Objective： The aim of our study was to investigate the feasibility and safety of thoracoscopic internal mammary lymphadenectomy as a method to refine and thereby improve nodal staging in breast cancer. Methods： Duri...Objective： The aim of our study was to investigate the feasibility and safety of thoracoscopic internal mammary lymphadenectomy as a method to refine and thereby improve nodal staging in breast cancer. Methods： During the period from June 2004 to May 2007, 50 patients with operable breast cancer underwent modified radical mastectomy （MRM） or breast conserving surgery （BCS）, followed by thoracoscopic internal mammary lymphadenectomy, using 3 ports through the skin incision of the MRM or the BCS. Metal clips were used to mark precise site of lymphadenectomy. Results： of total number of 50 patients, the mean age of patients was 44 years （range, 27-60 years）. 40 （80%） had medio-central tumor, 10 （20%） had lateral tumor. 35 （70%） had clinically involved axillary nodes. 16 out of 50 patients received neo-adjuvant CTH. 44 patients underwent MRM and 6 patients underwent BCS. No intra-operative complications occurred. Atelectasis was the only postoperative complication that was encountered, which occurred in 12 cases, and was treated conservatively. The average chest drainage period was 1.2 day （range, 1-2 days）. The total number of IMN metastasis was 18 patients （36%）. The risk of IMN metastasis was higher; in younger patients （P = 0.03）, in medio-central tumors （P = 0.03）, in bigger tumors （P = 0.05）, with heavier metastasis of axillary LNs （P = 0.001）. But a correlation with the histological pattern of the lry tumor didn＇t exist （P = 1）. Knowing the IMN status helped in proper staging of patients, 7 patients showed evident stage migration after adding the IMN analysis to that of primary tumor and axillary LN. During the follow up period （the median, 22 months; range, 7 to 42 months）, no patient had pleural dissemination or port-site metastasis. Conclusion： Thoracoscopic IMN lymphadenectomy is a safe procedure, which can be done serious additional complications or cosmetic compromise. And allow proper nodal staging, which allow proper treatment planning.展开更多
Pancreatic tuberculosis is an extremely rare form of extrapulmonary disease. The diagnosis preoperatively is difficult because clinical, laboratory and radiologic findings are nonspecific. Published data indicate that...Pancreatic tuberculosis is an extremely rare form of extrapulmonary disease. The diagnosis preoperatively is difficult because clinical, laboratory and radiologic findings are nonspecific. Published data indicate that these lesions mimic cystic neoplasms of the pancreas and the confirmation of clinical suspicion could only be obtained by an open surgical biopsy. Recently, fine needle aspiration cytology has been shown to be a safe, reliable and cost-effective alternative. We report a new case of a peripancreatic tuberculosis in a 52 year old woman and review the relevant literature, paying special attention to the usefulness of endoscopic ultrasound guided-fine needle aspiration in the diagnosis of abdominal tuberculosis.展开更多
文摘Objective： The aim of our study was to investigate the feasibility and safety of thoracoscopic internal mammary lymphadenectomy as a method to refine and thereby improve nodal staging in breast cancer. Methods： During the period from June 2004 to May 2007, 50 patients with operable breast cancer underwent modified radical mastectomy （MRM） or breast conserving surgery （BCS）, followed by thoracoscopic internal mammary lymphadenectomy, using 3 ports through the skin incision of the MRM or the BCS. Metal clips were used to mark precise site of lymphadenectomy. Results： of total number of 50 patients, the mean age of patients was 44 years （range, 27-60 years）. 40 （80%） had medio-central tumor, 10 （20%） had lateral tumor. 35 （70%） had clinically involved axillary nodes. 16 out of 50 patients received neo-adjuvant CTH. 44 patients underwent MRM and 6 patients underwent BCS. No intra-operative complications occurred. Atelectasis was the only postoperative complication that was encountered, which occurred in 12 cases, and was treated conservatively. The average chest drainage period was 1.2 day （range, 1-2 days）. The total number of IMN metastasis was 18 patients （36%）. The risk of IMN metastasis was higher; in younger patients （P = 0.03）, in medio-central tumors （P = 0.03）, in bigger tumors （P = 0.05）, with heavier metastasis of axillary LNs （P = 0.001）. But a correlation with the histological pattern of the lry tumor didn＇t exist （P = 1）. Knowing the IMN status helped in proper staging of patients, 7 patients showed evident stage migration after adding the IMN analysis to that of primary tumor and axillary LN. During the follow up period （the median, 22 months; range, 7 to 42 months）, no patient had pleural dissemination or port-site metastasis. Conclusion： Thoracoscopic IMN lymphadenectomy is a safe procedure, which can be done serious additional complications or cosmetic compromise. And allow proper nodal staging, which allow proper treatment planning.
文摘Pancreatic tuberculosis is an extremely rare form of extrapulmonary disease. The diagnosis preoperatively is difficult because clinical, laboratory and radiologic findings are nonspecific. Published data indicate that these lesions mimic cystic neoplasms of the pancreas and the confirmation of clinical suspicion could only be obtained by an open surgical biopsy. Recently, fine needle aspiration cytology has been shown to be a safe, reliable and cost-effective alternative. We report a new case of a peripancreatic tuberculosis in a 52 year old woman and review the relevant literature, paying special attention to the usefulness of endoscopic ultrasound guided-fine needle aspiration in the diagnosis of abdominal tuberculosis.
