Approximately 10 percent of T1 colorectal cancer (CRC) has lymph node metastasis. In this study, we aimed to determine possible predictors for nodal involvement in order to aid selection of ...appropriate patients for organ-preserving strategies.
We retrospectively reviewed CRC patients underwent radical surgery from January 2009 to December 2016, with final pathology report disclosed as T1 lesion. The paraffin-embedded samples were achieved for glycosylated proteins expression analysis by immunohistochemistry.
Totally, 111 CRC patients with T1 lesion were enrolled in this study. Of these patients, seventeen patients had nodal metastases, with the lymph node positive rate of 15.3%. Semiquantitative analysis of immunohistochemical results indicated that mean value of Tn protein expression in T1 CRC specimens was significantly different between patients with and without lymph node metastasis (63.6 vs. 27.4; p = 0.018).
Our data shown that Tn expression may be applied as a molecular predictor for regional lymph node metastasis in T1 CRC. Moreover, the organ-preserving strategy could be improved by proper classification of patients. The mechanism involved in expression of Tn glycosylation protein and CRC metastasis need further investigation.
People with hemophilia (PWH), especially severe hemophilia, often experience bleeding episodes, which occur mostly at major joints. Intramural hematoma of the gastrointestinal (GI) tract is a rare, ...potentially life-threatening clinical bleeding manifestation in PWH. Prompt identification and timely administration of clotting factor concentrates are of utmost importance for effective management and optimal patient outcomes. In this report, we present the case of a 48-year-old male with severe hemophilia A. The patient developed a spontaneous intramural hematoma of the jejunum, leading to signs of acute abdomen, bloody stool, and paralytic ileus. Conservative management with factor VIII (FVIII) infusion was successfully administered. However, within a span of three months, the patient suffered from a recurrent episode of intramural hematoma, which was again effectively treated with conservative therapy. Subsequently, prophylactic FVIII therapy was administered to the patient, resulting in the absence of recurrence for over three years. Inspired by this case, we conducted a comprehensive review of the relevant literature and gathered data from 79 reported cases of intramural hematoma that were documented between the years 1956 and 2022. We classified these cases based on the site affected within the gastrointestinal (GI) tract (spread across five different locations) and proceeded to conduct a simple pooling analysis on the data collected, which subsequently revealed that the overall mortality rate of intramural hematoma in people with hemophilia (PWH) was found to be 12.2%, while children have a higher mortality rate (23.3%) than adults (4.9%). We hope this case report and literature review increase awareness of this rare bleeding manifestation in PWH, the effectiveness of conservative treatment, and the possibility of prophylaxis against recurrence.
Background
Full‐thickness local excision (FTLE) for rectal cancer showing clinical complete remission (cCR) after neoadjuvant chemoradiation therapy (NCRT) is associated with good oncological ...results. The purpose of this study was to report the results of robotic transanal minimally invasive surgery for such patients.
Methods
Patients were treated with a 5‐fluorouracil‐based NCRT regimen. The determination of cCR was based on digital rectal examination, colonoscopy, and magnetic resonance imaging.
Results
Six patients underwent transanal FTLE using the da Vinci Xi surgical system. The median operative time was 106.5 minutes, and the estimated blood loss was minimal. The mean length of hospital stay was 4.2 days. After 18.2 months of follow‐up, none of the patients developed local recurrences or distant disease.
Conclusions
With the use of robotic technology, FTLE can be performed with relative ease and can be considered as a viable alternative to radical resection or a “Watch and Wait” strategy.
Background
Pathologic complete response has been proven to have oncological benefits for locally advanced rectal cancer treated with chemoradiation therapy. The aims of this study are to analyze and ...determine the factors to predict pathologic complete response for patients treated with preoperative neoadjuvant therapy.
Methods
Patients with biopsy-proven, locally advanced rectal cancer were treated neoadjuvantly followed by radical surgical resection. Tumors were re-assessed after completing chemoradiation, including pelvic magnetic resonance images, colonoscopic examination, and re-biopsy. The results of examination were compared with the final pathologic status.
Results
A retrospective chart review of 166 patients was conducted. Twenty-five patients (15.1%) had pathologic complete response after chemoradiation. The 5-year overall survival rates were better in the complete response group than the residual tumor group (91.1% vs. 70.8%;
P
= 0.047), and there were also significant differences in the 5-year disease-free survival rates between these two groups (91.1% vs. 70.2%;
P
= 0.027). The prediction rates for pathologic complete response by re-biopsy, magnetic resonance images, and colonoscopy were 21.4%, 33.3%, and 53.8%, respectively. In addition, when we further combine the results of colonoscopic findings and re-biopsy, the prediction rate for pathologic complete response reached 77.8% (
P
= 0.009).
Conclusions
Combining the results of the re-biopsy and post-treatment colonoscopic findings, we can achieve a good prediction rate for pathologic complete response. Post-treatment magnetic resonance images are not useful tools in predicting tumor clearance following chemoradiation.
The objective of the current study was to find out whether yoga practice was beneficial to the spine by comparing degenerative disc disease in the spines of long-time yoga practitioners and non-yoga ...practicing controls, using an objective measurement tool, magnetic resonance imaging. This matched case–control study comprised 18 yoga instructors with teaching experience of more than 10 years and 18 non-yoga practicing asymptomatic individuals randomly selected from a health checkup database. A validated grading scale was used to grade the condition of cervical and lumbar discs seen in magnetic resonance imaging of the spine, and the resulting data analyzed statistically. The mean number of years of yoga practice for the yoga group was 12.9 ± 7.5. The overall (cervical + lumbar) disc scores of the yoga group were significantly lower (indicating less degenerative disc disease) than those of the control group (
P
< 0.001). The scores for the cervical vertebral discs of the yoga group were also significantly lower than those of the control group (
P
< 0.001), while the lower scores for the yoga group in the lumbar group approached, but did not reach, statistical significance (
P
= 0.055). The scores for individual discs of yoga practitioners showed significantly less degenerative disease at three disc levels, C3/C4, L2/L3 and L3/L4 (
P
< 0.05). Magnetic resonance imaging showed that the group of long-term practitioners of yoga studied had significantly less degenerative disc disease than a matched control group.
Objective This study was to investigate the usefulness and limitations of cardiac magnetic resonance imaging (MRI). We compared echocardiography (ECHO) and perfusion scans to evaluate: left ...ventricular wall scar formation of the myocardium; hypokinesis, akinesis, or dyskinesis of the myocardium; regurgitation of the aortic and mitral valves; post acute myocardial infarction (AMI) ventricular function; and the viable myocardium (ischemia/infarction). Methods Twenty patients received both cardiac MRI and ECHO. Among them, nine patients received perfusion scans. The modalities and methods examined in this study were not the most advanced or updated protocols. Results We compared the results of cardiac MRI with those of ECHO and perfusion scans. We found significant correlations between the interpretations of left ventricular wall morphological change with dynamic images for hypokinesia, akinesia, and dyskinesia of the myocardium. We also found possible correlations between cardiac MRI and perfusion scans regarding their results to produce a “bull's eye target figure” to evaluate severe ischemia and infarctions. Conclusion We found that cardiac MRI provided a useful adjunct to ECHO on interpretations of left ventricular wall morphological change. The correlations between qualitative interpretations of cardiac MRI versus perfusion scan respective to ‘bull's eye target figures’, were found to be moderately matching. There was an unsatisfactory mismatching of correlations between quantitative by manual input and the drawing inaccuracy and an unavoidable error of the post-processing technique of cardiac MRI on ejection fraction (EF) and end systolic volume (ESV).
Background The 64-multidetector computed tomography (64-MDCT) has developed into a mature clinical tool to detect coronary artery disease. This 64-MDCT system permits cross-sectional and longitudinal ...imaging of the coronary arteries with a high spatial and temporal resolution. However, small vessels, side branches and the distal portions of the main coronary arteries are not always optimally visualized. Purpose The aim of this study was to evaluate the effect of nitroglycerin (NTG) on lumen diameters and the number of visualized side branches of the coronary arteries on 64-MDCT. We also assessed whether NTG would affect the quality of the images of the coronary arteries obtained by 64-MDCT. Methods Sixty-seven patients were randomized and divided into two groups: Group C (31 patients, no sublingual NTG) and Group N (36 patients, sublingual NTG given before the scan). We measured the lumen diameter of the coronary artery and visibility of the side branches by using the 64-MDCT system and also evaluated the image quality by using the scores. Results The cardiac 64-MDCT images of these patients showed that the average diameters of the proximal segments in the right coronary artery, left main artery, left anterior descending coronary artery, and left circumflex coronary artery were 4.1 ± 0.7 mm, 3.9 ± 0.6 mm, 3.6 ± 0.7 mm, and 3.4 ± 0.6 mm, respectively, in Group N and 3.0 ± 0.5 mm, 3.1 ± 0.6 mm, 2.8 ± 0.5 mm, and 2.7 ± 0.5 mm, respectively in Group C. In addition, the scores for visibility and image quality for the side branches in Group N were significant higher than for those in Group C. Conclusion Our study indicates that CT coronary angiography using 64-MDCT with NTG administration produces images of diagnostically acceptable quality in all coronary segments. Thus, NTG might be recommended for routine 64-MDCT coronary angiography examinations.
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