羊膜移植联合干扰素滴眼液治疗原发性翼状胬肉效果评估

目的评估羊膜移植联合应用重组人干扰素α2b滴眼液(简称干扰素滴眼液)治疗原发性翼状胬肉的临床效果。方法采用随机对照临床试验方法,纳入于2018年6—12月在北京同仁眼科中心就诊并按时完成随访的原发性翼状胬肉患者49例55眼,采用随机数字表法将受试者分为试验组23例25眼和对照组26例30眼。试验组采用翼状胬肉切除联合羊膜移植术+干扰素滴眼液进行治疗,对照组采用翼状胬肉切除术联合自体结膜移植术。试验组于术后第3天采用干扰素滴眼液点眼,连续用药3个月,分别于术后3 d、7 d、1个月、3个月以及半年对患者进行随访,观察患者的最佳矫正视力(BCVA)、角膜上皮缺损修复情况以及翼状胬肉复发率。结果术后6个月,2个组BCVA下降、稳定和提高的眼数分布比较,差异无统计学意义(P=0.259)。术后2个组术眼均有1眼在14 d内角膜上皮完全修复,其余术眼角膜上皮均在7 d内完全修复,2个组间不同角膜上皮愈合时间眼数分布比较,差异无统计学意义(P=1.000)。术后6个月,2个组患眼均未出现翼状胬肉真性复发,2个组结膜增生1、2、3级眼数比较,差异无统计学意义(Z=0.461,P=0.497)。试验组与对照组中出现纤维血管组织增生者分别占12.0%(3/25)和6.7%(2/30),但纤维血管组织增生均仅处于结膜与植片交界处,未到达植片中央及角膜缘。结论与传统翼状胬肉切除联合自体结膜移植术比较,羊膜移植联合干扰素滴眼液点眼治疗原发性翼状胬肉复发率无升高,对健康结膜组织损伤小。

POAG患者Schlemm管功能与选择性激光小梁成形术疗效的关系

目的探讨原发性开角型青光眼(POAG)患者Schlemm管功能与选择性激光小梁成形术(SLT)疗效的关系。方法采用系列病例观察研究方法,纳入2017年3—12月于华中科技大学同济医学院附属同济医院就诊的POAG患者17例25眼,其中男12例18眼,女5例7眼。采用三面镜观察患者有氧运动前Schlemm管全周有无回血,以全周任意区域见回血者为阳性,全周未见回血者为阴性;采用非接触式眼压计和自动血压计分别测量患者运动试验前后眼压及心率,运动后眼压下降值≥4.6 mmHg(1 mmHg=0.133 kPa)者为阳性,<4.6 mmHg者为阴性;采用光相干断层扫描(OCT)观察运动试验前后患眼Schlemm管有无扩张及其扩张面积,以运动试验后Schlemm管开放的钟点位置较前增加,和/或至少1个钟点位置Schlemm管面积较前增大者为阳性。将上述3项指标均为阳性者作为Schlemm管功能阳性组(8眼),部分指标阳性者作为Schlemm管功能部分阳性组(11眼),上述指标均为阴性者作为Schlemm管功能阴性组(6眼)。各组患眼均接受SLT治疗,分别于术后1周、2周及1个月进行随访,测量眼压,随访期间患者其余治疗不变。比较手术前后不同时间点各组术眼眼压值、眼压下降值及下降率的差异。结果Schlemm管功能阴性组、部分阳性组和阳性组术眼术前眼压分别为(20.33±9.22)、(25.75±9.03)和(22.28±4.78)mmHg,术后1周眼压分别为(17.10±2.98)、(20.00±7.60)和(18.75±8.53)mmHg,术后2周眼压分别为(19.00±3.94)、(19.18±4.46)和(15.50±4.98)mmHg,术后1个月眼压分别为(19.33±4.32)、(18.00±3.63)和(14.38±3.24)mmHg,各组术眼眼压值总体比较差异无统计学意义(F_(分组)=1.028,P=0.374),手术前后不同时间点眼压总体比较差异有统计学意义(F_(时间)=6.751,P=0.002);其中与术前比较,术后1周Schlemm管功能阴性组,术后1周、2周和1个月Schlemm管功能部分阳性组及术后2周、1个月Schlemm管功能阳性组眼压值均明显降低,差异均有统计学意义(均P<0.05)。各组术眼手术后不同时间点眼压下降值总体比较差异均无统计学意义(F_(分组)=0.952,P=0.401;F_(时间)=0.828,P=0.402);各组术眼手术后不同时间点眼压下降率总体比较差异均无统计学意义(F_(分组)=1.840,P=0.182;F_(时间)=0.419,P=0.660)。结论Schlemm管功能较好的POAG眼接受SLT治疗后降眼压疗效更好,运动前Schlemm管回血和运动后眼压下降及管道扩张是Schlemm管功能良好的标志。

Treatment of Primary Liver Cancer with Postoperative After-Loading Radiotherapy and Gemcitabine

Objective： To evaluate the curative effectiveness of postoperative after-loading radiotherapy with the use of gemcitabine in 22 patients with primary liver cancer. Methods： From Oct. 1999 to Dec. 2001, 22 patients with primary liver cancer underwent postoperative after-loading radiotherapy 3-10 days after hepatectomy and chemotherapy using gemcitabine （1400 mg every week for 3 weeks, repeated after one week interval, total cycles were 6） and compared with 22 cases of sole hepatectomy. Three-six catheters were placed for irradiation after hepatectomy. The single-dose of after-loading radiotherapy was 10 Gy, 24 sessions per person. Results＇. The rate of AFP negative-reversion was 100% （17/17） in the treated group, higher than in control group （62.5%, 10/16, P〈0.05）. In the treated group, the 1-year relapse rate, metastasis rate and survival rate were 18.2% （4/22）, 0 and 100% （22/22） respectively, while in the control group they were 45.5% （10/22）, 13.6% （3/22） and 77.3% （17/22） respectively. There were significant differences between the two groups in relapse rate, metastasis rate and survival rate within a year （P〈0.05）. Conclusion： Postoperative after-loading radiotherapy with gemcitabine is an effective way for the treatment of primary liver cancer.

Clinical Experience of Primary Retroperitoneal Tumor: Report of 600 Cases

Objective： To summarize the experience of management for primary retroperitoneal tumor （PRPT） and to analyze the factors influencing the outcome after operation. Methods： The data of 600 cases of PRPT in General Hospital of PLA were reviewed retrospectively. Results： Of 600 cases of PRPT, 546 were surgically treated. Among theme 369 were malignant and 177 benign. 366 cases were followed up for 1 month to 15 years. The 1-years 3-year, and 5-year survival rate in the patients subject to complete resection was 90.5%, 73.2% and 53.6%, respectively, and that in incomplete resection patients was 70.6%, 32.0%, 5.7% respectively （P〈0.01）. The Cox multi-various regression analysis revealed showed completeness of tumor resection, sex and histologic type were associated closely with local recurrence. Conclusion： Sufficient preoperative preparation and complete tumor resection play important roles for reducing recurrence and improving survival.

Perioperative management of primary liver cancer

AIM:To minimize the complications and mortality and improve the survival in primary liver cancer (PLC) patients undergoing hepatic resection. METHODS: We conducted a retrospective analysis of 2143 PLC patients treated from January 1990 to January 2004. The patients were divided into two groups using January 1997 as a cut-off. Small tumor size (< 5 cm), preoperative redox tolerance index (RTI), vascular control method, and postoperative arterial ketone body ratio (AKBR) were used as indicators of surgical outcome. RESULTS: Small tumors had less complications and lower mortality and higher overall survival rate. Use of RTI for selecting patients and types of hepatectomy, reduced complications (21.1% vs 11.0%) and mortality (1.6% vs 0.3%). The half liver vascular occlusion protocol (n = 523) versus the Pringle method (n = 476) showed that the former significantly reduced the postoperative complications (25.8% vs 11.9%) and mortality (2.3% vs 0.6%) respectively, and cut mean hospital stay was 3.5 d. Postoperative AKBR was a reliable indicator of the energy status in survivors. CONCLUSION: RTI is of value in predicting hepatic functional reserve, half liver occlusion could protect the residual liver function, and AKBR measurement is a simple and accurate means of assessing the state of postoperative metabolism. Optimal perioperative management is an important factor for minimizing complications and mortality in patients undergoing hepatic resection.

Long-term survival for spontaneous rupture of hepatocellular carcinoma treated with hepatectomy

Objective- To determine the prognostic factors of ruptured hepatocellular carcinoma （HCC） and report the management of patients with spontaneous rupture of HCC in a single center during a 5-year period and to evaluate one-stage hepatectomy Methods- A series of 4,209 patients with HCC were collected at Eastern Hepatobiliary Surgery Hospital from April 2002 to November 2006, of whom 200 patients （4.8%） with ruptured HCC were studied retrospectively regarding their clinical characteristics and prognostic factors. The one-stage therapeutic approach to manage ruptured HCC consisted of initial management by conservative method, transarterial embolization （TAE） or surgical hepatectomy. Results of various treatments were evaluated and compared in the randomly selected 202 patients with no history of rupture during the same study period. Results： A total of 200 patients with spontaneous rupture of HCC were studied who underwent surgical treatment （n=105）, TAE 33 and conservative treatment （ConT 62）. A multivariate analysis using the Cox hazard regression model （including all the patients n=200） identified surgical hepatectomy as the only independent factor determining a relatively long survival period （P〈0.0001） On the other hand, in a further analysis of the patients in whom surgical hepatectomy was successfully performed （n=105）, which identified a maximum tumor size exceeding 6 cm as significant determinants of a poor 12-month （P=0.036）, and a multivariate analysis did not identify as any inverse independent factor determining relatively long-term survival, only a maximum tumor size exceeding 6 cm exhibited a tendency toward being a determinant factor （P=0.083）. Conelusionz Considering the high propensity to spontaneous rupture, as long as preoperatively clinical evaluation meet surgery requirements, elective one-stage hepatectomy for patients with ruptured HCC is the first treatment option. Prolonged survival could be achieved in selected patients with hepatic resection, although the survival results were inferior to those of the patients who did not have the complication of rupture

Primary squamous cell carcinoma of the liver:A successful surgically treated case

Primary squamous cell carcinoma (SCC) of the liveris rare. Totally nine such cases have been reportedin the literature. Primary SCC of the liver has beenreported to be associated with hepatic teratoma,hepatic cyst, or hepatolithiasis. Complete remission ofpoorly differentiated SCC of the liver could be achievedby systemic chemotherapy followed by surgery orremarkably respond to hepatic arterial injection of lowdose chemotherapeutic drugs. Here we report the fi rstcase of primary SCC of the liver presenting as a solidtumor and receiving successful hepatic resection with9-mo disease free survival.

Rational Operation for Primary Gastric Carcinoma with Liver Metastasis

OBJECTIVE To investigate the prognosis of advanced gastric carcinoma patients with liver metastasis, and provide a foundation for rational operations. METHODS The operations and prognosis of 102 primary gastric carcinoma patients with liver metastasis were studied retrospectively. RESULTS In gastric carcinoma patients with H1 metastasis who underwent a resection operation, the 6-month, 1- and 2-year post-operative survival rates were 61%, 42% and 7%. There was a statistically significant difference in survival between resected and non-resected patients （P=0.000） in gastric carcinoma cases with H2 metastasis, resection operations resulted in 54%, 16% and 8% respective survival rates, with no significant difference compared to patients not receiving a resection （P=0.132）. Gastric carcinoma patients with H3 metastasis who received a resection operation showed 25%, 13% and 0% respective survivals with no significantly better prognosis compared to the non-resected cases （P=0.135）. There was no statistically significant difference in survival between the cases with or without peritoneal metastasis （P=0.152）. CONCLUSION A resection operation provides a better prognosis for gastric carcinoma patients with H1 metastasis independent of peritoneal metastasis, but resection has no benefit for gastric carcinoma cases with H2 or H3 metastasis. Peritoneal metastases are not the significant influencing factor for the prognosis of gastric cancer with liver metastasis.

Primary Breast Lymphoma （PBL）： A Literature Review

Primary breast lymphoma is a rare disease. It is mainly found in female patients, the right breast in more frequently involved. The majority of PBL are diagnosed by biopsy or post- operative pathological findings. The combined therapy regimen, the main part of which is CHOP chemotherapy, is the main stream. Radical surgery is to be avoided.

Synchronous Multiple Primary Gastric Carcinomas： A Case Report

IntroductionCarcinomas of the stomach are the most common malignant tumors in China. Due to the recent developments in diagnostic techniques and instrumentation, the early detection of gastric carcinoma （GC） has increased. Yet synchronous multiple primary gastric carcinomas, de- fined as 2 or more primary gastric carcinomas occurring in 1 patient simultaneously, are not frequently seen. The etiology of synchronous tumors is still unclear, and their coexistence can be problematic for surgeons, oncologists and pathologists in regards to diagnosis, treat- ment, and follow-up. Research has focused mainly on such issues as the frequency of occurrence of primary multiple carcinomas, identi- fication of high-risk groups, early diagnosis, treatment methods, and prognostic factors. The purpose of this article is to present a rare case of synchronous tumors and to review the literature addressing the surgical treatment for patients with multiple cancers.

Radiotherapy combined with transcatheter arterial chemoembolization for unresectable hepatocellular carcinoma–a prospective clinical trial

Objective: This study evaluated the therapeutic effect of external beam radiotherapy (RT) combined with trans- catheter arterial chemoembolization (TACE) on the patients with unresectable hepatocellular carcinoma (HCC). Methods: From June 1994 to April 2002, 114 patients with unresectable HCC were nonrandomized prospectively stepped into our study. All patients received TACE as initial therapy, except 54 also received combination therapy with external beam therapy. Sur- vival failure patterns were analyzed and compared between the two groups. Results: Overall survival rates in the patients in the radiotherapy group were 65%, 47%, 38% at 1, 2, 3 years, respectively, improved over the non-radiotherapy group rates of 54%, 36.5%, 18% at 1, 2, 3 years, respectively. There was significant difference between two groups (P < 0.05). The survival rates correlated with tumor size, number of tumors, and portal vein embolus. Conclusion: TACE combined with RT is a more effective treatment than TACE alone in patients with unresectable HCC.

Primary choriocarcinoma of uterine cervix treated by uterine artery drug pouring and embolism: one case report

Primary choriocarcinoma of the uterine cervix (PCC) is an extremely rare disease. The conventional treatment of PCC is a combination of hysterectomy and chemotherapy. We present one rare case proved by cervical biopsy. The patient was an 36-year-old Chinese woman with irregular vaginal bleeding for 60 days. A cervical tumoral mass was seen in the pelvic examination and biopsy revealed active hyperplasia of trophoblastic cell. Because of massive vaginal haemorrhage, the patient accepted uterine artery drug pouring and embolism emergently. This management had gained a satisfactory effect. Thus, Uterine artery drug pouring and embolism is one new and effective weapon for PCC, which can preserve the patient’s productive ability.

Biophysical Substantiation of a Surgical Method of Treatment of a Primary Arterial Hypertension

It is shown that flow of a blood in a passive elastic tube essentially unstable process accompanying with a flutter of a stream. Biophysical principles of neuroreflex regulation of an arterial bloodstream in cardiovascular system are considered. It is shown that this regulation has dual-purpose character： reduction of the hydraulic resistance and maintenance stable no flutter stream of blood. The reasons of a primary arterial hypertension occurrence, and also some accompanying it physical and physiological phenomena are considered. The surgical method of treatment of the primary arterial hypertension, connected with denervation of renal arteries is substantiated.

Surgical management of primary hyperparathyroidism guided by double-phase Tc-99m-MIBI scintigraphy

Objective:The aim of this work was to study the clinicopathological features of cases with primary hyperparathyroidism (PHPT) referred to National Cancer Institute (NCI), Cairo University in the last six years and to study the role of nuclear medicine techniques in the initial diagnosis and preoperative localization directing surgical management of these cases. Methods: This study included 27 patients with PHPT properly diagnosed and treated in the NCI, Cairo University from January 2005 to December 2010. Preoperative neck U/S and Tc-99m-MIBI scintigraphy were done in all cases. If preoperative localization detected a single lesion, unilateral exploration was done. Bilateral exploration was done if multiple foci of active parathyroid glands or no lesions were detected. Results: This study included 27 patients (8 males and 19 females). The median age was 43 years (range from 19 to 68 years). All cases presented with bone disease in the form of bony pain in 23 patients, bony swellings in 15 patients and pathological fractures in 6 cases. Twenty one patients (77.8%) had single adenoma, 5 cases (18.5%) had parathyroid hyperplasia, and only one case had double adenomas. The sensitivity of neck U/S in detecting single adenoma was 61.9% (13/21), with 81% positive predictive value (PPV) while the sensitivity of Tc-99m-MIBI scintigraphy was 90.5% (19/21) with 100% PPV. Based on preoperative localization tests, unilateral exploration was done in 19 patients with solitary adenomas. All cases in this group were cured with no reported case of persistent or recurrent hypercalcemia. Conclusion: Presentation of PHPT may mimic malignant bone tumors but fortunately these patients were correctly diagnosed with bone scan which confirm the presence of metabolic bone disease rather than bone metastases. This was followed by estimation of serum calcium and parathormone levels for confirmation. Unilateral exploration based on the combination of ultrasound and preoperative localization by Tc-99m-MIBI scintigraphy was effective and could replace the standard bilateral neck exploration in cases with solitary adenoma. Bilateral neck exploration was required for suspected bilateral disease, hyperplasia or non visualized parathyroids.

Surgical treatment of primary tracheobronchial malignant tumors

Objective： The aim of our study was to explore the clinical experience of surgical treatment for primary tracheobronchial malignant tumors. Methods： The clinicopathological data of 18 patients with primary tracheobronchial malignant tumors surgically treated from February 1994 to August 2007 were reviewed retrospectively. The surgical management included sleeve tracheal resection in 8 cases, lower trachea and carina resection with carina reconstruction in 4 cases, local enucleation of the tumor in 4 cases, left or right carino-pneumon-ection in 2 cases, and resection of the tracheal or bronchial tumor and reconstruction of the airway under cardiopulmonary bypass （CPB）in 6 cases. Results： Among the 18 cases, there were 7 adenoid cystic carcinomas, 9 squamous cell carcinomas, 1 lymphoepithelial-like carcinoma and 1 follicular non-Hodgkin tymphoma. All the cases recovered well except one who died of endotracheal bleeding and asphyxia at the 10th postoperative day. Conclusion： Surgical resection is the most effective treatment for primary tracheobronchial malignant tumors. The selection of operation modes should be individualized according to patients＇ condition. Both complete resection and safety should be taken into consideration simultaneously.

Use of perioperative chemotherapy in colorectal cancer metastatic to the liver

A curative-intent approach may improve survival in carefully selected patients with oligometastatic colorectal cancer.Aggressive treatments are most frequently administered to patients with isolated liver metastasis,though they may be judiciously considered for other sites of metastasis.To be considered for curative intent with surgery,patients must have disease that can be definitively treated while leaving a sufficient functional liver remnant.Neoadjuvant chemotherapy may be used for upfront resectable disease as a test of tumor biology and/or for upfront unresectable disease to increase the likelihood of resectability(so-called‘conversion’chemotherapy).While conversion chemotherapy in this setting aims to improve survival,the choice of a regimen remains a complex and highly individualized decision.In this review,we discuss the role of RAS status,primary site,sidedness,and other clinical features that affect chemotherapy treatment selection as well as key factors of patients that guide individualized patient-treatment recommendations for colorectal-cancer patients being considered for definitive treatment with metastasectomy.