Epilepsy is one of the most common neurological diseases in children, about 2/3 can be seizure-free after anti-seizure medications (ASMs) treatment, but there are still some drug-resistant epilepsy (DRE) need surgical treatment, epilepsy surgery including excision surgery, dissociation surgery and palliative surgery, surgery can make 30%~40% DRE fully controlled. Clinicians usually choose to discontinue ASMs after seizure-free for 1 to 2 years after epilepsy surgery, but there has been controversy about whether to discontinue ASMs after surgery in children with epilepsy, how long to discontinue ASMs, the timing of ASMs withdrawal, and there is still a lack of unified guidelines. This article will comprehensively analyze and summarize the risk of recurrence after ASMs withdrawal in children with epilepsy.
ObjectiveTo investigate the clinical efficacy of carbon dioxide (CO2) laser ablation in the treatment of laryngeal papilloma and analyze the relevant factors for recurrence.
MethodsWe retrospectively analyzed the clinical data of 102 patients with laryngeal papilloma treated between February 2003 and October 2010 in our department. They were divided into the juvenile group (n=70) and adult group (n=32). Patients in both groups underwent microsurgery with CO2 laser ablation to remove the lesions under general anesthesia. During the process, we observed patients'site of lesions, recurrence time, the incidence of postoperative vocal adhesions, and the occurrence of malignancy.
ResultsAll patients were followed up for 1 to 8 years. Eleven cases of vocal cord adhesion occurred, and patients with the adhesion all had former joint lesions, which accounted for 27.5% of all the anterior commissure adhesion patients. Four cases of malignancy all occurred in adults with an adult malignancy rate of 12.5%. Recurrence occurred in 41 cases and 76 cases of times, including 5 times in 2 cases, 4 times in 4 cases, 3 times in 3 cases, twice in 9 cases, and once in 23 cases. The difference in times of recurrence was significant between the juvenile and the adult group (P<0.05). Significant difference was found between single lesion and multiple lesion recurrence in both groups (P<0.05). There was no significant difference between the two groups in terms of single lesion recurrence (P>0.05), while the difference in multiple lesion occurrence was significant (P<0.05). The first recurrence time was within 12 months after surgery in both groups, and recurrence mainly occurred within 6 months after surgery. Single lesion and multiple lesion recurrence mainly manifested as anterior commissure lesions (2/3, 66.7%) and subglottic lesions (5/6, 83.3%) respectively.
ConclusionMicro-laryngoscopy CO2 laser laryngeal papilloma resection is safe, effective, and minimally invasive in the treatment of laryngeal papilloma, and is the preferred surgical method in clinic, but it still needs further improvement.
ObjectiveTo investigate the values of serum CEA and CA19-9 in predicting postoperative recurrence and metastasis and prognosis for gastric cancer.
MethodsPreoperative serum levels of CEA and CA19-9 were measured by electrochemiluminescence assay in 136 patients with gastric cancer. The relationships of serum CEA level, CA19-9 level to clinicopathologic features, postoperative recurrence and metastasis, and prognosis of gastric cancer were analyzed. Kaplan-Meier method (log-rank test) was used to survival analysis.
ResultsThere were 67 patients with postoperative recurrence and metastasis in 136 patients with gastric cancer. The positive rate was 48.5% (66/136) for CEA and 43.4% (59/136) for CA19-9. There was a significant correlation between CEA level and T stage, TNM stage, lymph node metastasis, or vascular invasion (P=0.011, P=0.018, P=0.021, P=0.024). There was a significant correlation between CA19-9 level and T stage or lymph node metastasis (P=0.018, P=0.045). The rate of postoperative recurrence and metastasis was 60.6% (40/66) in positive CEA, 61.0% (36/59) in positive CA19-9, 38.6% (27/70) in negative CEA, and 40.3% (31/77) in negative CA19-9, respectively. The rate of postoperative recurrence and metastasis in the positive CEA or positive CA19-9 was significantly higher than those in the negative CEA or negative CA19-9 (P=0.010, P=0.016). Kaplan-Meier analysis showed that patients with positive CEA or positive CA19-9 had worse survival than those with negative CEA or CA19-9 (P=0.003, P=0.007).
ConclusionsCEA and CA19-9 have important values in detecting recurrence and metastasis, predicting patient survival after gastric cancer surgery. Combined analysis of these markers is considered to be helpful for improving the prediction of the postoperative recurrence and metastasis and prognosis of gastric cancer.
Intravitreal injection of anti-VEGF drugs for the treatment of retinopathy of prematurity (ROP) is a hot topic of research, and it can be used to treat the ROP (Ⅰzone). The current anti-VEGF drugs include bevacizumab, ranibizumab, aflibercept and conbercept, etc. However, in recent years, several studies have confirmed that anti-VEGF drugs have an increased recurrence rate and a longer recurrence time than conventional laser photocoagulation therapy. The follow-up period should be extended and repeated injections may be required. Due to the lack of large-scale prospective clinical studies, the recurrence rate, time window of recurrence, risk factors and treatment methods of various anti-VEGF drugs for ROP are still unclear. Anti-VEGF drugs in the treatment of ROP needs to accumulate more evidence-based medical evidence.
Objective To investigate the cl inical outcome of treating dorsal wrist gangl ion with an improved surgical strategy by excising the gangl ion completely along their stalk and repairing the dorsal carpal l igaments under brachial anesthesia. Methods From March 2005 to January 2007, 34 patients with dorsal wrist gangl ion were treated and studied retrospectively. There were 14 males and 20 females, aged 25-65 years (43 years on average). The left sides were involved in 22 cases and right sides in 12 cases. Thirteen cases of relapse received excision for 1 to 4 times under local anesthesia, with amean period of 17 months (14 days to 7 years) from excision to recurrence. Twenty-one patients were first attack cases with a mean period of 11 months (15 days to 8 years) from diagnosis to excision. The size of the gangl ion ranged from 1.5 cm × 1.2 cm to 4.5 cm × 4.0 cm. Now, each surgical process was performed under brachial anesthesia, and a pneumathode tourniquet was used. In 6 patients, the stalks of gangl ion did not invade the carpal l igaments, and gangl ion was removed completely without immobil ization after operation. In 28 patients, the stalks of gangl ion invaded the carpal l igaments, gangl ion was excised completely along its stalk to the dorsal carpal structure; the l igaments were sutured directly in 16 cases and were repaired with adjacent tissue such as the wall of sheathing canal of extensor tendon in 12 cases. The wrists were immobil ised for 3 weeks. Results Primary wound heal ing was achieved in all incisions. All patients were followed up for 26-36 months with an average of 31.5 months. Only 2 cases (5.9%) recurred. The range of motion of the wrist remained normal and the symptom of the dorsal wrist was rel ieved sl ightly. Patients’ satisfaction score ranged from 60 to 100, with an average of 83.8. Conclusion The gangl ion should be excised completely together with defect repair of dorsal carpal l igament under brachial anesthesia and the wrist immobil ised for 3 weeks, the recurrence rate will be reduced greatly.
Modified Goligher’s highly selective vagotomy (HSV) for 217 cases of duodenal ulcers is reported. In this series they were: duodenal ulcer (100 cases), combined gastric and duodenal ulcers (79 cases) and complicated perforating, bleeding or stenosed ulcers (38 cases). In the complicated duodenal ulcer, HSV was usually carried out with suturing bleeding point, perforated ulcer or with pyloroplasty. With a follow-up of 3~20 years, the recurrence rate werelt;2% and 85.7% of cases had excellent or good results as Visick classification. Considerations relevant to the HSV technic are deemed worthy of emphasis; complete resection of gastric branches of anterior and posterior vagal trunks and preservation of the first limb of the "Crow’s foot", extended dissection of the distal 5-7cm of the esophagus and division of the distal 8-10cm of the bundle of the gastroepiploic vessels in order to deprive the whole parietal cell mass of its vagal supply. In 4 patients, recurrence were easily controlled with remedies or operation for gastric retention by rational type. The authors suggest that the modified HSV plus mucusdeprived antrectomy be the rational surgical choice for duodenal ulcer.
ObjectiveTo explore the value of 3.0 T MRI functional imaging in differential diagnosis of radiation brain injury and recurrence of glioblastoma multiforme.MethodsFrom March 2017 to January 2018, 31 patients diagnosed with brain glioblastoma multiforme in Peking University International Hospital were collected continuously, including 14 cases of tumor recurrence and 17 cases of radiation-induced brain injury. All the patients routinely underwent conventional MRI head scan, three-dimension arterial spin labeling (3D-ASL), dynamic susceptibility contrastperfusion weighted imaging (DSC-PWI), and enhanced MRI scan sequence; related parameters were recorded and compared.ResultsCerebral blood flow (CBF) value of abnormal enhanced area in the recurrence group was significantly higher than that in the brain injury group with 3D-ASL scan (t=3.016, P=0.005), and no difference was found in edema area between the two groups (P>0.05). In the recurrence group, CBF value of abnormal enhanced area was significantly higher than that of the normal area (t=2.628, P=0.014); however, there was no significant difference in the CBF value between the abnormal enhancement foci and the normal areas in the radiation brain injury group (P>0.05). Relative cerebral blood volume (rCBV) ratio (t=2.894, P=0.007) and relative cerebral blood volume (rCBF) ratio (t=2.694, P=0.012) of abnormal enhanced area, as well as rCBV ratio (t=2.622, P=0.013) and rCBF ratio (t=2.775, P=0.010) of edema area in the recurrence group were significantly higher than those in the brain injury group with DSC-PWI scan. No differences were found in relative mean transit time (rMTT) ratio and relative time to peak (rTTP) ratio between the two groups (P>0.05). In the brain injury groupr, CBV ratio (t=2.921, P=0.008) and rCBF ratio (t=3.100, P=0.004) of abnormal enhanced area were significantly higher than those of the edema area, and no difference was found in rMTT ratio or rTTP ratio (P>0.05). In the recurrence group, no difference was found in all focal parameters between abnormal enhanced area and edema area (P>0.05). In diagnosis value analysis, the areas under the curve of CBF in 3D-ASL scan, and rCBF ratio, rCBV ratio in DSC-PWI scan were 0.752, 0.675, and 0.645, respectively; the cut-off values were 34.59, 1.48, and 1.67, respectively; the sensitivities were 79.2%, 61.5%, and 58.3%, respectively; and the specificities were 44.4%, 32.8%, and 22.4%, respectively.ConculsionThe diagnostic value of functional MRI imaging in distinguishing glioblastoma multiforme recurrence and radiation-induced brain injury is high recommendated; further research and clinical application should be needed.
ObjectiveTo investigate the surgical skills and clinical effects of the laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair in treatment of recurrent inguinal hernia with plug prefix mesh.
MethodsThe clinical data such as operation time, intraoperative blood loss, postoperative hospital stay, and postoperative complications of 87 patients with recurrent inguinal hernia reoperated in laparoscopic TAPP after inguinal hernioplasty with plug prefix mesh (recurrent hernia group), in the Department of Gastroenterology and Hernia surgery of the First Affiliated Hospital of Kunming Medical University from January 2011 to December 2013, were retrospectively analyzed, which were compared with the 834 incipient inguinal hernia patients operated first by TAPP (incipient hernia group) at the same time.
ResultsThe operations were completed successfully in all of the 921 patients without conversion to open surgery. The operation time and intraoperative blood loss in the recurrent hernia group were significantly more than those in the incipient hernia group (P=0.000, P=0.000), the postoperative hospital stay had no signifcant difference between two groups (P=0.057). No recurrences were observed in the recurrent hernia group and incipient hernia group for following-up of (31±4) months and (28±6) months, respectively. Compared with the incipient hernia group, the rates of postoperative pain on day 30 and seroma on day 1 and 3 were higher in the recurrent hernia group (P=0.001, P=0.040, P=0.003, respectively). There were no severe complications such as collateral damage, foreign body sensation, incision infection, intestinal obstruction and so on in the two groups.
ConclusionsThe laparoscopic TAPP inguinal hernia repair is safe and effective for patients with recurrent inguinal hernia with plug prefix mesh. More skills are required to reduce the complications. The operation time and intraoperative blood loss in reoperated patients with recurrent inguinal hernia are more than those in patients with incipient inguinal hernia. The rates of seroma on day 1 and 3 are also higher.
ObjectiveTo investigate the relationship between topical reactive lymphoid hyperplasia and postoperative recurrence and survival of gastric cancer patients.
MethodsThe clinical and pathological data of gastric cancer patients who underwent D2 radical gastrectomy from January 2007 to July 2009 were retrospectively analyzed. Based on the number of reactive lymph nodes, cases were divided in to topical reactive lymphoid hyperplasia group (RLH, n=18) and non-RLH group (n=43) by using a median method. The postoperative disease-free survival (DFS) and overall survival (OS) rates of patients in different groups were compared using Kaplan-Meier method and log-rank test, respectively.
ResultsThere were no significant difference between the two groups in age, gender, pathological stage, surgical approach, extent of surgery or methods of postoperative chemotherapy (P > 0.05). The median disease-free survival time was 50 months in RLH group, and the median disease-free survival time was 39 months in non-RLH group. DFS of patients in RLH group was significant higher than non-RLH group (66.7% vs. 34.9%, P=0.048). The median survival time was 53.6 months and 52.3 months, respectively, in RLH group and non-RLH group. No difference was found in OS between the two groups (72.2% vs. 60.5%, P=0.338).
ConclusionTopical reactive lymphoid hyperplasia reactive the immunity of gastric cancer patients and contact postoperative DFS rate.
【Abstract】ObjectiveTo evaluate the therapeutic benefits of three styles of hernioplasties such as the traditional hernioplasty, the mesh only hernioplasty and the plug amp; mesh hernioplasty. MethodsThe traditional hernioplasty in 534 cases(583 sides), the mesh only hernioplasty in 57 cases(60 sides) and the plug amp; mesh hernioplasty in 51 cases(54 sides) were performed. The comparing studies on the operative time, the postoperative complications, the recurrent rate and so on were analyzed. ResultsThe average operative time of the traditional styles group was (34.26±4.56) min, which was significantly shorter than the mesh only group 〔(40.35±6.24) min, P＜0.05〕 and the plug amp; mesh group 〔(49.12±8.69) min, P＜0.01〕 respectively. This significant difference between the mesh only group and the plug amp; mesh group was also identified (P＜0.05). Postoperative complications in the traditional styles group, the mesh only group and the plug amp; mesh group were 1.12%, 1.75% and zero,respectively (Pgt;0.05). Recurrent rate in the traditional styles group was 5.99%(32/534), which was significantly higher than that of the mesh only and the plug amp; mesh group (no recurrence). The average hospitalizing time in the traditional styles group, the mesh only group and the plug amp; mesh group was (7.11±3.06) days，（5.38±2.53） days and （6.19±3.61） days, respectively, in which there was no significant difference among groups. The activityrecovering time in the traditional styles group was (16.98±4.35) days, which was significantly longer than （7.26±2.46） days in the mesh only group and （8.02±3.35） days in the plug amp; mesh group. Conclusion The mesh only hernioplasty or the plug amp; mesh hernioplasty have a lower recurrent rate comparing with that in the traditional hernioplasty, which should be much more popularly applied in the treatment of inguinal hernia.
