surgery

摘要： BACKGROUND Primary hepatic neuroendocrine neoplasm(NEN)is a rare condition,and it is difficult to differentiate between primary and metastatic hepatic NENs.Herein,we report a case of primary hepatic NEN that initially mimicked a hemangioma but showed a gradual increase in size on long-term careful observation.CASE SUMMARY A 47-year-old woman was incidentally diagnosed with a 12-mm liver mass,suspected to be a hemangioma.Since then,regular follow-up had been carried out.Ten years later,she was referred to our institute due to the tumor(located in segment 4)having increased to 20 mm.Several imaging studies depicted no apparent extrahepatic lesion.Positron emission tomography(PET)/computed tomography exhibited significant accumulation in the mass lesion,which made us consider the possibility of malignancy.Left hepatectomy was performed.The histopathological diagnosis was neuroendocrine tumor grade 2,with somatostatin receptor 2 a/5 positivity.Postoperative somatostatin receptor scintigraphy(SRS)showed no other site,leading to the diagnosis of NEN of primary hepatic origin.The gradual growth of the hepatic NEN over 10 years suggested that it was likely to be a primary liver tumor.CONCLUSION In this case,positivity on PET and postoperative SRS may have helped determine whether the tumor was primary or metastatic.

摘要： Artificial intelligence(AI)is defined as the theory and development of computer systems able to perform tasks normally requiring human intelligence,such as visual perception,speech recognition,and decision-making.Machine learning and deep learning(DL)are subfields of AI that are able to learn from experience in order to complete tasks.AI and its subfields,in particular DL,have been applied in numerous fields of medicine,especially in the cure of cancer.Computer vision(CV)system has improved diagnostic accuracy both in histopathology analyses and radiology.In surgery,CV has been used to design navigation system and robotic-assisted surgical tools that increased the safety and efficiency of oncological surgery by minimizing human error.By learning the basis of AI,surgeons can take part in this revolution to optimize surgical care of oncologic disease.

摘要： Introduction: cervical spine trauma remains one of the most common causes of morbidity in the world with a significant financial burden on our society. It is a devastating event for the patient and family. The aim of this study is to share our experience in the surgery management of cervical spine injury in rural area. Methods: We did retrospective and single center study for one year from August 2020 to August 2021. We included all the patients who had undergone surgery for cervical spine injury in our hospital. Results: The study is based on 14 patients, 9 males and 5 females (sex ratio: 1.8). The average age was 34 years old and 08 (57%) were employed at time of injury. Road traffic accident was the most common cause, it was found in 11 (78%) cases followed by falls in 2 (14%) and interpersonal assault in 1 (7%). The Time admission ranged from 03 hours to 03 weeks. The most associated lesion was head trauma 7 (50%) followed by chest injury in 05 (35%) and 92% of our patient had motor deficit. Surgery was performed in all cases. Closed reduction was performed in 09 (64%) before surgery. Different types of complications that we had encountered were: infection 01 (07%) case, bed sores 02 (14%) cases, respiratory distress 02 (14%) cases and cervical kyphosis 01 (07%) case. After 06 months 71% of patients have progressed well with partial or complete recovery of their deficit. 14% of death in our series were noted and 28% of patients returned to work. Conclusion: cervical spine trauma remains a heavy socio-professional handicap. In rural areas, despite the lack of equipment and the difficulties of care, our results are satisfactory. However, it is necessary to insist on psychotherapy for these patients.

摘要： Introduction: Stomach cancer is a malignant tumor developed at the expense of the gastric wall. Gastric cancer is a common cancer occupying the 5th rank of cancers in the world, or 5.7% of all cancers. Purpose: To study epidemiological, diagnostic, therapeutic, and prognostic aspects of stomach cancer. Methodology: This was a retrospective and prospective study, which was carried out in the General Surgery Department at the teaching hospital Gabriel Touré between January 1, 1999, and December 31, 2020, and all cases of stomach cancer were confirmed by histological examination. Result: We recorded 857 cases of stomach cancer or 40.1% of digestive cancers. The sex ratio was 1.6. The average age was 55 years ± 13 years. The main clinical signs were epigastralgia (98.6%), vomiting (93.34%), weight loss (96.03%), and anorexia (46.1%). It was adenocarcinoma (97.55%), and antropyloric location (78.64%). Patients were Stage IV (72.817%) cases. Among the 857 patients, 722 were operated on, accounting for 84.25% of the cases. Surgery was palliative in 60.66% and curative in 25.62%. Gastrectomy of 4/5 plus D2 type curage was the most performed in curative surgery. The median overall postoperative survival was 5 months. Conclusion: Stomach cancer is the most common digestive cancer in our department, the diagnosis is most often late, so palliative surgery occupies an important place.

摘要： BACKGROUND Primary intracranial extraskeletal myxoid chondrosarcoma(EMC)is an extremely rare low-to intermediate-grade malignant soft tissue sarcoma,and only 15 cases have been reported in the literature.Due to its rarity,clinical data and research on this tumor type are extremely limited,the pathogenesis and histological origin are still unclear,and the diagnostic and standard clinical treatment strategies for intracranial EMC remain controversial and undefined.CASE SUMMARY We reported a case of a 52-year-old male who was admitted to the hospital with headache and dizziness for 1 mo,and his health status deteriorated during the last week.CT of the head showed a well-defined low-density lesion situated in the left cavernous sinus.Brain magnetic resonance imaging(MRI)showed a 3.4 cm×3.0 cm sized,well-defined,round-shaped and heterogeneously enhanced lesion located in the left cavernous sinus.The entire lesion was removed via supratentorial craniotomy and microsurgery.Postoperative pathological diagnosis indicated primary intracranial EMC.Subsequently,the patient underwent 45 Gy/15 F stereotactic radiotherapy after discharge.At present,it is 12 mo after surgery,with regular postoperative follow-up and regular MRI examinations,that there are no clinical symptoms and radiographic evidence indicating the recurrence of the tumor,and the patient has returned to normal life.CONCLUSION Currently,the most beneficial treatment for primary intracranial EMC is gross total resection combined with postoperative radiotherapy.Long-term follow-up is also necessary for patients.

摘要： BACKGROUND Although papillary thyroid microcarcinoma(PTMC)is not considered a threatening tumor,in some cases,it can be aggressive.Metastatic thrombosis of papillary thyroid carcinoma,follicular thyroid carcinoma,Hürthle cell carcinoma,poorly differentiated thyroid carcinoma and anaplastic thyroid carcinoma have been reported in the literature,but there have been no reports about PTMC.CASE SUMMARY A 45-year-old woman presented with a thyroid mass and thrombosis in a middle thyroid vein during a physical examination.She had no symptoms,and the physical examination showed no positive signs.Subsequent ultrasonographyguided fine-needle aspiration biopsy results indicated an atypical lesion of ambiguous significance,with some actively growing cells(TBSRTCⅢ)and the BRAFV600E mutation not present.This patient underwent left thyroidectomy,isthmus lobectomy,prophylactic central lymph node dissection and thromboembolectomy.Postoperative pathology showed papillary microcarcinoma of the left thyroid,and the thrombus in the middle thyroid vein was a tumor thrombus.CONCLUSION Middle thyroid vein tumor thrombus is an extremely rare condition in PTMC,but it does exist.Lobectomy and thromboembolectomy may be an option for patients with thrombi in the middle vein of the thyroid,and we strongly suggest close follow-up of these patients.

摘要： BACKGROUND Retroperitoneal cysts are rare and usually asymptomatic abdominal lesions.Epidermoid cysts are frequent benign cutaneous tumors,but retroperitoneal localization of these cysts does not occur very often.CASE SUMMARY We report a case report of a 25-year-old woman with a giant mass in the abdominal cavity.Because imaging examination indicated that the mass probably originated from the pancreas,the mass was considered a solid pseudopapillary tumor of the pancreas(SPTP).However,surgery revealed a retroperitoneal epidermoid cyst located behind the pancreas neck and the root of the superior mesenteric artery(SMA).We performed complete resection of the tumor.Postoperative pathology showed an epidermoid cyst.The patient fared well after two months of follow-up.CONCLUSION Surgery is the gold standard for the diagnosis and treatment of retroperitoneal epidermoid cysts.Retroperitoneal epidermoid cysts around the pancreas are easily misdiagnosed as cystic SPTPs.Surgeons should pay particular attention to preoperative diagnosis to reduce severe surgical complications and improve the quality of life of patients.

摘要： Portal invasion of hepatocellular carcinoma(HCC)occurs in 12.5%-40%of patients diagnosed with cancer and yields poor clinical outcomes.Since it is a common cause of inoperability,sorafenib was regarded as the standard treatment for HCC in the Barcelona Clinic of Liver Cancer guidelines.However,the median survival of the Asian population was only approximately 6 mo,and the tumor response rate was less than moderate(<5%).Various locoregional modalities were performed,including external beam radiotherapy(EBRT),transarterial chemoembolization,hepatic arterial infusion chemotherapy,and surgery,alone or in combination.Among them,EBRT is a noninvasive method and can safely treat tumors involving the major vessels.Palliative EBRT has been commonly performed,especially in East Asian countries,where locally invasive HCC is highly prevalent.Although surgery is not commonly indicated,pioneering studies have demonstrated encouraging results in recent decades.Furthermore,the combination of neo-or adjuvant EBRT and surgery has been recently used and has significantly improved the outcomes of HCC patients,as reported in a few randomized studies.Regarding systemic modality,a combination of novel immunotherapy and vascular endothelial growth factor inhibitor showed results superior to that of sorafenib as a first-line agent.Future clinical trials investigating the combined use of these novel agents,surgery,and EBRT are expected to improve the prognosis of HCC with portal invasion.

摘要： Background: Fast track surgery is an evidence-based multidisciplinary approach. The underlying principle is to enable patients to recover from surgery and leave the hospital sooner by minimizing the stress responses on the body during surgery. Our aim was to compare the outcome of fast-track protocol and conventional methods in colorectal surgery. Method: It was an observational cross-sectional study carried out at the Department of Surgery in different tertiary level hospitals, Dhaka Bangladesh during the period January 2014 to December 2017. Among this population, 50 patients were placed in the fast-track program (Group A) from January 2014 to December 2015 and 50 patients were in the conventional method (Group B), from January 2016 to December 2017. The fast-track patients were selected after receiving ethical approval from the Bangladesh College of Physician & Surgeons. Data analysis was done using the statistical package for social science (SPSS) for windows version 20. Results: The average age of the patients was 45.24 ± 16.65 years (range: 11 - 70 years) in the fast track group (Group A) and 43.24 ± 17.76 years in the conventional method (Group B). The majority were female between two groups, with 56% in group A and 52% in group B. General and surgical complications occurred in 9 (18%) patients and 11 (22%) patients respectively in group A. On the other hand in group B general and surgical complications occurred in 10 (20%) patients and 13 (26%) patients respectively. The average hospital stay was 9.24 ± 5.99 days in group A and the average hospital stay was 10.10 ± 6.04 days in group B. Conclusion: Making the decision to adopt fast-track surgery will challenge current traditional practice for all members of the multidisciplinary team across the whole local health community.

摘要： Hepatic artery aneurysm (HAA) is a rare disease. HAA is generally asymptomatic disease when symptomatic, they usually present with abdominal pain, upper gastrointestinal (GI) bleeding and/or jaundice, hypovolaemia secondary to rupture or GI bleeding with normal GI endoscopy. Surgical repair and endovascular treatment are the two therapeutic options available at present. Case report: A 49-year-old male presented at the emergency department with high gastrointestinal bleeding, abdominal pain and jaundice. Gastroscopy showed an ulcer with flat pigmented haematin on ulcer base (Forrest IIc) that was controlled by medical treatment. CT angiography was done and showed aneurysm of the proper hepatic artery almost totally thrombosed measuring 100 × 59 mm associated with signs of contained rupture. Emergency surgery was indicated. The laparotomy objectified a rupture of the aneurysm in the biliary tree in per operative excision of aneurysm and ligation of the hepatic pedicle was carried out. After surgery, the evolution was favorable with a follow-up of 8 months. Conclusion: HAA rupture is a rare cause of upper GI bleeding. The mortality rate after rupture is relatively high. CT angiography or MRI can diagnose a ruptured of HAA. Urgent surgery should be the first choice in patients with a ruptured HAA with active hemorrhage causing hemorrhagic shock.

摘要： Primary small-cell carcinoma of the esophagus is a rare malignant esophageal cancer. Although surgery is relatively successful in eradicating the local tumor, the post-resection five year survival rate for primary small-cell carcinoma of the esophagus is lower than primary squamous cell carcinoma of the esophagus. The purpose of this study is to analyze the clinic manifestation, pathological feature and treatment of primary small-cell carcinoma of the esophagus. Methods: A total of 73 cases with primary small-cell carcinoma of the esophagus treated by surgery from 1984 to 2003were analyzed retrospectively.Results: The overall resection rate was 94.5﹪. The radical resection rate was 89.0﹪ and operative mortality was 1.4﹪. Those who survived for 1 year, 3 year and 5 year were 50.7﹪, 13.7﹪ and 8.2﹪, respectively.Conclusions Primary small-cell carcinoma of the esophagus was a rare malignant tumor with poor prognosis. Surgical resection is the main method for the patients in stage I or II of primary small-cell carcinoma of the esophagus. Postoperative chemotherapy is appeared to offer benefit for these patients. For those in stage Ⅲ or IV should be managed with chemotherapy and radiation therapy.

摘要： Rotator cuff tear is one of the most common disorders of the shoulder. To examine the prognostic indicators associated with clinical outcome in rotator cuff surgery, a retrospective evaluation of 28 multivariate factors in 1,120 shoulders in 1,067 patients was performed. The data was analyzed by logistic regression and Kendall's tau-b correlation analysis. The degree of degenerative changes correlated with several factors that were selected for further evaluation using logistic regression by forward stepwise analysis. The results show that there was a high correlation with age, degree and type of tendon tear, preoperative pain and preoperative muscle power. The correlation between the type of tear, surgical outcome and the other factors in RCT was analyzed by nonparametric correlation methods. High correlation was seen between the type of tear and the tendons involved, degree of retraction, age, subacromial bone spur, operative technique,pre-and post-operative muscle power, pre-operative abduction and hand dominance. Additionally, there was a high correlation between good post-operative outcome and post-operative activities of daily living, post-operative pain, post-operative muscle power, degree of tendon retraction, pre-operative activities of daily living, type of tendon tear, pre-operative external rotation, muscle power and pain, and duration of symptoms.

摘要： Synovial sarcoma usually occurs in the extremities and is rare in the headand neck. In this study, we analyzed a group of5 synovial sarcomas arising in theParapharyngeal space. The series comprised5 men (100%) and no women (0%). Incommon with synovial sarcoma at more conventional sites, this is a disease of youngadults: ages ranged from22-41 years (median,35 years). Treatment, all5 patientsreceived radical excision and postoperative radiotherapy,2 patients with pulmonarymetastasis received additional chemotherapy. The chemotherapy included bothdoxorubicin and ifosfamide. Histologically,2 examples were of monophasic type,3were biphasic. The tumor size ranged from2.0 to6.6 cm. Follow-up on5 patientsrevealed that [2 were alive without disease3.8 and4 years respectively.2 patients diedof disease2.2 and3.1 years after the diagnosis respectively.1 patient was alive withlocal recurrence and pulmonary metastasis]. The prognosis of synovial sarcoma inparapharyngeal space seems relatively good for those patients whose tumor size is lessthan5 cm.

摘要： Synovial sarcoma usually occurs in the extremities and is rare in the headand neck. In this study, we analyzed a group of5 synovial sarcomas arising in theParapharyngeal space. The series comprised5 men (100%) and no women (0%). Incommon with synovial sarcoma at more conventional sites, this is a disease of youngadults: ages ranged from22-41 years (median,35 years). Treatment, all5 patientsreceived radical excision and postoperative radiotherapy,2 patients with pulmonarymetastasis received additional chemotherapy. The chemotherapy included bothdoxorubicin and ifosfamide. Histologically,2 examples were of monophasic type,3were biphasic. The tumor size ranged from2.0 to6.6 cm. Follow-up on5 patientsrevealed that [2 were alive without disease3.8 and4 years respectively.2 patients diedof disease2.2 and3.1 years after the diagnosis respectively.1 patient was alive withlocal recurrence and pulmonary metastasis]. The prognosis of synovial sarcoma inparapharyngeal space seems relatively good for those patients whose tumor size is lessthan5 cm.

摘要： Synovial sarcoma usually occurs in the extremities and is rare in the headand neck. In this study, we analyzed a group of5 synovial sarcomas arising in theParapharyngeal space. The series comprised5 men (100%) and no women (0%). Incommon with synovial sarcoma at more conventional sites, this is a disease of youngadults: ages ranged from22-41 years (median,35 years). Treatment, all5 patientsreceived radical excision and postoperative radiotherapy,2 patients with pulmonarymetastasis received additional chemotherapy. The chemotherapy included bothdoxorubicin and ifosfamide. Histologically,2 examples were of monophasic type,3were biphasic. The tumor size ranged from2.0 to6.6 cm. Follow-up on5 patientsrevealed that [2 were alive without disease3.8 and4 years respectively.2 patients diedof disease2.2 and3.1 years after the diagnosis respectively.1 patient was alive withlocal recurrence and pulmonary metastasis]. The prognosis of synovial sarcoma inparapharyngeal space seems relatively good for those patients whose tumor size is lessthan5 cm.

摘要： Synovial sarcoma usually occurs in the extremities and is rare in the headand neck. In this study, we analyzed a group of5 synovial sarcomas arising in theParapharyngeal space. The series comprised5 men (100%) and no women (0%). Incommon with synovial sarcoma at more conventional sites, this is a disease of youngadults: ages ranged from22-41 years (median,35 years). Treatment, all5 patientsreceived radical excision and postoperative radiotherapy,2 patients with pulmonarymetastasis received additional chemotherapy. The chemotherapy included bothdoxorubicin and ifosfamide. Histologically,2 examples were of monophasic type,3were biphasic. The tumor size ranged from2.0 to6.6 cm. Follow-up on5 patientsrevealed that [2 were alive without disease3.8 and4 years respectively.2 patients diedof disease2.2 and3.1 years after the diagnosis respectively.1 patient was alive withlocal recurrence and pulmonary metastasis]. The prognosis of synovial sarcoma inparapharyngeal space seems relatively good for those patients whose tumor size is lessthan5 cm.

摘要： It has been shown that application of molecular biological techniques to surgical margins of some cancers could predict risk of local recurrence. However, the optimallength of surgical resection with tumor-free surgical margins for esophageal squamous cell carcinoma (ESCC) is unknown. This study was conducted to evaluate the optimal length of surgical resection for ESCC with molecularly tumor-free surgical margins marked by P53 and Ki67. METHODS: Surgical specimens from 70 patients with ESCC were collected for study. The lengths of the upper margin, tumor, and lower margin of every specimen were measured during the operation. Each specimen was divided into three giant pathologic sections, stained with H&E and immunohistochemically for P53 and Ki67, and examined microscopically. The lengths of the upper and lower resection sides were measured for P53 and Ki67 positive expression. The actual surgical lengths were calculated by the principle of rational shrinkage. Results: All surgical margins were histologically tumor-free, while the positive rates of P53 and Ki67 were 66﹪ and 54﹪. The positive rates of P53 and Ki67 in the upper resection side were 17﹪ and 20﹪. The mean lengths of the upper resection side showing P53 and Ki67 positive expression were 1.08±1.12 cm and 1.64±1.01 cm, and the maximum lengths were 3.73 cm and 3.26 cm. The positive rates of P53 and Ki67 in the lower resection side were 20﹪ and 23﹪. The mean lengths of the lower resection side of P53 and Ki67 with positive expression were 1.11±1.15 cm and 1.34±0.94 cm,and the maximum lengths were 3.73 cm and 3.61 cm. CONCLUSION: The optimal length of surgical resection with molecularly tumor-free surgical margins of ESCC is not more than 5 cm.

摘要： It has been shown that application of molecular biological techniques to surgical margins of some cancers could predict risk of local recurrence. However, the optimallength of surgical resection with tumor-free surgical margins for esophageal squamous cell carcinoma (ESCC) is unknown. This study was conducted to evaluate the optimal length of surgical resection for ESCC with molecularly tumor-free surgical margins marked by P53 and Ki67. METHODS: Surgical specimens from 70 patients with ESCC were collected for study. The lengths of the upper margin, tumor, and lower margin of every specimen were measured during the operation. Each specimen was divided into three giant pathologic sections, stained with H&E and immunohistochemically for P53 and Ki67, and examined microscopically. The lengths of the upper and lower resection sides were measured for P53 and Ki67 positive expression. The actual surgical lengths were calculated by the principle of rational shrinkage. Results: All surgical margins were histologically tumor-free, while the positive rates of P53 and Ki67 were 66﹪ and 54﹪. The positive rates of P53 and Ki67 in the upper resection side were 17﹪ and 20﹪. The mean lengths of the upper resection side showing P53 and Ki67 positive expression were 1.08±1.12 cm and 1.64±1.01 cm, and the maximum lengths were 3.73 cm and 3.26 cm. The positive rates of P53 and Ki67 in the lower resection side were 20﹪ and 23﹪. The mean lengths of the lower resection side of P53 and Ki67 with positive expression were 1.11±1.15 cm and 1.34±0.94 cm,and the maximum lengths were 3.73 cm and 3.61 cm. CONCLUSION: The optimal length of surgical resection with molecularly tumor-free surgical margins of ESCC is not more than 5 cm.

摘要： It has been shown that application of molecular biological techniques to surgical margins of some cancers could predict risk of local recurrence. However, the optimallength of surgical resection with tumor-free surgical margins for esophageal squamous cell carcinoma (ESCC) is unknown. This study was conducted to evaluate the optimal length of surgical resection for ESCC with molecularly tumor-free surgical margins marked by P53 and Ki67. METHODS: Surgical specimens from 70 patients with ESCC were collected for study. The lengths of the upper margin, tumor, and lower margin of every specimen were measured during the operation. Each specimen was divided into three giant pathologic sections, stained with H&E and immunohistochemically for P53 and Ki67, and examined microscopically. The lengths of the upper and lower resection sides were measured for P53 and Ki67 positive expression. The actual surgical lengths were calculated by the principle of rational shrinkage. Results: All surgical margins were histologically tumor-free, while the positive rates of P53 and Ki67 were 66﹪ and 54﹪. The positive rates of P53 and Ki67 in the upper resection side were 17﹪ and 20﹪. The mean lengths of the upper resection side showing P53 and Ki67 positive expression were 1.08±1.12 cm and 1.64±1.01 cm, and the maximum lengths were 3.73 cm and 3.26 cm. The positive rates of P53 and Ki67 in the lower resection side were 20﹪ and 23﹪. The mean lengths of the lower resection side of P53 and Ki67 with positive expression were 1.11±1.15 cm and 1.34±0.94 cm,and the maximum lengths were 3.73 cm and 3.61 cm. CONCLUSION: The optimal length of surgical resection with molecularly tumor-free surgical margins of ESCC is not more than 5 cm.

摘要： It has been shown that application of molecular biological techniques to surgical margins of some cancers could predict risk of local recurrence. However, the optimallength of surgical resection with tumor-free surgical margins for esophageal squamous cell carcinoma (ESCC) is unknown. This study was conducted to evaluate the optimal length of surgical resection for ESCC with molecularly tumor-free surgical margins marked by P53 and Ki67. METHODS: Surgical specimens from 70 patients with ESCC were collected for study. The lengths of the upper margin, tumor, and lower margin of every specimen were measured during the operation. Each specimen was divided into three giant pathologic sections, stained with H&E and immunohistochemically for P53 and Ki67, and examined microscopically. The lengths of the upper and lower resection sides were measured for P53 and Ki67 positive expression. The actual surgical lengths were calculated by the principle of rational shrinkage. Results: All surgical margins were histologically tumor-free, while the positive rates of P53 and Ki67 were 66﹪ and 54﹪. The positive rates of P53 and Ki67 in the upper resection side were 17﹪ and 20﹪. The mean lengths of the upper resection side showing P53 and Ki67 positive expression were 1.08±1.12 cm and 1.64±1.01 cm, and the maximum lengths were 3.73 cm and 3.26 cm. The positive rates of P53 and Ki67 in the lower resection side were 20﹪ and 23﹪. The mean lengths of the lower resection side of P53 and Ki67 with positive expression were 1.11±1.15 cm and 1.34±0.94 cm,and the maximum lengths were 3.73 cm and 3.61 cm. CONCLUSION: The optimal length of surgical resection with molecularly tumor-free surgical margins of ESCC is not more than 5 cm.