A case report of the old patient with congenital aortic coarctation and severe coronary heart disease / 天津医药

Congenital coarctation of the aorta(CoA)is a congenital macrovascular disease.Most of the untreated CoA patients died before the age of 30 years. This study presented a 67-year-old patient who was first diagnosed as aortic coarctation with severe coronary heart disease and was long-term survival.This paper reviewed the diagnosis and treatment of the patient and reviewed the relevant literature of the diagnosis and treatment.

Risk factors associated with postoperative hospital stay after pancreaticoduodenectomy: a retrospective study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Postoperative hospital stay after pancreaticoduodenectomy (PD) is relatively longer than after other gastrointestinal operations. The aim of the current study was to investigate the risk factors associated with prolonged hospital stay after PD.</p><p><b>METHODS</b>Patients who had PD at the Cancer Hospital of Chinese Academy of Medical Sciences between December 2008 and November 2012 were selected for this retrospective study. Clinical and pathological data were collected and analyzed. The primary outcome was postoperative length of stay. Normal discharge or recovery was defined as a postoperative hospital stay of no more than 10 days; otherwise it was defined as delayed discharge or recovery (including hospital death).</p><p><b>RESULTS</b>A total of 152 patients were enrolled in the present study. Postoperative hospital stay was (19.7 ± 7.7) days (range 7-57). Of the 152 patients, 67 were discharged within the normal time and 85 had delayed discharge. Postoperative complications occurred in 62.5% (95/152), and the mortality rate was 3.29% (5/152). Multiple regression analysis showed that delayed discharge was significantly associated with postoperative complications (adjusted odds ratio (OR) 10.40, 95% confidence interval (CI) 3.58-30.22), age (adjusted OR 4.09, 95% CI 1.16-14.39), body mass index (BMI) (adjusted OR 4.40, 95% CI 1.19-16.23), surgical procedure (adjusted OR 26.14, 95% CI 4.94-153.19), blood transfusion (adjusted OR 7.68, 95% CI 2.09-28.27), and fluid input (adjusted OR 3.47, 95% CI 1.24-11.57).</p><p><b>CONCLUSIONS</b>Postoperative complications increase the time to postoperative hospital discharge. The length of hospital stay after PD is also associated with age, BMI, blood transfusion, surgical procedure, and fluid input. Further studies with more patients are needed in future.</p>

Status of glucose metabolism in Chinese essential hypertensive patients / 中华心血管病杂志

<p><b>OBJECTIVE</b>To investigate glucose metabolism status and its relationship with blood pressure, obesity, renal function and cardio-cerebral vascular events in Chinese essential hypertensive patients.</p><p><b>METHODS</b>Essential hypertensive patients without diabetic history were enrolled in this cross-sectional survey. All patients filled in questionnaires and received physical examination and laboratory tests. Oral glucose tolerance test (OGTT, fasting and 2 hours glucose level after drinking the 75 g glucose solution) was performed in patients who signed the informed consent.</p><p><b>RESULTS</b>(1) The control rate of systolic BP was lower in patients with dysglycemia than in patients without dysglycemia (41.0% vs. 46.4%, P = 0.000). (2) The albuminuria detection rate and the abnormal rate of estimated glumerular filtration rate (eGFR) increased significantly with the deterioration of glucose metabolism. (3) Multifactor-analysis showed that abnormal waist circumference, decreased eGFR and presence of albuminuria were independent risk factors for abnormal glucose metabolism. Cardiovascular events was significantly higher in patients with abnormal glucose metabolism than patients with normal glucose metabolism.</p><p><b>CONCLUSION</b>Abnormal glucose metabolism is common in Chinese essential hypertensive patients. When complicated with abnormal glucose metabolism, essential hypertensive patients had poor blood pressure control rate and were related to higher cardiovascular risk.</p>

The role of slow-release 5-fluorouracil implantation in treatment of unresectable pancreatic cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To study the role of slow-release 5-fluorouracil implantation in treatment of unresectable pancreatic cancer.</p><p><b>METHODS</b>85 cases of untreated patients with locally advanced pancreatic cancer (LAPC) were randomized into two groups: Trial group: slow-release 5-fluorouracil implantation (50 patients) and control group (35 patients). Observing the objective tumor response, clinical benefit response, toxicity, complications and survival of patients of the two groups.</p><p><b>RESULTS</b>In the trial group the overall response rate (PR + NC) was 76.0%, and the clinical benefit response rate was 52.0%. No toxicity was observed. Pancreatic fistula occurred in 2 patients. The median survival time of the two groups was 9.0 months and 4.0 months, respectively. The survival rates of 6- and 12-month were 56.8% vs. 31.4% and 22.9% vs. 2.9% in the two groups, respectively (P = 0.012).</p><p><b>CONCLUSION</b>Slow-release 5-fluorouracil implantation is a simple, safe and effective method in treatment of LAPC.</p>

Surgical treatment and prognosis of primary duodenal carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the clinicopathological features, surgical treatment and prognosis of primary carcinoma of the duodenum.</p><p><b>METHODS</b>The clinicopathological data of 86 patients with primary duodenal carcinoma from January 1996 to June 2007 were retrospectively reviewed and analyzed by SPSS 13.0.</p><p><b>RESULTS</b>The clinical manifestation includes upper abdominal pain, jaundice, anemia, gastrointestinal obstruction, melena and weight loss. Four patients had a tumor located in the first portion of the duodenum, 66 in the second portion, 12 in the third portion and 4 in the fourth portion. The preoperative correct diagnostic rate by BUS was 41.7%, by CT 69.4%, by MRI 75.0%, by duodenal endoscopy 84.0%, and by air barium double radiography 80.9%. Complete resection of the tumors was achieved in 38 patients, palliative resection in 45 cases, and exploration alone in 3 cases. The median survival time of the group with complete resection was 42 months versus 13 months in the group with palliative resection, with a significant difference between the two groups (P < 0.05).</p><p><b>CONCLUSION</b>Primary carcinoma of the duodenum has no specific symptoms. Early diagnosis and complete resection are effective to improve prognosis.</p>

Small pancreatic cancer diagnosis and prognosis / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the clinicopathological characteristics, diagnostic methods and prognosis of small pancreatic cancer.</p><p><b>METHODS</b>From May 2000 to January 2007, 89 patients with pancreatic cancer underwent surgery in our hospital. Of those, 14 had a tumor < or = 2 cm in diameter (small tumor group), and the other 75 had a tumor >2 cm in diameter (controlled group). The clinicopathological data of all the cases were retrospectively reviewed and analyzed.</p><p><b>RESULTS</b>In the small pancreatic cancer group, CT and MRI detected 66.7% (8/12) and 77.8% (7/9) of the tumors, respectively. Serosal infiltration was found in 2 cases, lymph node involvement in 3 cases, and retroperitoneal infiltration in 3 cases. The follow-up duration of this group was 4-86 months. The overall 3- and 5-year survival rates were 42.8% and 31.7%, while in the control group, the overall 3- and 5-year survival rates were 29.7% and 22.5%, respectively. The multivariate analysis showed that the lymph node involvement, serosal infiltration and retroperitoneal infiltration were independent risk factors (P<0.05). However, the tumor size was not shown to be an independent risk factor (OR value = 1.45, P = 0.971).</p><p><b>CONCLUSION</b>CT and MRI are valuable in detecting small pancreatic cancer. Small pancreatic cancers are likely to have a better prognosis when compared with larger ones. Lymph node metastasis and local infiltration are independent predictors of prognosis but not tumor size.</p>

Application of tru-cut biopsy combined with fine needle aspiration biopsy in the intraoperative pathological diagnosis of pancreatic carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the method and value of tru-cut biopsy (TCB) combined with fine needle aspiration biopsy (FNAB) in the pathological diagnosis of pancreatic carcinoma during operation.</p><p><b>METHODS</b>From April 2007 to October 2008, 22 cases who were suspected to suffer from pancreatic carcinoma were enrolled into this prospective study. All of them underwent a tru-cut biopsy combined with fine needle aspiration biopsy for the pathological diagnosis during operation.</p><p><b>RESULTS</b>Of the 22 patients, 20 were finally diagnosed as having pancreatic carcinoma, while 2 having pancreatitis. The diagnosis of pancreatic carcinoma was confirmed in 19 by tru-cut biopsy combined with fine needle aspiration biopsy, while other 3 cases were not confirmed as pancreatic carcinoma. Among those 3 cases, one was diagnosed as having pancreatic carcinoma with hepatic metastasis by liver nodular biopsy, one as suffering from autoimmune pancreatitis, and another case as having chronic pancreatitis confirmed by follow-up for 9 months without any changes after the operation. The accuracy of FNA, TCB and FNA combined with TCB in the diagnosis for suspected pancreatic cancer were 86.4%, 90.9%, and 95.5%, respectively. No pancreatic fistula and bleeding developed after operation.</p><p><b>CONCLUSION</b>Tru-cut biopsy is more accurate in diagnosis for the suspected pancreatic cancer than fine needle aspiration biopsy during operation. Tru-cut biopsy combined with fine needle aspiration biopsy can improve the accuracy of diagnosis, and is a safe and effective diagnostic method.</p>

Diagnosis and management of metastatic pancreatic tumors / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To study the clinicopathological features and prognostic factors of metastatic pancreatic tumor.</p><p><b>METHODS</b>The clinical data of 18 metastatic pancreatic tumors were retrospectively analyzed. The primary foci of these 18 patients included: 8 lung cancer, 2 gastric cancer, and malignant histiocytoma, melanoma, rectal cancer, thyroid cancer, renal cell carcinoma, esophageal carcinoma, liver cancer and ovarian cancer each.</p><p><b>RESULTS</b>All these 18 patients harboring metastatic pancreatic tumor did not show any specific symptoms but were frequently found to have a solitary (14 cases) or multiple (4 cases) homogeneous and hypodense nodules on CT scan without any enhancement except one metastatic renal cell carcinoma. The diagnosis was cytologically confirmed in 14 patients by fine needle aspiration biopsy guided by CT or ultrasonography, and diagnosed by postoperative pathology in the other 4 patients. After receiving combined modality treatment, their survival time was 8 to 38 months with an average of 19 months.</p><p><b>CONCLUSION</b>Metastatic pancreatic tumors are rare and give no specific symptom or image finding. Selection of appropriate combined modality treatment according to the type of primary focus is very important for the management.</p>

Peritoneal lavage cytology in 66 patients with gastric carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the clinical and prognostic value of peritoneal lavage cytology (PLC) in detecting free cancer cells (FCC).</p><p><b>METHODS</b>PLC of 66 gastric cancer patients being operated was prospectively analyzed to assess the prognostic significance of positive cytological finding and its relation with serosal invasion, lymph node metastasis and stage classification.</p><p><b>RESULTS</b>The overall positive rate of cytology was 36.4% (24/66). These was a closely relation between positive cytology results and serosal invasion (P = 0.025), abdominal lymph node involvement (P < 0.005) and stage classification. Peritoneal recurrence in patients with positive cytological findings was significantly higher than that with negative results (P = 0.006 7).</p><p><b>CONCLUSION</b>Micrometastasis to the abdominal cavity, formed by free cancer cells exfoliated from the tumor, are significantly responsible for peritoneal dissemination. Serosal invasion and metastatic nodes have greater risk for positive cytology and implies poor prognosis. Peritoneal lavage cytology, if practiced in all gastric cancer patients being operated, can predict the operative effect and prognosis, increase the accuracy of clinical stage and provide information for further adjuvant therapy.</p>