Axial length,vitreoretinal pathology,and anterior chamber depth can predict postoperative refractive outcomes in phacovitrectomy/silicone oil removal

AIM:To evaluate the postoperative refractive prediction error(PE)and determine the factors that af fect the refractive outcomes of combined pars plana vitrectomy(PPV)or silicone oil removal(SOR)with cataract surgery.METHODS:The study is a retrospective,case-series study.Totally 301 eyes of 301 patients undergoing combined PPV/SOR with cataract surgery were enrolled.Eligible individuals were separated into four groups according to their preoperative diagnoses:silicone oil-filled eyes after PPV(group 1),epiretinal membrane(group 2),macular hole(group 3),and primary retinal detachment(RD;group 4).The variables af fecting postoperative refractive outcomes were analyzed,including age,gender,preoperative best-corrected visual acuity(BCVA),axial length(AL),keratometry average,anterior chamber depth(ACD),intraocular tamponade,and vitreoretinal pathology.The outcome measurements include the mean refractive PE and the proportions of eyes with a PE within±0.50 diopter(D)and±1.00 D.RESULTS:For all patients,the mean PE was-0.04±1.17 D,and 50.17%of patients(eyes)had a PE within±0.50 D.There was a significant difference in refractive outcomes among the four groups(P=0.028),with RD(group 4)showing the least favorable refractive outcome.In multivariate regression analysis,only AL,vitreoretinal pathology,and ACD were strongly associated with PE(all P<0.01).Univariate analysis revealed that longer eyes(AL>26 mm)and a deeper ACD were correlated with hyperopic PE,and shorter eyes(AL<26 mm)and a shallower ACD were correlated with myopic PE.CONCLUSION:RD patients have the least favorable refractive outcome.AL,vitreoretinal pathology,and ACD are strongly associated with PE in the combined surgery.These three factors affect refractive outcomes and thus can be used to predict a better postoperative refractive outcome in clinical practice.

Anesthetic Treatment in Operations of Small Pelvic Organs Pathology

The article presents data on the surgical treatment of 405 patients with pelvic organ surgical and gynecological diseases. When using regional anesthesia during operations in the lower abdominal cavity of patients with pelvic pathology, a smoother operation course and early postoperative period were observed compared with general anesthesia use. In this work, 405 patients with surgical and gynecological diseases of pelvic organs, operated in the surgical and gynecological departments were analyzed. When using regional anesthesia, it was observed that intraoperative blood loss in patients and consumption of narcotic analgesics in the postoperative period decreases.

Clinicopathologic features, diagnosis and surgical treatment of intrahepatic cholangiocarcinoma in 104 patients

BACKGROUND: The outcome of surgical treatment of pa- tients with intrahepatic cholangiocarcinoma (ICC) is poor. This study was designed to analyze the relationship between clinicopathologic features and the survival time after opera- tion. METHODS: The operation was performed in 104 patients with mass-forming type ICC at our hospital between No- vember 1996 and May 2000. Seventy-nine patients (76.0%) were followed up successfully. Sixteen clinicopathological variables including age, sex, history of chronic liver di- sease , HBsAg, operation, adjuvant therapy, ascites, lymph node metastasis, invasion of adjacent organs, tumor size, necrosis of tumor, envelope, intrahepatic metastasis, Inter- national Union Against Cancer (UICC) TNM staging, his- tology, and cirrhosis were selected for univariate and multi- variate analyses to evaluate their influence on the prognosis. RESULTS: The accumulative 1-, 3-, 5-year survival rates of the 79 patients were 49.4%, 17.3%, 9.6% respectively. Univariate analysis revealed that sex (P=0.0221), HBsAg (P=0.0115), operation (P=0.0042), adjuvant therapy (P= 0.0389), ascites (P=0.0001), invasion (P=0.0220), intra- hepatic metastasis (P=0.0000) and TNM stage (P= 0.0001) were related to survival time. Multivariate analysis revealed that HBsAg, ascites and TNM stage were signifi- cantly related to prognosis. CONCLUSION: Early diagnosis and treatment and major hepatectomy are essential to improving the results of surgi- cal treatment of ICC patients.

Clinicopathological and prognostic analysis of 429 patients with intrahepatic cholangiocarcinoma

AIM:To understand the clinicopathological characteristics and treatment selections and improve survival and provide valuable information for patients with intrahepatic cholangiocarcinoma(ICC). METHODS:We retrospectively evaluated 5311 liver cancer patients who received resection between October 1999 and December 2003.Of these,429(8.1%)patients were diagnosed with ICC,and their clinicopathological, surgical,and survival characteristics were analyzed. RESULTS:Upper abdominal discomfort or pain(65.0%), no symptoms(12.1%),and hypodynamia(8.2%)were the major causes for medical attention.Laboratory tests showed 198(46.4%)patients were HBsAg positive, 90(21.3%)hadα-fetoprotein>20μg/L,50(11.9%) carcinoembryonic antigen>10μg/L,and 242(57.5%) carbohydrate antigen 19-9(CA19-9)>37 U/mL.Survival data was available for 329(76.7%)patients and their mean survival time was 12.4 mo.The overall survival of the patients with R0,R1 resection and punching exploration were 18.3,6.6 and 5.6 mo,respectively. Additionally,CA19-9>37 U/mL was associated with lymph node metastases,but inversely associated withcirrhosis.Multivariate analysis indicated that radical resection,lymph node metastases,macroscopic tumor thrombi and size,and CA19-9 were associated with prognosis. CONCLUSION:Surgical radical resection is still the most effective means to cure ICC.Certain laboratory tests(such as CA19-9)can effectively predict the survival of the patients with ICC.

A clinicopathological analysis in unsuspected gallbladder carcinoma: A report of 23 cases

AIM： To study the clinicopathological characteristics of unsuspected gallbladder carcinoma （UGC）. METHODS： We retrospectively studied 23 cases of UGC in Tongji Hospital, and compared their clinicopathological characteristics with 33 cases of preoperatively diagnosed gallbladder carcinoma （PDGC）. RESULTS： The proportion of UGC coexisting with cholecystolithiasis was significantly higher than that of PDGC （x^2 = 13.53, P 〈 0.01）. The infection rate of hepatitis B virus was 21.74% （5/23） in UGC and 30.30% （10/33） in PDGC. Nine （39.13%） of 23 patients with UGC and 8/33 （24.24） PDGC had contact with schistosome pestilent water. The rate of multiple pregnancies was 56.52% （13/23） in the patients with UGC and 42.42% （14/33） in PDGC. The primary location of the UGC was mostly in the neck and body of the gallbladder, and that of the PDGC was often in the body and bottom. The incidence of Nevin stage I and 11 UGC was significantly higher than that of PDGC （x^2 = 4.44, P 〈 0.05 and 2 = 4.96, P 〈 0.05） while that of Nevin stage V UGC was significantly lower than that of PDGC （x^2 = 7.59, P 〈 0.01）. According to the grading of carcinoma, the incidence of well-differentiated UGC was significantly higher than that of PDGC （2 = 4.16, P 〈 0.05）, and that of poorlydifferentiated UGC was significantly lower than that of PDGC （x^2 = 4.48, P 〈 0.05）.CONCLUSION： There are different characteristics between UGC and PDGC, such as in primary location, malignant degree and incidence of coexistence with cholecystolithiasis. Cholecystolithiasis, hepatitis B, schistosome and multiple pregnancies were high risk factors for gallbladder carcinoma.

Laparoscopic right hemicolectomy for ascending colon cancer with persistent mesocolon

Persistent ascending or descending mesocolon is an embryological anomaly that occurs during the final process of intestinal development in organogenesis.Specifically,the primitive dorsal mesocolon fails to fuse with the parietal peritoneum in the fifth month of gestation.Herein,we describe a case of ascending colon cancer with persistent ascending and descending mesocolon treated by laparoscopic right hemicolectomy.Preoperative computed tomography imaging of the abdomen demonstrated that the descending colon shifted at the midline of the abdomen and the sigmoid colon was located under the ascending colon.The detailed preoperative imaging examination revealed malpositioning of the large intestine and aided in the procedural planning.Because persistent mesocolon may result in the formation of abnormal adhesions,an accurate preoperative diagnosis is essential.We propose that it is important to consider this anomaly when making the preoperative imaging diagnosis to ensure a safe operation.

Impact of interval between neoadjuvant chemoradiotherapy and surgery in rectal cancer patients

BACKGROUND Epidemiologically,in China,locally advanced rectal cancer is a more common form of rectal cancer.Preoperative neoadjuvant concurrent chemoradiotherapy can effectively reduce the size of locally invasive tumors and improve disease-free survival(DFS)and pathologic response after surgery.At present,this modality has become the standard protocol for the treatment of locally advanced rectal cancer in many centers,but the optimal time for surgery after neoadjuvant therapy is still controversial.AIM To investigate the impact of time interval between neoadjuvant therapy and surgery on DFS and pathologic response in patients with locally advanced rectal cancer.METHODS A total of 231 patients who were classified as having clinical stage II or III advanced rectal cancer and underwent neoadjuvant chemoradiation followed by surgery at the National Cancer Center/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College from November 2014 to August 2017 were involved in this retrospective cohort study.The patients were divided into two groups based on the different time intervals between neoadjuvant therapy and surgery:139(60.2%)patients were in group A(≤9 wk),and 92(39.2%)patients were in group B(>9 wk).DFS and pathologic response were analyzed as the primary endpoints.The secondary endpoints were postoperative complications and sphincter preservation.RESULTS For the 231 patients included,surgery was performed at≤9 wk in 139(60.2%)patients and at>9 wk in 92(39.8%).The patients’clinical characteristics,surgical results,and tumor outcomes were analyzed through univariate analysis combined with multivariate regression analysis.The overall pathologic complete response(pCR)rate was 27.2%(n=25)in the longer time interval group(>9 wk)and 10.8%(n=15)in the shorter time interval group(≤9 wk,P=0.001).The postoperative complications did not differ between the groups(group A,5%vs group B,5.4%;P=0.894).Surgical procedures for sphincter preservation were performed in 113(48.9%)patients,which were not significantly different between the groups(group A,52.5%vs group B,43.5%;P=0.179).The pCR rate was an independent factor affected by time interval(P=0.009;odds ratio[OR]=2.668;95%CI:1.276-5.578).Kaplan-Meier analysis and Cox regression analysis showed that the longer time interval(>9 wk)was a significant independent prognostic factor for DFS(P=0.032;OR=2.295;95%CI:1.074-4.905),but the time interval was not an independent prognostic factor for overall survival(P>0.05).CONCLUSION A longer time interval to surgery after neoadjuvant therapy may improve the pCR rate and DFS but has little impact on postoperative complications and sphincter preservation.

Relationship between abdominal trauma or surgery and mesenteric panniculitis

Mesenteric panniculitis is a rare disease characterized by chronic non-specific inflammation of mesenteric fat tissue.Several etiologic and/or associated factors have been reported in the literature so far.Although trauma or surgery is one of the potential etiologic factors for mesenteric panniculitis,to the best of our knowledge,no strong correlation has been shown in the literature until now.

Clinicopathological analysis of patients with gastric cancer in 1200 cases

INTRODUCTIONGastric cancer is one of the most common fatal malignancies in the world. The prognosis is generally poor in advanced gastric cancer .The low survival is related to delayed diagnosis, metastasis and recurrence after operation .The aim of this paper was to find correlation between clinical factors was to find correlation between clinical factors and biologic behavior of gastric cancer in a series of 1200 patients undergoing surgical resection.

Clinicopathologic Correlation: Firm Mass on the Lateral Aspect of the Posterior Maxilla

We present the case of a 45-year-old Hispanic female with a slowly enlarging mass on her left maxilla in the region of teeth #15 and #16. A differential diagnosis is presented along with the histologic findings and treatment rendered. The prognosis and biology of the lesion are discussed.

A Study of Molecular Resection Margins for Esophageal Squamous Cell Carcinoma Using Large Pathologic Sections

OBJECTIVE It has been shown that application of molecular biological techniques to surgical margins of some cancers could predict risk of local recurrence. However, the optimal length of surgical resection with tumor-free surgical margins for esophageal squamous cell carcinoma （ES- CC） is unknown. This study was conducted to evaluate the optimal length of surgical resection for ESCC with molecularly tumor-free surgical margins marked by p53 and Ki67.METHODS Surgical specimens from 70 patients with ESCC were collected for study. The lengths of the upper margin, tumor, and lower margin of every specimen were measured during the operation. Each specimen was divided into three large pathologic sections, stained with H＆E and immunohistochemically for p53 and Ki67, and examined microscopically. The lengths of the upper and lower resection ends were measured for p53 and Ki67 positive expression. The actual surgical lengths were calculated by the principle of rational shrinkage.RESULTS All surgical margins were histologically tumor-free, while the positive rates of p53 and Ki67 were 66% and 54%. The positive rates of p53 and Ki67 in the upper resecti0n end were 17% and 20%. The mean lengths of the upper resection end showing p53 and Ki67 positive expression were 1.08±1.12 cm and 1.64±1.01 cm, and the maximum lengths were 3.73 cm and 3.26 cm. The positive,rates of p53 and Ki67 in the lower resection end were 20% and 23%. The mean lengths of the lower resection end of p53 and Ki67 with positive expression were 1.11±1.15 cm and 1.34±0.94 cm, and the maximum lengths were 3.73 cm and 3.61 cm.CONCLUSION The optimal length of surgical resection with molecularly tumor-free surgical margins of ESCC is not more than 5 cm.

A randomized retrospective clinical study on the choice between endodontic surgery and immediate implantation

Background:Periapical endodontic surgery(PES)for root amputation and tooth replacement by immediate implant placement are two possible treatment options for bone lesions in the root apex of a tooth that has previously undergone endodontic treatment.Treatment methods are performed when the effectiveness of orthograde canal revision is questionable or when such treatment cannot be performed.The effectiveness of these methods varies from study to study.Objective:clinical evaluation of the efficacy of periapical endodontic surgery for root amputation and immediate implant placement with simultaneous tooth extraction in the proximate and long-term treatment.Materials and methods:The study included 183 patients between the ages of 24 and 63.Patients were divided into 2 groups;group I-endodontic surgery was performed to resect the apex of the tooth root(108 patients)and group II-an operation to install an implant with simultaneous tooth extraction(75 patients).In group I,in 36 cases,PES was performed in the area of the first molars and premolars,and 72 cases in the area of incisors and canines.In group II,75 patients received 231 implants.Results:In all 108 patients of group I in the postoperative period and within 1 month,the wounds healed without complications.In none of the 36 operated premolars and molars,there was no definitive elimination of the radiographic bone loss(Rude grade 2 and 3)after 12 months.In the area of incisors and canines,complete healing was observed only in 37.5%of cases(I class according to Rud).In group II,out of 184 implants installed immediately after tooth extraction,one was removed one month after implantation.In other cases,all implants were successfully integrated with the subsequent fabrication of prosthetic construction.Conclusion:The complex“implant(installed in the socket of the tooth immediately after its removal)-bone-soft tissues-prosthetic construction”is stable over time in terms of functional and aesthetic parameters,preservation of bone tissue,and mucous membrane.

Endoscopic Endonasal Surgery at the Yaounde General Hospital-Cameroon: Case Study of 30 Operated Patients

Introduction: Endoscopic endonasal surgery is currently a validated therapeutic modality in most nasal sinus disorders. In developed countries, this practice is common and sees the indications constantly reviewed;In sub-Saharan Africa, this surgical technique is popularized. The external pathways are morbid and not very functional. In our daily practice at the Yaounde General Hospital (YGH), this technique is still in its infancy. Gradually it’s entering our habits and sees its indications increases. Through this study, we are reporting readily available data from our experience. Objectives: The objective was to study the practice of endoscopic endonasal surgery in our setting. Patients and Method: This was a cross-sectional, descriptive, retrospective study. The site of study was the ear-nose and throat service of Yaounde General Hospital. The study was conducted from January 2013 to December 2020, for an 8 years basis. The sampling was consecutive. We included in this study all patients operated on for a nasal sinus disease by the endoscopic endonasal modality. We excluded patients with incomplete files, as well as those who had a complementary transfacial approach during the same operation. The data were collected on prepared questionnaire. Data analysis is done with ssps 23.0 software. Results: We recruited 30 cases, out of a total of 330 interventions carried out in our department. The prevalence of this surgery in our activity was 9%. Male and female had equal ratio of 50%. The most represented age group was 30 - 40 years (33.3%). All the patients had a facial sinus CT scan, we did not note any anatomical variant as risk. Two patients of our sample size had a history of sinus surgery, treated externally. Chronic maxillary sinusitis was the surgical indication in 36.7%, followed by Killian antro-choanal polyps in 13.3%, nasosinus polyposis in 13.3% and all performed under general anesthesia. The most performed procedure was unilateral mean meatotomy with 43.33% followed by bilateral mean meatotomy with 20%, ethmoidectomy 13.3%, bimeatotomy 10%. The admission lasted for 2 days. 100% of patients had a previous nasal tamponade at the end of the intervention. The tamponade was removed on the second postoperative day in 100% of patients. 16.7% of patients presented with complications of low abundance postoperative bleeding. All patients noted clinical improvement over the initial symptoms postoperatively. Conclusion: Endoscopic endonasal surgery is experiencing slow but certain progress in our daily practice. The operated patients are young, chronic maxillary sinusitis is the main indication, the most performed procedure is the unilateral mean meatotomy. The operation goes uneventful with satisfactory prognosis. A study with a larger sample is necessary in order to refine our results. The practice remains limited by the technical platform, which needs to be strengthened, in order to optimize the practice.

青年(18~40岁)非透明细胞型肾恶性肿瘤患者的临床病理特点及预后

目的分析总结单中心青年(18~40岁)非透明细胞型肾恶性肿瘤手术患者的临床、病理特征及预后,为同类患者的诊治提供参考。方法回顾性分析2012年1月—2022年8月于北京大学第三医院泌尿外科收治的113例青年非透明细胞型肾恶性肿瘤手术患者的病例资料,其中男性57例(50.4%),女性56例(49.6%);平均发病年龄(31.6±5.8)岁;左侧57例(50.4%)、右侧56例(49.6%)。青年肾恶性肿瘤手术患者约占同期所有年龄段肾恶性肿瘤手术患者总数的12.4%,其中青年非透明细胞型肾恶性肿瘤手术患者占同期青年肾恶性肿瘤手术患者总数的34.8%。结果102例(90.3%)患者行微创手术(腹腔镜或机器人辅助),另外11例(9.7%)行开放手术;肾部分切除术55例(48.7%),根治性肾切除术58例(51.3%),肾癌瘤栓患者11例(9.7%)。手术均顺利完成,围手术期无严重并发症发生。病理类型包括肾嫌色细胞癌32例(28.3%)、MiT家族易位性肾细胞癌25例(22.1%)、乳头状肾细胞癌20例(17.7%)、3种病理亚型合计占总体的68.1%。术后随访46(2~115)个月,8例(7.8%,8/102)出现肿瘤转移,2例死亡。结论青年非透明细胞型肾恶性肿瘤相对少见,病理类型以嫌色细胞癌为主,微创手术仍是该类肾恶性肿瘤患者的主要治疗方式,多数病理类型远期预后较好,合并瘤栓患者转移风险高、预后较差。

泌尿生殖系统孤立性纤维瘤20例分析

目的探讨泌尿生殖系统孤立性纤维瘤(SFT)的诊断、治疗、长期随访结果,并比较良恶性SFT的特点。方法回顾性分析南京鼓楼医院2004年1月-2021年8月收治的20例泌尿生殖系统SFT患者,分析患者的一般特征、临床症状、影像学结果、治疗方法、病理及长期随访结果等资料。结果患者肿瘤发生在肾脏9例、盆腔7例、膀胱3例、前列腺1例。6例表现出临床症状,包括下肢无力、尿痛、排尿困难、尿频伴排便习惯改变、腰痛、腹壁包块伴腹痛等,14例无任何症状。肿瘤中位直径5.2(1.7~15.0)cm。所有患者均行手术治疗,其中机器人辅助下手术8例、开放手术5例、腹腔镜下手术5例、经尿道切除膀胱肿瘤2例。CT平扫表现为高、低、混合密度软组织肿块均可存在,强化CT出现强化结果。病理显示恶性SFT组织的核分裂象、形态变异、坏死、Ki-67指数高表达比例明显高于良性SFT。改良的Demicco预后风险分层模型结果显示,所有恶性SFT患者均为中等风险。SFT根治性肿瘤切除术组无病生存期(DFS)比单纯肿瘤切除术组稍长,但差异无统计学意义(P=0.203)。结论CD34、Bcl2、STAT6、CD99等标志物可用于诊断SFT;Ki-67指数、肿瘤坏死常用于鉴别其良恶性;改良的Demicco预后风险分层模型在预测SFT的预后中具有重要作用;手术切除是SFT最常见的治疗方法,良性SFT预后优于恶性。

乳腺癌新辅助化疗病理完全缓解率及影响因素分析

目的:分析影响患者新辅助化疗(neoadjuvant chemotherapy, NAC)后病理完全缓解(pathologic complete remission, pCR)的相关因素,为乳腺癌(breast cancer, BC)患者应用NAC联合保乳手术治疗方案提供参考和依据。方法:研究对象来源于2013年01月至2021年12月在山西白求恩医院乳腺外科治疗的Ⅱ-Ⅲ期女性BC患者。采集患者的人口学特征、临床病理资料以及化疗相关信息,观察肿瘤原发灶的变化评价NAC的短期疗效。结果:研究共260例研究对象,保乳手术(breast-conserving surgery, BCS)率为21.9%,pCR率为18.1%。肿瘤pCR的单因素分析中,是否哺乳(P<0.05)、ER、PR、HER-2、Ki-67表达、分子分型、靶向治疗及治疗方案均与乳腺pCR相关(P≤0.01)。多因素分析中,肿瘤分子分型与肿瘤pCR显著相关(OR=0.077,95%CI:0.022~0.262)。结论:NAC可以减小肿瘤,提高保乳率及pCR率。不同分子分型的肿瘤pCR率有显著差异,尤其是在三阴性乳腺癌患者中。外科医生可选择适合NAC的乳腺癌患者,提高患者的生活质量。

静脉腔内激光闭合术和内镜深筋膜下穿通静脉离断术治疗下肢静脉曲张伴病理性穿通静脉功能不全的临床效果研究

目的观察静脉腔内激光闭合术(endovenous laser ablation,EVLA)和内镜深筋膜下穿通静脉离断术(subfascial endoscopic perforator surgery,SEPS)治疗下肢静脉曲张伴病理性穿通静脉功能不全的临床效果。方法选取2021年4月至2024年3月敦化市医院诊治的83例下肢静脉曲张伴病理性穿通静脉功能不全患者,根据治疗方式不同分为EVLA组(n=42)、SEPS组(n=41)。对比两组患者手术相关指标、疼痛程度、应激反应、生活质量。结果EVLA组患者的手术用时、切口长度、住院时长、术后卧床时长均短于SEPS组,术中失血量少于SEPS组,差异均有显著性(P<0.05)。两组患者术后的并发症发生率无显著差异(P>0.05)。术后3、12、24、48h,EVLA组患者的NRS评分均低于SEPS组,差异均有显著性(P<0.05)。术前,两组患者的皮质醇及肾上腺素水平无显著差异(P>0.05)。术后2d,两组患者的皮质醇、肾上腺素水平较术前升高,且EVLA组的皮质醇及肾上腺素水平低于SEPS组,差异均有显著性(P<0.05)。术前,两组患者的慢性静脉功能不全问卷(chronic venous insuffi ciency questionnaire,CIVIQ)评分无显著差异(P>0.05)。术后3个月,两组患者的CIVIQ评分较术前均升高,EVLA组的CIVIQ评分高于SEPS组,差异有显著性(P<0.05)。结论对于下肢静脉曲张伴病理性穿通静脉功能不全的患者,EVLA、SEPS在降低并发症发生率方面效果相似,但EVLA可缩短患者康复时间,减轻患者应激反应与机体疼痛感,并提高患者的生活质量。

小肠超长纵行溃疡—罕见CMUSE1例报道并文献复习

本文报道湘雅常德医院收治的1例合并10 cm长条纵行溃疡经手术病理明确诊断的罕见隐源性多灶性溃疡性狭窄性小肠炎病例,并且就其临床病理学特点及与其他小肠溃疡性疾病的鉴别诊断进行讨论,以加深临床及病理医师对该疾病的认识。

面部结节性筋膜炎一例

本文报道一例面部结节性筋膜炎患者的临床特征、诊断过程及治疗方案。经手术切除肿物,病理结果显示(右面部)基于HE形态,结合免疫酶标结果,符合结节性筋膜炎。免疫酶标结果显示:“C”梭形细胞SMA+++、Vinentin+++、β-Catenin浆+、P53++,术后1年随访未见异常。