Computer tomography (CT) and magnetic resonance imaging (MRI),as conventional imaging modalities,are the preferred methodology for tumor,nodal and systemic metastasis (TNM) staging. However,all the noninvasive techniq...Computer tomography (CT) and magnetic resonance imaging (MRI),as conventional imaging modalities,are the preferred methodology for tumor,nodal and systemic metastasis (TNM) staging. However,all the noninvasive techniques in current use are not sufficiently able to identify primary tumors and even unable to define the extent of metastatic spread. In addition,relying exclusively on macromorphological characteristics to make a conclusion runs the risk of misdiagnosis due mainly to the intrinsic limitations of the imaging modalities themselves. Solely based on the macromorphological characteristics of cancer,one cannot give an appropriate assessment of the biological characteristics of tumors. Currently,positron emission tomography/computer tomography (PET/CT) are more and more widely available and their application with 18F-fluorodeoxyglucose (18F-FDG) in oncology has become one of the standard imaging modalities in diagnosing and staging of tumors,and monitoring the therapeutic efficacy in hepatic malignancies. Recently,investigators have measured glucose utilization in liver tumors using 18F-FDG,PET and PET/CT in order to establish diagnosis of tumors,assess their biologic characteristics and predict therapeutic effects on hepatic malignancies. PET/ CT with 18F-FDG as a radiotracer may further enhance the hepatic malignancy diagnostic algorithm by accurate diagnosis,staging,restaging and evaluating its biological characteristics,which can benefit the patients suffering from hepatic metastases,hepatocellular carcinoma and cholangiocarcinoma.展开更多
AIM: In this retrospective study of unresectable hepatocellular carcinoma (HCC), we have investigated the efficacy of CT-derived parameters, laboratory measurements, clinical assessment and associated transarterial em...AIM: In this retrospective study of unresectable hepatocellular carcinoma (HCC), we have investigated the efficacy of CT-derived parameters, laboratory measurements, clinical assessment and associated transarterial embolization (TAE) as predictors of post-radiotherapy survival time. METHODS: Sixty-six patients diagnosed with unresectable HCC that had undergone radiotherapy at two medical university hospitals in Taipei were enrolled in the study. Using multivariant analysis, pre-treatment parameters including tumor number and CT confirmation of PVT and ascites were compared. Multivariant analysis was also used for comparison of the mean pretreatment values for laboratory measurements, including alpha-fetoprotein, direct/total bilirubin and GOT/GPT levels, and clinical history of chronic hepatitis across the three survival-time categories. The x2 was used to test the significance of the relationship between survival time and TAE procedure. The P values for the above tests were deemed statistically significant where P<0.05. RESULTS: Portal vein thrombosis (P= 0.032) and ascites (P><0.05) were negative predictors of post-radiation survival time. Low-grade liver cirrhosis (A or B), lower tumor volume and low levels of AFT, GOT/GPT, and total bilirubin were predictors of longer post-radiation survival time (P<0.05). CONCLUSION: The CT and clinical and laboratory assessment provide a reference for, and enable estimation of, probable survival times in HCC patients after radiotherapy. Tumor volume, severity of liver cirrhosis, status with respect to portal vein thrombosis and ascites and AFT, GOT/GPT and total bilirubin values were significant predictors of survival in this study.展开更多
Small cell neuroendocrine carcinoma of the ampulla of Vater is extremely rare and different from the common ampullary adenocarcinoma. The ampullary adenoma is also a rare neoplasm and has the potential to develop an a...Small cell neuroendocrine carcinoma of the ampulla of Vater is extremely rare and different from the common ampullary adenocarcinoma. The ampullary adenoma is also a rare neoplasm and has the potential to develop an adenocarcinoma. Their coexistence has been rarely reported in the literature. We herein describe an unusual case of a small cell neuroendocrine carcinoma associated with a villous adenoma in the ampulla of Vater with emphasis on computed tomography (CT) and histopathological findings. We also discuss their clinical, histopathological and radiological features as well as possible histogenesis.展开更多
Objective: To evaluate the clinical value of multi-slice helical CT angiography (MSCTA) in diagnosis of cerebral vascular diseases. Methods: 52 patients with cerebral vascular diseases were examined with GE Light Spee...Objective: To evaluate the clinical value of multi-slice helical CT angiography (MSCTA) in diagnosis of cerebral vascular diseases. Methods: 52 patients with cerebral vascular diseases were examined with GE Light Speed 4-slice and 16-slice helical CT. Pitch: 0.5–3, slice thickness: 0.625–1.25 mm, adult injection dosage: 90–100 mL, children injection dos- age: 2 mL/kg, injection rate: 2.5–4.0 mL/s, delay time: 15–22 s. Intelligent track scan (Smart prep Rx) were adopted in parts of these cases. Three-dimensional cerebral vascular images were processed at ADW 3.1 and ADW 4.2 workstation. Results: MSCTA could clearly display spacious anatomic details of cerebral aneurysm, including its origin, size, neck width, and trend etc. MSCTA results of 19 cases were consistent with those of operations. The diameter of the smallest cerebral aneurysm shown in our research was about 3 mm. As a non-invasive examination, MSCTA could also be applied in post-operational evaluation of cerebral aneurysm by observing the location of silver clip and the distant vessels. Besides, MSCTA could be used to diagnose arteriovenous malformation and moyamoya disease. Of all the three-dimentional imaging methods, volume rendering (VR) is the best means to display the cerebral vascular diseases. Conclusion: As a non-invasive examination, MSCTA plays an important role in detection, pre-operational and post-operational evaluation of cerebral vascular diseases.展开更多
During a 17-year period, 38 patients with primary tracheobronchial tumors received surgical treatment in PUMC Hospital. Arnong the 38. 12 had low-malignancy tracheal tumors, 11 had benign tracheal tumors, 14 had low m...During a 17-year period, 38 patients with primary tracheobronchial tumors received surgical treatment in PUMC Hospital. Arnong the 38. 12 had low-malignancy tracheal tumors, 11 had benign tracheal tumors, 14 had low malignancy bronchial tumors and 1 had a benign bronchial tumor. Fifteen operations were perforrned on 12 patients with low-malignancy tracheal tumors, including local resection of the tumor and tracheal wall in 4 and curettage of the tumor plus electrical cauterization in 10. Postoperative radiotherapy was used as an adjuvant treatment in 8 patients with adenocystic carcinoma. Eight patients have survived for more than 5 years and 3 patients have survived for longer than 10 years postoperatively. All 11 patients with benign tumors received curettage of the tumor and were followed up for an average of 6. 5 years. Among them, 9 are still alive. Of the 14 patients with low malignancy bronchial tumors, 5 underwent curettage of the tumor plus electrical cauterization through incision of the main bronchus or intermedial bronchus, and 7 underwent lobectomy or pneumonectomy. The authors conclude that the correct diagnosis rate can be increased by enhancing recognition of this disease and applying tracheal tomography and bronchoscopy.展开更多
AIM： To summarize the operative experiences for giant leiomyoma of esophagus.METHODS： Eight cases of giant esophageal leiomyoma （GEL） whose tumors were bigger than 10 cm were treated surgically in our department f...AIM： To summarize the operative experiences for giant leiomyoma of esophagus.METHODS： Eight cases of giant esophageal leiomyoma （GEL） whose tumors were bigger than 10 cm were treated surgically in our department from June 1980 to March 2004.All of these cases received barium swallow roentgenography and esophagoscopy. Leiomyoma located in upper thirds of the esophagus in one case, middle thirds of the esophagus in five cases, lower thirds of the esophagus in two cases. Resection of tumors was performed successfully in all of these cases. Operative methods included transthoracic extramucosal enucleation and buttressing the muscular defect with pedicled great omental flap （one case）, esophagectomy and esophagogastrostomy above the arch of aorta （three cases）, total esophagectomy and esophageal replacement with colon （four cases）. Histological examination confirmed that all of these cases were leiomyoma.RESULTS： All of the eight patients recovered approvingly with no mortality and resumed normal diet after operation. Vomiting during meals occurred in one patient with esophagogastrostomy, and remained 1 mo. Reflux esophagitis occurred in one patient with esophagogastrostomy and was alleviated with medication. Thoracic colon syndrome （TCS） occurred in one patient with colon replacement at 15 mo postoperatively. No recurrence occurred in follow-up from 6 mo to 8 years.CONCLUSION： Surgical treatment for GEL is both safe and effective. The choices of operative methods mainly depend on the location and range of lesions. We prefer to treat GEL via esophagectomy combined with esophagogastrostomy or esophagus replacement with colon. The long-time quality of life is better in the latter.展开更多
Three cases of pulmonary leiomyosarcoma were presented.The characteristic clinical features were described with review of literature.In comparison with bronchogenic carcinoma, the leiomyosarcoma has some characteristi...Three cases of pulmonary leiomyosarcoma were presented.The characteristic clinical features were described with review of literature.In comparison with bronchogenic carcinoma, the leiomyosarcoma has some characteristics:1) On chest X-ray,it usually appears as a sharply demarcated, even density round mass,growing rapidly within the lung, it rarely accompanies with hilar or mediastinal lymph node metastasis.2) The preoperative cytological or pathological diagnosis is difficult either by sputum smear or by bronchoscopic biopsy or by fine needle percutaneous aspiration biopsy.31 Pathological differential diagnosis of leiomyosarcoma of lung from anaplastic lung cancer is difficult.In conclusion,the primary pulmonary leiomyosarcoma is a rare malignant tumor,detecting the present illness seriously,paying attention to the chest X-ray films characterize,early surgical resection is the only way to get diagnosis and effective treatment method.展开更多
AIM: The optimal treatment for bile duct stones (in terms of cost, complications and accuracy) is unclear. The aim of our study was to determine the predictive factors for preoperative endoscopic retrograde cholangiop...AIM: The optimal treatment for bile duct stones (in terms of cost, complications and accuracy) is unclear. The aim of our study was to determine the predictive factors for preoperative endoscopic retrograde cholangiopancreatography (ERCP).METHODS: Patients undergoing preoperative ERCP (≤90 d before laparoscopic cholecystectomy) were evaluated in this retrospective study from the 1^st of January 1996 to the 31^st of December 2002. The indications for ERCP were elevated serum bilirubin, elevated liver function tests (LFT), dilated bile duct (≥8 mm) and/or stone at US examination, coexisting acute pancreatitis and/or acute pancreatitis or jaundice in patient's history. Suspected prognostic factors and the combination of factors were compared to the result of ERCRRESULTS: Two hundred and six preoperative ERCPs were performed during the observed period. The rate of successful cannulation for ERC was (97.1%). Bile duct stones were detected in 81 patients (39.3%), and successfully removed in 79 (97.5%). The number of prognostic factors correlated with the presence of bile duct stones. The positive predictive value for one prognostic factor was 1.2%, for two 43%,for three 72.5%, for four or more 91.4%.CONCLUSION: Based on our data preoperative ERCP is highly recommended in patients with three or more positive factors (high risk patients). In contrast, ERCP is not indicated in patients with zero or one factor (low risk patients).Preoperative ERCP should be offered to patients with two positive factors (moderate risk patients), however the practice should also be based on the local conditions (e.g.skill of the endoscopist, other diagnostic tools).展开更多
文摘Computer tomography (CT) and magnetic resonance imaging (MRI),as conventional imaging modalities,are the preferred methodology for tumor,nodal and systemic metastasis (TNM) staging. However,all the noninvasive techniques in current use are not sufficiently able to identify primary tumors and even unable to define the extent of metastatic spread. In addition,relying exclusively on macromorphological characteristics to make a conclusion runs the risk of misdiagnosis due mainly to the intrinsic limitations of the imaging modalities themselves. Solely based on the macromorphological characteristics of cancer,one cannot give an appropriate assessment of the biological characteristics of tumors. Currently,positron emission tomography/computer tomography (PET/CT) are more and more widely available and their application with 18F-fluorodeoxyglucose (18F-FDG) in oncology has become one of the standard imaging modalities in diagnosing and staging of tumors,and monitoring the therapeutic efficacy in hepatic malignancies. Recently,investigators have measured glucose utilization in liver tumors using 18F-FDG,PET and PET/CT in order to establish diagnosis of tumors,assess their biologic characteristics and predict therapeutic effects on hepatic malignancies. PET/ CT with 18F-FDG as a radiotracer may further enhance the hepatic malignancy diagnostic algorithm by accurate diagnosis,staging,restaging and evaluating its biological characteristics,which can benefit the patients suffering from hepatic metastases,hepatocellular carcinoma and cholangiocarcinoma.
文摘AIM: In this retrospective study of unresectable hepatocellular carcinoma (HCC), we have investigated the efficacy of CT-derived parameters, laboratory measurements, clinical assessment and associated transarterial embolization (TAE) as predictors of post-radiotherapy survival time. METHODS: Sixty-six patients diagnosed with unresectable HCC that had undergone radiotherapy at two medical university hospitals in Taipei were enrolled in the study. Using multivariant analysis, pre-treatment parameters including tumor number and CT confirmation of PVT and ascites were compared. Multivariant analysis was also used for comparison of the mean pretreatment values for laboratory measurements, including alpha-fetoprotein, direct/total bilirubin and GOT/GPT levels, and clinical history of chronic hepatitis across the three survival-time categories. The x2 was used to test the significance of the relationship between survival time and TAE procedure. The P values for the above tests were deemed statistically significant where P<0.05. RESULTS: Portal vein thrombosis (P= 0.032) and ascites (P><0.05) were negative predictors of post-radiation survival time. Low-grade liver cirrhosis (A or B), lower tumor volume and low levels of AFT, GOT/GPT, and total bilirubin were predictors of longer post-radiation survival time (P<0.05). CONCLUSION: The CT and clinical and laboratory assessment provide a reference for, and enable estimation of, probable survival times in HCC patients after radiotherapy. Tumor volume, severity of liver cirrhosis, status with respect to portal vein thrombosis and ascites and AFT, GOT/GPT and total bilirubin values were significant predictors of survival in this study.
文摘Small cell neuroendocrine carcinoma of the ampulla of Vater is extremely rare and different from the common ampullary adenocarcinoma. The ampullary adenoma is also a rare neoplasm and has the potential to develop an adenocarcinoma. Their coexistence has been rarely reported in the literature. We herein describe an unusual case of a small cell neuroendocrine carcinoma associated with a villous adenoma in the ampulla of Vater with emphasis on computed tomography (CT) and histopathological findings. We also discuss their clinical, histopathological and radiological features as well as possible histogenesis.
基金Supported by a grant from the Scientific Research Program of the Educational Department of Liaoning prooince (No. 05L097)
文摘Objective: To evaluate the clinical value of multi-slice helical CT angiography (MSCTA) in diagnosis of cerebral vascular diseases. Methods: 52 patients with cerebral vascular diseases were examined with GE Light Speed 4-slice and 16-slice helical CT. Pitch: 0.5–3, slice thickness: 0.625–1.25 mm, adult injection dosage: 90–100 mL, children injection dos- age: 2 mL/kg, injection rate: 2.5–4.0 mL/s, delay time: 15–22 s. Intelligent track scan (Smart prep Rx) were adopted in parts of these cases. Three-dimensional cerebral vascular images were processed at ADW 3.1 and ADW 4.2 workstation. Results: MSCTA could clearly display spacious anatomic details of cerebral aneurysm, including its origin, size, neck width, and trend etc. MSCTA results of 19 cases were consistent with those of operations. The diameter of the smallest cerebral aneurysm shown in our research was about 3 mm. As a non-invasive examination, MSCTA could also be applied in post-operational evaluation of cerebral aneurysm by observing the location of silver clip and the distant vessels. Besides, MSCTA could be used to diagnose arteriovenous malformation and moyamoya disease. Of all the three-dimentional imaging methods, volume rendering (VR) is the best means to display the cerebral vascular diseases. Conclusion: As a non-invasive examination, MSCTA plays an important role in detection, pre-operational and post-operational evaluation of cerebral vascular diseases.
文摘During a 17-year period, 38 patients with primary tracheobronchial tumors received surgical treatment in PUMC Hospital. Arnong the 38. 12 had low-malignancy tracheal tumors, 11 had benign tracheal tumors, 14 had low malignancy bronchial tumors and 1 had a benign bronchial tumor. Fifteen operations were perforrned on 12 patients with low-malignancy tracheal tumors, including local resection of the tumor and tracheal wall in 4 and curettage of the tumor plus electrical cauterization in 10. Postoperative radiotherapy was used as an adjuvant treatment in 8 patients with adenocystic carcinoma. Eight patients have survived for more than 5 years and 3 patients have survived for longer than 10 years postoperatively. All 11 patients with benign tumors received curettage of the tumor and were followed up for an average of 6. 5 years. Among them, 9 are still alive. Of the 14 patients with low malignancy bronchial tumors, 5 underwent curettage of the tumor plus electrical cauterization through incision of the main bronchus or intermedial bronchus, and 7 underwent lobectomy or pneumonectomy. The authors conclude that the correct diagnosis rate can be increased by enhancing recognition of this disease and applying tracheal tomography and bronchoscopy.
基金Supported by the Science and Technology Foundation of Hubei Province, No. 992P1203
文摘AIM： To summarize the operative experiences for giant leiomyoma of esophagus.METHODS： Eight cases of giant esophageal leiomyoma （GEL） whose tumors were bigger than 10 cm were treated surgically in our department from June 1980 to March 2004.All of these cases received barium swallow roentgenography and esophagoscopy. Leiomyoma located in upper thirds of the esophagus in one case, middle thirds of the esophagus in five cases, lower thirds of the esophagus in two cases. Resection of tumors was performed successfully in all of these cases. Operative methods included transthoracic extramucosal enucleation and buttressing the muscular defect with pedicled great omental flap （one case）, esophagectomy and esophagogastrostomy above the arch of aorta （three cases）, total esophagectomy and esophageal replacement with colon （four cases）. Histological examination confirmed that all of these cases were leiomyoma.RESULTS： All of the eight patients recovered approvingly with no mortality and resumed normal diet after operation. Vomiting during meals occurred in one patient with esophagogastrostomy, and remained 1 mo. Reflux esophagitis occurred in one patient with esophagogastrostomy and was alleviated with medication. Thoracic colon syndrome （TCS） occurred in one patient with colon replacement at 15 mo postoperatively. No recurrence occurred in follow-up from 6 mo to 8 years.CONCLUSION： Surgical treatment for GEL is both safe and effective. The choices of operative methods mainly depend on the location and range of lesions. We prefer to treat GEL via esophagectomy combined with esophagogastrostomy or esophagus replacement with colon. The long-time quality of life is better in the latter.
文摘Three cases of pulmonary leiomyosarcoma were presented.The characteristic clinical features were described with review of literature.In comparison with bronchogenic carcinoma, the leiomyosarcoma has some characteristics:1) On chest X-ray,it usually appears as a sharply demarcated, even density round mass,growing rapidly within the lung, it rarely accompanies with hilar or mediastinal lymph node metastasis.2) The preoperative cytological or pathological diagnosis is difficult either by sputum smear or by bronchoscopic biopsy or by fine needle percutaneous aspiration biopsy.31 Pathological differential diagnosis of leiomyosarcoma of lung from anaplastic lung cancer is difficult.In conclusion,the primary pulmonary leiomyosarcoma is a rare malignant tumor,detecting the present illness seriously,paying attention to the chest X-ray films characterize,early surgical resection is the only way to get diagnosis and effective treatment method.
文摘AIM: The optimal treatment for bile duct stones (in terms of cost, complications and accuracy) is unclear. The aim of our study was to determine the predictive factors for preoperative endoscopic retrograde cholangiopancreatography (ERCP).METHODS: Patients undergoing preoperative ERCP (≤90 d before laparoscopic cholecystectomy) were evaluated in this retrospective study from the 1^st of January 1996 to the 31^st of December 2002. The indications for ERCP were elevated serum bilirubin, elevated liver function tests (LFT), dilated bile duct (≥8 mm) and/or stone at US examination, coexisting acute pancreatitis and/or acute pancreatitis or jaundice in patient's history. Suspected prognostic factors and the combination of factors were compared to the result of ERCRRESULTS: Two hundred and six preoperative ERCPs were performed during the observed period. The rate of successful cannulation for ERC was (97.1%). Bile duct stones were detected in 81 patients (39.3%), and successfully removed in 79 (97.5%). The number of prognostic factors correlated with the presence of bile duct stones. The positive predictive value for one prognostic factor was 1.2%, for two 43%,for three 72.5%, for four or more 91.4%.CONCLUSION: Based on our data preoperative ERCP is highly recommended in patients with three or more positive factors (high risk patients). In contrast, ERCP is not indicated in patients with zero or one factor (low risk patients).Preoperative ERCP should be offered to patients with two positive factors (moderate risk patients), however the practice should also be based on the local conditions (e.g.skill of the endoscopist, other diagnostic tools).
