AIM To investigate the feasibility and safety of secondary endoscopic submucosal dissection(ESD) for residual or locally recurrent gastric tumors. METHODS Between 2010 and 2017, 1623 consecutive patients underwent ESD...AIM To investigate the feasibility and safety of secondary endoscopic submucosal dissection(ESD) for residual or locally recurrent gastric tumors. METHODS Between 2010 and 2017, 1623 consecutive patients underwent ESD for gastric neoplasms at a single tertiary referral center. Among these, 28 patients underwent secondary ESD for a residual or locally recurrent tumor. Our analysis compared clinicopathologic factors between primary ESD and secondary ESD groups. RESULTS The en bloc resection and curative rate of resection of secondary ESD were 92.9% and 89.3%, respectively. The average procedure time of secondary ESD was significantly longer than primary ESD(78.2 min vs 55.1 min, P = 0.004), and the adverse events rate was not significantly different but trended slightly higher in the secondary ESD group compared to the primary ESD group(10.7% vs 3.8%, P = 0.095). Patients who received secondary ESD had favorable outcomes without severe adverse events. During a mean follow-up period, no local recurrence occurred in patients who received secondary ESD. CONCLUSION Secondary ESD of residual or locally recurrent gastric tumors appears to be a feasible and curative treatment though it requires greater technical efficiency and longer procedure time.展开更多
Background: Mitral valve repair in secondary mitral regurgitation is still uncertain as the chance of recurrence is approximately 30 percent after solely undersized annuloplasty. Some procedures adding to the sub...Background: Mitral valve repair in secondary mitral regurgitation is still uncertain as the chance of recurrence is approximately 30 percent after solely undersized annuloplasty. Some procedures adding to the subvalvular level are proposed to alleviate the recurrent rate. This study was to evaluate the clinical and echocardiographic outcomes of papillary muscle relocation plus undersized ring in secondary mitral regurgitation (2<sup>nd</sup> MR). Methods: Medical records of moderate to severe 2<sup>nd</sup> MR with tethering depth of more than 1 cm patients who underwent papillary muscle relocation plus undersized ring from 2014 to 2020 were reviewed. Clinical and echocardiographic parameters before and after operation were analyzed. Results: Thirty-two patients were included during the 6-year period. There was no perioperative mortality. Two patients died at one year from ischemic stroke and car accidents with overall 5-year survival of 93.7%. All patients were in NYHA class I and II with MR grading as trivial or mild at a median follow-up of 33 months. Postoperative mean tenting depth, area and posterior leaflet angle decreased remarkably from 1.18 cm, 2.61 cm<sup>2</sup> and 46.5 degree to 0.65 cm, 1.22 cm<sup>2</sup> and 28.6 degree, respectively (p 0.001, 0.02, and 0.01). Moreover, left ventricular function and remodeling were also notably improved (EF;38.2% vs 49.1%: p = 0.018, LVEDD;62.8 vs 54.6 mm: p = 0.005, LVESD;50.2 vs 42.4 mm: p = 0.01). Conclusions: Papillary muscle relocation combined with undersized annuloplasty improved mid-term clinical outcomes. Apart from reduction of recurrent MR rate, restoration of mitral configuration and reverse LV remodeling could be the effect of adding subvalvular correction in this pathology.展开更多
Objective To investigate the functional repair of secondary deformity of unilateral cleft lip. Methods The nasal branch,nasolabial branch,and labial branch of orbicularis oris muscle were dissected and repositioned pr...Objective To investigate the functional repair of secondary deformity of unilateral cleft lip. Methods The nasal branch,nasolabial branch,and labial branch of orbicularis oris muscle were dissected and repositioned precisely to correct the secondary deformity of unilateral cleft lip. Results 96 parients were treated展开更多
Over the last two decades multiple studies have demonstrated an increased incidence of additional malignancies in patients with intraductal papillary mucinous neoplasms(IPMNs).Additional malignancies have been identif...Over the last two decades multiple studies have demonstrated an increased incidence of additional malignancies in patients with intraductal papillary mucinous neoplasms(IPMNs).Additional malignancies have been identified in 10%-52% of patients with IPMNs.The majority of these additional cancers occur before or concurrent with the diagnosis of IPMN.The gastrointestinal tract is most commonly involved in secondary malignancies,with benign colon polyps and colon cancer commonly seen in western countries and gastric cancer commonly seen in Asian countries.Other extrapancreatic malignancies associated with IPMNs include benign and malignant esophageal neoplasms,gastrointestinal stromal tumors,carcinoid tumors,hepatobiliary cancers,breast cancers,prostate cancers,and lung cancers.There is no clear etiology for the development of secondary malignancies in patients with IPMN.Although population-based studies have shown different results from single institution studies regarding the exact incidence of additional primary cancers in IPMN patients,both have reached the same conclusion:there is a higher incidence of extrapancreatic malignancies in patients with IPMNs than in the general population.This f inding has signif icant clinical implications for both the initial evaluation and the subsequent long-term followup of patients with IPMNs.If a patient has not had recent colonoscopy,this should be performed during the evaluation of a newly diagnosed IPMN.Upper endoscopy should be performed in patients from Asian countries or for those who present with symptoms suggestive of upper gastrointestinal disease.Routine screening studies(breast and prostate) should be carried out as currently recommended for patient's age both before and after the diagnosis of IPMN.展开更多
Metastases of esophageal carcinoma to the skeletal muscle are rare,but the incidence may be increasing because of better diagnosis resulting from widespread use of positron emission tomography/computed tomography(PET/...Metastases of esophageal carcinoma to the skeletal muscle are rare,but the incidence may be increasing because of better diagnosis resulting from widespread use of positron emission tomography/computed tomography(PET/CT).A cohort of 205 patients with esophageal carcinoma treated at our center who had PET/CT between 2006 and 2010 was retrospectively evaluated for the presence of skeletal muscle metastases.Four patients had skeletal muscle metastases of esophageal carcinoma,including two patients with squamous cell carcinoma.In another patient with squamous cell carcinoma of the esophagus and synchronous skeletal muscle metastases,muscle metastases were subsequently shown to be related to second primary pancreatic adenocarcinoma.In all cases,skeletal muscle metastases were the first manifestation of systemic disease.In three patients palliation was obtained with the combination of external beam radiation therapy,systemic chemotherapy or surgical resection.Skeletal muscle metastases are a rare complication of esophageal carcinoma.展开更多
Metastatic hepatic leiomyosarcoma is a rare malignant smooth muscle tumor.We report a case of metastatic hepatic leiomyosarcoma associated with smooth muscle tumor of uncertain malignant potential(STUMP).A 68-year-old...Metastatic hepatic leiomyosarcoma is a rare malignant smooth muscle tumor.We report a case of metastatic hepatic leiomyosarcoma associated with smooth muscle tumor of uncertain malignant potential(STUMP).A 68-year-old female presented with a liver mass(60 mm × 40 mm, Segment 4).She underwent left salpingooophorectomy for an ovary tumor with STUMP in a broad ligament 6 years ago.Though FDG-PET showed obvious metabolically active foci, abnormal metabolically active foci other than the lesion were not detected.A malignant liver tumor was strongly suspected and laparoscopic partial liver resection was performed with vessel-sealing devices using the crush clamping method and Pringle maneuver.Immunohistochemical findings revealed metastatic liver leiomyosarcoma associated with STUMP in a broad ligament.This case is an extremely rare case of malignant transformation from primary STUMP to metastatic hepatic leiomyosarcoma.It provides important evidence regarding the treatment for metastatic hepatic leiomyosarcoma associated with STUMP.展开更多
BACKGROUND Paraneoplastic neurological syndrome manifesting as secondary Parkinson disease caused by breast cancer is extremely rare.CASE SUMMARY We report a 39-year-old primipara of 31 gestational weeks,who presented...BACKGROUND Paraneoplastic neurological syndrome manifesting as secondary Parkinson disease caused by breast cancer is extremely rare.CASE SUMMARY We report a 39-year-old primipara of 31 gestational weeks,who presented with worsening tremors,facial stiffness and speech disfluencies,and decreased limb strength.Thorough physical examinations and auxiliary tests suggested secondary Parkinson’s disease,but the pathogenesis was unknown.During the cesarean section at the 31 weeks plus 6 d,an exploration and liver biopsy revealed a metastatic,poorly differentiated adenocarcinoma.The positron emission tomography and immunohistochemical analysis confirmed a breast ductal carcinoma of stage IV.To our knowledge,only two reports have documented the association between the breast cancer and the Parkinson disease,and neither occurred in pregnant women.CONCLUSION Our case alerts the secondary Parkinson disease as the possible presentation of breast cancer,the most common malignancy during pregnancy.展开更多
基金Supported by Basic Science Research Program through the National Research Foundation of Korea(NRF)funded by the Ministry of Science and ICT(NRF-2015R1C1A1A01054352)
文摘AIM To investigate the feasibility and safety of secondary endoscopic submucosal dissection(ESD) for residual or locally recurrent gastric tumors. METHODS Between 2010 and 2017, 1623 consecutive patients underwent ESD for gastric neoplasms at a single tertiary referral center. Among these, 28 patients underwent secondary ESD for a residual or locally recurrent tumor. Our analysis compared clinicopathologic factors between primary ESD and secondary ESD groups. RESULTS The en bloc resection and curative rate of resection of secondary ESD were 92.9% and 89.3%, respectively. The average procedure time of secondary ESD was significantly longer than primary ESD(78.2 min vs 55.1 min, P = 0.004), and the adverse events rate was not significantly different but trended slightly higher in the secondary ESD group compared to the primary ESD group(10.7% vs 3.8%, P = 0.095). Patients who received secondary ESD had favorable outcomes without severe adverse events. During a mean follow-up period, no local recurrence occurred in patients who received secondary ESD. CONCLUSION Secondary ESD of residual or locally recurrent gastric tumors appears to be a feasible and curative treatment though it requires greater technical efficiency and longer procedure time.
文摘Background: Mitral valve repair in secondary mitral regurgitation is still uncertain as the chance of recurrence is approximately 30 percent after solely undersized annuloplasty. Some procedures adding to the subvalvular level are proposed to alleviate the recurrent rate. This study was to evaluate the clinical and echocardiographic outcomes of papillary muscle relocation plus undersized ring in secondary mitral regurgitation (2<sup>nd</sup> MR). Methods: Medical records of moderate to severe 2<sup>nd</sup> MR with tethering depth of more than 1 cm patients who underwent papillary muscle relocation plus undersized ring from 2014 to 2020 were reviewed. Clinical and echocardiographic parameters before and after operation were analyzed. Results: Thirty-two patients were included during the 6-year period. There was no perioperative mortality. Two patients died at one year from ischemic stroke and car accidents with overall 5-year survival of 93.7%. All patients were in NYHA class I and II with MR grading as trivial or mild at a median follow-up of 33 months. Postoperative mean tenting depth, area and posterior leaflet angle decreased remarkably from 1.18 cm, 2.61 cm<sup>2</sup> and 46.5 degree to 0.65 cm, 1.22 cm<sup>2</sup> and 28.6 degree, respectively (p 0.001, 0.02, and 0.01). Moreover, left ventricular function and remodeling were also notably improved (EF;38.2% vs 49.1%: p = 0.018, LVEDD;62.8 vs 54.6 mm: p = 0.005, LVESD;50.2 vs 42.4 mm: p = 0.01). Conclusions: Papillary muscle relocation combined with undersized annuloplasty improved mid-term clinical outcomes. Apart from reduction of recurrent MR rate, restoration of mitral configuration and reverse LV remodeling could be the effect of adding subvalvular correction in this pathology.
文摘Objective To investigate the functional repair of secondary deformity of unilateral cleft lip. Methods The nasal branch,nasolabial branch,and labial branch of orbicularis oris muscle were dissected and repositioned precisely to correct the secondary deformity of unilateral cleft lip. Results 96 parients were treated
文摘Over the last two decades multiple studies have demonstrated an increased incidence of additional malignancies in patients with intraductal papillary mucinous neoplasms(IPMNs).Additional malignancies have been identified in 10%-52% of patients with IPMNs.The majority of these additional cancers occur before or concurrent with the diagnosis of IPMN.The gastrointestinal tract is most commonly involved in secondary malignancies,with benign colon polyps and colon cancer commonly seen in western countries and gastric cancer commonly seen in Asian countries.Other extrapancreatic malignancies associated with IPMNs include benign and malignant esophageal neoplasms,gastrointestinal stromal tumors,carcinoid tumors,hepatobiliary cancers,breast cancers,prostate cancers,and lung cancers.There is no clear etiology for the development of secondary malignancies in patients with IPMN.Although population-based studies have shown different results from single institution studies regarding the exact incidence of additional primary cancers in IPMN patients,both have reached the same conclusion:there is a higher incidence of extrapancreatic malignancies in patients with IPMNs than in the general population.This f inding has signif icant clinical implications for both the initial evaluation and the subsequent long-term followup of patients with IPMNs.If a patient has not had recent colonoscopy,this should be performed during the evaluation of a newly diagnosed IPMN.Upper endoscopy should be performed in patients from Asian countries or for those who present with symptoms suggestive of upper gastrointestinal disease.Routine screening studies(breast and prostate) should be carried out as currently recommended for patient's age both before and after the diagnosis of IPMN.
文摘Metastases of esophageal carcinoma to the skeletal muscle are rare,but the incidence may be increasing because of better diagnosis resulting from widespread use of positron emission tomography/computed tomography(PET/CT).A cohort of 205 patients with esophageal carcinoma treated at our center who had PET/CT between 2006 and 2010 was retrospectively evaluated for the presence of skeletal muscle metastases.Four patients had skeletal muscle metastases of esophageal carcinoma,including two patients with squamous cell carcinoma.In another patient with squamous cell carcinoma of the esophagus and synchronous skeletal muscle metastases,muscle metastases were subsequently shown to be related to second primary pancreatic adenocarcinoma.In all cases,skeletal muscle metastases were the first manifestation of systemic disease.In three patients palliation was obtained with the combination of external beam radiation therapy,systemic chemotherapy or surgical resection.Skeletal muscle metastases are a rare complication of esophageal carcinoma.
文摘Metastatic hepatic leiomyosarcoma is a rare malignant smooth muscle tumor.We report a case of metastatic hepatic leiomyosarcoma associated with smooth muscle tumor of uncertain malignant potential(STUMP).A 68-year-old female presented with a liver mass(60 mm × 40 mm, Segment 4).She underwent left salpingooophorectomy for an ovary tumor with STUMP in a broad ligament 6 years ago.Though FDG-PET showed obvious metabolically active foci, abnormal metabolically active foci other than the lesion were not detected.A malignant liver tumor was strongly suspected and laparoscopic partial liver resection was performed with vessel-sealing devices using the crush clamping method and Pringle maneuver.Immunohistochemical findings revealed metastatic liver leiomyosarcoma associated with STUMP in a broad ligament.This case is an extremely rare case of malignant transformation from primary STUMP to metastatic hepatic leiomyosarcoma.It provides important evidence regarding the treatment for metastatic hepatic leiomyosarcoma associated with STUMP.
基金Chinese Academy of Medical Sciences Initiative for Innovative Medicine,No.CAMS-2017-I2M-1-002National Sciencetechnology Support Plan Projects,No.2015BAI13B04
文摘BACKGROUND Paraneoplastic neurological syndrome manifesting as secondary Parkinson disease caused by breast cancer is extremely rare.CASE SUMMARY We report a 39-year-old primipara of 31 gestational weeks,who presented with worsening tremors,facial stiffness and speech disfluencies,and decreased limb strength.Thorough physical examinations and auxiliary tests suggested secondary Parkinson’s disease,but the pathogenesis was unknown.During the cesarean section at the 31 weeks plus 6 d,an exploration and liver biopsy revealed a metastatic,poorly differentiated adenocarcinoma.The positron emission tomography and immunohistochemical analysis confirmed a breast ductal carcinoma of stage IV.To our knowledge,only two reports have documented the association between the breast cancer and the Parkinson disease,and neither occurred in pregnant women.CONCLUSION Our case alerts the secondary Parkinson disease as the possible presentation of breast cancer,the most common malignancy during pregnancy.
