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Objective:To explore the indications and effect of surgical treatment of autoimmune pancreatitis.Methods:Clinical data of these 15 patients with autoimmune pancreatitis diagnosed and treated at the Department of General Surgery, the First Hospital of Peking University from 2010 to 2021 were retrospectively analyzed.Results:The main clinical symptoms were obstructive jaundice, abdominal pain, distension and weight loss. The diagnosis of AIP was confirmed by EUS-FNA in 6 patients,among them, 4 did not relapse after oral hormone treatment, 2 did not receive relevant treatment, and 1 developed gastric cancer one year later. Under a suspicion of malignancy, 9 patients underwent surgical laparotomy ,and the diagnosis was established by pathology. There was no recurrence after oral hormone therapy in 1 patient who underwent laparotomy and pancreatic biopsy. One out of the 3 patients with choledochojejunostomy relapsed after 3 years. Of the 5 patients who underwent pancreatectomy, 4 had no obvious recurrence, and 1 had recurrence after 3 years.Conclusions:Untypical autoimmune pancreatitis is likely to be misdiagnosed as pancreatic cancer. For patients with suspicious malignancy, operational management and biopsy may benefit.
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Objective:To investigate the clinical imaging features and prognosis of von Hippel-Lindau (VHL) syndrome associated with pancreatic lesions.Method:The retrospective case-control study was conducted. The clinicopathological data of 161 patients with VHL syndrome who were admitted to Peking University First Hospital from September 2010 to August 2022 were collected. There were 83 males and 78 females, with age of onset as 27.0(range, 8.0-66.0)years. Observation indicators: (1) imaging results of VHL syndrome associated with pancreatic lesions; (2) clinical characteristics of VHL syndrome associated with pancreatic lesions; (3) comparison of clinicopathological factors in patients with VHL syndrome associated with pancreatic cystic lesions; (4) comparison of clinicopathological factors in patients with VHL syndrome associated with pancreatic neuroendocrine neoplasms (pNENs). (5) Treatment and prognosis of patients with VHL syndrome associated with pancreatic lesions. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the independent sample t test. Measurement data with skewed distribution were represented as M(range), and comparison between groups was conducted using the non-parameter test. Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test. Results:(1) Imaging results of VHL syndrome associated with pancreatic lesions. Of the 161 patients with VHL syndrome, there were 151 patients associated with pancreatic lesions and 10 patients not associated with pancreatic lesions. Of the 151 patients with VHL syndrome associated with pancreatic lesions, there were 136 patient with pancreatic cystic lesions and 34 patients with pNENs, 22 patients with both pNENs and pancreatic cystic lesions, and the type of pancreatic lesions could not be accurately determined in 3 cases. (2) Clinical characteristics of VHL syndrome associated with pancreatic lesions. The age of onset in 151 patients with VHL syndrome associated with pancreatic lesions was 33.0(range, 14.0-68.0)years. Cases with gene site mutation of exon 1, exon 2, exon 3 and other types of gene site was 51, 16, 43 and 41, respectively. There were 116 patients of VHL type 1 and 35 patients of VHL type 2. There were 92 patients with family history of VHL syndrome and 59 patients without family history of VHL syndrome. There were 127 patients combined with renal cell carcinoma, 112 patients combined with central nervous system lesions, 46 patients combined with retinal hemangioblastoma. Patients may combined with multiple lesions. (3) Comparison of clinicopathological factors in patients with VHL syndrome associated with pancreatic cystic lesions. The age of onset, VHL syndrome type (VHL1 type, VHL2 type) and cases combined with renal cell carcinoma were 32.5(range, 14.0-68.0)years, 110, 26 and 115 in 136 patients with VHL syndrome associated with pancreatic cystic lesions, versus 22.0(range, 8.0-64.0)years, 13, 12 and 14 in 25 patients with VHL syndrome not associated with pancreatic cystic lesions, showing significant differences in the above indicators between them ( Z=-3.384, χ2=9.770, 10.815, P<0.05). (4) Comparison of clinicopathological factors in patients with VHL syndrome associated with pNENs. The age of onset, gene mutation sites (exon 1, exon 2, exon 3, other types of gene site) and VHL syndrome type (VHL1 type, VHL2 type) were 33.5(range, 14.0-64.0)years, 12, 5, 14, 3 and 18, 16 in 34 patients with VHL syndrome associated with pNENs, versus 27.0(range, 9.0-66.0)years, 41, 12, 32, 42 and 105, 22 in 127 patients with VHL syndrome not associated with pNENs, showing significant differences in the above indicators between them ( Z=-4.030, χ2=8.814, 13.152, P<0.05). (5) Treatment and prognosis of patients with VHL syndrome associated with pancreatic lesions. Of the 161 patients with VHL syndrome, 3 patients underwent surgical treatment, and the remaining patients were followed up. All 161 patients with VHL syndrome were followed up for 6 (range, 1-12)years, in which 15 patients died and 146 patients alive during the follow-up. The follow-up time of 3 patients undergoing surgical treatment was 4, 14, 9 years, respectively, and all of them were alive. Conclusions:The clinical imaging features of pancreatic lesions related to VHL syndrome are cystic lesions and pNENs, which with the characteristics of multiple lesions and benign tumors. Such patients usually do not requiring surgical treatment and have good prognosis.
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Objective:To evaluate the risk factors of acute kidney injury (AKI) in patients with multiple wasp stings.Methods:Patients with multiple wasp stings were retrospectively enrolled in Hanzhong Central Hospital from September 2010 to November 2020. Based on whether the patients developed AKI, the patients were divided into AKI group and non-AKI group. The general characteristics and laboratory examinations between the two groups were compared. The logistic regression model was used to analyze the risk factors of AKI.Results:A total of 356 patients with multiple wasp stings were recruited in this study, with 196 males (55.1%). The age was 56.0(45.0, 64.0) years old. There were 59 patients (16.6%) with hypertension and 13 patients (3.6%) with diabetes. There were 51 patients (14.3%) in the AKI group and 305 patients (85.7%) in the non-AKI group. Baseline data and biochemical examinations indicated that the two groups showed significant differences in gender, age, sting sites (systemic or local), sting needles, proportions of gross hematuria, leukocyte count, hemoglobin, creatine kinase, alanine transaminase, aspartate aminotransferase, total bilirubin, proportions of urinary protein, and proportions of urine occult blood (all P<0.05). The multivariate logistic regression analysis results showed that the increasing number of sting needles (every 10 needles increase, OR=1.866, 95% CI 1.289-2.071, P=0.001), gross hematuria ( OR=9.770, 95% CI 2.586-36.910, P=0.001), decreasing hemoglobin (every 1 g/L increase, OR=0.016, 95% CI 0.001-0.355, P=0.009), increasing aspartate aminotransferase (every 100 U/L increase, OR=1.311, 95% CI 1.144-1.502, P<0.001), and increasing total bilirubin (every 10 μmol/L increase, OR=1.200, 95% CI 1.008-1.430, P=0.041) were independent influencing factors of AKI. Conclusions:The increasing number of sting needles, gross hematuria, decreasing hemoglobin, increasing aspartate aminotransferase, and increasing total bilirubin are independent risk factors of AKI in patients with multiple wasp stings.
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Objective:To investigate the clinicopathological characteristics and treatment strategies of undifferentiated carcinoma with osteoclast-like giant cells of pancreas (UCOGCP).Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 5 patients with UCOGCP who were admitted to Peking University First Hospital from January 2004 to January 2019 were collected. There were 1 male and 4 females, aged from 33 to 71 years, with a median age of 56 years. Patients underwent preoperative laboratory test, imaging and histopatho-logical examinations. Patients with pancreatic head tumors underwent pancreaticoduodenectomy, and those with tumors in the body or tail of pancreas underwent distal pancreatectomy combined with splenectomy. All patients underwent standard lymph node dissection. Postoperative adjuvant therapy was individually decided by a multidisciplinary team. Observation indicators: (1) preopera-tive examination and treatment; (2) postoperative histopathological situations; (3) follow-up. Follow-up using outpatient examination and telephone interview was performed to detect tumor recurrence of patients up to January 2020. Measurement data with normal distribution were represented as Mean± SD. Measurement data with skewed distribution were described as M (range). Count data were described as absolute numbers. Results:(1) Preoperative examination and treatment: of the 5 UCOGCP patients, CA19-9 was elevated as 65.43 U/mL in only 1 patient preoperatively, while the CA19-9 was normal in other 4 patients. Four patients showed a solid cystic mass on preoperative contrast-enhanced computed tomography (CT) scan, and 1 patient showed a delayed peripheral enhancement of the solid tumor with central necrosis. The magnetic resonance imaging (MRI) scan showed hypointense signals on T1, T2 and weighted diffusion sequences in all 5 patients. Three of the 5 patients were resectable according to imaging data, 1 patient had locally advanced tumor, infiltrating the transverse colon, stomach, and partial small intestine, with the portal vein thrombus, and 1 patient had pancreatic head tumor with a liver metastatic lesion of 0.4 cm diameter which was detected on position emission tomography CT and was diagnosed as UCOGCP by endoscopic ultrasound-guided fine-needle aspiration biopsy. All patients underwent radical resection. Of the 3 patients with resectable tumors, 2 patients underwent pancreaticoduo-denectomy and 1 patient underwent distal pancreatectomy combined with splenectomy. One patient with locally advanced tumor in the body and tail of pancreas underwent distal pancreatectomy + transverse colostomy + partial gastrectomy + portal vein thrombectomy, and 1 patient with pancreatic head tumor and liver metastasis underwent pancreatoduodenectomy combined with left lateral hepatectomy. Of the 5 patients, 2 received postoperative adjuvant chemotherapy with single-agent gemcitabine, 1 received albumin-paclitaxel+gemcitabine combination chemotherapy, 1 received S1 as single agent chemotherapy, and 1 did not receive adjuvant chemotherapy. (2) Postoperative histopathological situations: of the 5 patients, 4 cases showed a cystic solid appearance of gross specimens, and 1 case had a solid appearance with central hemorrhagic necrosis. The tumor diameter was 5.2 cm(range, 2.0?14.0 cm). All the 5 patients achieved negative margins. Of the 5 patients, there was 1 case with portal vein invasion, 2 cases with vascular invasion, 3 cases with perineural invasion, and 2 cases with regional lymph node metastasis. One patient may had multiple tumor invasion and metastasis. Four of 5 patients had paraffin specimens available for immuno-histochemical staining. Four patients were positive for both CD68 and vimentin stains, while 3 patients were positive for programmed death ligand-1 (PD-L1), including 2 samples with 5% positive cells and 1 sample with 25% positive cells. Postoperative pathological examination showed a large number of spindle histiocytoid sarcoma cells scattered with osteoclast like giant cells and pleomorphic carcinoma giant cells. The tumor mutation burden in the 4 patients was 3.23 Muts/Mb(range, 2.61?21.77 Muts/Mb). Microsatellite status was stable in 4 patients. The next generation sequencing of 4 patients showed that all patients had KRAS mutation which was the most frequently mutation in pancreatic ductal adenocarcinoma. Of the 4 patients, 1 case had germline pathogenic mutation in TP53, 1case had somatic mutation in TP53, 1 case had somatic mutation in TP53, BLM, CDKN2A, and 1 case had somatic mutation in ARID1A. (3) Follow-up: 5 patients were followed up for 14?173 months, with a median follow-up time of 46 months. During the follow-up, 4 patients achieved disease-free survival and 1 patient had local recurrence at postoperative 11 months.Conclusions:UCOGCP is a rare variant of pancreatic tumor that exhibits a cystic solid mass in imaging examinations. High expression of PD-L1 is common in UCOGCP. The prognosis for UCOGCP is favorable following radical surgery. Patients may benefit from extended radical surgery even if the tumor has locally progression or distant metastasis.
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Objectives@#To examine the value of multi-slice spiral CT angiography (MSCTA) in the analysis of anatomical variation and structural classification of right colon vessels.@*Methods@#From August 2015 to August 2017, 198 patients (96 of whom underwent laparoscopic radical resection of right colon cancer) at Department of General surgery of Peking University First Hospital were retrospectively collected, and the results of abdominal enhanced CT scan were collected and three-dimensional reconstruction of blood vessels was performed. There were 104 males and 94 females. The age was 64(27) years (M(QR), range: 19 to 87 years). Right gastroepiploic vein, anterior superior pancreaticoduodenal vein, right colonic vein (RCV), superior right colonic vein, ileocolon artery or vein (ICA or ICV), middle colon artery or vein (MCA or MCV) and Henle trunk were observed and recorded respectively. The anatomical relationship between the positions of blood vessels, the length of Henle trunk and surgical trunk were measured.@*Results@#ICV and ICA were the most constant anatomic structures. The ICV/ICA of all patients came directly from SMV/SMA, 36.9% (73/198) ICV going in front of SMV and 63.1% (125/198) behind SMV. 72.2% (143/198) of the patients had RCV imported into Henle trunk and the rest into SMV. Middle colonic vein (MCV) could be observed in 81.3% (161/198) of the cases. 81.4% (131/161) of MCV were imported into SMV, 16.8% (27/161) into Henle trunk, 1.2% (2/161) into the first jejunal vein and 0.6% (1/161) into the splenic vein. Henle trunk was divided into 4 types, among which the occurrence probability of gastric node and pancreatic trunk was the highest. The dry length of Henle trunk was (0.82±0.39) cm (range: 0.37 to 1.68 cm). The length of surgical trunk was (2.54±0.83) cm (range: 1.57 to 3.95 cm). Accuracy of MSCTA results was 96.9%(93/96).@*Conclusions@#Anatomical variation of blood vessels in the right colon is common. Abdominal CT angiography can accurately determine the anatomical structure of the blood vessels in the right colon.
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Objective@#To investigate the risk factors and computed tomography (CT) diagnostic accuracy of anastomotic leakage after resection of rectal cancer (Dixon) .@*Methods@#This retrospective study was conducted in Peking University First Hospital from January 2013 to June 2015. A cohort of 452 patients with rectal cancer was enrolled in the study. All the patients underwent anterior resection. The relationship between clinical-pathological data (including sex, age, body mass index (BMI) , presence of diabetes, hypohemoglobin (Hb < 90 g/L) , hypoalbuminemia (Alb < 35 g/L) , the distance from the lower edge of the tumors to the anus, tumor diameter, tumor differentiation, tumor TNM stage, neoadjuvant therapy status, ligation of the left colonic artery (LCA) , preventive colostomy, and anastomotic leakage was analyzed retrospectively. Univariate analysis using χ2 test and multivariate analysis by using the Ordered Classification Arguments Logistic regression model.@*Results@#Of all the cases, 281 and 171 patients were men and women, respectively. The median age was 64 years (range, 18-88 years) . Forty-seven patients (10.4%) were diagnosed with anastomotic leakage, and the median diagnostic time of anastomotic leakage was 6.5 days (range, 3-31 days) . One patient with anastomotic leakage died because of respiratory failure within 1 month postoperatively; 11 patients underwent salvage colostomy performed 2-34 days (median, 7 days) after the first surgery. All the 11 patients underwent colostomy closure within 2 years. The other 35 patients recovered by antibiotic and peritoneal lavage treatment. The mean length of postoperative hospital stay in patients without anastomotic leakage was 8.4±2.4 days, which was significantly shorter than that in patients with anastomotic leakage (34.6±15.7 days) , and the difference was statistically significant (t = 24.127, P = 0.008) . The results of the univariate analysis showed that BMI≥28 kg/m2 (χ2 = 7.550, P = 0.000) , diabetes mellitus (χ2 = 5.055, P = 0.025) , Hb < 90 g/L preoperatively (χ2 = 5.718, P = 0.017) , Alb < 35 g/L preoperatively (χ2 = 8.096, P = 0.004) , distance of < 6 cm from the lower edge of the tumors to the anus (χ2 = 8.205, P = 0.004) and LCA ligation (χ2 = 16.540, P = 0.000) were risk factors for the occurrence of anastomotic leakage. Multivariate analysis showed that BMI≥28 kg/m2 (OR = 1.758, 95%CI: 1.265-2.454, P = 0.021) , distance of < 6 cm from the lower edge of the tumors to the anus (OR=1.530, 95%CI: 1.035-2.117, P = 0.037) , LCA ligation (OR = 1.551, 95%CI: 1.035-2.131, P = 0.042) were independent risk factors for anastomotic leakage. The CT diagnostic sensitivity of anastomotic leakage was 91.2% (31/34) . The false positive rate of CT for diagnosing anastomotic leakage was zero 7 days after the Dixon procedure.@*Conclusion@#Important factors, including BMI of patients, LCA ligation, and the distance from the lower edge of the tumors to the anus are related with anastomotic leakage. The individual treatments should be considered based on the patient′s clinical condition. CT was recommended 7 days postoperatively when anastomotic leakage was highly suspected.
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The first edition of Liver Imaging Reporting and Data System (LI-RADS) is proposed by American College of Radiology (ACR) in 2011 for diagnosis of hepatocellular carcinoma (HCC) in at-risk patients.It is created to standardize the reporting and data collection of CT and MR imaging for HCC to classify observation.Since it had been announced,many validation studies had been performed and the first edition of LI-RADS had been revised in 2013 and 2014,respectively.In July 2017,the latest revision (LI-RADS(R)v2017) has just been launched more reasonable and practical with new algorithms,new revised categories for LI-RADS and new criteria for many imaging features.The changes of CT/MR in LIRADS(R) v2017 were interpretated in this article.
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The first edition of Liver Imaging Reporting and Data System (LI-RADS) is proposed by American College of Radiology (ACR) in 2011 for diagnosis of hepatocellular carcinoma (HCC) in at-risk patients.It is created to standardize the reporting and data collection of CT and MR imaging for HCC to classify observation.Since it had been announced,many validation studies had been performed and the first edition of LI-RADS had been revised in 2013 and 2014,respectively.In July 2017,the latest revision (LI-RADS(R)v2017) has just been launched more reasonable and practical with new algorithms,new revised categories for LI-RADS and new criteria for many imaging features.The changes of CT/MR in LIRADS(R) v2017 were interpretated in this article.
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Objective To assess the safety and efficacy of extended liver resection using preoperative PTCD (percutaneous transhepatic cholangial drainage) and PVE (portal vein embolization) to treat patients with locally advanced hilar cholangiocarcinoma.Methods We collected and analyzed the clinical data of 27 patients with Bismuth types Ⅲ and Ⅳ hilar cholangiocarcinoma who underwent extended hepatecomy using preoperative PTCD and PVE in our hospital.Results There were 21 patients with R0 resection and 6 patients with R1 resection.The mortality rate was 0％.Eight patients died of cancer recurrence.Conclusion Preoperative PTCD and PVE combined with extended hepatectomy were safe and efficacious in treating patients with locally advanced hilar cholangiocarcinoma,which resulted in potential cure.
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PurposeConventional gastric CT provides poor contrast for gastric cancer lesions, the purpose of this study is to investigate the application value of dual energy CT image fusion technology in the improvement of lesion contrast in gastric cancer.Materials and Methods Abdominal dual energy contrast-enhanced CT images of 30 gastric cancer patients were retrospectively analyzed, dual-energy images were reconstructed with different linear and nonlinear fusion settings, contrast between lesions and normal gastric wall, lesion contrast to noise ratio (CNR) were compared among 100 kVp, 140 kVp and different fusion groups, and image quality was evaluated subjectively.Results There were statistically significant differences among the gastric cancer contrast and CNR of 100 kVp, 140 kVp and three linear blending images (F=29.6 and 26.1,P<0.001), with M=0.7 linear fusion group showing the highest CNR. The gastric cancer contrast and CNR was signiifcantly higher with a bandwidth (BW) of 0 HU when compared among the three groups of nonlinear blending images (F=268.5 and 49.5,P<0.001). Moreover, the nonlinear group with a width of 0 HU had a 36% and 47% increase in lesion contrast and CNR over that of a linear blending image. In the subjective evaluation of images, the BW=0 HU nonlinear fusion image was most frequently estimated as the most preferred images for lesion observation of gastric cancer.Conclusion Nonlinear blending with a BW of 0 HU improves display of gastric cancer, and has the potential clinical value to increase the accuracy of staging.
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Objective To explore the effect of total flavonoids of astragalus (TFA) on the apoptosis of endothelial cells induced by serum of uremia patient .Methods The serum of 22 healthy volunteers and 25 uremia patients receiving regularly hemodialysis were enrolled in the study .HUVECs were used as research objects ,which were divided into control group(adding serum of healthy people when cell synchronized) and uremia group (adding serum of uremia patient when cell synchronized ) .Low dose ,moderate dose and high dose group were prepared by adding 0 .5 ,1 .0 ,2 .0 mg/mL TFA respectively 6 h before cell synchronization .After 24 hours′culture since the serum were added ,the morphological change of endothelial cells were observed by microscopy ,proliferation activities were tested by using MTT ,SOD activities were tested by using xanthine oxidase method ,NO levels were measured by u-sing nitrate reductase colorimetric method ,DNA damage was detected by using comet assay ,the morphological change of apoptosis was observed by using TUNEL method .Results Compared with the control group ,the proliferation activity ,SOD activity ,NO lev-els were lower in uremia group(P< 0 .01) ,DNA tailing rate ,apoptosis index(AI) significantly increased (P<0 .01) .Compared with cells of uremia group ,cell proliferation activity of all the TFA intervention groups increased (P<0 .05) ,NO levels also in-creased (P<0 .01) .Compared with uremia group ,moderate and high dose group′s SOD activity increased (P<0 .05) ,DNA damage tailing rate decreased (P<0 .05) .Conclusion Total flavonoids of astragalus reduces apoptosis of HUVECs induced by serum of uremia patient ,the possible mechanism is associated with the decrease of oxidative stress .
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Objective To determine the value of liver analysis application in liver segmentation and planning of surgery.Methods Thirty patients suspected having hepatic disease were recruited in this study.Contrast-enhanced CT examinations were performed with Philips Brilliance 64-slice CT,and multi-phase images were obtained.The patients were divided into group B(with focal hepatic lesion,15 patients),and group A(without hepatic lesion,15 patients).We use the portal-venous(60-70 s)images to analysis.Liver volume and vessel recognition were edited manually if necessary,then liver segmentation proceeded automatically.All data were analyzed by the t test,chi-square test,Mann-Whitney U analysis,with SPSS 15.0 software.Results There was no significant difference of post-processing procedure between the two groups(P =0.361).The liver volume was(1374.61 ±444.05)cm3 in the group B and(1225.70±272.07)cm3 in the group A(P=0.108).The accuracy of vessel recognition was no significant difference between the two groups(P=0.87).21 vessels were recognized incorrectly include 18 hepatic veins.Conclusion The liver analysis application provides a 3D reconstruction allow vivid observation of liver segmentation and accurate estimation of the liver volume.It has broad prospect in diagnosing and surgical planning of the liver disease.