Emergent hepatectomy and transcatheter arterial embolization for spontaneous rupture of primary hepatocellular carcinoma / 中国综合临床

Objective To evaluate the indications,method and prognosis of emergent hepateetomy and tran-scatheter arterial embolization(TAE) for spontaneous rupture of primary liver carcinoma(PLC). Methods Clinical data of 85 cases with PLC were analyzed. Patients were divided into four groups: the group of delayed hepatectomy (group A,n=30);the group of emergent transcatheter arterial embolization (group B,n=22);the group of emer-gent hepatectomy (group C, n=18) and the group of medical treatment (group D, n=15). The hemostasis achieve-ment ratio, operative complications, perioperative morbidity, 1-year and 3-year survival rates among the four groups were compared. Results In group A and B, celiac urteriogram in 52 cases showed that extravasation of contrast media happened in 14 cases (26.9%). The hemostasis achievement ratio was 100% (30/30, 22/22, 18/18) in group A,B and C,respectively,which was remarkably higher than that in group D(40%,6/15) (P<0.05);The in-hospital fatality was 0% (0/30),3.8% (2/52) and 16.7% (3/18),which was lower than that of group D(80.0%, 12/15) (P<0.01). The 1-year survival rate was 76.7% and 3-year survival rate of group A was 53.3%, which was higher than that of group B (45.5 % and 31.8 %) and group C (44.4% and 33.3 %) (P<0.05). The cases in group D did not survive one year(P<0.01). Conclusions Emergent hepatectomy and transcatheter arterial emboli-zation are safe and feasible for spontaneous rupture of primary hepatocellular carcinoma. For those with resectable ca-ses,surgical resection is the first choice after transcatheter arterial embolization.

Expression of muc-1 gene in non-small cell lung cancer and its clinical significance / 吉林大学学报(医学版)

Objective To explore the relationship between expression of muc-1 gene in non-small cell lung cancer (NSCLC) tissues and lymph node metastasis and its clinical significance.Methods The expression of muc-1 gene in 36 specimens of NSCLC tissues and 10 normal lung tissues were determined by RT-PCR.Results muc-1 gene was positively expressed in 19 of 36 specimens of NSCLC tissues,the positive expression rate was 52.7%.The expression of muc-1 mRNA in NSCLC tissues was related to metastasis of lymph node(?2 =6.733,P0.05).The positive expression rate of muc-1 gene was higher in NSCLC tissues with lymph node metastasis(N0 10%,N1 58.82%,N2 88.9%).Conclusion The lymph node metastasis rate in NSCLC patients with muc-1 gene positive expression is higher,the detection of muc-1 gene expression can guide the prognosis and therapy of NSCLC patients after operation.

Reconstruction of dog trachea using prosthesis constructed with autogenous costal perichondrium / 吉林大学学报(医学版)

Objective To study the feasibility of reconstructing trachea by implanting autogenous costal perichondrium tracheal prosthesis.Methods Ten dogs were used.Three pieces of costal perichondrium of every dog were wrapped on a silicon bar used as skeleton and implanted into sternohyoid muscle adjacent to trachea to establish blood supply.Four weeks later,silicon bar was removed and perichondrium ring served as tracheal prosthesis.Trachea resection and prosthesis replacement was performed.Viability of dogs,gross and microscopic pathological changes were studied to evaluate the effect of prosthesis replacement.Results The respiratory tracts of the 8 survival dogs were not obstructed.Their diet,activity and bark were not different from those of the normal dogs.With abundant blood supply,the prosthesis fused tightly with the surrounding tissue.Anastomotic orifice healed without cicatricial tissue and granulation tissue.The internal surfaces of prosthesis were smooth and glossy with white tunica mucosa covered.Under light microscope,internal surfaces of prosthesis were found covered by pseudostratified columnar epithelium with few cilia.Under tracheal mucous membrane,there were fibrous membrane,neonate chondrocytes and striated muscle cells stratum successively.Fibrous membrane was composed of collagen and fibroblasts with a few inflammatory cells scattered.A small number of neonate chondrocytes were found under fiber membrane.Plasma of these chondrocytes looked pale after staining,which indicated that these chondrocytes were neonate.Striated muscle cells connected with the neonate chondrocytes firmly. Neonate capillaries and micro blood vessels of various diameters were abundant in striated muscle stratum.Conclusion It is feasible to reconstruct dog trachea using prosthesis constructed with autogenous costal perichondrium.

Sleeve lobectomy versus pneumonectomy for lung cancer: a comparative analysis of survival and sites or recurrences.

BACKGROUND: Sleeve lobectomy (SL) in a lung-saving procedure indicated for central tumors for which the alternative is pneumonectomy (PN). Although it has been suggested that it may provide as good if not better survival results than pneumonectomy in the treatment of lung cancer, there are very few reports of clinical series comparing operative mortality, survival, and sites of recurrences between these procedures. METHODS: Survival and sites of recurrences were analyzed and compared in 1,230 consecutive patients who underwent PN (n = 1,046) or SL (n = 184) in a single institution. Sleeve lobectomy was always done when technically possible. Thus PN was reserved for lesions that could not be removed by a bronchoplastic procedure. Pathologic staging was accomplished by nodal sampling except for N2 and selected N1 patients who underwent mediastinal lymphadenectomy. Ultimately, all patients were staged according to the 1997 TNM nomenclature. RESULTS: There were 3 operative deaths of the 184 SL patients (operative mortality of 1.6%) and 55 operative deaths of the 1,046 PN patients (operative mortality of 5.3%, p = 0.036). Follow-up was complete for all 1,230 patients. For the entire group, survival at 5 years was 52% after SL and 31% after PN (p < 0.0001). These rates for patients with complete resection were 58% for SL and 33% for PN (p = 0.021). There was also a significant difference in survival favoring SL for patients with pathologic stage I (p = 0.018) and stage II (p = 0.005) disease. When recurrences occurred (n = 577), the site of first recurrence was local in 22% of patients with SL and in 35% of patients with PN. CONCLUSIONS: Sleeve lobectomy can be done with a much lower risk of operative mortality than PN. Although it is recognized that stage for stage, PN patients likely have more advanced disease, long-term survival and local control are significantly better when complete resection can be achieved by SL.

Myasthenia gravis in pediatric and elderly patients / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To determine whether the clinical and pathologic characteristics and prognoses of myasthenia gravis (MG) patients below 15 years differ from those patients over 50 years after thymectomy.</p><p><b>METHODS</b>We reviewed the registry material of 30 pediatric and 32 elderly MG patients after thymectomy, including their age, sex, clinical classification, pathological types, and prognoses. The Chi-square test or Wilcoxon's rank-sum test was used to determine the statistical differences between the children and elderly groups.</p><p><b>RESULTS</b>No significant difference was seen in sex distribution between the two groups. (Chi-square test, P=0.625), but there were differences in clinical classification: more type I was observed in the pediatric group than in the elderly group, but more type II or III was seen in the elderly group (Wilcoxon's rank-sum test, P<0.001). As to pathological types, the pediatric group was also significantly different from the elderly group (Chi-square test, P<0.01). All of the patients (100%) in the pediatric group had thymus hyperplasia, but in the elderly group more than half (56.26%) were found to have thymoma (benign or malignant). The prognoses after thymectomy were better in the pediatric group than in the elderly group (Wilcoxon's rank-sum test, P<0.001).</p><p><b>CONCLUSIONS</b>Because the prognoses are generally better than those of the elderly patients, we should be careful when operating on pediatric patients of ocular type. The elderly patients tend to receive more aggressive treatment because of more severe generalized types often associated with thymoma and poor prognoses. Both pediatric and elderly patients are seldom associated with other autoimmune disease.</p>

Hemocoagulase in abdominal operation and its effect on hemoagglutination / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the hemostatic role of hemocoagulase in abdominal operation and its effects on coagulation.</p><p><b>METHODS</b>180 patients receiving abdominal operation were studied prospectively by randomized, double-blind controlled and multicenter design. They were divided into Hemocoagulase group (60 patients), lizhixue group (60), and manitol hexanitrate group (60). The groups were, observed in terms of the effects on hemostatic time, hemorrhagic volume, hemorrhagic volume per square unit, and body coagulation (BT, CT, PT, APTT and PLT) parameters.</p><p><b>RESULTS</b>The groups received different drugs. The average hemostatic time in the hemocoagulase group was 121.6 s, hemorrhagic volume was 9.6 g, and hemorrhagic volume per square unit was 0.2 g. The similar results were observed in the lizhixue group (P > 0.05), but they were significantly different (P < 0.05) from those of the manitol hexanitrate group (159.2 s, 12.49 g, 0.3 g). In the hemocoagulase and lizhixue groups hemorrhagic and hemoagglution time decreased 30 minutes and 1 day after operation. This finding was significantly differenct from that in the manitol hexanitrate group (P < 0.05).</p><p><b>CONCLUSION</b>Hemocoagulase plays a good hemostatic role in the hemorrhagic capillary at abdominal incision.</p>