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1.
Article in Chinese | WPRIM | ID: wpr-695563

ABSTRACT

Objective To investigate the preoperative localizaion diagnosis and surgical strategies of primary hyperparathyroidism (pHPT).Methods The clinical data of pHPT patients who underwent initial parathyroid surgery at the Peking Union Medical College Hospital from Jan.2009 to Apr.2017 were retrospectively analyzed to explore preoperative localization and surgical options.Results There were a total of 902 surgical cases included in the study with 674 women and 228 men.All had preoperative parathyroid ultrasonography (US) (sensitivity 97.18%,positive predictive value (PPV) 98.40%) and 99Tcm-sestamibi (MIBI) scan (sensitivity 94.24%,PPV 98.00%).The combination of US and MIBI scan had a sensitivity of 92.39% and PPV of 97.37%.MIBI scan showed negative results in 51 cases.We found that male patients with cystic lesions were more likely related to negative MIBI scan (P<0.05).Among 89 patients with negative MIBI and/or US,39 received neck CT,17 received positron emission tomography (PET)/CT,and 9 received ultrasound-guided biopsy for further localization.800 patients (88.69%) underwent minimally invasive parathyroid surgery (MIP) with anesthesia of cervical plexus block.656 patients (72.72%) had normal parathyroid hormone (PTH) level on the first post-operative day,140 patients (15.52%) had postoperative hypocalcaemia and 234 patients (25.94%) presented hypocalcaemic symptoms within 3 days after operation,which could be relieved by intravenous calcium or continuous medicine taken by mouth.During the follow-up of the 800 MIP patients,4 had recurrence and one patient was not cured.Conclusions Parathyroid US and MIBI scan are of good value in localizaion diagnosis.Neck CT or PET/CT should be used as supplementary approaches in patients with negative US and/or MIBI scan.MIP with anesthesia of cervical plexus block is simple and feasiable for pHPT cases with accurate localization.

2.
Chinese Journal of Surgery ; (12): 582-586, 2017.
Article in Chinese | WPRIM | ID: wpr-809109

ABSTRACT

Objective@#To discuss the diagnosis, preoperative imaging and surgical technique of patients who underwent reoperation for persistent hyperparathyroidism.@*Methods@#A prospective database about primary hyperparathyroidism in Department of General Surgery, Peking Union Medical College Hospital was searched for the patients who underwent reoperation for persistent hyperparathyroidism from January 2009 to December 2016. The information about the initial operation, preoperative imaging study and result of reoperations were collected and reviewed. A total of 58 patients underwent reoperation for hyperparathyroidism. Eleven of these patients were referred to this institute for reoperation after missing single parathyroid lesion in the initial parathyroidectomy. Nine patients were female, and the mean patient age at reoperation was 54.9 years.@*Results@#For this group, the accuracy of ultrasound neck scan and sestamibi scintigraphy was 10/11 in identifying diseased parathyroid gland before reoperation. Combined with enhanced CT and SPECT, all parathyroid lesions were localized before reoperations. With general anesthesia or cervical plexus block, all diseased parathyroid glands were removed in the reoperations. No signs of hyperparathyroidism appeared during follow-up.@*Conclusions@#The initial surgery for primary hyperparathyroidism should be performed in experienced center to avoid reoperations. Combining preoperative localization and cervical exploration will help to increase the success rate of reoperation.

3.
Article in English | WPRIM | ID: wpr-327808

ABSTRACT

Objective To summarize our experiences in the diagnosis and prognosis of different subtypes of primary thyroid lymphoma (PTL). Methods The clinical data of 27 PTL patients who were treated in our hospital from January 1998 to December 2014 were retrospectively analyzed. The pathological types of these patients included B cell lymphoma unclassifiable (BCLU) (n=5),mucosa-associated lymphiod tissue lymphoma (MALT) (n=9),diffuse large B cell lymphoma (DLBCL) (n=12),and T cell lymphoma (n=1). Results Of all these 27 cases,the most common clinical symptom was painless swelling of the neck (n=21,77.8%). Of 7 patients who had received preoperative fine needle biopsy,lymphoma was suspected in 2 cases (28.6%). Among these 7 cases,the positive rate of suspicious lymphoma was 66.7% in 3 DLBCL patients,0 in 3 MALT patients,and 0 in 1 BCLU paitent. Also,25 patients underwent intraoperative frozen pathological examination,which revealed lymphoma or suspicious lymphoma in 16 cases (64.0%); in these patients,the positive rate was 66.7% for BCLU,77.8% for MALT,58.3% for DLBCL,and 0 for T-cell lymphomas. The overall survival was (89.3±12.4) months,and the overall 5-year survival rate was 61.6%. The estimated survival in symptomatic group was 31.6 months,which was significantly shorter than that in asymptomatic group (97.9 months) (P=0.032). Other factors including age,sex,tumor size,tumor stage,international prognostic index,tracheal compression,lactate dehydrogenase,residual tumor,and pathological type showed no significant effect on survival(all P>0.05). Conclusions DLBCL has the highest fine needle biopsy positive rate,MALT has the highest frozen pathological positive rate,and intraoperative frozen pathology has more malignant results than the preoperative fine needle biopsy in the diagnosis. The accompanying lymphoma symptoms may be an adverse prognostic factor.

4.
Chinese Journal of Surgery ; (12): 30-33, 2016.
Article in Chinese | WPRIM | ID: wpr-308473

ABSTRACT

<p><b>OBJECTIVE</b>To evaluate the effect and safety of enucleation of insulinoma under the Da Vinci robotic surgical system combination with intraoperative ultrasonography(IOUS) for the localization.</p><p><b>METHODS</b>The clinical materials of 50 insulinoma cases which underwent IOUS and assisted by the robotic surgical system from September 2012 to September 2014 in Peking Union Medical College Hospital were reviewed retrospectively. The patients were followed up by outpatient review and telephone until October 2014. The diagnostic accuracy rate, operation time, blood loss, complications and cure rate were analyzed by t-test.</p><p><b>RESULTS</b>The locations of tumors were 13 in the head, 21 in the body and 13 in the tail of pancreas, 2 were multiple insulinoma, 1 was ectopic to mesenterium.The average operation time was 142 minutes; the average blood loss was 165 ml.Three(6.0%) patients were transformed to open.One patient experienced postoperative bleeding about 300 ml on the 7(th) day after operation and no infection and perioperative death.Thirty-five cases were of class A and 14 of class B according to the clinical grading of postoperative pancreatic fistula.The blood glucose 60 minutes after tumor dissection was significantly elevated than that before operation ((6.2±1.8)mmol/L vs.(3.7±1.2)mmol/L)(t=-6.89, P<0.01). The cure rate was 100% as all the patients' symptoms were disappeared during follow-up time.</p><p><b>CONCLUSIONS</b>Combination IOUS is a highly sensitive method for the localization of insulinoma, which is helpful in localizing tumors precisely in insulinoma cases assisted by robotic surgical system and shortening operation time.It is safe and effective for insulinoma enucleation.</p>


Subject(s)
Blood Glucose , Humans , Insulinoma , Diagnostic Imaging , General Surgery , Operative Time , Pancreas , Diagnostic Imaging , General Surgery , Pancreatic Neoplasms , Diagnostic Imaging , General Surgery , Postoperative Complications , Retrospective Studies , Robotic Surgical Procedures , Ultrasonography
5.
Article in Chinese | WPRIM | ID: wpr-496000

ABSTRACT

Objective To investigate the clinical characters of pancreatitis in patients with primary hyperparathyroidism (PHPT).Methods The clinical data of patients with PHPT undergoing parathyroidectomy from Jan.2009 to May.2014 in Peking Union Medical College Hospital were retrospectively analyzed for coexistent pancreatitis.Results 571 patients received parathyroidectomy due to PHPT during this period.Thirteen patients (2.3%)with PHPT were confirmed with coexistent pancreatitis by clinical manifestation and abdominal imaging evaluation,including acute pancreatitis in 9 patients and chronic pancreatitis in 4 patients.PHPT with pancreatitis was associated with preoperative serum intact parathyroid hormone(iPTH)higher than 500 pg/ml (P=0.025)and occurrence of hypercalcemic crisis (P=0.013).The age and sex of patients,preoperative serum calcium,gallstones,urinary calculi and bone fracture were not related with pancreatitis in this group.The average follow-up period for these patients was 34(ranging from 13 to 68)months.All patients were free from hyperparathyroidism recurrence.Only one young lady with chronic pancreatitis suffered from repeated pancreatitis after surgery.Conclusions Serum iPTH higher than 500 pg/ml and occurrence of hypercalcemic crisis were possible risk factor of pancreatitis in patients with PHPT.Parathyroidectomy can help to prevent the recurrence of pancreatitis in these patients.

6.
Article in Chinese | WPRIM | ID: wpr-464283

ABSTRACT

AIM:To investigate the effect of signal transducer and activator of transcription 1 ( STAT 1 ) on proliferation and interferon-β(IFN-β) sensitivity of human non-small-cell lung cancer H1299 cells.METHODS:STAT1 or EGFP gene was transfected into H1299 cells by the lentiviral vectors system.The cell number was counted under a mi-croscope and cell proliferation was tested by MTT assay.In addition, the cells transfected with STAT1 and EGFP were trea-ted with IFN-βand cell viability was measured by MTT assay.The protein levels of p-STAT1, ICAM-1 and PCNA were de-tected by Western blot.RESULTS: Over-expression of STAT1 inhibited H1299 cell proliferation (P<0.05).H1299 cells transfected with STAT1 gene had a higher sensitivity to IFN-βthan the control cells transfected with EGFP ( P <0.05).Overexpression of STAT1 increased the protein level of p-STAT1, and reduced IACM-1 expression in H1299 cells. Moreover, STAT1 enhanced STAT1 phosphorylation and downregulated the expression of PCNA in H1299 cells treated with IFN-β.CONCLUSION:STAT1 inhibits the proliferation and enhances the IFN-βsensitivity of non-small-cell lung cancer H1299 cells.

7.
Chinese Mental Health Journal ; (12): 349-354, 2015.
Article in Chinese | WPRIM | ID: wpr-463136

ABSTRACT

Objective:To investigate the relationship between problem behaviorand father-child relationship in 4-6-year-oldchildren. Methods:Totally 102 children were recruited in a kindergarten in Beijing,with 36 aged four,36 aged five,30 aged six and 55 being boys and 47 being girls. Child Behavior Checklist (CBCL)was used to measure preschoolers'problem behaviors,and Family Relations Index (FRI)was adopted to assess children's rela-tionship with their fathers. Results:There were 41,49,and 12 children being classified as negative,neutral and posi-tive father-child relation respectively. Kruskal-Wallis Test revealed that there was no significant difference in scores of 3 CBCL subtests and 8 factors (P>0. 05 )among 4-,5-,and 6-year-old children. Children with negative father-child relationship scored higher on CBCL problem behavior subtests than those with neutral father-child relationship[30. 5 (7. 0,58. 0)vs. 16. 0 (0. 0,69. 0),P<0. 05 ]. They alsoscored higher on withdrawn behavior than children with neutralor positive father-child relationship [3. 0 (0. 0,4. 0)vs. 1. 0 (0. 0,6. 0),1. 0 (0. 0,4. 0),P<0. 05] . Mann-Whitney U Test manifested that boys scored higher in attention problem than girls (P<0. 0 1 ),but no gen-der difference was found in the other problem behaviors. Kruskal-Wallis Test showed that boys with negative father-child relationship scored higher than those with neutral father-child relationship on problem behavior subtest,anxie-ty-depression,attention problem,and internalized problem (Ps<0. 05 ). Boys with negative father-child relationship scored higher than those with neutraland positivefather-child relationship on withdrawn behavior (Ps <0. 05 ). No difference was found whether in CBCL subtests or problem behavior factors for girls with different types of father-child relationship. Conclusion:It suggests that the children with negative father-child relationship display more problem behavior and withdrawn symptoms;boys have more attention problems than girls;compared with girls, boys'problem behavior may be more closely related to therelationship with their father.

8.
Article in Chinese | WPRIM | ID: wpr-622047

ABSTRACT

Objective To investigate the treatment for papillary thyroid carcinoma (PTC) located in the isthmus.Methods 90 patients with PTC located in the isthmus receiving surgery from May 2007 to Dec.2013 were enrolled.Patients' age,muhifocality,capsular invasion,central compartment lymph node metastasis were analyzed and compared with the results of 82 patients who had PTC within the thyroid lobe.Results In patients with PTC located in the isthmus,those with multi foci were older((49.4 ± 9.9)years,P =0.004).Patients with capsular invasion had larger tumor((1.02 ± 0.43) cm,P =0.001).Compared with PTC within the lobe,PTC located in isthmus were more likely to be multifocal (27.8% vs 14.6%,P =0.036)and capsular invasive(42.2% vs.19.5%,P =0.001).Central compartment lymph nodes metastasis rate was higher in patients with PTC located in isthmus but no statistical difference was found(53.3% vs 48.8%,P =0.551).Conclusions PTC located in the isthmus tends to be more aggressive at early stage.Central compartment lymph node metastasis occursearly and can be on both sides.Most patients should receive total thyroidectomy and central compartment lymph node dissection of both sides,but there's no need to dissect lymph node beneath the recurrent laryngeal nerve on the contralateral central compartment.

9.
Article in Chinese | WPRIM | ID: wpr-450803

ABSTRACT

Pancreatic cancer is a highly malignant tumor.It is of great importance to improve the effectiveness of treatment by studying the mechanisms which lead to invasion and metastasis in pancreatic cancer.In some malignant tumors,tumor associated macrophage (TAM) plays an important role in tumor progression and invasion.TAM also plays an important role in pancreatic cancer which consists mainly of stromal elements.Research into the mechanisms for occurrence and development of pancreatic cancer,the role played by TAM as well as TAM transformation between the different phenotypes may bring a breakthrough in the treatment of pancreatic cancer.

10.
Article in Chinese | WPRIM | ID: wpr-400470

ABSTRACT

ObjectiveTo analyze therapeutic efficiency of 125 iodine brachytherapy seeds implantation guided by flexible fiber-optic bronchoscopy(FFB)image in terminal central non-small cell lung carcinoma (NSCLC).MethodsUnder therapy planning system (TPS) and guided by flexible fiber-optic bronchoscopy image,125 iodine seeds were implanted in 66 Confirmed terrainal cases with NSCLC and its posology Was validated and rechecked regularly.Remlts Complete remission (CR) was observed in 15 cases and partial remission (PR) in 36 cases during the first-year follow-up,with an overall efficiency rate (CR+PR) of 77.3 percent and one-year survival of 80.3 percent.Complete remission (CR) was observed in seven cases,partial remission (PR) in 22 cases,stable condition (SC) in three cases.and no progression was found during the second-year follow-up,respectively,with an overall efficiency rate (CR+PR) of 90.6 percent and two-year survival of 43.8 percent No radioactive damage were observed in the early and late stages of therapy.ConclusionsTherapy with radioactive 125 iodine seeds implantation guided by flexible fiber-optic bronchoscopy image could relieve airway obstruction effectively in terminal lung cancer and control progression of bronchiogenic carcinoma.

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