Haibin Zhou

Abstract Background Endoscopic placement of biliary stents to relieve jaundice is the main palliative treatment for unresectable extrahepatic cholangiocarcinoma. Endoscopic biliary radiofrequency ablation (RFA) has been reported to prolong stent patency, which may be beneficial in improving patient survival. However, available evidence is still insufficient, as most reported studies are retrospective case series. The aim of this study was to explore the clinical effect and safety of RFA in patients with unresectable extrahepatic cholangiocarcinoma. Methods 65 patients with unresectable extrahepatic cholangiocarcinoma, except Bismuth type III and IV hilar cholangiocarcinoma, were enrolled and randomly underwent either RFA combined with biliary stenting (RFA + stent group; n = 32) or biliary stent only (stent-only group; n = 33). Overall survival time, stent patency period, and postoperative adverse events were recorded. Results In the 21-month follow-up period, the overall mean survival time was significantly longer in the RFA + stent group than in the stent-only group (13.2 ± 0.6 vs. 8.3 ± 0.5 months; P < 0.001). The mean stent patency period of the RFA + stent group was also significantly longer than that of the stent-only group (6.8 vs. 3.4 months; P = 0.02). There was no significant difference in the incidence of postoperative adverse events between the two groups (6.3 % [2/32] vs. 9.1 % [3/33]; P = 0.67). Conclusion Endoscopic RFA combined with stenting can significantly prolong survival and the stent patency period without increasing the incidence of adverse events in patients with extrahepatic cholangiocarcinoma patient, except Bismuth type III and IV hilar cholangiocarcinoma. This approach can be considered as a safe and effective palliative treatment for these patients.

PURPOSE: The aim of this multicenter study was to evaluate the clinical outcome of anterior cruciate ligament (ACL) reconstruction by use of the Ligament Advanced Reinforcement System (LARS) artificial ligament (Surgical Implants and Devices, Arc-sur-Tille, France) with 3- to 5-year follow-up. METHODS: From August 2004 to July 2006, 159 patients with ACL rupture underwent arthroscopic ACL reconstruction with LARS artificial ligament at 4 orthopaedic sports medicine centers in China. They were retrospectively followed up for 50 +/- 6 months (range, 36 to 62 months). Outcome assessment included physical examination, KT-1000 arthrometer testing (MEDmetric, San Diego, CA), magnetic resonance imaging, radiography, Lysholm score, Tegner score, International Knee Documentation Committee score, and subjective satisfaction rate. Quadriceps and hamstring isokinetic strength was evaluated in 68 patients. RESULTS: The side-to-side difference in anterior translation (injured side - uninjured side) measured by KT-1000 arthrometer was 1.5 +/- 1.6 mm (range, -1 to 7 mm) postoperatively, and knee stability was significantly improved compared with preoperative data (P < .0001). Quadriceps and hamstring isokinetic peak torque of the injured limb expressed as a percentage of the contralateral limb was 93.6 +/- 10.7 and 95.8 +/- 12.0, respectively. The Lysholm score improved from 65.1 +/- 12.3 points (range, 30 to 95 points) preoperatively to 94.5 +/- 7.0 points (range, 65 to 100 points) postoperatively (P < .0001). The Tegner score improved from 3.1 +/- 1.6 (range, 0 to 6) preoperatively to 6.1 +/- 1.5 (range, 1 to 9) postoperatively (P < .0001). According to the International Knee Documentation Committee score, 94% of patients were graded A or B at last follow-up. Ninety-three percent of patients were very satisfied or satisfied with their outcome. LARS artificial ligament rupture occurred in 3 patients; knee synovitis developed in 1 of these patients. CONCLUSIONS: ACL reconstruction with LARS artificial ligament used in patients with the ACL stump preserved in the acute and chronic phases has a very good outcome at mean of 50 months' follow-up. The overall complication rate for ACL reconstruction with LARS artificial ligament is 5.7%, and knee synovitis developed in only 1 case. LEVEL OF EVIDENCE: Level IV, therapeutic case series.