To explore the advantage and indication of combined anterior and posterior surgeries for lumbarsacral junction tuberculosis. Methods Eleven cases of the lumbarsacral junction tuberculosis were treated with combined anterior (radical debridement and autograft) and posterior (instrumentation and fusion) surgeries in one stage between January 2002 and December 2006. There were 9 males and 2 females with the age of 20-56 years old. The courseof disease was 4 to 15 months, 6 months on average. The lessons were located at L5, S1 in 7 patients, at L4,5, S1 in 2 patients and at L5, S2 in 2 patients. The involved vertebral bodies were at 2 segments in 7 patients; and 3 segments in 5 patients. The preoperative kyphosis was 5 to 8° with an average 9°. The sinus was associated in 3 patients, 3 patients had radiculopathy; 4 had paeumonophthisis and 9 had abscess. Results The followed-up period was from 6 months to 3 years, 18 months on average. According to Chen score, among the 11 cases, there were excellent in 9, good in 2. All incisions were healed up primarily. After operation, spinal fusion was achieved in 10 cases within 5 months to 7 months, 6 months on average, and pseudoarthrosis in 1 case was found by the CT examination. The postoperative kyphosis was 0 to 4° with the mean of 2° and the radiculopathy in 3 cases all got nerve function recovery. Conclusion Lumbarsacral junction tuberculosis treated with this surgical technique can achieve a high satisfactory rate with restoring the spinal stabil ity, arresting the disease early, providing early fusion, correcting the kyphosis and preventing progression of kyphosis particularly if lumbosacral spine tuberculosis is associated with sinus or preoperative diagnosis cannot exclude suppurative spondyl itis.
【Abstract】ObjectiveTo evaluate the localized biopsy of nonpalpable breast lesions (NPBLs) and its role in the early diagnosis and treatment of breast cancer. MethodsOne hundred and fifty-eight NPBLs from a series of 141 women detected by mammography were resected with wire localization technique. ResultsForty-two lesions (26.6%, 42/158) in 42 patients were diagnosed with malignant result, including 12(28.6%) patients with stage 0 breast cancer, 24(57.1%) with stageⅠ, 2(4.8%) with stage Ⅱ and 4(9.5%) with stage Ⅲ disease according to American Joint Committee on Cancer (AJCC) staging system（the 6th edition）. The contralateral axillary lymph nodes metastasis were found in only one (2.4%) patient with stage Ⅲ disease and the other fortyone patients remained free of recurrent disease at a median follow-up of 31 months.ConclusionThe results showed that the most nonpalpable breast cancers detected by mammography were earlystage breast cancers and had good prognosis. The NPBLs should get a localized biopsy in order to facilitate the early diagnosis and treatment of nonpalpable breast cancers.
B-type ultrasound images have important applications in medical diagnosis. However, the widely spread intensity inhomogeneity, low-scale contrast, constructed defect, noise and blurred edges all make it difficult to implement automatic segmentation of lesion in the images. Based on region level set method, a subordinate degree region level set model was proposed, in which subordinate degree probability of each pixel was defined to reflect the pixel subjection grade to target and background respectively. Pixels were classified to either target or background by calculation of their subordinate degree probabilities, and edge contour was obtained by region level set iterations. In this paper, lesion segmentation is regarded as local segmentation of specific area, and the calculation is restrained to the local sphere abide by the contour, which greatly reduce the calculation complexity. Experiments on B-type ultrasound images showed improved results of the proposed method compared to those of some popular level set methods.
ObjectiveTo investigate the value of small incision approach in the anterior surgery of thoracic and lumbar spinal tuberculosis.MethodsA clinical data of 65 patients with thoracic or lumbar spinal tuberculosis treated with posterior-anterior surgery between January 2015 and January 2018 was retrospectively analyzed. The patients were divided into small incision group (group A, 29 patients) and traditional incision group (group B, 36 patients) according to the length of anterior incision. There was no significant difference in general data such as gender, age, disease duration, segment of lesion, American Spinal Cord Injury Association (ASIA) grading, preoperative pain visual analogue scale (VAS) score, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and Cobb angle of spinal kyphosis between 2 groups (P>0.05). The length of anterior incision, operation time, intraoperative blood loss, postoperative complications, postoperative hospitalization time, ESR, and CRP were recorded and compared. The VAS score was used to evaluate the pain after operation. The Cobb angles in patients with spinal kyphosis were measured and the loss of angle and correction rate of angle were calculated. The result of bone graft fusion was assessed according to the Bridwell standard.ResultsThe length of anterior incision, operation time, intraoperative blood loss, and hospitalization time of group A were all significantly less than those of group B (P<0.05). All patients in both groups were followed up 12-29 months (mean, 20 months). There were 4 cases (13.8%) and 14 cases (38.9%) of postoperative complications in groups A and B respectively, showing significant difference (χ2=5.050, P=0.025). The ESR and CRP in 2 groups all returned to normal at 6 months after operation, and there was no significant difference in ESR and CRP between 2 groups at 3 months, 6 months, and last follow-up (P>0.05). At last follow-up, the neurological function of patient with neurological symptoms was significantly better than that before operation, and there was no significant difference between 2 groups (Z=0.167, P=0.868). The VAS scores of 2 groups at each time point after operation were significantly lower than those before operation (P<0.05); the VAS score in group A was significantly lower than that in group B (t=?2.317, P=0.024) at 1 day after operation, but there was no significant difference between 2 groups (t=?0.862, P=0.392) at last follow-up. Among the patients with kyphosis, the Cobb angle was significantly decreased at 1 day after operation and last follow-up when compared with preoperative angle (P<0.05); but there was no significant difference between 1 day after operation and last follow-up (P>0.05). There was no significant difference in Cobb angle, loss of angle, and correction rate between 2 groups after operation (P>0.05). The bone graft healed well at last follow-up in 2 groups. There was no significant difference in bone graft fusion rate between 2 groups at 6 months after operation, 1 year after operation, and last follow-up (P>0.05). At last follow-up, all patients cured, and no recurrence occurred.ConclusionIn the anterior surgery of thoracic and lumbar tuberculosis, the application of small incision approach can achieve the similar effectiveness as traditional incision surgery with the advantages of minimally invasive, less complications, and quick recovery.
Objective To study the clinical results of focal debridement and primary internal fixation with CD rod in treatment of multisegmental spinaltuberculosis.Methods From July 1999 to November 2002, 16 patients with multisegmental spinal tuberculosis were given focal debridement and primary internal fixation with CD rod trans sick vertebra. There were 9 males and 7 females, aging from 21 to 59 years. The course of disease was 2 to 11 months. The locations of lesion were T 6T 11 in 11 patients and T 10 -L2 in 5 patients.The involved vertebral bodies were 3 segments in 13 patients, 4 or more than 4 segments in 3 patients. There were 5 cases of Pott’s paralysis (according to Frankel classification system: 3 cases of degree C, 2 cases of degree D) and 4 cases of kyphosis and 2 cases of collapse. Focal debridement and internal fixation was performed in 1 or 2 incisions according to concrete conditions. Results All patients were followed up 11 months (6 months-3years), spinal tuberculosis was completely cured and the grafted bones were fused in all 16 patients. All patients obtainedprimary healing of the incision. Postoperative complication met with cerebrospinal fluid leakage in 1 case. After 6 months, 5 cases of paraplegia recovered. The kyphosis was corrected partly. No loose and dislocation of the nails and rods was found. Conclusion Focal debridement and primary internal fixation with CD rod can stabilize involved spinal segments, prevent and correct local deformity,and improve its curative ratio and fused ratio of grafted bone.
Objective To investigate the cl inical outcomes of one stage debridement and closed-suction drainage for treatment of infection after lumbar instrumentation. Methods Between June 2002 and March 2008, 12 patients with infection after lumbar instrumentation were treated with one stage debridement and closed-suction drainage, including 9 males and 3females and aging 35-68 years (48.5 years on average). The disease duration varied from 7 days to 183 days (56 days on average). The segments of internal fixation included 7 cases single segment at levels of L4, 5, 4 cases of double segments at levels of L 4, 5, L5, S1 (2 cases), and L3, 4, L4, 5 (2 cases), and 1 case of three segments at levels of L3, 4, L4, 5, L5, S1. Two patients were treated with internal fixator removal. Results The bacterial culture results of intervertebral discs were positive in 8 cases for Staphylococcus aureus and in 3 cases for Enterobacter cloacae, negative in 1 case. Primary healing of incisions were achieved in all cases. Twelve patients were followed up 18-53 months (34.7 months on average). The white blood cell count, erythrocyte sedimentation rate, and C reactive protein significantly decreased after operation, showing significant differences at 15 days after operation when compared with those before operation (P lt; 0.05). No obvious low back pain was observed. Pathological-changed vertebra-space fused. No displacement and breakage of internal fixator occurred; in 2 patients who were given internal fixator removal, no removal of the instrumentation was performed again. The X-ray films showed that the average kyphosis decreased 0.8° at 18 months after operation. At last follow-up, the visual analogue scale score was 2 ± 1, showing significant difference (P lt; 0.05) when compared with that (10 ± 2) before operation. Conclusion One stage debridement and closed-suction drainage therapy is an effective method for treating infection after lumbar instrumentation. The operation is easy and can reduce hospitalization days.
Objective To evaluate the cl inical significance of the combination of intensified anti-tuberculosis treatment, posterior transpedicular screw system internal fixation, intertransverse bone grafting, and anterior approach focus debridement for the treatment of thoracolumbar tuberculosis. Methods From January 2005 to December 2007, 20 patients with thoracolumbar tuberculosis (T10-L3) were treated. There were 13 males and 7 females aged 21-64 years old (average 44 years old). The course of disease was 3 months to 3 years (average 10 months). The focus involved single vertebrae bodies in 8 cases, two vertebrae bodies in 9 cases, and three vertebrae bodies in 3 cases. The preoperative Cobb angle was 9-35° (average 26.7°). The neurological function was evaluated according to the Frankel grading criterion, there were 2 cases of grade B, 5 of grade C, 7 of grade D, and 6 of grade E. Vertebral body defect index score: 9 cases of 1-2 points, 7 cases of 2-3 points, and 4 cases above 3 points. After receiving the systemic five-drug treatment of anti-tuberculosis for 2-3 weeks, the patients underwent the posterior transpedicular screw system internal fixation and intertransverse bone grafting, and then received tuberculosis focus debridement via anterior approach, nerve decompression, and bone grafting fusion. Results The time of operation averaged 210 minutes and the mean blood loss during operation was 650 mL. Postoperatively, 2 patients had mild belting sensation in their thorax and 2 patients had mild pneumothorax. Their symptoms rel ived 2-3 weeks later without specific treatment. All the patients were followed up for 12-23 months. X-ray films showed that all the patients achieved successful bony fusion 6-18 months after operation, and the Cobb angle was 7-21° (average 15.2°) 12 months after operation without aggravation. The Frankel gradingsystem was used to assess the postoperative neurological function, 1 patient in grade B before operation was improved to grade C after operation, 1 patient in grade B was improved to grade D, 1 patient in grade C was improved to grade D, 4 patients in grade B were improved to grade E, and 7 patients in grade D were improved to grade E. All of the incisions healed and erythrocyte sedimentation rate became normal 2 weeks to 3 months after operation. All the patients showed no obvious abnormity in l iver and kidney function. There was no recurrence of tuberculosis. Conclusion It seems that the systemic drug treatment of antituberculosis before and after operation, the thorough debridement of focus during operation, and the effective and rel iable wayto reconstruct for the spinal stabil ity are the key points for the treatment of spinal tuberculosis.
How to improve the performance of circulating tumor DNA (ctDNA) signal acquisition and the accuracy to authenticate ultra low-frequency mutation are major challenges of minimal residual disease (MRD) detection in solid tumors. In this study, we developed a new MRD bioinformatics algorithm, namely multi-variant joint confidence analysis (MinerVa), and tested this algorithm both in contrived ctDNA standards and plasma DNA samples of patients with early non-small cell lung cancer (NSCLC). Our results showed that the specificity of multi-variant tracking of MinerVa algorithm ranged from 99.62% to 99.70%, and when tracking 30 variants, variant signals could be detected as low as 6.3 × 10?5 variant abundance. Furthermore, in a cohort of 27 NSCLC patients, the specificity of ctDNA-MRD for recurrence monitoring was 100%, and the sensitivity was 78.6%. These findings indicate that the MinerVa algorithm can efficiently capture ctDNA signals in blood samples and exhibit high accuracy in MRD detection.
ObjectiveTo evaluate the role of surgical resection on synchronous multiple pulmonary nodules identified difficultly in clinics.MethodsThe clinical data of 97 patients with synchronous multiple pulmonary nodules who received surgical resection between 2012 and 2019 in Hunan Cancer Hospital were retrospectively analyzed. There were 72 males and 25 females, aged 58.1±9.0 years. Among these patients, there were 78 patients with ipsilateral and 19 patients with bilateral pulmonary nodules. Clinicopathological parameters between main nodules and secondary nodules were evaluated. Perioperative morbidity was also assessed.ResultsThe operation was successfully completed on all patients for the ipsilateral and bilateral lesions. Totally, 71.1% of mian lesions was mostly removed by lobectomy, and the completion rate of video-assisted thoracoscopic surgery (VATS) was 69.1% (67/97); 80.4% of secondary lesions were mostly removed by wedge resection, and the completion rate of VATS was 71.1% (69/97). The incidence of grade 3 or higher complications after unilateral or bilateral surgery was 12.8% and 5.3%, respectively. Postoperative pathology confirmed that the main lesions were malignant in 65 patients (67.0%), mainly adenocarcinoma (63.1%), of which 43.1% were in the stage Ⅰ; 32 patients were benign, mainly tuberculoma (56.3%). There were 29 patients of malignant secondary lesions, 67 benign, and 1 both benign and malignant; the pathological agreement rate of primary and secondary lesions was 54.6% (lung cancer metastases in the lung and all the benign). When the primary lesion was malignant with its diameters of <3 cm, 3-<5 cm, 5-7 cm, >7 cm, the metastatic rate of secondary lesions was 42.5%, 15.8%, 20.0%, 0, respectively. When the primary lesion was malignant with lymph node metastasis, the probability of the secondary lesion being a metastatic tumor was higher than that without lymph node metastasis (46.7% vs. 30.0%, P>0.05). When the primary lesion was malignant and the primary and secondary lesions were located in the same lobe, the secondary lesions were more likely to metastasize (54.5%), while when they were located on different lobes on the same side or different sides, the secondary lesions were more likely to be benign (58.1%, 72.7%), and the possibility of metastasis was small ( 32.6%, 9.1%). When the primary lesion was benign and clinical differential diagnosis was difficult, the secondary lesion was benign.ConclusionFor synchronous multiple pulmonary nodules, the diameter of the primary lesion is large, the metastatic rate of secondary lesions tends to decrease. In ipsilateral synchronous multiple pulmonary nodules, especially with node metastasis, the risk of metastatic nodule increases. Bilateral surgical resection does not significantly increase the perioperative morbidity.
