Do certain surgical steps increase postoperative morbidity after cytoreductive surgery and HIPEC- a retrospective analysis

IntroductionIt has been shown that cytoreductive surgery (CRS) in combination with hyperthermic intraperitoneal chemotherapy (HIPEC) is an effective treatment for patients suffering from peritoneal malignancies. Despite good results, there is an ongoing debate about this treatment due to perioperative morbidity.The aim of this study is to identify relevant risk factors for an unfavorable postoperative outcome after CRS and HIPEC.Materials and methodsA retrospective analysis of a prospectively recorded database of all patients undergoing CRS and HIPEC between 2013 and 2020 in the Department of Surgery of the University Hospital Dresden was performed with a special focus on certain surgical steps of multivisceral resection, one- or 2- stage CRS/HIPEC and underlying diagnosis as possible risk factors for worse postoperative course.ResultsN = 173 CRS and HIPEC procedures were performed for various diagnoses. Relevant postoperative morbidity was 24% and 30d-mortality 1.2%. Simultaneous liver resections, preoperative hypalbuminemia and 2-staged CRS/HIPEC were significant risk factors for a worse postoperative course in multivariable analysis. Assessment of the association of simultaneous anastomoses and morbidity and mortality was inconclusive.ConclusionCRS and HIPEC is a safe treatment without relevant intraoperative morbidity and mortality and acceptable postoperative outcome. One-stage CRS/HIPEC should be preferred.     

SOX1 antibodies in sera from patients with paraneoplastic neurological syndromes

Objectives – SOX1 antibodies have been described in patients with Lambert–Eaton myasthenic syndrome (LEMS) in association with voltage‐gated calcium channel antibodies as serological markers of small cell lung cancer (SCLC). This study was aimed to screen for additional SOX1 autoimmunity in onconeural antibody‐positive sera from patients with paraneoplastic neurological syndromes (PNS) other than LEMS and to identify the clinical–immunological profile and associated tumours of patients with coexisting SOX1 antibodies. Methods– We retrospectively analysed sera from 55 patients with different PNS positive for well‐characterized antineuronal antibodies for the presence of SOX1 antibodies by recombinant ELISA and immunoblot. Results– Eight (14.5%) patients showed additional SOX1 antibodies in the ELISA and the recombinant immunoblot. Five patients had coexisting Hu antibodies, while the other three showed coexisting CV2/CRMP5, amphiphysin, and coexisting CV2/CRMP5 and Hu antibodies, respectively. PNS included (partially overlapping) subacute sensory neuropathy, subacute sensorimotor neuropathy, cerebellar degeneration, brainstem encephalitis, encephalomyelitis and limbic encephalitis. No tumour was detected in two patients, while the others had lung cancer (four SCLC and two non‐SCLC). One patient showed SOX1‐specific intrathecal antibody synthesis. Conclusions– We describe SOX1 reactivity for the first time overlapping with CV2/CRMP5 and amphiphysin antibodies. SOX1 reactivity is predominantly associated with Hu antibodies and SCLC, but can occur also in other types of lung cancer. Neurological manifestations present in patients with coexisting SOX1 antibodies and well‐characterized antineuronal antibodies do not differ from those previously described in patients positive for antineuronal antibodies but no SOX1‐specific anti‐glial antibodies.     

卡泊芬净治疗40例恶性血液病患者合并侵袭性真菌感染临床研究

目的探讨卡泊芬净治疗恶性血液病合并侵袭性真菌感染(IFI)的疗效及安全性。方法回顾分析2010年1月至2011年12月40例接受卡泊芬净治疗(首日70 mg/d,之后50 mg/d,疗程依患者病情而定)恶性血液病患者的临床资料,观察患者的疗效和不良反应。结果 40例患者男性26例,女性14例,中位年龄38(16~72)岁。确诊患者4例,临床诊断10例,拟诊26例。血培养光滑念珠菌及热带念珠菌阳性各1例,胸腔积液培养曲霉菌阳性2例;合格痰液培养阳性10例,其中白色念珠菌4例,曲霉菌2例,光滑念珠菌2例,克柔念珠菌1例,热带念珠菌1例。40例患者中痊愈17例(42.5%),显效8例(20.0%),进步8例(20.0%),无效7例(17.5%),总有效率为62.5%。有效患者中位退热时间为4.5(1~11)d。初治组21例,有效17例,有效率为81%;挽救组19例,有效8例,有效率为42.1%。卡泊芬净治疗过程中不良反应较轻,一般经治疗可恢复。结论恶性血液病合并IFI应用卡泊芬净治疗疗效肯定,不良反应轻,可以作为IFI患者抗真菌的首选或挽救性治疗药物之一。     

甲状腺细胞病理学Bethesda报告系统的临床应用:肿瘤专科医院5729例样本的回顾性分析

目的分析肿瘤专科医院甲状腺细胞病理学Bethesda报告系统的数据特点,评价甲状腺细针穿刺(fine needle aspiration,FNA)的诊断能力。方法回顾性分析2017年1月至2018年12月中国医学科学院肿瘤医院行甲状腺FNA检查的5729个组织的临床资料,来自5011例患者,其中男1174例,女3837例,年龄7~88岁,中位年龄45岁。以术后组织病理学结果为金标准,分析Bethesda分级系统各诊断级别的恶性风险和甲状腺FNA的诊断能力。结果5729个细胞学诊断包括:无法诊断或标本不满意(nondiagnostic or unsatisfactory,ND/UNS)456个(8.0%),良性(benign)1055个(18.4%),意义不明确的非典型病变或意义不明确的滤泡性病变(atypia of undetermined significance or follicular lesion of undetermined significance,AUS/FLUS)409个(7.1%),滤泡性肿瘤或可疑滤泡性肿瘤(follicular neoplasm or suspicious for a follicular neoplasm,FN/SFN)80个(1.4%),可疑恶性(suspicious for malignancy,SUS)982个(17.1%),恶性(malignant)2747个(47.9%)。3239个有术后病理结果,其中恶性者3109个(95.99%)。各诊断级别的恶性风险分别为:ND/UNS 75.00%,良性40.91%,AUS/FLUS 77.67%,FN/SFN 41.67%,SUS 96.86%,恶性99.96%。FNA诊断的敏感性、特异性、准确性、阳性预测值和阴性预测值分别为98.8%、60.5%、97.7%、98.9%和59.1%。结论肿瘤专科医院甲状腺Bethesda报告系统的数据具有恶性诊断占比高和各诊断级别恶性风险高的特点。FNA诊断准确性高,且有较高的阳性预测值。     

Is Routine Urine Cytology Useful in the Haematuria Clinic?

INTRODUCTION

The objective of this study was to determine the value of routine urine cytology in the initial evaluation of patients presenting to a one-stop haematuria clinic.

PATIENTS AND METHODS

A total of 1000 consecutive patients who attended the haematuria clinic between June 2003 and November 2004 were studied prospectively. A standard protocol was used to investigate these patients. This included urine cytology, upper tract imaging and flexible cystoscopy.

RESULTS

Overall, 986 samples of urine were sent for cytology. In 126 patients, the report was abnormal; of these, 71 patients were found to have bladder transitional cell carcinoma by flexible cystoscopy and a further 3 had upper tract transitional cell carcinoma diagnosed radiologically. The remaining 52 patients with abnormal cytology were not found to have cancer on further investigations. The total cost for urine cytology and additional investigations was £50,535.

CONCLUSIONS

In this study of the initial evaluation of patients with haematuria, no case of urothelial malignancy was diagnosed on the basis of urine cytology alone. Therefore, urine cytology need not be used routinely in the initial diagnostic workup for haematuria.     

ATG/ALG在非清髓性造血干细胞移植治疗血液病中临床应用

目的探讨抗胸腺细胞球蛋白(ATG)和抗淋巴细胞球蛋白(ALG)在非清髓性异基因造血干细胞移植中作用和毒副作用,对移植并发症的影响。方法以ATG/ALG为基础的非清髓性预处理方案,对14例恶性血液病、11例重型再生障碍性贫血(SAA)实施异基因骨髓或脐血造血干细胞移植;对5例恶性血液病实施供者淋巴细胞输注。移植物抗宿主病(GVHD)预防:恶性血液病采用环孢菌素A(CSA)联合短程甲氨喋呤(MTX),SAA患者采用CSA联合甲基强的松龙。结果3例患者未植入,于移植早期死于感染。其余22例恢复造血,ANC>0.5×109/L和Plt>20×109/L平均为12.1(3~29)d和20.1(5~79)d。移植后3例为供者型完全嵌合体(CC);19例为混合嵌合体(MC),4例自行转为CC,5例DLI后由MC转变为CC。移植早期均未见aGVHD,DLI后并发Ⅰ度aGVHD1例、Ⅱ度aGVHD3例,2例皮肤局限型cGVHD、2例为广泛型cGVHD。并发严重的细菌、病毒和真菌感染各2例、4例和5例。ATG/ALG使用过程中全部出现寒战、发热和流感样症状等。结论ATG/ALG使用安全,促进造血干细胞植入,减少aGVHD发生并降低严重程度。     

去甲氧柔红霉素治疗老年血液肿瘤

目的去甲氧柔红霉素是一种新的蒽环类抗癌药.方法用去甲氧柔红霉素治疗老年(≥60岁)血液肿瘤患者6例.结果 6例患者均获得明显疗效,且不良反应较小.结论在条件许可时,老年血液肿瘤患者选用含去甲氧柔红霉素的联合化疗,可能具有疗效好、不良反应小的优势.     

妇科恶性肿瘤患者纤维蛋白溶解系统的研究

目的　研究妇科恶性肿瘤患者血浆纤维蛋白溶解系统的改变。方法　采用定量酶联免疫吸附试验和发色底物法 ,对 5 7例妇科恶性肿瘤患者 (肿瘤组 )、30例非恶性肿瘤者 (对照组 )血浆中组织型纤溶酶原激活物 (t PA)、纤溶酶原激活物抑止物 (PAI 1)和D 二聚体 (D D)含量及t PA和PAI 1活性进行测定。结果　肿瘤组血浆t PA含量与活性较对照组明显升高 ,PAI 1活性明显下降 ,差异有显著性 (P <0 .0 1) ;D D含量较对照组明显升高 (P <0 .0 5 )。结论　血浆纤溶系统在妇科恶性肿瘤中有明显改变 ,这种改变可能与妇科恶性肿瘤的发展相关 ,进一步研究纤溶系统与妇科恶性肿瘤转移的关系十分必要     

恶性肿瘤合并双输尿管梗阻的介入治疗

目的评价经皮双肾盂穿刺顺行性置入输尿管支架管治疗恶性肿瘤合并输尿管梗阻的临床疗效。方法对32例恶性肿瘤合并输尿管梗阻患者,采用CT扫描定位后行经皮双肾盂穿刺,穿刺成功后在透视监视下顺行性置入双输尿管支架管。置管后定期检测肾功能。采用Kaplan-Meier法进行生存分析。结果CT引导下经皮双肾盂穿刺成功率为100%,顺行性双输尿管支架管置入成功率为90.6%,成功置管的患者肾功能恢复正常的比率为100%,肾功能恢复正常的中位时间为4天（2～13天）。29例成功置管的患者平均生存时间为6.3个月。一过性血尿为最常见的并发症,发生率为100%。结论CT引导下经皮双肾盂穿刺顺行性置入输尿管支架管治疗恶性输尿管梗阻成功率高,可以逆转输尿管梗阻引起的肾功能衰竭。