Classification of anal fistulas based on magnetic resonance imaging / 中华胃肠外科杂志

OBJECTIVE@#To explore the diagnostic value of magnetic resonance imaging(MRI) in anal fistula.@*METHODS@#A total of 2160 patients were clinically diagnosed with anal fistula at the Sixth Affiliated Hospital of Sun Yat-sen University from March 2010 to September 2015. Among them, 232 cases with operative history at other hospital, 218 with Crohn's disease, 6 with rectum cancer and 8 with other disease were excluded, and 1696 patients were finally enrolled and retrospectively analyzed. The saggital FSE T2WI imaging was confirmed based on the midline of body, and then the coronal and axial scanning line were confirmed. The key point was that the coronal scanning line must parallel and the axial scanning line must be perpendicular to the major axis of anal canal. The characteristics of anal fistula were recorded, and anal fistula were classified as five types, including intersphincteric, transphincteric, suprasphincteric, extrasphincteric and superficial fistula according to the Parks classification and our experience. The distribution of internal opening was described by using lithotomy position clock method.@*RESULTS@#Of 1696 patients, 1456 were males and 240 females with median age of 26.5 (0.2 to 87.0) years. Age of 8.4% (143/1696) cases was under 20 years old, of 57.4%(973/1696) cases was between 20 to 40, of 28.4%(482/1696) cases was between 40 to 60, of 5.8%(98/1696) cases was over 60. The 1696 MR examinations included 1128 on 1.5T MR and 568 on 0.5T MR. Of all the anal fistulas was 29.0%(492) high position and 71.0%(1204) was low position. Among the 1696 patients, 1057 were intersphincteric fistulas(62.3%), 407 were transphincteric fistulas(24.0%), 68 were suprasphincteric fistulas(4.0%), 54 were extrasphincteric fistulas (3.2%), 67 were superficial fistulas(4.0%), and 43(2.5%) were difficult to classify. A total of 1996 internal openings were found and most of them were located around the dentate line of 5-7 o'clock in lithotomy position(47.7%, 952/1996).@*CONCLUSIONS@#Anal fistula mainly occur in young men, and the most common type is intersphincteric fistula. MRI can accurately classify anal fistulas and clearly demonstrate internal openings, and provide reliable evidence for clinical treatment and surgery.

Electronic cleaning of intestinal contents tagging by diatrizoate meglumine for single-source dual-energy CT colonography with sequential acquisitions and volume scanning / 重庆医学

Objective To study the feasibility of applying electronic cleaning to intestinal contents tagging by diatrizoate meglumine for single-source dual-energy CT colonography with sequential acquisitions and volume scanning.Methods Twenty-four volunteers had fine effect of intestinal contents tagging by diatrizoate meglumine,good colorectal distension effect,fine image quality of dual-energy fusion colorectal images,and with informed consents were enrolled in this study.The single-source dual-energy CT colonography with sequential acquisitions and volume scanning was performed with an Acquilion ONE 320 row CT scanner,tube voltage 135 kVp/80 kVp.The intestinal contents conducted the dual-energy electronic cleaned based on decomposition of intestinal contents tagging by diatrizoate meglumine,soft tissue and air.The intestinal contents in one segment of intestinal lumen being 100％ electronically cleaned served as the basic standard,the electronic cleaning effects were divided into the 5 grades:excellent,good,moderate,fair and poor;and grade 1-3 were effective fecal electronic cleaning.Results The grade 1,2,3,4,5 of electronic cleaning effect for solid as the main intestinal contents were 22.2％,53.3％,17.8％,6.7％ and 0％ respectively;and which of electronic cleaning effect for liquid as the main intestinal contents were 47.5％,47.5％,5.0％,0％ and 0％ respectively.The together total effective electronic cleaning of intestinal contents was 97.9％ and the electronic cleaning effect was good.Conclusion Electronic cleaning could be used in the intestinal contents tagging by diatrizoate meglumine for single-source dual-energy CT colonography with sequential acquisitions and volume scanning.

Imaging diagnosis of perianal fistula in Crohn disease / 中华胃肠外科杂志

Anal fistula is the most common perianal lesion in Crohn disease (CD), which usually is complicated and difficult to treat, and has a high recurrence rate and serious influence on the quality of life of patients. Inaccurate or incomplete intervention may result in irreversible damage. In order to achieve the best outcome, an optimal disease assessment is crucial. Many imaging modalities are useful for the evaluation of perianal fistulas in CD, which may help confirm the diagnosis, accurately classify the disease, plan the most suitable treatment, and monitor the efficacy. Magnetic resonance imaging (MRI), endoscopic ultrasonography (EUS) and anal endosonography (AES) are considered to be the suitable options for evaluation of the initial perianal fistula, both in terms of sensitivity and specificity, while MRI is more suitable for monitoring the curative efficacy. Fistulography (by X ray or CT) is generally less applied due to inferior soft tissue performance, radiation exposure, etc. This paper reviews the various imaging modalities, analyzes their advantages and disadvantages in order to assist clinicians in selecting the most appropriate examination individually.

An investigation on utilization of maternal health care in migrant maternity in Putuo district of Shanghai / 中华行为医学与脑科学杂志

ObjectiveTo describe utilizations of maternal health care in migrant maternity in Putuo District and to identify the gap between primipara and multipara.In order to improve utilizations of Maternal Health Care in migrant maternity.MethodsQuestionnaire survey was carried out among lying-in migrant maternity to obtain information on utilization of maternal health care.Database was established the by Epidata 2.1 and Statistical analyzed by SPSS11.0.ResultsThere was significant difference between multipara and primipara in age,household registration and cultural degree(P＜0.01 ).Women registered at early stage of the pregnancy with 50.51％,completed full pre-natal health check-up with 82.83％,received postnatal visits with 78.45％ in migrant maternity.There was significant difference between multipara and primipara in registered at early stage of the pregnancy,full pre-natal health check-up,received the postpartuu visit,registered at first level hospital and the medical insurance coverage in migrant maternity(P＜0.01 ).ConclusionsThe levels of utilizations of maternal health care in migrant maternity in putuo district are significantly lower than local maternity,the levels of utilizations of maternal health care in multipara are lower than primipara in Putuo district.Improve utilizations of maternal health care in multipara and enhance utilizations of maternal health care in migrant maternity in Putuo district.

Dose-escalation in non-small-cell lung cancer treatment using 3-dimensional conformal radiotherapy:preliminary results / 中国癌症杂志

Purpose:To evaluate the feasibility of dose escalation in non small cell lung cancer(NSCLC) treatment using 3 dimensional conformal radiotherapy and to assess the immediate responses and acute side effects.Methods:25 patients with inoperable NSCLC were evaluated from October 2000 to July 2001. Conventional irradiation technique was used until the tumor dose reached 40 41.4Gy. FOCUS2.6.1 of CMS three dimensional treatment planning system(3D TPS) was used to design the dose escalation treatment plan and DVHs was used to optimize it.The planning target volume (PTV)encompassed 1 1.5cm outside the clinical target volume(CTV).The irradiation doses of dose escalation treatment plan ranged from 25Gy to 30Gy,and were delivered in daily fractions of 2.5 3 Gy,5 days a week. WHO criteria and RTOG/EORTC grading scheme were used to assess the immediate responses and acute side effects.Results:All 25 patients completed the treatment successfully. The median radiation dose to the gross tumor volume(GTV) was 7012cGy(62 45 Gy 71 40 Gy).The overall immediate response rate (CR+PR)was 72.0%(18/25). According to the RTOG grading scheme , acute radiation esophagitis occurred in 24.0%(6/25)of patients with Grade 1 2 and 4.0%(1/25)with Grade 3 respectively. Acute radiation pneumonitis occurred in 16.0%(4/25)of patients with Grade 1 2 and 4.0%(1/25)with Grade3 respectively. The bone marrow toxicity occurred in 16.0%(4/25)with Grade 1 2. Damage to the heart occurred in 12.0%(3/25) with grade1 2. Median follow up is 14 months.Conclusions:Dose escalation in NSCLC treatment using 3 dimensional conformal radiotherapy has an encouraging immediate response rate with lower acute complication. Late side effects of irradiated and survival will be observed. [

Value of radiotherapy following breast-conserving surgery in early stage breast cancer / 中国癌症杂志

Purpose:To validate further the importance of r adiotherapy following breast-conserving surgery in early breast cancer. Methods:From 1994.12 to 2001.12,237patients with early stage breast can cer were treated Of these patients,eighty-three received breast-conserving surgery followed by radiotherapy,and one hundred and fifty-four received modified radical mastectom y.All patients with breast-conserving surgery underwent postoperative radiother apy.The range of radiation dose depends on the size,location of tumor,and involv ement of axillaty nodes.Tangential chest wall fields delivered 5000cGy with 8MV -X ray beam in 5 weeks .An additional 1500cGy was delivered in 8 days to tumor bed with electron beam.Among the patients with modified radical mastectomy.only 3 received postoperative radiotherapy.Results:In both the breast-conserving surgery group and modified radical mastectomy gro up,one patient recurred regionally,and one died respectively .In the modified ra dical mastectomy group,there were no regional lymph nodes recurrence,but two of them had distant metastasis.The 5year survival of the two groups were 96.49%and 98.61%,respectively.The breasts are soft and resilient in the breast-conserving surgery group,and breast shape whole after surgery.Conclusions :Breast-conserving surgery plus postoperative radiotherapy in early breast can cer can obtain treatment results similar to modified radical mastectomy,with goo d cosmetic