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As of 2018 cancer is responsible for almost 9.6 million deaths annually and, with an aging population, the incidence of cancer is expected to continue to rise. Surgery is an important treatment modality for patients with solid organ cancers. It has been postulated that, due to potentially overlapping processes underlying the development of malignancy and the therapeutic pathways of various anesthetic agents, the choice of anesthetic type and method of administration may affect post-operative outcomes in patients with cancer. This is a literature review of the most recent evidence extracted from various databases including PubMed, EMBASE, and the Cochrane, as well as journals and book reference lists. The review highlights the pathophysiological processes underpinning cancer development and the molecular actions of anesthetic agents, pre-clinical and retrospective studies investigating cancer and anesthetics, as well as ongoing clinical trials. Overall, there are conflicting results regarding the impact of regional vs. general anesthesia on cancer recurrence, whilst the majority of data suggest a benefit of the use of intravenous propofol over inhalational volatile anesthetics. The biological changes associated with the surgical inflammatory response offer a unique opportunity to intervene to counteract any potentially cancer-promoting effects.
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As of 2018 cancer is responsible for almost 9.6 million deaths annually and, with an aging population, the incidence of cancer is expected to continue to rise. Surgery is an important treatment modality for patients with solid organ cancers. It has been postulated that, due to potentially overlapping processes underlying the development of malignancy and the therapeutic pathways of various anesthetic agents, the choice of anesthetic type and method of administration may affect post-operative outcomes in patients with cancer. This is a literature review of the most recent evidence extracted from various databases including PubMed, EMBASE, and the Cochrane, as well as journals and book reference lists. The review highlights the pathophysiological processes underpinning cancer development and the molecular actions of anesthetic agents, pre-clinical and retrospective studies investigating cancer and anesthetics, as well as ongoing clinical trials. Overall, there are conflicting results regarding the impact of regional vs. general anesthesia on cancer recurrence, whilst the majority of data suggest a benefit of the use of intravenous propofol over inhalational volatile anesthetics. The biological changes associated with the surgical inflammatory response offer a unique opportunity to intervene to counteract any potentially cancer-promoting effects.
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Purpose The incidence and drug resistance rate ofAcinetobacter baumannii pneumonia are becoming more and more serious.To summarize the computed tomography (CT) appearance ofAcinetobacter baumannii pneumonia and to provide evidence for early clinical diagnosis and treatment.Materials and Methods The imaging findings of 49 patients with sputum culture confirmed Acinetobacter baumannii pneumonia were retrospectively analyzed,and the imaging features were summarized.Results The three most common patterns of chest CT findings in Acinetobacter baumannii pneumonia were ground-glass opacification (69.4%,34/49),consolidation (67.3%,33/49),and pleural effusion (53.1%,26/49).While,the most common patterns of chest X-ray were pulmonary plaque (83.7%,41/49),consolidation (36.7%,18/49),and pleural effusion (36.7%,18/49).Further analysis showed that there was no statistically significant difference in the CT and X-ray findings between combined infection of Acinetobacter baumannii with other pathogens and single Acinetobacter baumanniizxcvbnm,infection (P>0.05).Conclusion The three most common changes of chest imaging of Acinetobacter baumannii pneumonia are ground-glass opacification,pulmonary consolidation and pleural effusion.It is of great significance to summarize its imaging features for early diagnosis,treatment and prognosis-predicting.
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Objective To discuss the relationship of life quality and active function state, erythrocyte sedimentation (ESR), tumor necrosis factor-α (TNF-α) and C-reaction protein (CRP) of patients with ankylosing spondylitis (AS). Methods A total of 95 cases of patients with AS received and cured in our hospital during the period from Feb 2010 to April 2013 were selected as research objects. The BASDAI and BASFI scores of all research objects were evaluated by collecting information and questionnaires, and its relations with distance between the pillow wall, distance between the ground, thoracic activity, laboratory indexes (ESR, CRP and TNF-α) and multiple linear regression were analyzed as well. Results BASDAI and BASFI had close relation, while BASDAI had obvious relations with distance between the pillow wall, distance between the ground, thoracic activity, CRP, TNF-α and amended Schober test (P<0.05) but no relation with ESR (P>0.05). The analysis on multiple linear regression of BASDAI and BASFI showed that CRP,TNF-αand amended Schober test were all the influence factors of life quality and activity factors of patients with AS, and with statistical differences (P<0.05). Conclusion Disease activities and function of AS have close relation, and amended schober test, CRP and TNF-α can influence the functional activities of patients, which provide the reliable theory evi-dences for clinical treatment guidance and prognosis recovery.
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Objective To evaluate whether dynamic contrast enhanced-MRI (DCE-MRI) can help clinicians in differentiating malignant tumors from benign lesions and in predicting and correlating the histologic grade for breast cancer patients.Methods DCE-MRI from 98 patients (with histopathological confirmation) in our department were retrospectively analyzed.In the first dynamic phase,the hot and cold spot ROIs were selected as the regions with maximum and minimum Slopein,respectively.The kinetic characteristics (including hot spot,cold spot,and heterogeneous characteristics) and morphologic features were evaluated.The ROC curve analysis was used to test the diagnostic power of all DCE-MRI parameters (inflow slope,Slopein ; washout slope; inflow slope ratio; washout slope ratio; time-signal intensity curve shape; rim enhancement; internal homogeneity) for differentiating malignant tumors from benign breast lesions.Joncheere-Terpstra test was adopted to analyze the kinetic data.Categorical data were analyzed by using the Fisher test.Results Hot spot Slopein might have the biggest area (0.620) under the ROC curve (but not significant) among all the different MRI parameters(P > 0.05).Its sensitivity,specificity,positive predictive value,negative predictive value were 63.2% (55/87) and 72.7% (8/11),respectively.The cold spot parameter Slopein(P =0.025),heterogeneity parameter ratio-in (P =0.031),and internal homogeneity (P =0.032) showed a significant correlation with histologic grade.The median and quartile of cold spot Slopein in pathologic Ⅰ,Ⅱ,and Ⅲ were 6.1 × 10-3,5.4 × 10-3 and 1.4 × 10-3,respectively;inflow slope ratio:6.6,9.8 and 17.6 ; pathologic Ⅰ,Ⅱ,and Ⅲ showed 2,1,and 0 patients with homogeneity enhancement,respectively ; intermediate enhancement:5,12,and 2 patients,respectively;heterogeneity enhancement:2,6,and 8 patients.Conclusions The DCE-MRI is a potential tool in helping clinicians to predict the histologic grading in breast cancers.Parameter hot spot Slopein might help differentiae malignant tumors from the benign counterpart.
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Objective To elucidate the CT characteristics and pathology of acute miliary pulmonary tuberculosis (AMPT). Methods The CT features of AMPT in 25 cases were analyzed retrospectively, and the CT features in HIV-seronegative and HIV-seropositive patients were compared by 2-sided exact propability Chi-square test. Two lung specimens were inflated and fixed by Heitzman's method. HRCT scans, gross specimen section (80-150 μm) and histologic section (5 μm) were performed on dry lung specimens and CT-pathologic correlation was conducted. The distribution of micronodules in the secondary lobule on HRCT and pathology in one specimen was evaluated by Chi-square test. Results Twenty five patients with AMPT were included in this study, including 11 HIV-seropositive patients and 14 HIV-seronegative patients. HRCT showed diffuse micronodules randomly distributed throughout both lungs in 25 patients, and ground-glass opacity (17 patients)was the predominant complicated finding. Coalescence of nodules and consolidation in HIV-seropositive patients (5 and 6 patients) were markedly higher than that in HIV-seronegative patients (none). In lung specimens, most nodules located in the lung parenchyma between the central bronchovascular bundle and the perilobular structures (792 and 560 nodules), which located in the interlobular septum pathologically. The distribution of micronodules in the secondary lobule showed on HRCT (1060 nodules)and pathology(864 nodules) was not significantly difference(x2=2.814,P>0.05). HRCT showed ground-glass opacities when ARDS occured, which were pulmonary edema,inflammation and hyaline membrane on alveolar wall pathologically. Conclusions The HRCT characteristic of nodule distribution in AMPT is random. ARDS should be suspected when diffuse ground-glass opacities appear on HRCT.
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Objective To assess the capability of the colon computer-aided-detection(CAD) for the detection of colonic neoplasm on low-dose CT colonography with changing sphericity filter values. Methods Low dose (50 mA) CT colonography data from 56 patients with 159 colonic neoplasms confirmed by conventional colonoscopy and surgery were divided into four groups: colorectal cancer, ≥ 10 mm polyps,5. 1 to 9. 9 mm polyps and ≤ 5.0 mm polyps. The golden standard was established by matching the neoplasms on CT colonography images. The datasets analyzed subsequently by the Colon CAD system at four discrete sphericity filter settings (SFV): 0. 25, 0. 50, 0. 75 and 1.00. The location and size of highlight lesions by the colon CAD were recorded. Comparison was made with the known golden standard in order to determine the detective rate of colonic neoplasms. Chi-square tests were used to compare the detection rates of four groups by CAD SFV at four settings. Results Fifty six patients had 159 colonic neoplasms including 44 colonic cancers, 45 large polyps (max diameter≥ 10. 0 mm), 32 median polyps (max diameter 5. 1 to 9. 9 mm) and 38 small polyps ( max diameter ≤5.0 mm). The colon CAD had the detective rate of 85.5%( 136/159), 85.5% ( 136/159 ), 79. 2% ( 126/159 ) and 56. 0% (89/159) for all colonic neoplasms at four sphericity filter settings 0. 25, 0. 50, 0. 75 and 1.00 respectively. There was statistically significant difference between the sphericity filter settings at 0. 25 and 1.00 ( P < 0. 05). Detective rate was highest at lower sphericity, false-positive rate increased at same time, however, 91.4% ( 138/151 )to 93.9% (31/33 )of false-positives were rapidly dismissible with 2D axial images, only 6. 1% (2/33)to 8.6% (13/151)of false-positives needed to discriminate with multiplanar reconstruction or 3D virtual colonoscopy. Conclusion The Colon CAD system can detect colonic neoplasms satisfactorily in low dose CT colonography and may satisfy the needs of radiologists with different experience by changing sphericity filter settings.
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Objective To evaluate the value of computer-aided detection (CAD) system for pulmonary nodule detection using digital chest radiography in lung cancer screening. Methods One hundred consecutive digital chest radiographs from 6280 outpatients for lung cancer screening were independently reviewed by a thoracic radiologist and a computer-aided pulmonary nodule detection system.The radiographs were also reviewed by two experienced thoracic radiologists and the true nodules confirmed by two radiologists with reference to the CT images were marked and stored as a gold standard in the CAD system. The sensitivity and false positive of the radiologist and the CAD system for the detection of nodules on digital chest radiographs were compared. Results Ninety-five and 304 nodules were identified by radiologist and the CAD system, respectively. Of 134 nodules marked as true nodules by experienced radiologists, 82 (61.2%) and 105 (78. 4% ) nodules were identified by the radiologist and the CAD,respectively. The radiologist missed 35 true nodules which were only detected by CAD. The CAD system missed 10 true nodules which were only detected by radiologist. One hundred and twelve (83.6%) nodules were identified by radiologist with the CAD system. One hundred and ninety-nine nodules identified by CAD were false-positive with a rate of 2. 0 ( 199/100 ) per case. Conclusion Combining review of digital radiographs by radiologist with CAD system can improve the detection of pulmonary nodules in lung cancer screening.
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Objective To study the morphological appearance and pathological basis of the fine pulmonary reticulation at HRCT.Methods One hundred and seven patients were analyzed about the morphology findings and dynamic changes on pulmonary HRCT.Twenty-four coal worker's pneumoconiosis(CWP)specimens were examined to make comparison between CT and pathology.The data was analyzed by using the Chi-square test.Results The reticular gap was less than 3 mm in diameter.The morphology of reticulation was round or irregular.Pulmonary parenchyma was seen between the gaps.The reticular wall was smooth or coarse.The thickness was less than 1 mm.One hundred and seven patients had accompanying signs including ground-glass opacity(68.2%,73 patients),crazy paving(23.4%,25 patients),interlobular septal thickening(84.1%,90 patients),emphysema(32.7%,35 patients),interface sign(58.9%,63 patients),traction bronchiolectasis(41.1%,44 patients)and honeycombing(26.2%,28 patients).The differences of the honeycomb,traction bronchiolectosis,interbobular septal thickening,interface sign and paving were statistically significant between the fibrotic group and pneunonia(P<0.01).Pneumonia showed extensive area of ground-glass opacity(GGO)with fine reticulation.Fine reticulation with both interlobular septal thickening and small nodules were observed more frequently in lmphangitic carcinomatosis.Idiopathic pulmonary fibrosis(IPF)showed fine reticulation among the honeycombing.Connective tissue disease (CTD)showed fine reticulation with rarely honeycombing and it could be partly absorbed.Fine reticulation with emphysema was seen in chronic bronchitis.In the 58 follow-up patients,the fine reticulation increased in 26 patients,decreased or disappeared in 22 patients and showed no change in 10 patients.The major pathological basis of the fine reticulation was intralobular interstitial thickening,including fibrosis hyperplasia,inflammatory cells and tumor cells infiltration,effusion filling,smut deposition and so on.Conclusions The fine reticulation was caused by intralobular interstitial thickening including inflammation,interstitial hyperplasia,pulmonary fibrosis and tumor.The fine reticulation is helpful to prompt the diagnosis of these diseases,but the diagnosis need its combination with the other CT findings and dynamic changes.
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Objective To investigate the clinical value of chest low-dose CT (LDCT) combined with computer-aided detection (CAD) system for lung cancer screening in high risk population. Methods Two hundred and nineteen healthy candidates underwent 64-slice LDCT scan. All images were reviewed in consensus by two radiologists with 15 years of thoracic CT diagnosis experience. Then the image data were analyzed with CAD alone. Finally images were reviewed by two radiologists with 5 years of CT diagnosis experience with and without CT Viewer software. The sensitivity, false positive rate of CAD for pulmonary nodule detection were calculated. SPSS 11.5 software and Chi-square test were used for the statistics. Results Of 219 candidates ,104(47.5% )were detected with lung nodules. There were 366 true nodules confirmed by the senior radiologists. The CAD system detected 271 (74.0%)true nodules and 424 false-positive nodules. The false-positive rate was 1.94/per case. The two junior radiologists indenfifid 292(79.8%), 286(78.1%) nodules without CAD and 336 (91.8%), 333 (91.0%) nodules with CAD respectively. There were significant differences for radiologists in indentifying nodules with or without CAD system (P<0.01). Conclusions CAD is more sensitive than radiologists for indentifying the nodules in the central area or in the hilar region of the lung. While radiologists are more sensitive for the peripheral and sub-pleural nodules,or ground glass opacity nodules, or nodules smaller than 4 mm. CAD can not be used alone. The detection rate can be improved with the combination of radiologist and CAD in LDCT screen.
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Cavity is the frequent imaging findings of lung diseases. Many pulmonary diseases can form cavity in the course and are difficult to distinguish. Peripheral lung cancer is a common malignant tumour and can form cavity. The definition and pathological basis of lung cavity, CT diagnosis and differential diagnosis of peripheral lung cancer cavity and the application of multi-slice spiral CT in the diagnosis of lung disease with cavity were reviewed in this article.
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Objective To evaluate the effectiveness of immediate quantitative coronary angiography (QCA) analysis in percutaneous coronary intervention (PCI). Methods The parameters of QCA and conventional methods before and after PCI were compared and statistics was performed by using t test or ANOVA methods. Results One hundred and two patients were enrolled in our study. Significant differences between QCA and conventional methods were found in evaluation of lesion length [ ( 22.9 ± 8.9 ) mm vs (24. 8 ± 10. 6) mm,t = 9. 63, P < 0. 05 ], stenosis diameter [ (3.0 ± 0.4 ) mm vs (2. 9 ± 0. 7) mm, t = 6. 31, P < 0. 05 ] and stenosis area [ ( 87. 8 ± 10. 7 ) mm2 vs ( 85.0 ± 12.9 ) mm2, t = 2. 54, P < 0.05 ], and also in different vessels. Stenosis diameter and stenosis area after stenting in target lesion were lower than the international standards. Conclusion Immediate QCA analysis can be effective in directing stent implantation.
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Objective To assess the feasibility of using an automatic tube current modulation (ATCM)method to obtmn consistent image quality with reduced radiation dose for young children undergoing chest scans with a set of 64-slice spiral CT.Methods Fifry young children underwent chest scans on a GE 64-slice VCT with automatic tube current modulation.The noise index(NI)for this study group was set to 8 or 9 based on the proposed reference for pediatric chest imaging in our hospital.We compared image quality and radiation dose for the study group with the age-matched control group of 50 young children acquired with standard protocol of fixed-mAs(120 and 150 mAs for under 1 and above 1 year old,respectively).The volume CT dose index(CTDIvol)values were recorded for beth groups.Two experienced pediatric radiologists assessed image quality on a 5-point scale with 5 being the best.Scores greater than or equal to 3 were considered clinically acceptable.The degree of interobserver concordance was determined by Kappa statistics.Results The average objective image noise and CTDIvol for control group was(4.78±0.58)and(6.68±0.62)mGy,respectively.For the study group the mean value of objective mAs wag(41.6±11.6)(20-79 mAs)with mean CTDIvol of(2.34 4±0.71)mGy,and the use of ATCM produced mean noise of(7.84±0.66).The average CTDIvol with the use of NI of 8-9 was about 65% lower than that with the fixed mAs setting.The mean image quality score for the study group and control group was(3.46±0.40)and(4.65±0.46)respectively.All studies had acceptable image quality,and there was good inter-observer agreement in diagnostic acceptability(Kappa=0.474 and 0.536).Conclusion The automatic tube current modulation method could be used to obtain consistent image qualityfor young children undergoing 64-slice MSCT chest scans.With proper noise level setting(NI=8 or 9),one may obtmn clinically acceptable images with much reduced radiation dose.
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OBJECTIVE To investigate the risk factors,characteristics,measures of prevention and treatment of hospital fungal infection among maintenance hemodialysis patients.METHODS Clinical data of 128 maintenance hemodialysis patients between Jan 2002 and Dec 2006 were enrolled in this retrospective study of hospitalized infection cases.RESULTS During above period,36 infection episodes of 27 cases were occurred.The major infection site was lungs(69.4%).the Candida albicans was the main pathogen species(61.1%).The underlying and complicating diseases such as diabetes,chronic obstructive pulmonary disease and tumor,long antibiotics using,long hospitalization,poor nutrition status,inadequate hemodialysis,and venous indwelling catheter were the risk factors which led to fungal infection among maintenance hemodialysis patients.CONCLUSIONS The maintenance hemodialysis patients are easy to induce fungal infection.The C.albicans is the main pathogen species.The incidence of underlying diseases is rather high.Treatment of original diseases and complicating diseases,the standard using of antibiotics,adequate hemodialysis,the nutrition status and the reduction of the indwelling time of venous catheter are all the keys to decrease the fungal infection.
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<p><b>OBJECTIVE</b>To study the early X-ray and CT findings of patients with severe acute respiratory syndrome (SARS).</p><p><b>METHODS</b>Chest radiography and CT were performed in 28 patients with SARS within one to three days after onset of the disease. CT examinations included conventional spiral CT and high-resolution CT (HRCT). The radiographic and CT findings of these patients were analyzed retrospectively.</p><p><b>RESULTS</b>Abnormal CT findings were noted in all the patients, but abnormal chest radiographic findings in 17 cases (60.7%, 17/28). CT showed single small focal patchy opacities in 23 patients (82.1%, 23/28), including oval ground-glass opacities in 20 patients, lobular distribution ground-glass opacities in 2 and small patchy consolidation in one. Multi-focal ground-glass opacities were found in 2 patients and extensive opacities in three. In the 28 patients, a total of 31 lesions were found in the upper (7, 22.6%), middle (3, 9.7%), and lower lobes (21, 67.7%). The diameter of the lesions ranged from 20 to 35 mm.</p><p><b>CONCLUSION</b>The dominant feature of early SARS patients is focal patchy opacity in the lung, and oval small ground-glass opacities are the common morphological findings on CT.</p>
Sujets)
Adulte , Femelle , Humains , Mâle , Adulte d'âge moyen , Radiographie thoracique , Syndrome respiratoire aigu sévère , Imagerie diagnostique , Anatomopathologie , TomodensitométrieRésumé
Objective To analyze the CT characteristic of pulmonary inflammatory mass and peripheral lung cancer, and to look for the method of diagnosis solitary pulmonary nodule. Methods 28 patients of pulmonary inflammatory masses and 33 patients of peripheral lung cancers were included in the study,all patients conformed by pathology. The lesions were divided into typical and atypical masses according to morphology. Observing the signs of lesions and using the results ameliorate the morphological classification. Tested the method by ROC. Results According to the standard of morphology, the diagnosis sensitivity, specificity and accuracy of inflammatory mass are 64.3%, 72.7% and 68.9% respectively. The ameliorated sensitivity, specificity and accuracy are 75%, 81.8% and 78 7% respectively. Conclusion The method of making morphology as basement and sign as supplement can improve the sensitivity, specificity and accuracy of diagnosis.
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Objective To study the X ray and CT findings of pneumocystis carinii pneumonia in AIDS. Methods Five AIDS patients who had chest abnormalities were analyzed. Results Pneumocystis carinii pneumonia appeared as diffuse infiltrative and interstitial fine nodules. Conclusion If the diffuse and infiltrative interstitial fine nodule are the appearances in patients with AIDS, the pneumocystis carinii pneumonia should be considered.
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Objective To study the chest X-ray appearances and dynamic imaging changes in severe acute respiratory syndrome diagnosed clinically. Methods The sequential chest X-ray examinations at 1-4 day intervals were performed in 72 patients with severe acute respiratory syndrome. Results The findings on chest X-ray images were analyzed. The abnormalities on the chest X-ray films most commonly occurred at 4-7 days after onset (53 cases, 73.6%), and the most severe manifestations on the chest films usually presented at 8-14 days (54 cases, 75.0%). The absorption of the abnormal changes on the films occurred at 15-21 days in most cases (37 cases, 51.4%). The main features included bilateral or unilateral single or multiple patchy shadows (58 cases, 80.6%), and the lesions changed rapidly at the peak period. The lesions presented wandering features in some cases. The lesions still remained on CT scans in 11 cases (11/20, 55.0%) within one month after the absorption on X-ray film. Conclusion The chest radiography can be used to display dynamic changes of SARS, but it isn't able to distinctly demonstrate tine pulmonary lesions of SARS.
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Objective To investigate the imaging finding,the pathologic bases,and the diagnostic value of nodule notch due to pleural indentation (NNPI),and to evaluate the potential role of multiplanar reconstruction (MPR) in the diagnosis of small peripheral lung cancer (SPLC) associated with pleural indentation (PI).Methods (1) 91 cases of SPLC and 59 cases of benign nodule confirmed by pathology were collected in this paper.A correlative study was done between the two groups.Eleven fresh lobectonic specimens from 9 cases of SPLC and 2 cases of benign nodule were collected.A correlative study to the preoperative CT scans,postoperative scans of the inflated specimens with the gross pathology of the specimens was done.(2) Twenty cases of SPLC and 12 cases of benign nodule,associated with PI,were collected in the study about MPR.Attention was focused on its role in showing NNPI.Results (1) NNPI was depicted as follows: On the position of the connection between the nodule and the line associated with PI,and a notch was shaped on the margin of nodule.The specificity of NNPI to malignant PI was 96.5%.(2) On MPR image,the occurrence of NNPI (80%) was higher than that on CT scans (? 2=13.205,P
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Purpose To study X-ray and CT findings of pulmonary infection in AIDS. Methods We evaluate 10 cases who have chest abnormalities. The all patients have X-ray and CT examination. Results Imaging of pulmonary tuberculosis in AIDS, including infiltrative imaging and diffuse patchy imaging, enlarged mediastinum lymph nodes and extra chest enlarged lymph nodes. The imaging of legionella species is infiltrative imaging. Carinii pneumonia appearances diffuse infiltrative and interstitial abnormalities. Conclusion Pulmonary tuberculosis, legionella species and carinii pneumonia are common infections in AIDS. The patchy, consolidations, diffused diseases and enlarged lymph nodes are important imaging appearances.