Evidence-based medical evidence of prophylactic bilateral salpingectomy / 中国实用妇科与产科杂志

Clinical data indicated that the fallopiantube may be related to high-level serous ovarian cancer.Current studies show that prophylactic bilateral sal-pingectomy can reduce the risk of ovarian cancer inpremenopausal women and it has been used as a pri-mary prevention of ovarian cancer.In recent years,much more attention has been paid to the value ofprophylactic bilateral salpingectomy in preventingovarian cancer.We will discuss the value of prophy-lactic bilateral salpingectomy and its effect on ovarianfunction.

Controversy and countermeasure of treatment for locally advanced cervical carcinoma / 中国实用妇科与产科杂志

The choice of treatment in locally advanced cervical carcinoma is a hot topic in the controversy of treatment for gynecology tumor.The three primary therapies for locally advanced cervical carcinoma are concurrent chemotherapy and radiotherapy,direct radical hysterectomy and operation after radiotherapy.This article mainly discusses several types of treatment and advises personalized treatment for locally advanced cervical carcinoma.

Spectrum and risk factors for invasive candidiasis and non-Candida fungal infections after liver transplantation / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Invasive fungal infections are an important cause of posttransplant mortality in solid-organ recipients. The current trend is that the incidence of invasive candidiasis decreases significantly and invasive aspergillosis occurs later in the liver posttransplant recipients. The understanding of epidemiology and its evolving trends in the particular locality is beneficial to prophylactic and empiric treatment for transplant recipients.</p><p><b>METHODS</b>A retrospective analysis was made of recorded data on the epidemiology, risk factors, and mortality of invasive fungal infections in 352 liver transplant recipients.</p><p><b>RESULTS</b>Forty-two (11.9%) patients suffered from invasive fungal infection. Candida species infections (53.3%) were the most common, followed by Aspergillus species (40.0%). There were 21 patients with a superficial fungal infection. The median time to onset of first invasive fungal infection was 13 days, first invasive Candida infection 9 days, and first invasive Aspergillus infection 21 days. Fifteen deaths were related to invasive fungal infection, 10 to Aspergillus infection, and 5 to Candida infection. Invasive Candida species infections were associated with encephalopathy (P = 0.009) and postoperative bacterial infection (P = 0.0003) as demonstrated by multivariate analysis. Three independent risk factors of invasive Aspergillus infection were posttransplant laparotomy (P = 0.004), renal dysfunction (P = 0.005) and hemodialysis (P = 0.001).</p><p><b>CONCLUSIONS</b>The leading etiologic species of invasive fungal infections are Candida and Aspergillus, which frequently occur in the first posttransplant month. Encephalopathy and postoperative bacterial infection predispose to invasive Candida infection. Posttransplant laparotomy and poor perioperative clinical status contribute to invasive Aspergillus infection. More studies are needed to determine the effect of prophylactic antifungal therapy in high risk patients.</p>

Liver transplantation for hepatocellular carcinoma: prognostic analysis of 89 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize the experience of liver transplantation (LT) for hepatocellular carcinoma (HCC) in one center and identify prognostic factors for survival.</p><p><b>METHODS</b>The clinical data and survival results of 89 patients with HCC receiving LT from January 1999 to December 2003 were retrospectively analyzed and various clinicopathologic risk factors for actuarial survival and tumor free survival were evaluated by univariate and multivariate analysis.</p><p><b>RESULTS</b>Six-month, 1-, and 2-year survival rates were 81.8%, 55.3% and 43.7%, respectively. The 6-month, 1-, and 2-year tumor free survival rates were 62.4%, 35.6% and 24.9%, respectively. The overall tumor recurrence and metastasis rate was 52.8%. In the univariate analysis, portal vein tumor thrombi (PVTT) (chi(2) = 15.14, P = 0.0001), tumor size (chi(2) = 15.05, P = 0.0001), hepatic cirrhosis background (chi(2) = 6.14, P = 0.0132), preoperative alpha-fetoprotein (AFP) level (chi(2) = 5.82, P = 0.0159) and histopathologic grading (chi(2) = 4.61, P = 0.0319) were found to be significantly associated with actuarial survival rate. Seven factors influencing tumor free survival included PVTT (chi(2) = 26.30, P < 0.0001), tumor size (chi(2) = 25.25, P < 0.0001), preoperative AFP level (chi(2) = 14.83, P = 0.0001), histopathologic grading (chi(2) = 12.54, P = 0.0004), tumor distribution (chi(2) = 12.73, P = 0.0004), number of nodules (chi(2) = 9.81, P = 0.0017) and cirrhosis background (chi(2) = 9.76, P = 0.0018). In the multivariate Cox regression analysis, the prognostic factors independently associated with patient survival were identified to be PVTT (RR = 4.721, P = 0.001), age (RR = 3.282, P = 0.007) and histopathologic grading (RR = 2.368, P = 0.037). For tumor free survival, histopathologic grading (RR = 3.739, P < 0.0001), PVTT (RR = 4.382, P = 0.001), cirrhosis background (RR = 0.421, P = 0.011), age (RR = 2.312, P = 0.027) and AFP (RR = 2.301, P = 0.047) were identified as prognostic parameters.</p><p><b>CONCLUSIONS</b>LT is a good therapeutic option for strictly selected patients with HCC. PVTT and histopathologic grading are the most important factors of predicting outcomes of HCC patients undergoing LT. Further studies should be strengthened to establish a reliable and feasible selection criteria and an optimal prognosis scoring system for LT.</p>

The prevention and treatment of cytomegalovirus infection after liver transplantation / 中华外科杂志

<p><b>OBJECTIVE</b>To review diagnosis and treatment experience of cytomegalovirus (CMV) infection after liver transplantation.</p><p><b>METHODS</b>The clinical data of 96 patients receiving liver transplantation in our hospital from January 2001 to December 2002 were analyzed retrospectively.</p><p><b>RESULTS</b>CMV infection occurred in 19 patients, blood IE-E antigen of CMV and PP65 antigen of CMV was detected in all the patients with CMV infection, 8 patients with CMV-IgM positivity, 3 of them presented with dyspnea, 4 with fever and 2 with jaundice, 14 patients had no symptoms of CMV infection. IE-E antigen of CMV and PP65 antigen of CMV in blood of 18 patients became negative after treatment with ganciclovir, 1 patients died from interstitial pneumonitis.</p><p><b>CONCLUSIONS</b>Cytomegalovirus infection after liver transplantation is associated with many factors, the key point of CMV infection is prevention actively and early treatment after operation. The detection of blood antigen of CMV is necessary for early diagnosis and guiding treatment of CMV infection, ganciclovir is effective for treatment of CMV infection.</p>

Causes and management of respiratory complication after liver transplantation / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To identify the causes of respiratory complications following liver transplantation (LT) and to discuss the management of these complications.</p><p><b>METHODS</b>One hundred and twenty four cases with pulmonary complications in the first two weeks after LT were identified among 163 patients admitted to the First Affiliated Hospital, College of Medicine, Zhejiang University from February, 1999 to March, 2003.</p><p><b>RESULTS</b>The incidence rate of complications was 76%(124/163) with the total cure rate of 92%(114/124). The cure rates of the various complications were as follows: pleural effusion 100%(113/113), pneumonia 92%(76/83), respiratory insufficiency 91%(59/65), pulmonary hypertension 98%(101/103), pulmonary edema 98(58/59), atelectasis 100%(4/4) and pneumothorax 100%(2/2).</p><p><b>CONCLUSION</b>To drainage the pleural effusion with an unicameral venous catheter is safety and effective. To cure or prevent pneumonia and atelectasis, aseptic manipulating, aspiration of sputum and keeping respiratory channel open were the key measurements of treatment. Restrictive ventilatory functional disturbance (RVFD) and dysfunction of ventilation are two major types of respiratory insufficiency in early stage of post-transplantation. The causes of pulmonary hypertension and edema are associated with pulmonary angiotasis and blood flow volume, and the vasodilator and diuretic often introduced in the therapy.</p>

Orthotopic liver transplantation for end-stage liver diseases in 71 cases / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To assess the role of orthotopic liver transplantation (OLT) in the treatment of end-stage liver diseases and to discuss the experience of the operation.</p><p><b>METHODS</b>Retrospective analysis of clinical data of 71 cases of liver transplantation was performed in our hospital from April 1993 to August 2001.</p><p><b>RESULTS</b>One year survival rate of recipients with benign hepatic disease was over 75%. The survival time and life quality of malignant recipients were also improved. Lamivudine monotherapy during the operation period could reduce HBV reinfection rate. The practice of OLT without veno-venous bypass (VVB) was associated with a shorter operating time, less hemorrhape, and thus less blood transfusion during the operation compared with standard technique of OLT with routine use of VVB. The occurrence rate of biliary complications was 5.98% and vascular complication 8.96%.</p><p><b>CONCLUSIONS</b>OLT should become a routine therapeutic choice for end-stage liver diseases. Lamivudine is helpful to reduce HBV reinfection after OLT in HBV-related liver diseases. OLT without VVB is safe and can be performed in the majority of adult patients. The early diagnosis and timely application of interventional radiological technique are important for the treatment of biliary and vascular complications.</p>