Rectal bleeding is frequently seen in patients undergoing transrectal ultrasound(TRUS)-guided multiple biopsy of the prostate,but is usually mild and stops spontaneously.We report what is believed to be the first case...Rectal bleeding is frequently seen in patients undergoing transrectal ultrasound(TRUS)-guided multiple biopsy of the prostate,but is usually mild and stops spontaneously.We report what is believed to be the first case of life-threatening rectal bleeding following this procedure,which was successfully treated by endoscopic intervention through placement of three clips on the sites of bleeding.This case emphasizes endoscopic intervention associated with endoclipping as a safe and effective method to achieve hemostasis in massive rectal bleeding after prostate biopsy.Additionally,current data on the complications of the TRUS-guided multiple biopsy of the prostate and the options for treating fulminant rectal bleeding, a consequence of this procedure,are described.展开更多
Preoperative staging of the axilla in women with invasive breast cancer using ultrasound-guided needle biopsy(UNB) identifies approximately 50% of patients with axillary nodal metastases prior to surgical intervention...Preoperative staging of the axilla in women with invasive breast cancer using ultrasound-guided needle biopsy(UNB) identifies approximately 50% of patients with axillary nodal metastases prior to surgical intervention. Although moderately sensitive, it is a highly specific staging strategy that is rarely falsely-positive, hence a positive UNB allows patients to be triaged to axillary lymph-node dissection(ALND) avoiding potentially unnecessary sentinel node biopsy(SNB). In this review, we extend our previous work through an updated literature search, focusing on studies that report data on UNB utility. Based on data for 10,934 breast cancer patients, sourced from 35 studies, a positive UNB allowed triage of 1,745 cases(simple proportion 16%) to axillary surgical treatment: the utility of UNB was a median 19.8% [interquartile range(IQR) 11.6%-26.7%] across these studies. We also modelled data from a subgroup of studies, and estimated that amongst patients with metastases to axillary nodes, the odds ratio(OR) for high nodal disease burden for a positive UNB versus a negative UNB was 4.38 [95% confidence interval(95% CI): 3.13, 6.13], P<0.001. From this model, the estimated proportion with high nodal disease burden was 58.9%(95% CI: 50.2%, 67.0%) for a positive UNB, whereas the estimated proportion with high nodal disease burden was 24.6%(95% CI: 17.7%, 33.2%) if UNB was negative. Overall, axillary UNB has good clinical utility and a positive UNB can effectively triage to ALND. However, the evolving landscape of axillary surgical treatment means that UNB will have relatively less utility where surgeons have modified their practice to omission of ALND for minimal nodal metastatic disease.展开更多
Objective： To investigate the value of the plasma transforming growth factor β1 （TGF-β1） level in diagnosis and prognosis of prostate cancer （PCa）. Methods： The ELISA kits for human TGF-β1 were used to measur...Objective： To investigate the value of the plasma transforming growth factor β1 （TGF-β1） level in diagnosis and prognosis of prostate cancer （PCa）. Methods： The ELISA kits for human TGF-β1 were used to measure the TGF-β1 level in plasmas. A cohort of 295 consecutive PCa patients in recent more than two years in the First Hospital of Peking University of China was enrolled to the study. Furthermore, 55 control subjects were healthy and without evidence of PCa, who were random people that came to the hospital and were identified by prostate biopsy. Results： An age-related frequency chart indicated that 99% confidence interval of the difference with PCa was at the age of 53-85 years. The PCa patients aged 53-85 were classified into three groups according to TNM staging. Group A had Stages TO, T1 and T2. Group B had Stage T3 and Group C had Stage T4. Compared with control group, Group A had the lower level of plasma TGF-β1 （P 〈 0.05）, Group B had the higher level of plasma TGF-β1 （P 〈 0.05） and Group C had the even higher level of plasma TGF-β1 （P 〈 0.01）. According to TNM staging, Group D had Stages TO, T1 and T2 with the normal level of total PSA （tPSA）. Group E with the normal level of tPSA had metastasis after resection. Compared with control group, Group D had the lower plasma level of TGF-β1 （P 〈0.05） and Group E had higher plasma level of TGF-β1 （P 〈 0.01）. Conclusion： The plasma TGF-β1 level decreases at early stage of PCa and increases at later stage of PCa, especially at tumor metastasis after the resection. The plasma TGF-β1 level may therefore be complementary to PSA for PCa prognosis.展开更多
文摘Rectal bleeding is frequently seen in patients undergoing transrectal ultrasound(TRUS)-guided multiple biopsy of the prostate,but is usually mild and stops spontaneously.We report what is believed to be the first case of life-threatening rectal bleeding following this procedure,which was successfully treated by endoscopic intervention through placement of three clips on the sites of bleeding.This case emphasizes endoscopic intervention associated with endoclipping as a safe and effective method to achieve hemostasis in massive rectal bleeding after prostate biopsy.Additionally,current data on the complications of the TRUS-guided multiple biopsy of the prostate and the options for treating fulminant rectal bleeding, a consequence of this procedure,are described.
基金partly funded by National Health and Medical Research Council (NHMRC) program (Grant No. 633003) to the Screening & Test Evaluation Program, Australia
文摘Preoperative staging of the axilla in women with invasive breast cancer using ultrasound-guided needle biopsy(UNB) identifies approximately 50% of patients with axillary nodal metastases prior to surgical intervention. Although moderately sensitive, it is a highly specific staging strategy that is rarely falsely-positive, hence a positive UNB allows patients to be triaged to axillary lymph-node dissection(ALND) avoiding potentially unnecessary sentinel node biopsy(SNB). In this review, we extend our previous work through an updated literature search, focusing on studies that report data on UNB utility. Based on data for 10,934 breast cancer patients, sourced from 35 studies, a positive UNB allowed triage of 1,745 cases(simple proportion 16%) to axillary surgical treatment: the utility of UNB was a median 19.8% [interquartile range(IQR) 11.6%-26.7%] across these studies. We also modelled data from a subgroup of studies, and estimated that amongst patients with metastases to axillary nodes, the odds ratio(OR) for high nodal disease burden for a positive UNB versus a negative UNB was 4.38 [95% confidence interval(95% CI): 3.13, 6.13], P<0.001. From this model, the estimated proportion with high nodal disease burden was 58.9%(95% CI: 50.2%, 67.0%) for a positive UNB, whereas the estimated proportion with high nodal disease burden was 24.6%(95% CI: 17.7%, 33.2%) if UNB was negative. Overall, axillary UNB has good clinical utility and a positive UNB can effectively triage to ALND. However, the evolving landscape of axillary surgical treatment means that UNB will have relatively less utility where surgeons have modified their practice to omission of ALND for minimal nodal metastatic disease.
文摘Objective： To investigate the value of the plasma transforming growth factor β1 （TGF-β1） level in diagnosis and prognosis of prostate cancer （PCa）. Methods： The ELISA kits for human TGF-β1 were used to measure the TGF-β1 level in plasmas. A cohort of 295 consecutive PCa patients in recent more than two years in the First Hospital of Peking University of China was enrolled to the study. Furthermore, 55 control subjects were healthy and without evidence of PCa, who were random people that came to the hospital and were identified by prostate biopsy. Results： An age-related frequency chart indicated that 99% confidence interval of the difference with PCa was at the age of 53-85 years. The PCa patients aged 53-85 were classified into three groups according to TNM staging. Group A had Stages TO, T1 and T2. Group B had Stage T3 and Group C had Stage T4. Compared with control group, Group A had the lower level of plasma TGF-β1 （P 〈 0.05）, Group B had the higher level of plasma TGF-β1 （P 〈 0.05） and Group C had the even higher level of plasma TGF-β1 （P 〈 0.01）. According to TNM staging, Group D had Stages TO, T1 and T2 with the normal level of total PSA （tPSA）. Group E with the normal level of tPSA had metastasis after resection. Compared with control group, Group D had the lower plasma level of TGF-β1 （P 〈0.05） and Group E had higher plasma level of TGF-β1 （P 〈 0.01）. Conclusion： The plasma TGF-β1 level decreases at early stage of PCa and increases at later stage of PCa, especially at tumor metastasis after the resection. The plasma TGF-β1 level may therefore be complementary to PSA for PCa prognosis.
