Primary mediastinal seminoma often occurs in the anterior mediastinum of young males. It is unusual for the tumor to originate in the middle or posterior mediastinum, and such cases have rarely been reported in the English literature. The present study reports the case of a 52-year-old man with a 3.0-cm primary seminoma arising in the middle mediastinum. The patient presented with the symptoms of cough and chest tightness. Fluorine-18 fluorodeoxyglucose-positron emission tomography (18F-FDG-PET) scans revealed unique abnormal FDG uptake in the middle mediastinum. A mediastinoscopy was performed and integral excision was found to be difficult. A biopsy was performed and the histological examination revealed a primary seminoma. Following 4 cycles of a standard bleomycin, etoposide and cisplatin chemotherapy regimen, and chest irradiation at a total dose of 40 Gy in 20 fractions, the tumor exhibited a partial response, decreasing in size, and FDG uptake was no longer observed on 18F-FDG-PET scan. The last follow-up date was April 2016 and the patient has remained disease-free for 20 months.
Objective
To investigate the application value of nephroscopic treatment for the infection after internal drainage in severe acute pancreatitis patients complicated with walled-off necrosis (WON).
Methods
Clinical data of 5 WON patients who were misdiagnosed with pancreatic pseudocyst and developed infected pancreatic necrosis after undergoing internal drainage in Chinese PLA General Hospital between January 2010 and February 2016 were retrospectively analyzed. Among the 5 patients, 3 were males and 2 were females, with the age ranging from 39 to 67 years old and the median of 47 years old. Two cases underwent open internal drainage and 3 underwent gastroscopic percutaneous catheter internal drainage. Typical clinical and imaging manifestations of infected pancreatic necrosis were all observed postoperatively. The informed consents of all patients were obtained and the local ethical committee approval was receive. Patients initially underwent CT guided percutaneous catheter drainage (PCD), and then underwent percutaneous nephroscopic debridement of peripancreatic necrotic tissues by retroperitoneal approach and postoperative lavage and drainage.
Results
Four cases recovered and discharged from hospital after once nephroscopic treatment, and 1 after twice nephroscopic treatment. The median postoperative length of stay was 15(7-32) d. No perioperative death or postoperative complications were observed.
Conclusions
Nephroscopic treatment is a good remedial therapy with advantages of minimal invasion and good efficacy for infection after internal drainage in patients with WON who are misdiagnosed with pancreatic pseudocyst.
Key words:
Necrosis; Pancreatic pseudocysts; Internal drainage; Nephroscopic necrosectomy
To provide the anatomical basis for the selection of osteotomy site in leg lengthening or tibial slip.Between August 2010 and July 2014, 10 adult fresh amputated leg specimens were collected. The pressure perfusion of red latex was performed by the popliteal artery. The anterior tibial artery and its main branches were separated and exposed, and the periosteal branch of anterior tibial artery was adequately exposed; the posterior tibial artery and its main branches were exposed; the peroneal artery was separated and exposed. The tibial and peroneal artery and its branches were observed and measured. When measuring the proximal end, the medial tibial plateau bone margin, the most prominent part of the tibial tuberosity, and the fibular head edge were used as a reference; when measuring the distal end, distal medial condyle of tibia malleolus tip, tibial lateral malleolus lateral tip, and distal tibial articular surface were used as a reference; the vertical distance between tibia proximal and distal main arteries and bone end reference was measured to determine the optimal osteotomy position of upper and lower tibia. The osteotomy index was calculated which was used to represent the relative position of osteotomy site in the whole tibia.The proximal tibial osteotomy site located at (78.2 ± 19.5) mm from medial tibial plateau margin, (41.8 ± 16.0) mm from the tibial tuberosity pole, and (66.7 ± 16.4) mm from the fibular head edge. The distal tibial osteotomy site located at (70.8 ± 12.1) mm above the inferior margin of tibial medial malleolus, (83.3 ± 13.0) mm above the inferior margin of lateral malleolus tip, and (59.1 ± 11.7) mm from distal tibial articular surface. The proximal tibial osteotomy index was 18.45-23.35 (mean, 20.46); the distal tibial osteotomy index was 14.36-23.05 (mean, 18.81).The metaphyseal-diaphyseal connection shold be selected in the proximal and distal tibia osteotomy, the lower one third of the tibia is not suitable for ostetomy.
To assess the value of real-time three-dimensional echocardiography (RT-3DE) in evaluating changes in left atrial volume and function in type 2 diabetes mellitus (DM) and type 2 diabetic nephropathy (DN) patients.104 control subjects, 109 DN patients, and 111 DM patients were recruited and underwent RT-3DE. Data pertaining to the left atrium were analyzed using the 3DQA software in order to determine left atrial maximum volume index (LAVImax), left atrial pre-systolic volume index (LAVIp), left atrial minimum volume index (LAVImin), total left atrial ejection fraction (LAEFt), passive left atrial ejection fraction (LAEFp), and active left atrial ejection fraction (LAEFa). Differences between these three groups and correlations between individual index values and E/e' ratios were additionally assessed.LAVImax, LAVIp, and LAVImin were higher in the DN and DM groups relative to controls, whereas LAEFt and LAEFp were higher in controls relative to DM and DN patients (P < 0.05). LAVImax, LAVIp, and LAVImin in the DN group were significantly higher than those in the DM group, while LAEFt, LAEFp were higher in DM patients relative to DN patients (P < 0.05). The E/e' ratio was also found to be significantly correlated with LAVImax, LAVIp, and LAVImin.Our results indicate that RT-3DE can be used to assess changes in left atrial volume and function in patients with diabetes and can be used to monitor disease progression-related damage to such left atrial functionality.
Objective
To investigate the effect of high body mass index (BMI) on perioperative complications under thoracoscope radical resection of lung cancer and its clinical efficacy.
Methods
A total of 235 patients who received pulmonary radical resection under thoracoscope between January 2012 and December 2017 in Department of Thoracic Surgery of the First Hospital of Lanzhou University were retrospectively analyzed. The patients were divided into normal BMI group (BMI≥18.5 kg/m2 and BMI < 24.0 kg/m2, n = 147) and high BMI group (BMI≥24.0 kg/m2, n = 88) according to BMI in China. The incidence of postoperative complications and clinical efficacy were compared by using χ 2 test and t test. Logistic regression was used to identify that if high BMI was the independent risk factor of postoperative pulmonary infection in patients with lung cancer.
Results
The incidence of the complications in high BMI group was higher than that in normal BMI group, including pulmonary infection [17.0% (15/88) vs. 6.1% (9/147), χ2 = 7.162, P < 0.05], pulmonary atelectasis [11.4% (10/88) vs. 3.4% (5/147), χ2 = 5.840, P < 0.05], respiratory failure [5.7% (5/88) vs. 0.1% (1/147), χ2 = 5.535, P < 0.05] and poor wound healing [10.2% (9/88) vs. 3.4% (5/147), χ2 = 4.578, P < 0.05]. Postoperative recovery time [(7.1±1.4) d vs. (6.7±0.8) d, t = 2.706, P < 0.05], chest drainage tube removal time [(3.8±1.6) d vs. (3.4±0.7) d, t = 3.089, P < 0.05] in high BMI group were longer than those in normal BMI group. Multiple-factor analysis showed that the independent risk factors were diabetes, high blood pressure, high BMI, long operation time, old age, smoking history (all P < 0.05).
Conclusions
The incidence of pulmonary infection, pulmonary atelectasis and poor wound healing for the patients with high BMI is increased. Besides, postoperative recovery time and chest drainage tube removal time are prolonged. High BMI is an independent risk factor of pulmonary infection.
Key words:
Body mass index; Lung neoplasms; Lobectomy; Perioperative complications
A 63-year old female complained of right lower abdominal mass for 3 months, and she was admitted to hos- pital with a diagnosis colon tumor. On physical examination, an abdominal mass was found in her right quadrant, sized in 13 cm × 8 cm × 6 cm, hard, movable with clear margin. Laboratory examination revealed that Hb 12.4 g/L, CEA 5.4 μg/L, CA125 24.4 U/mL, CA153 U/mL and CA19-9 < 2.0 U/mL. A cord-like cystic mass in right abdominal cavity, primitive impression of gastrointestinal tumor, was detected by ultrasound examination, and CT scan demonstrated that a cystic occupation in right pelvic cavity, and exophytic tumor at cecum was found by fibrocolonoscopy. An exploratory laparotomy underwent by epidural anesthesia, a sausage-like tumor with size of 15 cm × 8 cm × 5 cm was seen at right abdominal cavity, and a diagnosis of appendiceal mucocele was made by intraoperative frozen pathological examination, then an appendectomy was performed, ad the patient recovered smoothly after operation and discharged on the 4th op- eration day.
Abstract Recent years, the cardiac vascular disease has arisen owing to acute myocardial infarction (MI) and heart failures leads to death worldwide. Various treatments are available for MI in modern medicine such as implantation of devices, pharmaceutical therapy, and transplantation of organs, nonetheless it has many complications to find an organs donor, devices for stenosis, high intrusiveness and long-time hospitalization. To overcome these problems, we have designed and developed a novel hydrogel material with combination of Se NPs loaded poly(ethylene glycol)/tannic acid (PEG/TA) hydrogel for the treatment of acute MI repair. Herein, Se NPs was characterized by the effective analytical and spectroscopic techniques. In vitro cell compatibility and anti-oxidant analyses were examined on human cardiomyocytes in different concentrations of Se NPs and appropriate Se NPs loaded hydrogel samples to demonstrate its greater suitability into in vivo cardiac applications. In vivo investigations of MI mice models injected with Se hydrogels established that LV wall thickness was conserved significantly from the value of 235.6 µm to 390 µm. Addition that, the relative scar thickness (33.6 %) and infarct size (17.1 %) of the MI model was enormously reduced after injection of Se hydrogel when compared to the Se NPs and control (MI) sample, respectively, which confirmed that Se introduced hydrogel have greatly influenced on the restoration of infarcted heart. Based on the investigated results of the nanoformulated samples, it could be a promising material for future generations treatment of acute myocardial infarction and cardiac repair applications.
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