Treatment of fat-poor renal angiomyolipoma with ectopic blood supply by fluorescent laparoscopy:A case report and review of literature

BACKGROUND Renal angiomyolipoma and renal cell carcinoma are the most common benign and malignant tumors of the kidney respectively,and the preoperative differential diagnosis is crucial due to the wide difference in treatment methods.Fat-poor renal angiomyolipoma is a relatively rare type of in renal angiomyolipoma.Its fat imaging features are not obvious,and it is easily misdiagnosed as renal cell carcinoma.CASE SUMMARY We report the case of a 41-year-old man who complained of osphyalgia.Subsequent abdominal computed tomography scans revealed that a heterogeneous mass was seen in the lower pole of the right kidney,with the size of about 53 mm×47 mm.And showed two right renal arteries,with the mass supplied by an ectopic vessel from the abdominal aorta.Fluorescent laparoscopic blockade of the right renal heterotopic artery and partial nephrectomy was performed.Based on histological and immunohistochemical findings,the tumor was diagnosed as fatpoor renal angiomyolipoma.CONCLUSION The use of fluorescent laparoscopy can effectively help intraoperative management,and the fluorescence pattern provided by intravenous indocyanine green can help suggest the final diagnosis,effectively guide the surgical decisionmaking,and avoid preoperative imaging diagnosis leading to nephrectomy for benign renal tumors,through fluorescent navigation of tumor supply vessel precise block,minimize the loss of renal function.

The origin of blood supply for cavernous hemangioma of the liver

OBJECTIVE: To investigate the origin of blood supply to cavernous hemangioma of the liver (CHL). METHODS: To observe the relation of cavernous hemangioma of the liver to the hepatic artery and portal vein, we performed serial selective hepatic arteriography in 22 patients. Five patients after ligation of the right hepatic arteries underwent portography and liver staining by in jection of methylene blue into the portal veins and 2 patients had hepatic specimens resected, which were made into a model cast by filling the hepatic veins (yellow) and portal venous branches (blue) with methyl methacrylate after vascular lavage. RESULTS: Serial selective hepatic arteriography showed that hepatic arteries and hemangioma were displayed simultaneously, and that hemangioma was supplied by one to numerous arterial branches. In the portal phase of portography, contrast medium failed to enter the tumor and the intrahepatic branches of the portal vein were pushed aside by the tumor; in the liver parenchymal phase, however, the tumor appeared to be a low-density area. Hepatic arteriography and portography revealed that the fistula between the artery and portal vein may not be existed. The liver stained with methylene blue showed that the normal hepatic parenchyma could be stained with deep blue; in contrast, the tumor was not stained at all. The casting specimens showed that the eroded tumor left a round vacant area because of its total shedding, and no blue stained branches of the portal vein extended into the tumor. CONCLUSION: Blood supply of CHL may originate from the hepatic artery.

Liver blood supply after a modified Appleby procedure in classical and aberrant arterial anatomy

Reported here are two cases of a modified Appleby operation for borderline resectable ductal adenocarcinoma of the pancreatic body, in one of which a R0 distal resection was attended to by excision, not only of the celiac axis, but also of the common and left hepatic arteries in the presence of arterial anatomic variation Michels, type Ⅷb. The possibility and avenues of the maintenance of the blood supply to the left hepatic lobe after surgical aggression of this kind are demonstrated employing computed tomography (CT) and 3-D CT angiography. Furthermore, both cases highlight all important worrisome aspects of pancreatic cancer resectability prediction.

Source of blood supply of liver cavernous hemangioma and sclerosis and embolization treatment

AIM To investigate the source of blood supply of carvenous hemangioma of liver (CHL) and provide a feasibile treatment for CHL via hepatic artery. METHODS Ⅰ. Origin of blood supply of CHL: portovenography, hepatic arteriography and portal vein staining were performed in 5 patients. Two casts of hepatic blood vessels from resected specimen were observed. Ⅱ. Clinical data: Among 75 patients (30 males, 45 females, aged 25～57 years with a mean of 37 4). 56 were of solitary type (44 on the right lobe, 12 on the left with 4 having intraparenchymatoma) and 19 were of multiple type (9 on the right, 2 the left, 8 whole liver). Twenty two patients were treated by sclerosis, 50 by embolization via hepatic artery and 3 were excised. RESULTS In 5 cases with portography, the contrast medium did not enter the tumor, the tumor appeared as low denty area and the intrahepatic branches of portal vein were pushed aside. In 5 cases with portal vein staining, the normal liver parenchyma was stained deep blue, and the tumor was not stained. The tumor area appeared as a round vacant cavity in 2 specimen casts. In 72 patients treated with sclerosis a or embolization via hepatic artery or through interventional method, the tumors diminished by 10%～30% in diameter and no tumors grew larger. CONCLUSION The blood supply of CHL originates from the hepatic artery. Tumors treated with sclerosis and emblization decreased in size or got fiberized.

Applied anatomical study of the vascularized ulnar nerve and its blood supply for cubital tunnel syndrome at the elbow region

Cubital tunnel syndrome is often accompanied by paresthesia in ulnar nerve sites and hand muscle atrophy. When muscle weakness occurs, or after failure of more conservative treatments, anterior transposition is used. In the present study, the ulnar nerve and its blood vessels were examined in the elbows of 18 adult cadavers, and the external diameter of the nutrient vessels of the ulnar nerve at the point of origin, the distances between the origin of the vessels and the medial epicondyle of the humerus, and the length of the vessels accompanying the ulnar nerve in the superior ulnar collateral artery, the inferior ulnar collateral artery, and the posterior ulnar recurrent artery were measured. Anterior transposition of the vascularized ulnar nerve was per- formed to treat cubital tunnel syndrome. The most appropriate distance that the vascularized ulnar nerve can be moved to the subcutaneous tissue under tension-free conditions was 1.8 ± 0.6 cm （1.1-2.5 cm）, which can be used as a reference value during the treatment of cubital tunnel syndrome with anterior transposition of the vascularized ulnar nerve.

INVESTIGATION OF BLOOD SUPPLY OF BRONCHOGENIC CARCINOMA DERIVING FROM PULMONARY ARTERY

Microfil perfusion technique was used to investigate the blood supply of bronchogenic carcinoma deriving from pulmonary artery on 20 fresh specimens of lung cancer, including 11 squamous carcinoma, 6adenocarcinoma, 1 alveolar cell carcinoma and 2undifferentiated carcinoma cases. The results showed that the appearance and quantity of pulmonary blood supply of bronchogenic carcinoma depended on and changed with the site, activity,growth mode as well as the local condition of tumor nodules; pulmonary artery supplied blood to the Periphery of the tumor and its iunermost part as well; vessels from pulmonary artery in tumor nodules were generally less in number than those in the surrounding normal lung tissues around. The results suggested that the tumor blood supply from pulmonary artery should he evaluated comprehensively and dynamically; during interventional chemotherapy via pulmonary artery, patients should bc selected carefully and the catheter for infusion placed in suitable position so as to gain the best therapeutic effect.

成渝地区采供血信息系统互联互通探索

依托成都市血液中心与重庆市血液中心血液管理信息系统,通过确定业务需求、技术方案等,建设成渝地区献血者信息核查系统、特殊血型和血小板供者融合库。通过开展“成渝地区采供血信息系统互联互通”项目,为血站阻断献血间隔期不足和检测不合格献血者,满足特殊血液需求提供了数据支撑和技术保障,降低了献血风险,提升了特殊血液保障能力。

基于脾升胃降理论穴位埋线论治高脂血症

高脂血症是血脂水平异常所引起的疾病,患病率逐年升高。其核心病机为水谷精微不归正化,停而成饮,聚而成痰湿,生成膏脂,聚于营血,治疗以调理脾胃的升降为总则,左主升、右主降,故选用左侧足太阴脾经、右侧足阳明胃经及其他调理脾胃升降功能之要穴,通过穴位埋线,产生持续且强烈的刺激,以调节脾胃运化功能,使脾胃运化水谷精微功能恢复正常,血液中的脂浊得化,为高脂血症的治疗提供新的思路方法。

免疫治疗对晚期胃癌中医证型演变规律的影响

目的:观察免疫治疗对晚期胃癌(gastric cancer, GC)患者中医证型演变规律的影响。方法:共纳入58例晚期GC患者,其中腹膜转移组38例,无腹膜转移组20例,收集患者的一般资料、临床病理学特征及治疗前后中医证型。运用χ~2检验评估各项指标间的相关性,运用Kaplan-Meier法评估各种证型无进展生存期(progression-free survival, PFS)。结果:58例GC患者治疗前中医证型以痰湿凝结证、肝胃不和证为主,两种证型PFS比较,差异无统计学意义(P>0.05);治疗后以气阴两虚证、脾胃虚寒证为主,两种证型PFS比较,差异无统计学意义(P>0.05)。腹膜转移组治疗前主要证型为肝胃不和证、痰湿凝结证、气滞血瘀证;治疗后主要证型为脾胃虚寒证、气阴两虚证、气血亏虚证。无腹膜转移组治疗前主要证型为气阴两虚证、痰湿凝结证、脾胃虚寒证;治疗后主要证型为气阴两虚证、脾胃虚寒证、气血亏虚证。腹膜转移组治疗前肝胃不和证与痰湿凝结证肿瘤原发部位、分化程度、组织学、分期比较,差异并无统计学意义(P>0.05)。58例晚期GC患者PFS为(5.19±2.95)个月,其中腹膜转移组PFS为(4.22±2.77)个月,无腹膜转移组PFS为(7.02±2.40)个月,两组PFS比较,差异具有统计学意义(P<0.05)。将58例GC患者肝胃不和证、痰湿凝结证、气滞血瘀证归为实证,气阴两虚证、脾胃虚寒证、气血亏虚证归为虚证。实证与虚证PFS比较,差异无统计学意义(P>0.05)。结论:肝胃不和证和痰湿凝结证在晚期腹膜转移患者中多见,且生存期更短,免疫治疗可改善晚期GC患者中医证型的分布规律,加强对晚期GC患者中医证型的关注,并进行及早干预,有助于提高患者的生存期。

从“胃络-玄府”探讨慢性萎缩性胃炎的病机及风药开玄之运用

慢性萎缩性胃炎属胃癌前病变,其病机复杂多变,症状反复发作,迁延不愈。该文从胃络-玄府角度入手,分析了慢性萎缩性胃炎玄府郁闭、胃络瘀阻的病机,探讨风药治疗慢性萎缩性胃炎的开通玄府、畅达胃络之功效。认为借助风药辛温走窜通达之性,可解表、理气、升阳、通络、散结而开通玄府,畅达胃络。治疗慢性萎缩性胃炎时运用风药可开玄,玄府通则脾胃升清降浊功能可恢复;风药可引经报使,佐助其他药物共同取效;风药尚可燥湿,结合其开玄之效更助运化湿邪之功。治疗慢性萎缩性胃炎酌情配伍风药可提升中医药治疗效果,为其临床中医药治疗提供参考。

Effects of San Qi on Gastric Secretion and Protective Factors of Gastric Mucosa in the Rat with Precancerous Lesion of Stomach

In the model rat with precancerous lesion of stomach induced by the combined method of insertion of a spring into the pylorus and high salt hot paste,effects of San Qi (三七 Radix Notoginseng) on gastric secretion and protective factors of stomach were investigated.The results indicated that gastric secretion,gastric mucosal blood flow (GMBF) and aminohexose content lowered significantly,and malondialdehyde (MDA) increased significantly (P<0.01) in the model group as compared with the normal group;after treatment with San Qi Powder for 12 weeks,both gastric secresion and GMBF increased,and MDA content decreased as compared with the negative control group (P<0.01),with no significant increase of aminohexose content.It is suggested that San Qi (三七 Radix Notoginseng) may improve gastric secretion,and that increase of GMBF and antagonism against the lesion of oxygen free radicals are possibly one of its mechanisms.

Relationship between ABO blood groups and carcinoma of esophagus and cardia in Chaoshan inhabitants of China

AIM:To study the relationship between ABO blood groups and carcinoma of esophagus and cardia in Chaoshan inhabitants of China, which is a unique Littoral high-risk area of esophageal carcinoma in China. The poor communication and transportation in the past has made Chaoshan a relatively closed area and kept its culture and custure of old China thousand years ago. METHODS: Data on age, sex, ABO blood type and X-ray or pathological diagnose of the patients with carcinoma of esophagus or cardia were collected from the Tumor Hospital. First Affiliated Hospital, Second Affiliated Hospital of Shantou University Medical College; and the Central Hospital of Shantou and the Central Hospital of Jieyang. A total of 6685 patients with esophageal carcinoma (EC) and 2955 patients with cardiac cancer (CC) in Chaoshan district were retrospectively assessed for their association with ABO blood groups. RESULTS: The distribution of ABO blood groups in patients with EC or CC was similar to the normal local population in Chaoshan. However, blood group B in male patients with CC and in the patients with carcinoma in the upper third esophagus was 2.3% and 4.7% higher than the corresponding controls. The relative risk B O was 1.1415 (P【0.05) and 1.2696 (P【0.05), respectively. No relationship was found between ABO blood groups and tumor differentiation. CONCLUSION: ABO blood group B is associated with the incidence of CC in male individuals and carcinoma in the upper third esophagus. The distribution of ABO blood groups varies in the different geographical and ethnic groups. As a result, proper controls are very important for such studies.

Evaluation of the dual vascular supply patterns in ground-glass nodules with a dynamic volume computed tomography

BACKGROUND In recent years,the detection rate of ground-glass nodules(GGNs)has been improved dramatically due to the popularization of low-dose computed tomography(CT)screening with high-resolution CT technique.This presents challenges for the characterization and management of the GGNs,which depends on a thorough investigation and sufficient diagnostic knowledge of the GGNs.In most diagnostic studies of the GGNs,morphological manifestations are used to differentiate benignancy and malignancy.In contrast,few studies are dedicated to the assessment of the hemodynamics,i.e.,perfusion parameters of the GGNs.AIM To assess the dual vascular supply patterns of GGNs on different histopathology and opacities.METHODS Forty-seven GGNs from 47 patients were prospectively included and underwent the dynamic volume CT.Histopathologic diagnoses were obtained within two weeks after the CT examination.Blood flow from the bronchial artery[bronchial flow(BF)]and pulmonary artery[pulmonary flow(PF)]as well as the perfusion index(PI)=[PF/(PF+BF)]were obtained using first-pass dual-input CT perfusion analysis and compared respectively between different histopathology and lesion types(pure or mixed GGNs)and correlated with the attenuation values of the lesions using one-way ANOVA,student’s t test and Pearson correlation analysis.RESULTS Of the 47 GGNs(mean diameter,8.17 mm;range,5.3-12.7 mm),30(64%)were carcinoma,6(13%)were atypical adenomatous hyperplasia and 11(23%)were organizing pneumonia.All perfusion parameters(BF,PF and PI)demonstrated no significant difference among the three conditions(all P>0.05).The PFs were higher than the BFs in all the three conditions(all P<0.001).Of the 30 GGN carcinomas,14 showed mixed GGNs and 16 pure GGNs with a higher PI in the latter(P<0.01).Of the 17 benign GGNs,4 showed mixed GGNs and 13 pure GGNs with no significant difference of the PI between the GGN types(P=0.21).A negative correlation(r=-0.76,P<0.001)was demonstrated between the CT attenuation values and the PIs in the 30 GGN carcinomas.CONCLUSION The GGNs are perfused dominantly by the PF regardless of its histopathology while the weight of the BF in the GGN carcinomas increases gradually during the progress of its opacification.

Coronary Heart Diseases Treated by the Methods of Supplementing Qi, Activating Blood Circulation, Expelling Wind & Dredg- ing Channels: Summary of 35 Cases

The basic recipe is composed of RadixAstragali seu Hedysari,Radix Puerariae,fried Semen Ziziphi Spinosa,each 30g;Radix Peucedani 12g,Herba Asari 3g,

Risk factors for blood transfusion and its prognostic implications in curative gastrectomy for gastric cancer

BACKGROUND Gastric cancer(GC)is still a prevalent neoplasm around the world and its main treatment modality is surgical resection.The need for perioperative blood transfusions is frequent,and there is a long-lasting debate regarding its impact on survival.AIM To evaluate the factors related to the risk of receiving red blood cell(RBC)transfusion and its influence on surgical and survival outcomes of patients with GC.METHODS Patients who underwent curative resection for primary gastric adenocarcinoma at our Institute between 2009 and 2021 were retrospectively evaluated.Clinicopathological and surgical characteristics data were collected.The patients were divided into transfusion and non-transfusion groups for analysis.RESULTS A total of 718 patients were included,and 189(26.3%)patients received perioperative RBC transfusion(23 intraoperatively,133 postoperatively,and 33 in both periods).Patients in the RBC transfusions group were older(P<0.001),and had morecomorbidities(P=0.014),American Society of Anesthesiologists classification III/IV(P<0.001),and lower preoperative hemoglobin(P<0.001)and albumin levels(P<0.001).Larger tumors(P<0.001)and advanced tumor node metastasis stage(P<0.001)were also associated with the RBCtransfusion group.The rates of postoperative complications(POC)and 30-d and 90-d mortalitywere significantly higher in the RBC transfusion group than in the non-transfusion group.Lowerhemoglobin and albumin levels,total gastrectomy,open surgery,and the occurrence of POC werefactors associated with the RBC transfusion.Survival analysis demonstrated that the RBCtransfusions group had worse disease-free survival(DFS)and overall survival(OS)compared withpatients who did not receive transfusion(P<0.001 for both).In multivariate analysis,RBCtransfusion,major POC,pT3/T4 category,pN+,D1 lymphadenectomy,and total gastrectomywere independent risk factors related to worse DFS and OS.CONCLUSIONPerioperative RBC transfusion is associated with worse clinical conditions and more advancedtumors.Further,it is an independent factor related to worse survival in the curative intentgastrectomy setting.

质量管理在血站采供血工作中的应用

目的 分析在血站采供血工作中质量管理的应用价值。方法 选取2021年7月—2022年7月在济宁市中心血站献血的70名献血者和11名护理工作人员,均实施质量管理,纳入研究组;另选择2020年5月—2021年5月在血站献血的70名献血者和11名护理工作人员,实施常规管理,纳入对照组。对比和分析工作管理效果。结果 研究组工作管理质量(设备维修保养、责任心、消毒工作质量、环境质量)各项评分高于对照组(P<0.05);研究组献血者总满意度为97.14%,高于对照组的81.43%(P<0.05);研究组一次穿刺成功率、采血质量达标率、健康教育覆盖率分别为92.86%、98.57%、100%,高于对照组的72.86%、85.71%、90.00%,研究组工作差错率为2.86%,低于对照组的17.14%(P<0.05)。结论 在血站采供血工作中质量管理应用价值较高,在工作管理质量、献血者满意度、一次穿刺成功率、采血质量达标率、工作差错率、健康教育覆盖率方面优势明显。

Experience in the Treatment of Tumors by Replenishing Qi and Nourishing Blood,Detoxicating and Resolving Masses

The pathogenesis of malignant tumors is the deficiency of vital Qi and the excess of pathogenic Qi.Its basic treating principle is to strengthen vital Qi to eliminate pathogenic factor.The paper is to summarize the clinical experiences in tumor treatment of Dr.Chen Shizhou,a well-known traditional Chinese medicine expert in Weifang City,Shandong Province.He put forward the treatment method of"replenishing Qi and nourishing blood,detoxicating and resolving masses",paying attention to protecting stomach qi and advocating survival with tumor,with remarkable clinical effects.

采供血机构信息化发展现状与策略研究——以北京市采供血机构为例

目的对北京市采供血机构信息化建设现状、需求和问题进行调查分析,为进一步完善北京市采供血系统信息化建设提供策略建议。方法采用序贯访谈法,收集北京市血液中心相关科室、中心血站、中心血库和临床用血机构等的信息系统相关定性资料并进行整理分析。结果北京市采供血机构目前运行有6个信息系统,涵盖了采供血服务管理、献血信息查询和上报、采供血机构业务管理、献血者信息管理以及血液信息宣传、信息公示等功能,但仍存在系统信息化程度较低、缺乏信息化建设的顶层设计、数据标准不统一、系统分析统计功能不完善等问题。结论北京市采供血机构在信息化发展上需要进一步开展网络设施建设,重构系统架构,完善血液管理信息化平台功能,统一数据、接口实现信息共享,利用新兴技术实现采供血服务和管理的智能化和精准化。

李延从脾胃论治冠心病的临床经验

冠心病为临床中常见的心血管疾病,可归属中医学的“胸痹”“心痛”等疾病范畴。李延教授认为本病之病性总属本虚标实之证,以脾虚、脾胃健运失常为本,标实在于痰浊、血瘀、气滞、寒凝等有形实邪痹阻心脉。治疗时重视调理脾胃,重用黄芪、白术、党参、五味子等健脾养心以治本,结合通阳化浊、活血化瘀、疏肝理气、温阳散寒等治法,标本兼治,通补兼顾,使脾气健旺,心气充沛,瘀去痰消,胸阳得以舒展,则心之血脉恢复畅通,胸痹心痛诸症得到缓解。李延教授从脾胃论治冠心病的经验可为中医临床诊治冠心病提供参考。

2021—2023年江西省采供血机构血液安全调研情况分析

目的调查分析江西省各采供血机构贯彻落实法律法规情况和工作开展情况,持续提升血液安全水平,保障血液和血液制品质量安全。方法采取听取汇报、查阅资料、实地查看等方式对2021—2023年江西省12家血站、16家单采血浆站开展血液安全调研。结果通过调研,了解了本省各采供血机构工作中的亮点特色,同时也发现了本省采供血机构在人员、机器、物料、方法、环境方面存在的问题,3年的调研中,血站累计发现问题111次,单采血浆站累计发现问题157次。结论根据调研结果,让本省各采供血机构明确改进的方向,也为卫生行政管理部门制定政策提供依据,提高采供血服务水平和血液质量安全监督工作效率。