Effect of post-transplant double filtration plasmapheresis on recurrent focal and segmental glomerulosclerosis in renal transplant recipients

In the present study, we reviewed the effect of post-transplant double filtration plasmapheresis (DFPP) on recurrent focal segmental glomerulosclerosis (FSGS) in the transplanted kidney allograft. Sixteen patients with post-transplant recurrent FSGS were enrolled in this study. Out of 16 patients with recurrent FSGS after transplantation, five did not receive DFPP and lost their grafts, while 11 did receive DFPP and four of these patients lost their grafts. Seven patients were able to maintain normal renal function for an average observation period of 57.1 +/- 40.7 months (range 7-125 months). In five patients who had a significant reduction in urinary protein after DFPP, the urinary protein level decreased from 26.60 +/- 23.05 g/day (range 3.34-62.6 g/day) to 2.95 +/- 3.42 g/day (range 0.02-8.64 g/day) and renal function was maintained. The beneficial effects of DFPP on graft outcome were more likely to occur if the patients experienced a marked drop in urinary excretion. Thus, post-transplant DFPP appears to be effective for reducing urinary protein levels and improving long-term graft survival. With the small numbers in this trial, however, none of the findings were statistically significant. We recommend the use of post-transplant DFPP to prevent the progression of recurrent FSGS.     

Recurrent rectal prolapse

PURPOSE: The aim of this study was to assess the clinical and functional outcome of surgery for recurrent rectal prolapse and compare it with the outcome of patients who underwent primary operation for rectal prolapse. METHODS: All patients who underwent surgery for rectal prolapse were evaluated for age, gender, procedure, anorectal manometry and electromyography findings, and morbidity. The results for patients who underwent surgery for recurrent rectal prolapse were compared with a group of patients matched for age, gender, surgeon, and procedure who underwent primary operations for rectal prolapse. RESULTS: A total of 115 patients underwent surgery for rectal prolapse. Twenty-seven patients, 10 initially operated on at this institution and 17 operated on elsewhere, underwent surgery for recurrent rectal prolapse. These 27 patients were compared with 27 patients with primary rectal prolapse operated on in our department. In the recurrent rectal prolapse group, prior surgery included rectopexy in 7 patients, Delorme's procedure in 7 patients, perineal rectosigmoidectomy in 7 patients, anal encirclement procedure in 4 patients, and resection rectopexy in 2 patients. Operations performed for recurrence were perineal rectosigmoidectomy in 14 patients, resection rectopexy in 8 patients, rectopexy in 2 patients, pelvic floor repair in 2 patients, and Delorme's procedure in 1 patient. There were no statistically significant differences between the groups in preoperative incontinence score (recurrent rectal prolapse, 13.6±7.8vs. rectal prolapse, 12.7±7.2; range, 0–20) or manometric or electromyography findings, and there were no significant differences in mortality (0vs. 3.7 percent), mean hospital stay (5.4±2.5vs. 6.9±2.8 days), anastomotic complications (anastomotic stricture (0vs. 7.4 percent), anastomotic leak (3.7vs. 3.7 percent) and wound infection (3.7vs. 0 percent)), postoperative incontinence score (2.8±4.8vs. 1.5±2.7), or recurrence rate (14.8vs. 11.1 percent) between the two groups at a mean follow-up of 23.9 (range, 6–68) and 22 (range, 5–55) months, respectively. The overall success rate for recurrent rectal prolapse was 85.2 percent. CONCLUSION: The outcome of surgery for rectal prolapse is similar in cases of primary or recurrent prolapse. The same surgical options are valid in both scenarios.Funded in part by a generous grant from the Eleanor Naylor Dana Charitable Trust Fund and the Caporella Family.Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, Philadelphia, Pennsylvania, June 22 to 26, 1997.     

甘露聚糖肽注射液联合羟基喜树碱预防浅表性膀胱癌术后复发的临床疗效观察

目的:观察甘露聚糖肽注射液联合羟基喜树碱预防浅表性膀胱癌术后复发的临床疗效观察。方法:选取本院2012年4月至2014年2月收治的浅表性膀胱癌患者50名,随机分为羟基喜树碱组和羟基喜树碱+甘露聚糖肽组,每组25例,观察药物治疗后对患者一年、两年及三年内癌症复发率、不良反应,采用ELISA法检测对尿液中IL-8的影响,利用案例分析法、比较分析法及统计学方法分析结果。结果:灌注1、2、3、4、5次后羟基喜树碱组患者IL-8含量均高于甘露聚糖肽与羟基喜树碱联用组,且均有统计学意义(P<0.05),与联用组治疗前比较,灌注后IL-8水平也明显下降。结果预示甘露聚糖肽联合羟基喜树碱可显著降低患者IL-8水平从而有效预防膀胱癌复发,效果优于羟基喜树碱单用。结论:甘露聚糖肽注射液联合羟基喜树碱膀胱灌注能显著降低浅表性膀胱癌患者术后的复发率、不良反应,并且可以降低患者尿液中IL-8含量。     

14例食管癌放疗后复发再程放疗的疗效观察

目的:观察食管癌放疗后复发再程放疗的疗效.方法:对14例再程放疗的食管癌患者采用Varian 23EX电子直线加速器适形放疗,1.2Gy/次,2次/日,总剂量DT33~62Gy,放疗2~3周.结果:10例病变消退(8例食道黏膜恢复,2例癌性狭窄,采用球囊扩张扩大食道,可正常进食),无效3例病灶扩大,1例发生呕血,死亡;未发生放射性脊髓炎,有不同程度放射性食管炎;1年存活率50.00%、2年存活率28.57%.结论:放疗后复发再程放疗,有助于消除食管癌复发症状,改善患者生存质量,安全可靠,但仍有部分患者难获显著疗效.     

经口内镜下食管憩室肌切开术治疗食管憩室的疗效分析

探讨经口内镜下食管憩室肌切开术治疗食管憩室的中远期疗效以及术后憩室复发的危险因素。方法　对2016年5月1日—2019年8月1日在东南大学附属中大医院接受经口内镜下食管憩室肌切开术治疗的31例食管憩室病例进行回顾性研究,主要观察术后Eckardt评分、治疗成功率和复发率,并采用多因素Logistic回归模型分析术后憩室复发的独立危险因素。结果　31例均顺利完成经口内镜下食管憩室肌切开术,术后随访（30.6±11.1）个月（20~63个月）。31例术前Eckardt评分（8.2±2.4）分,术后1个月（1.4±0.7）分,术后6个月（1.4±1.1）分,术后12个月（1.3±1.1）分,术后24个月（1.3±0.9）分,与术前比较,术后各随访时间点的Eckardt评分均有明显下降（P<0.001）。术后随访1、6、12、24个月的治疗成功率分别为96.8%（30/31）、90.3%（28/31）、90.3%（28/31）和90.3%（28/31）。有3例复发,总复发率为9.7%（3/31）。Logistic回归分析结果显示,病程（P=0.038,OR=1.041,95%CI：1.002~1.080）和术前Eckardt评分（P=0.024,OR=2.299,95%CI：1.117~4.728）是影响术后憩室复发的独立危险因素。结论　经口内镜下食管憩室肌切开术治疗食管憩室的中远期疗效理想,但病程长、术前Eckardt评分高者易复发。     

Impact of spatio-temporal recurrence pattern on overall survival for invasive intraductal papillary mucinous neoplasia – A comparison with pancreatic ductal adenocarcinoma

BackgroundResections for intraductal papillary mucinous neoplasia (IPMN) have increased dramatically during the last decade. Recurrence pattern and impact of adjuvant chemotherapy for solid pancreatic ductal adenocarcinoma (PDAC) is well known, but not for invasive IPMN (inv-IPMN).ObjectivesTo elucidate the impact of spatio-temporal recurrence pattern and adjuvant chemotherapy on overall survival for inv-IPMN compared with PDAC.MethodsWe conducted a retrospective single-center observational study of consecutive patients ≥18 years of age who underwent resection for inv-IPMN or PDAC at Karolinska University Hospital, between 2009 and 2018. Different initial recurrence sites and time frames as well as predictors for death were assessed with multivariable Cox and logistic regressions. Survival analyses were performed using the Kaplan-Meier model and log rank test.ResultsOf 396 resected patients, 92 were inv-IPMN and 304 PDAC. Both recurrence rate and death rate within three-years were lower for inv-IPMN compared to PDAC (p = 0.006 and p = 0.007 respectively). Across the whole cohort, the most common recurrence patterns were multi-site (25%), single-site liver (21%) and single-site locoregional (10%) recurrence. The most prominent predictors for death in multivariable Cox regression, especially if occurred within the first year, were multi-site (HR 17.0), single-site peritoneal (HR 13.6) and single-site liver (HR 13.1) recurrence. These predictors were less common in inv-IPMN compared to PDAC (p = 0.007). The effect of adjuvant chemotherapy was similar in the two groups.ConclusionResected inv-IPMN exhibits a less aggressive recurrence pattern than PDAC that translates into a more favorable overall survival.     

Invasive IPMN relapse later and more often in lungs in comparison to pancreatic ductal adenocarcinoma

BackgroundThe different oncological outcomes of invasive intraductal papillary mucinous neoplasm (I-IPMN) and pancreatic ductal adenocarcinoma (PDAC) are debated. This study aimed to compare disease recurrence patterns and histopathological characteristics in patients with resected I-IPMN and PDAC.MethodsConsecutive patients undergoing surgical resection for stage I-III I-IPMN or PDAC between 2010 and 2016 were retrospectively analyzed. Patients treated with neoadjuvant therapy or resected for Tis neoplasia were excluded. All surgical specimens were re-staged according to AJCC-8th-edition.ResultsA total of 330 patients were included, of whom 43 had I-IPMN and 287 had PDAC. Median follow-up time was 26.7 (1.3–92.3) months and estimated median disease-free survival (DFS) was 60.3 months (47.2–73.4) for I-IPMN and 23.8 (19.3–28.2) months for PDAC (p < 0.001). During follow-up, 32.6% of I-IPMN and 67.9% of PDAC patients experienced recurrence (p < 0.001). The sites of first recurrence were the lungs (38.5% vs 13.1%, p = 0.027), liver (28.6% vs 45.0%, p = 0.180) and local (15.4% vs 36.6%, p = 0.101) for I-IPMN and PDAC, respectively. At multivariate analysis, I-IPMN histology remained an independent predictive factor for longer DFS (OR 0.528, CI 95% 0.278–1.000, p = 0.050), regardless of stage or adjuvant chemotherapy. I-IPMN and PDAC differed in rates of neuroinvasion (51.2% vs 97.2%) and positive lymph node status (N+) (46.5% vs 82.7%), especially in patients with lower T status.ConclusionI-IPMN showed a different recurrence pattern compared to PDAC, with a higher lung tropism, and longer DFS. This different biological behavior is associated with lower rates of neuroinvasion and nodal involvement, especially in early-stage disease.     

Clinical analysis of the risk factors for recurrence of HCC and its relationship with HBV

AIM: To comprehend the risk factors of recurrence of hepatocellular carcinoma (HCC) and its relationship with the infection patterns of hepatitis B virus (HBV).METHODS: All materials of 270 cases of postoperative HCC were statistically analyzed by SPSS software.Recurrence and metastasis were classified into early( ≤2 years) and late phase (&gt;2 years). Risk factors for recurrence and metastasis after surgery in each group were analyzed.RESULTS: Out of 270 cases of HCC, 162 cases were followed up in which recurrence and metastasis occurred in 136 cases. There were a lot of risk factors related to recurrence and metastasis of HCC; risk factors contributing to early phase recurrence were serum AFP level, vascular invasion, incisal margin and operative transfusion, gross tumor classification and number of intrahepatic node to late phase recurrence. The HBV infective rate of recurrent HCC was 94.1%, in which ““HBsAg, HBeAb, HBcAb““ positive pattern reached 45.6%. The proportion of HBV infection in solitary large hepatocellular carcinoma (SLHCC)evidently decreased compared to nodular hepatocellular carcinoma (NHCC) (P&lt;0.05).CONCLUSION: The early and late recurrence and metastasis after hepatectomy of HCC were associated with different risk factors. The early recurrence may be mediated by vascular invasion and remnant lesion, the late recurrence by tumor‘s clinical pathology propert, as multicentric carcinogenesis or intrahepatic carcinoma de novo. HBV replication takes a great role in this process.From this study, we found that SLHCC has more satisfactory neoplasm biological behavior than NHCC.