To summarize and analyze the key points of anesthesia management for elderly patients undergoing retroperitoneal tumor resection and its impact on patient prognosis, with an aim to provide reference for perioperative management of such patients.
Methods
This study retrospectively analyzed the anesthesia management of elderly patients (aged≥65 years) who underwent retroperitoneal tumor resection under general anesthesia at Peking University International Hospital from January 2015 to December 2022, and identified the influencing factors of total length of stay, postoperative hospitalization duration, and postoperative complication classification.
Results
A total of 248 patients were included in this study, including 136 males and 112 females with an average age of (69.7±4.4) years.Preoperative ASA classification was 134 cases of grade II, 106 cases of grade III, and 8 cases of grade IV.One hundred and twenty-nine patients (52.0%) had two or more surgeries, with the duration of surgery and anesthesia being(287.2±132.0) minutes and (362.9±135.9) minutes, respectively.Goal-directed fluid therapy was used during surgery, and blood products were supplemented according to the indications for blood transfusion.After surgery, 198 patients (79.8%) were extubated and returned to ordinary ward, while 50 patients (20.2%)were admitted to the intensive care unit for further treatment.The mean total length of stay was (38.0±21.9)days, and the mean length of postoperative hospitalization was (26.5±20.7) days.Multiple linear regression analysis showed that the length of hospitalization and postoperative hospitalization were positively correlated with the use of prothrombin complex concentrate during surgery and the level of blood glucose at the end of surgery.There were 44 cases of severe complications (Clavien-Dindo grade≥3a) after surgery, Logistic regression analysis showed that male gender, intraoperative infusion of artificial colloid solution, and postoperative lactate level were independent risk factors for severe postoperative complications; Four deaths occurred due to septic shock, hemorrhagic shock, and multiple organ failure.
Conclusion
For elderly patients undergoing retroperitoneal tumor resection, comprehensive preoperative preparation and more precise anesthesia management are required.During the operation, surgeons should avoid the infusion of artificial colloidal fluids, carefully administer prothrombin complex concentrate, and monitor male patients, blood glucose, and lactate levels after surgery.Targeted treatment can help improve patient prognosis.
Retroperitoneal extrarenal or pelvic epithelioid angiomyolipomas are clinically rare, and some of them show malignant biological behavior.Due to the lack of specific symptoms and imaging findings, patients often experience a delayed diagnosis and treatment.This study aimed to improve the understanding of this disease by summarizing our diagnosis and treatment experience with 14 cases and reviewing the literature.
Methods
The clinical data of 14 patients with retroperitoneal extrarenal or pelvic epithelioid angiomyolipoma who underwent surgical treatment and achieved pathological confirmation in Peking University International Hospital from January 2014 to April 2024 were retrospectively analyzed.The clinical manifestations, imaging and pathological features, diagnosis, and treatment of the disease were summarized based on the domestic and foreign literature.
Results
There were 4 males and 10 females in this group.The patients ranged in age from 20 to 67 years at presentation, with a median age of 39 years.There were 12 cases of initial onset (4 cases discovered in physical examination, 5 cases of abdominal discomfort, 2 cases of low back pain, 1 case of constipation) and 2 cases of recurrence.The lesions were located in retroperitoneal region in 11 cases and pelvic cavity in 3 cases.Plain CT scans showed slightly lower or equal density, and the tumor could have internal bleeding and necrosis when it was large.The solid component showed uneven and obvious enhancement.All patients in this group underwent open surgery.Postoperative pathology indicated malignancy in 10 cases.Immunohistochemical staining was positive for HMB45 in 85.7% (12/14) of patients, for MelanA in 64.3% (9/14), and for SMA in 91.7%(11/12).Postoperative complications in 2 cases (abdominal hemorrhage in 1 case and wound infection in 1 case) improved after conservative treatment.The patients underwent regular follow-up after discharge.As of July 2024, the follow-up time ranged from 4～88 months, with a median time of 35 months.Two cases were lost to follow-up.One case (case 13) was confirmed to have pelvic tumor recurrence 5 months after surgery(being on oral sirolimus treatment now).One case (case 5) had no significant changes in residual tumor in abdominal aortic wall, and no tumor recurrence or metastasis was observed in the remaining patients.
Conclusion
Extraperitoneal extrarenal or pelvic epithelioid angiomyolipomas are most common in young and middle-aged women.The clinical manifestations of the disease are atypical.The low diagnostic accuracy of imaging examination easily leads to confusion with liposarcoma and vasogenic tumor.Diagnosis of the disease depends on postoperative pathology and immunohistochemistry.The specific simultaneous expression of melanin markers (HMB45 and Melan-A) and myogenic markers (SMA) is characteristic.Surgical resection is the preferred treatment option, but mTOR inhibitors are promising for the treatment of the disease.Some patients present with malignant neoplastic features.Tumor recurrence and distant metastasis can still occur in these patients even after surgical treatment, so regular follow-up observation is required after surgery.
To investigate the clinical manifestations, diagnosis, pathological features,treatment and prognosis of retroperitoneal synovial sarcoma, and to improve surgeons' understanding of retroperitoneal synovial sarcoma.
Methods
Retrospective analysis was made on the clinical data of 7 cases of retroperitioneal synovial sarcoma patients undergoing surgical resection in Peking University International Hospital from January 2015 to January 2024,and to do the follow-up visit.
Results
The clinical manifestations of the patients were not typical, most of them were low back pain (2 cases) and abdominal pain (4 cases).The characteristic findings of CT were that the tumor was lobed or lumpy soft tissue mass,the density was slightly lower than the muscle density, and necrosis area was visible in the tumor body.The enhanced scan showed uniform or uneven enhancement, and sometimes calcification was seen at the edge of the mass.All patients in this group underwent surgical treatment, and the tumors were often larger and invaded the surrounding organs.Postoperative complications occurred in 2 cases (gastroparesis 1, intestinal basket 1),and perioperative death occurred in 1 case (respiratory failure).SS18 gene rearrangement was present in all 7 patients.All patients were followed up until March 2024 and died of the disease,median survival was 56 months.
Conclusion
The clinical manifestations of patients with synovial sarcoma are nonspecific, and the characteristic chromosomal translocation is the gold standard for diagnosis.Surgical resection is still the main treatment.This kind of tumor has high malignant degree, easy recurrence after operation and poor prognosis.
To explore the clinical diagnosis, treatment, and surgical efficacy for retroperitoneal paraganglioma.
Methods
The clinical data of 42 cases of retroperitoneal paraganglioma admitted to Peking University International Hospital from April 2015 to January 2024 were retrospectively analyzed, and their clinical characteristics, surgical efficacy, and prognosis were discussed.
Results
Of the 42 patients with retroperitoneal paraganglioma, 19 had functional catecholamine-secreting tumors before surgery, 15 had no obvious symptoms, and 8 had abdominal distension, abdominal pain, and back pain.Forty cases had a single tumor, and two had multiple tumors.Twenty-two cases had obvious fluctuation in blood pressure during operation.Thirty-eight cases achieved R0 or R1 excision, and four achieved R2 resection.Six cases underwent combined organ resection.The median maximum tumor diameter was 7 (range, 3～27) cm.Intraoperative blood loss was 800 (range, 50～4500) ml.There were 7 cases of postoperative complications.Compared with patients with stable blood pressure, those with intraoperative blood pressure fluctuation had significantly larger tumor size, more bleeding, and prolonged postoperative hospital stay (P＜0.05).After 3～68 months of follow-up, two patients had recurrence and one had distant metastasis.
Conclusion
Surgery is the main treatment method for retroperitoneal paraganglioma.Intraoperative blood pressure fluctuation increases the risk of surgery.Accurate preoperative assessment and adequate preoperative preparation can help reduce the risk of surgery.
To investigate the clinical characteristics and prognostic factors of patients undergoing left-sided retroperitoneal tumour resection combined with organ resection.
Methods
The clinical data of 55 patients who underwent left-sided retroperitoneal tumour excision combined with organ resection in the Department of Surgical Oncology of Minhang Branch of Fudan University Cancer Hospital were retrospectively analysed from December 2016 to December 2022.The clinical characteristics, surgical modalities, overall survival (OS), and recurrence-free survival (RFS) of the patients were analysed.Kaplan-Meier curves were used for survival analysis.Cox regression analysis was used to explore the factors influencing patients’ long-term prognosis after left-sided retroperitoneal tumour resection combined with organ resection.
Results
All the 55 patients achieved complete resection of the tumour.Their median age was 60 (range, 17～84 ) years.Median tumour diameter was 16 (range, 6～45) cm.Median follow-up time was 26 (range, 3～73) months.The incidence of postoperative Clavien-Dindo grade III complications was 14.5%(8/55).The 1-, 3-, and 5-year OS rates were 87.2%, 83.5%, and 70.3%, respectively, and the 1-, 3-, and 5-year RFS rates were 80.0%, 58.6%, and 44.0%, respectively.Cox univariate and multivariate analyses showed that only pathological grade and tumour diameter were factors affecting the prognosis of the patients, whereas age, gender, being operated for the first time or not, case type, number of combined organ resections, and intraoperative bleeding were were not.Only pathological grade and being operate for the first time or not were factors affecting the RFS of patients, while age, gender, tumour diameter, case type, number of combined organ resections, and amount of intraoperative bleeding were not.
Conclusion
Left-sided retroperitoneal tumour resection combined with organ resection facilitates complete resection of the retroperitoneal tumour with manageable postoperative complications.Pathological grade and tumour diameter are risk factors for patient prognosis, and postoperative pathological grade and being operate for the first time or not are risk factors for recurrence-free survival of patients.
To explore the application skills and feasibility of Mattox approach combined with midline approach in the resection of retroperitoneal tumors.
Methods
The clinical data of 33 patients who underwent surgical resection of retroperitoneal tumors via Mattox approach combined with midline approach between January 1, 2023 and July 31, 2024 in the Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital were retrospectively analyzed.
Results
The tumors were completely resected in all the 33 patients.The operation time was 70～360 min and the amount of blood loss during operation was 100～2500 ml.The size of resected tumors ranged from 4 to 40 cm.Neither accidental collateral damage nor death occurred in the perioperative period.
Conclusion
Mattox maneuver combined with midline approach could completely expose the left retroperitoneal space, is conducive to safe removal of tumors, and deserves wide clinical use.
To investigate the efficacy and clinical application value of injectable platelet-rich fibrin (i-PRF) combined with artificial dermis in the treatment of chronic refractory wounds.
Methods
Forty patients admitted to the Department of Burn and Plastic Surgery of Affiliated Hospital of Nantong University from August 2021 to December 2022 were randomly divided into either an artificial dermis alone group or an i-PRF combined with artificial dermis group, with 20 patients in each group.In both groups of patients, the wound was processed until the base tissue was fresh.The artificial dermis alone group underwent artificial dermis transplantation only, and the i-PRF combined combined with artificial dermis group received i-PRF injection derived from autologous blood in the wound and its peripheral tissue, as well as the application of i-PRF injection on the wound surface, followed by artificial dermis transplantation.After regular postoperative dressing changes, for artificial dermis vascular after secondary skin graft repair wound.Wound bacterial colonization, inflammatory indexes, wound pain, time to artificial dermis vascularization,number of dressing changes, hospital stay, and cost were compared between the two groups.
Results
Regarding wound bacterial colonization, there were 13 cases of positive bacterial culture in the artificial dermis alone group and 14 cases in the combination group, with no significant difference in the positive rate of bacterial culture between the two groups (P＞0.05).Seven days after surgery, there were 8 cases of positive bacterial culture in the the artificial dermis alone group, with a negative conversion rate of 38.46%, and 3 cases in the combination group, with a negative conversion rate of 78.57%; the negative conversion rate differed significantly between the two groups (P＜0.05).With regard to inflammation indexes, there was no significant differences in blood leukocytes, C-reactive protein, or procalcitonin between the two groups before surgery(P＞0.05).At 6 d and 12 d after surgery, the time effect was tested in the two groups alone, and the difference was statistically significant (P＜0.05).When the grouping effect was tested separately, the inflammatory indexes of the combination group were lower than those of the artificial dermis alone group, except for those at 12 d after surgery (P＜0.05).For wound pain, the VAS pain scores before surgery and at 1 d after surgery did not differ significantly between the two groups (P＞0.05).At 6 d and 12 d after surgery, the VAS pain scores in both groups decreased, and the VAS pain scores in the combination group were lower than those of the artificial dermis alone group (P＜0.05).The time to vascularization of the artificial dermis,was shorter in the combination group than in the artificial dermis alone group (P＜0.05).The combination group had less dressing changes than the artificial dermis alone group (P＜0.05).The postoperative hospitalization days were fewer and treatment costs were less in the combination group than in the artificial dermis alone group(P＜0.05).
Conclusion
Compared with artificial dermis alone, I-PRF combined with artificial dermis can reduce wound bacterial colonization, control inflammation, relieve wound pain, reduce dressing changes,shorten artificial dermis vascularization and hospital stay, and reduce costs in the treatment of chronic refractory wounds.
To summarize our clinical experience with Pseudomonas aeruginosa injection in the treatment of refractory high-output chyle leakage in the neck.
Methods
In this study, we retrospectively analyzed the clinical data of two patients with refractory high-output chyle leakage after cervical lymph node dissection for thyroid cancer admitted to Cancer Hospital & Shenzheng Hospital,Chinese Academy of Medical Sciences, of which 1 was female and 1 was male.Both patients underwent primary surgery.Both patients were considered to have chyle leakage caused by the rupture of the thoracic duct at the left neck, and the maximum daily drainage volume exceeded 1000 ml.
Results
The patients had poor response to conservative therapy, and both of them received retrograde injection of Pseudomonas aeruginosa injection through the left cervical drain, and were finally discharged from the hospital without serious complications and sequelae.
Conclusion
Pseudomonas aeruginosa injection in the operative area is effective and safe in the treatment of refractory high-output chyle leakage in the neck, and it can significantly shorten the duration of chyle leakage.
To investigate the clinical and genetic feasures of children with neurodegeneration with brain iron accumulation.
Methods
A retrospective analysis was conducted on the clinical manifestations and imaging data of six children with neurodegeneration with brain iron accumulation who were treated at the First Affiliated Hospital of Xinjiang Medical University from March 2021 to June 2024.Gene sequencing was performed on the children and their families using whole exome technology.
Results
Among the six pediatric patients, four were girls and two were boys, with ages ranging from 1 year and 7 months to 6 years old.All patients presented with comprehensive developmental delay clinically,and two patients showed significant developmental regression.Among them, one patient had myasthenia gravis (ocular muscle type).Gene sequencing showed that four children had WDR45 gene mutations,namely, c.519+1_519+3del c.381del, c.984C＞G, and c.400C＞T.After Sanger sequencing verification,all mutations were found to be de novo.Two cases had PLA2G6 gene mutations, with one case carrying both c.1547_1548dupCG (repeat mutation) and c.1799G＞A gene mutations, and the other case carrying c.1002dupA mutation.
Conclusion
Neurodegeneration with brain iron accumulation has clinical and genetic diversity.Whole exome gene sequencing, combined with medical history and MRI, can help with early diagnosis and guide treatment.The detection of new mutation sites broadens the spectrum of gene variation.
Antisynthetase syndrome (ASS) is a subtype of idiopathic inflammatory myopathy.Anti-aminoacyl-tRNA synthetase antibodies can be detected in the serum of ASS patients.ASS may clinically manifest as arthritis, myositis, and interstitial lung disease (ILD).ILD can also be the first manifestation of the ASS, but its pathogenesis is still not very clear.This paper summarizes the possible pathogenesis of ASS, several common target antigens and their functions, the role of anti-ARS antibodies, and the clinical characteristics of different antibodies, in order to help other clinicians understand the pathogenesis and clinical diagnosis and treatment of this disease.
Brucellosis is an acute or chronic zoonotic infectious disease caused by Brucella.This disease is a natural focal disease with strong infectivity and is widely distributed around the world.More than 500000 cases of brucellosis are reported worldwide every year, seriously threatening people's lives and health.The direct economic loss caused by this disease exceeds 3 billion US dollars every year.In view of the great harmfulness of brucellosis and its characteristics of lack of typical clinical symptoms, non-specificity,and easy recurrence, timely carrying out sensitive, accurate, and specific laboratory tests is particularly urgent and important for the diagnosis of this disease.This paper reviews the common diagnostic methods used in existing laboratories and the emerging diagnostic methods with the development of biomolecular biology and bioinformatics technology in recent years, in order to provide theoretical reference and technical support for the laboratory diagnosis of brucellosis.
Human skin wounds are contaminated by pathogens, which aggravate and prolong the inflammatory response.This can cause chronic or difficult wound healing, resulting in delayed wound healing and scar formation.Studies have found that Gram-negative (G-) bacteria are the main pathogens causing chronic wound inflammation, delayed wound healing, and scar formation in chronic wound and burn wound infection.Lipopolysaccharide, a unique endotoxin of G- bacteria, is the main inflammatory medium causing chronic wound inflammation.Therefore, reducing wound pathogen infection and chronic inflammatory response can greatly improve wound healing quality and prevent scar formation.This review describes the function, pathogenic characteristics, and mechanism of wound pathogens in wound healing and scar formation, and proposes that the control of pathogen infection in wounds is an effective strategy to promote wound healing and protect against scar formation, with an aim to lay a theoretical foundation and provide clinical guidance for the prevention and treatment of pathological scar.
Heart failure is the final stage in the progression of various heart diseases.The diagnosis, treatment, and management of heart failure patients present a significant challenge.Exercise-based cardiac rehabilitation can reduce mortality rates in heart failure patients, decrease the frequency of repeated hospitalizations, and improve quality of life.Heart failure with mid-range ejection fraction (HFmrEF) is a newly defined type of heart failure.This review summarizes the definition, clinical characteristics, and cardiac rehabilitation strategies for HFmrEF.HFmrEF patients exhibit clinical features that are intermediate between those of heart failure with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF).Cardiac rehabilitation is safe and effective for HFmrEF patients, being able to improve patient prognosis and quality of life.Rehabilitation strategies include pharmacotherapy, exercise training, nutritional guidance, etc., with exercise training being the core component.Cardiopulmonary exercise testing plays a crucial role in assessing and guiding rehabilitation for HFmrEF patients.Current research on HFmrEF rehabilitation is still limited,necessitating more large-scale randomized controlled trials to evaluate optimal rehabilitation protocols.
