The Clinical Utility of a Adding Lateral Approach to Conventional Vertical Approach for Prone Stereotactic Vacuum-Assisted Breast Biopsy

Objective

The purpose of this study is to evaluate the clinical utility of adding lateral approach to conventional vertical approach for prone stereotactic vacuum-assisted breast biopsies.

Materials and Methods

From April 2010 to May 2012, 130 vacuum-assisted stereotactic biopsies were attempted in 127 patients. While a vertical approach was preferred, a lateral approach was used if the vertical approach failed. The success rate of biopsies utilizing only a vertical approach was compared with that using both vertical and lateral approaches and the breast thickness for both procedures was measured and compared with that for vertical approach. In addition, pathology results were evaluated and the causes of the failed biopsies were analyzed.

Results

Of the 130 cases, 127 biopsies were performed and 3 biopsies failed. The success rate of the vertical approach was 83.8% (109/130); however, when the lateral approach was also used, the success rate increased to 97.7% (127/130) (p = 0.0004). The mean breast thickness was 2.7 ± 1 cm for the lateral approach and 4 ± 1.2 cm for the vertical approach (p < 0.0001). The histopathologic results in 76 (59.8%) of the biopsies were benign, 23 (18.1%) were high-risk lesions, and 28 (22.0%) were malignant. The causes of biopsy failure were thin breasts (n = 2) and undetected difficult lesion location (n = 1).

Conclusion

The addition of lateral approach to conventional vertical approach in prone stereotactic vacuum-assisted breast biopsy improved the success rate of stereotactic biopsy, especially in patients with thin breasts.     

肺癌患者红细胞免疫功能与外周血T淋巴细胞亚群的改变及其相关因素研究

 目的 为了观察肺癌患者红细胞免疫功能及T淋巴细胞亚群的变化.方法 采用检测55例肺癌患者红细胞免疫功能及T淋巴细胞亚群,并与15例肺良性肿瘤患者和20例正常人对照.结果 (1)肺癌组红细胞C3 b受体花环率(RBC-C 3 bRR)、CD 3<'+>、CD4<'+>、CD 8<'+>、CD4<'+>/CD8<'+>比值低于正常人(P<0.05～0.01),红细胞免疫复合物花环率(RBC-ICR)依次高于肺良性肿瘤组、正常人(P<0.05～0.01).(2)肺癌RBC-C 3 bRR与CD4<'+>/CD 8<'+>成直线正相关(P<0.01,r=0.9131).(3)Ⅲa、Ⅲb期肺癌,RBC-C 3 bRR、CD 3<'+>、CD4<'+>、CD 4<'+>/CD 8<'+>比值低于Ⅰ、Ⅱ期肺癌患者、正常人(P<0.05～0.01),而RBC-ICR高于正常人(P<0.01).Ⅰ、Ⅱ期病人CD3<'+>、CD 4<'+>、CD 8<'+>低于正常人(P<0.01).RBC-ICR高于正常人(P<0.01).(4)术后10～14 d,根治组与术前比较:RBC-C 3 bRR、CD 3<'+>、CD 4<'+>/CD 8<'+>比值显著升高(P<0.01),而RBC-ICR、CD 8<'+>显著降低(P<0.01);术后与正常人比较:RBC-C 3 bRR、CD4<'+>/CD 8<'+>比值无显著差异(P>0.05).姑息组与术前比较:RBC-C 3 bRR、CD 4<'+>、CD 4<'+>/CD 8<'+>比值显著升高(P<0.05～0.01),而RBC-ICR显著下降(P<0.01),CD 3<'+>、CD 8<'+>无明显改变,术后与正常人比较:RBC-C 3 bRR、CD4<'+>/CD 8<'+>比值无显著差异(P>0.05).探查组与术前比较:两者指标无显著差异(P>0.05).结论 肺癌患者RBC免疫和T细胞亚群的检测及其相关性分析,对肺癌的诊断,治疗及病情预后估计有一定价值.     

Palliative treatment of neoplastic strictures by self-expanding nitinol Strecker stent

The purpose of this study was to evaluate technical and clinical results of self-expanding esophageal stent implanted in patients with malignant esophageal strictures and clinically significant dysphagia. From June 1992 to September 1994, 27 patients with inoperable tumors of the esophagus or gastric cardiac were treated by placement of 37 self-expanding nitinol stents. Water-soluble contrast and endoscopy studies were performed after the procedure and during the follow-up period. Successful stenting of the stricture was achieved in 27 patients. The mean dysphagia grade dropped from 2.3 to 1 (SD ± 0.54) immediately after the procedure. After the insertion of the stent, 16 patients died in a period of time ranging from 0 to 13 months (mean 5.6 months), whereas at the end of the study 11 patients were alive 4–15 months after the procedure (mean 8.3 months). No major complications were observed. The results of this study are encouraging because esophageal stent placement was technically easy and clinically effective. Correspondence to: F. Maspes     

鼻腔、副鼻窦原发性肿瘤70例CT分析

本文回顾分析了70例经手术病理证实的鼻腔、副鼻窦原发性良恶性肿瘤的临床和CT表现。讨论了良恶性肿瘤的鉴别诊断,不典型的CT表现及CT的检查价值,认为CT检查可做为鼻腔、副鼻窦肿瘤的首选方法。     

An evaluation of the decreasing incidence of positive surgical margins in a large retropubic prostatectomy series

PURPOSE: Positive surgical margins adversely affect biochemical recurrence-free survival after radical retropubic prostatectomy (RRP) for prostate cancer. We retrospectively reviewed a large series of men who underwent RRP at a single academic university urology program to define the change in the incidence of organ confined (OC) disease and positive surgical margin (SM+) during the last 2 decades. MATERIALS AND METHODS: Between 1982 and 2001, 9,035 men underwent RRP for clinically localized prostate cancer (T1 to T3a) at a single institution. We compared the incidences of OC disease and SM+ in this population. RESULTS: An increasing proportion of men presented with OC disease over time. The incidence of SM+ in the overall RRP population decreased dramatically over time. However, in men with nonorgan confined disease (pT3), the proportion with SM+ was stable and consistently elevated (22.7% to 27.8%), after the initial decrease from the early 1980s (53%). CONCLUSIONS: Widespread early detection programs for prostate cancer resulted in a downward stage migration in men presenting with clinically localized prostate cancer at our institution during the last 2 decades. The decrease in the percentage of men with SM+ was due to the increasing number of men with organ confined disease. These results imply that the decrease in surgical margin rates in the overall RRP population is most likely due to stage migration and improved patient selection, rather than major improvements in surgical technique. The stable percentage of SM+ among men with pT3 disease dictates the need for continued evaluation of surgical technique and the need for effective adjuvant therapy.     

Small renal oncocytoma with central cystic degeneration

A case of a small renal oncocytoma with central cystic degeneration, 15 mm in diameter, is reported. Contrast-enhanced computed tomography showed the tumor contained a central hypoattenuating region and had an irregular, heterogeneously enhanced wall. Magnetic resonance images showed a well-circumscribed lesion and the T(1)-weighted image indicated medium signal intensity, whereas the T(2)-weighted image indicated slight hypointensity. Both T(1)- and T(2)-weighted images showed central hyperintensity. Our preoperative diagnosis was renal cell carcinoma originating in a renal cyst wall or cystic renal cell carcinoma. Nephrectomy was performed because frozen-section examination did not completely rule out malignancy. The final pathological diagnosis of the entire surgical specimen was renal oncocytoma with cystic degeneration. To our knowledge, this is the 14th case of renal oncocytoma with central cystic degeneration reported in the published works. We discuss herein the variant forms of oncocytoma and difficulties with their preoperative diagnosis, especially when the tumor is small.     

基层医院开展中低位直肠肿瘤腹腔镜手术的初期经验

目的:探讨基层医院开展腹腔镜中、低位直肠肿瘤手术的可行性和安全性。方法:回顾性分析从2010年6月至2012年6月开展的腹腔镜中、低位直肠肿瘤切除术19例以及同期开展的21例开腹手术病人的资料,比较两组病人在手术时间、术中出血量、术后住院时间、术后肛门排气时间、术后并发症、淋巴结清扫数量等方面的差异。结果:两组在年龄、性别、肿瘤位置、Dukes分期等方面无差异。腹腔镜组无一例中转开腹。在术中出血量、术后住院时间、术后肛门排气时间等方面,腹腔镜组明显优于开腹组;而在手术时间、术后并发症发生率、淋巴结清扫数量上两组无统计学差异。结论:专业团队、术中遵循直肠全系膜切除原则以及掌握适应证是基层医院安全、有效开展腹腔镜中、低位直肠肿瘤手术的基础和重要条件。     

胆管癌性阻塞姑息性T管引流术后再发梗阻的介入治疗

目的　探索胆管癌性阻塞外科姑息性T管引流术后再发梗阻的介入治疗。方法　胆管癌性阻塞外科姑息性T管引流术后再发黄疸患者 7例 ,采用经皮肝穿刺胆道引流术 (PTCD) 金属内支架置入术 .共使用 7枚金属内支架。结果　 7例采用经皮经肝穿刺或经T型管通路置入胆管支架均获得成功。无并发症发生。术后总胆红素、转氨酶、谷酰转肽酶和碱性磷酸酶明显下降 ,与术前比较有显著性差异 ,7例术后黄疸消退满意。结论　经皮胆管内金属支架置入术姑息性治疗恶性阻塞性黄疸外科留置T管术后再狭窄 ,安全可靠 ,操作简单 ,费用低 ,治疗效果好 ,并发症少 ,为无法手术切除胆管癌而留置T管的患者提供了一种良好的治疗手段     

FDG双探头符合成像与X线断层图像同机融合在胸腹部肿瘤病变诊断中的价值

目的 :初步评价FDG双探头符合成像与X线断层图像同机融合在胸腹部肿瘤病变诊断中的价值。材料和方法 :回顾性分析 2 2例疑为胸腹部肿瘤或肿瘤术后复发而行18F -FDG双探头符合成像与X线断层联合扫描同机图像融合患者的资料。结果 :14例肿瘤或肿瘤术后复发的患者FDG显像 ,在 34个病灶中共检出 33个病灶 ( 97.1% )。融合影像可更加直观清晰地显示占位性病变或肿大淋巴结的代谢活性。其中 4例 ( 4 /14 )患者位于邻近膈肌上下及胸椎体、前列腺的 6个病灶 ( 6 /34)必须借助融合图像才能精确定位。结论 :FDG双探头符合成像与X线断层图像同机融合可明显提高符合显像定位诊断的准确性。     

SPIO与Gd-DTPA联合增强检测大鼠肝癌病灶的实验研究

目的 :观察联合使用SPIO和Gd DTPA对大鼠肝癌模型的增强特点。材料和方法 :制作 3 0只大鼠肝癌模型 ,增强前后行MR扫描 ,平扫序列包括SE、TSE、GRE的T1、T2WI序列。增强扫描分为 4组 ,其中Gd +SPIO联合增强组 10只 ,先注射Gd DTPA ,行SE、GRET1WI扫描 ,随后给予SPIO造影剂 ,扫描序列同平扫 ;SPIO +Gd联合增强组 10只 ,先注射SPIO ,行SE、GRET1WI扫描 ,12min后再给予Gd DTPA ,扫描序列同平扫 ;Gd、SPIO增强组各为 5只 ,增强扫描序列同平扫。分析各增强扫描组中病灶的增强特点。结果 :两种联合增强方法中 ,肝脏信号强度在所有扫描序列中均较平扫时下降 ,但与SPIO增强组无差异 ;病灶的SNR、CNR在SE、GRET1WI中明显高于平扫和SPIO、Gd DTPA增强法 ;在T2WI中病灶的SNR、CNR和单独使用SPIO无显著性差异。两种联合增强方法之间的SNR和CNR在每种扫描序列中没有显著性差异。结论 :SPIO和Gd DTPA联合增强方法利用了两种造影剂的优势 ,增加了肿瘤病变的对比 ,可提高发现病变的几率。