BACKGROUND Intrapancreatic accessory spleen(IPAS)shares similar imaging findings with hypervascular pancreatic neuroendocrine tumors(PNETs),which may lead to unnecessary surgery.AIM To investigate and compare the diag...BACKGROUND Intrapancreatic accessory spleen(IPAS)shares similar imaging findings with hypervascular pancreatic neuroendocrine tumors(PNETs),which may lead to unnecessary surgery.AIM To investigate and compare the diagnostic performance of absolute apparent diffusion coefficient(ADC)and normalized ADC(lesion-to-spleen ADC ratios)in the differential diagnosis of IPAS from PNETs.METHODS A retrospective study consisting of 29 patients(16 PNET patients vs 13 IPAS patients)who underwent preoperative contrast-enhanced magnetic resonance imaging together with diffusion-weighted imaging/ADC maps between January 2017 and July 2020 was performed.Two independent reviewers measured ADC on all lesions and spleens,and normalized ADC was calculated for further analysis.The receiver operating characteristics analysis was carried out for evaluating the diagnostic performance of both absolute ADC and normalized ADC values in the differential diagnosis between IPAS and PNETs by clarifying sensitivity,specificity,and accuracy.Inter-reader reliability for the two methods was evaluated.RESULTS IPAS had a significantly lower absolute ADC(0.931±0.773×10^(-3)mm^(2)/s vs 1.254±0.219×10^(-3)mm^(2)/s)and normalized ADC value(1.154±0.167 vs 1.591±0.364)compared to PNET.A cutoff value of 1.046×10^(-3)mm^(2)/s for absolute ADC was associated with 81.25%sensitivity,100%specificity,and 89.66%accuracy with an area under the curve of 0.94(95%confidence interval:0.8536-1.000)for the differential diagnosis of IPAS from PNET.Similarly,a cutoff value of 1.342 for normalized ADC was associated with 81.25%sensitivity,92.31%specificity,and 86.21%accuracy with an area under the curve of 0.91(95%confidence interval:0.8080-1.000)for the differential diagnosis of IPAS from PNET.Both methods showed excellent inter-reader reliability with intraclass correlation coefficients for absolute ADC and ADC ratio being 0.968 and 0.976,respectively.CONCLUSION Both absolute ADC and normalized ADC values can facilitate the differentiation between IPAS and PNET.展开更多
BACKGROUND Ventral hernia,also known as incisional hernia,is a common complication of previous surgery.The contents of ventral hernia may include omentum,preperitoneal fat,small intestine or colon.However,ventral hern...BACKGROUND Ventral hernia,also known as incisional hernia,is a common complication of previous surgery.The contents of ventral hernia may include omentum,preperitoneal fat,small intestine or colon.However,ventral hernia with protrusion of more than two parenchymal organs simultaneously is extremely rare,and its repair is very complex and difficult.Surgeons should make a comprehensive assessment based on their own experience and the individual characteristics of the hernia.In addition,psychological therapy should be emphasized in the whole treatment process.CASE SUMMARY We report a rare case of asymptomatic giant ventral hernia for 15 years in a 21-year-old female.The patient underwent umbilical hernia repair at the age of 1 year.Approximately 5 years later,ventral hernia recurred and repair with Mesh was performed,but the operation failed due to postoperative infection,and a huge mass appeared in the left abdominal wall.The mass increased gradually with the development and maturity of the body.Computerized tomography scan demonstrated that the patient's total spleen,part of the pancreas and left lobe of the liver were simultaneously herniated through the abdominal incisional hernia.As the patient was unable to endure the inconvenience of life and the potential risk of spleen or liver rupture,she underwent a ventral hernia repair with Mesh at our hospital.The operation was successful and the patient had a good recovery.During a 3-mo follow-up,the patient remained asymptomatic and the appearance of the surgical incision was greatly improved.CONCLUSION Ventral hernia is a common complication of abdominal surgery.Ventral hernia with protrusion of more than two parenchymal organs simultaneously is extremely rare.Surgeons should pay attention to the psychological treatment while restoring the abdominal physiological function in ventral hernia patients.展开更多
Over the past decade,medical researchers in China have debated whether the Pi(脾)corresponds to the biomedical spleen or pancreas.This debate exemplifies a broader phenomenon of“anatomical retrofitting”,or the anach...Over the past decade,medical researchers in China have debated whether the Pi(脾)corresponds to the biomedical spleen or pancreas.This debate exemplifies a broader phenomenon of“anatomical retrofitting”,or the anachronistic imposition of contemporary categories onto living historical objects.“Anatomical retrofitting”as a means of rectifying cases of mistranslation further positions the biomedical spleen and pancreas as representing ahistorical,universal truths.This framework gives rise to a conceptual binary:while the biomedical spleen is universalized as what philosophers may describe as“logical”ontology,the Pi connects to a different nature of reality,or“metaphysical”ontology.Far from being an object of imprecision,the Pi was a dynamic vessel that also shared characteristics with the humoral spleen.Given that scholars in China have already subjected Pi to historical scrutiny,this paper urges scholars to do the same with biomedical anatomy.For instance,historically situating the humoral spleen demonstrates that it became less known and less articulated as it transformed into the biomedical spleen.Meanwhile,the pancreas remained an unstable epistemic object that took on the dynamic functions of the humoral spleen in nineteenth-century organotherapy.Through primary source analysis and literature review,this paper contends that the apparent ontological incommensurability between Pi and spleen is neither mutually exclusive nor irreconcilable.Instead,the dynamic nature of internal viscera,their many functions,and their participation in epistemic practices contribute to an ongoing ontological ambivalence that persists despite the forced certainty of anatomical retrofitting.展开更多
209178 Long-term prevention of virus recurrence among recipients with HBV active replication following liver transplantation/Dai Jun(Liver Transplant Center,West Chin Hosp,Sichuan Univ,Chengdu 610041)…∥Chin J Hepat...209178 Long-term prevention of virus recurrence among recipients with HBV active replication following liver transplantation/Dai Jun(Liver Transplant Center,West Chin Hosp,Sichuan Univ,Chengdu 610041)…∥Chin J Hepatobil Surg.-2009,15(2).-106~109Objective To investigate the long-term prophylactic outcome in recipierts with HBV active replication under LAM or/and HBIG prophylaxis after liver transplantation.Methods The liver biopsy specimens and serum samples were collected during the follow-up.ELISA and chemiluminesent microparticle immunoassay,HBV-DNA fluorescent quantification,immunohistochemisty and HBV-DNA in situ hybridization were performed for analysis.The alteratio of HBV markers in serial biopsy and sera of 55 recipients were investigated retrospectively.Results The mean time of follow-up was 69.14 months.Twelve cases had hepatitis B virus reinfection after transplantation.The accumulated ratio of hepatitis B virus reinfection was 4.8%(2/42)in LAM+HBIG group and 76.9%(10/13) in LAM monoprophylaxis group(P=0.000).The 1-,2-,3-and 4-yr,survival rates in combined prophylaxis group were 100%,97.1%,92.7% and 92.7%,respectively.The 1-,2-,3-and 4-yr survival rates in LAM mono prophylaxis group were 76.9%,69.2%,53.8% and 46.2%,respectively(P=0.000).The rates of hepatitis B virus reinfection in combination prophylaxis group(1-,2-,3-and 4-yr recurrence rates of 2.4%,2.4%,2.4%,and 8.5%,respectively) was markedly lower than those in mono prophylaxis group(1-,2-,3-and 4-yr recurrence rates of 16.1%,41.3%,66.4% and 66.4%,respectively)(P=0.000).Conclusion Currently HBIG combined with LAM is an optimal prophylatic protocol to reduce the hepatitis B virus reifection rate.However,poor compliance of recipients to a prescribed course of prophylaxis as well as viral staus itself is still the main cause of hepatitis B virus reinfection after liver transplantation in China.Compliance education and adjusting the prophylatic protocols according to the viral alteration after liver transplantation may help to further decrease the hepatitis B virus reinfection rate.17 refs,4 tabs.展开更多
AIM: To evaluate the safety and feasibility of laparoscopic spleen-preserving distal pancreatectomy (LSPDP) with autologous islet transplantation (AIT) for benign tumors of the pancreatic body-neck.
Here,we report a case of intrapancreatic accessory spleen confirmed by pathologic diagnosis and discuss its differential diagnosis and surgical management with a review of the literature.
BACKGROUND Intrapancreatic accessory spleen(IPAS)is an uncommon condition,with the majority of cases presenting as solid lesions.Thus,this condition is frequently misdiagnosed as pancreatic solid neoplasm.Moreover,spl...BACKGROUND Intrapancreatic accessory spleen(IPAS)is an uncommon condition,with the majority of cases presenting as solid lesions.Thus,this condition is frequently misdiagnosed as pancreatic solid neoplasm.Moreover,splenic cavernous hemangioma is a rare disorder,whereas lesions with a cystic appearance arising from IPAS have not been reported.CASE SUMMARY Herein,we present a case involving a 32-year-old male who had a complex cystic lesion in the tail of the pancreas revealed by conventional ultrasound.The lesion was misdiagnosed as a pancreatic cystadenoma because of its confusing anatomic location,as well as due to its peripheral nodular and internal septal enhancement patterns on contrast-enhanced ultrasound.After multidisciplinary discussion,the patient finally underwent laparoscopic pancreatic body and tail resections.Postoperative pathology demonstrated the lesion to be a cavernous hemangioma arising from the IPAS.CONCLUSION Cavernous hemangioma in the intrapancreatic accessory spleen may mimic pancreatic cystadenoma,which is a condition with the potential to be malignant.Imaging follow-ups or surgical interventions may be helpful for the exclusion of malignant risks in complicated cystic lesions,especially those with parietal and septal enhancements.展开更多
目的探讨腹腔镜下Kimura法和Warshaw法两种保脾胰体尾切除术的围术期疗效与安全性。方法回顾性分析2017年8月至2023年8月于空军军医大学西京医院接受腹腔镜下保脾胰体尾切除术的133例患者临床资料,根据手术方式不同分为Kimura组(77例)和...目的探讨腹腔镜下Kimura法和Warshaw法两种保脾胰体尾切除术的围术期疗效与安全性。方法回顾性分析2017年8月至2023年8月于空军军医大学西京医院接受腹腔镜下保脾胰体尾切除术的133例患者临床资料,根据手术方式不同分为Kimura组(77例)和Warshaw组(56例),比较两组患者手术时长、术中出血量等围术期指标及术后胰瘘发生率、脾梗死等并发症发生情况。结果Kimura组和Warshaw组两组患者在手术时长[(215.8±64.8)min vs(193.5±77.6)min]、术中出血量[(194.2±53.7)mLvs(176.5±69.2)mL]、术后排气及禁食时间[2(1)d vs 3(1)d]、术后住院时间[9(4)d vs 8(3)d]等围术期指标及术后胰瘘(3例vs 4例)、脾梗死(0例vs 3例)、腹腔积液(3例vs 2例)、腹腔感染(2例vs 1例)等并发症发生情况方面比较差异均无统计学意义(P>0.05)。结论腹腔镜下Kimura法和Warshaw法两种保脾胰体尾切除术对于胰体尾良性及低度恶性肿瘤均是安全有效的手术方式,且围术期疗效相当。展开更多
基金Supported by the National Natural Science foundation of China,No. 82202135, and No. 82171925Foundation of Excellent Young Doctor of Jiangsu Province Hospital of Chinese Medicine,No. 2023QB0112+1 种基金Innovative Development Foundation of Department in Jiangsu Hospital of Chinese Medicine,No. Y2021CX19Developing Program for High-level Academic Talent in Jiangsu Hospital of TCM,No. y2021rc03
文摘BACKGROUND Intrapancreatic accessory spleen(IPAS)shares similar imaging findings with hypervascular pancreatic neuroendocrine tumors(PNETs),which may lead to unnecessary surgery.AIM To investigate and compare the diagnostic performance of absolute apparent diffusion coefficient(ADC)and normalized ADC(lesion-to-spleen ADC ratios)in the differential diagnosis of IPAS from PNETs.METHODS A retrospective study consisting of 29 patients(16 PNET patients vs 13 IPAS patients)who underwent preoperative contrast-enhanced magnetic resonance imaging together with diffusion-weighted imaging/ADC maps between January 2017 and July 2020 was performed.Two independent reviewers measured ADC on all lesions and spleens,and normalized ADC was calculated for further analysis.The receiver operating characteristics analysis was carried out for evaluating the diagnostic performance of both absolute ADC and normalized ADC values in the differential diagnosis between IPAS and PNETs by clarifying sensitivity,specificity,and accuracy.Inter-reader reliability for the two methods was evaluated.RESULTS IPAS had a significantly lower absolute ADC(0.931±0.773×10^(-3)mm^(2)/s vs 1.254±0.219×10^(-3)mm^(2)/s)and normalized ADC value(1.154±0.167 vs 1.591±0.364)compared to PNET.A cutoff value of 1.046×10^(-3)mm^(2)/s for absolute ADC was associated with 81.25%sensitivity,100%specificity,and 89.66%accuracy with an area under the curve of 0.94(95%confidence interval:0.8536-1.000)for the differential diagnosis of IPAS from PNET.Similarly,a cutoff value of 1.342 for normalized ADC was associated with 81.25%sensitivity,92.31%specificity,and 86.21%accuracy with an area under the curve of 0.91(95%confidence interval:0.8080-1.000)for the differential diagnosis of IPAS from PNET.Both methods showed excellent inter-reader reliability with intraclass correlation coefficients for absolute ADC and ADC ratio being 0.968 and 0.976,respectively.CONCLUSION Both absolute ADC and normalized ADC values can facilitate the differentiation between IPAS and PNET.
基金Supported by the National Natural Science Foundation of China,No.81172269 and No.30972910Jiangsu Provincial Commission of Health and Family Planning,No.Z201603+1 种基金Youth talent support program of Nanjing City during the 13th Five-Year Plan Period,No.QRX17107Natural Science Fund of Nanjing Medical University,No.2017NJMU041.
文摘BACKGROUND Ventral hernia,also known as incisional hernia,is a common complication of previous surgery.The contents of ventral hernia may include omentum,preperitoneal fat,small intestine or colon.However,ventral hernia with protrusion of more than two parenchymal organs simultaneously is extremely rare,and its repair is very complex and difficult.Surgeons should make a comprehensive assessment based on their own experience and the individual characteristics of the hernia.In addition,psychological therapy should be emphasized in the whole treatment process.CASE SUMMARY We report a rare case of asymptomatic giant ventral hernia for 15 years in a 21-year-old female.The patient underwent umbilical hernia repair at the age of 1 year.Approximately 5 years later,ventral hernia recurred and repair with Mesh was performed,but the operation failed due to postoperative infection,and a huge mass appeared in the left abdominal wall.The mass increased gradually with the development and maturity of the body.Computerized tomography scan demonstrated that the patient's total spleen,part of the pancreas and left lobe of the liver were simultaneously herniated through the abdominal incisional hernia.As the patient was unable to endure the inconvenience of life and the potential risk of spleen or liver rupture,she underwent a ventral hernia repair with Mesh at our hospital.The operation was successful and the patient had a good recovery.During a 3-mo follow-up,the patient remained asymptomatic and the appearance of the surgical incision was greatly improved.CONCLUSION Ventral hernia is a common complication of abdominal surgery.Ventral hernia with protrusion of more than two parenchymal organs simultaneously is extremely rare.Surgeons should pay attention to the psychological treatment while restoring the abdominal physiological function in ventral hernia patients.
文摘Over the past decade,medical researchers in China have debated whether the Pi(脾)corresponds to the biomedical spleen or pancreas.This debate exemplifies a broader phenomenon of“anatomical retrofitting”,or the anachronistic imposition of contemporary categories onto living historical objects.“Anatomical retrofitting”as a means of rectifying cases of mistranslation further positions the biomedical spleen and pancreas as representing ahistorical,universal truths.This framework gives rise to a conceptual binary:while the biomedical spleen is universalized as what philosophers may describe as“logical”ontology,the Pi connects to a different nature of reality,or“metaphysical”ontology.Far from being an object of imprecision,the Pi was a dynamic vessel that also shared characteristics with the humoral spleen.Given that scholars in China have already subjected Pi to historical scrutiny,this paper urges scholars to do the same with biomedical anatomy.For instance,historically situating the humoral spleen demonstrates that it became less known and less articulated as it transformed into the biomedical spleen.Meanwhile,the pancreas remained an unstable epistemic object that took on the dynamic functions of the humoral spleen in nineteenth-century organotherapy.Through primary source analysis and literature review,this paper contends that the apparent ontological incommensurability between Pi and spleen is neither mutually exclusive nor irreconcilable.Instead,the dynamic nature of internal viscera,their many functions,and their participation in epistemic practices contribute to an ongoing ontological ambivalence that persists despite the forced certainty of anatomical retrofitting.
文摘209178 Long-term prevention of virus recurrence among recipients with HBV active replication following liver transplantation/Dai Jun(Liver Transplant Center,West Chin Hosp,Sichuan Univ,Chengdu 610041)…∥Chin J Hepatobil Surg.-2009,15(2).-106~109Objective To investigate the long-term prophylactic outcome in recipierts with HBV active replication under LAM or/and HBIG prophylaxis after liver transplantation.Methods The liver biopsy specimens and serum samples were collected during the follow-up.ELISA and chemiluminesent microparticle immunoassay,HBV-DNA fluorescent quantification,immunohistochemisty and HBV-DNA in situ hybridization were performed for analysis.The alteratio of HBV markers in serial biopsy and sera of 55 recipients were investigated retrospectively.Results The mean time of follow-up was 69.14 months.Twelve cases had hepatitis B virus reinfection after transplantation.The accumulated ratio of hepatitis B virus reinfection was 4.8%(2/42)in LAM+HBIG group and 76.9%(10/13) in LAM monoprophylaxis group(P=0.000).The 1-,2-,3-and 4-yr,survival rates in combined prophylaxis group were 100%,97.1%,92.7% and 92.7%,respectively.The 1-,2-,3-and 4-yr survival rates in LAM mono prophylaxis group were 76.9%,69.2%,53.8% and 46.2%,respectively(P=0.000).The rates of hepatitis B virus reinfection in combination prophylaxis group(1-,2-,3-and 4-yr recurrence rates of 2.4%,2.4%,2.4%,and 8.5%,respectively) was markedly lower than those in mono prophylaxis group(1-,2-,3-and 4-yr recurrence rates of 16.1%,41.3%,66.4% and 66.4%,respectively)(P=0.000).Conclusion Currently HBIG combined with LAM is an optimal prophylatic protocol to reduce the hepatitis B virus reifection rate.However,poor compliance of recipients to a prescribed course of prophylaxis as well as viral staus itself is still the main cause of hepatitis B virus reinfection after liver transplantation in China.Compliance education and adjusting the prophylatic protocols according to the viral alteration after liver transplantation may help to further decrease the hepatitis B virus reinfection rate.17 refs,4 tabs.
文摘AIM: To evaluate the safety and feasibility of laparoscopic spleen-preserving distal pancreatectomy (LSPDP) with autologous islet transplantation (AIT) for benign tumors of the pancreatic body-neck.
文摘Here,we report a case of intrapancreatic accessory spleen confirmed by pathologic diagnosis and discuss its differential diagnosis and surgical management with a review of the literature.
基金Supported by the National Natural Science Foundation of China,No.81571697.
文摘BACKGROUND Intrapancreatic accessory spleen(IPAS)is an uncommon condition,with the majority of cases presenting as solid lesions.Thus,this condition is frequently misdiagnosed as pancreatic solid neoplasm.Moreover,splenic cavernous hemangioma is a rare disorder,whereas lesions with a cystic appearance arising from IPAS have not been reported.CASE SUMMARY Herein,we present a case involving a 32-year-old male who had a complex cystic lesion in the tail of the pancreas revealed by conventional ultrasound.The lesion was misdiagnosed as a pancreatic cystadenoma because of its confusing anatomic location,as well as due to its peripheral nodular and internal septal enhancement patterns on contrast-enhanced ultrasound.After multidisciplinary discussion,the patient finally underwent laparoscopic pancreatic body and tail resections.Postoperative pathology demonstrated the lesion to be a cavernous hemangioma arising from the IPAS.CONCLUSION Cavernous hemangioma in the intrapancreatic accessory spleen may mimic pancreatic cystadenoma,which is a condition with the potential to be malignant.Imaging follow-ups or surgical interventions may be helpful for the exclusion of malignant risks in complicated cystic lesions,especially those with parietal and septal enhancements.
文摘目的探讨腹腔镜下Kimura法和Warshaw法两种保脾胰体尾切除术的围术期疗效与安全性。方法回顾性分析2017年8月至2023年8月于空军军医大学西京医院接受腹腔镜下保脾胰体尾切除术的133例患者临床资料,根据手术方式不同分为Kimura组(77例)和Warshaw组(56例),比较两组患者手术时长、术中出血量等围术期指标及术后胰瘘发生率、脾梗死等并发症发生情况。结果Kimura组和Warshaw组两组患者在手术时长[(215.8±64.8)min vs(193.5±77.6)min]、术中出血量[(194.2±53.7)mLvs(176.5±69.2)mL]、术后排气及禁食时间[2(1)d vs 3(1)d]、术后住院时间[9(4)d vs 8(3)d]等围术期指标及术后胰瘘(3例vs 4例)、脾梗死(0例vs 3例)、腹腔积液(3例vs 2例)、腹腔感染(2例vs 1例)等并发症发生情况方面比较差异均无统计学意义(P>0.05)。结论腹腔镜下Kimura法和Warshaw法两种保脾胰体尾切除术对于胰体尾良性及低度恶性肿瘤均是安全有效的手术方式,且围术期疗效相当。
