[Synchronous primary bilateral macronodular adrenal hyperplasia with renal cell carcinoma: a case series of three patients].

Three cases of synchronous primary bilateral macronodular adrenal hyperplasia(PBMAH) and renal cell carcinoma (RCC) in the Department of Urology of Peking Union Medical College Hospital were retrospectively reviewed. The clinical features, imaging features, treatment methods and pathological features of these patients were analyzed. It was found that the genetic relationship between synchronous PBMAH and RCC needs further research. And RCC is easy to be misdiagnosed. We should pay high attention to imaging features to find out whether there are lesions in bilateral kidneys when we deal with bilateral adrenal lesions. Laparoscopic approach is recommended for PBMAH and RCC. Total or partial nephrectomy should be performed according the tumor size and location of the renal mass. Patients with PBMAH should be closely followed up after bilateral adrenalectomy to avoid delay in diagnosis or treatment of RCC.

[Macular buckling for highly myopic traction maculopathy].

Objective: To observe the efficacy of macular buckling in the treatment of highly myopic traction maculopathy. Methods: Retrospective case series study. The patients with high myopia who underwent macular buckling at the Zhongshan Ophthalmic Center of Sun Yat-sen University from June 2014 to June 2019 were enrolled, including 136 males and 212 females. The age was (56.68±11.59) years old. The outcomes measured included retinal reattachment rate, foveoschisis recovery rate, macular hole closure rate, postoperative best corrected visual acuity (BCVA), axial length (AL), and complications. The measurements were recorded preoperatively and at 1 month, 6 months, 1 year, 2 years, and 3 years postoperatively. The data was statistically analyzed using paired t test. Results: A total of 378 eyes were included, including 216 eyes with foveoschisis and macular detachment and 162 eyes with macular holes and macular detachment. Among them, 296 eyes underwent macular buckling, and the other 82 eyes underwent macular buckling combined with pars plana vitrectomy. During the follow-up period, 373 eyes (98.68%) achieved retinal reattachment; in patients with foveoschisis, 204 eyes (94.44%) were recovered; in patients with macular holes, 89 eyes (54.09%) achieved closure. All the postoperative results of BCVA were better than the preoperative value (1.459±0.841). BCVA continued to increase from postoperative month 1, remained stable at 1 year, and reached 0.908±0.606 at 3 years (t=6.896, P<0.01). All the postoperative results of AL were shorter than the preoperative value. The AL shortened by (4.423±1.740)mm at one month (t=33.144, P<0.01), increased gradually thereafter, remained stable at 1 year, and shortened by (2.101±1.643) mm at three years (t=6.392, P<0.01). The common complications included transient high intraocular pressure in 98 eyes (25.92%), epiretinal hemorrhage in 67 eyes (17.72%), and vitreous hemorrhage in 9 eyes (2.38%), which all resolved spontaneously within 1 month. In the early postoperative period, all patients had a certain degree of eye movement limitation, and 39 eyes (10.31%) had diplopia which resolved within 6 months without treatment. The strabismus surgery was arranged to treat esotropia in 6 eyes (1.58%). The macular buckle was removed from 1 eye (0.26%) because of the inability to tolerate diplopia. There were 8 eyes (2.11%) requiring a second operation to adjust the position of the buckle. The macular buckle was also removed from 4 eyes (1.05%) due to the implant rejection. Conclusion: Macular buckling can effectively shorten the AL, resolve posterior scleral staphyloma, and improve vision in the treatment of highly myopic traction maculopathy. (Chin J Ophthalmol, 2021, 57: 433-439).

Role of pelvic radiotherapy for locally advanced rectal cancer and synchronous unresectable distant metastases.

PURPOSE: To evaluate the efficacy and safety of pelvic irradiation combined systematic chemotherapy in patients with locally advanced (cT3-T4 and/or cN+) rectal cancer and synchronous unresectable distant metastases. PATIENTS AND METHODS: A total of 76 eligible patients who received pelvic radiotherapy and concurrent capecitabine-based chemotherapy were retrospectively reviewed. Patients survival curves were constructed using the Kaplan-Meier method, and a multivariate analysis was performed to identify independent prognostic factors. RESULTS: Most of the adverse events were mild during the period of combined chemoradiotherapy. Twenty-two patients experienced resection of primary tumour and 16 patients underwent radical surgery of all lesions. Only five patients had pelvic progression during the follow-up period. The median progression-free survival and median overall survival were 13 and 30 months, respectively. Radical surgery of all lesions following chemoradiotherapy was found to be an independent prognostic factor according to multivariate analysis. CONCLUSIONS: Pelvic irradiation combined with systematic chemotherapy in patients with locally advanced rectal cancer and synchronous unresectable distant metastases is effective and tolerable, both for pelvic and distant control. A curative resection following chemoradiotherapy was associated with prolonged survival.

Tumour diameter is a predictor of mesorectal and mesenteric lymph node metastases in anorectal melanoma.

AIM: Anorectal melanoma is a rare neoplasm with poor prognosis. The aim of this study was to investigate what clinicopathological factors predict lymph node metastases and to investigate their association with survival. METHOD: Patients undergoing surgery with curative intent for primary anorectal melanoma in Fudan University Shanghai Cancer Center between 1989 and 2011 were studied retrospectively. The associations between clinicopathological factors and lymph node metastases and prognosis were determined. RESULTS: Forty-three patients underwent a potentially curative resection with a median follow-up of 20 months; the 5-year overall survival rate was 29.6% with median overall survival of 28 months. Tumour diameter > 3 cm was associated with mesorectal and mesenteric lymph node metastases (P = 0.013). Perineural invasion (hazard ratio 5.683; 95% CI 1.978-16.328; P = 0.001) was the only factor that independently predicted survival. CONCLUSION: Tumour diameter was associated with mesorectal and mesenteric lymph node metastases; therefore, wide local excision may not be appropriate for surgery with curative intent for patients with a tumour diameter ≥ 3 cm. Perineural invasion was an important prognostic factor for anorectal melanoma.

Interaction between synchronous bilateral prophylactic oophorectomy and adjuvant chemotherapy in female patients with locally advanced colorectal cancer.

AIM: In this study we explored the prognostic impact of synchronous bilateral prophylactic oophorectomy in female patients with primary colorectal cancer undergoing radical surgery. METHOD: From 1991 to 2000, 267 female patients with stage II or stage III colorectal cancer, who had undergone curative resection, were retrospectively reviewed. In 224 patients, the ovaries were preserved. The other 43 patients underwent synchronous bilateral prophylactic oophorectomy. Univariate and multivariate analyses (Kaplan-Meier and Cox regression, respectively) were used to evaluate the effect of prophylactic oophorectomy and other clinical factors on the prognosis of patients. RESULTS: Both univariate and multivariate analyses showed that tumor stage and adjuvant chemotherapy were the only two significant clinical factors that affected the 5-year overall survival of patients (P < 0.01). There was no significant difference in the 5-year overall survival between patients who had, or had not, undergone prophylactic oophorectomy (75%vs 73%, P > 0.05). In the subgroup analysis by adjuvant chemotherapy, the 5-year overall survival in patients receiving adjuvant chemotherapy was similar between nonoophorectomy and oophorectomy groups. However, in patients without adjuvant chemotherapy, the oophorectomy group was shown to have a significantly better 5-year overall survival than the nonoophorectomy group (76%vs 51%, P = 0.047). CONCLUSION: Prophylactic oophorectomy may improve the overall survival of female patients with locally advanced colorectal cancer without adjuvant chemotherapy, but its survival benefit vanished in patients receiving adjuvant chemotherapy. The role of prophylactic oophorectomy may be substituted by adjuvant chemotherapy, which makes prophylactic oophorectomy unnecessary during surgery for locally advanced colorectal cancer.

Occupational exposure to bloodborne viruses in the Amsterdam police force, 2000-2003.

OBJECTIVES: To assess and evaluate the rate and outcome of occupational exposure to hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) in the Amsterdam police force. METHODS: Retrospectively, all accidents with risk for viral transmission reported to the Municipal Health Service between January 1, 2000 and December 31, 2003 were described and analyzed in 2004. RESULTS: Over a 4-year period, 112 exposures with a viral transmission risk were reported (the estimated exposure rate was 68/10,000/year). Of these exposures, 89 (79%) sources were tested, finding 4% HBV-positive, 4% HIV-positive, and 18% HCV-positive. Immunoglobulin for HBV infection was given 44 times; HIV post-exposure prophylaxis was prescribed 16 times and 13 of 16 discontinued the course within a few days because the transmission source tested HIV-negative. No seroconversions were seen in persons exposed. CONCLUSIONS: The rate of exposure is low. The majority of the sources could be traced and tested. However, a comprehensive and effective protocol is essential in minimizing the risk of occupational HBV, HCV, and HIV infection in police officers, even if HBV vaccination is provided.

[Clinical study of the relationship between the lateral recesses and the nerve roots].

To explicate the relationship and the clinical signification between the normal or narrow lateral recesses and the nerve roots, we measured the diameter of the entrans zone of the lateral recess, the interval between the upper articular processes and the interval between the nerve root and ab line on 50 normal cases, 43 narrow cases and 32 stenosis cases with VIDS image analysis system. The results showed that the nerve root was in the center side of the ab line in the normal station, with the degrees of the degeneration and cohesion ncreasing, the nerve root was in the lateral recess side of the ab line, and was compressed by the lateral recess. The authors considered that the real clinical signification of the entrance zone of the lateral recess was danger to the nerve root, but the deciding factors were the degrees of the degeneration and cohesion of the upper articular processes. The pathological conditions that resulted in the stenosis of the lateral recess and dangered the nerve root such as disc, flavum ligament and posterior port of the fibra ring were discussed in the article.

[Three-dimensional recons-truction of lumbar-sacral canal and its contents: experimental study].

In order to suit the needs of studies in spinal column surgery on three-dimensional spatial structure and morphology of lumbar-sacral canal and the nervous tissue within it, an experimental model was applied by the authors using lumbosacral specimens from two fresh young adult cadavers. Successive 2mm thick CTM screening was carried out from L3 to S2 vertebral bodies with an interval of 1mm. The serial two-dimensional CT photographical pictures so obtained were inputted into a computer and the three-dimensional images were reconstructed through a VIDAS image analysis system. The experimental results indicated that the three-dimensional images of reconstructed vertebral canal and the nervous tissue within it were lifelike. These images could not only reveal their three-dimensional structure and morphology, but also be cut and composed together at any direction and section by turning and transpositioning along X, Y and Z axes. The authors hold that the visual effect expressed by three-dimensional images reconstructed from two-dimensional pictures can play important role in stereomorphologic, biomechanical, and other studies in fields of anatomy, image analysis, and clinical medicine.

[Dynamec changls in dimension of cross-sectional areas of lumbar canal and dural sac: an experimental study].

The variation in the cross-sectional areas (CSA) of lumbar canal and dural sac under extension and flexion was studied by using CT scans in ten human cadaver lumbar spine specimens. CSA at different levels or same level in varying positions were distinctive. CSA in flexion position was increased, while in extension position reduced. Dynamic changes of CSA of canal (CSAC) at L4,5,L5-S1 were very significant (P < 0.01), and those of CSA of dural a (CSADS) at all levels but L5-S1 were significant (P < 0.05). It was considered that dynamic changes of CSAC at intervertebral levels were determined by the range of lumbar motions, but those of CSADS were influenced by changes of canal and biomechanical factors of intracanal soft-tissue and changes of dural sac length. Measurement of CSADS was more significant than that of CSAC.

[Treatment of lumbar spinal stenosis with partial laminectomy and canal enlargement].

Thirty-eight patients with lumbar spinal stenosis were treated by partial laminectomy, incision of ligmental flava and canal enlargement. According to the pathological characteristic of lumbar spinal stenosis, both decompression and stability of the lumbar spine would be achieved by limited surgical treatment to the pathological segment and removing of any pathological factors. The average time for follow-up is 14 months. The excellent rate is 89.5%. The technique of the operation was also described and discussed.

[Myelographic diagnosis and treatment of lumbosacral nerve root anomalies].

Altogether 480 patients were examined with myelography in the study from 1987 to 1992 and 28 cases having anomalous lumbosacral nerve roots with other concomitant diseases were found. The anomalies were classified three types based on myelographic findings. Type 1, root sleeve displacement; Type 2, a, roots through one foramen; b, roots through two foramina; c, roots through three foramina; Type 3, double roots through one foramen. All patients were proved and treated during operation. The results of treatment were good (92.8%). We considered that most lumbosacral nerve roots anomalies were asymptomatic, however, when they were compressed by degenerative canal tissue, classic nerve root pain appeared eventually. Myelography is helpful to its diagnosis and treatment.

[Non-bony lumbar stenosis treated by excision of limited lamina and enlargement of spinal canal: a report of 45 cases].

In the treatment of 45 cases with non-bony lumbar stenosis, we adopted remain of spinal process and supraspinal ligament, excision of limited lamina and ligament flavum, enlargement of spinal canal. Follow-up of 40 cases showed 31 were excellent, 7, good and 2 poor. Satisfactory results were obtained in 95% of the cases: non-bony lumbar stenosis considered a type of acquired lumbar stenosis. Clinically, it was characterized by claudication. Diagnosis of the disease mainly depends on dynamic flexion-extension myelography. The advantages of this method include excision of spinal canal soft tissue which compressed nerve, small damage of bone structure, recover of the patients and lumbar stability.

Radiation therapy of nasopharyngeal carcinoma: prognostic factors based on a 10-year follow-up of 1302 patients.

One thousand three hundred and two patients with carcinoma of the nasopharynx were initially treated with radiation therapy at this hospital in 1974. The overall 1-, 3-, 5-, and 10-year survival rates were 89.86%, 60.60%, 47%, and 33.03% respectively. At the end of the radiotherapeutic course the residual lesion rate was 10.52% in the nasopharynx 17.27% in cervical lymphnode. In about one-half of the cases with residual lesions, the masses disappeared without further treatment. Prognosis was not improved in the group with supplemental doses. The recurrence rates of the primary nasopharyngeal and metastatic cervical lesion were 18.43%, and 16.12% respectively within 10 years after initial treatment. The 10-year survival rate of the patients with a second course of radiotherapy was 15.04%, higher than of those not retreated (4.9%). Data of this group also reveal that the present pathological classification cannot reflect the degree of prognosis. Increase dosage or combination with chemotherapy did not improve the prognosis. Radiation encephalomyetic damage is discussed.