The present study aimed to investigate presurgical neoadjuvant targeted therapy for patients with kidney cancer and vena cava tumor embolus, in order to examine its indications, therapeutic effects and optimal timing of surgery. Between June 2009 and June 2014, 12 patients from The People's Liberation Army General Hospital (Beijing, China) were diagnosed with kidney cancer with superior vena cava tumor embolus, and received presurgical neoadjuvant targeted therapy (sorafenib 400 mg twice a day or sunitinib 50 mg/day) for a median of 13.3 weeks. Patients included 8 males and 4 females, with a median age of 49.8 years. Kidney cancer was present on the left side in 3 patients and in the right side in 9 patients. The median tumor embolus length was 9.7 cm (range, 6.5-14.0 cm). Tumor embolus levels II, III and IV, classified by the Mayo Clinic standard, were observed in 2, 6 and 4 patients, respectively. Median treatment time and average targeted therapy discontinuation time were observed to be longer in sunitinib-treated patients compared with sorafenib-treated patients. In total, 2 patients in the present study had partial remission (PR) and 8 patients had stable disease (SD); for tumor embolus, 4 patients had PR and 8 patients had SD. Tumor embolus length decreased by a median value of 18.7% (range, 0.0-42.1%) or 1.8 cm (range, 0.1-5.2 cm). Tumor diameter decreased by a median value of 8.6% (range, 0.0-38.9%) or 0.7 cm (range, 0.0-3.5 cm). The level of the tumor thrombus, classified by the Mayo Clinic standard, was observed to decrease following sunitinib treatment, including two cases downgraded from tumor thrombus level IV to II, one case from level IV to III and two cases from level III to II. Presurgical neoadjuvant targeted molecular therapy may have the potential to reduce the tumor stage of patients, as well as decreasing the surgical difficulty for radical nephrectomy.
Chronic constipation is a polysymptomatic heterogeneous disorder with the incidence rising in many countries, and becomes a common disease affecting the quality of life and financial burden. In China surgical guideline, the primary constipation is divided into 3 types: slow transit constipation, outlet obstructive constipation, mixed constipation. The Rome IIII( criteria is usually referred to diagnosis, considering with clinical features and patient complaints. Through detail interrogation, physical examination and various detections, the secondary causes should be excluded, and etiological treatment is worth to try. Surgery is generally recommended as the second-line therapy, and finally only few patients require operation. There are still several controversies over the choice of surgical procedures and the mode of anastomosis in patients with slow transit constipation. Common surgical procedures include total colectomy with ileorectal anastomosis (TAC-IRA), subtotal colectomy with ileosigmoid anastomosis, ileorectal anastomosis or cecal-rectal anastomosis. Now laparoscopic operations have been widely applied to these patients, and have achieved good efficacy, and the application of robots is also under exploration. With the outlet obstructive constipation complicated pathogeny, the mechanisms currently involved include paradoxical puborectalis contraction, increased perineal descent, rectal intussusception, rectocele and rectal prolapse. In recent years, aiming at the above mechanisms, variety of surgical methods has been explored, including bilateral partial resection of puborectalis (PDPR) for paradoxical puborectalis contraction, rectal mucosa longitudinal plication plus sclerosing agent injection, procedure for prolapse and hemorrhoids (PPH), rectal mucosal resection and muscle plication procedure (Delorme), stapled transanal rectal resection (STARR) and laparoscopic ventral mesh rectopexy (LVR) etc for rectal prolapse. However, there is still no long-term large sample study to prove the advantages and disadvantages of these operations, so operative procedure should be chosen according to the actual situation of the patient. With the integration of the pathogenesis and the diversification of the treatment methods, the constipation still needs the precise treatment combined with multidisciplinary support in the future.
Long-term results of 1035 previously untreated patients with nasopharyngeal carcinoma seen at Cancer Hospital, Chinese Academy of Medical Sciences, between March 14, 1958 and March 15, 1968 are presented. Of the 1035 patients, 715 were treated with radiation therapy; 281 patients did not receive radiation therapy; and 39 patients whose records were lost. The patients were further subdivided according to the dose of radiation therapy (>4000 rad versus <4000 rad), the presence or absence of pathologic confirmation of diagnosis, whether or not follow-up was complete, and whether or not distant metastases developed during treatment. All patients are included in the analysis. The 5-year and 10-year absolute survival rates for the entire group of 1035 patients are 19.6% and 14.5%, respectively. The 5-year and 10-year relative survival rates for the 715 patients who received radiation therapy are 28.4% and 21.0%, respectively. The 5-year and 10-year relative survival rates of the 464 with a pathologically confirmed diagnosis, who were without evidence of distant metastases and who received at least 4000 rad were 34.7% and 25.4%, respectively. Details regarding our statistical methods as well as an exact breakdown of the patient population are presented.
Objective To analyze the complications after procedure for prolapse and hemorrhoids (PPH) in treating severe mucocutaneous hemorrhoids.Methods The clinical data of 550 patients with severe mucocutaneous hemorrhoids who were admitted to the Hangzhou Hospital of Nanjing Medical University from January 2005 to December 2013 were retrospectively analyzed.All the patients were treated by PPH or PPH + external hemorrhoids resection.The postoperative complications were recorded and assessed.Patients were followed up via outpatient examination and telephone interview till June 2014.Results Operation was successfully carried out on all the 550 patients.The operation time and duration of hospital stay were (15 ± 10)minutes and (4.2 ± 1.8)days,respectively.A total of 445 patients were followed up for 6-60 months,with the median time of 28 months.The overall incidence of complications was 14.61％ (65/445).Forty-five patients were complicated with anal pain,12 with hemorrhoid recurrence,7 with bleeding,5 with dysporia,4 with anastomotic stenosis and 2 with rectal and perianal infection.Of the 12 patients with hemorrhoids recurrence,5 was alleviated by medication and 7 received PPH for the second time.Of the 4 patients with anastomotic stricture,the condition of 2 patients were alleviated by anus dilatation,and the condition of 1 patient was alleviated by balloon dilatation under enteroscope,1 patient received circular incision of the stricture because of severe stricture and failed of conservative treatment.Of the 2 patients with rectal and perianal infection,1 was alleviated by intravenous and local medication,and the other patient who was complicated with anal fistula was alleviated by surgery.The condition of other patients was improved after symptomatic treatment.Conclusions PPH is effective and safe for the treatment of severe mucocutaneous hemorrhoids.The main complication is anal pain,and it could be cured or alleviated by symptomatic treatment.
Key words:
Severe mucocutaneous hemorrhoids; Procedure for Prolapsed Hemorrhoids; Complications
Les cavites laterales sont des zones mortes a surface libre situees sur le cote d’un ecoulement fluvial ou cotier. Les vitesses caracteristiques au sein de la cavite etant beaucoup plus faibles que celles de l’ecoulement, une couche de melange se developpe a l’interface entre ces deux regions. Cette couche de melange peut alors transferer de la quantite de mouvement de l’ecoulement vers la cavite et ainsi mettre en mouvement la cavite et peut aussi transferer de la masse entre les deux regions, telle une pollution venant de l’ecoulement amont. L’etude de cette these a alors consiste a etudier les caracteristiques de la couche de melange, qui est rendue specifique par le fait qu’elle se developpe entre deux coins geometriques formes par l’intersection entre les parois de la cavite et celles de l’ecoulement principal. Nous avons alors pu identifier l’origine et l’alternance des mouvements de fluide dans la direction transverse: de la cavite vers l’ecoulement et inversement. Concernant la mise en mouvement de la cavite, le choix a ete fait de considerer un ecoulement principal fixe et de modifier l’extension de la cavite dans la direction perpendiculaire a l’ecoulement, passant ainsi d’une cavite rectangulaire alignee avec l’ecoulement principal a une cavite allongee dans le sens oppose. La mesure de champ de vitesse par PIV 2D a alors montre une forte evolution de la forme de l’ecoulement a mesure que la geometrie de la cavite evolue : un systeme avec deux cellules alignees dans le sens de l’ecoulement a un systeme a une seule cellule, puis un systeme a deux cellules et enfin un systeme complexe 3D ont ainsi ete observes pour une cavite de plus en plus allongee. Ensuite, une modification du dispositif experimental a permis de mesurer de deux facons differentes le transport de scalaire de l’ecoulement principal vers la cavite, de comprendre les processus associes a ce transfert et enfin de quantifier cette capacite de transfert pour differents ecoulements principaux et differentes geometries de cavites. Nous avons notamment montre que la geometrie de la cavite a peu d’effet alors que le nombre de Reynolds et la profondeur d’eau normalisee ont un effet majeur sur cette capacite de transfert de masse entre les deux regions.
As an extremely rare malformation, congenital pouch colon is characterized by shortened colon, markedly dilated pouch and anorectal malformations. In boys, pouch usually terminates in a colovesical fistula; in girls, terminal fistula opens into urethra or vestibule. Clinical presentations are typical and and its diagnosis is easily made by a large gas shadow or air-fluid level on radiograph. Its clinical managements and surgical options have remained controversial. Staged repair is performed after colostomy or ileostomy. Yet tubularization of dilated segment is dependent on the length of normal colon.
Key words:
Colon, abnormalities; Congenital pouch colon
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