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Differentiated thyroid cancer is one of the most common endocrine malignant tumors, and thyroidectomy is its basic treatment measures. Insufficient attention is paid to its postoperative bone hungry syndrome and parathyroid hyperfunction or hyperparathyroidism, which will seriously affect the patient’s life quality and prognosis. This paper will explore the etiology, dangers, diagnosis, prevention, and treatment for hungry bone syndrome, parathyroid hyperfunction and hyperparathyroidism of thyroid cancer patients after thyroidectomy.
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Objective:To evaluate the clinical feasibility, safety, and advantages of small lateral cervical incision for parathyroid exploration and resection.Methods:A total of 31 consecutive patients who underwent parathyroidectomy with a small lateral cervical incision, in the Department of Endocrinology and Breast Surgery of the First Affiliated Hospital of Chongqing Medical University from Apr. to Nov. 2021, including 11 males and 20 females, aged (49.32±13.79) years, ranging from 28 to 86 years, were selected to make retrospective statistical analysis of the surgical time, hospital stay, intraoperative blood loss, postoperative drainage and postoperative complications of the patients. All patients were injected with carbon nanoparticles suspension injection guided by color ultrasound to locate the enlarged parathyroid gland before surgery. EXCEL 2019 software was used for statistical analysis.Results:Thirty-one patients underwent parathyroidectomy through a small lateral cervical incision. Primary hyperparathyroidism was performed in 19 cases (including 2 cases with bilateral small lateral cervical incision, 2 cases with unilateral excision of thyroid mass combined with parathyroidectomy, 1 case with resection of huge parathyroid adenoma, and 1 case with local anesthesia) . Twelve patients with secondary hyperparathyroidism underwent total parathyroidectomy through bilateral small lateral cervical incision and forearm autogenous parathyroid transplantation (including bilateral thyroid mass resection combined with bilateral total parathyroidectomy and forearm autogenous parathyroid transplantation in 2 cases, local anesthesia and cervical plexus nerve block in 2 cases, and ectopic parathyroid gland in thyroid in 1 case) . Among them, the average operative time of patients with primary hyperparathyroidism was (54.74±27.71 & 74.14±31.73) min, the average intraoperative blood loss was (8.11±5.05 & 14.43±10.94) ml, the average postoperative drainage was (14.37±24.64 & 26.36±32.87) ml, the average postoperative parathyroid hormone was (11.59±16.46 & 26.65±56.38) pg/ml, the average hospital stay was (10.00±5.09 & 10.96±4.55) d, and the postoperative complication rate was (3.2% & 0%) .Conclusions:Parathyroid gland exploration and resection through small lateral cervical incision is a safe and effective surgical method and can also complete thyroid exploration and parathyroidectomy at the same time. Appropriate anesthesia should be selected after a full assessment of the patient’s basic condition.
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Background and purpose: With the increase of aging population, elderly patients (age ≥70 years) with esophageal squamous cell carcinoma occurred more and more. However, few studies have focused on elderly esophageal squamous cell carcinoma patients. This study aimed to assess the outcomes and prognostic factors for elderly patients with esophageal squamous cell carcinoma treated after deifnitive chemoradiotherapy. Methods:We retrospectively analyzed 53 patients (age≥70 years) with esophageal squamous cell carcinoma and treated with deifnitive radiotherapy with or without chemotherapy from Fudan University Shanghai Cancer Center from Mar. 2009 to Dec. 2011. Results:Median age was 74 years. Twenty-nine patients underwent radiotherapy, 24 patients underwent radiochemotherapy. 1-, 2-, 3-, and 5- year survival was 62%, 44%, 33% and 19% respectively. Grade 2 and above acute radiation-induced esophageal toxicity and radiation pneumonitis occur rate was 6% and 9% respectively. No treatment-related deaths occurred and no patients experienced any grade 4 and above toxicities. Multivariate analysis identiifed treatment modality, tumor site and smoking history as independent prognostic factors for overall survival. Conclusion:Radiotherapy may be an acceptable treatment option for elderly patients with esophageal squamous cell carcinoma. In appropriately selected patients, concurrent chemotherapy could bring a better overall survival.
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The prognosis of patients with brain metastases from non-small cell lung cance (NSCLC) is dismal,and whole brain radiation therapy(WBRT) cannot simultaneously control the extracranial lesions.Study results of Tyrosine kinase inhibitor(TKI) for brain metastases in patients with lung cancer are encouraging,and treatment efficacy is related to EGFR mutation status.The sensitizing theoretical foundation exists in utilizing erlotinib combined with WBRT for the treatment in brain metastases patients with lung cancer.Currently,a small clinical trial data shows that erlotinib combined with WBRT has better efficacy compared to erlotinib alone,and the toxicity can be tolerated.
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Background and purpose: Radiation therapy is still the most primary treatment of brain metastases, and prognosis is affected by many factors. The aim of this study was to identify the prognostic factors and to establish a prognostic index model in patients with brain metastases after whole-brain radiotherapy (WBRT). Methods: We reviewed the clinical date of 140 patients with brain metastases radiotherapy in our hospital from Jan. 2008 to Jul. 2011. The signiifcance of prognostic variables in the survival was resulted from both univariate analysis and multivariate analysis. The prognostic index (PI) was established based on Cox regression analysis and subgrouping values. It was assessed whether recursive partitioning analysis classes (RPA), basic score for brain metastases (BS-BM) and the graded prognostic assessment index (GPA) were related to prognosis. Results:The median survival time was 222 days. The univariate analysis showed that the independent prognostic factors were KPS performance status, number of brain metastases, presence of extracranial metastases, primary tumor status, radiation dose, hemoglobin. The multivariate analysis showed that KPS performance status (P=0.002, Wald=9.700), presence of extracranial metastases (P=0.018, Wald=5.604) and primary tumor status (P=0.001, Wald=10.212) were signiifcantly correlated with overall survival. RPA, BS-BM and GPA were closely related to their prognosis by Log-rank test. In predicting 3 months and 6 months of survival for patients, PI was better than other modes. Conclusion:Our data suggest that the 3 indexes RPA,BS-BM and GPA are valid prognostic index models, but PI model is better.
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Objective To explore the effects of experiential teaching mode in pediatrics of traditional Chinese medicine. Methods One hundred students were randomly divided into trial group and control group, 50 students in each group. Trial group used the experiential teaching mode, while students in the control group were taught with traditional teaching mode. Results The degree of interest in pediatrics of traditional Chinese medicine, communication with the children and the parents of the patients, and examination results in the trial group were superior to the control group (P<0.05). Conclusion The effects of experiential teaching mode in pediatrics of traditional Chinese medicine are satisfied, and worth popularizing in teaching.
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Local recurrence is more frequent in postoperative cervical cancer patients with high-risk factors.It is confirmed that adjuvant pelvic radiotherapy (RT) for the cervical cancer patients after surgery with high-risk factors can improve local control but can't improve the overall survival.Researches show that concurrent chemo-radiotherapy (CCRT) can improve survival rates compared with radiotherapy,but the adverse effects such as leucopenia and gastrointestinal toxicity are observed frequently.Intensity-modulated radiation therapy (IMRT) has been developed to deliver a high radiation dose to an irregular target volume,with relative sparing of adjacent normal tissues.IMRT has excellent local tumor control and overall survival.
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Therapies for malignant glioma include surgery,radiotherapy and chemotherapy.In recent years,the overall effective rate of temozolomide is better than other chemotherapy drugs,but partly patients have resistance to temozolomide.Angiogenesis inhibitors show promising activity,but it is expensive.Celecoxib has antiangiogenic activity,which has become a new option.
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[Objective]To explore the effects of the model establishment methods on energy metabolism indicators of model rats.[Methods] Set up normal group,model group(high fat diet + high temperature and high humidity + colon bacillus),contrary group (routine diet + high temperature and high humidity + colon bacillus),the activity of liver mitochondria Na+-K+-ATPase was detected by principle of determines the content of phosphorus.[Results] The Na+-K+-ATPase active inmodel group was remarkably decreased,and had no significantly difference from contrary group.[Conclusion]The liver mitochondria Na+-K+-ATPase being remarkably decreased is one of pathological basis of damp-heat model,un-related with high fat diet.
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Objective To supply the foundation of Shuyuwan as drug curing on wounded stress disease, by exploring its immunity pharmacology. Methods The effect of the Shuyuwan upon the wounded stress mice IL-2 mRNA and IL-2R mRNA gene expression were detected by Q-RT-PCR. Results The Shuyuwan used in the wounded stress mice can improve IL-2 mRNA and IL-2R mRNA level significantly (P
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Objective To evaluate the CT diagnostic value for rectal carcinoma.Methods CT images were reviewed restrospectively in 26 cases of rectal carcinoma confirmed by biopsy,surgery and pathology.Results The accuracy rate of stage D by CT preoperate staging was 85.7%,stage B-2 20%,the accuracy rate of postoperate tumor recurrence was 60%,distant metastases was 75%.Conclusion CT preoperate staging should be mainly applied for advanced stage patients that would be appropriate to treatment and avoid unnecessary surgery.It played an important role in monitoring tumor recurrence and distant metastases.
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Background and purpose:Radical cystectomy is viewed as the standard treatment for bladder carcinoma,but organ preservation has been attempted for patients with muscle-invasive bladder carcinoma over the past decades as an alternative to radical cystectomy.The majority of studies included transurethral resection of bladder tumor(TURB),radiotherapy,and chemotherapy,as a feasible and safe organ-sparing approach with the similar outcome to radical cystectomy.The current study evaluated the outcomes and complications of the radiation therapy for the patients with bladder cancer,and prognosis factors had been analyzed.Methods:We retrospectively analyzed 21 patients with bladder cancer.The clinical stages of the patients were 15 with T_2;5 with T_3 and 2 with T_4.2 of them were lymph node-positive,16 of patients were pathologically proved as transitional cell carcinoma,4 as adenocarcinoma and 1 as transitional cell carcinoma plus squamous cell carcinoma.Conventional fractionation radiotherapy was given at a median dose of 54.5Gy(ranged 49.2-69.9 Gy) after surgery.Kaplan-Meier method and Logrank method were used for the statistical analysis.Results:Median follow-up was 32 months.The overall survivals at 1 year,3 years and 5 years were 90.5%,47.1%,and 36.7% respectively.The local disease free rates were 95.0%,62.4%,and 47.5% respectively.15 of 16 patients' deaths were related to the tumor.In univariate analysis,only small field irradiation was found as a prognosis factor in survival(?~(2)=5.36,P=0.02).Conclusions:Combined treatment appears to provide high response rates and can be offered as an alternative option to radical cystectomy for selected patients who refuse or are unsuitable for surgery.A large number of patients,multicenter,prospective randomized trial would be desirable to evaluate the role of radiotherapy in the multi-modality treatment of bladder cancer.
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Objective On basis of physical dose optimization, LQ model was used to investigate the difference between the curves of biological effective dose and physical isodose. The influence of applying the biological dose concept on three dimensional conformal radiotherapy of prostate carcinoma was discussed. Methods Four treatment plannings were designed for physical dose optimization: three fields, four-box fields, five fields and six fields. Target dose uniformity and protection of the critical tissue -rectum were used as the principal standard for designing the treatment planning. Biological effective dose (BED) was calculated by LQ model. The difference between the BED curve drawn in the central layer and the physical isodose curve was studied. The difference between the adjusted physical dose (APD) and the physical dose was also studied. Results Five field planning was the best in target dose uniformity and protection of the critical tissue -rectum. The physical dose was uniform in the target, but the biological effective doses revealed great discrepancy in the biological model. Adjusted physical dose distribution also displayed larger discrepancy than the physical dose unadjusted. Conclusions Intensified Modulated Radiotherapy (IMRT) technique with inversion planning using biological dose concept may be much more advantageous to reach a high tumor control probability and low normal tissue complication probability.
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Objective To evaluate the outcome , side effects and prognosis of prostate carcinoma treated with external radiotherapy. Methods From 1990 to 1999, a total of 45 prostate carcinoma patients were treated. Four cases were lost during follow up. Forty one patients underwent orchiectomy before radiation therapy , 29 received orchiectomy combined with hormone treatment. All patients received conventional radiation therapy with a median dose of 68.3 ?Gy (50.4 75.9?Gy), 1.8 2.0?Gy per fraction, five fractions weekly. Results The median follow up duration was 28 months (1 111 months). The overall 5 year survival was 76.4% and the 5 year disease specific survival was 76.5%. In terms of acute GI side effects, the frequencies of Grade Ⅰ, Ⅱ or Ⅲ reactions were 53.5%, 7.0% and 9.3% while Grade Ⅰ or Ⅱ , acute GU side effects were 41.9% and 4.7%, respectively. For the long term deleterious effects,Grade Ⅰ or Ⅱ in GI late complications were 16.7% and 7.1% and the GU late morbidities of Grade Ⅰ,Ⅱ or Ⅲ were 23.8%, 4.8% and 2.4%, respectively. Regional lymph node metastasis was closely correlated with both overall survival (P= 0.002 ) and disease specific survival (P= 0.002 ). Multivariate analysis revealed, only regional lymph node metastasis was of prognostic value to predict the overall survival and disease specific survival. Conclusion The outcome of radiation therapy for patients with T 2 T 4 prostate carcinoma is satisfactory with the side effects tolerable to most patients.