BACKGROUND The incidence and mortality of colorectal cancer continue to rise.For early-stage colorectal cancer,endoscopic resection has become a preferred or important treatment option due to its significant advantage...BACKGROUND The incidence and mortality of colorectal cancer continue to rise.For early-stage colorectal cancer,endoscopic resection has become a preferred or important treatment option due to its significant advantages in operative time,extent of trauma,and medical costs.However,increasing lesion diameter significantly elevates the technical difficulty of endoscopic resection.Currently,robust evidence-based evidence regarding the upper size limit for safely and effectively resecting lesions endoscopically remains lacking.AIM To evaluate the efficacy and safety of endoscopic resection for colorectal lesions≥30 mm in diameter.METHODS This retrospective study reviewed data from 102 patients who underwent endoscopic resection for colorectal lesions measuring≥30 mm in diameter at General Hospital of Northern Theater Command between January 2023 and July 2024.RESULTS Among 102 patients who underwent endoscopic resection,99 received endoscopic submucosal dissection and 3 underwent endoscopic full-thickness resection.Four patients(3.9%)required conversion to surgical radical resection postoperatively.All patients exhibited favorable wound healing at the resection sites,and no long-term complications were observed during the 3-month postoperative colonoscopy follow-up.The primary perioperative complication was post-endoscopic submucosal dissection electrocoagulation syndrome(PEECS)(24/102,23.5%).Multivariate analysis identified lesion location in the transverse colon as an independent risk factor for PEECS occurrence(odds ratio=6.734,95%confidence interval:1.623-27.945,P=0.009).CONCLUSION Large colorectal lesion diameter does not constitute an absolute contraindication to endoscopic resection.Experienced endoscopic centers can achieve complete resection with a favorable efficacy and safety profile.Notably,lesion location in the transverse colon is identified as an independent risk factor for PEECS.展开更多
BACKGROUND Rosai-Dorfman disease(RDD),or sinus histiocytosis with massive lymphadenopathy,is a benign histiocytic disorder.Extranodal involvement is common,occurring in>40%of patients,but bone involvement occurs in...BACKGROUND Rosai-Dorfman disease(RDD),or sinus histiocytosis with massive lymphadenopathy,is a benign histiocytic disorder.Extranodal involvement is common,occurring in>40%of patients,but bone involvement occurs in<10%of cases.In addition,primary bone RDD is extremely rare.The majority of patients are adolescents and young adults,and the mean age at onset is 20-years-old.CASE SUMMARY We report an 8-year-old Chinese girl who presented to our hospital with an insidious onset of swelling and pain in the middle shaft of her right tibia for 4 mo.We performed total surgical resection of the right tibia lesion and allograft transplantation.A good prognosis was confirmed at the 6 mo follow-up.Pain and swelling symptoms were totally relieved,range of motion of her right knee and ankle returned to normal,and there was no clinical evidence of lesion recurrence at last follow up.Our case is the second reported case of osseous RDD without lymphadenopathy in the shaft of the tibia of a child.CONCLUSION Extranodal RDD is a rare disease and can be misdiagnosed easily.Lesion resection and allograft transplantation are an option to treat extranodal RDD in children with good short term result.Pediatric orthopedist should be aware of this rare disease,especially extranodal involvement.展开更多
Background:Infantile spasms(IS)are the most common childhood epileptic encephalopathy.Focal cortical dysplasia(FCD)and gray matter heterotopias(GH)are common structural causes of IS.The recommended first-line treatmen...Background:Infantile spasms(IS)are the most common childhood epileptic encephalopathy.Focal cortical dysplasia(FCD)and gray matter heterotopias(GH)are common structural causes of IS.The recommended first-line treatment for IS patients with structural causes is surgical intervention,according to the International League Against Epilepsy(ILAE)commission guidelines.However,there is currently no consensus on appropriate timings of surgery.Case presentations:Two structural IS cases are presented here:one was caused by FCD,and the other by GH.Both patients exhibited recurrent seizures at the age of 2 months,had poor responses to various antiepileptic drugs(AEDs)and displayed severe mental and motor developmental retardation.Seizure types included focal seizures and spasms.Brain magnetic resonance imaging showed abnormal gray signal or suspicious FCD lesions that coincided with the origin of the focal seizures.The patients underwent lesion resection before the age of 6 months.Follow-up observation showed that seizures of both patients were completely controlled several days after the surgery.All AEDs were gradually reduced in dosage within 1 year,and the mental and motor development almost returned to normal.Conclusion:Early resection of lesions in structural IS patients has benefits of effectively controlling convulsions and improving developmental retardation.Infants at several months of age can well tolerate craniotomy,and their cognitive development is more likely to return to normal after early surgery.展开更多
基金Supported by the Shenyang Science and Technology of Liaoning Province,No.22-321-32-15.
文摘BACKGROUND The incidence and mortality of colorectal cancer continue to rise.For early-stage colorectal cancer,endoscopic resection has become a preferred or important treatment option due to its significant advantages in operative time,extent of trauma,and medical costs.However,increasing lesion diameter significantly elevates the technical difficulty of endoscopic resection.Currently,robust evidence-based evidence regarding the upper size limit for safely and effectively resecting lesions endoscopically remains lacking.AIM To evaluate the efficacy and safety of endoscopic resection for colorectal lesions≥30 mm in diameter.METHODS This retrospective study reviewed data from 102 patients who underwent endoscopic resection for colorectal lesions measuring≥30 mm in diameter at General Hospital of Northern Theater Command between January 2023 and July 2024.RESULTS Among 102 patients who underwent endoscopic resection,99 received endoscopic submucosal dissection and 3 underwent endoscopic full-thickness resection.Four patients(3.9%)required conversion to surgical radical resection postoperatively.All patients exhibited favorable wound healing at the resection sites,and no long-term complications were observed during the 3-month postoperative colonoscopy follow-up.The primary perioperative complication was post-endoscopic submucosal dissection electrocoagulation syndrome(PEECS)(24/102,23.5%).Multivariate analysis identified lesion location in the transverse colon as an independent risk factor for PEECS occurrence(odds ratio=6.734,95%confidence interval:1.623-27.945,P=0.009).CONCLUSION Large colorectal lesion diameter does not constitute an absolute contraindication to endoscopic resection.Experienced endoscopic centers can achieve complete resection with a favorable efficacy and safety profile.Notably,lesion location in the transverse colon is identified as an independent risk factor for PEECS.
基金Supported by Natural Science Foundation of Hunan Province,China,No.2019JJ50324.
文摘BACKGROUND Rosai-Dorfman disease(RDD),or sinus histiocytosis with massive lymphadenopathy,is a benign histiocytic disorder.Extranodal involvement is common,occurring in>40%of patients,but bone involvement occurs in<10%of cases.In addition,primary bone RDD is extremely rare.The majority of patients are adolescents and young adults,and the mean age at onset is 20-years-old.CASE SUMMARY We report an 8-year-old Chinese girl who presented to our hospital with an insidious onset of swelling and pain in the middle shaft of her right tibia for 4 mo.We performed total surgical resection of the right tibia lesion and allograft transplantation.A good prognosis was confirmed at the 6 mo follow-up.Pain and swelling symptoms were totally relieved,range of motion of her right knee and ankle returned to normal,and there was no clinical evidence of lesion recurrence at last follow up.Our case is the second reported case of osseous RDD without lymphadenopathy in the shaft of the tibia of a child.CONCLUSION Extranodal RDD is a rare disease and can be misdiagnosed easily.Lesion resection and allograft transplantation are an option to treat extranodal RDD in children with good short term result.Pediatric orthopedist should be aware of this rare disease,especially extranodal involvement.
基金the National Natural ScienceFoundation of China(No.81671297).
文摘Background:Infantile spasms(IS)are the most common childhood epileptic encephalopathy.Focal cortical dysplasia(FCD)and gray matter heterotopias(GH)are common structural causes of IS.The recommended first-line treatment for IS patients with structural causes is surgical intervention,according to the International League Against Epilepsy(ILAE)commission guidelines.However,there is currently no consensus on appropriate timings of surgery.Case presentations:Two structural IS cases are presented here:one was caused by FCD,and the other by GH.Both patients exhibited recurrent seizures at the age of 2 months,had poor responses to various antiepileptic drugs(AEDs)and displayed severe mental and motor developmental retardation.Seizure types included focal seizures and spasms.Brain magnetic resonance imaging showed abnormal gray signal or suspicious FCD lesions that coincided with the origin of the focal seizures.The patients underwent lesion resection before the age of 6 months.Follow-up observation showed that seizures of both patients were completely controlled several days after the surgery.All AEDs were gradually reduced in dosage within 1 year,and the mental and motor development almost returned to normal.Conclusion:Early resection of lesions in structural IS patients has benefits of effectively controlling convulsions and improving developmental retardation.Infants at several months of age can well tolerate craniotomy,and their cognitive development is more likely to return to normal after early surgery.
