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Objective:To explore the value of 3.0 T high resolution MRI (HR-MRI) in the follow-up of drug treatment in acute and non-acute ischemic stroke caused by middle cerebral artery (MCA) plaque.Methods:The perspective study enrolled patients with ischemic stroke caused by MCA stenosis from October 2012 to October 2015 in the department of Neurology and Neurosurgery of Changhai Hospital Affiliated to Naval Medical University. All the patients underwent HR-MRI and then were divided into acute and non-acute stroke groups according to the intervels of the last symptom onset to the time of HR-MRI examination. All patients were informed consent to receive antiplatelet drug and intensive lipid therapy and followed up with HR-MRI. The HR-MRI sequence including T 2WI, T 1WI and contrast-enhanced T 1WI of vessel wall, and T 2WI and DWI of brain were routinely performed. T-test of paired samples was used to evaluate the changes of stenosis rate of vascular lumen, plaque enhancement degree, plaque volume and plaque burden on HR-MRI, and the NIHSS score of nervous system and blood biochemical indicators of the patients before and after treatment. Chi square test was used to compare the difference in ischemic event recurrcence between the acute and the non-acute stroke group. Results:A total of 31 acute stroke patients and 20 non-acute stroke patients were enrolled in the study. The mean follow-up time of acute stroke group was (671.71±522.86) days. Compare with the baseline, the stenosis rate of vascular lumen ( P=0.039), plaque enhancement degree ( P<0.001), plaque volume ( P=0.024) and plaque burden ( P=0.031) were all improved after the drug treatment, the NIHSS score of nervous system was also significantly improved, and the levels of total cholesterol (TC) and low density lipoprotein cholesterol (LDL-C) in 12 patients were significantly decreased. The mean follow-up time of patients with non-acute stroke was (695.35±555.90) days. The stenosis rate of vascular lumen, plaque enhancement degree, plaque volume and plaque burden were slightly improved, but without statistical significance ( P>0.05). There were no significant changes in NIHSS score of nervous system, TC, triglyceride (TG) and LDL-C ( P>0.05), however the high density lipoprotein cholesterol (HDL-C) was significantly increased than that in the baseline ( P=0.02). During the follow-up period, no new cerebral infarction was found in the DWI images of the two groups. Six patients had transient ischemic attack (TIA) recurrence in the acute stroke group and 5 patients in the non-acute stroke group, there was no significant difference between both groups(χ 2=0.229, P= 0.632). Conclusion:HR-MRI can be used as an important evaluation method for the follow-up of MCA atherosclerotic plaque therapy. After antiplatelet therapy and intensive lipid-lowering therapy, the plaque volume and burden of MCA offending plaque, and plaque enhancement decreased in acute stroke patients but there was no significant change in non-acute patients.
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Objective:To summarize the MRI features of intrapancreatic accessory spleen (IPAS) and G1 grade pancreatic neuroendocrine neoplasms (PNENs), and clarify the radiological features for differential diagnosis.Methods:The data of 11 patients with IPAS confirmed by surgical pathology or 99mTc thermal denatured red blood cell imaging and 9 patients with G1 grade PNENs confirmed by surgical pathology in the tail of pancreas from January 2013 to December 2019 admitted in First Affiliated Hospital of Navy Medical University were retrospectively analyzed. MRI features of IPAS group and PNENs group, including shape, size, whether it protruded beyond the contour of the pancreas, cystic degeneration, plain scan of T 2WI, DWI signal, multistage enhancement mode, false capsule, etc. were studied and compared. Results:There was significantly statistical difference between the two groups in the terms of contour protrusion, T 2WI and DWI signals, multistage enhancement, and pseudomembrane (all P< 0.05). Protruded lesion was more common in the PNENs group (9/9 cases) than in the IPAS group (3/11). The T 2WI and DWI signals of lesions in the PNENs group were slightly higher than those in the IPAS group, and the proportion of high T 2WI and DWI signal lesions in the PNENs group was 6/9 cases and 4/9 cases, respectively, while the proportion of high T 2WI and DWI signal lesions in the IPAS group was 0/11 cases. Multistage enhancement of lesions in the PNENs group was more likely to be consistent (6/9), while lesions in the IPAS group were more inconsistent (10/11). In the PNENs group, all lesions showed false envelope after enhancement (9/9), while in the IPAS group, no false envelope was observed after enhancement (0/11). Conclusions:The presence of protruded lesions, the characteristics of T 2WI and DWI signals, the mode of multiphase enhancement and the false envelope were essential signs for differentiating IPAS and G1 grade PNENs.
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Objective:To improve the current understanding on the imaging features of pancreatic schwannoma.Methods:Clinical data of pancreatic schwannoma patients admitted in Changhai Hospital affiliated with Navy Medical University from January 1989 to January 2019 were retrospectively analyzed, related literature on pancreatic schwannomas was retrieved through the Chinese and English database, and clinical and imaging features of pancreatic schwannoma were analyzed.Results:A total of 84 cases were analyzed, including 3 cases of pancreatic schwannomas in Changhai hospital, and 81 cases reported in the literature. The age of onset was 17-78 years old, with an average of 55 years. There were 30 males and 54 females. The main symptoms were abdominal pain or the detection of pancreatic mass via body check. Pancreatic schwannoma was mainly in pancreatic head, and the lesion has a long diameter of 1-18 cm with an average of 4.6 cm, which can be solid, cystic (most frequent) and cystic-solid. The border of the lesion from the normal tissue was clear, and semi-transparent capsule composed of neural external membrane and fiber were often found. 15 patients underwent endoscopic ultrasonography guided fine needle aspiration, and diagnostic accuracy was 73.3%(11/15). No typical findings for pancreatic schwannoma was detected on CT. MRI was performed in 35 cases, and 12 cases had complete data. The characteristics of target sign were tumor tissue in completely low signal at T 1WI, and in partially low signal and partially high signal at T 2WI, and completely opposite signal characteristics of T 2WI area after T 1 enhancement, referring to the finding that low T 2WI signal part was gradually enhanced to be high signal, but high signal part was not enhanced and in low signal. Conclusions:Pancreatic schwannoma is rare, and its target signs by MRI have imaging features which can help to improve the preoperative diagnosis.
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Objective:To evaluate the imaging and clinicopathological characteristics of pancreas perivascular epithelioid cell tumors (PEComa).Methods:The clinical data of patients with pancreatic PEComa admitted in Changhai Hospital of Navy Medical University from Nov 2013 to Nov 2017 were retrospectively analyzed. Related literature on PEComa were searched and the image and clinicopathological characteristics were investigated.Results:Two pancreatic PEComa patients were admitted in Changhai Hospital. Twenty-nine PEComa patients were reported in previous literature. A total of 31 cases were detected, including 3 men and 27 women. The onset age of the patients ranged from 17-74 years old with a mean of 48 years old. The lesions were located at the pancreatic head and neck in 20 cases, and at the pancreatic body and tail in 11 cases. 27 cases had a single lesion, and 4 cases had multiple lesions. Tumor diameter ranged from 1.0-11.5 cm with a mean of 4.1 cm. The cystic solid of the lesions was recorded in 23 patients, and 18 cases had solid mass. Pancreatic duct dilation was reported in 21 patients and 14 of them did not have pancreatic duct dilation. Enhancement mode of the lesions was examined in 21 patients, and the enhancement degree of the lesions were higher than that of the pancreas in 16 cases.Conclusions:PEComa has a certain imaging characteristic, which could help obtain a preoperative diagnosis.
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Objective To study the internal relationship between resting tremor and slow response in patients with Parkinson’s disease. Methods The movement characteristics of wrist joints in valgus direction was studied by dynamic modeling on wrist joints of the upper limbs. The system delay concept was introduced with human autonomous control and the sensory delay characteristics of Parkinson’s patients was simulated, to make stability analysis and dynamic response of the involuntary wrist movement. Results The stability analysis and numerical solution of this time-delayed control system showed that when the sensation was delayed to a certain extent, involuntary tremor of wrist joints in patients with Parkinson’s disease would happen, which conformed to resting tremor from Parkinson’s disease. Conclusions Resting tremor from Parkinson’s disease is caused by sensation and movement delay.
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Objective@#To evaluate the imaging and clinicopathological characteristics of pancreas perivascular epithelioid cell tumors (PEComa).@*Methods@#The clinical data of patients with pancreatic PEComa admitted in Changhai Hospital of Navy Medical University from Nov 2013 to Nov 2017 were retrospectively analyzed. Related literature on PEComa were searched and the image and clinicopathological characteristics were investigated.@*Results@#Two pancreatic PEComa patients were admitted in Changhai Hospital. Twenty-nine PEComa patients were reported in previous literature. A total of 31 cases were detected, including 3 men and 27 women. The onset age of the patients ranged from 17-74 years old with a mean of 48 years old. The lesions were located at the pancreatic head and neck in 20 cases, and at the pancreatic body and tail in 11 cases. 27 cases had a single lesion, and 4 cases had multiple lesions. Tumor diameter ranged from 1.0-11.5 cm with a mean of 4.1 cm. The cystic solid of the lesions was recorded in 23 patients, and 18 cases had solid mass. Pancreatic duct dilation was reported in 21 patients and 14 of them did not have pancreatic duct dilation. Enhancement mode of the lesions was examined in 21 patients, and the enhancement degree of the lesions were higher than that of the pancreas in 16 cases.@*Conclusions@#PEComa has a certain imaging characteristic, which could help obtain a preoperative diagnosis.
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Objective@#To improve the current understanding on the imaging features of pancreatic schwannoma.@*Methods@#Clinical data of pancreatic schwannoma patients admitted in Changhai Hospital affiliated with Navy Medical University from January 1989 to January 2019 were retrospectively analyzed, related literature on pancreatic schwannomas was retrieved through the Chinese and English database, and clinical and imaging features of pancreatic schwannoma were analyzed.@*Results@#A total of 84 cases were analyzed, including 3 cases of pancreatic schwannomas in Changhai hospital, and 81 cases reported in the literature. The age of onset was 17-78 years old, with an average of 55 years. There were 30 males and 54 females. The main symptoms were abdominal pain or the detection of pancreatic mass via body check. Pancreatic schwannoma was mainly in pancreatic head, and the lesion has a long diameter of 1-18 cm with an average of 4.6 cm, which can be solid, cystic (most frequent) and cystic-solid. The border of the lesion from the normal tissue was clear, and semi-transparent capsule composed of neural external membrane and fiber were often found. 15 patients underwent endoscopic ultrasonography guided fine needle aspiration, and diagnostic accuracy was 73.3%(11/15). No typical findings for pancreatic schwannoma was detected on CT. MRI was performed in 35 cases, and 12 cases had complete data. The characteristics of target sign were tumor tissue in completely low signal at T1WI, and in partially low signal and partially high signal at T2WI, and completely opposite signal characteristics of T2WI area after T1 enhancement, referring to the finding that low T2WI signal part was gradually enhanced to be high signal, but high signal part was not enhanced and in low signal.@*Conclusions@#Pancreatic schwannoma is rare, and its target signs by MRI have imaging features which can help to improve the preoperative diagnosis.
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OBJECTIVE@#To investigate the clinical significance of minimal residual disease (MRD) monitoring by multiparameter flow cytometry (MFC) before allogeneic hematopoietic stem cell transplantation (allo-HSCT) in acute leukemia.@*METHODS@#81 cases of patients with AL treated with allo-HSCT in Department of Hematology, the First Affiliated Hospital of Chongqing Medical University form July 2015 to July 2018 was selected and retorspectively analyed. of which 79 patients were in CR and two patients were in non-CR. The CR group was further divided into two groups of MRD and MRD based on the MRD level prior to HSCT.@*RESULTS@#Among 81 patients, there were statistically significant differences in the three-year overall survival(OS) (CR 82.2%: NCR 0%), cumulative relapse incidence(RI) (CR 17.7%; NCR 100%) and leukemia-free survival rate(LFS) (CR 42.3%: NCR 0%) between CR and NCR group(P<0.05). Among 79 CR patients, MRD was negative in 30 patients while positive in 49 patients, there was significant differences in the three-year overall survival between MRD and MRD group. The results of univariate analysis showed that the MRD group showed lower LFS compared with that of MRD group （10.5% vs 36.2%）(P＜0.001，95%CI).@*CONCLUSION@#MRD patients shows longer LFS as compared with that of MRD patients, therefore, MRD monitoring by MFC before allo-HSCT is very important for the prognosis of the AL patients.
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Objective To assess the influencing factors of pneumothorax incidence after CT-guided percutaneous core needle biopsy. Methods The clinical and imaging data of 597 patients, who underwent CT-guided percutaneous core needle biopsy in Changhai Hospital of Second Military Medical University from Jan. 2013 to Apr. 2015, were retrospectively analyzed. Pearson Chi-square test, continuity-adjusted Chi-square test and Mann-Whitney U test were used to compare the general characteristics, nidus factors and operational factors between the post-operative pneumothorax and non-pneumothorax patients. Parameter estimation and hypothesis test of logistic regression model were used for univariate and multivariate analyses of the above-mentioned parameters. Results The incidence of pneumothorax after CT-guided percutaneous core needle biopsy was 26.97% (161/597). There were significant differences between the post-operative pneumothorax and non-pneumothorax groups in the age, nidus length-diameter, nidus depth, body position, traversing aerated lung, traversing interlobar fissure and traversing subpleural bleb (Z＝1.971, Z＝3.823, Z＝2.169, χ2 ＝29.196, χ2 ＝11.967, χ2 ＝23.353, χ2 ＝ 29.970; P0.05, P0.01). Multivariate analysis showed that the age68 years old (OR＝1.021, 95% CI 1.002-1.040, P＝0.032), traversing aerated lung (OR＝2.251, 95% CI 1.110-4.566, P＝0.025), traversing interlobar fissure (OR＝5.092, 95% CI 2.630-9.861, P0.001) and traversing subpleural bleb (OR＝6.313, 95% CI 2.312-17.243, P0.001) were risk factors of the post-operative pneumothorax, and nidus length-diameter3.1 cm and supine position were the protecting factors (OR＝0.826, 95% CI 0.732-0.933, P＝0.002; OR＝0.318, 95% CI 0.209-0.483, P0.001). Conclusion The age, nidus length-diameter, body position (supine), traversing aerated lung, traversing interlobar fissure and traversing subpleural bleb are the influencing factors of pneumothorax incidence after CT-guided percutaneous core needle biopsy.
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Objective To explore the remodeling modes and the plaque distribution of atherosclerotic BA at 3.0T high resolution MRI.Methods 90 symptomatic patients with atherosclerotic stenosis of BA on digital subtraction angiography (DSA) (50 ％-99 ％) were recruited consecutively.Luminal area,vessel area of maximal narrow sites and the reference sites were measured.The differences of involved imaging parameters between negative group and positive group were analyzed.Results 51 patients with required imaging quality were enrolled finally.Among the 51 patients,the rate of positive remodeling cases was 72.5％ (37/51) and negative remodeling took over 27.5％ (14/51).Compared with the negative remodeling group,the positive remodeling group had greater plaque size,larger plaque burden percentage,and higher maximal wall thickness at maximal lumen narrowing sites.The plaques were mainly located at ventral wall of the vessel.Conclusion 3.0T high-resolution MR imaging could be applied in assessing the remodeling modes and plaque distribution of BA stenosis.
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<p><b>BACKGROUND</b>The optimal surgical management of nonfunctional pancreatic neuroendocrine tumors (NF-PNETs) is still controversial. Here, we evaluated the impact of lymph node status on postoperative recurrence in patients with NF-PNET and the potential of preoperative variables for predicting lymph node metastasis (LNM).</p><p><b>METHODS</b>In this mono-institutional retrospective cohort study conducted in 100 consecutive patients who underwent NF-PNET resection between January 2004 and December 2014, we evaluated risk factors for survival using the Kaplan-Meier method and the Cox regression model. Predictors of LNM were evaluated using the logistic regression model, and the power of predictive models was evaluated using receiver operating characteristic curve analysis.</p><p><b>RESULTS</b>Five-year disease-free survival of resected NF-PNET was 64.1%. LNM was independently associated with postoperative recurrence (hazard ratio = 3.995, P = 0.003). Multivariate analysis revealed tumor grade as an independent factor associated with LNM (G2 vs. G1: odds ratio [OR] =6.287, P = 0.008; G3 vs. G1: OR = 12.407, P = 0.001). When tumor grade was excluded, radiological tumor diameter >2.5 cm (OR = 5.430, P = 0.013) and presence of symptoms (OR = 3.366, P = 0.039) were significantly associated with LNM. Compared to neoplasms with radiological diameter >2.5 cm (32.1%), tumors ≤2.5 cm had an obviously lower risk of LNM (7.7%), indicating the reliability of this parameter in predicting LNM (area under the curve, 0.693). Incidentally discovered NF-PNETs ≤2.5 cm were associated with a low-risk of LNM and excellent survival.</p><p><b>CONCLUSIONS</b>LNM is significantly associated with postoperative recurrence. Radiological tumor diameter is a reliable predictor of LNM in NF-PNETs. Our results indicate that lymphadenectomy in small (≤2.5 cm) NF-PNETs is not routinely necessary.</p>
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Female , Humans , Male , Middle Aged , Disease-Free Survival , Kaplan-Meier Estimate , Logistic Models , Lymph Node Excision , Lymphatic Metastasis , Pathology , Multivariate Analysis , Pancreatic Neoplasms , Pathology , General Surgery , Proportional Hazards Models , Retrospective StudiesABSTRACT
Objective To explore the CT findings of benign and malignant pancreatic neuroendocrine tumors and improve its diagnostic accuracy.Methods The clinical information and enhanced CT findings of 96 cases with pathologically-proved pancreatic neuroendocrine tumors were retrospectively reviewed.The CT findings were evaluated by several factors,which included tumor size,morphology,location,internal composition,calcification,separation,bile duct and pancreatic duct dilation and CT value.Results All cases were divided into benign or malignant according to pathological grades,and benign group involved 40 cases with 41 lesions,while malignant group involved 56 cases with 59 lesions.The size of malignant lesions was significantly larger than that of benign lesions (median size 6.0 cm vs 2.2 cm),the shape of the lesions was irregular,and was mainly cystic solid,and mottling,curve shape,clumps calcification was present,then the bile duct and pancreatic duct was mild to moderately dilated,and the difference between the two groups was statistically significant (P ＜0.05).But the difference of tumor location,separation was not significant.45.76％ (27/59) of the malignant lesions reached the peak value in arterial phase,and 44.07％ (26/59) reached the peak value in venous phase;while 68.29％ (28/41) of the benign lesions reached the peak value in arterial phase,and 31.71％ (13/41) reached the peak value in venous phase.The CT values of malignant lesions in plain CT scanning,arterial phase,venous phase,balance phase were (39.02 ±7.53),(121.20 ± 54.73),(125.25 ± 40.77),(101.41 ± 28.68) Hu,while they were (41.49 ± 8.59),(144.73 ± 53.95),(157.05 ±44.72),(121.02 ±29.80) Hu in benign group.In plain CT scanning,the difference of CT value between malignant and benign lesions was not significant;but in the enhanced phase,the CT value of malignant lesions was significantly lower than that of benign lesions,and the difference was statistically significant (P ＜ 0.05).Conclusions The lesion with its size ≥ 3.0 cm,irregnlar morphology,cystic necrosis,calcification,pancreatic and bile duct dilatation is suggestive of malignancy tumor.The average CT values of malignant group are lower than those of the benign group in arterial,venous and balance phases.
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Objective To evaluate the clinical significance of monitoring of D‐dimer ,fibrinogen and fibrin degradation products after hip replacement for diagnosing and preventing the lower extremity deep venous thrombosis .Methods A total of 66 cases of patients who carried out hip replacement from April 2013 to April 2015 in the department of orthopaedic in this hospital were se‐lected .Patients complicated with lower extremity deep venous thrombosis were enrolled into the observation group ,while patients without lower extremity deep venous thrombosis were enrolled into the control group .Levels of D‐dimer ,fibrinogen and fibrin deg‐radation products were strictly monitored after hip replacement and were comparatively analysed .Results There were no statisti‐cally significant differences in levels of fibrinogen and fibrin degradation products between the two groups (P>0 .05) ,while statisti‐cally significant difference was found in level of D‐dimer between the two groups(P<0 .05) .Conclusion The monitoring of D‐di‐mer ,fibrinogen and fibrin degradation products after hip replacement could have clinical significance for diagnosing and preventing lower extremity deep venous thrombosis .
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Objective To explore the compatibility rules of acupoints and meridians in acupuncture-moxibustion treatment for vertigo, by using the association rules of data mining.Method The relevant data were collected from literatures about acupuncture-moxibustion in treating vertigo from the Pre-Qin Period to Qing Dynasty to establish a database. Then the involved acupoint and meridian groups were further extracted by using association rules of data mining.Result Shangxing (GV 23) and Fengchi (GB 20), Fenglong (ST 40) and Jiexi (ST 41), Hegu (LI 4) and Fengchi (GB 20), Fenglong (ST 40) and Fengchi (GB 20), Waiguan (TE 5) and Zulinqi (GB 41), Hegu (LI 4) and Fenglong (ST 40), Hegu (LI 4) and Jiexi (ST 41), Yanggu (SI 5) and Zulinqi (GB 41), Yanggu (SI 5) and Fengchi (GB 20), Shenting (GV 24) and Shangxing (GV 23) are the most commonly used acupiont pairs; the Governor Vessel, Gallbladder Meridian and Bladder Meridian are the most commonly used meridian groups.Conclusion It’s reasonable to use association rules to study the ancient acupuncture-moxibustion literatures, and the results about acupoint and meridian groups provide references for both clinical practice and experimental researches.
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Objective To investigate the risk factors of pancreatic fistula after pancreaticoduodenectomy.Methods The clinical data of 310 patients who received pancreaticoduodenectomy at the Ruijin Hospital of Shanghai Jiaotong University from January 2005 to May 2013 were retrospectively analyzed.The risk factors associated with the interoperative pancreatic fistula were analyzed.The univariate and multivariate analysis were done using the Pearson chi-square test and non-conditional Logistic regression model.Results A total of 134 patients had postoperative complications,including 103 (33.23％) with pancreatic fistula,among them 40 patients developed additional complications.The results of univariate analysis showed that preoperative levels of hemoglobin,total bilirubin,diameter of the pancreatic duct and postoperative level of albumin were risk factors of pancreatic fistula after pancreaticoduodenectomy (x2 ＝ 4.543,6.087,6.265,5.311,P ＜ 0.05).The results of multivariate analysis showed that preoperative level of total bilirubin equal to or above 34.2 μmol/L,the diameter of the pancreatic duct under 3 mm and the level of postoperative albumin under 28 g/L were the independent risk factors of pancreatic fistula (OR =1.806,1.936,1.780; 95％ confidence interval:1.107-2.948,1.170-3.206,1.002-3.165,P ＜ 0.05).Conclusion Preoperative jaundice (the level of total bilirubin ≥ 34.2 umol/L),pancreatic duct diameter ＜ 3 mm and postoperative malnutrition (albumin ＜ 28 g/L) indicate a higher incidence of postoperative pancreatic fistula.
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The da Vinci robotic surgical system has the advantages of three-dimensional vision and high degree of accuracy,flexibility and repeatability,which makes surgical procedures such as digestive tract anastomosis easier to conduct under minimally invasive conditions.In this article,the feasibility and principle of digestive tract anastomosis and the procedures of pancreaticojejunostomy and pancreaticogastrostomy by the da Vinci robotic surgical system are introduced,so as to improve the quality of anastomosis and reduce the incidences of postoperative complications.Compared with traditional laparotomy,da Vinci robotic surgical system simplified the surgical procedures and reduced the trauma,which is suitable for digestive tract anastomosis in pancreatic surgery.The method of pancreatic anastomosis should be selected in consideration of the condition of patients,surgical procedure and the experience of surgeons.
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Objective To observe computed tomography features of neuroendocrine tumor of the pancreas.Methods Computed tomography scans for 28 patients with pathologically proven neuroendocrine tumor of the pancreas were retrospectively analyzed.The data of tumor locations,diameters of the tumor and internal composition,pattern of enhancement,changes of biliary and pancreatic duct,and lymphatic metastasis,remote metastasis were recorded.Results A total of 32 lesions were detected,24 lesions were single lesions,while 4 lesions were multiple lesions (2 lesions within pancreas).The shapes of these lesions were nodule-like or mass-like.Eighteen lesions were located in pancreatic tail,10 in pancreatic head,2 in pancreatic body,and 2 between pancreatic tail and body.Among the lesions located in pancreatic head,pancreatic duct dilation were detected in 5 cases,bile duct dilation in 1 case,both biliary and pancreatic duct dilation in 2 cases,and no dilation in the remaining 2 cases.The diameters of the tumor ranged from 1.0 to 20.0cm (mean5.1 cm),and the size was ＜2 cmin 1 case,2 ～5 cm in 23 cases; ＞5 cm in 8 cases.After enhancement,the lesions were enhanced to different degrees,and the peak value occurred in the pancreatic phase.Twenty-three lesions invaded adjacent vessels or organs,and lymphatic metastasis was observed in 5 cases,remote metastasis were recorded in 6 cases.Conclusions Neuroendocrine tumor of the pancreas has certain features on computed tomography.It is highly likely to make the pre-operative diagnosis when clinical data is also taken into consideration.
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Objective To study the relationship between hepatic arterial buffer response (HABR),recovery of liver function,early biliary complications and small-for-size syndrome (SFSS).Methods Early hepatic hemodynamic parameters (including hepatic arterial flow (HAF),portal venous flow (PVF) were measured using duplex Doppler sonography in 34 patients who received living donor liver transplantation (preoperatively n＝26,intraoperatively n=26) and on postoperative days 1,2,3,and 7.Alanine aminotransferase (ALT),aspartate aminotransferase (AST) and total bilirubin (TBIL) level were measured preoperatively and on postoperative days 1,2,3,7,14,21,and 28.If TBIL level was elevated,we used B ultrasonography or CT and even ERCP to diagnose early biliary complications.The days taken for AST,AI T and TBIL to recover and the number of patients with early (＜60 days) biliary complications (bile leakage or bile stricture) and with small-for-size syndrome (SFSS) were recorded.Results Passive hepatic artery buffer response (HABR) was present in 11 patients early after living donor liver transplantation (group 1) and it disappeared in 23 patients (group 2).The recovery in days taken for normalization of AST (10.6± 8.8),AIT (11.6±9.0) and TBlL (average of 29) in group 1 were shorter than in group 2.However,the differences did not reach statistics difference (P＞0.05).The overall incidences of early biliary complications and small-for-size syndrome (SFSS) in group 1 were significantly lower than in group 2 (P=0.04).The survival rate in group 1 was 82 ％,compared with 74 ％ in group 2.Conclusions Passive hepatic arterial buffer response (HABR) disappeared in some patients early after living donor liver transplantation.There were high incidences of early biliary complications and small-for-size syndrome (SFSS) in these patients.Measurcment of hepatic buffer response in the early stage after living donor liver tranaplanta tion is valuable for predition of early biliary complications and small-for-size syndrome (SFSS),thus helping to prevent failure in transplantation.
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Objective To investigate the protective effect of polymyxin B (PMB) to the liver graft after liver transplantation and the underlying mechanism in rats.Methods Male SD rats were selected as the donors and recipients.Non-artery whole liver transplantation model was established in rats according to Kamada's two-cuff method.The rats were divided into two groups by the way of random number table method:control group (normal saline,0.5 ml) and PMB group (PMB,1 mg/ml,0.4 mg/kg+ normal saline 0.5 ml).The levels of portal vein plasma endtotoxin (EU/ml)were determined by endotoxin-analyzing machine of BET-24A. ALT,BUN,and TNF-α,IL-6 in serum were measured by using machine of Automatic Analyzer and ELISA,respectively.The CD14,TLR4,NFκB and AP-1 in the grafts were measured by RT-PCR and Western blotting,and pathological changes were observed. Results PMB decreased the levels of portal vein plasma endotoxin 1 h after reperfusion in PMB group as compared with control group (P＜0.05),and the levels of portal vein plasma endotoxin returned to the normal levels 6 h after reperfusion in both two groups (P＞0.05).After operation,the levels of ALT,TNFα and IL-6 in serum were significantly reduced (P＜0.05),the expression of CD14 and TLR4 mRNA in the grafts was significantly decreased (P＜0.05),the expression of Hsp60 protein and mRNA,and NF-κB and AP1 proteins in the grafts were reduced (P＜0.05),and the pathological damage to the grafts was significantly alleviated in PMB group as compared with control group.Conclusion PMB reduced the levels of portal vein plasma endotoxin after reperfusion in liver transplantation in rats.PMB improved liver function,reduced the injury of inflammatory response,decreased the levels of endotoxin signal pathway markers and alleviated the pathological damage to the grafts.
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Objective To explore CT and MR radiological characteristics of atypical hemangiomas of the liver (AHL). Methods The CT and MRI findings of 6 patients with pathologically proven AHL were retrospectively analyzed. Results The common radiological findings of hemangiomas of the liver included: (l)The lesions were oval-shaped with smooth outline. (2) The lesions were of slightly hypodense on plain CT scan. On MRI scan, the lesions showed slightly low signal with T1WI and high signal with T2WI, and the lesions had central scars. (3) On dynamic contrast-enhanced CT or MRI scan, the lesions had peripheral nodular enhancement and a centripetal gradual fill-in pattern without enhancement of the central scars. The special radiological features of AHL included: (l)Necrotic or cystic changes and calcification could be found in the central scars. (2) Hemorrhage could also be observed in the lesions though it was rare; they had enhanced CT signal and aberrantly short Tl and T2 signals. (3)The lesions might compress the hepatic parenchyma,biliary and vascular structures, leading to secondary changes such as deformity, abnormal bloody supply, and bile duct obstruction. Conclusion Diagnosis of typical hemangiomas of the liver is not difficult. But more observation and analysis are needed to diagnose AHL.