Safety evaluation of preoperative stent insertion and clinical analysis on comparison of outcomes between preoperative stent insertion and emergency surgery in the treatment of obstructive left-sided colorectal cancer.

OBJECTIVE: To evaluate the safety of preoperative stent insertion and compare the short- and long-term outcomes between preoperative stent insertion and emergency surgery in the treatment of obstructive left-sided colorectal cancer. METHODS: The clinical data of 302 patients who underwent surgery for obstructive left-sided colorectal cancer from January 2009 to May 2014 were retrospectively analyzed. They were divided into two groups according to whether to receive stenting for the success rate and complications of stent insertion in colonic lumen by colonoscope, and the number of cases of primary resection and anastomosis, and short-term complications such as incision infection, anastomotic leakage, spleen tear and abdominal abscess as well as mortality and survival rate during hospitalization were compared. RESULTS: The success rate of endoscopic nitinol alloy memorial stent insertion in colonic lumen was 97.62%, and the overall incidence of complications was 14.5%, of which the incidence of serious complications (perforation, stent migration) was 4.76%. The primary anastomosis rate was significantly higher in the stent insertion group (85.71%) than that in the emergency surgery group (36.24%). The overall complication rate in the stent insertion group (14 cases) was significantly lower than that in the emergency surgery group (102 cases). There was no significant difference between survival curves (P>0.05). CONCLUSION: Preoperative stent insertion in colonic lumen by colonoscope for decompression is an ideal auxiliary method in the treatment of obstructive left-sided colorectal cancer, and may increase primary anastomosis rate, avoid neostomy, reduce short-term complications, and improve the long-term survival compared to emergency surgery.

Correlations between microsatellite instability, ERCC1/XRCC1 polymorphism and clinical characteristics, and FOLFOX adjuvant chemotherapy effect of colorectal cancer patients.

Patients with MSI colorectal tumor have good prognosis and cannot benefit from 5-fluorouracil (5-Fu)-based chemotherapy reported by previous studies. While, single nucleotide polymorphisms (SNP) of ERCC1 and XRCC1 have be proved to influence clinical outcome of colorectal cancer patients treated with oxaliplatin-based chemotherapy. We aim to study the correlation between molecular status and clinical- pathological features, and their effect on CRC patients' clinical outcome treated with mFOLFOX6 adjuvant chemotherapy. In this study, MSI status was determined in tumors and paired normal tissues from 101 colorectal cancer (CRC) patients. We also examined SNP of ERCC1 (c. C354T) and XRCC1 (c.G1196A) in 83 and 85 patients' blood. MSI was found to be significantly correlated with well/moderate histopathological differentiation (p = 0.038) and CRC family history (p = 0.003). CEA and CA19-9 levels was positive correlated significantly by Spearman correlation analysis (Pearson's r = 0.823, p < 0.0001). No significant correlation was found between MSI status and ERCC1/XRCC1 polymorphisms. We found greater drop of CEA level in mFOLFOX6 sensitive group than low sensitive group after mFOLFOX6 adjuvant chemotherapy according to MSI status, ERCC1 and XRCC1 SNP. MSI was significantly correlated with well/moderate histopathological differentiation (p = 0.038) and CRC family history (p = 0.003). The MSI status, ERCC1 and XRCC1 polymorphisms may influence the clinical outcome of colorectal cancer patients treated with mFOLFOX6 adjuvant chemotherapy.

[Perspective research of the influence of caloric restriction combined with psychotherapy and chemotherapy associated by hybaroxia on the prognosis of patients suffered by glioblastoma multiforme].

OBJECTIVE: To explore the influence of caloric restriction combined with psychotherapy and chemotherapy associated by hybaroxia on the prognosis of patients with intracranial glioblastoma multiforme. METHODS: This was a perspective, nonrandom, no-double-blinded controlled study. All patients underwent total resection during November 2007 to April 2009 at Beijing Tiantan Hospital and Beijing Tiantan Puhua Hospital. All diagnoses were confirmed by molecule pathology. While 23 patients in control group underwent resections and radiochemotherapy, 11 patients in experimental group were further treated by caloric restriction plus psychotherapy and chemotherapy-associated hybaroxia. The life spans were compared between two groups. RESULTS: The mean survival time of patients in experimental group was (38 ± 13) months versus (20 ± 12) months in control group. The survival time of patients in experimental group was significantly longer than that in control group (P < 0.05). CONCLUSION: Caloric restriction plus psychotherapy and chemotherapy-associated hybaroxia can apparently prolong the life span of patients with glioblastoma multiforme.

Radiation-induced malignant fibrous histiocytoma of the occipital: a case report.

Malignant fibrous histiocytoma (MFH) is a rare neoplasm exhibiting a propensity for aggressive clinical behavior. Effective treatment modality is surgical resection with wide margins, but its rate of recurrence and metastasis is still high. Early detection and complete excision of the tumor is necessary. A MFH of the occipital developed in a 51-year-old woman eight years after surgery and radiation for medulloblastoma of the cerebellar vermis. The secondary neoplasm arose at the site of tumor resection within the irradiated field, and was resected. The development of sarcomas is a recognized complication of radiation therapy. The final diagnosis after the operation was MFH. Radiation-induced sarcoma (RIS) is well known, but radiation-induced MFH is relatively rare in the head and neck region, especially in the occipital. The imaging findings are not diagnosis specific, but strict follow-up within the radiation field by computerized tomography (CT) and magnetic resonance imaging (MRI) and appreciation of the expected latency period may help in providing the diagnosis of RIS.

Surgical treatment of spinal vascular malformations performed using intraoperative indocyanine green videoangiography.

This study aims to evaluate the benefits of intraoperative indocyanine green (ICG) videoangiography and associated surgical outcomes of patients with spinal vascular malformations. ICG videoangiography was used during 24 surgical interventions to treat spinal vascular malformations at the Beijing Tiantan Hospital from August 2009 to May 2011. The vascular malformations were removed or the fistulae were occluded with the assistance of ICG videoangiography. The completeness of fistula clipping or nidus extirpation and each patient's neurological status were evaluated. Among these 24 patients, there were seven with spinal dural arteriovenous fistulae, five glomus arteriovenous malformations, one juvenile arteriovenous malformation, nine perimedullary arteriovenous fistulae, and two perimedullary arteriovenous fistulae in combination with perimedullary arteriovenous malformations. Intraoperative ICG videoangiography confirmed the definite clipping of the fistulous points and complete removal of intramedullary arteriovenous malformations in all but one patient. All patients had satisfactory preservation of spinal cord blood supply and venous return. No adverse effects or complications related to ICG videoangiography occurred. Three patients were lost to follow up; 21 patients were followed clinically with a mean follow up of 7.5 months. The neurological deficits completely resolved in six patients, improved significantly in 10, remained stable in two, and were aggravated in three patients. Our experience shows that intraoperative ICG videoangiography offers useful information on the pathological and physiological vascular anatomy encountered during surgery for spinal vascular malformations.

[Microneurosurgical treatment of massive tuberculum sellae meningiomas].

OBJECTIVE: To summarize the characteristics of the pathological anatomy and blood supply model of massive tuberculum sellae meningiomas (MTSM) and explore its corresponding microneurosurgical strategies. METHODS: The clinical data of 16 MTSM patients were reviewed retrospectively. From January 1998 to January 2010, according to their unique pathological anatomy and blood supply model, all patients underwent microneurosurgical removal with induced hypotension through tumor corridor by the bi-subfrontal anterior longitudinal fission (n = 14), right frontolateral approach (n = 1) and pterional approach (n = 1). There were 5 males and 11 females with a mean age of 48.5 years old (range: 26 - 65). But the mean follow-up period was 74.9 months (range: 4 - 132) in 2/4 cases. RESULTS: Among all cases, the mean tumor diameter was 58.9 mm (range: 51.1 - 76.2 mm). Simpson grade I, II, III, IV removal of MTSMs were accomplished in 3, 9, 3 and 1 case respectively. One case died within 4 postoperative days. Visual acuity improved in 10 patients, remained unchanged in 2 and deteriorated in 2. Transient postoperative diabetes insipidus occurred in 9 cases. CONCLUSION: It is critical to understand the unique characteristics of pathological anatomy and blood supply model of MTSM so as to adopt proper microneurosurgical strategies to remove it in situ.