Hepatic hemangiomas are congenital vascular malformations,considered the most common benign mesenchymal hepatic tumors,composed of masses of blood vessels that are atypical or irregular in arrangement and size. Hepati...Hepatic hemangiomas are congenital vascular malformations,considered the most common benign mesenchymal hepatic tumors,composed of masses of blood vessels that are atypical or irregular in arrangement and size. Hepatic hemangiomas can be divided into two major groups:capillary hemangiomas and cavernous hemangiomas These tumors most frequently affect females (80%) and adults in their fourth and fifth decades of life. Most cases are asymptomatic although a few patients may present with a wide variety of clinical symptoms,with spontaneous or traumatic rupture being the most severe complication. In cases of spontaneous rupture,clinical manifestations consist of sudden abdominal pain,and anemia secondary to ahaemoperitoneum. Disseminated intravascular coagulopathy can also occur. Haemodynamic instability and signs of hypovolemic shock appear in about one third of cases. As the size of the hemangioma increases,so does the chance of rupture. Imaging studies used in the diagnosis of hepatic hemangiomas include ultrasonography,dynamic contrast-enchanced computed tomography scanning,magnetic resonance imaging,hepatic arteriography,digital subtraction angiography,and nuclear medicine studies. In most cases hepatic hemangiomas are asymptomatic and should be followed up by means of periodic radiological examination. Sur gery should be restricted to specific situations. Absolute indications for surgery are spontaneous or trau m atic rupture with hemoperitoneum,intratumoral blee ding and consumptive coagulopathy (Kassabach-Merrit syndrome). In a patient presenting with acute abdo minal pain due to unknown abdominal disease,sponta neous rupture of a hepatic tumor such as a hemangio ma should be considered as a rare differential diagnosis.展开更多
Gastroesophageal reflux disease (GORD) is a pathological process in infants manifesting as poor weight gain, signs of esophagitis, persistent respiratory symptoms and changes in neurobehaviour. It is currently estimat...Gastroesophageal reflux disease (GORD) is a pathological process in infants manifesting as poor weight gain, signs of esophagitis, persistent respiratory symptoms and changes in neurobehaviour. It is currently estimated that approximately one in every 350 children will experience severe symptomatic gastroesophageal reflux necessitating surgical treatment. Surgery for GORD is currently one of the common major operations performed in infants and children. Most of the studies found favour laparoscopic approach which has surpassed open antireflux surgery as the gold standard of surgical management for GORD.However, it must be interpreted with caution due to the limitation of the studies, especially the small number of subject included in these studies. This review reports the changing trends in the surgical treatment of GORD inchildren.展开更多
BACKGROUND: Duodenal gastrointestinal stromal tumors, which are rare, comprise 3%-5% of all gastrointestinal stromai tumors. We present a case of a metastatic duodenal gastrointestinal stromal tumor that was successfu...BACKGROUND: Duodenal gastrointestinal stromal tumors, which are rare, comprise 3%-5% of all gastrointestinal stromai tumors. We present a case of a metastatic duodenal gastrointestinal stromal tumor that was successfully treated by simultaneous tight hemihepatectomy and pancreaticoduodenectomy. METHODS: A 50-year-old woman was admitted to our department for the treatment of a possible metastatic duodenal gastrointestinal stromal tumor (GIST). At laparotomy a large duodenal tumor was found displacing the head of the pancreas. A 3 cm in diameter lesion in the posterior aspect of segment Ⅷ of the liver was also noted. Simultaneous right hepatectomy and pancreaticoduodenectomy were performed. RESULTS: Histological examination revealed a high grade metastatic duodenal GIST strongly positive for c-kit, CD34, and vimentin. The patient had no additional therapy. A follow-up of 21 months showed that the patient is very well and there is no evidence of recurrent diseases. CONCLUSIONS: Malignant stromai tumors of the duodenum are rarely encountered. They are usually slow growing, and may be amenable to curative surgery, even after occurrence of metastases. Resection of localized liver metastasis is still advocated when feasible, since imatinib does not provide a complete or long-term response. Combined surgical resection is an efficacious treatment for patients with metastatic duodenal gastrointestinal stromal tumor.展开更多
Background: Two types of treatment are being used for patients with ruptured intracranilal aneurysms: endovascular detachable-coil treatment or craniotomy and clipping. We undertook a randomised, multicentre trial to ...Background: Two types of treatment are being used for patients with ruptured intracranilal aneurysms: endovascular detachable-coil treatment or craniotomy and clipping. We undertook a randomised, multicentre trial to compare these treatments in patients who were suitable for either treatment because the relative saf ety and efficacy of these approaches had not been established. Here we present c linical outcomes 1 year after treatment. Methods: 2143 patients with ruptured in tracranial aneurysms, who were admitted to 42 neurosurgical centres, mainly in t he UK and Europe, took part in the trial. They were randomly assigned to neurosu rgical clipping (n=1070) or endovascular coiling (n=1073). The primary outcome w as death or dependence at 1 year (defined by a modified Rankin scale of 3-6). S econdary outcomes included rebleeding from the treated aneurysm and risk of seiz ures. Long-term follow up continues. Analysis was in accordance with the random ised treatment. Findings: We report the 1-year outcomes for 1063 of 1073 patien ts allocated to endovascular treatment, and 1055 of 1070 patients allocated to n eurosurgical treatment. 250 (23.5%) of 1063 patients allocated to endovascular treatment were dead or dependent at 1 year, compared with 326 (30.9%) of 1055 p atients allocated to neurosurgery, an absolute risk reduction of 7.4%(95%CI 3. 6-11.2, p=0.0001). The early survival advantage was maintained for up to 7 year s and was significant (log rank p=0.03). The risk of epilepsy was substantially lower in patients allocated to endovascular treatment, but the risk of late rebl eeding was higher. Interpretation: In patients with ruptured intracranial aneury sms suitable for both treatments, endovascular coiling is more likely to result in independent survival at 1 year than neurosurgical clipping; the survival bene fit continues for at least 7 years. The risk of late rebleeding is low, but is m ore common after endovascular coiling than after neurosurgical clipping.展开更多
Purpose This multicenter qualitative study aimed to explore the perceptions of clinicians and research ethics boards(REBs)regarding ethical issues in Investigator Initiated Trials(IITs).Methods Between February and Ap...Purpose This multicenter qualitative study aimed to explore the perceptions of clinicians and research ethics boards(REBs)regarding ethical issues in Investigator Initiated Trials(IITs).Methods Between February and April 2024,semi-structured interviews were conducted with 27 participants from 15 tertiary hospitals,including clinical doctors and members of REBs.Responses were grouped and analyzed using a descriptive phenomenological approach.Results Clinicians expressed challenges in navigating the formal review process due to limited access to information and unclear guidelines.Academic review highlighted a deficiency in research literacy among clinical investigators,leading to flawed study design.Ethical review revealed concerns about inadequate ethical awareness among clini-cians,resulting in failed ethical approvals.Moreover,delays in review processes and resource shortages were noted,hindering the efficient conduct of IITs.Conclusion The findings underscore the need for comprehensive training programs to enhance clinicians’research literacy and ethical awareness.Establishing a comprehensive system to support IITs,including enhanced guidance and support from REBs,is essential to ensure the quality and integrity of IITs in China.展开更多
Current evidence clearly demonstrates that coronary artery bypass grafting （CABG） remains the ＂gold standard＂ treatment for most patients with multivessel and left main stem disease. This article summarizes the re...Current evidence clearly demonstrates that coronary artery bypass grafting （CABG） remains the ＂gold standard＂ treatment for most patients with multivessel and left main stem disease. This article summarizes the relevant evidence basis demonstrating that CABG, in comparison to stenting, reduces mortality and subsequent myocardial infarction and the need for repeat revascularization. The article also describes the evidence basis to support the use of more arterial grafts during CABG and the current role of off-pump CABG.展开更多
文摘Hepatic hemangiomas are congenital vascular malformations,considered the most common benign mesenchymal hepatic tumors,composed of masses of blood vessels that are atypical or irregular in arrangement and size. Hepatic hemangiomas can be divided into two major groups:capillary hemangiomas and cavernous hemangiomas These tumors most frequently affect females (80%) and adults in their fourth and fifth decades of life. Most cases are asymptomatic although a few patients may present with a wide variety of clinical symptoms,with spontaneous or traumatic rupture being the most severe complication. In cases of spontaneous rupture,clinical manifestations consist of sudden abdominal pain,and anemia secondary to ahaemoperitoneum. Disseminated intravascular coagulopathy can also occur. Haemodynamic instability and signs of hypovolemic shock appear in about one third of cases. As the size of the hemangioma increases,so does the chance of rupture. Imaging studies used in the diagnosis of hepatic hemangiomas include ultrasonography,dynamic contrast-enchanced computed tomography scanning,magnetic resonance imaging,hepatic arteriography,digital subtraction angiography,and nuclear medicine studies. In most cases hepatic hemangiomas are asymptomatic and should be followed up by means of periodic radiological examination. Sur gery should be restricted to specific situations. Absolute indications for surgery are spontaneous or trau m atic rupture with hemoperitoneum,intratumoral blee ding and consumptive coagulopathy (Kassabach-Merrit syndrome). In a patient presenting with acute abdo minal pain due to unknown abdominal disease,sponta neous rupture of a hepatic tumor such as a hemangio ma should be considered as a rare differential diagnosis.
文摘Gastroesophageal reflux disease (GORD) is a pathological process in infants manifesting as poor weight gain, signs of esophagitis, persistent respiratory symptoms and changes in neurobehaviour. It is currently estimated that approximately one in every 350 children will experience severe symptomatic gastroesophageal reflux necessitating surgical treatment. Surgery for GORD is currently one of the common major operations performed in infants and children. Most of the studies found favour laparoscopic approach which has surpassed open antireflux surgery as the gold standard of surgical management for GORD.However, it must be interpreted with caution due to the limitation of the studies, especially the small number of subject included in these studies. This review reports the changing trends in the surgical treatment of GORD inchildren.
文摘BACKGROUND: Duodenal gastrointestinal stromal tumors, which are rare, comprise 3%-5% of all gastrointestinal stromai tumors. We present a case of a metastatic duodenal gastrointestinal stromal tumor that was successfully treated by simultaneous tight hemihepatectomy and pancreaticoduodenectomy. METHODS: A 50-year-old woman was admitted to our department for the treatment of a possible metastatic duodenal gastrointestinal stromal tumor (GIST). At laparotomy a large duodenal tumor was found displacing the head of the pancreas. A 3 cm in diameter lesion in the posterior aspect of segment Ⅷ of the liver was also noted. Simultaneous right hepatectomy and pancreaticoduodenectomy were performed. RESULTS: Histological examination revealed a high grade metastatic duodenal GIST strongly positive for c-kit, CD34, and vimentin. The patient had no additional therapy. A follow-up of 21 months showed that the patient is very well and there is no evidence of recurrent diseases. CONCLUSIONS: Malignant stromai tumors of the duodenum are rarely encountered. They are usually slow growing, and may be amenable to curative surgery, even after occurrence of metastases. Resection of localized liver metastasis is still advocated when feasible, since imatinib does not provide a complete or long-term response. Combined surgical resection is an efficacious treatment for patients with metastatic duodenal gastrointestinal stromal tumor.
文摘Background: Two types of treatment are being used for patients with ruptured intracranilal aneurysms: endovascular detachable-coil treatment or craniotomy and clipping. We undertook a randomised, multicentre trial to compare these treatments in patients who were suitable for either treatment because the relative saf ety and efficacy of these approaches had not been established. Here we present c linical outcomes 1 year after treatment. Methods: 2143 patients with ruptured in tracranial aneurysms, who were admitted to 42 neurosurgical centres, mainly in t he UK and Europe, took part in the trial. They were randomly assigned to neurosu rgical clipping (n=1070) or endovascular coiling (n=1073). The primary outcome w as death or dependence at 1 year (defined by a modified Rankin scale of 3-6). S econdary outcomes included rebleeding from the treated aneurysm and risk of seiz ures. Long-term follow up continues. Analysis was in accordance with the random ised treatment. Findings: We report the 1-year outcomes for 1063 of 1073 patien ts allocated to endovascular treatment, and 1055 of 1070 patients allocated to n eurosurgical treatment. 250 (23.5%) of 1063 patients allocated to endovascular treatment were dead or dependent at 1 year, compared with 326 (30.9%) of 1055 p atients allocated to neurosurgery, an absolute risk reduction of 7.4%(95%CI 3. 6-11.2, p=0.0001). The early survival advantage was maintained for up to 7 year s and was significant (log rank p=0.03). The risk of epilepsy was substantially lower in patients allocated to endovascular treatment, but the risk of late rebl eeding was higher. Interpretation: In patients with ruptured intracranial aneury sms suitable for both treatments, endovascular coiling is more likely to result in independent survival at 1 year than neurosurgical clipping; the survival bene fit continues for at least 7 years. The risk of late rebleeding is low, but is m ore common after endovascular coiling than after neurosurgical clipping.
基金supported by grants from the National Key R&D Program of China(2022YFE0133100)the Natural Science Foundation Project of Chongqing(CSTB2022NSCQ-MSX0118)。
文摘Purpose This multicenter qualitative study aimed to explore the perceptions of clinicians and research ethics boards(REBs)regarding ethical issues in Investigator Initiated Trials(IITs).Methods Between February and April 2024,semi-structured interviews were conducted with 27 participants from 15 tertiary hospitals,including clinical doctors and members of REBs.Responses were grouped and analyzed using a descriptive phenomenological approach.Results Clinicians expressed challenges in navigating the formal review process due to limited access to information and unclear guidelines.Academic review highlighted a deficiency in research literacy among clinical investigators,leading to flawed study design.Ethical review revealed concerns about inadequate ethical awareness among clini-cians,resulting in failed ethical approvals.Moreover,delays in review processes and resource shortages were noted,hindering the efficient conduct of IITs.Conclusion The findings underscore the need for comprehensive training programs to enhance clinicians’research literacy and ethical awareness.Establishing a comprehensive system to support IITs,including enhanced guidance and support from REBs,is essential to ensure the quality and integrity of IITs in China.
文摘Current evidence clearly demonstrates that coronary artery bypass grafting （CABG） remains the ＂gold standard＂ treatment for most patients with multivessel and left main stem disease. This article summarizes the relevant evidence basis demonstrating that CABG, in comparison to stenting, reduces mortality and subsequent myocardial infarction and the need for repeat revascularization. The article also describes the evidence basis to support the use of more arterial grafts during CABG and the current role of off-pump CABG.
