence, the diagnosis and treatment of these patients could be im-proved by further advancements in basic and clinical research in cancer therapy.
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Objective Evaluation of cerebral blood flow in patients with transient ischemic attack (TIA) using cerebral CT perfusion imaging.Methods CT perfusion scan was performed on a consecutive series of 20 patients with clinical definite TIA.Following their initial CT scan at acute stage of TIA, patients underwent two repeat CT perfusion scanning of region of interest at acute stage and one month after symptom remission.Results Mild to moderate decrease in regional cerebral blood flow (rCBF) and unchanged or mildly decrease in regional cerebral blood volume (rCBV) were observed at acute stage in the majority cases.Normal cerebral perfusion was found in 12 cases and mild to moderate decrease of rCBF in 8 cases one month after TIA.During the one-year follow-up period, all of 12 cases with normal cerebral perfusion did not have recurrence while among 8 cases with mild to moderate decrease of rCBF at initial scan, 6 cases had recurrent TIA or cerebral infarction and 2 cases did not have recurrence.Patients with more severe cerebral perfusion defects usually had a shorter interval time between two attacks.Conclusions Intensive intervention should be performed on patients with severe and long lasting decrease of cerebral perfusion.