A rare cause of acute abdominal pain in adolescence: Hydrosalpinx leading to isolated torsion of fallopian tube

Torsion of the fallopian tube accompanying hydrosalpinx is a rare occurrence in the pediatric population. This report describes a 13 year old sexually inactive girl with isolated tubal torsion due to hydrosalpinx. The girl had lower left abdominal pain for two days. The physical examination revealed left lower quadrant tenderness with a firm round anterior mass on rectal examination. Abdominal ultrasound showed left tubal enlargement with free pelvic peritoneal fluid. Magnetic Resonance Imaging (MRI) showed engorgement and dilatation of the left fallopian tube without contrast enhancement suspicious of tubal torsion. At operation, torsion of the left tube on its longitudinal axis was observed, and a salpingectomy was performed.     

320排CT靶重建联合MRI扫描对孤立性肺结节中早期周围型肺癌的诊断价值

目的 探讨320排CT靶重建联合MRI扫描在孤立性肺结节良、恶性鉴别诊断及肺癌早期诊断中的价值。方法 回顾性分析延安市人民医院320排640层CT低剂量扫描、CT标准靶重建、联合1.5TMRI检查,对临床检出的42例肺内孤立结节(SPN)进行相关诊断研究,分析本项技术是否能够明显提高诊断的准确率。结果 42例可疑孤立性肺小结节中检出42例检出率为100%,常规CT扫描病变检出正确例数28例正确率为66.67%,靶重建后检出正确例数为34例准确率为80.95%,联合CT靶重建及MRI检出正确例数40例,准确率可高达95.42%。结论 CT靶重建技术联合MRI扫描简单易行,患者容易接受,且能提高诊断的准确性。     

Isolated Hepatic Perfusion for the Treatment of Patients With Colorectal Cancer Liver Metastases After Irinotecan-Based Therapy

Background Irinotecan given with 5-fluorouracil and leucovorin is currently used as first-line therapy for patients with metastatic colorectal cancer (CRC). However, the response duration is <1 year, and second-line systemic chemotherapy has limited efficacy. We analyzed the efficacy of isolated hepatic perfusion (IHP) for patients with progressive CRC liver metastases after irinotecan.Methods Between March 1993 and February 2003, 124 patients with CRC liver metastases underwent IHP on institutional review board–approved protocols. The overall treatment mortality was 4% (5 of 124). Twenty-five patients (10 women and 15 men; mean age, 53 years) were identified who had progressive liver metastases by carcinoembryonic antigen, imaging studies, or both after irinotecan. A 1-hour hyperthermic IHP (mean hepatic temperature, 40.0°C) with melphalan 1.5 mg/kg (mean total dose, 100 mg) was administered via laparotomy. Perfusion with an oxygenated extracorporeal circuit was established with inflow via a cannula in the gastroduodenal artery and common hepatic artery inflow occlusion. Outflow was via a cannula in an isolated segment of the inferior vena cava. During IHP, portal and inferior vena caval flow were shunted to the axillary vein. Patients were assessed for radiographical response, recurrence pattern, and survival.Results The mean number of prior irinotecan cycles in 25 patients was 6 (range, 2–14), and it was given primarily as second-line therapy. The median number of liver metastases before IHP was 10 (range, 1–50), and the median percentage of hepatic replacement by tumor was 25%. The mean operative time was 9 hours (range, 6–12 hours), and the median hospital stay was 11 days (range, 8–76 days). There was 1 complete response and there were 14 partial responses in 25 patients (60%), with a median duration of 12 months (range, 5–35 months). Disease progressed systemically in 13 of 25 patients at a median of 5 months (range, 3–16 months). The median overall survival was 12 months (range, 1–47 months), and the 2-year survival was 28%.Conclusions For patients with progressive CRC liver metastases after irinotecan, IHP has good efficacy in terms of response rate and duration. Continued evaluation of IHP with melphalan as second-line therapy in this clinical setting is justified.     

Current State of Neck Dissection in the United States

The status of the cervical lymph nodes is the most important prognosticator in head and neck squamous cell carcinoma. The neck dissection is both a therapeutic and staging procedure and has evolved to include various types with standardized level designations (I–VI) for lymph node groups: the radical neck dissection, modified radical neck dissection, the selective neck dissection, and the extended neck dissection. The gross and histologic examination of a neck dissection should provide the critical information (size of metastasis, number of lymph nodes involved) for staging purposes. Additionally, extracapsular spread of lymph node metastasis must be reported because of its significance as an adverse prognosticator. Current dilemmas in nodal disease are the detection of micrometastases, isolated tumor cells, and molecular positivity. The significance of these categories of disease is still unclear, though they may explain a subset of the estimated 10% of the regional recurrences in the neck despite pathologic node negativity by traditional methods of evaluation. Sentinel lymph node biopsy has been recently applied to head and neck squamous cell carcinoma to enhance the management of the clinicoradiographically node negative patients. While still investigational, sentinel lymph node biopsy shows promise in selecting patients who require a neck dissection. Rapid highly automated real-time RT-PCR based platforms will allow for incorporation of molecular findings into the intraoperative evaluation of a sentinel lymph node.     

Isolated pulmonary stenosis in an elderly person: Report of a case

We report a rare case of isolated pulmonary stenosis in a 66-year-old woman. The patient underwent successful pulmonary valve replacement with a stentless bioprosthetic valve. The pulmonary valve was exposed with a longitudinal incision from the right ventricular outflow tract to the pulmonary trunk. The proximal posterior part of the bioprosthetic valve was anastomosed to the pulmonary valve annulus and the distal side was anastomosed to the pulmonary artery with an inclusion technique. The defect from the pulmonary artery to the right ventricular outflow tract was closed using an equine pericardium patch. The patient had an uneventful postoperative course.     

Outcomes Following Isolated Limb Infusion for Melanoma. A 14-Year Experience

Background  Isolated limb infusion (ILI) is a minimally invasive technique for delivering regional chemotherapy in patients with advanced and metastatic melanoma confined to a limb. It is essentially a low-flow isolated limb perfusion (ILP) performed via percutaneous catheters without oxygenation. Methods  From our prospective database 185 patients with advanced metastatic melanoma of the limb treated with a single ILI between 1993 and 2007 were identified. In all patients a cytotoxic drug combination of melphalan and actinomycin-D was used. Drug circulation time was 20–30 min under mild hyperthermic conditions (38–39°C). Results  The majority of patients (62%) were female. Their average age was 74 years (range 29–93 years). Most patients had MD Anderson stage III disease (134/185). The overall response rate was 84% [complete response (CR) rate 38%, partial response rate 46%]. Median response duration was 13 months (22 months for patients with CR; P = 0.01). Median follow-up was 20 months and median survival was 38 months. In those patients with a CR, the median survival was 53 months (P = 0.005). CR rate and survival time decreased with increasing stage of disease. On multivariate analysis significant factors for a favorable outcome were achievement of CR, stage of disease, thickness of primary melanoma, the CO₂ level in the isolated circuit, and a Wieberdink limb toxicity score of III (considerable erythema and edema). Conclusion  The response rates and duration of response after ILI are comparable to those achieved by conventional ILP. ILI is a minimally invasive alternative to the much more complex and morbid conventional ILP technique for patients with advanced metastatic melanoma confined to a limb.     

经皮选择性肝脏隔离灌注化疗肝细胞形态及凋亡研究

目的探讨经皮选择性肝脏隔离灌注化疗（PSIHP）的可行性及隔离效果。方法实验猪8头，利用介入放射学方法进行经皮选择性肝脏隔离灌注化疗结合血液灌流。化疗药物选用5-Fu。比较灌注及未灌注区域肝细胞形态和凋亡指数。结果灌注区域肝细胞损伤明显，肝细胞凋亡指数（52．83±5．12）明显高于未灌注区域肝细胞凋亡指数（3．52±0．96）（P〈0．01）。结论PSIHP是一种简单有效的肝脏隔离灌注化疗技术，隔离效果佳，对未灌注区域肝组织有良好的保护作用。     

新型双球囊导管经皮选择性隔离肝脏灌注化疗的效果研究

目的探讨自制双球囊导管经皮选择性隔离肝脏灌注化疗的隔离效果。方法12只成年猪随机分为两组：HAI组6头,进行常规经肝动脉灌注化疗;PSIHP组6头,利用自制双球囊导管经介入放射学方法行经皮选择性隔离肝脏灌注化疗结合血液灌流。化疗药物选用5-FU,分别检测肝静脉及外周血液中的血药浓度峰值,了解球囊隔离肝脏效果。结果HAI组肝静脉血和外周静脉血浓度峰值分别为4658.420±433.204mg/L和1676.140±226.933mg/L,PSIHP组为5321.711±517.318mg/L和65.735±6.425mg/L。两组外周静脉血浓度峰值有显著性差异（P〈0.01）。结论自制新型双球囊导管能有效隔离肝脏,是一种理想的隔离肝脏灌注化疗的球囊导管。     

咪唑安定预处理对缺血-再灌注离体心脏的保护作用

目的探讨咪唑安定预处理对缺血-再灌注离体心脏的保护作用。方法采用Wistar大鼠离体心脏langendofff灌注模型。实验动物随机分为四组,每组8只：正常对照组（C组）,缺血-再灌注组（I-R组）,缺血预处理组（IPC组）,咪唑安定预处理组（MPC组）。观察咪唑安定预处理对心肌缺血-再灌注后不同时间点冠脉流出液中肌酸激酶（CK）、乳酸脱氢酶（LDH）,心肌组织中超氧化物歧化酶（SOD）、髓过氧化物酶（MPO）、丙二醛（MDA）以及再灌注性心律失常、心功能的变化。结果咪唑安定预处理可以减少心肌缺血-再灌注损伤的心肌冠脉流出液中CK、LDH的含量,提高SOD活性,降低MPO、MDA水平,并且抑制再灌注心律失常的发生,保护心功能。结论咪唑安定预处理对缺血-再灌注离体心脏具有一定的保护作用。     

Type A esophageal atresia: a critical review of management strategies at a single center

Purpose

The purpose of was to study the short- and long-term outcomes in the management of isolated esophageal atresia with different operative strategies.

Methods

All patients undergoing type A atresia repair over a 15-year period were included. Demographic data, birth weight, gestational age, incidence of associated anomalies, management, and long-term outcomes were studied.

Results

Fifteen patients with type A atresia (9 male) were treated in the study period. The mean gestational age was 35.5 weeks (range, 27-39 weeks), and the mean birth weight was 2179 g (range, 670-3520 g). Eight babies had associated anomalies. Thirteen patients underwent gastrostomy as the initial procedure, and 2 underwent the Foker procedure. In the delayed management group, 9 patients underwent primary anastomosis, with 2 patients needing proximal pouch myotomy. Two patients underwent a Collis gastroplasty. Two patients underwent a cervical esophagostomy and a gastric tube replacement at 4 months and 1 year, respectively. Eight patients (60%) in this group had anastomotic leaks. All patients are currently on prokinetics and proton pump inhibitors. Seven required antireflux surgery. The median length of hospital admission was 4 months (range, 3-19 months). The native esophagus was preserved in 13 (85%) of 15 babies. All patients are alive, and 14 of 15 are capable of feeding orally.

Conclusions

Type A esophageal atresia continues to be associated with significant morbidity despite advances in surgical technique and intensive care.