Laparoscopic Pancreaticoduodenectomy:Strength,Weakness,and Future Directions / 中国医学科学院学报

Laparoscopic pancreatoduodenectomy(LPD)is one of the most challenging abdominal procedures.It has been developed for nearly 25 years since the first report in 1994.During the first 10 years,LPD has developed slowly due to widespread controversy and opposition.In the past 10 years,a number of breakthroughs have been made in LPD with the introduction of high-definition laparoscopy,improvements in laparoscopic instruments,advances in minimally invasive surgery,improved selections of patients,and accumulation of experiences in open pancreaticoduodenectomy(OPD).However,many controversies still exist.This review summarizes the strength and weakness of LPD versus OPD in terms of indications,learning curve,complications,short-term benefits,long-term oncology results,and cost and proposes its future directions.

Clinicopathologic features of familial nonmedullary thyroid carcinoma / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Familial nonmedullary thyroid carcinoma (FNMTC) is a variant of nonmedullary thyroid carcinoma(NMTC) with particular clinicopathologic features. In recent years, a number of studies have shown that FNMTC is more invasive than sporadic NMTC(SNMTC). The purpose of this study was to explore the differences in clinicopathologic features of FNMTC between different types of families and to determine in which of these families more invasive FNMTC occurred.</p><p><b>METHODS</b>We retrospectively reviewed all patients with thyroid carcinoma admitted to Peking Union Medical College Hospital from January 2009 to July 2013 in the database. Of all 2000 cases, 55 met the inclusive criteria for FNMTC and were studied. There are two different grouping methods. The first is that all samples were allocated to families with three or more first-degree relatives affected (FNMTC-3 group) and families with only two affected first-degree relatives (FNMTC-2 group). The second is that all patients were divided into families with three or more affected first-degree relatives over two generations (FNMTC-3-2 group) and the other families. We compared the clinicopathologic features such as sex, age, tumor size, multifocality, location, complications by thyroiditis, complications by benign thyroid nodules, surgical procedure, capsule invasion, histological type, lymph node metastases, tumor node metastasis stage, and BRAF mutation between FNMTC-2 group and FNMTC-3 group. We also made the same comparison between FNMTC-3-2 group and other families.</p><p><b>RESULTS</b>No pronounced differences in clinicopathological features were present between FNMTC-2 group and FNMTC-3 group. The proportion of FNMTC-3-2 group aged <45 years was significantly higher than that in the other families (58.8% vs. 26.3%, P = 0.021). A similar difference was found in the proportion of lymph node metastasis (64.7% vs. 34.2%, P = 0.035).</p><p><b>CONCLUSIONS</b>FNMTC-3-2 is more invasive than the other families. Early screening and positive treatment for members of these families are recommended.</p>

Application of timolol in preventing variceal hemorrhage in patients with portal hypertension / 中国医学科学院学报

<p><b>OBJECTIVE</b>To determine the effectiveness of timolol in preventing first variceal hemorrhage in portal hypertensive patients with esophageal varices.</p><p><b>METHODS</b>A total of 42 cirrhotic patients with esophageal varices were enrolled in this study and received timolol or band ligation therapy randomly,with 21 patients in each group. The diameters of portal vein (PV), superior mesenteric vein (SMV), and splenic vein (SPV) as well as the portal venous flow and the splenic venous flow were measured. The first esophageal variceal bleeding of the two groups was recorded.</p><p><b>RESULTS</b>The diameters of PV, SMV, and SPV as well as the flow of PV and SPV showed no significant difference before and after treatment in band ligation group (P>0.05). In timolol group,however,the diameter of portal vein significantly decreased after treatment [(14.11±2.96) mm vs. (12.15±1.61)mm, P<0.05], and the average blood flow of portal vein also significantly decreased after treatment [(1277.33±495.19) ml/min vs. (719.17±245.16)ml/min, P<0.05]. Both timolol and band ligation effectively prevented esophageal variceal bleeding, and the risk of first esophageal variceal bleeding in these two groups were not significantly different (15% vs. 10%, P<0.05).</p><p><b>CONCLUSIONS</b>Timolol is safe and effective in preventing the first variceal bleeding in portal hypertensive patients with esophageal varices.</p>