Clinical application of self-expanding metallic stent in the management of acute left-sided colorectal malignant obstruction

瞄准：在尖锐左边的颜色的管理用自我膨胀的金属性的斯滕特氏印模膏(SEMS ) 的申请总结我们的经验表面的恶意的阻塞。方法：经历在 2000 年 4 月和 2004 年 1 月之间的 SEMS 的放置的所有病人的回顾的图表评论被执行。结果：SEMS 的插入与偶尔的内视镜的帮助在 fluoroscopic 指导下面在 26 个病人被尝试。损害的地点位于二个病人，的结肠左曲七个病人，的左冒号八个病人的 S 字形的冒号和九个病人的直肠。SEMS 的打算的使用为在 7 个病人并且作为到在 19 个病人的选任的外科的一座桥的减轻。在后者组， SEMS 的放置允许外科手术前全身并且肠准备和下列一个阶段吻合。成功的斯滕特氏印模膏放置在 22 被完成(85%) 26 个病人。临床的肠阻塞在 21 在成功的斯滕特氏印模膏放置以后解决了 24 个小时(95%) 病人。三 SEMS 相关的次要的复杂并发症发生了，二 stents 移植了，一个人引起了肛门疼痛。结论：SEMS 在尖锐恶意的颜色的管理代表一个有效、安全的工具表面的阻塞。作为到外科的一座桥， SEMS 能为系统的支持和肠准备提供时间并且排除对烘便的转向或在桌子上洗室年龄的需要。作为一项辩解的措施， SEMS 能为突现的结肠开口术消除需要。

Effect of non-anticoagulant N-desulfated heparin on expression of vascular endothelial growth factor, angiogenesis and metastasis of orthotopic implantation of human gastric carcinoma

AIM: To investigate the effect of N-desulfated heparin on tumor metastasis and angiogenesis, and expression of vascular endothelial growth factor (VEGF) of ortho- topic implantation of human gastric carcinoma in male severe combined immune deficiency (SCID) mice.? METHODS: Human gastric cancer SGC-7901 cells were orthotopically implanted into the stomach of SCID mice.? The mice were randomly divided into normal saline group and N-desulfated heparin group.? One week after operation, the mice in N-desulfated heparin group re- ceived i.?v.? injections of N-desulfated heparin (SShhaanngghhaaii Institute of Cell Biology, Chinese Academy of Sciences, 10 mg/kg.?d)) ttwwiiccee wweeeekkllyy ffoorr ???? wwkk..?? ??hhee mmiiccee iinn nnoorrmmaall saline group received i.?v.? injections of normal saline (100 μL) twice weekly for ?? wk.? ?he mice were sacrificed six weeks after implantation.? ?umor metastasis was evalu- ated histologically for metastasis under microscope.? In- tratumoral microvessel density (MVD) and VEGF expres- sion were evaluated immuohistochemically.? VVVEEEGGGFFF mmmRR?NNNAAA expression in gastric tissue of SCID mice was detected by real time PC?.? RESULTS: The tumor metastasis rate was 80% in nor- mal saline group and 20% in N-desulfated heparin group (P ???? 00..??00??))..?? MMVVDD wwaass ??..??00 ???? ????..??11 iinn nnoorrmmaall ssaalliinnee ggrroouupp and 4.??? ?? 1.?? in N-desulfated heparin group (P ???? 00..??00??))..?? VEGF positive immunostaining was found in cytoplasmof cancer cells.? ?he rate of VEGF positive expression was higher in normal saline group than in N-desulfated hepa- rin treated group (90% vs 20%, P ???? 00..??00??))..?? VVEEGGFF mm??NNAA expression was significantly inhibited by N-desulfated heparin and was higher in normal saline group than in N-desulfated heparin group (Ct value 19.??1 ?? 1.?01 vs 22.??? ?? 1.???6, P ???? 00..??00??))..?? NN--ddeessuullffaatteedd hheeppaarriinn ssiiggnniiffii- cantly inhibited the expression of VEGF mRNA in can- cer cells.? No bleeding occurred in N-desulfated heparin group.? CONCLUSION: N-desulfated heparin can inhibit me- tastasis of gastric cancer by suppressing tumor VEGF expression and tumor angiogenesis, but has no obvious anticoagulant activity.?

Prediction of synchronous colorectal cancers by computed tomography in subjects receiving an incomplete colonoscopy:A single-center study

AIM:To assess the value of computed tomography(CT)for diagnosis of synchronous colorectal cancers(SCRCs)involving incomplete colonoscopy.METHODS:A total of 2123 cases of colorectal cancer(CRC)were reviewed and divided into two groups according to whether a complete or incomplete colonoscopy was performed.CT results and final histological findings were compared to calculate the sensitivity and specificity associated with CT for detection of SCRCs following complete vs incomplete colonoscopy.Factors affecting the CT detection were also analyzed.RESULTS:Three hundred and seventy-four CRC patients underwent incomplete colonoscopy and 1749received complete colonoscopy.Fifty-six cases of SCRCs were identified by CT,and 36 were missed.In the incomplete colonoscopy group,the sensitivity and specificity of CT were 44.8%and 93.6%,respectively.The positive and negative predictive values were 23.6%and 95.0%,respectively.In contrast,the sensitivity and specificity of CT for the complete colonoscopy group were 68.3%and 97.0%,while the positive and negative predictive values were 22.2%and 98.7%,respectively.In both groups,the mean maximum dimension of the concurrent cancers identified in the CT-negative cases was shorter than in the CT-positive cases(incomplete group:P=0.02;complete group:P<0.01)Topographical proximity to synchronous cancers was identified as a risk factor for missed diagnosis(P=0.03).CONCLUSION:CT has limited sensitivity in detecting SCRCs in patients receiving incomplete colonoscopy.Patients with risk factors and negative CT results should be closely examined and monitored.

Super-Flexible Through-the-Scope Self-Expandable Metallic Stent Insertion for the Management of Malignant Tortuous Hepatic or Splenic Flexure Colonic Obstruction

To the Editor： The methods for obstruction of colon cancer include emergency surgery or self-expanding metallic stents （SEMSs）. SEMS insertion was shown to be a safe, easy, and effective treatment for left-sided malignant colon obstruction, for palliative treatment or as bridge to resection. The cases reported of SEMS insertion in the colon proximal to the splenic flexure were 〈5% of all studies. The long distances and the tortuosity of the distal bowel make it difficult to advance and position the stent in the target proximal colon, and obstruction of right colon has traditionally been managed by acute operation.