Tertiary syphilis,especially in cases involving visceral gummatous disease,can be confused with cancer of the solid organs.We report a case of tertiary hepatic syphilis that manifested with intrahepatic masses in a pa...Tertiary syphilis,especially in cases involving visceral gummatous disease,can be confused with cancer of the solid organs.We report a case of tertiary hepatic syphilis that manifested with intrahepatic masses in a patient who had an underlying primary peritoneal serous carcinoma (PPSC).The patient was diagnosed with PPSC and achieved a complete remission of PPSC following six cycles of platinum-based chemotherapy.Two hepatic nodules developed during the follow-up period and were initially labeled as hepatic metastases from the underlying PPSC,based on radiological findings.A resection of hepatic nodules was performed for therapeutic and diagnostic purposes,because there were no other metastatic foci except in the liver.Unex-pectedly,serology and histology confirmed tertiary sy philis.This rare case emphasizes the importance of including tertiary syphilis in the differential diagnosis of a space-occupying lesion,even with an existing diagn osis of underlying cancer.展开更多
目的:探讨右美托咪定持续输注对择期行肿瘤细胞减灭术(CRS)联合腹腔热灌注化疗术(HIPEC)腹膜癌患者围术期应激反应、乳酸(Lac)清除率和术后康复的影响。方法:收集60例全身麻醉下行CRS联合HIPEC腹膜癌患者的临床资料,筛选后剔除4例患者,...目的:探讨右美托咪定持续输注对择期行肿瘤细胞减灭术(CRS)联合腹腔热灌注化疗术(HIPEC)腹膜癌患者围术期应激反应、乳酸(Lac)清除率和术后康复的影响。方法:收集60例全身麻醉下行CRS联合HIPEC腹膜癌患者的临床资料,筛选后剔除4例患者,分为对照组(常规麻醉)27例和右美托咪定组29例。所有患者常规全身麻醉,右美托咪定组患者同时给予右美托咪定;术中监测有创动脉压(ABP)和中心静脉压(CVP),测定心脏指数(CI),计算心率血压乘积(RPP),术中以每搏变异度(SVV)指导补液。记录手术前(T0)、 HIPEC开始前(T1)、 HIPEC结束后(T2)和手术结束后(T3)时平均动脉压(MAP)、心率(HR)、RPP、CVP及CI和血中Lac、碱剩余(BE)、血糖(Glu)和皮质醇水平,计算Lac清除率;记录2组患者术后3 d内并发症发生情况。结果:循环相关指标,在T0时2组患者MAP、HR、RPP、CVP和CI比较差异无统计学意义(P>0.05);在T1时,与对照组比较,右美托咪定组患者RPP减少(P<0.05);在T2时,与对照组比较,右美托咪定组患者HR和CVP均明显降低(P<0.05),RPP减少(P<0.05);在T3时,与对照组比较,右美托咪定组患者HR、MAP和CVP明显降低(P<0.05),RPP减少(P<0.05),2组患者CI比较差异无统计学意义(P>0.05)。血气及应激相关指标,在T0时,2组患者血中Lac、BE、Glu和皮质醇水平比较差异无统计学意义(P>0.05);在T1和T2时,与对照组比较,右美托咪定组患者血中Lac、Glu和皮质醇水平降低(P<0.05),BE负值减少(P<0.05)。术后Lac水平和肝肾功能,在术后12 h (T4)、术后24 h (T5)、术后48 h (T6)和术后72 h (T7)时,与对照组比较,右美托咪定组患者Lac水平降低(P<0.05),Lac清除率明显升高(P<0.05);T5和T7时右美托咪定组患者丙氨酸氨基转移酶(ALT)和天门冬氨酸氨基转移酶(AST)水平明显降低(P<0.05)。术后并发症发生情况,与对照组比较,术后3 d内右美托咪定组患者术后低血压、恶心呕吐、腹胀、寒战和睡眠�展开更多
Background Peritoneal tuberculosis and primary peritoneal carcinoma can both present as an abdominal mass and ascites with elevated serum CA125. The purpose of our study was to evaluate the clinical features of perito...Background Peritoneal tuberculosis and primary peritoneal carcinoma can both present as an abdominal mass and ascites with elevated serum CA125. The purpose of our study was to evaluate the clinical features of peritoneal tuberculosis, compare them with features of primary peritoneal carcinoma, and establish definitive diagnostic procedures. Methods We conducted a retrospective study in patients with peritoneal tuberculosis from January 1995 to October 2010 at Peking Union Medical College Hospital. During this time, the data of 38 patients with primary peritoneal carcinoma were reviewed. Results The median age was 34 years （range, 19-80 years）. The most common symptoms were abdominal distension （16/30, 53.3%） and an abdominal mass （12/30, 40.0%）. The serum CA125 level was elevated in 25 patients （83.3%）. The median level of cancer antigen CA125 was 392.5 U/ml （range, 0.6-850.0 U/ml）. Abdominal ultrasound revealed a pelvic mass in 25 patients and ascites in 20 patients. Diagnostic laparoscopy was performed in 15 patients （50.0%） and exploratory laparotomy was performed in 12 patients （40.0%）, and 3 patients （10.0%） who underwent laparoscopy converted to laparotomy because of severe adhesions. The intraoperative findings were adhesions, multiple white tubercles, and ascites. Frozen tissue sections were obtained in 17 patients, and 14 of whom showed chronic granulomatous reactions. Final pathological examinations confirmed the diagnosis. Conclusions Peritoneal tuberculosis should be considered as a differential diagnosis, especially for young women with an abdominal mass, ascites, and elevated serum CA125 levels. Laparoscopy is a useful diagnostic method for peritoneal tuberculosis, and intraoperative frozen sections are recommended when the diagnosis is in doubt.展开更多
Background Phenotypic and genotypic heterogeneity is a known feature of many cancers.Whether serum tumor marker kinds vary and change following chemotherapy is still unclear.The aim of this study was to investigate wh...Background Phenotypic and genotypic heterogeneity is a known feature of many cancers.Whether serum tumor marker kinds vary and change following chemotherapy is still unclear.The aim of this study was to investigate whether there is a change in the expression of serum tumor markers following chemotherapy,and the potential clinical significance in patients with epithelial ovarian carcinoma （EOC） or primary serous peritoneal carcinoma （PSPC）.Methods Samples were collected before surgery,during chemotherapy and during follow-up for enzyme-linked immunosorbent assay （ELISA）-based evaluation of serum CA-125,CA19-9 and CP2 levels in patients with EOC or PSPC who had received primary debulking surgery followed by adjuvant chemotherapy.In total,72 patients were examined,including 37 patients with recurrent lesions and 35 patients receiving first-line chemotherapy.Results In 35 de novo patients,20% （7/35） demonstrated a significant changed serum tumor marker kinds among whom the patients with mucinous carcinoma （57.1%,4/7） showed resistance to chemotherapy.In the 37 recurrent patients,51.4% （19/37） had changed serum tumor markers,of whom 57.9% （11/19） presented with serous carcinoma.There was no significant difference in median progression-free survival or overall survival in patients with drug-sensitive or drug-resistant recurrence in patients with changed tumor marker kinds relative to those with unchanged markers.However,for patients with changed serum tumor markers there was a trend towards prolonged survival compared with the unchanged serum tumor marker group.In the 17 patients with secondary recurrence,37.5% （6/17） had changed tumor marker levels.The ratios of CA-125/CP2 and CA-125/CA19-9 were significantly different after either chemotherapy or recurrence.Conclusions Serum tumor marker expression in patients with EOC or PSPC may change after chemotherapy or recurrence,indicating that in addition to the markers that are abnormal before surgery,those markers that are normalshould also 展开更多
文摘Tertiary syphilis,especially in cases involving visceral gummatous disease,can be confused with cancer of the solid organs.We report a case of tertiary hepatic syphilis that manifested with intrahepatic masses in a patient who had an underlying primary peritoneal serous carcinoma (PPSC).The patient was diagnosed with PPSC and achieved a complete remission of PPSC following six cycles of platinum-based chemotherapy.Two hepatic nodules developed during the follow-up period and were initially labeled as hepatic metastases from the underlying PPSC,based on radiological findings.A resection of hepatic nodules was performed for therapeutic and diagnostic purposes,because there were no other metastatic foci except in the liver.Unex-pectedly,serology and histology confirmed tertiary sy philis.This rare case emphasizes the importance of including tertiary syphilis in the differential diagnosis of a space-occupying lesion,even with an existing diagn osis of underlying cancer.
文摘目的:探讨右美托咪定持续输注对择期行肿瘤细胞减灭术(CRS)联合腹腔热灌注化疗术(HIPEC)腹膜癌患者围术期应激反应、乳酸(Lac)清除率和术后康复的影响。方法:收集60例全身麻醉下行CRS联合HIPEC腹膜癌患者的临床资料,筛选后剔除4例患者,分为对照组(常规麻醉)27例和右美托咪定组29例。所有患者常规全身麻醉,右美托咪定组患者同时给予右美托咪定;术中监测有创动脉压(ABP)和中心静脉压(CVP),测定心脏指数(CI),计算心率血压乘积(RPP),术中以每搏变异度(SVV)指导补液。记录手术前(T0)、 HIPEC开始前(T1)、 HIPEC结束后(T2)和手术结束后(T3)时平均动脉压(MAP)、心率(HR)、RPP、CVP及CI和血中Lac、碱剩余(BE)、血糖(Glu)和皮质醇水平,计算Lac清除率;记录2组患者术后3 d内并发症发生情况。结果:循环相关指标,在T0时2组患者MAP、HR、RPP、CVP和CI比较差异无统计学意义(P>0.05);在T1时,与对照组比较,右美托咪定组患者RPP减少(P<0.05);在T2时,与对照组比较,右美托咪定组患者HR和CVP均明显降低(P<0.05),RPP减少(P<0.05);在T3时,与对照组比较,右美托咪定组患者HR、MAP和CVP明显降低(P<0.05),RPP减少(P<0.05),2组患者CI比较差异无统计学意义(P>0.05)。血气及应激相关指标,在T0时,2组患者血中Lac、BE、Glu和皮质醇水平比较差异无统计学意义(P>0.05);在T1和T2时,与对照组比较,右美托咪定组患者血中Lac、Glu和皮质醇水平降低(P<0.05),BE负值减少(P<0.05)。术后Lac水平和肝肾功能,在术后12 h (T4)、术后24 h (T5)、术后48 h (T6)和术后72 h (T7)时,与对照组比较,右美托咪定组患者Lac水平降低(P<0.05),Lac清除率明显升高(P<0.05);T5和T7时右美托咪定组患者丙氨酸氨基转移酶(ALT)和天门冬氨酸氨基转移酶(AST)水平明显降低(P<0.05)。术后并发症发生情况,与对照组比较,术后3 d内右美托咪定组患者术后低血压、恶心呕吐、腹胀、寒战和睡眠�
文摘Background Peritoneal tuberculosis and primary peritoneal carcinoma can both present as an abdominal mass and ascites with elevated serum CA125. The purpose of our study was to evaluate the clinical features of peritoneal tuberculosis, compare them with features of primary peritoneal carcinoma, and establish definitive diagnostic procedures. Methods We conducted a retrospective study in patients with peritoneal tuberculosis from January 1995 to October 2010 at Peking Union Medical College Hospital. During this time, the data of 38 patients with primary peritoneal carcinoma were reviewed. Results The median age was 34 years （range, 19-80 years）. The most common symptoms were abdominal distension （16/30, 53.3%） and an abdominal mass （12/30, 40.0%）. The serum CA125 level was elevated in 25 patients （83.3%）. The median level of cancer antigen CA125 was 392.5 U/ml （range, 0.6-850.0 U/ml）. Abdominal ultrasound revealed a pelvic mass in 25 patients and ascites in 20 patients. Diagnostic laparoscopy was performed in 15 patients （50.0%） and exploratory laparotomy was performed in 12 patients （40.0%）, and 3 patients （10.0%） who underwent laparoscopy converted to laparotomy because of severe adhesions. The intraoperative findings were adhesions, multiple white tubercles, and ascites. Frozen tissue sections were obtained in 17 patients, and 14 of whom showed chronic granulomatous reactions. Final pathological examinations confirmed the diagnosis. Conclusions Peritoneal tuberculosis should be considered as a differential diagnosis, especially for young women with an abdominal mass, ascites, and elevated serum CA125 levels. Laparoscopy is a useful diagnostic method for peritoneal tuberculosis, and intraoperative frozen sections are recommended when the diagnosis is in doubt.
文摘Background Phenotypic and genotypic heterogeneity is a known feature of many cancers.Whether serum tumor marker kinds vary and change following chemotherapy is still unclear.The aim of this study was to investigate whether there is a change in the expression of serum tumor markers following chemotherapy,and the potential clinical significance in patients with epithelial ovarian carcinoma （EOC） or primary serous peritoneal carcinoma （PSPC）.Methods Samples were collected before surgery,during chemotherapy and during follow-up for enzyme-linked immunosorbent assay （ELISA）-based evaluation of serum CA-125,CA19-9 and CP2 levels in patients with EOC or PSPC who had received primary debulking surgery followed by adjuvant chemotherapy.In total,72 patients were examined,including 37 patients with recurrent lesions and 35 patients receiving first-line chemotherapy.Results In 35 de novo patients,20% （7/35） demonstrated a significant changed serum tumor marker kinds among whom the patients with mucinous carcinoma （57.1%,4/7） showed resistance to chemotherapy.In the 37 recurrent patients,51.4% （19/37） had changed serum tumor markers,of whom 57.9% （11/19） presented with serous carcinoma.There was no significant difference in median progression-free survival or overall survival in patients with drug-sensitive or drug-resistant recurrence in patients with changed tumor marker kinds relative to those with unchanged markers.However,for patients with changed serum tumor markers there was a trend towards prolonged survival compared with the unchanged serum tumor marker group.In the 17 patients with secondary recurrence,37.5% （6/17） had changed tumor marker levels.The ratios of CA-125/CP2 and CA-125/CA19-9 were significantly different after either chemotherapy or recurrence.Conclusions Serum tumor marker expression in patients with EOC or PSPC may change after chemotherapy or recurrence,indicating that in addition to the markers that are abnormal before surgery,those markers that are normalshould also
