[The use of bronchial occlusion test in a preterm infant with severe bronchopulmonary dysplasia complicated by severe lobar emphysema]. / æ”¯æ°”ç®¡å°å µè¯•éªŒåœ¨æ—©äº§å„¿é‡åº¦æ”¯æ°”ç®¡è‚ºå‘è‚²ä¸è‰¯ä¼´ä¸¥é‡è‚ºå¶æ°”è‚¿ä¸­çš„åº”ç”¨1例.

In infants with severe bronchopulmonary dysplasia (sBPD), severe pulmonary lobar emphysema may occur as a complication, contributing to significant impairment in ventilation. Clinical management of these infants is extremely challenging and some may require lobectomy to improve ventilation. However, prior to the lobectomy, it is very difficult to assess whether the remaining lung parenchyma would be able to sustain adequate ventilation postoperatively. In addition, preoperative planning and perioperative management are also quite challenging in these patients. This paper reports the utility of selective bronchial occlusion in assessing the safety and efficacy of lobectomy in a case of sBPD complicated by severe right upper lobar emphysema. Since infants with sBPD already have poor lung development and significant lung injury, lobectomy should be viewed as a non-traditional therapy and be carried out with extreme caution. Selective bronchial occlusion test can be an effective tool in assessing the risks and benefits of lobectomy in cases with sBPD and lobar emphysema. However, given the technical difficulty, successful application of this technique requires close collaboration of an experienced interdisciplinary team.

Surface topography index: a novel deformity severity assessment index for pectus excavatum.

BACKGROUND: The surface topography index (STI) has great potential in both routine computed tomography (CT) scan and emerging optical imaging systems. However, the diagnostic accuracy and stability of the STI as a deformity severity assessment index has not been fully confirmed. Therefore, the aim of the present study was to determine the diagnostic performance of the STI as a novel deformity severity assessment index for pectus excavatum. METHODS: The present study consisted of 722 chest CT images from a single center. The standard CT index (CTI) and STI were calculated for all patients. The between-group difference and the level of compliance between the CTI and STI was analyzed by t-test and Pearson correlation. The diagnostic value and optimum discriminatory values of the CTI and STI were calculated by a receiver-operating characteristic (ROC) curve and DeLong's test. RESULTS: The distributions of the CTI and STI were similar and showed a slight overlap between the pectus excavatum (PE) and non-PE groups. Both the CTI and STI significantly differed between the 2 groups (P<0.001). The STI demonstrated a strong Pearson correlation with the CTI (r=0.91, 95% confidence interval: 0.88-0.91, P<0.001). The ROC curves showed that STI =1.58 (sensitivity: 0.93, specificity: 0.95) could be considered equivalent to CTI =2.72 (sensitivity: 0.93, specificity: 0.97) as the optimum discriminatory values. DeLong's test showed no significant difference in the ROC curve results between the CTI and STI (Z=0.90, P=0.37). CONCLUSIONS: The STI has comparative discrimination ability in PE diagnosis and deformity severity assessment when used with the standard CTI. The STI as a novel index is not only an ideal evaluation metric of PE deformity but also an objective trait for PE patients just as weight and height for everyone.

Imaging features of spinal atypical teratoid rhabdoid tumors in children.

This study aims to analyze and summarize the imaging features of spinal atypical teratoid/rhabdoid tumors (AT/RT) in children.Imaging features in 8 children with spinal AT/RT confirmed by surgical pathology were retrospectively analyzed. All patients had underwent total spine 3.0 T magnetic resonance imaging (MRI) and 64-slice spiral computed tomography (CT). Among these 8 patients, head MR non-enhanced and spinal enhanced scanning was applied to 5 patients, while CT examination was applied to 3 patients.All 8 patients were characterized by cauda equina syndrome. The lesions of 7 patients were in the thoracolumbar spinal junction, while the lesion of the remaining patient was in the lumbar spine. Furthermore, among these patients, the lesions of 5 patients were limited to the intraspinal canal (1 lesion in the epidural space, and 4 lesions in the subdural space), while the lesions of 3 patients invaded the paravertebra (2 lesions in the epidural space and 1 lesion in the subdural space). Three or more spinal segments were invaded by tumors in 7 patients, while sacral canal was affected in 5 patients. All 8 patients experienced bleeding in the tumors. Enhanced MRI revealed meningeal enhancement in 6 patients, and bilateral nerve root enhancement in 4 patients. The masses in 3 patients brought damages to the intervertebral foramen or sacral pore. The lesion of 1 patient was featured by skip growth. One patient had total spinal metastasis and 3 had hydrocephalus. The masses in 2 patients had a slightly low density when detected by CT, and enhanced scanning revealed a mild to moderate enhancement.Spinal AR/TR had the following characteristics: children were characterized by cauda equina syndrome; the mass that invaded the thoracolumbar spinal junction and the extramedullary space of multiple segments grew along the spinal longitudinal axis; bleeding mass was revealed in MRI imaging; meninges, nerve root, and sacral canal metastases occurred. The gold standard for the definite diagnosis of AT/RT is biopsy combined with immunohistochemistry.

Intussusception patients older than 1 year tend to have early recurrence after pneumatic enema reduction.

PURPOSE: To identify age risk factors of early recurrent intussusception after pneumatic enema reduction. Management opinions are proposed. METHODS: Two thousand two hundred and ninety-five intussusception patients' medical records from January 2009 to December 2011 were retrospectively reviewed and analyzed. RESULTS: Of the 2295 patients, the intussusception of 1917 of them was initially reduced by pneumatic enema, with 127 cases recurring within 72 h. The early recurrence rate is 6.62%. The early recurrence rate of patients younger than 1 year old is 2.1% (22/1032), while the rate for those older than 1 year is 11.9% (105/885). The difference is significant (P = 0.0001). There were no significant differences between age groups older than 1 year. One hundred and seventeen cases of recurrence happened within 48 h, which accounted for 92.1% of all early recurrence. Recurrence patients were treated again with pneumatic enema, with a successful reduction in 93.7%. They were followed up for 2-4 years; the long-term recurrent rate was 11.8% (14/119). No patient had poor prognosis because of delayed treatment. CONCLUSION: Intussusception patients older than 1 year tend to have greater early recurrence rate after pneumatic enema reduction; 92.1% of the early recurrent cases happened in 48 h. There is no need to hospitalize patients after pneumatic enema reduction. A repeat pneumatic enema is a good choice before surgical approach.

[Experimental study of CT-guided percutaneous ethanol ablation in rabbit renal VX2 tumor].

BACKGROUND AND OBJECTIVE: CT-guided percutaneous ethanol ablation (PEA) has been widely used in treating solid tumors such as hepatoma, lung cancer, adrenal nonfunctional adenoma. This study was to explore the efficacy, safety and feasibility of CT-guided PEA in treating renal tumor in rabbit. METHODS: Twenty-five rabbits carrying VX2 tumor were randomized into PEA group (15 rabbits) and control group (10 rabbits). After CT-guided PEA, the area of the largest cross section lipiodol deposition in PEA group was measured. After one week, the kidneys carrying VX2 tumor were removed, tumor size in both groups and the area of the largest cross section coagulation necrosis in PEA group were measured. Wound infection and the changes of living habits of the rabbits were observed after experiment. RESULTS: A total of 25 VX2 tumors were developed in the 25 rabbits. The area of the largest cross section was 1.38-2.25 cm(2), with an average of (1.61+/-0.04) cm(2). There was no significant difference in tumor size between the two groups. After ablation, the area of lipiodol deposition in PEA group was 1.31-1.85 cm(2), with an average of (1.56+/-0.05) cm(2). At one week after ablation, the area of the largest cross section of tumors was significant smaller in PEA group than in control group [(1.58+/-0.03) cm(2) vs. (1.94+/-0.03) cm(2), P<0.05]; the area of coagulation necrosis in PEA group was 1.27-1.78 cm(2), with an average of (1.54 +/-0.04) cm(2), and was similar to the area of lipiodol deposition (P>0.05). Tumor tissue in ablation areas showed acidophilia changes and irregular coagulation necrosis. There was no obvious complication in PEA group. CONCLUSION: CT-guided PEA can effectively inactivate rabbit kidney VX2 tumors, and it is a safe and feasible treatment without obvious complications.

Application of multislice spiral CT angiography on transcatheter arterial chemoembolization for hepatocellular carcinoma.

BACKGROUND AND OBJECTIVE: Multislice spiral CT angiography (MSCTA) is very important in the diagnosis and treatment of liver diseases. Currently, most studies on three-dimensional MSCTA of the liver vascular system focus on the liver tumors, preoperative assessment of liver transplantation and the systematic anatomy of the liver vascular system. This study was to investigate the clinical application of MSCTA on transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) by comparing images of MSCTA and digital subtraction angiography (DSA). METHODS: MSCT dual-phase enhanced scanning was performed in 50 patients with advanced HCC. Both hepatic artery angiography and portal vein angiography were conducted using maximal intensity projection (MIP) and volume rendering technique (VRT). DSA of the celiac artery, superior mesenteric artery, renal artery and diaphragm artery, as well as TACE were performed in all patients. MSCTA and DSA images of the 50 patients were compared. RESULTS: MSCTA and DSA showed equal detectability in revealing classification of the hepatic artery anatomy and tumor blood vessels, with a coincidence of 100% (p = 1.00). However, MSCTA was superior to DSA in displaying arterioportal shunt and portal vein tumor thrombus. CONCLUSIONS: As a noninvasive and easy to conduct technique, MSCTA can accurately provide information of the hepatic artery, portal vein and tumor supply vessels. Therefore MSCTA has a favorable value to guide TACE for HCC.

[CT-guided percutaneous ethanol ablation in the treatment of malignancies with pleural or chest wall invasion].

OBJECTIVE: To explore the feasibility and efficiency of CT-guided percutaneous ethanol ablation (PEA) in the treatment of malignant tumors with pleural or chest wall invasion. METHODS: Nine patients of malignant tumors with pleural or chest wall invasion that failed to respond to operation, radiotherapy, or chemotherapy were treated by PEA under CT guidance. The improvement of quality of life (QOL) during the treatment was observed and the efficiency was evaluated by CT scan. Follow-up was conducted for 6 - 24 months. RESULTS: After successful ethanol ablation, cancer pain of the patients was relieved obviously and pain degree reduced to 0 - 3 score according to the numerical rating scale (NRS). Cough and hemoptysis disappeared. Appetite and sleeping were improved markedly. Body weight increased and the Karnofsky performance status (KPS) score was over 90. No serious adverse effect and complication occurred during and after PEA. PEA was performed successfully 34 times in 18 lesions of these 9 patients. In follow-up, local recurrence and new tumors appeared in 2 patients, but good results were achieved after the second PEA treatment. One tumor came to recurrence in a patient of lung cancer, but it was well controlled after another two times of PEA treatment. One patient with lung cancer gave up treatment and came to recurrence after successful PEA treatment 7 months later. Two patients of primarily hepatocellular carcinoma died of brain metastases 8 and the 9 months after treatment. CONCLUSION: With little damage and few complications, CT-guided PEA is convenient and effective in treatment of malignant tumors with pleural invasion.

Combined treatment of hepatocellular carcinoma with partial splenic embolization and transcatheter hepatic arterial chemoembolization.

AIM: To prospectively evaluate the efficacy and safety of partial splenic embolization (PSE) combined with transcatheter hepatic arterial chemoembolization (TACE) in treatment of hepatocellular carcinoma (HCC). METHODS: Fifty patients suffering from primary HCC associated with hypersplenism caused by cirrhosis were randomly assigned to 2 groups: group A receiving PSE combined with TACE (n = 26) and group B receiving TACE alone (n = 24). Follow-up examinations included calculation of peripheral blood cells (leukcytes, platelets and red blood cells) and treatment-associated complications. RESULTS: Prior to treatment, there was no significant difference in sex, age, Child-Pugh grade, tumor diameter, mass pathology type and peripheral blood cell counts between the 2 groups. After treatment, leukocyte and platelet counts were significantly higher in group A during the 3-mo follow-up period (P < 0.05), but lower in group B (P < 0.05). Severe complications occurred in 3 patients (11.5%) of group A and in 19 patients (79.2%) of group B (P < 0.05), and there was no significant difference in symptoms of post-embolization syndrome, including abdominal pain, fever, mild nausea and vomiting between the 2 groups (P > 0.05). CONCLUSION: PSE combined with TACE is more effective and safe than TACE alone for patients with HCC associated with hypersplenism caused by cirrhosis.