Objective： The aim of this study was to approach an efficient way in the treatment of pericardial effusion of lung cancer. Methods： Sixteen patients with pericardial effusion of lung cancer are drained with Safe-Dwel Tlus, then cisplatin and etoposide were injected into the pericardial cavity, and the draining continually effusion to less 50 ml per day. Results： The total effective rate was 93.8％ with 13 cases of complete response rate and 2 cases of partial response rate. The median survival time was 6.5 months. 2 cases died from the relapse of pericardial effusion or no effect. Eleven cases had gastrointestinal tract reaction, and 3 cases with repression of bone marrow. However all side effects were controlled by treatment. Conclusion： Safe-Dwel Tlus drain with injecting cisplatin and etoposide into pericardial cavity may be a better way to control malignant pericardial effusion of lung cancer.

BACKGROUNDSuccessful treatment of gliomas in or adjacent to language areas constitutes a major challenge to neurosurgery. The present study was performed to evaluate the procedure of language mapping via intraoperative direct cortical electrical stimulation under awake anaesthesia when performed prior to resective glioma surgery.

METHODSThirty patients with gliomas and left-hemisphere dominance and, who underwent language mapping via intraoperative direct cortical electrical stimulation under awake anaesthesia before resective glioma surgery, were analyzed retrospectively. All patients had tumors in or adjacent to cortical language areas. The brain lesions were removed according to anatomic-functional boundaries with preservation of areas of language function. Both preoperative and postoperative functional findings were evaluated.

RESULTSIntraoperative language areas were detected in 20 patients but not in four patients. Language mapping failure for reasons attributable to the anaesthesia or to an intraoperative increase in intracranial pressure occurred in six cases. Seven patients presented with moderate or severe language deficits after six months of follow-up. Total resection was achieved in 14 cases, near-total resection in 12 cases and subtotal resection in four cases.

CONCLUSIONSIntraoperative cortical electrical stimulation is an accurate and safe approach to identification of the language cortex. Awake craniotomy intraoperative cortical electrical stimulation, in combination with presurgical neurological functional imaging to identify the anatomic-functional boundaries of tumor resection, permits extensive tumor excision while preserving normal language function and minimizing the risk of postoperative language deficits.

Adolescent ; Adult ; Brain Mapping ; Brain Neoplasms ; surgery ; Cerebrum ; surgery ; Female ; Glioma ; surgery ; Humans ; Language ; Male ; Middle Aged ; Neurosurgical Procedures ; methods ; Retrospective Studies

OBJECTIVESTo investigate the feasibility and safety of one-day bowel preparation for colorectal surgery.

METHODSForty patients undergone colorectal surgery were divided randomly into the Control group and the Experimental group and received 3-day magnesium sulfate and 1-day sodium phosphate bowel preparations before the operation, respectively. The levels of hemoglobin, hematocrit, serum electrolytes, and anaerobe counts in the stool prior and post bowel preparation were examined. The general status, surgical complications, and structure of intestinal mucosa in the patients were observed after the operation.

RESULTSThere was no significant difference in the anastomoses healing, infectious complications, serum tests and intestinal mucosa structures between the two groups. Less diarrhea occurred prior and post the surgery in the experimental group, and they felt better with the bowel preparation. The anaerobe counts in stool were higher after the bowel preparation than before in both groups.

CONCLUSIONSOne-day bowel preparation with sodium phosphate is a safe and reliable method for colorectal surgery. The shortening of preparation time can reduce the degrees of uncomfortable feeling and disruptions of intestinal micro-ecology and barrier.

Colorectal Neoplasms ; surgery ; Enema ; Humans ; Intestinal Mucosa ; drug effects ; microbiology ; Magnesium Sulfate ; administration & dosage ; Middle Aged ; Phosphates ; administration & dosage ; Postoperative Complications ; Preoperative Care ; methods ; Prospective Studies

OBJECTIVETo evaluate the characteristics of autophagy in fibrotic and postoperative remnant liver.

METHODSMale Wistar rats were randomly divided into three groups: control group; fibrosis group, which received the solution of CCl4 in oil twice a week for 5 weeks; and hepatectomy group, which underwent 70% hepatectomy. Liver tissues and plasma were harvested 18 hours after the surgery. The rats' general conditions and plasma liver function were observed. Histopathological characteristics and regeneration were observed with microscope and transmission electron microscope. Qualitative analysis of autophagosome was made base on the data from transmission electron microscope.

RESULTSCompared with the control group, plasma total protein and albumin level significantly decreased in the fibrosis group (P < 0.01). Proliferating cell nuclear antigen (PCNA) index was 85%-95% in the fibrosis group. Plasma alanine aminotransferase and aspartate aminotransferase levels significantly increased in the hepatectomy group compared with the control group (P < 0.01), while the autophagical index significantly decreased in both the fibrosis group and hepatectomy group compared with the control group (-95%, P < 0.01; -19%, P < 0.05, respectively). PCNA index was 20%-30% in the hepatectomy group.

CONCLUSIONSAutophagy is weakened after fibrosis and hepatectomy, although it differs between these two processes. Proper regulation of autophagy may help facilitate the recovery of the residual liver function after hepatectomy.

Alanine Transaminase ; blood ; Animals ; Aspartate Aminotransferases ; blood ; Autophagy ; Disease Models, Animal ; Hepatectomy ; Humans ; Liver ; metabolism ; pathology ; physiopathology ; surgery ; Liver Cirrhosis ; metabolism ; pathology ; physiopathology ; surgery ; Male ; Proliferating Cell Nuclear Antigen ; metabolism ; Random Allocation ; Rats ; Rats, Wistar

OBJECTIVETo improve the diagnosis and treatment of primitive neuroectodermal tumors (PNET) of the pancreas.

METHODSOne patient with PNET of the pancreas was reported in this article. The corresponding literatures on the diagnosis and treatment was reviewed.

RESULTSThe patient was diagnosed as pancreatic PNET by her clinical, microscopic, and immunohistochemical features as well as cytogenetic analysis after the resection of the tumor located in the uncinate process in PUMC Hospital. Radiochemotherapy was given after the operation for 8 months and no recurrence was observed. Since PNET of pancreas have no specific clinical symptoms and most patients have jaundice and/or abdominal pain, the diagnosis depended on the immunohistochemical features of positive P30/32(MIC2) and at least two of the neural markers. The cytogenetic analysis showed translocation mainly harbored the characteristic t (11; 22) (q24; q12). Since pancreatic PNET were highly aggressive, early chemotherapy, close follow-up, and immediate surgical interventions were required as early as possible.

CONCLUSIONPNET can occur in pancreas, and diagnosis and treatment should be made as early as possible to improve the outcome.

Child ; Combined Modality Therapy ; Female ; Follow-Up Studies ; Humans ; Neuroectodermal Tumors, Primitive ; diagnosis ; therapy ; Pancreatic Neoplasms ; diagnosis ; therapy

OBJECTIVEThe aim of this study was to identify the long-term character of the domestic bileaflet mechanical valve in the chronic implanted sheep model and to evaluate the potential value of the modal.

METHODSSix adult sheep underwent implanted mechanical bileaflet valve in pulmonary position under the cardio-pulmonary bypass with beating heart. The chronic implanted sheep model was built up and observed in the respects of a long-term survival, function of prosthesis and pathological specimen.

RESULTSSix adult sheep survived with good condition after operation. The average survival period of six sheep was (221 +/- 208) days. Two sheep were postoperatively sacrificed in 41 and 71 days, respectively. The necropsy revealed normal valve function without thrombosis, periprosthetic leakage and overgrowth of fibrous tissue. One sheep died from dysfunction of prosthetic valve at the postoperative 196 days. The reason was the prosthetic thrombosis with slight overgrowth of fibrous tissue in periprosthesis. The other two sheep died from severe anemia at the postoperative 196 days and 234 days, and the autopsy revealed no abnormal finding else. And one remained to survive with good condition up to now (over 617 days) and was checked by Doppler echocardiogram twice at the postoperative 438 days and 479 days, respectively. The results showed normal function of the bileaflet valve in pulmonary position.

CONCLUSIONThe long-term good effects would be achieved by using the implanted new domestic bileaflet valve in pulmonary position of sheep.

Animals ; Heart Valve Prosthesis Implantation ; methods ; Male ; Models, Animal ; Pulmonary Valve ; surgery ; Sheep

OBJECTIVEPancreatic metastasis from renal cell carcinoma (RCC) is a rare event and has not been reported in our country. We report a series of 3 patients with metastatic RCC to the pancreas after radical nephrectomy at our institution. The published reports in the literature were reviewed, and the diagnosis, treatment as well as prognosis of this rare event were discussed.

METHODSThe data of 3 RCC patients with metastasis to the pancreas were reviewed retrospectively, including radical nephrectomy, metastatic interval, the second and third surgical removal. Survival of the three patients was analyzed and the reports in the literature were compared as well.

RESULTSThe average interval from radical nephrectectomy to the comfirmed pancreatic metastasis was 6.6 years (range, 1.2 to 12 years). The pathological stage revealed T2N0M0 (n = 2) or T3N0M0 (n = 1), with right-sided tumor in 2 patients and left side in 1. One patient was asymptomatic, while the other two cases were symptomatic at presentation, including upper abdominal pain, weight loss, slight xanthochromia of the skin and titillation, clay stool (n = 1); irregular fever, weight loss and jaundice (n = 1). All pancreatic metastases were hypervascular on arterial stage of CT imaging. One patient had only a solitary pancreatic metastasis (n = 1), the another showed two metastatic lesions (n = 1), the third one had multiple lesions (n = 1). Surgical removal was accomplished in 2 patients: including pylorus-preserving pancreaticoduodenectomy in one, and pylorus-preserving pancreaticoduodenectomy together with partial tail resection in another one. The third one only received interventional therapy due to widespread extrapancreatic metastasis, and died of disseminated disease 11 months after the therapy. One of the above two surgically treated patients underwent the second removal due to local recurrence 2.5 years after the first removal of pancreatic metastasis. These two patients were still alive after follow-up of 8.6 years and 16.1 years, respectively.

CONCLUSIONRenal cell carcinoma is an unpredictable tumor that may demonstrate very delayed metastasis even from early-stage of the disease. The pancreas is a rare site of metastasis from renal cell carcinoma. We advocate careful long-term follow-up of patients with a history of RCC. Aggressive surgical management of pancreatic metastatic lesions may provide a chance of long-term survival.

Aged ; Carcinoma, Renal Cell ; pathology ; surgery ; Chemotherapy, Cancer, Regional Perfusion ; Female ; Follow-Up Studies ; Humans ; Kidney Neoplasms ; pathology ; surgery ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Nephrectomy ; methods ; Pancreatic Neoplasms ; diagnosis ; drug therapy ; secondary ; surgery ; Pancreaticoduodenectomy ; methods ; Retrospective Studies ; Tomography, X-Ray Computed ; Ultrasonography, Doppler, Color

OBJECTIVETo explore the possibility of using melanoma antigen (MAGE)-1 and MAGE-3 gene encoding proteins as an index of potential target for immunotherapy in intrahepatic cholangiocarcinoma (IHCC) patients.

METHODSThe expressions of MAGE-1 and MAGE-3 genes in tumor tissues and tumor adjacent non-IHCC liver tissues were examined by RT-PCR method. The relationship between positive expression rates of MAGE-1 and MAGE-3 genes and clinical data including sex, age, tumor diameters, tumor envelope, tumor nodules number, and hepatitis B virus surface antigen were determined.

RESULTSThe positive expression rates of MAGE-1 (35%) and MAGE-3 genes (45%) were significantly higher in the tumor tissues than in tumor adjacent tissues (0) (P<0.01). The positive expression rates of MAGE-1 and MAGE-3 genes had no relationship with the clinical data (P >0.05), except the morphology of tumor (P <0.05).

CONCLUSIONThe high expression rates of MAGE-1 and MAGE-3 genes in IHCC suggests the MAGE-1 and MAGE-3 gene may be a target for immunotherapy in IHCC patients.

Adult ; Aged ; Antigens, Neoplasm ; genetics ; Bile Duct Neoplasms ; genetics ; Bile Ducts, Intrahepatic ; pathology ; Cholangiocarcinoma ; genetics ; Female ; Humans ; In Vitro Techniques ; Liver Neoplasms ; genetics ; Male ; Melanoma-Specific Antigens ; Middle Aged ; Neoplasm Proteins ; genetics ; Reverse Transcriptase Polymerase Chain Reaction

OBJECTIVETo explore the mechanism of hypoalbuminemia in patients with severe sepsis.

METHODSI(125)-labeled albumin was administered intravenously to 10 health volunteers and 10 patients with severe sepsis. Blood samples were taken at 0, 1, 2, 4, 8, 12, 24 hours and 2, 3, 4, 5, 6, 7, 9, 11, 13, 15, 18, 22, 25 days for the measurement of the dose of gamma-radiation and the curve of concentration and time. Then the half-life time (t(1/2)), apparent volume of distribution (V(d)) and transportation rate (K(12)) from center compartment to side compartment of albumin were calculated.

RESULTSThe half-life time in septic group was obviously shorter than that in control group (8.2 +/- 1.4 vs. 12.5 +/- 1.7, P < 0.01). The transportation rate in the septic group was higher than that in the control group [(4.4 +/- 1.9) x 10(-2)/h vs. (2.4 +/- 0.6) x 10(-2)/h, P < 0.05]. There was no significant difference in apparent volume of distribution between the two groups.

CONCLUSIONSIn patients with severe sepsis, the distribution rate of albumin from vessel to tissue was obviously increased and the decomposition rate of albumin was markedly improved.

Adult ; Aged ; Female ; Half-Life ; Humans ; Kinetics ; Male ; Middle Aged ; Sepsis ; metabolism ; Serum Albumin ; metabolism

Objective:Cardiopulmonary resuscitation quality index (CQI) is based on pulse oximetry plethysmographic waveform (POP), which have been proved able to reflect the peripheral circulation state as good as the quality of chest compression during cardiopulmonary resuscitation (CPR). It has been confirmed that CQI is as good as the partial pressure of end-tidal carbon dioxide (P ETCO 2) in prognostic evaluation of CPR patients. The purpose of this study was to explore whether advanced airway establishment affects the prognostic value of CQI during CPR. Methods:This was a prospective descriptive study. 376 patients receiving CPR were divided into advanced airway group and non-advanced airway group according to whether advanced airway was established, each of which was divided into ROSC (return of spontaneous circulation) group and non-ROSC group according to whether they got ROSC. The changes of CQI and P ETCO 2 during CPR were collected, and the relation of these parameters and the prognosis of patients was analyzed. Results:In advanced airway group, both CQI [(63.3±20.7) vs (49.7±23.8)] and P ETCO 2 [(19.8 (11.4, 31.6) vs 8.8 (3.3, 15.8)] mmHg were statistically different between ROSC group and non-ROSC group ( P <0.05). The cut-off value for these two parameters were 60.4 and 16.3 mmHg respectively. There was no significant difference between the two curves ( P>0.05). In the non-advanced airway group, CQI [(63.0±21.8) vs (42.2±29.0)] were also statistically different between the ROSC group and the non-ROSC group ( P <0.05). The cut-off value of CQI in advanced airway group and non-advanced airway group were 60.4 and 61.1, respectively. And there was no statistical difference between the two curves ( P>0.05). Conclusions:During CPR, CQI can be used to evaluate the prognosis of patients, which is as good as that of P ETCO 2. Establishment of advanced airway does not affect the prognostic evaluation of CQI during CPR.