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Objective To investigate the clinical application value of contrast-enhanced ultrasound (CEUS) in hepatic artery thrombosis (HAT) after pediatric liver transplantation. Methods Clinical data of 126 pediatric recipients undergoing liver transplantation were retrospectively analyzed. The incidence of HAT after pediatric liver transplantation was summarized. Color Doppler ultrasound and CEUS manifestations of HAT were compared. Results According to color Doppler ultrasound, 17 cases were highly suspected with HAT. Nine cases were highly suspected with HAT by CEUS, who were subsequently confirmed by CT angiography (CTA) or surgery. CEUS manifestations of HAT showed that hepatic artery was not seen surrounding the portal vein during the arterial phase or even portal venous phase. Hepatocyte necrosis occurred in 4 patients with HAT, and no perfusion of intrahepatic contrast agent was observed on CEUS. Conclusions CEUS yields high clinical application value in the diagnosis of HAT after pediatric liver transplantation. It has significant advantages compared with traditional CTA, which could be widely applied in clinical practice.
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BACKGROUND@#Human epididymis secretory protein 4 (HE4) is a new ovarian cancer biomarker. The factors influencing HE4 levels are not clear, and the reference data in China are limited. Here, we aim to evaluate the effects of menopause and age on HE4 levels and to provide a possible reference value for HE4 in healthy Chinese people.@*METHODS@#A total of 2493 healthy females aged 40 years or older were recruited from March 2013 to March 2017 with the cooperation of four medical institutions across Beijing, China. The serum levels of HE4 and cancer antigen 125 (CA125) were measured by enzyme-linked immunosorbent assay. The Wilcoxon rank-sum test of variance and a stratified analysis were used to analyze the relationships among age, menopausal status, and levels of HE4 or CA125. Confidence intervals (5%-95%) were determined for reference ranges in different populations.@*RESULTS@#There was a statistically significant difference in median HE4 levels between the post-menopausal (n = 2168) and pre-menopausal groups (n = 325) (36.46 vs. 24.04 pmol/L, Z = -14.41, P < 0.001). HE4 increased significantly with age in the post-menopausal groups (H = 408.18, P < 0.001) but not in the pre-menopausal subjects (Z = -0.43, P = 0.67). The upper 95th percentile of HE4 levels were 44.63 pmol/L for pre-menopausal women, 78.17 pmol/L for post-menopausal women, and 73.3 pmol/L for all women. In the post-menopausal population, the HE4 reference ranges were 13.15 to 47.31, 14.31 to 58.04, 17.06 to 73.51, 24.50 to 115.25, and 35.71 to 212.37 pmol/L for different age groups from forty divided by decade. The CA125 level was affected mainly by menopausal status and not age.@*CONCLUSIONS@#Menopausal status and age were both important factors influencing the level of HE4, and age affected HE4 levels mainly in post-menopausal women. The HE4 level was higher in the post-menopausal population than in the pre-menopausal population and increased with age.
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BACKGROUND@#After radical hysterectomy for cervical cancer, the most common complication is lower urinary tract symptoms. Post-operatively, bladder capacity can alter bladder function for a prolonged period. This study aimed to identify factors affecting bladder storage function.@*METHODS@#A multicenter, retrospective cohort study was conducted. Information of patients with stages IA2 to IIB cervical cancer with urodynamic study results were retrospectively collected from nine hospitals between June 2013 and June 2018 according to the inclusion criteria. Demographic, surgical, and oncological data were collected. The univariate and multivariate logistic regression was used to identify clinical factors associated with bladder storage function.@*RESULTS@#Two hundred and three patients with cervical cancer had urodynamic testing post-operatively. Ninety-five (46.8%) patients were diagnosed with stress urinary incontinence (SUI). The incidence of low bladder compliance (LBC) was 23.2%. Twenty-seven (13.3%) patients showed detrusor overactivity (DO). Fifty-seven patients (28.1%) presented with a decreased maximum cystometric capacity (DMCC). The probability of composite bladder storage dysfunction was 68.0%. Multivariate analysis confirmed that laparoscopy represents a protective factor for SUI with an odds ratio of 0.498 (P = 0.034). Patients who underwent a nerve-sparing procedure were less odds to experience SUI (P = 0.014). A significant positive correlation between LBC and DO was observed (P < 0.001). A greater length of the resected vagina and chemoradiotherapy were common risk factors for LBC and DO, while radiotherapy exerted a stronger effect than chemotherapy. Additionally, patients who received chemoradiotherapy frequently developed a DMCC. The follow-up time was not correlated with bladder storage function.@*CONCLUSION@#A nerve-sparing procedure without longer resected vagina is recommended for protecting the bladder storage function.
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Objective To evaluate the application value of quantitative parameters of contrast-enhanced ultrasound (CEUS) in evaluating the donor liver from donation after brain death (DBD). Methods Clinical data of 25 DBD donor livers and 10 healthy adult livers were retrospectively analyzed. CEUS examinations of DBD donor livers and healthy livers were collected. Quantitative parameters included the area under curve (AUC), maximum intensity (Imax), time to peak (TTP) and mean transit time (mTT), etc. Results Among 25 cases of DBD donor livers, 23 cases showed normal enhancement pattern, and the other 2 cases presented with abnormal enhancement pattern. Compared with the control group, the AUC, Imax and mTT values of DBD donor livers were significantly decreased (all P < 0.05). Conclusions CEUS quantitative parameters can be effective means to evaluate the micro-perfusion of DBD donor livers.
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Objective To investigate the safety and efficacy of radiofrequency ablation (RFA) combined with extracting blood from hemangiomas guided with CEUS for treating hepatic cavernous hemangiomas (HCH).Methods Data of 55 patients with 77 lesions of HCH underwent CEUS guided RFA combined with extracting blood from hemangiomas during January 2010 to December 2016 were retrospectively analyzed.Conventional ultrasound and CEUS were performed before therapy,in order to obtain the size and blood supply information of lesions,also performed immediately after treatment and 3 months later to calculate the volume of hemangiomas and the rate of hemangiomas after the treatment,as well as the rate of non-blood supply 3 months after the treatment.Then statistical analysis was done.Results The mean operation time was (31.53±15.89)min,and the blood extracting from hemangiomas was (135.36± 68.13)ml.There was positive correlation between the volume of hemangiomas before treatment and the blood extracting from hemangiomas (r=0.722,P＜0.05).No serious complication occurred among 55 cases,while mild complications happened in 9 cases (9/55,16.36 ％).The volume of hemangiomas decreased immediately and 3 months after treatment (both P＜0.05),and the rate of hemangiomas reducing was (48.76±32.58) ％ and (22.37±35.73) ％,respectively.The rate of non-blood supply 3 months after treatment was 96.10％ (74/77).Conclusion CEUS-guided RFA combined with extracting blood from hemangiomas is an effective and safe method,which has potential to become a first-line therapy.
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<p><b>OBJECTIVE</b>To analyze the postoperative complications in patients with endometrial carcinoma undergoing surgical operation in different modes and to explore the surgical safety of retroperitoneal lymph node dissection.</p><p><b>METHODS</b>Two hundred and nineteen patients with endometrial cancer treated in our hospital between May 2006 and April 2012 were included in this study. Their clinicopathological data were retrospectively analyzed. Among them, 65 patients received total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH+BSO group), 54 patients received TAH and BSO and pelvic lymph node dissection (PLX group), and 100 patients received TAH and BSO and PLX and para-aortic lymph node dissection (PALX group). The surgical procedures and postoperative complications in different operation modes were analyzed.</p><p><b>RESULTS</b>The operation time was (114.84 ± 6.45) min in the TAH+BSO group, (182.94 ± 6.62) min in the PLX group, and (188.27 ± 5.77) min in the PALX group. The operation time in the TAH+BSO group was significantly shorter than that in the PLX and PALX group (P < 0.001). The amount of blood loss was (222.97 ± 38.42) ml in the TAH+BSO group, (311.80 ± 21.62) ml in the PLX group, and (391.51 ± 53.20) ml in the PALX group. respectively. The amount of blood loss in the TAH+BSO was significantly less than that in the PLX and PALX group (P = 0.009). Lymphedema of the lower extremities was the most frequent complication of retroperitoneal lymph node dissection and the incidence rate was 31.8%. Lymphocyst was the second frequent complication, with an incidence rate of 27.3%. The incidence rate of ileus in the PALX group was significantly higher than that in the PLX group (P = 0.001). There were no significant differences in the incidence rate of lymphedema, lymphocyst and deep vein thrombosis between the PALX and PLX groups (P > 0.05).</p><p><b>CONCLUSIONS</b>Retroperitoneal lymph node dissection is an acceptable operation mode, although slightly increasing the incidence of ileus, compared with the TAH+BSO group. It is needed to choose appropriate indication in order to decrease the post-operative complications.</p>
Subject(s)
Adult , Female , Humans , Middle Aged , Blood Loss, Surgical , Carcinoma, Endometrioid , Pathology , General Surgery , Endometrial Neoplasms , Pathology , General Surgery , Extremities , Hysterectomy , Methods , Lymph Node Excision , Lymph Nodes , Lymphatic Metastasis , Lymphedema , Lymphocele , Operative Time , Ovariectomy , Methods , Pelvis , Postoperative Complications , Epidemiology , Retrospective StudiesABSTRACT
<p><b>OBJECTIVE</b>To study the characteristics of HE4 expression in patients with epithelial ovarian cancer, and to evaluate whether the pre-treatment serum human epididymis protein 4 (HE4) level is an independent prognostic factor in the patients.</p><p><b>METHODS</b>The clinicopathological characteristics and follow-up information of 112 patients with epithelial ovarian cancer were collected. The pre-treatment serum samples from these patients were measured for HE4 and CA125 expression. Serum HE4 levels were tested by a quantitative enzyme-linked immunosorbent assay (ELISA) and serum CA125 levels were tested using Elecsys kit. The correlation of HE4 and CA125 expressions with overall survival and other clinical data were analyzed.</p><p><b>RESULTS</b>The median level of pre-treatment serum HE4 and CA125 in the 112 patients was 415.5 pmol/L (26.9-3253.5 pmol/L) and 699 U/ml (5-17 694 U/ml), respectively. Serum HE4 level before treatment was significantly related to grade (r = 0.21, P = 0.037), stage (r = 0.40, P = 0.001), amount of ascites (r = 0.39, P = 0.001), serum CA125 level (r = 0.53, P = 0.001) and residual disease after surgery (r = 0.22, P = 0.027), but was not related to menopausal stauts (P = 0.115), revealed by Spearman correlation test.However, logistic multivariate regression analysis indicated that residual tumor size was not significantly correlated with pre-operative HE4 level (P = 0.259). The mean survival of the 112 patients was 53 months. Log rank test indicated that the overall survival in patients with higher HE4 level was significantly shorter than those with lower HE4 level (P = 0.001). Multivariate Cox proportional hazard model analysis revealed that the pre-treatment serum HE4 level and residual tumor size were independent prognostic factors for overall survival (P = 0.044 and P = 0.048).</p><p><b>CONCLUSION</b>Pre-treatment serum HE4 level is a valuable prognostic factor for the overall survival in patients with epithelial ovarian cancer.</p>
Subject(s)
Female , Humans , Biomarkers, Tumor , Metabolism , CA-125 Antigen , Metabolism , Enzyme-Linked Immunosorbent Assay , Neoplasms, Glandular and Epithelial , Diagnosis , Metabolism , Ovarian Neoplasms , Diagnosis , Metabolism , Prognosis , Proteins , MetabolismABSTRACT
Unlike other non-gynecologic solid tumors, such as breast cancer, lung cancer, metastasis to bone from endometrial carcinoma is rare, metastasis to extremity is extremely rare. We report a 51-year-old multiparous woman with FIGO Stage IVb Grade 2 endometrial adenocarcinoma which metastasized to left lower extremity bone. She received an amputation of left lower extremity below the knees, and a total abdominal hysterectomy and bilateral salpingo-oophorectomy, and followed by systemic chemotherapy, radiation therapy to the pelvis and progestational agent. She had a complete response to above treatments, and disease-free survival for 10 months. After recurrence, she received chemotherapy, radiotherapy and progestational agent once again. She had lived 56 months and is still alive by the time of report. Metastasis of endometrial carcinoma to extremity bone can rarely occur and should be considered when the patient with endometrial carcinoma complained of unexplained pain and swelling associated with extremity bone.
Subject(s)
Female , Humans , Middle Aged , Bone Neoplasms , Pathology , General Surgery , Endometrial Neoplasms , Pathology , General SurgeryABSTRACT
<p><b>OBJECTIVE</b>To investigate the validity of hepatic resection as a treatment option for hepatic parenchymal metastasis in patients with recurrent epithelial ovarian cancer.</p><p><b>METHODS</b>A retrospective review of the clinicopathological and follow up data of 39 patients treated in our hospital from 1996 to 2008 was conducted.</p><p><b>RESULTS</b>Ten patients underwent partial hepatic resection for metastatic ovarian cancer. All the 10 patients underwent surgery were with unilobar metastasis and the number of tumors was lower than 3(P < 0.05). No significant difference existed in patient age, the primary pathology type and tumor grade, the rate of optimal primary cytoreductive surgery, the disease free survival after the primary therapy and the serum CA125 level at the liver metastasis when compared with the 29 patients accepted salvage chemotherapy (P > 0.05). There were 7 patients who achieved optional surgery. The operation complication was 3/10 and there was no perioperative mortality. There were 2 patients without postoperative chemotherapy in the 8 recurrent patients with microscopic negative margins. The median recurrence time was 12 (5 - 24) months after the hepatic resection. The overall median survival periods after hepatic metastasis were 26 and 9 months and the 3-years cumulative survival rates were 60.0% and 16.8% for the optimal surgery patients including hepatic surgery and the salvage chemotherapy patients, respectively (P < 0.05).</p><p><b>CONCLUSION</b>Hepatic resection for liver metastatic epithelial ovarian cancer is safe and may achieve long-term survival in patients after optimal second cytoreductive surgery.</p>
Subject(s)
Female , Humans , CA-125 Antigen , Blood , Disease-Free Survival , Liver Neoplasms , Pathology , General Surgery , Neoplasm Recurrence, Local , Pathology , Neoplasms, Glandular and Epithelial , Pathology , Neoplasms, Second Primary , Ovarian Neoplasms , Pathology , Retrospective Studies , Salvage TherapyABSTRACT
<p><b>OBJECTIVE</b>To investigate the impact of surgical resection extent and other clinicopathological characteristics on the prognosis in patients with clinical stage I endometrial carcinoma.</p><p><b>METHODS</b>The data of 135 surgically treated patients with clinical stage I endometrial carcinoma were retrospectively analyzed. Fifty-seven patients (group A) underwent simple hysterectomy and salpingo-oophorectomy with or without pelvic lymphadenectomy. The other 78 patients (group B) received sub-radical or radical hysterectomy and salpingo-oophorectomy with or without pelvic lymphadenectomy. The impact of surgery extent and other clinicopathological characteristics on the prognosis in patients with clinical stage I endometrial carcinoma were retrospectively analyzed.</p><p><b>RESULTS</b>There were no significant differences between two groups in the pathological stage, pathologic type, tumor grade, depth of myometrial invasion, vascular tumor emboli, ovary invasion, lymph node metastasis, positive peritoneal cytology and adjuvant therapy (P > 0.05). However, the patients in group A had a significantly shorter operating time (105 vs. 145 min), less estimated blood loss (150 vs. 300 ml) and blood transfusion (0 approximately 600 vs. 0 approximately 1200 ml), and a shorter postoperative hospital stay (12 vs. 13 days) than that in group B (all P < 0.05). The overall rates of post-operative complications were 15.8% in group A versus 26.9% in group B (P > 0.05). The recurrence rate in the group A was 14.0% versus 6.4% in group B (P > 0.05). Furthermore, the five-year survival rate in group A was 76.9% versus 85.8% in group B (P > 0.05). Multivariate analysis demonstrated that the important risk factors for clinical stage I endometrial carcinoma were deep myometrium invasion, high pathological grade, positive peritoneal cytology and ovarian metastasis, rather than surgical resection extent.</p><p><b>CONCLUSION</b>Surgery extent is not an important factor affecting the prognosis in patients with clinical stage I endometrial carcinoma, and extended surgery does not improve their survival. Therefore, excessive resection should be avoided in such cases.</p>
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Middle Aged , Adenocarcinoma, Clear Cell , Pathology , General Surgery , Therapeutics , Blood Loss, Surgical , Carcinoma, Adenosquamous , Pathology , General Surgery , Therapeutics , Carcinoma, Endometrioid , Pathology , General Surgery , Therapeutics , Chemotherapy, Adjuvant , Endometrial Neoplasms , Pathology , General Surgery , Therapeutics , Hysterectomy , Methods , Length of Stay , Lymph Node Excision , Neoplasm Invasiveness , Neoplasm Recurrence, Local , Radiotherapy, Adjuvant , Retrospective Studies , Survival RateABSTRACT
<p><b>OBJECTIVE</b>To compare the survival of patients with stage IIc or IV epithelial ovarian cancer treated either with neoadjuvant chemotherapy (NAC) followed by cytoreductive surgery or primary cytoreductive surgery (PCS) followed by adjuvant chemotherapy.</p><p><b>METHODS</b>The clinical and pathological data of 160 patients with stage IIIc or IV epithelial ovarian cancer diagnosed pathologically between 1997 and 2005 were retrospectively reviewed. Forty-two patients were treated with NAC followed by cytoreductive surgery (NAC group) and 118 patients with PCS followed by adjuvant chemotherapy (PCA group).</p><p><b>RESULTS</b>The overall response rate of NAC group was 69.1%. No significant difference was observed between the NAC group and PCS group in operating time, intra-operative blood loss and units of blood-transfusion (P > 0.05). Optimal cytoreductive surgery was performed in 88.1% of NAC group versus in 71.2% of PCS group (P < 0.05). In those who had optimal cytoreductive surgery, the recurrent rate was 43.2% in NAC group versus 56.0% in PCS group without significant difference between two groups (P > 0.05). The disease-free survival and progression-free survival was 7 and 8 months in NAC group, which were significantly shorter than 13 and 18 months in PCS group (P < 0.05), however, the median overall survival (OS) was 34 months in NAC group versus 43 months in PCS group without significant difference (P > 0.05). In the patients with optimal cytoreductive surgery, it was 34 months in NAC group versus 48 months in PCS group without significant difference either between two groups (P > 0.05).</p><p><b>CONCLUSION</b>Neoadjuvant chemotherapy followed by cytoreductive surgery can improve the rate of optimal cytoreductive surgery for the patients with stage IIIc or IVepithelial ovarian cancer, but this regimen may neither reduce the recurrent rate nor prolong the survival when compared with the patients treated with primary cytoreductive surgery followed by adjuvant chemotherapy.</p>
Subject(s)
Adult , Aged , Female , Humans , Middle Aged , Antineoplastic Combined Chemotherapy Protocols , Therapeutic Uses , Cisplatin , Therapeutic Uses , Cyclophosphamide , Therapeutic Uses , Cystadenocarcinoma, Papillary , Drug Therapy , Pathology , General Surgery , Disease Progression , Disease-Free Survival , Follow-Up Studies , Neoadjuvant Therapy , Neoplasm Recurrence, Local , Neoplasm Staging , Ovarian Neoplasms , Drug Therapy , Pathology , General Surgery , Paclitaxel , Retrospective Studies , Survival Rate , Taxoids , Therapeutic UsesABSTRACT
<p><b>OBJECTIVE</b>Extraovarian peritoneal serous papillary carcinoma (EPSPC) is both histologically and clinically similar to stage III-IV ovarian papillary serous carcinoma (OPSC). The purpose of this study is to investigate the clinical findings, treatment, and outcome of EPSPC patients compared with stage III-IV OPSC patients.</p><p><b>METHODS</b>The data of 12 EPSPC patients and 45 stage III-IV OPSC patients were retrospectively reviewed, comparing the characteristics on clinical presentation and treatment, sensitivity to first-line chemotherapy agents and survival.</p><p><b>RESULTS</b>By analysis of patients' characteristics, presenting signs and symptoms, type and extent of surgery, tumor response to first-line chemotherapy, recurrence-free interval, recurrence site and serum CA-125 levels, no significant difference was observed between the EPSPC patients and stage III-IV OPSC controls. The prevailing presenting symptoms were abdominal mass and ascites. The mainstay of treatment was debulking surgery followed by adjuvant platinum-based chemotherapy. The complete clinical response of stage III-IV OPSC was 91.8% compared with 25.0% for women with EPSPC (P < 0.01).</p><p><b>CONCLUSION</b>The clinical and surgical characteristics of EPSPC are similar to those of stage III-IV OPSC. When the same treatment strategy is applied, similar response and survival are expected in either condition.</p>