Reconstruction of the abdominal wall by using a combination of the human acellular dermal matrix implant and an interpositional omentum flap after extensive tumor resection in patients with abdominal wall neoplasm: A preliminary result

AIM： To present our trial using a combination of the human acellular dermal matrix （HADM） implant and an interpositional omentum flap to repair giant abdominal wall defects after extensive tumor resection. METHODS： Between February and October of 2007, three patients with giant defects of the abdominal wall after extensive tumor resection underwent reconstruction with a combination of HADN and omentum flap. Postoperative morbidities and signs of herniation were monitored. RESULTS： The abdominal wall reconstruction was successful in these three patients, there was no severe morbidity and no signs of herniation in the follow-up period. CONCLUSION： The combination of HADM and omentum flap offers a new, safe and effective alternative to traditional forms in the repair of giant abdominal wall defects. Further analysis of the long-term outcome and more cases are needed to assess the reliability of this technique.

Abdominal wall actinomycosis simulating a malignant neoplasm:Case report and review of the literature

Abdominal wall actinomycosis is a rare disease frequently associated with the presence of an intra uterine device.We report on a case of a 47-year-old woman who had used an intrauterine device for many years and had removed it about a month prior to the identif ication of an abdominal wall abscess caused by Actinomyces israelii.The abscess mimicked a malignancy and the patient underwent a demolitive surgical treatment.The diagnosis was obtained only after histopathological examination.Postoperatively,the patient developed an infection of the wound which was treated with daily medication.The combination of long-term high dose antibiotic therapy with surgery led to successful treatment.

Diagnostic Value of Mini-laparoscopy in Patients with Abdominal Neoplasm

Objective：Blood biochemistry,ascites tests,and imaging examinations have low sensitivities in abdominal neoplasm diagnoses.In addition,exploratory laparotomy is not suitable for final stage patients.Mini-laparoscopy has recently emerged as a new diagnostic technology for abdominal disease.The aim of this research was to evaluate the value of mini-laparoscopy in diagnosing abdominal neoplasms.Methods：Clinical and operational data were retrospectively analyzed in 20 cases with pathologically confirmed abdominal malignancies.Of these,10 cases were each diagnosed by mini-laparoscopy and exploratory laparotomy.The surgical and anesthesia expenses,perioperative nursing,monitoring and treating charges,postoperative hospital stay and complications were compared between groups.Results：The surgical and anesthesia costs were statistically lower in patients who received a mini-laparoscopy （P0.01）.Perioperative drug expenses and nursing and monitoring charges were also significantly decreased （P0.05 and P0.01,respectively）.Further,the gastrointestinal function recovery time and postoperative hospital stay were significantly reduced in the mini-laparoscopy group.There was no significant difference between the two groups regarding the preoperative hospital stay and postoperative complications.Conclusion：Mini-laparoscopy effectively reduces surgical injury and treatment costs,and is capable of safely diagnosing abdominal tumors.Moreover,the procedure is also easy to perform.

Intra-abdominal ectopic bronchogenic cyst with a mucinous neoplasm harboring a GNAS mutation: A case report

BACKGROUND Bronchogenic cysts are congenital cysts caused by abnormal sprouting from the ventral foregut during fetal life.They usually occur in the mediastinum or lung,but there are very rare cases of ectopic bronchogenic cysts that develop in the abdominal cavity.A unique intra-abdominal ectopic bronchogenic cyst with a mucinous neoplasm that was producing carcinoembryonic antigen(CEA),harboring a GNAS mutation,is reported.The present case may contribute to clarifying the mechanism of tumorigenesis and malignant transformation of ectopic bronchogenic cysts.CASE SUMMARY In 2007,a man in his 50s was incidentally found to have an intra-abdominal cystic mass,8 cm in diameter.Surgical resection was recommended,but he preferred to remain under observation.In 2020,his serum CEA level increased to 26.7 ng/mL,and abdominal computed tomography showed a 15 cm×12 cm,multifocal,cystic mass located predominantly on the lesser curvature of the stomach.Since malignancy could not be ruled out,he finally underwent surgical resection.Histologically,the cystic wall was lined by ciliated columnar epithelium,accompanied by bronchial gland-like tissue,bronchial cartilage,and smooth muscle.Part of the cyst consisted of atypical columnar epithelium with an MIB-1 index of 5%and positive for CEA.Moreover,a GNAS mutation(p.R201C)was detected in the atypical epithelium,leading to a diagnosis of an ectopic bronchogenic cyst with a low-grade mucinous neoplasm.The patient is currently undergoing outpatient follow-up without recurrence.CONCLUSION An extremely rare case of an abdominal bronchogenic cyst with a low-grade mucinous neoplasm harboring a GNAS mutation was reported.

Malignant myopericytoma originating from the colon: A case report

BACKGROUND Myopericytoma is a benign tumor that typically occurs within subcutaneous tissue and most often involves the distal extremities,followed by the proximal extremities,neck,thoracic vertebrae and oral cavity.Complete resection is often curative.Malignant myopericytoma is extremely rare and has a poor prognosis.Here,we report for the first time a case of malignant myopericytoma originating from the colon.CASE SUMMARY A 69-year-old male was admitted to our hospital with right upper quadrant pain for five days.Imaging suggested a liver mass with hemorrhage.A malignant hepatic tumor was the initial diagnosis.Surgical resection was performed after a complete preoperative work up.Initial postoperative pathology suggested that the mass was a malignant myoblastoma unrelated to the liver.Four months after the first surgery,an enhanced computed tomography(CT)scan revealed a recurrence of the tumor.The diagnosis of malignant myopericytoma derived from the colon was confirmed on histopathological examination of the specimen from the second surgery.The patient did not return to the hospital regularly for surveillance.The first postoperative abdominal CT examination six months after the second surgery demonstrated multiple liver metastases.Survival time between the diagnosis of the tumor to death was approximately one year.CONCLUSION Malignant myopericytoma is a rare cancer.Preoperative diagnosis may be difficult.Due to a lack of treatment options,prognosis is poor.

Diffusion-weighted MRI in abdominal oncology:Clinical applications

Diffusion-weighted magnetic resonance imaging(DWI) provides image contrast that is different from that obtained by conventional magnetic resonance techniques.Although previously,DWI has been used to evaluate various diseases of the central nervous system,several technical advances have expanded the clinical applications of DWI beyond the central nervous system.As a result,many reports have been published on the use of DWI in abdominal diseases.Particularly,abdominal DWI has now being focused on evaluation of patients with abdominal cancer.DWI can be used for pretreatment tumor detection,characterization including predicting tumor response to therapy,monitoring tumor response during therapy,and follow-up study after treatment to detect possible tumor recurrence.

Nude mice multi-drug resistance model of orthotopic transplantation of liver neoplasm and Tc-99m MIBI SPECT on p-glycoprotein

AIM: To establish a model of drug-resistant neoplasms using a nude mice model, orthotopic transplantation of liver neoplasm and sporadic abdominal chemotherapy. METHODS: Hepatocellular carcinoma cells HepG2 were cultured and injected subdermally to form the tumor-supplying mice. The orthotopic drug-resistant tumors were formed by implanting the tumor bits under the envelope of the mice liver and induced by abdominal chemotherapy with Pharmorubicin. Physical examination, ultrasonography, spiral CT and visual inspection were used to examine tumor progression. RT-PCR and immunohistochemistry were used to detect expression of mdr1 mRNA and its encoded protein p-glycoprotein (p-gp). Tc-99m sestamibi scintigraphy was performed by obtaining planar abdominal images at 20 min after injection, and the liver/heart ratios were calculated. RESULTS: Post-implantation mortality was 0% (0/25), tumor implantation success was 90% (22/25), and the rate of implanting successfully for the second time was 100% (3/3). Tumor induction using Pharmorubicin was 80% (16/20). The mdrl mRNA expression of the induced group was 23 times higher than that of the control group, and p-gp protein expression was 13-fold higher compared to the control group. The liver/heart ratio (as assessed in vivo, using Tc-99m radiography) was decreased significantly in the induced group as compared to the control group. CONCLUSION: We have established an in vivo model of mdrl in nude mice by orthotopic transplantation of liver neoplasm coupled to chemotherapy. We propose that identification of drug resistance as characterized by decreased 99mTc-ppm radiography due to enhanced clearance by p-gp may be useful in detecting in vivo drug resistance, as well as a useful tool in designing more effective therapies.

检测肺癌中辅助性T细胞(Th_1/Th_2)的临床意义

目的 探讨辅助性T细胞Th1 和Th2 细胞因子对肺癌患者的临床意义 ,为肿瘤的免疫治疗提供依据。方法 采用放射免疫 (RIA)和酶联免疫吸附法 (ELISA)检测 86例肺癌患者、5 9例肺良性病患者及45例正常对照辅助性T细胞分泌的细胞因子。以IL 2和TNF α的水平代表Th1 型细胞因子 ,IL 4、IL 6和IL 8的水平代表Th2 型细胞因子。结果 肺癌患者IL 2 [( 2 4.6± 12 .0 ) μg/L]的水平显著低于肺良性病患者[( 71.1± 2 5 .4) μg/L] (t =3 .82 ,P <0 .0 1)和正常对照 [( 69.3± 19.5 ) μg/L] (t =2 .76,P <0 .0 1) ,IL 6[( 0 .13± 0 .0 4) μg/L]的水平显著低于正常对照 [( 0 .2 3± 0 .0 5 ) μg/L ) (t =3 .3 9,P <0 .0 1) ,IL 4[( 2 5 4.2±78.0 ) μg/L]、IL 8[( 0 .49± 0 .16) μg/L]、TNF α[( 2 .76± 1.12 ) μg/L]的水平明显高于肺良性病患者 [( 63 .6± 18.6) μg/L ,( 0 .3 6± 0 .18) μg/L ,( 0 .96± 0 .2 0 ) μg/L]及正常对照 [( 60 .9± 19.6) μg/L ,( 0 .3 5± 0 .0 7) μg/L ,( 0 .93± 0 .19) μg/L] (t值分别为 4.10、4.89和 3 .76,P均 <0 .0 1) ,肺良性病患者和正常对照之间的IL 2、TNF α、IL 4、IL 8均未见明显差异 (P >0 .0 5 ) ,肺癌组IL 6的水平与肺良性病组 [( 0 .15± 0 .0 4)

Tomotherapy摆位误差修正的精度及其对PTV外放边界的影响

目的探讨Tomotherapy兆伏级CT(megavoltage CT,MVCT)摆位误差修正的精度及其对计划靶区(planning target volume,PTV)外放边界的影响。方法选取头颈部、胸部和腹部肿瘤患者各20例。每例患者治疗期间各随机选6次治疗,每次治疗前行MVCT扫描、配准,得到摆位修正前误差数据,摆位修正后再进行1次MVCT扫描、配准,得到修正后的误差数据,分析修正前和修正后误差分布情况,并计算MVCT摆位修正前、后因摆位误差引起的PTV外放边界大小。结果摆位修正后的摆位误差比修正前下降,所有部位修正后摆位误差的平均值均≤0.5 mm。在每次治疗前进行误差修正的情况下,所有部位因摆位误差引起的PTV外放边界均<2 mm。结论MVCT摆位误差修正可减小PTV外放边界大小,修正后精度非常高,可保证Tomotherapy治疗摆位的精度。

Pain sensation in pancreatic diseases is not uniform: The different facets of pancreatic pain

AIM: To systematically characterize specific pain patterns in the most frequent pancreatic diseases.

C-reactive protein,procalcitonin,interleukin-6,vascular endothelial growth factor and oxidative metabolites in diagnosis of infection and staging in patients with gastric cancer

AIM:The current study was to determine the serum/pLasma levels of VEGF,IL-6,malondialdehyde (MDA),nitric oxide (NO),PCT and CRP in gastric carcinoma and correlation with the stages of the disease and accompanying infection. METHODS:We examined the levels of serum VEGF,IL-6, PCT,CRP and plasma MDA,NO in 42 preoperative gastric cancer patients and 23 healthy subjects.There were infection anamneses that had no definite origin in 19 cancer patients. RESULTS:The VEGF levels (mean±SD; pg/mL) were 478.05±178.29 and 473.85±131.24 in gastric cancer patients with and without infection,respectively,and these values were not significantly different (P>0.05).The levels of VEGF, CRP,PCT,It-6,MDA and NO in cancer patients were significantly higher than those in healthy controls and the levels of CRP,PCT,It-6,MDA and NO were statistically increased in infection group when compared with non- infection group (P<0.001). CONCLUSION:Although serum VEGF concentrations were increased in gastric cancer,this increase might not be related to infection.CRP,PCT,IL-6,MDA and NO have obvious drawbacks in the diagnosis of infections in cancer patients. These markers may not help to identify infections in the primary evaluation of cancer patients and hence to avoid unnecessary antibiotic treatments as well as hospitalization. According to the results of this study,IL-6,MDA,NO and especially VEGF can be used as useful parameters to diagnose and grade gastric cancer.

Overlooked diagnosis of Castleman disease within the abdomen

Castleman disease is a rare disorder of the lymphoid tissue,characterized by lymph node enlargement with distinctive histologic features.It usually occurs within the mediastinum and rarely within the abdomen.It is usually indistinguishable from other mediastinal and hilar masses before determining a surgical approach.We present two cases of Castleman disease within the abdomen mimicking a neoplasm.

Sarcomatoid carcinoma of the pancreas—a rare tumor with an uncommon presentation and course:A case report and review of literature

BACKGROUND Sarcomatoid carcinoma of the pancreas(SCP)is a rare type of pancreatic neoplasm,and only a few cases have been described in the literature.Histologically,it is composed mostly of atypical spindle cells with apparent sarcomatous features.CASE SUMMARY This is a report of a 61-year-old Chilean woman who underwent medical investigation for acute abdominal pain.Computed tomography identified a solid tumor in the tail of the pancreas with features suspicious of malignancy.En-bloc distal pancreatectomy and splenectomy were performed to excise the tumor.Histopathology and immunohistochemistry were confirmatory of sarcomatoid carcinoma with lymphovascular invasion.After surgery,the patient did not receive chemotherapy.Previous studies indicate a poor prognosis for this type of malignancy.However,our patient has survived for 35 mo with no recurrence to date.CONCLUSION The case presented herein is a patient with an SCP with a rare presentation and long-term survival after surgery despite not receiving adjuvant chemotherapy.

主动脉腔内修复术治疗腹主动脉瘤或夹层合并腹部恶性肿瘤

目的 观察主动脉腔内修复术(EVAR)治疗腹主动脉瘤(AAA)或腹主动脉夹层(AAD)合并腹部恶性肿瘤的价值。方法 回顾性分析17例接受EVAR治疗的AAA(n=14)/AAD(n=3)合并腹部恶性肿瘤患者,其中12例于EVAR后接受腹腔镜肿瘤切除术、1例接受开腹肿瘤切除术,4例因心肺功能欠佳仅接受药物治疗;观察EVAR治疗效果。结果 EVAR成功率为100%,术中无严重不良反应及并发症;术后1个月CTA显示支架位置良好、通畅。术后随访1~28个月,期间均未见明显并发症,亦未见AAA/AAD相关死亡病例。结论 EVAR治疗AAA/AAD合并腹部恶性肿瘤效果较佳。

胰腺导管腺癌腹腔隐匿性转移术前预测模型的构建

目的建立能有效预测胰腺导管腺癌腹腔隐匿性转移发生风险的术前预测模型。方法回顾性分析2018年9月至2020年12月我科收治的986例行手术治疗的胰腺导管腺癌患者的临床资料,将单因素分析中P≤0.2的变量纳入二元logistic回归模型,筛选出腹腔隐匿性转移的独立预测因素,并据此建立列线图预测模型。使用ROC曲线评估该预测模型预测腹腔隐匿性转移的能力。结果986例胰腺导管腺癌患者中腹腔隐匿性转移的发生率为8.42%(83/986);男593例(60.14%)、女393例(39.86%);年龄为(62.40±9.43)岁。单因素分析显示,腹腔隐匿性转移与腹痛、腹痛时间、总胆红素、前白蛋白、丙氨酸转氨酶、天冬氨酸转氨酶、碱性磷酸酶、乳酸脱氢酶、癌胚抗原、甲胎蛋白、糖类抗原(CA)125、CA19-9、CA724、腹水、肿瘤大小、肿瘤部位、突破被膜、侵犯周围脏器、腹腔干侵犯程度、肠系膜上动脉侵犯程度、脾动脉侵犯程度、脾静脉侵犯程度、第9组可疑淋巴结转移、第13组可疑淋巴结转移、第14组可疑淋巴结转移、第17组可疑淋巴结转移、腹膜后存在可疑淋巴结转移、肝可疑转移瘤、肝可疑转移瘤位置、腹腔不确定性病灶、腹腔手术史有关(P均<0.05)。多因素二元logistic回归分析显示,年龄、腹水、肿瘤短径、侵犯周围脏器、肠系膜上动脉侵犯程度、第13组可疑淋巴结转移、肝可疑转移瘤、腹腔不确定性病灶、腹腔手术史是胰腺导管腺癌发生腹腔隐匿性转移的独立预测因素。基于上述独立预测因素构建列线图预测模型,该模型预测胰腺导管腺癌腹腔隐匿性转移的ROC AUC值为0.783(P=0.001),最佳临界风险评分为77.68,灵敏度为0.650,特异度为0.787。结论本研究建立的列线图预测模型有助于提高胰腺导管腺癌腹腔隐匿性转移的术前诊出率。

右美托咪定对老年糖尿病患者腹部肿瘤根治术后心肌损伤的影响

目的探讨右美托咪定对老年糖尿病患者腹部肿瘤根治术后心肌损伤的影响。方法选择择期行腹部肿瘤根治术的2型糖尿病患者92例,男50例,女42例,年龄≥65岁,BMI 18~28 kg/m^(2),ASAⅡ或Ⅲ级。将患者随机分为两组:右美托咪定组(D组)和对照组(C组)。D组于麻醉诱导前静脉泵注右美托咪定1μg/kg,给药时间为10~15 min,随后以0.5μg·kg^(-1)·h^(-1)的速度静脉泵注至手术结束前30 min;C组给予等量生理盐水。记录入室时、术毕即刻、术后6、24 h时血浆肌酸激酶同工酶(CK-MB)、肌钙蛋白I(cTnI)、丙二醛(MDA)、超氧化物歧化酶(SOD)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)和白细胞介素-10(IL-10)的浓度、HR和MAP。记录术中不良事件(低血压、心动过缓以及心动过速)的发生情况。记录入PACU 10 min时、出PACU时、术后6、24 h的疼痛数字评价量表(NRS)评分。记录术后拔管时间、PACU停留时间、苏醒期躁动、术后心血管事件(低血压、心动过缓、室性早搏、心肌缺血)的发生情况。结果与入室时比较,术毕即刻、术后6、24 h两组CK-MB、cTnI、MDA、TNF-α、IL-6、IL-10浓度明显升高(P<0.05),SOD浓度明显降低(P<0.05),术毕即刻两组MAP明显降低(P<0.05),C组HR明显减慢(P<0.05)。与C组比较,术毕即刻、术后6、24 h D组CK-MB、cTnI、MDA、TNF-α、IL-6浓度明显降低(P<0.05),SOD、IL-10浓度明显升高(P<0.05),术毕即刻HR明显增快(P<0.05),MAP明显升高(P<0.05),术中低血压、心动过速、入PACU 10 min和出PACU NRS评分以及苏醒期躁动、术后低血压、心动过缓的发生率明显降低(P<0.05)。结论右美托咪定可改善老年糖尿病患者腹部肿瘤根治术后的氧化应激及炎症反应,减轻术后心肌损伤。

小儿腹部中高危神经母细胞瘤新辅助化疗CT测量评价方法比较

目的:比较小儿腹部中高危神经母细胞瘤新辅助化疗CT测量评价方法。方法:回顾性选取我院接受新辅助化疗的49例腹部中高危神经母细胞瘤,男31例,女18例,年龄2~144月。基于CT图像测量肿瘤在新辅助化疗前后的一维、二维和三维指标,并基于椭圆形公式计算肿瘤体积。逐层勾画肿瘤三维感兴趣区并得到勾画体积。计算不同测量指标在肿瘤新辅助化疗前后的改变。以勾画体积为参考标准,分析不同测量指标的相关性及一致性。结果:化疗前后的不同测量指标均与勾画体积具有显著正相关性(P均<0.001)。化疗前计算体积与勾画体积具有统计学差异(P<0.05),而化疗后计算体积与勾画体积无统计学差异(P>0.05)。化疗前后的不同测量指标比值与勾画体积比值均具有显著正相关性(P均<0.001)。计算体积比值与勾画体积比值无统计学差异(P<0.05),而一维、二维及三维测量比值与勾画体积比值均具有统计学差异(P均<0.001)。结论:一维、二维及三维测量虽然与腹部神经母细胞瘤在新辅助化疗后的体积改变均具有显著的正相关性,但均低估了腹部神经母细胞瘤对新辅助化疗的治疗反应,而根据椭圆形公式计算得出的体积改变更有助于反映腹部神经母细胞瘤在新辅助化疗后的实际改变。

胰腺癌腹腔转移诊断方式的研究进展

转移发生较早是胰腺癌预后差的重要因素之一。及早发现腹腔转移能够促使患者尽早接受新辅助治疗和转化治疗,避免了非必要的手术创伤。本文综述了影像学方法、实验室方法及联合多方式综合评估等手段对胰腺癌腹腔转移的诊断效能,简述了CT、MRI、超声、肿瘤标志物及miRNA检测等方式在胰腺癌腹腔转移中的应用,并总结了部分采用多类指标综合评判从而提高转移风险预测能力的相关研究成果,以期为临床诊断方式的选择和应用提供借鉴。

BEP与ACM化疗方案治疗滋养细胞肿瘤患者的疗效对比

【目的】对比博莱霉素(BLM)、依托泊苷(VP-16)、顺铂(DDP)联合化疗(BEP)与放线菌-D(Act-D)、环磷酰胺(CTX)、甲氨蝶呤(MTX)三联序贯化疗(ACM)治疗滋养细胞肿瘤(GTN)患者的疗效及对妊娠结局的影响。【方法】选取2020年2月至2021年5月本院收治的102例GTN患者,按照随机数字表法分为BEP组(给予BEP治疗)和ACM组(给予ACM治疗),每组51例。比较两组患者临床疗效、性生活恢复时间、性功能评分、不良反应发生率、妊娠结局及治疗前后卵巢功能指标[雌二醇(E_(2))、黄体生成素(LH)及卵泡雌激素(FSH)]。【结果】治疗后,两组总有效率比较,差异无统计学意义(χ^(2)=1.041,P=0.308)。治疗后,两组患者E_(2)、LH及FSH水平均降低(P<0.05),但ACM组E_(2)、LH及FSH水平均高于BEP组(P<0.05)。两组化疗后性生活恢复时间、性功能评分比较,差异无统计学意义(t=0.293、1.814,P=0.770、0.073)。两组不良反应总发生率比较,差异无统计学意义(χ^(2)=1.055,P=0.316)。ACM组妊娠成功率高于BEP组(χ2=4.767,P<0.05)。【结论】BEP、ACM化疗方案治疗GTN的疗效相当,不良反应发生率接近,但ACM化疗对GTN患者的卵巢功能影响较小,有利于提高治疗后妊娠成功率。