Objective To explore the CT manifestations of non-functional islet cell tumor(NFICT)Methods The findings of plain and enhancement CT scanning from 17 cases with NFICT,which were confirmed by the surgeries and pathological sections,were analyzed retrospectively.Ninty ml of non-ioniodine contrast reagent with 3ml/s injection flow rate was employed as the enhancer for measuring the arteriovenous double phase CT value of the pancreas and tumor.Results Tumors were found in all the cases who received CT scan.Compared with pancreatic substance in the CT plain scan,tumors with low density were found in 2 cases,tumors with mixed low density in 11 cases and tumors with isodensity in 4 cases.Local calcification in tumor was found in 5 cases.Various degrees of strengthening were showed in 17 cases with enhancement scanning.Obvious enhancement in arterial phase presented in 5 cases,moderate enhancement in 6 cases and slight enhancement in 6 cases.Conclusions CT plain scan of NFICT shows that the tumor margins are clear and some tumors have calcification.All tumors in the CT enhancement scanning show various degrees of enhancement,the persistent enhancement from arterial phase to portal vein phase is the characteristic manifestation of NFICT.

Objective To determine the clinical value of cytological diagnosis of the impressed specimens in the radical gastrectomy for patients with gastric cancer. Methods During radical gastrectomies for 52 patients with gastric cancer, 232 impressed specimens were taken from the tumor tissues,paratumor tissues, proximal and distal incision margin,and partial lymph nodes respectively, to detect if there was tumor cells by cytological examination and compared with the pathology. Results In the tumor tissues,there were no pseudo positive specimen,and the pseudo negative specimen occurred in 1.In the incision margin,there was no pseudo negative specimen,while 12 pseudo positive specimens were found.In the paratumor tissues,there were 3 pseudo negative and 10 pseudo positive specimens.In all specimens,the sensibility was 92.8%; specificity was 85.8%; accuracy rate was 87.9%. Conclusions Cytological examination of the impressed specimens in radical gastrectomy is helpful in detecting residue tumor tissue in the incision margin, especially in hospitals without rapid pathologic examination.If cytological examination is combined with rapid pathological examination,the results will be better.

Background: Hypoalbuminemia adversely affects the clinical outcomes of various cancers. The purpose of this study was to estimate the prognostic value of hypoalbuminemia 3–5 weeks after treatment in patients with metastatic renal cell carcinoma (mRCC) who received sorafenib or sunitinib as first-line treatment. Methods: In this single-center, retrospective study, we assessed the progression-free survival (PFS) and overall sur-vival (OS) of 184 mRCC patients who received first-line sorafenib or sunitinib treatment. PFS and OS were compared between patients with post-treatment hypoalbuminemia (post-treatment albumin level <36.4 g/L) and those with normal post-treatment albumin level (albumin level ≥36.4 g/L). The Memorial Sloan Kettering Cancer Center (MSKCC)risk model stratified mRCC patients into three risk categories. Prognostic values of all patient characteristics including MSKCC risk category were determined by using univariate and multivariate Cox regression models. Prognostic value was further determined using the Harrell concordance index and receiver operating characteristic curve analysis. Results: The median PFS and OS of the 184 patients were 11 months (95% confidence interval [CI] 9–12 months) and 23 months (95% CI 19–33 months), respectively. Patients with post-treatment hypoalbuminemia had significantly shorter median PFS (6 months [95% CI 5–7 months]) and OS (11 months [95% CI 9–15 months]) than patients who had normal post-treatment albumin levels (PFS: 12 months [95% CI 11–16 months], P < 0.001; OS: 31 months [95% CI 24–42 months], P < 0.001), respectively. Multivariate analysis showed that post-treatment hypoalbuminemia was an independent predictor of PFS (hazard ratio [HR], 2.113; 95% CI 1.390–3.212; P < 0.001) and OS (HR, 2.388; 95% CI 1.591–3.585; P < 0.001). Post-treatment hypoalbuminemia could also be combined with the MSKCC risk category for better prediction about OS. The model that included post-treatment hypoalbuminemia and MSKCC risk category improved the predictive accuracy for PFS and OS (c-index: 0.68 and 0.73, respectively) compared with the basic MSKCC risk model (c-index: 0.67 and 0.70, respectively). The prognostic values for PFS and OS of the integrated MSKCC risk model involving post-treatment hypoalbuminemia were significantly more accurate than the basic MSKCC risk model using likelihood ratio analysis (both P < 0.001). Conclusions: Post-treatment hypoalbuminemia can be considered an independent prognostic factor for patients with mRCC who undergo first-line treatment with tyrosine kinase inhibitors. Additionally, integrating post-treatment serum albumin level into the basic MSKCC risk model can improve the accuracy of this model in predicting patient overall survival and progression-free survival.

ObjectiveTo evaluate the nutritional status of elderly Chinese operative patients with lung cancer as well as its correlation with postoperative complications through the application of modified mini-nutritional assessment (MNA) and short-form MNA (MNA-SF).MethodsOne hundred and fifty elderly Chinese patients with lung cancer underwent operation were enrolled in this study from June 2010 to June 2011.Collected information including preoperative nutritional evaluation in modified MNA and MNA-SF,general information of patients,disease status,anthropometric measurements,biochemical markers,and postoperative complications.ResultsAccording to the modified cutoff point of the full MNA in the 150patients (98 males,52 females),10.7％(16/150) patients were malnourished,32.0％(48/150) patients were at risk of malnutrition and 57.3％(86/150) patients were well nourished.MNA was (23.7 ± 3.8) scores.Positive correlations were found between MNA and body mass index (BMI),mid-arm circumference(MAC)and calf circumference (CC) (P ＜ 0.01 ).MNA-SF was ( 11.5 ± 2.4) scores.Positive correlations were found between MNA-SF and BMI,triceps skinfold (TSF),MAC,CC,MNA (P＜0.01 or ＜0.05).The incidence of postoperative complications was as following sequentially: respiratory complication was 37.4％ (55/147),cardiovascular complication was 31.3％(46/147),thoracic cavity complication was 0.7％( 1/147 ).There was no significant difference among groups in different numbers of complications (P=0.590) and among groups in different types of complications (P =0.601 ).ConclusionsModified MNA is suited to elderly Chinese operative patients with lung cancer.Evaluation shows that there is high prevalence of malnutrition among this population,and the correlations between MNA results and postoperative complications should be confirmed in further study.Positive correlations were found between MNA and body mass index (BMI),mid-arm circumference(MAC)and calf circumference (CC) (P ＜ 0.01 ).MNA-SF was ( 11.5 ± 2.4) scores.Positive correlations were found between MNA-SF and BMI,triceps skinfold (TSF),MAC,CC,MNA (P＜0.01 or ＜0.05).The incidence of postoperative complications was as following sequentially: respiratory complication was 37.4％ (55/147),cardiovascular complication was 31.3％(46/147),thoracic cavity complication was 0.7％( 1/147 ).There was no significant difference among groups in different numbers of complications (P=0.590) and among groups in different types of complications (P =0.601 ).ConclusionsModified MNA is suited to elderly Chinese operative patients with lung cancer.Evaluation shows that there is high prevalence of malnutrition among this population,and the correlations between MNA results and postoperative complications should be confirmed in further study.

Background: Sorafenib and sunitinib are widely used as first-line targeted therapy for metastatic renal cell carcinoma (mRCC) in China. This study aimed to compare the efficacy, safety, and quality of life (QoL) in Chinese mRCC patients treated with sorafenib and sunitinib as first-line therapy. Methods: Clinical data of patients with mRCC who received sorafenib (400 mg twice daily; 4 weeks) or sunitinib (50 mg twice daily; on a schedule of 4 weeks on treatment followed by 2 weeks off) were retrieved. Primary outcomes were overall survival (OS), progression-free survival (PFS), adverse events (AEs), and QoL (SF-36 scores), and secondary outcomes were associations of clinical characteristics with QoL. Results: Medical records of 184 patients (110 in the sorafenib group and 74 in the sunitinib group) were reviewed. PFS and OS were comparable between the sorafenib and sunitinib groups (bothP > 0.05). The occurrence rates of leukocytopenia, thrombocytopenia, and hypothyroidism were higher in the sunitinib group (36.5％ vs. 10.9％, P < 0.001; 40.5％ vs. 10.9％,P < 0.001; 17.6％ vs. 3.6％,P= 0.001), and that of diarrhea was higher in the sorafenib group (62.7％ vs. 35.2％,P < 0.001). There was no significant difference in SF-36 scores between the two groups. Multivariate analysis indicated that role-physical and bodily pain scores were associated with the occurrence rate of grade 3 or 4 AEs (P= 0.017 and 0.005). Conclusions: Sorafenib has comparable efficacy and lower toxicity profile than sunitinib as first-line therapy for mRCC. Both agents showed no significant impact on QoL of patients.

ObjectiveTo analyze the incidence of benign lesions in patients undergoing surgery for presumed renal cell carcinoma (RCC) and investigate the correlation of tumor size and histopathological characteristics.MethodsFrom Jan 2003 to Sep 2010,1531 patients (1042 males,489 females with average age of 55.1 years (15 -89 years) underwent nephrectomy.There were 1123 radical nephrectomies and 408 partial nephrectomies for solitary renal cortical neoplasms presumed to be RCC in preoperative imaging study.The pathological tumor size,the percentage of benign lesions and histologic subtypes were analyzed retrospectively.The correlation of Fuhrman grading and tumor size in clear cell type RCC and papillary RCC was investigated as well.Results Pathological examinations revealed that there were 81 (5.3％)benign lesions of 1531 patients.The incidence of benign lesions was 7.8％ in renal masses smaller than 4.0cm,3.8％ in masses with 4.1 - 7.0 cm,and 1.1％ in masses larger than 7.0 cm ( P ＜ 0.01 ).Angiomyolipoma was the most predominant histologic subtype in benign renal lesions with a frequency of 69.5％,52.6％ and 33.3％ in ≤4.0 cm,4.1 - 7.0 cm and ＞ 7.0 cm subgroups,respectively.Oncocytoma was present in 13.6％,15.8％ and 33.3％ of the benign lesions in the above 3 subgroups (P =0.47).One thousand four hundred and fifty cases of malignancies (94.7％) were identified.The frequency of clear cell type RCC was 91.7％ in malignant tumors smaller than 4.0 cm,88.1％ in 4.1 - 7.0 cm malignancies,and 77.6％ in tumors ＞7.0 cm； the frequency of papillary RCC was 4.0％,4.2％ and 7.7％ in the above 3 subgroups,and the frequency of chromophobe cell RCC was 3.6％,5.2％ and 6.3％ accordingly ( P ＜0.01 ).One thousand three hundred and seventeen cases of clear cell type RCC and papillary RCC with definite Fuhrman grading were identified.The probability of high grade tumors increased with size,while the probability of low-grade lesions decreased (r =0.94,P ＜ 0.01 ),especially for tumors smaller than 11.0cm.ConclusionsPatients in the present study population show a low incidence of benign renal lesions.Benign lesions are less common in larger tumors than in smaller ones.The proportion of clear cell type RCC decreases in larger tumors,however papillary RCC and chromophobe cell RCC are increasing.The probability of high-grade tumors increases with size.The correlation between tumor size and histopathological characteristics may be helpful in patients counseling and decision-making.

Objective To study the evolution of renal cell carcinoma treated in a single institution over the past 12 years.Methods A total of 1923 patients with renal cell carcinoma surgically treated from 1999 to 2010 were included in this study.Age at diagnosis,gender,symptoms,tumor size,TNM stage,histological subtype,Fuhrman grade and type of treatment were compared among 3 periods (Period 1:1999-2002,Period 2:2003-2006,Period 3:2007-2010).Results The number of patients grew fasty from 267 cases in the Period 1 to 1092 cases in the Period 3.The incidentally diagnosed cases increased significantly from 49.8％ to 73.6％ (P ＜0.01),while the mean age of patients at diagnosis,the male to female ratio and the proportion of young (＜40 years old) patients were not statistically different.The tumor size at diagnosis gradually decreased from 6.1 cm to 4.8 cm (P ＜ 0.01),and the proportion of small tumors less than 4 cm increased remarkably from 30.3％ to 54.4％ (P ＜ 0.01).Concerning the surgical approach,open surgery decreased from 98.5％ to 73.8％ (P ＜ 0.01),and laparoscopic surgery increased from 1.50％ to 26.2％ (P ＜ 0.01).Overall,the rate of nephron-sparing surgery increased from 5.2％ to 34.7％ (P ＜0.01) in all cases.The use of nephron-sparing surgery increased significantly from 17.9％ to 54.7％ in T1a subset and from 0.00％ to 14.8％ in T1b subset respectively (P ＜ 0.01).Furthermore,radiofrequency ablation was applied and the percent of this approach reached 2.47％ in Period 3.Conclusions The evolution of clinical-pathological characteristics and surgical treatment for renal cell carcinoma in a single institution is apparent over the last 12 years.With the increase of incidentally diagnosed cases and small renal tumors,nephron-sparing surgery has been widely performed in T1 subset instead of traditional radical nephrectomy.

OBJECTIVE: To evaluate the utilization of functional neck dissection for treatment of recurrent branchial cleft anomalies. METHOD: Fifteen patients with recurrent branchial cleft anomalies (fistula and cyst) undergoing functional neck dissection were retrospectively analyzed. RESULT: Complications included 2 incisions secondary healing, 1 postoperative choking persisting for 1 months and 1 Horner's syndrome. There was no recurrence after a follow up from 2 months to 6 years,except 2 cases were lost to follow-up. CONCLUSION Functional neck dissection is an effective and safe surgical management for recurrent second and third branchial cleft anomalies(fistula and cyst).
Adolescent ; Adult ; Branchial Region ; abnormalities ; surgery ; Child ; Female ; Humans ; Male ; Neck ; surgery ; Neck Dissection ; methods ; Recurrence ; Retrospective Studies ; Young Adult

Objective: To determine the HIV infection of a 13-year-old leukemia patient Wei using molecular tracing technique. Methods: Three blood samples were collected from the persons who were associated with HIV positive blood donation member Lang. The viral load was tested and pol gene was sequenced and analyzed. At the same time using HyPhy2.2.4 and Cytoscape 3.6.1 to establish the molecular network with these 3 samples sequences and other HIV subtypes sequences obtained from Luzhou. Results: The HIV-1 viral load test result of the three patients were: Lang 933 CPS /ml (treated, blood donor), Wei (blood recipitent) 89 813 CPS /ml, Deng (blood recipitent) 85 158 CPS /ml. The subtype of HIV-1 of these three samples were all recombinant HIV CRF01_AE, and the pol gene similarity was 98.8% (Lang and Wei), 99.7% (Lang and Deng), and 99.1% (Wei and Deng), respectively. The gene sequences of the three samples were linked into clusters (the gene distance was less than 0.004). Conclusions The patient Wei with leukemia was infected with HIV-1 due to blood transfusion during the seroconversion period, and the three patients were more likely to be infected with the same HIV-1 strain. It is necessary to popularize the use of high-sensitivity nucleic acid detection method in blood collection and supply institutions, which can effectively improve the safety of blood use.

OBJECTIVE: To explore the proper diagnosis and therapy method in aged patients with bronchial foreign body. METHOD: A retrospective analysis was performed on 15 aged patients with bronchial foreign body by clinical characteristics. The experience of diagnosis and therapy in these cases were summarized. RESULT: Misdiagnosed or missed diagnosis were found in 6 of 15 aged patients with bronchial foreign body. Three bronchial foreign bodies were taken out successfully under topical anesthesia. Twelve bronchial foreign bodies were taken out under topical anesthesia and balanced anesthesia. No complications happened in all case. CONCLUSION Clinical manifestation of bronchial foreign body is often unrepresentative in most aged patients. The chest X-ray of most cases can not show actual appearance of foreign bodies. In addition, history of foreign body in bronchus is often uncertain. So bronchial foreign bodies have often been misdiagnosed or missed diagnosed in aged patients. Suitable anesthesia method is the key to taking out bronchial foreign body in aged patients.
Aged ; Aged, 80 and over ; Anesthesia ; methods ; Bronchi ; Diagnostic Errors ; Female ; Foreign Bodies ; diagnosis ; surgery ; Humans ; Male ; Retrospective Studies