[Application of ultrasonic surface location for internal jugular vein catheterization via central approach].

OBJECTIVE: To explore the clinical value of ultrasonic surface localization in internal jugular vein catheterization. METHODS: Totally 150 patients with American Society of Anesthesiologists physical status I -III who were planning to receive elective surgeries were randomized into anatomical landmark group, ultrasonic surface positioning group, and ultrasound-guided group using computed random table, with 50 cases in each group. The right internal jugular vein catheterization was performed after tracheal intubation. In the anatomic landmark group, patients were punctured using surface marks through central approach. In ultrasonic surface positioning group and ultrasound-guided group, patients were punctured with ultrasonic localization and guidance through central approach. The relationship between internal jugular vein and carotid artery, the position of the needle into the vein, the success rate of puncture, the change times of puncture point, and the complications were recorded. RESULTS: Ultrasound scan revealed that the relationship between the right internal jugular vein and the right common carotid artery could be divided into three types: parallel (12.7%), partial overlapping (69.3%), and complete overlapping (18.0%). The average "safety distance" of jugular vein puncture was (1.15 +/- 0.47) cm. The success rate of the first puncture attempt in ultrasonic surface positioning group and ultrasound-guided group were 78.0% and 82.0%, respectively, which was significantly higher than that in anatomic landmark group (22.0%) (P < 0.05), whereas the complication incidence in anatomic landmark group (12.0%) were significantly higher than those in ultrasonic surface positioning group (0) and ultrasound-guided group (0) (P < 0.05). CONCLUSIONS: Ultrasonic surface positioning applied during internal jugular vein catheterization is helpful to reveal the inner diameters as well as the origin and course of arteries and veins in the puncture and identify the abnormalities as early as possible. As a simple support technique for internal jugular vein puncture, it is suitable for clinical application.

[Local cellular immune response induced by ultrasound-guided tumor bed superantigen injection after percutaneous microwave coagulation therapy for liver cancer].

OBJECTIVE: To investigate the local cellular immune response after injection of superantigen, the highly agglutinative staphylococin (HAS), into the tumor bed after ultrasound-guided percutaneous microwave coagulation therapy (PMCT) in the liver cancer patients. METHODS: Ninety-two patients with pathologically proven primary liver cancer were divided into two groups: 45 in group A were treated by PMCT alone and 47 in the group B by combined with ultrasound-guided percutaneous injection of highly agglutinative staphylococin (HAS). Before and after PMCT and HAS treatment, the patients underwent ultrasound-guided percutaneous biopsy from the tumor bed and the samples were examined by pathology and immunohistochemistry. The infiltration of CD3+, CD4+, CD57+ and CD68+ lymphocytes in treatment zone was compared between the two groups. Moreover, the infiltrating immunocytes were observed by transmission electron microscopy. RESULTS: One week after HAS injection, the densities of CD3+, CD4+, CD57+ and CD68+ cells in the group B were 54.50 +/- 18.44, 38.14 +/- 12.44, 33.38 +/- 10.79 and 45.56 +/- 16.53, respectively. All the above mentioned parameters increased significantly in varying degrees compared with that before PMCT or HAS injection (P < 0.05). Four weeks after HAS injection, the density of CD3+, CD4+, CD57+ and CD68+ cells in the group B were 32.67 +/- 10.42, 23.43 +/- 6.99, 18.63 +/- 7.89 and 30.01 +/- 11.05, respectively, still significantly higher than those before PMCT (P < 0.05). Five weeks after PMCT and HAS injection, the densities of CD3+, CD4+, CD57+ and CD68+ cells in the group B were 54.50 +/- 18.44, 38.14 +/- 12.44, 33.38 +/- 10.79 and 45.56 +/- 16.53, versus 32.03 +/- 8.11, 15.67 +/- 8.32, 15.23 +/- 8.26 and 29.67 +/- 11.98 in the group A, respectively, still with a significant difference between the two groups (P < 0.05). A lot of lysosomes, endoplasmic reticulum and mitochondria in the immune cells after injection of HAS were observed by transmission electron microscopy. CONCLUSION: The local cellular immunity in liver cancer treatment area can be significantly improved by ultrasound-guided injection of highly agglutinative staphylococin after percutaneous microwave coagulation therapy.

Prognostic factors and recurrence of small hepatocellular carcinoma after hepatic resection or microwave ablation: a retrospective study.

PURPOSE: This study aims to analyze the long-term therapeutic results of small HCC less than 5 cm in diameter after microwave ablation (MA) or hepatic resection (HR) and choose factors that could predict metastasis and recurrence of small HCC. MATERIALS AND METHODS: The metastasis and recurrence of 194 patients with one HCC less than 5 cm in diameter who underwent curative HR or MA between January 1995 and December 2004 were reviewed retrospectively; immunohistochemistry was used to analyze the expressions of VEGF, bFGF, and c-Met in HCC tissues. Posttreatment prognostic factors were evaluated by multivariate analysis using Cox's proportional hazards model. The variables included the expressions of these three proteins in HCC tissues, the clinical and pathologic characteristics of the patients. RESULTS: The retrospective study showed that 1-, 3-, and 5-year disease-free survival rates of patients with single HCC of diameter <5 cm were 71.3, 57.0 and 32.5%, respectively. Furthermore, 1-, 3-, and 5-year disease-free survival rates of the patients in MA group and resection group were 72.8, 54.0 and 33.0%; 68.5, 60.0, and 25.6%, respectively. There was no significant difference in disease-free survival rates between these two groups. The result of multivariate analysis showed that differentiation degree of HCC and the expressions of VEGF and c-Met in HCC tissues could be as the independent prognostic factors affecting metastasis and recurrence in patients with small HCC, whereas the methods of therapy had no impact on prognosis. CONCLUSIONS: The metastasis and recurrence rate after MA is similar to that after HR, and the methods of therapy do not affect the prognosis of small HCC. The metastasis and recurrence of patients with small HCC will differ depending on tumor differentiation, expressions of VEGF and c-Met in HCC tissues.

[Influence of microwave ablation and surgical resection of small primary hepatocellular carcinoma on hematogenous dissemination of tumor cells].

OBJECTIVE: To study the influence of percutaneous microwave ablation (PMA) and surgical resection for patients with small primary hepatocellular carcinoma (PHC) on dissemination of tumor cells in peripheral blood determined by AFP mRNA. METHODS: Forty patients with small PHC (The maximal diameter < or = 5 cm) confirmed histologically were included in this study. All the patients had single tumor nodule only without metastasis. Of the 40 patients, 19 were treated by PMA and 21 by surgical resection. Blood samples were collected and tested immediately before treatment, 30 min after the mass ablated/resected, 1 d and 7 d later by RTD-Nested-RT-PCR for AFP mRNA. The CD3, CD4, CD8 and CD4/CD8 in blood, and hepatic function were tested at the same time points as well. RESULTS: After treatment, ALT and AST in peripheral blood increased in both groups, but more intensely in the surgical group. The CD3, CD4 and CD4/CD8 in peripheral blood decreased at 30 min, 1 day and 7 days after surgical resection, and the lowest value was at 30 min after surgery. The immune function was kept at the same level as pre-treatment in the PMA group. AFP mRNA copies in blood could be detected in 27 of 40 patients (67.5%) in two groups before treatment, and the copy number was increased after treatment. There was no significant difference between the two groups. The patients were followed up for 1 - 16 months. AFP mRNA copies in blood could be detected persistently in the 4 patients with extrahepatic metastasis or liver recurrence. CONCLUSION: Surgical resection and microwave ablation may cause PHC cells dissemination into the blood circulation in patients with small PHC, and there was no difference between the two treatment groups. The cellular immune function in peripheral blood is decreased after surgical resection, but is maintained at the same level as pre-treatment in the PMA group. The impairment of liver function is less severe after PMA treatment than surgical resection. PMA may provide certain value for clinical management of small hepatocellular carcinoma.

[Long-term results of percutaneous sonographically-guided microwave ablation therapy of early-stage hepatocellular carcinoma].

OBJECTIVE: To evaluate the long-term results of percutaneous microwave coagulation therapy in the treatment of early hepatocellular carcinoma. METHODS: From May 1994 to June 2004, a total of 216 patients with 275 nodules of hepatocellular carcinoma whose diameter

[Evaluation of long-term therapeutic effects of ultrasound-guided percutaneous microwave ablation of liver metastases].

OBJECTIVE: To explore therapeutic results of local microwave ablation for hepatic metastasis and the factors influencing the survival after percutaneous microwave ablation therapy. METHODS: From July 1995 to June 2005 128 patients with 282 hepatic metastases nodules with the primary diseases of upper gastrointestinal tumor (n = 26), colorectal tumor (n = 44), breast carcinoma (n = 19), pulmonary carcinoma (n = 15), and malignant tumor in other part of the body (n = 24), underwent percutaneous microwave ablation therapy and were followed up for 29.7 +/- 19.9 months (1 - 103 months). The largest diameter of the metastatic nodules was 3.5 +/- 1.6 cm (0.7 - 8.6 cm). Sixty-four cases had 140 nodules 3.0 cm in diameter. Forty-seven patients had single nodule, 44 patients had 2 nodules, and 93 patients had 3 or more nodules. Fifty-seven patients had tumor of low differentiation, 53 had tumor of middle differentiation, and 18 had highly differentiated tumors. Kaplan-Meier method was used to calculate the cumulative survival rate. Statistical comparison of the effects of potential predictive factors on survival rate was performed using log-rank analysis. Multivariate analysis of the survival rates was performed by using Cox's proportional hazard model. RESULTS: The 1, 2, 3, 4, and 5-year cumulative survival rates of all 128 patients were 90.88%, 73.84%, 51.09%, 36.14%, and 31.89% respectively. Univariate analysis showed that tumor size (P = 0.028), tumor differentiation (P = 0.026) and local recurrence or new metastases (P < 0.001) significantly affected the survival. Multivariate analysis revealed that tumor size (P = 0.035), recurrence or new metastases (P = 0.001) and tumor differentiation (P = 0.038) each had a significant effect on survival. CONCLUSION: There is a significantly higher probability of long-term survival for patients with well-differentiated tumors 3.0 cm or less in diameter and without recurrence or new metastasis after percutaneous microwave ablation.

Construction and clinical significance of a predictive system for prognosis of hepatocellular carcinoma.

AIM: The aims of this study were to explore individualized treatment method for hepatocellular carcinoma (HCC) patients whose maximum tumor size was less than 5 cm to improve prognosis and survival quality. METHODS: Thirty cases of primary HCC patients undergoing tumor resection were retrospectively analyzed (resection group). All the tumors were proved as primary HCC with pathologic examination. The patients were divided into two groups according to follow-up results: group A, with tumor recurrence within 1 year after resection; group B, without tumor recurrence within 1 year. Immunohistochemical stainings were performed using 11 kinds of monoclonal antibodies (AFP, c-erbB2, c-met, c-myc, HBsAg, HCV, Ki-67, MMP-2, nm23-H1, P53, and VEGF), and expressing intensities were quantitatively analyzed. Regression equation using factors affecting prognosis of HCC was constructed with binary logistic method. HCC patients undergoing percutaneous microwave coagulation therapy (PMCT) were also retrospectively analyzed (PMCT group). Immunohistochemical stainings of tumor biopsy samples were performed with molecules related to HCC prognosis, staining intensities were quantitatively analyzed, coincidence rate of prediction was calculated. RESULTS: In resection group, the expressing intensities of c-myc, Ki-67, MMP-2 and VEGF in cancer tissue in group A were significantly higher than those in group B (t = 2.97, P = 0.01; t = 2.42, P = 0.03<0.05; t = 2.57, P = 0.02<0.05; t = 3.43, P = 0.004<0.01, respectively); the expressing intensities of 11 kinds of detected molecules in para-cancer tissue in groups A and B were not significantly different (P>0.05). The regression equation predicting prognosis of HCC is as follows: P(1) = 1/[1+e(-(3.663-0.412mycc-2.187Ki-67c-0.397vegfc))]. It demonstrates that prognosis of HCC in resection group was related with c-myc, Ki-67 and VEGF expressing intensity in cancer tissue. In PMCT group, the expressing intensities of c-myc, Ki-67 and VEGF in cancer tissue in group A were significantly higher than those in group B (t = 4.57, P = 0.000<0.01; t = 2.08, P = 0.04<0.05; t = 2.38, P = 0.02<0.05, respectively); the expressing intensities of c-myc, Ki-67 and VEGF in para-cancer tissue in groups A and B were not significantly different (P>0.05). The coincidence rate of patients undergoing PMCT in group A was 88.00% (22/25), in group B 68.75% (11/16), the total coincidence rate was 80.49% (33/41). CONCLUSION: The regression equation is accurate and feasible and could be used for predicting prognosis of HCC, it helps to select treatment method (resection or PMCT) for HCC patients to realize individualized treatment to improve prognosis.

[The influence of c-Myc, Ki-67, MMP-2 and VEGF expression on the prognosis of hepatocellular carcinoma patients with tumor resection].

OBJECTIVES: To explore the effect of c-Myc, Ki-67, MMP-2 and VEGF expression on prognosis of hepatocellular carcinoma (HCC) patients who had tumor resection. METHODS: Primary HCC patients who underwent tumor resection were retrospectively analyzed. The maximum size of their mononodular tumors was less than 5 cm, and no intrahepatic arterial chemotherapy was performed before the resections. They were followed up after resection and the time of recurrence was recorded. They were divided into 2 groups: group A (15 cases): tumor recurred within 1 year after tumor resection; group B (15 cases): with tumor recurrence after 2 years or without it. Paraffin sections of the tumors were remade from their old blocks. Immunohistochemistry stainings were performed with c-Myc, Ki-67, MMP-2 and VEGF monoclonal antibodies. Staining intensity of the tumor and paracancer tissues was quantitatively analyzed. RESULTS: c-Myc, Ki-67, MMP-2 and VEGF expressing intensities in cancer tissues in group A were higher than those in group B, and their expressed intensities in paracancer tissue in group A and B were not significantly different. CONCLUSION: The expressions of c-Myc, Ki-67, MMP-2 and VEGF in cancer tissues of the patients are related to the recurrence of their HCC after tumor resection.

[Ultrasound-guided percutaneous microwave coagulation therapy for hepatic metastases].

OBJECTIVE: To analyze the therapeutic results and prognostic factors of hepatic metastases treated by ultrasound-guided percutaneous microwave coagulation. METHODS: Seventy-four patients with 149 nodules of hepatic metastases were given percutaneous microwave coagulation therapy. The longest diameter of the metastatic nodule ranged from 0.7 - 6.8 cm (mean, 3.1 +/- 1.8 cm). The cumulative survival rate was analyzed by Kaplan-Meier method and the difference between groups was compared with log-rank test. Cox proportional hazard model was used to determine potential prognostic variables. RESULTS: The follow-up period for the 74 patients was 5 - 83 months (mean, 25.1 +/- 11.4 months). The overall 1-, 3-, and 5-year cumulative survival rates were 91.4%, 46.4% and 29.0%, respectively. The log-rank test showed that number of metastases, tumor size, tumor cell differentiation and local recurrence or new metastases were statistically significant prognostic factors; while age, sex and site of primary tumors were not significant prognostic factors. Multivariate analysis revealed that tumor differentiation, number of metastases and recurrence or new metastases were statistically significant prognostic factors. CONCLUSION: Ultrasound-guided percutaneous microwave coagulation therapy for hepatic metastases in patients with single metastasis, well-differentiated tumor, and without recurrence and new metastases could achieve long-term survival.

Effect of c-myc, Ki-67, MMP-2 and VEGF expression on prognosis of hepatocellular carcinoma patients undergoing tumor resection.

AIM: To explore the effect of c-myc, Ki-67, MMP-2 and VEGF expression on prognosis of hepatocellular carcinoma (HCC) patients undergoing tumor resection. METHODS: Primary HCC patients underwent tumor resection were retrospectively analysed. The maximum size of the tumor was less than 5 cm, there was only one nodule in each patient. No chemoembolization was performed before resection. They were followed up after resection, and the time of recurrence was recorded. They were divided into 2 groups: group A (15 cases): tumor recurrence within 1 year after tumor resection, and group B (15 cases): with or without tumor recurrence 2 years after tumor resection. Pathological slices were made with tumor wax-sample. Immunohistochemistry staining was performed with c-myc, Ki-67, MMP-2 and VEGF monoclonal antibodies. Staining intensity was quantitatively analysed with a pathological diagram-writing analyzing system. The expressing intensity differences of stained molecules in cancer tissue and para-cancer were analysed. RESULTS: c-myc, Ki-67, MMP-2 and VEGF expressing intensities in cancer tissue in group A were higher than those in group B (P values were 0.010, 0.030, 0.022 and 0.004, respectively), but they were not significantly different in para-cancer tissue in groups A and B (P values were 0.334, 0.343, 0.334 and 0.334, respectively). CONCLUSION: The expression of c-myc, Ki-67, MMP-2 and VEGF in cancer tissue is related to the recurrence of HCC after tumor resection.

[Pathologic diagnoses of core needle biopsies of the mediastinum].

OBJECTIVES: To assess the diagnostic accuracy and to study the histologic typing of mediastinal lesions using core needle biopsies. METHODS: The histopathology and immunophenotype of 65 mediastinal core needle biopsy specimens were studied retrospectively by light microscopy and immunohistochemical staining (ABC method). Gene rearrangement studies were performed in some of the non-Hodgkin's lymphomas cases using PCR. Follow-up records were also analyzed. RESULTS: Morphologically, all specimens showed a combination of epithelioid cells, lymphoid cells and fibrous tissue in different proportions. The pathologic diagnoses included lymphoma (21 cases), pulmonary carcinoma (20 cases), thymoma (14 cases), thymic carcinoma (4 cases), seminoma (3 cases) and chronic inflammation (1 case). Definitive diagnosis was not possible in 2 cases due to insufficient material. The tumor cells in lymphoma (21 cases) expressed CD20, CD3, TDT, CD30, CD15 or EMA, depending on their histologic subtypes. Tumor cells in the 17 pulmonary carcinoma cases expressed cytokeratin (CK), except 3 cases of small cell carcinoma of lung. Synaptophysin, chromogranin A and neuron-specific enolase were all positive in the 10 cases of small cell carcinoma of lung and 1 case of thymic small cell carcinoma (which was also CD5 negative). The 3 cases of adenocarcinoma of lung showed positivity for thyroid transcription factor-1 (TTF-1) and they were negative for CD5. The 14 thymoma cases expressed CK, CD3 or CD20. The 3 thymic carcinoma cases expressed CK and CD5. Placental-like alkaline phosphatase (PLAP) was positive in 3 seminoma cases which were CK-negative. Immunoglobulin heavy chain gene was rearranged in the 3 cases of diffuse large B-cell lymphoma and 1 B-cell anaplastic large cell lymphoma case. T-cell receptor beta gene was rearranged in 5 T-cell lymphoblastic lymphoma cases. CONCLUSIONS: Microscopic assessment of tissue samples from mediastinal core needle biopsies should be made in combination with clinical and radiologic information. Ancillary investigations, including immunohistochemical staining and/or gene rearrangement studie, are needed in both non-lymphoma and lymphoma cases of mediastinum.