BACKGROUND:The benefit of preoperative biliary drainage in jaundiced patients undergoing pancreaticoduodenectomy for a suspected malignancy of the periampullary region is still under debate. This study evaluated preoperative biliary drainage in relation to postoperative outcomes. STUDY DESIGN:At the Academic Medical Center, Amsterdam, the Netherlands, a cohort of 311 patients undergoing pancreaticoduodenectomy from June 1992 up to and including December 1999 was studied. Of this cohort 21 patients with external or surgical biliary drainage were excluded and 232 patients who had received preoperative internal biliary drainage were divided into three groups corresponding with severity of jaundice according to preoperative plasma bilirubin levels: < 40 microM (n = 177), 40 to 100 microM (n = 32), and > 100 microM (n = 23) were designated as groups 1, 2, and 3, respectively. These groups were compared with patients who underwent immediate surgery (n = 58) without preoperative drainage. RESULTS:The median number of stent (re)placements was 2 (range 1 to 6) with a median drainage duration of 41 days (range 2 to 182 days) and a stent dysfunction rate of 33%. Although patients in group 1 were better drained than patients in groups 2 and 3 (median reduction of bilirubin levels 82%, 57%, and 37%, respectively, p < 0.01), there was no difference in overall morbidity among the drained groups (50%, 50%, and 52%, respectively). There was no significant difference in overall morbidity between patients with and without preoperative biliary drainage (50% and 55%, respectively). CONCLUSIONS:Preoperative biliary drainage did not influence the incidence of postoperative complications, and although it can be performed safely in jaundiced patients it should not be used routinely.
Lymphedema is a common complication associated with breast cancer treatment, which has a serious impact on patients' limb function and quality of life. A clear and standardized diagnosis of breast cancer-related lymphedema is important for early identification of lymphedema and timely clinical diagnosis and treatment. Standardized, effective and timely management can reduce the incidence of lymphedema. This article reviews the current common diagnostic tools and methods and management methods, and evaluates their advantages and disadvantages in terms of both diagnosis and early management.
Objective:To compare the efficacy, adverse reactions and skin cosmetic effects between simultaneous integrated boost intensity-modulated radiotherapy and whole-breast intensity-modulated radiotherapy with sequential electronic boost radiotherapy for early breast cancer after breast-conserving surgery.Methods:The clinical data of 96 early breast cancer patients who underwent breast-conserving surgery in Shanxi Province Cancer Hospital from December 2015 to December 2017 were retrospectively analyzed, and the patients were divided into simultaneous integrated boost intensity-modulated radiotherapy group (observation group, 52 cases) and whole-breast intensity-modulated radiotherapy with sequential electronic boost radiotherapy group (control group, 44 cases) according to the postoperative radiotherapy method. In the observation group, the dose division scheme was 50 Gy/25 fractions (2 Gy/fraction) for the whole breast, while 60 Gy/25 fractions (2.4 Gy/fraction) was used in the tumor bed concomitantly, with a total treatment course of 33-35 d. In the control group, the dose division scheme was 50 Gy/25 fractions (2 Gy/ fraction) for the whole breast followed by tumor bed boost of 10 Gy/5 fractions (2 Gy/fraction), with a total treatment course of 40-42 d.Results:Median follow-up time of all patients was 70 months, the 5-year overall survival rates of the observation and control groups were 100.0% and 97.7%, the 5-year local recurrence-free survival rates were 98.1% and 95.5%, the 5-year disease-free survival rates were 98.1% and 93.2%, and the differences between the two groups in terms of overall survival, recurrence-free survival and disease-free survival were not statistically significant ( χ2 = 1.18, P = 0.277; χ2 = 0.44, P = 0.509; χ2 = 1.24, P = 0.265). The incidence of grade 1 and 2 acute radiation dermatitis was 63.5% (33/52) and 19.2% (10/52) in the observation group, and 50.0% (22/44) and 38.6% (17/44) in the control group, there was 1 case (2.3%) of grade 3 acute radiation dermatitis, and the difference between the two groups was statistically significant ( Z = -2.15, P = 0.032). The differences in the incidence of acute and late radiation lung injury between the two groups were not statistically significant (both P > 0.05). Except for 1 patient (2.3%) in the control group with poor cosmetic results, the rest of the patients in both groups achieved average or excellent cosmetic results ( P > 0.05). The radiotherapy time of the observation group was shorter than that of the control group, and the difference was statistically significant ( P = 0.001). Conclusions:Early breast cancer patients who received simultaneous integrated boost intensity-modulated radiotherapy or whole-breast intensity-modulated radiotherapy with sequential electronic boost radiotherapy after breast-conserving surgery could obtain good survival benefit, and the cosmetic results are all good without serious adverse effects. The treatment time of simultaneous integrated boost intensity-modulated radiotherapy is shorter and patient compliance is better.
Objective:To compare the value of 3 methods (threshold method, visual method and CT method) based on 18F-FDG PET-CT for qualitative diagnosis of solitary pulmonary nodules (SPN). Methods:The clinical characteristics, pathological results, CT signs and maximum standardized uptake value (SUV max) of 226 SPN patients who underwent 18F-FDG PET-CT and met lung imaging reporting and data system (Lung-RADS1.1) grading criteria grade 2-4 in Shanxi Province Cancer Hospital from January 2015 to January 2019 were retrospectively analyzed, and the diagnostic efficacy of threshold method (according to SUV max), visual method [according to the degree of fluorodeoxyglucose (FDG) uptake in the mediastinum or liver blood pool] and CT method (according to Lung-RADS1.1 grading criteria) for SPN were compared by using receiver operating characteristic (ROC) curve. The highest diagnostic accuracy of CT method and the highest diagnostic accuracy of threshold method and visual method were combined as PET-CT comprehensive diagnosis method, and the diagnostic efficiency of which was compared with the other methods. Results:Among the 226 patients with SPN, 174 cases were malignant and 52 cases were benign in pathology. ROC curve analysis showed that the area under the curve (AUC) of CT method 2 (defined Lung-RADS1.1 grade 4A and below as benign, grade 4B and above as malignant) in CT methods for qualitative diagnosis of SPN was 0.622, the sensitivity was 87.93%, and the accuracy was 76.11%, the diagnostic efficiency was higher than method 2. The AUC of the threshold method 1 (defined solid nodules that SUV max≥2.5 and ground-glass nodules that SUV max≥1.14 as malignant, the others as benign) in threshold methods for qualitative diagnosis of SPN was 0.675, the sensitivity was 85.06%, and the accuracy was 76.99%, the diagnostic efficiency was higher than other methods in the threshold methods and visual methods. The AUC of PET-CT comprehensive diagnosis method (combination of CT method 2 and threshold method 1) for qualitative diagnosis of SPN was 0.652, the sensitivity was 97.70%, and the accuracy was 82.74%, the diagnostic efficiency was higher than other methods. Conclusions:There is no significant difference among threshold method, visual method and CT method based on 18F-FDG PET-CT in qualitative diagnosis of SPN. The diagnostic efficiency of combining CT method with threshold method is significantly improved.
Objective:To investigate the influencing factors for underdiagnosis of high-grade squamous intraepithelial lesion (HSIL) of the uterine cervix and cervical cancer by colposcopy.Methods:The clinical data of 957 patients who underwent colposcopy and were diagnosed as HSIL or cervical cancer by histopathology at the Second Hospital of Shanxi Medical University from January 2017 to June 2022 were retrospectively analyzed, and logistic regression was used to analyze the influencing factors for underdiagnosis of HSIL and cervical cancer by colposcopy.Results:The results of univariate analysis showed that the underdiagnosis of HSIL and cervical cancer by colposcopy was related to whether or not menopause was present, whether or not there was coitus bleeding, whether or not there was irregular bleeding, liquid-based thin-layer cytology test (TCT) results, the morphology of the uterine cervix, the results of acetowhitening test, the results of iodine test, whether or not there was cuffed crypt (gland) openings, whether or not there was mosaicism, whether or not there was punctate vessels, whether or not the transformed zone was completely visible, the type of transformed zone, and whether or not the lesions involved the glands (all P < 0.05), but the underdiagnosis didn't related to whether or not there was human papillomavirus (HPV) infection, whether or not there was high-risk HPV multiple infections and the results of endocervical curettage (all P > 0.05). The results of multivariate logistic regression analysis showed that irregular bleeding ( OR = 4.279, 95% CI 2.170-8.441, P < 0.001), atypical squamous cells of uncertain significance (ASC-US) by TCT ( OR = 0.415, 95% CI 0.226-0.761, P = 0.004), atypical squamous cells, cannot exclud high-grade squamous intraepithelial lesion (ASC-H)/HSIL by TCT ( OR = 0.389, 95% CI 0.206-0.735, P = 0.004), thick acetowhite epithelium by acetowhitening test ( OR = 0.015, 95% CI 0.004-0.055, P < 0.001), and punctate vessels ( OR = 0.327, 95% CI 0.173-0.616, P = 0.001) were independent influencing factors for underdiagnosis of HSIL and cervical cancer by colposcopy. Conclusions:A history of irregular bleeding is a risk factor for underdiagnosis of HSIL of the uterine cervix and cervical cancer by colposcopy, while TCT results of ASC-US, ASC-H/HSIL and colposcopic visualization of thick acetowhite epithelium and punctate vessels could reduce the risk of underdiagnosis
