Results Of Pathological Examination Research Articles

PDL1Ig gene-loaded BMSCs Induce liver transplantation immune tolerance.

We investigated the effects of BMSCs, which was modified by programmed death ligand-1 immunoglobulin (PDL1Ig) gene, on the immunological rejection of orthotopic liver transplantation (OLT) in rats. Rat BMSCs were cultured and modified by recombinant adenovirus pAdEasy-1/PDL1Ig for 72h. The total protein was extracted, and the protein expression of PDL1Ig after transfection was detected by Western blotting. Mixed lymphocyte reaction was applied to detect the inhibitory effect of BMSCs, including pre-transfection and post-transfection, on the cell activity of T lymphocytes in peripheral blood. The male Wistar rats were used as donors, and the male Sprague-Dawley (SD) rats were used as recipients. The improved cuff method was computed in OLT to establish the rat orthotopic liver transplantation model of acute rejection. The rats were randomly divided into 4 groups, including a control group (10 pairs), BMSCs treatment group (10 pairs), BMSCs/GFP (green fluorescent protein) treatment group (10 pairs), and BMSCs/PDL1Ig treatment group (10 pairs). 5 rats in each group were randomly collected and euthanized at day 7 after the operation. The peripheral blood was gathered to detect levels of 3 types of cytokines, including interferon gamma (IFN-g), interleukin-4 (IL-4), and IL-2. In addition, the liver function of rats was checked, and the pathological changes of liver transplantation were observed under the optical microscope. The remaining five rats in every group were used for measuring the survival situation and survival time. After BMSCs were modified by a recombinant adenovirus pAdEasy-1/PDL1Ig for 72h, the expression of PDL1Ig in the BMSCs was detected. The inhibitory effects of BMSCs/PDL1Ig on the cell activity of lymphocytes were stronger than that of BMSCs/GFP. The levels of IL-4 in BMSCs/PDL1Ig group were significantly higher than those in the other 3 groups, and the levels of IFN-g and IL-2 were significantly decreased (p<0.05). The liver function of 4 groups was measured at day 7 after transplantation. Our results showed that the liver function in BMSCs/PDL1Ig group was most significantly improved, and the levels of ALT, AST, and TBil almost recovered to normal. The differences were statistically significant compared to the control group, BMSCs treatment group, and BMSCs/GFP treatment group. Results of pathological examination of liver tissue showed that the control group underwent severe rejection of liver transplantation. The BMSCs treatment group and BMSCs/GFP treatment group also rejected the liver transplantation, but the degree was lighter when compared to the control group. In addition, there was almost no rejection of liver transplantation in the BMSCs/PDL1Ig group. The recipient survival time of most rats was more than 100d, which was significantly longer than the other 3 groups (p<0.05). PDL1Ig-modified BMSCs can inhibit the rejection of liver transplantation in rats, induce the formation of the immune tolerance of liver transplantation, and the effect was more significant than that of BMSCs alone.

The Concentration of Iodine in Perigastric Adipose Tissue: A Novel Index for the Assessment of Serosal Invasion in Patients with Gastric Cancer after Neoadjuvant Chemotherapy

Objective: This study aims to explore the association between iodine concentration (IC) in perigastric adipose tissue (PAT), quantified by dual-energy computed tomography (DECT) and serosal invasion (SI) in patients with gastric cancer post-neoadjuvant chemotherapy (NAC). Methods: Forty-three patients with T4-staged gastric cancer were enrolled. IC and standardized IC in PAT (IC_PAT and SIC_PAT) were quantified by DECT pre and post NAC. A postoperative pathologic examination was performed to stage gastric cancer. Results: After NAC, a total of 43 participants were assigned to group A with 13 patients and group B with 30 patients according to the results of the postoperative pathologic examination. The accuracy of conventional CT in identifying SI was 74.42%. Differences of variations between pre- and post- NAC IC_PAT, SIC_PAT, ∆IC_PAT, and ∆SIC_PAT were observed respectively (p < 0.05). Intragroup IC_PAT and SIC_PAT also changed significantly after NAC (p < 0.05). The area under the ROC curve was 0.929, with the threshold of ∆SIC_PAT reaching 0.095. The sensitivity, specificity, and accuracy of SIC_PAT in identifying post-NAC SI were 92.30, 86.70, and 88.37% respectively. Moreover, the 2 measurements in the same patient maintain a high level of consistency. Conclusion: These results showed that SIC_PAT is a reliable index for identifying post-NAC SI.

Application value of the different lymph node staging system predicting prognosis of advanced gallbladder carcinoma

Application value of the different lymph node staging system predicting prognosis of advanced gallbladder carcinoma

Application value of vacuum sealing drainage in the wound repair after resection of pilonidal sinus

Objective To explore the application value of vacuum sealing drainage (VSD) in wound repair after resection of pilonidal sinus. Methods The retrospective cross-sectional study were conducted. The clinical data of 11 patients with pilonidal sinus who were admitted to the China-Japan Union Hospital of Jilin University from April 2015 to June 2016 were collected. All the patients received resection of pilonidal sinus after preoperative antibiotic therapy, and then received postoperative VSD and regular treatments of anti-infection and dressing changes. Observation indicators: (1) treatment situations: surgical procedures, operation time, volume of intraoperative blood loss, gross specimens, results of postoperative pathological examination, postoperative treatment (VSD), growth condition of granulation tissue, duration of hospital stay and treatment expenses; (2) follow-up situations: cases with follow-up, follow-up time, wound healing, postoperative complications and disease recurrence. Follow-up using outpatient examination and telephone interview was performed to detect the wound healing, postoperative complications and disease recurrence up to July 2017. Measurement data with normal distribution were represented as ±s. Measurement data with skewed distribution were described as M(range). Results (1) Treatment situations: all the 11 patients underwent successful surgery for pilonidal sinus. The operation time and volume of intraoperative blood loss were respectively (79±19)minutes and (10±4)mL. Observation of gross specimens of 11 patients: hairs were scattered within the resected lesions in 7 patients, and hairs didn't found in 4 patients. Results of postoperative pathological examination of 11 patients: there were acute and chronic inflammation accompanied with granulation tissues in the subepithelial fibrous tissues, and discrete multinucleated giant cell reaction. Of 11 patients undergoing VSD, 9 received VSD material changes for 3 times, 2 received VSD material changes for once, and wounds were not sutured after VSD removal. The new granulation tissues of 11 patients were found at (5.9±1.3)days postoperatively. The duration of hospital stay and treatment expenses were respectively (33.3±8.3)days and (37 790±8 811)yuan. (2) Follow-up situations: 11 patients were followed up for 12-18 months, with a median time of 14 months. The wound healing time was (41.0±9.0)days. Of 11 patients with follow-up, 10 were in the primary healing, 1 who was complicated with wound infection and abscess of wound deep surface underwent sacral wound incision and drainage, gauze packing and routine dressing change, and then wound healed completely. There was no recurrence in 11 patients during the follow-up. Conclusions The VSD has great application value in managing wounds after resection of pilonidal sinus, with a lower incidence of wound infection and smaller scar, and it is worth recommending to patients with wide wounds, high tension and serious infection. Key words: Pilonidal sinus; Infections diseases; Sacrococcygeal region; Surgical procedures, operative; Vacuum sealing drainage

TESTICULAR CANCER IN SOETOMO HOSPITAL SURABAYA: RETROSPECTIVE STUDY

Objective: The aim of this study was to determine the characteristics of the testicular cancer that were managed in Soetomo Hospital. Materials &amp; Methods: This was a retrospective descriptive study. We reviewed the medical records of patient with testicular tumor admitted in Soetomo Teaching Hospital Surabaya, from January 2008 until December 2013. The data regarding demographic characteristics, clinical presentation, grading and staging based on pathological examination result, and the management of the cancer. Data was presented in tabular and narrative in order to know the number and percentage of testicular cancer in Surabaya. Results: There were 46 patients with testicular cancer with mean age of 27.1 ± 7.9 years. Peak incidence was 15–35 years old (54%). Testicular mass was the most frequent clinical presentation in 42 patients (91%), abdominal mass and other complaints in 4 patients (9%). Most of the patients live outside Surabaya in 34 patients (72%). Location of the tumor was more frequently in scrotum, which occured in 42 patients (91%). A total of 4 patients (9%) were found to have a history of UDT. Based on the TNM staging, patients with stage pT3 were as many as 20 patients (43%), pT4 11 patients (24%), pT2 7 patients (15%) and pT1 4 patients (9%). In regional lymph nodes staging (N) N3 were as many as 26 patients (57%), N0 9 patients (20%), N2 5 patients (11%) and N1 2 patients (4%). Metastase staging (M) M0 was found in 27 patients (58%) and M1 tumor was found 42%. The major pathological finding was seminoma in 37 patients (80%), Yolk sac tumor in 4 patients (9%), Embryonal Ca in 1 patient (2%), Teratoma in 1 patient (2%) and mixed germ cell tumor in 3 patients (7%). The most widely theraphy was underwent orchidectomy followed by PEB chemotheraphy in 29 patients (64%), 3 patients (6%) underwent EBRT and PEB chemotheraphy, 5 patients (11%) underwent PEB chemotheraphy, There were 9 patients (19%) underwent orchidectomy alone. Group of seminoma tumor show normal limit of tumor marker α-FP and β-HCG and increased in non seminoma. Conclusion: Testicular cancer mostly appears in younger males. Most of testicular cancer was seminoma, diagnosed in advanced stage with metastase 42% of the patient. Most of the patients received orchidectomy followed by PEB chemotheraphy.

Treatment with Corticosteroid and/or Immunosuppressive Agents before Surgery can Effectively Improve the Surgical Outcome in Patients with Takayasu's Arteritis

ABSTRACTObjective: To analyze the clinical outcome of corticosteroid and/or immunosuppressive treatment preoperatively in patients with Takayasu's arteritis. Patients and Methods: Forty-six patients with Takayasu's arteritis who received cardiovascular surgery between January 2010 and December 2015 in Beijing Anzhen Hospital were enrolled in this study. Their clinical characteristics, preoperative drug therapy, surgical treatment, and pathological examination results were retrospectively analyzed for the effect of drugs on outcome of the surgery. Results: All 8 patients with active disease prior to surgery had postoperative complications including one death due to stubborn perivalvular regurgitation induced heart failure during the perioperative period. Among 38 patients without active disease prior to surgery, only 4 patients (10.5%) had postoperative complications. Thirty-four patients showed symptomatic relief in the perioperative period, of whom 23 patients treated with corticosteroid and/or immunosuppressive agents preoperatively. Conclusion: The surgery can effectively improve the symptoms of patients with Takayasu's arteritis. Active disease of Takayasu's arteritis markedly increased risk for postoperative complication and resulted in poor outcome of the surgery. Treatment with corticosteroid and/or immunosuppressive agents before surgery can effectively control the patient's condition, improve the rate of remission, and effectively reduce the incidence of postoperative complications.

Analysis of the Pathological Examination Results of 100 Colon Polyps Cases after EMR or ESD Operation

Aim: To study the characteristics of EMR (endoscopic mucosal resection) or ESD (endoscopic submucosal dissection) postoperative pathological examination of colonic polyps in different age groups, and the difference of pathological examination after EMR or ESD operation. Methods: A retrospective analysis was made of the EMR or ESD postoperative pathological data of 100 cases of colonic polyps patients in the Jingzhou Central Hospital digestive internal medicine. The time is from March 2016 to March 2018. Results: In 100 cases of EMR or ESD operation, there are 65 cases of young and middle-aged group. Pathological examination results include: 34 cases of adenomatous polyp, 18 cases of inflammatory polyp, 11 cases of benign tumors, 1 case of malignant tumor, 1 case of hyperplastic polyp. There are 35 cases of elderly group. Pathological examination results include: 27 cases of adenomatous polyp, 2 cases of inflammatory polyp, 2 cases of benign tumors, 4 cases of malignant tumor. 71 cases of complete EMR operation include: 51 cases of adenomatous polyp, 17 cases of inflammatory polyp, 3 cases of benign tumors; 29 cases of complete ESD operation include: 10 cases of adenomatous polyp, 3 cases of inflammatory polyp, 10 cases of benign tumors, 5 cases of malignant tumor, 1 case of hyperplastic polyp. Conclusion: For the pathological examination results after EMR or ESD operation, the proportion of inflammatory polyps in the young and middle-aged group was greater than that in the elderly group. The proportion of adenomatous polyps in the elderly group was larger than that in the young and middle-aged group. The proportion of adenomatous polyps in EMR was greater than that of ESD. The proportion of benign tumors and malignant tumors in ESD was greater than that of EMR. The difference has statistical significance.

Long-term and Perioperative Outcomes of Laparoscopic and Open Surgery for Rectal Cancer.

Objectives:The necessity of comparing oncologic results with the use of minimally invasive surgery in rectal cancer has arisen. The aim of the present study was to evaluate the treatment approach in rectal cancer and to compare the outcomes of laparoscopic and open surgery.Methods:Patients who underwent surgery for rectal carcinoma between January 2006 and January 2016 in our institution were evaluated. The results were compared between the two groups according to open or laparoscopic surgery. Clinical characteristics, preoperative and postoperative results, pathological examination results, and disease-free survival rates were compared after the surgical procedure.Results:A total of 121 patients were included in the study. Of the patients, 50 underwent open, and 71 underwent laparoscopic surgery. The median follow-up times were 56.75 months in the open surgery group and 55.2 months in the laparoscopic surgery group. Pathological examination revealed similar numbers of lymph nodes in both groups (p>0.05). The duration of hospital stay was statistically significantly lower in the open surgery group than in the laparoscopic group (p<0.05). The rates of disease-free survival were 74% in the open surgery group and 82.5% in the laparoscopic group, and no statistically significant difference was found (p>0.05).Conclusion:There was no significant difference in complication and recurrence between laparoscopic and open surgery for rectal cancer in our study. The duration of hospital stay of patients was statistically significantly lower in the laparoscopic group than in the open surgery group. Laparoscopic or open surgical options could be preferred according to the clinical suitability of the patient, experience of the surgeon, and resources of the center in rectal cancer treatment.

Importance of routine histopathological examination of a gallbladder surgical specimen: Unexpected gallbladder cancer.

Cholecystectomy performed for benign diseases of the gallbladder is important for the diagnosis of gallbladder cancer. This is done by pathological examination of the removed specimens for patients with no detected or suspected complications before surgery. Although some centers undertake selective approaches for histopathological examination of gallbladder specimens, many centers perform this examination routinely. In our study, we investigated results of pathological examinations carried out on cholecystectomy specimens, in respect to unexpected cases of gallbladder cancer. We reviewed cholecystectomy cases performed for benign diseases of gallbladder from January 2012 to February 2016 by investigating pathological specimens from the gallbladder. We evaluated demographical properties and their association with the pathological diagnosis and frequency of unexpected gallbladder cancer cases. We reported additional treatment and survival information of the malignancy cases after surgery. We reviewed 1294 cases of cholecystectomy, and the mean patient age was 47.5 ± 14.3 years. The most frequent diagnosis was chronic cholecystitis (92.3%), and it was more prevalent among younger patients and female sex (P < 0.0001). Five patients (0.4%) were determined to have gallbladder cancer, and the mean age of these cases was 65.6 ± 18.2 years. Two cases were Stage 2, two cases were Stage 3B, and one case was Stage 3A. There was no T1 or Tis tumor. Routine histopathological examination of gallbladder is significant with respect to the determination of additional interventions at the postoperative period required for cancer cases coincidentally diagnosed.

Clinical research of features of magnetic resonance imaging of high-voltage electrical burns in limbs at early stage

Clinical research of features of magnetic resonance imaging of high-voltage electrical burns in limbs at early stage

The impact of pituicytoma on hormone secretary function

BackgroundPituicytes are glial cells supporting hypothalamic axons in the posterior pituitary gland. Pituicytoma arises from pituicytes, and is currently classified as a World Health Organization grade I central nervous system tumor. Clinically, some patients with pituicytoma are misdiagnosed with functioning pituitary adenoma before surgical interventions and pathological examinations. This study was designed to investigate the correlation between pituicytoma and abnormal hormone function. MethodsThe records of patients who underwent pituitary surgery at Linkou Chang Gung Memorial Hospital between 2000 and 2016 were reviewed. Patients with a pathological diagnosis of pituicytoma were included. Among these patients, those with inadequate data and/or specimens were excluded. Clinical information including presenting symptoms, serum hormone level, neuroimages, and results of pathological examinations including hematoxylin and eosin stains and immunohistochemical stains were collected for analysis. ResultsBetween 2000 and 2016, eight patients were pathologically diagnosed with pituicytoma. Two patients were excluded due to missing data and/or specimens. Among the six remaining patients, five presented with hormone changes. The immunohistochemical stains of pituicytoma confirmed no secretory function; however, the surrounding pituitary glandular tissue showed positive results responsible for clinical hormone changes. ConclusionsPituicytoma had a negative endocrine secretory function in this study. However, pituicytoma was associated with hyperactivity of the surrounding pituitary glandular tissue, which resulted in clinically abnormal hormone secretion. The diagnosis of pituicytoma before a thorough pathological examination is difficult when the patients present with hormone dysfunction. Therefore, maximum resection of the pituitary tumor is necessary to make the diagnosis of pituicytoma and to exclude pituitary adenoma.

Diagnostic value of ultrasound-guided puncture biopsy in breast masses

Objective To explore the diagnostic value of ultrasound-guided puncture biopsy in breast masses. Methods 50 patients were enrolled in this study for breast mass examination and ultrasound presentation of BI-RADS class Ⅳ.All the patients underwent ultrasound-guided biopsy and pathological examination.The pathological results of the biopsy were compared with the final results of pathological diagnosis.The sensitivity and specificity of ultrasound-guided biopsy, and the accuracy of each type of breast mass examination were observed. Results 50 cases of breast masses were successfully punctured under ultrasound guidance, the postoperative pathological results were the diagnostic criteria.The puncture biopsy results showed that 16 cases of benign lesions and 34 cases of non-benign lesions.The postoperative pathological examination results showed that 13 cases of benign lesions, 37 cases of non-benign lesions, the sensitivity and the specificity of the biopsy was 89.19% and 92.31%.Pathological puncture results showed 16 cases of benign tumors with an accuracy rate of 81.25%, 27 cases of malignant tumors, the accuracy rate was 92.59%, 7 cases of high risk, the accuracy rate was 57.14%.Compared with the accuracy of the diagnosis of benign and malignant results, the diagnostic accuracy of high-risk results was the lowest(χ2=20.802, P<0.01). Conclusion Ultrasound-guided puncture biopsy can better identify the benign and malignant nature of breast masses, with high accuracy, small trauma, it is safe and reliable, and has important clinical value for the diagnosis of breast mass, which can provide a reliable basis for further clinical treatment scheme. Key words: Ultrasonography; Biopsy, needle; Breast neoplasms; Diagnostic

Clinical value of preventative surgical resection in the treatment of extra-hepatic portal vein aneurysm

Objective To investigate the clinical value of preventative surgical resection in the treatment of extra-hepatic portal vein aneurysm. Methods The method of retrospective descriptive study was conducted. The clinical data of 1 patient with extra-hepatic portal vein aneurysm who was admitted to the Guangzhou General Hospital of Guangzhou Military Command of PLA in May 2014 were collected. The patient suffered from dull pain in his epigastrium, with no obvious causative factors. The patient recieved abdominal B-ultrasound, CT scans abdominal and superior mesenteric artery, angiographies after admission in May 2014, and was diagnosed as with extra-hepatic portal vein aneurysm. The preventative surgical resection was selected according to the patient′s individual health status. Extra-hepatic portal vein aneurysm resection was conducted under the guidance of intraoperative ultrasonography after abdominal exploration. A double-cavity drainage tube was placed in the venturis hole when portal vein aneurysm was dissected and removed. Then the abdomen was closed. The patient received regular perioperative management. The operation time, volume of intraoperative blood loss, time for diet recovery, time of drainage tube removal, postoperative complications, results of laboratory tests, results of imaging findings, healing of incision, time of postoperative discharge from hospital, results of pathologic examination and follow-up were observed. Follow-up using outpatient examination or telephone interview was performed to detect the inspect status of portal vein and inspect recurrence of portal vein aneurysm by abdominal B-ultrasound and CT examinations till December 2014. Results The patient underwent successful extra-hepatic portal vein aneurysm resection. The operation time was 85 minutes and the volume of intraoperative blood loss was around 150 mL. The patient gradually returned to normal diet and self-care ability at postoperative day 3, and the abdominal drainage tube was removed at postoperative day 3. No postoperative complications including hemorrhage, portal vein thrombosis and dysfunction of liver were detected after operation. There were normal levels of blood routine and blood biochemical test. Postoperative B-ultrasound examination showed smooth blood flow in portal vein and the abdominal blood vessel CT angiography presented clear image of the portal vein, with smooth blood flow and normal lumen. The surgical incision recovered very well and the patient was discharged from hospital at postoperative day 9. Results of postopeartive pathologic examination showed that there were cystic-like tissues with simple squamous epithelium cells on the interior, the wall of which consisted of smooth muscle was in accordance of the structure of vein. The patient didn′t receive any other special treatment or take medicines postoperatively. The patient had good physical health and can take care of himself during six-month follow-up, without narrow portal vein, recurrence of portal vein aneurysm and other complications. Conclusion Preventative surgical resection is safe and feasible for extra-hepatic portal vein aneurysm, with a good efficacy. Key words: Portal vein aneurysm, extra-hepatic; Surgical procedures, operative; Preventability; Portal vein aneurysm resection

Feasibility of intensity-modulated radiation therapy with concurrent chemotherapy in patients with Siewert type II and III adenocarcinoma of the esophagogastric junction before surgery

Objective To analyze the feasibility of intensity-modulated radiation therapy (IMRT) with concurrent chemotherapy in patients with locally advanced Siewert type Ⅱ and Ⅲ adenocarcinoma of the esophagogastric junction (AEG). Methods A prospective study was performed on 45 patients with locally advanced Siewert type Ⅱ and Ⅲ AEG. These patients received two cycles of XELOX chemotherapy and concurrent IMRT to the involved field (45 Gy/25 f, 5 f/week) for 6 to 8 weeks before surgical resection. The patients ingested 800 to 1000 ml water to distend the stomach before computed tomography (CT) scan. The gross tumor volume of the primary tumor (GTV-t) was delineated on the CT image with a stomach wall thickness of>5 mm. GTV-t was expanded by a 2.0 cm margin along the esophagus, a 1.5-2.0 cm margin along the stomach, and a 0.8 cm margin axially outward to generate the clinical target volume of the primary tumor (CTV-t). GTV-lymph node (GTV-nd) was delineated based on CT/magnetic resonance imaging scan. CTV-nd only included GTV-nd and the involved lymph nodes. Planning target volume was generated by expanding the CTV by 0.8 to 1.0 cm. The feasibility of target volume delineation was explored by analyzing postoperative pathological examination results and radiotherapy toxicities. Results All the 45 patients completed preoperative concurrent chemoradiotherapy and surgery, with two cycles of chemotherapy in 39 patients and one cycle in 6 patients. The rates of R0 resection and pathological complete response (pCR) were 95.6%(43/45) and 22.2%(10/45), respectively. There were 10(22.2%), 17(37.8%), 15(33.3%), and 3(6.7%) patients with tumor regression grades 0, 1, 2, 3, respectively. The rate of lymph node metastasis was 37.8%(17/45), and the lymph node ratio was 4.33%(46/1062). The postoperative pathological examination showed that T and N downstaging after surgery was observed in 24 and 26 patients, respectively; the proportions of patients with T3-T4 tumors and positive lymph nodes after surgery declined by 51.1%(P=0.000) and 42.2%(P=0.000), respectively. The overall incidence of radiation esophagitis/gastritis was 44.4%(20/45), and the incidence rates of grade 1, 2, and 3 radiation esophagitis/gastritis were 18%, 22%, and 4%, respectively. The incidence of acute radiation pneumonitis was 6.7%(3/45), all in grades 1 and 2. There was one perioperative treatment-related death. Conclusions Two cycles of XELOX chemotherapy combined with concurrent 45 Gy radiotherapy before surgery in patients with locally advanced Siewert type Ⅱ and Ⅲ AEG can achieve a relatively high pCR rate, effectively reduce the lymph node metastasis rate, achieve downstaging, and increase R0 resection rate. This regimen has many good advantages, including low incidence of acute toxicities, good tolerability, and acceptable rate of perioperative treatment-related deaths. The target volume delineation involving metastatic lymph nodes is feasible. Key words: Esophagogastric junction adenocarcinoma/radiotherapy; Esophagogastric junction adenocarcinoma/chemotherapy; Involved-field irradiation, feasibility

Clinical features and treatment of solid pseudopapillary neoplasm of the pancreas

Clinical features and treatment of solid pseudopapillary neoplasm of the pancreas

New types of operation based on perihilar resection to cure hilar cholangiocarcinoma

Objective To explore clinical efficacy of new types of operation based on perihilar resection to cure hilar cholangiocarcinoma. Methods The retrospective descriptive study was conducted. The clinico-pathological data of 4 patients with different Bismuth type of hilar cholangiocarcinoma who were admitted to the Beijing Tsinghua Chunggung Hospital from December 2014 to June 2016 were collected. After preoperative examinations and evaluations, single perihilar resection or combined with central liver segmentectomy were performed. Observation indicators included: (1) intraoperative situations; (2) postoperative pathological examinations; (3) postoperative situations; (4) follow-up. Patients were followed up using outpatient examination up to June 2017. Follow-up included abdominal pain, fever, routine blood test, tumor marker test and imaging examination which detected tumor recurrence and metastasis. Measurement data were represented as average (range). Results (1) Intraoperative situations: 4 patients received successful operations, with an average operation time of 512 minutes (range, 300-620 minutes). Portal vein was blocked continuously, with an average occlusion time of 70 minutes (range, 57-80 minutes), an average volume of intraoperative blood loss was 537 mL (range, 200-1 000 mL). Two patients received transfusion of 2 U plasma, 4 U plasma + 4 U red blood cell (RBC), respectively. (2) Postoperative pathological examinations: results of postoperative pathological examinations in 4 patients showed that tumor size was respectively 1.5 cm×1.2 cm×1.1 cm, 1.3 cm×1.1 cm×1.0 cm, 2.0 cm×1.7 cm×1.5 cm and 2.0 cm×2.0 cm×1.5 cm. Tumor differentiation: 1 and 3 patients were respectively detected in moderate-differentiated cholangiocarcinoma and low-differentiated cholangiocarcinoma. Positive nerve plexus invasion was found in all 4 patients and 3 patients had regional lymph node metastasis. Four patients received R0 resection. TNM staging: T2aN1M0 and T2bN1M0 were found in 1 and 3 patients, respectively. (3) Postoperative situations: of 4 patients, 1 complicated with biliary leakage was cured by conservative treatment and then discharged from hospital at 67 days; 3 had good recovery and then discharged from hospital at day 21, 14 and 14, respectively. Patients didn′t receive postoperative adjuvant treatment, such as chemoradiotherapy. (4) Follow-up: 4 patients were followed up for 12-31 months. During follow-up, 4 patients were in good condition, and 1 with transient fever was relieved by conservative treatment. Levels of tumor marker in 4 patients were normal, results of enhanced CT scan showed no signs of tumor recurrence and intrahepatic bile duct dilatation. Conclusion After precisely evaluating the tumor extension among segmental bile duct, single perihilar resection or combined with central segmentectomy can effectively cure hilar cholangiocarcinoma. Key words: Biliary neoplasms, hilar; Perihilar resection; Segmental bile duct

Application value of artery approach in the lower colon region combined with portal vein resection and allograft vascular grafts in radical pancreaticoduodenectomy

Objective To investigate the application value of artery approach in the lower colon region combined with portal vein (PV) resection and allograft vascular grafts in radical pancreaticoduodenectomy for pancreatic cancer combined with vascular invasion. Methods The retrospective descriptive study was conducted. The clinicopathological data of 13 patients with pancreatic cancer involving in PV, splenic vein or junction who were admitted to the Beijing Chao Yang Hospital of Capital Medical University from March 2014 to June 2015 were collected. The superior mesenteric artery (SMA), tumors and soft tissues (including involved vessels) in the right of the celiac trunk were resected after exploring SMA and evaluating resectability of tumors. Patients underwent PV-splenic vein resection and reconstruction with allogenic vein. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) follow-up situation. Follow-up using outpatient examination and telephone interview was performed to detect survival of patients and tumor recurrence and metastasis up to April 2016. Measurement data with normal distribution were represented as ±s. Results (1) Surgical situations: 13 patients successfully underwent radical pancreaticoduodenectomy via artery approach in the lower colon region combined with PV, splenic vein resection and allograft vascular grafts. Operation time and volume of intraoperative blood loss were respectively (489±31)minutes and (407±96)mL, without intra- and post- operative deaths. (2) Postoperative situations: of 13 patients, 3 and 1 patients were respectively complicated with pancreatic fistula (2 in grade A and 1 in grade B) and gastroplegia, and cured by conservative treatment.There was no occurrence of bleeding, intraperitoneal infection, diarrhea, anastomotic stenosis and thrombus. The median duration of postoperative hospital stay was 12 days. Results of postoperative pathological examination: of 13 patients, high-, moderate- and low-differentiated adenocarcinoma was detected in 2, 7 and 4 patients respectively. Three patients had negative vascular margin, 2 had tunica intima invasion and 8 had tumor cell invasion in vascular adventitia.One, 2, 6, 4 patients were detected in ⅠB, ⅡA, ⅡB and Ⅲ staging, respectively. The negative margin rate by postoperative pathological examination was 11/13. (3) Follow-up situation: 13 patients were followed up 10 months postoperatively, with good survival and without tumor recurrence or metastasis. Conclusion The radical pancreaticoduodenectomy via artery approach in the lower colon region combined with PV/SMV resection and allograft vascular grafts is safe and feasible for pancreatic cancer involving in PV, splenic vein or junction, it can also evaluate early resectability of tumors, with good operative efficacy. Key words: Pancreatic neoplasms; Pancreaticoduodenectomy; Artery approach; Vascular grafts

Outcomes of robotic versus laparoscopic surgery for mid and low rectal cancer after neoadjuvant chemoradiation therapy and the effect of learning curve

Randomized controlled trials have demonstrated that laparoscopic surgery for rectal cancer is safe and can accelerate recovery without compromising oncological outcomes. However, such a surgery is technically demanding, limiting its application in nonspecialized centers. The operational features of a robotic system may facilitate overcoming this limitation. Studies have reported the potential advantages of robotic surgery. However, only a few of them have featured the application of this surgery in patients with advanced rectal cancer undergoing neoadjuvant chemoradiation therapy (nCRT).From January 2012 to April 2015, after undergoing nCRT, 40 patients with mid or low rectal cancer were operated using the robotic approach at our institution. Another 38 patients who were operated using the conventional laparoscopic approach were matched to patients in the robotic group by sex, age, the body mass index, and procedure. All operations were performed by a single surgical team. The clinicopathological characteristics and short-term outcomes of these patients were compared. To assess the effect of the learning curve on the outcomes, patients in the robotic group were further subdivided into 2 groups according to the sequential order of their procedures, with an equal number of patients in each group. Their outcome measures were compared.The robotic and laparoscopic groups were comparable with regard to pretreatment characteristics, rectal resection type, and pathological examination result. After undergoing nCRT, more patients in the robotic group exhibited clinically advanced diseases. The complication rate was similar between the 2 groups. The operation time and the time to the resumption of a soft diet were significantly prolonged in the robotic group. Further analysis revealed that the difference was mainly observed in the first robotic group. No significant difference was observed between the second robotic and laparoscopic groups.Although the robotic approach may offer potential advantages for rectal surgery, comparable short-term outcomes may be achieved when laparoscopic surgery is performed by experienced surgeons. However, our results suggested a shorter learning curve for robotic surgery for rectal cancer, even in patients who exhibited more advanced disease after undergoing nCRT.

Clinical application of wire guided localization of breast biopsy under X-ray guidance

Objective To study the diagnostic and treatment value of wire guided localization of breast biopsy for non-palpable breast lesions. Methods The clinical data of 314 cases of non-palpable breast lesion resection operation in our hospital were retrospectively analyzed.The accuracy rate of resection and postoperative pathological examination results were analyzed. Results All lesions were positioned accurately and completely resected, 48 cases in 314 cases were breast cancer(15.3%), in which 42 cases were early breast cancer which were confirmed by pathology(87.5%). Conclusion Wire guided localization of breast biopsy has high accuracy, low cost, which is useful for the diagnosis of early breast cancer, there is a certain value in clinical application. Key words: Mammography; Breast lesion; Biopsy

Computed tomography and magnetic resonance imaging features of the myomatous hepatic angiomyolipoma

Objective To investigate the computed tomography (CT) and magnetic resonance imaging (MRI) features of the myomatous hepatic angiomyolipoma (MHAML). Methods The retrospective cross-setional study was conducted. The clinicopathological data of 22 patients with MHAML who were admitted to the Southwest Hospital of the Third Military Medical University between January 2010 and June 2016 were collected. Patients underwent plain and enhanced scans of CT and MRI, and then received pathological examination after surgical resection or liver puncture and immunohistochemical staining. Observation indicators: (1) findings of CT and MRI, 2 radiologists independently read films; (2) diagnostic consistency of 2 radiologists; (3) results of pathological examination. The Kappa test was used for evaluating the consistency, κ≥0.75 as a good consistency, 0.40<κ<0.75 as a normal consistency and κ≤0.40 as a poor consistency. Results (1) Findings of CT and MRI: of 22 patients, 16 received CT scans and 6 received CT and MRI scans. Tumors of 22 patients were single lesion, showing similar-circular type. Tumors located in the right liver lobe, left liver lobe and caudate lobe were respectively detected in 14, 7 and 1 patients. ① Plain and enhanced scans of CT: tumors of 22 patients showed low density. Twenty patients had clear boundary of tumor and 2 had an unclear boundary. Tumors of 22 patients demonstrated obvious enhancement in arterial phase by enhanced scans of CT, including fast-in and slow-out enhancement in 10 patients and fast-in and fast-out enhancement in 12 patients. The draining veins inside tumors were detected in 12 patients in early arterial phase by enhanced scans of CT. The dilated blood vessels inside tumors were found in 12 patients. The ring enhancement of tumor margin was detected in 16 patients, with formation of small blood vessels involving tumor blood supply. ② MRI scan: tumors of 6 patients presented as low signal on T1WI and high signal on T2WI. Of 6 patients, 5 had clear boundary of tumor and 1 had an unclear boundary. Tumors of 6 patients demonstrated obvious enhancement in arterial phase by enhanced scans of MRI, with a fast-in and fast-out enhancement. The draining veins inside tumors were detected in 3 patients in early arterial phase by enhanced scans of MRI. The dilated blood vessels inside tumors were found in 1 patient. The persistent ring enhancement of tumor margin was detected in 5 patients, with formation of small blood vessels. All the lesions of 6 patients using GD-EOB-DTPA MR contrast-enhanced scan demonstrated restricted diffusion with a high b value (b=800 s/mm2), an average apparent diffusion coefficient of 1.549×10-3 mm2/s (1.209×10-3-1.796×10-3 mm2/s) and low a signal in liver phase. (2) Diagnostic consistency of 2 radiologists: there were good diagnostic consistencies of 2 radiologists in tumor location, density, T1WI, T2WI, bleeding, enhancement method and dilated blood vessels (κ=1.00, 1.00, 1.00, 1.00, 0.82, 0.82, P<0.05). There were normal diagnostic consistencies of 2 radiologists in tumor fat, calcification, component of cystolization, boundary, draining veins and enhancement of tumor margin (κ=0.46, 0.45, 0.64, 0.54, P<0.05). (3) Results of pathological examination: results of pathological examination of tumors from surgical resection of 17 patients and liver puncture of 5 patients showed that smooth muscle cells were the major components, and thick-walled vessels were found in the tumor of 12 patients. Results of immunohistochemical staining showed that anti melanoma specific monoclonal antibody (HMB-45) was positive. Conclusion The persistent enhancement of tumor margin, draining veins in early arterial phase by enhanced scans and dilated blood vessels might play roles in diagnosis of MHAML. Key words: Liver neoplasms; Angiomyolipoma; Myomatous type; Tomography, X-ray computed; Magnetic resonance imaging; GD-EOB-DTPA