OBJECTIVETo evaluate the accuracy of transrectal ultrasonography (TRUS) in the assessment of the invasion depth of rectal cancer, and analyze the value of TRUS in diagnosis of early rectal cancer.

METHODSTRUS was performed preoperatively in 163 patients with rectal cancer, and the results was compared with the postoperative pathological findings according to TNM staging. The early rectal cancer was diagnosed if the lesion was limited to mucosa and submucosa. The tumor located in mucosa was defined as mucosal cancer, while as submucosal cancer when the tumor invading into submucosa. Sixteen cases were confirmed as early cancer by pathology after the operation. No patients received chemotherapy and radiotherapy before operation.

RESULTSThe sensitivity of TRUS in the staging of the early rectal cancer was 87.5% (14/16), specificity was 98.6% (145/147), and the positive predictive value was 87.5% (14/16). The sensitivity of TRUS in predicting mucosal and submucosal cancer was 85.7% (6/7) and 66.7% (6/9), respectively. Sixteen patients with early rectal cancer were examined before and after filling rectum with water. After filling rectum, all tumors were visualized clearly, while 14 tumors were correctly diagnosed as early rectal cancer. Before filling rectum, only 6 tumors were visualized clearly, and 3 tumors were staged correctly. The ultrasonographic appearance of early rectal cancer manifested in two kinds: protruded and ulcerative, and most were protruded (81.6%).

CONCLUSIONSTRUS is a valuable imaging examination for diagnosis of early rectal cancer preoperatively. Visualization rate and diagnostic accuracy of early rectal cancer are improved dramatically after filling rectum with water.

Adult ; Aged ; Aged, 80 and over ; Early Diagnosis ; Endosonography ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Invasiveness ; diagnostic imaging ; Rectal Neoplasms ; diagnostic imaging ; pathology ; Rectum ; diagnostic imaging ; Sensitivity and Specificity

Background Introperitoneal hemorrhage is one of the most common complications of radiofrequency (RF) ablation of hepatic tumors. This study was designed to investigate the reason and management of intraperitoneal hemorrhage occurred during or after percutaneous RF ablation of hepatic tumors.Methods Three hundred and fifty-six patients with hepatic tumors have been treated at 592 procedures of ultrasound guided RF ablation. Intraperitoneal hemorrhage occurred in 5 patients (0.8%). The reasons and management of intraperitoneal hemorrhage in these 5 cases were retrospectively analyzed. Results Two patients with liver metastasis and one hepatocellular carcinoma (HCC) patient suffered from hemorrhage during the RF treatment. Two patients with recurrent HCC after surgery developed hemorrhage 20 minutes or 4 hours after RF treatment. One case of hemorrhage was due to the inappropriate electrode positioning induced liver laceration while treating a 1 cm liver metastasis near the liver capsule. One was due to the injury of a small vessel by the RF needle in another liver metastasis patient. Three cases were due to tumor rupture with two cases induced by cough or position change after treating large protruding HCC lesions. Four (80%) of the 5 cases of hemorrhage were rapidly identified by ultrasound. The causes and sites of bleeding during the RF treatment in three cases were confirmed through ultrasound, which were successfully treated using RF coagulation to achieve hemostasis of the bleeding site. Two patients with post-ablation hemorrhage recovered in one hour and 24 hours, respectively after given blood transfusion and other conservative measures. No surgical intervention was required. Two patients died of wide spread metastasis 23-36 months afterwards and the other three patients have lived for 18-25 months to date.Conclusions It is important to perform close monitoring during and after RF ablation in order to identify intraperitoneal hemorrhage in time. RF ablation of the bleeding sites was a simple and effective management when the bleeding site could be confirmed by ultrasound. The hemorrhage due to the rupture of large and protruding liver tumors could be serious and should be considered as contraindication for RF treatment.

BACKGROUNDConventional treatment for non-small cell lung cancer (NSCLC) brain metastases (BM) is whole-brain radiotherapy (WBRT). The efficacy is limited. It might be increased by a potent radiosensitizer such as gemcitabine, which is believed to cross the disrupted blood-brain barrier. The primary objective of this study was to determine the maximum tolerated dose (MTD) of weekly gemcitabine given concurrently with WBRT.

METHODSPatients with BM from NSCLC were included. The dose of WBRT was 3750 cGy (total 15 times, 3 weeks). Gemcitabine was given concurrently with WBRT on days 1, 8 and 15. The starting dose was 400 mg/m(2), escalated by 100 mg/m(2) increments. At least three patients were included per level. Dose limiting toxicity (DLT) was defined as grade 4 hematological or grade 2 neurological toxicity. When two or more patients experience DLT, the MTD was reached.

RESULTSA total of 16 patients were included; 69% had a performance status (PS) 1 (Eastern Cooperative Oncology Group, ECOG). A total of 69% had concurrent active extra cranial diseases. All had more than 3 BM. Up to 600 mg/m(2) (level 3) no neurology toxicity was observed. At 600 mg/m(2) two out of 9 patients developed grade 4 thrombocytopenia. One of the two patients' thrombocytopenia was confused with disseminated intravascular coagulation (DIC). At 700 mg/m(2) two out of 4 patients developed neurotoxicities. One developed grade 3 seizure and cognitive disorder. Another patient developed suspected grade 2 muscle weakness.

CONCLUSIONSThe MTD was reached at a dose of 700 mg/m(2). The dose of 600 mg/m(2) would be considered for further study.

Aged ; Brain Neoplasms ; radiotherapy ; secondary ; Carcinoma, Non-Small-Cell Lung ; pathology ; Cranial Irradiation ; Deoxycytidine ; administration & dosage ; adverse effects ; analogs & derivatives ; pharmacokinetics ; Female ; Humans ; Lung Neoplasms ; pathology ; Male ; Maximum Tolerated Dose ; Middle Aged ; Radiation-Sensitizing Agents ; administration & dosage

BACKGROUNDIntraperitoneal hemorrhage is one of the most common complications of radiofrequency (RF) ablation of hepatic tumors. This study was designed to investigate the reason and management of intraperitoneal hemorrhage occurred during or after percutaneous RF ablation of hepatic tumors.

METHODSThree hundred and fifty-six patients with hepatic tumors have been treated at 592 procedures of ultrasound guided RF ablation. Intraperitoneal hemorrhage occurred in 5 patients (0.8%). The reasons and management of intraperitoneal hemorrhage in these 5 cases were retrospectively analyzed.

RESULTSTwo patients with liver metastasis and one hepatocellular carcinoma (HCC) patient suffered from hemorrhage during the RF treatment. Two patients with recurrent HCC after surgery developed hemorrhage 20 minutes or 4 hours after RF treatment. One case of hemorrhage was due to the inappropriate electrode positioning induced liver laceration while treating a 1 cm liver metastasis near the liver capsule. One was due to the injury of a small vessel by the RF needle in another liver metastasis patient. Three cases were due to tumor rupture with two cases induced by cough or position change after treating large protruding HCC lesions. Four (80%) of the 5 cases of hemorrhage were rapidly identified by ultrasound. The causes and sites of bleeding during the RF treatment in three cases were confirmed through ultrasound, which were successfully treated using RF coagulation to achieve hemostasis of the bleeding site. Two patients with post-ablation hemorrhage recovered in one hour and 24 hours, respectively after given blood transfusion and other conservative measures. No surgical intervention was required. Two patients died of wide spread metastasis 23 - 36 months afterwards and the other three patients have lived for 18 - 25 months to date.

CONCLUSIONSIt is important to perform close monitoring during and after RF ablation in order to identify intraperitoneal hemorrhage in time. RF ablation of the bleeding sites was a simple and effective management when the bleeding site could be confirmed by ultrasound. The hemorrhage due to the rupture of large and protruding liver tumors could be serious and should be considered as contraindication for RF treatment.

Adult ; Aged ; Catheter Ablation ; adverse effects ; Female ; Hemoperitoneum ; diagnosis ; etiology ; therapy ; Humans ; Liver Neoplasms ; surgery ; Male ; Middle Aged