Long-term outcome and prognostic factors of patients with hilar cholangiocarcinoma

AIM： To evaluate the long-term outcome and prognostic factors of patients with hilar cholangiocarinoma. METHODS： Ninety-six consecutive patients underwent treatment for malignant hilar bile duct tumors during 1995-2005. Of the 96 patients, 20 were initially treated with surgery （n = 2 R0 / n = 18 R1）. In non-operated patients, data analysis was performed retrospectively. RESULTS： Among the 96 patients, 76 were treated with endoscopic transpapillary （ERC, n = 45） and/or percutaneous transhepatic biliary drainage （PTBD, n = 31）. The mean survival time of these 76 patients undergoing palliative endoscopic and/or percutaneous drainage was 359 ± 296 d. The mean survival time of patients with initial bilirubin levels 〉 10 mg/dL was significantly lower （P 〈 0.001） than patients with bilirubin levels 〈 10 mg/dL. The mean survival time of patients with Bismuth stage Ⅱ （n = 8）, Ⅲ （n = 28） and Ⅳ （n = 40） was 496 =1= 300 d, 441 ± 385 d and 274 ± 218 d, respectively. Thus, patients with advanced Bismuth stage showed a reduced mean survival time, but the difference was not significant. The type of biliary drainage had no significant benefidal effect on the mean survival time （ERC vs PTBD, P = 0.806）. CONCLUSION： Initial bilirubin level is a significant prognostic factor for survival of patients. In contrast, age, tumor stage according to the Bismuth-Corlette classification, and types of intervention are not significant prognostic parameters for survival. Palliative treatment with endoscopic or percutaneous biliary drainage is still suboptimal, new diagnostic and therapeutic tools need to be evaluated.

Operative timing and indications for patients with severe acute pancreatitis: report of 172 cases

Objective: To investigate the operative timing and indi-cations for severe acute pancreatitis(SAP).Methods: Data collected from 172 patients with SAPtreated in our hospital since 1980 were analyzed retro-spectively.Results: In the 94 patients who had undergone early op-eration before June 1992, 57 (62.8%) healed, 35 (37.2%)died, and 16 (17.0%) had no postoperative compli-cations. In the 78 patients who had been treated after July1992 according to the principle of individualization, 66(84.6%) healed, 12 (15.4%) died, and 37 (47.4%)had no postoperative complications. In the 78 patients32 received non-operative treatment but 30 (93.8%)cured, 12 early operation but 7(58.3%)cured, 18 lateoperation but 13 (72.2%) cured, and 16 selected timeoperation but all cured.Conclusions: It is concluded that individualized thera-py is effective and reasonable for treating SAP. Theindications for early, late and selected time operationshould be emphasized.

OBSERVATION ON THE THERAPEUTIC EFFECT OF ACUPUNCTURE IN THE TREATMENT OF POSTOPERATIVE HEMIPLEGIA

Objective: To observe the therapeutic effect of acupuncture in the treatment of hemiplegia resulted from craniocerebral operation. Methods: A total of 40 cases of postoperative hemiplegia patients were randomly and evenly divided into treatment group and control group that were respectively treated with acupuncture plus conventional therapy (anti-inflammation, intracranial pressure-lowering and alimentotherapy) and conventional therapy. Results: After treatment, the therapeutic effect for raising myodynamia of the paralyzed limbs in treatment group was significantly superior to that of control group (upper limb P<0.01, and lower limb P<0.05). Conclusion: Acupuncture can effectively facilitate the recovery of the paralyzed limb in patients undergoing cerebral surgical operation.

Treatment Recommendations among Radiation Oncologists in the Treatment of Cutaneous Squamous Cell Carcinoma with Perineural Invasion

Purpose: Post-operative radiotherapy (PORT) for resected cutaneous squamous cell carcinoma (CSCC) with perineural invasion (PNI) is controversial. Therefore, we conducted a survey to review treatment recommendations among Radiation Oncologists (ROs) in the management of CSCC with PNI. Materials & Methods: In March 2011, we contacted all ROs and trainees in the US through email addresses listed in the 2009 ASTRO directory. Our web-based survey presented clinical vignettes involving Mohs micrographically resected CSCC with microscopic PNI (mPNI) or clinical PNI (cPNI). For each vignette, ROs were asked to indicate if PORT was appropriate and to further specify the dose and volume to treat. Results: Three hundred fifty two responses were completed and analyzed. The majority of ROs (72%) had over 10 years of post residency experience. 64% of the sampled ROs had a special interest in treating head and neck cancers, and 64% treated 4 or more cases per year. Approximately 95% recommended PORT for cPNI whereas 59% recommended PORT for mPNI. Post residency experience (10+ yrs vs. <10 yrs) was associated with a greater propensity to recommend PORT for mPNI (48% vs. 30%, p = 0.005) and for mPNI of deep subcutaneous non-named nerve involvement (80% vs. 60%, p = 0.001). ROs treating 8 or more cases per year (vs. <7) were more likely to recommend PORT for mPNI in immunocompromised patients (74% vs. 57%, p = 0.01). Conclusions: Our study demonstrates significant variability among ROs in the management of CSCC with mPNI. For cases of cPNI, an overwhelming majority recommended PORT. In cases of mPNI, there was no consensus for recommending PORT, although experienced practitioners had a lower threshold for offering treatment. These results indicate the need for prospective clinical studies to clarify the role of PORT in CSCC patients with mPNI.

Surgical Treatment of Endometrial Cancer

Each year endometrial cancer is diagnosed in approximately 11.700 women in Germany. Operation is the therapy of choice in the primary treatment of patients with endometrial cancer. The traditional abdominal approach, vaginal, laparoscopic and robotic-assisted methods are available for the surgical treatment of EC today. This article compares and evaluates these different treatment options. With rising incidence of obesity, number of patients with endometrial cancer will also increase. However, operations in obese patients are more challenging. Laparotomy as standard therapy in endometrial cancer patients stage I and II should be replaced by laparoscopic approaches. Laparoscopy is oncologically adequate to open procedures and offers many advantages to patients. Robotic surgery in the treatment of endometrial cancer is still under evaluation. Most controversial points of treatment today are indication and extention of lymphadenectomy in different stages. In advanced tumor stages, optimal debulking should be performed in order to improve effectiveness of adjuvant chemotherapeutic and/or radiation therapy.

The height of the osteotomy and the correction of the kyphotic angle in thoracolumbar kyphosis

Background This study investigated the relationship between the height of osteotomy and the correction of the kyphotic angle during posterior closing wedge osteotmy with instrumentation and the spinal osteotomy with cage inserting into the intervertebral gap and closing posteriorly by a single posterior approach in thoracolumbar kyphosis, and using this relationship as the basis of the preoperative design. Methods From April 1996 to June 2007, 30 thoracolumbar kyphosis patients with complete medical records and clear X-ray photograms have undergone operation. Of these 30 cases, 16 cases underwent posterior closing wedge osteotmy with instrumentation while the height of the osteotomy and the correction of the angle have been measured; 14 cases underwent spinal osteotomy with cage inserting into the intervertebral gap and closing posteriorly by a single posterior approach while the height of the osteotomy, the height and the place of the cage and the correction of the angle were also measured. A simple geometrical model was simulated to calculate the relationship between the height of the oeteotomy and the correction of the angle and these results are finally compared with the data coming from the actual measuring by the Wilcoxon statistic method. Results The distribution of data from the 16 cases by posterior closing wedge osteotomy with instrumentation was as such： 9 male and 7 female, the mean age was 49.2 years （range 38--70）, the kyphosis improved from an average of 30° （range 15°--45°） preoperatively to 4° （range -26°--30°） postoperatively, the kyphosis was corrected on average 2.5-0 per 1 mm in the height of the osteotomy. The results from the simple geometrical model were that the mean of the correction of the angle per 1 mm was 2.2°. As a result, there was no significant difference （P 〉0.05） when comparing the measurement collected with the result simulated from the geometric model. The distribution of data from the 14 cases by spinal osteotomy with cage inserting into the intervertebral gap and closing posteriorly by a single posterior approach was as such： 5 male and 9 female, the mean age was 35.3 years old （range 15--57）, the kyphosis improved from an average of 64°- （range 34°--95°） preoperatively to 8.70 （range -10°--22°） postoperatively. The kyphosis was corrected on average of 6.2°- per 1 mm in the height of the psteotomy. The results from the simple geometrical model is that the mean of the correction of the angle per 1 mm was 6.6°. There was also no significant difference （P 〉0.05） when comparing the measurement collected with the result simulated from the geometric model. Conclusions The therapeutic effect is significant for both posterior closing wedge osteotomy with instrumentation and spinal osteotomy with cage inserting into the intervertebral gap and closing posteriorly by a single posterior approach. The posterior closing wedge osteotomy with instrumentation is an easier approach with the mean angle of the correction per 1 mm of 2.5°- and the maximum angle of correction of 45°. The spinal osteotomy with cage inserting into the intervertebral gap and closing posteriorly by a single posterior approach is more efficient with the mean angle of correction per I mm of 6.2°. It should be reserved for the severe cases of thoracolumbar kyphosis. We can also use the formula to held us constructing Preoperative desiqn.

Giant leiomyosarcoma of the pelvis： diagnosis and surgical management

Leiomyosarcoma most frequently arises in the vretropefitoneum, the intra-abdominal space, and the subcutaneous tissue of the extremities. Primary leiomyosarcoma of bone is a rare malignant neoplasm, most commonly involving bones around the knee.1 Although whether leiomyosarcoma can be considered a true primary bone tumor remains questionable, refinements in immunohistochemical techniques are causing this recognition to slowly gain favor. We report a case of a huge primary leiomyosarcoma of bone in the right pelvis.