Effects of Cdc42 overexpression on the estrogen-enhanced multidrug resistance in breast cancer cells / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the changes of Cdc42 expression under estrogen stimulation, and to explore the signaling pathway of intracellular material transportation caused by estrogen.</p><p><b>METHODS</b>MTT was used to test the drug sensitivity of cells. Real-time PCR was used to evaluate the expression of Cdc42 mRNA. The amount of ADM accumulated in MCF-7 cells was detected by flow cytometry. The protein levels of active-Cdc42 and Total-Cdc42 were measured by Western blot.</p><p><b>RESULTS</b>IC(50) of ADM in MCF-7 cells was increased from (0.098 ± 0.011) µg/ml to (0.134 ± 0.130) µg/ml (P < 0.05) after estrogen stimulation. The amount of ADM accumulated in MCF-7 cells was reduced from 7.253 ± 0.310 to 3.233 ± 0.313 (P < 0.05). All of Cdc42 mRNA, active-Cdc42 protein and total-Cdc42 protein were increased (P < 0.05). After the treatment with siRNA, the IC(50) of ADM in siRNA group was decreased to (0.057 ± 0.017) µg/ml (P < 0.05) compared with that in the control group. The amount of accumulated ADM was significantly increased in the siRNA group, and all the expression levels of Cdc42 mRNA, active-Cdc42 protein and total-Cdc42 protein were decreased in the siRNA group (P < 0.05).</p><p><b>CONCLUSIONS</b>Estrogen enhances the drug resistance in breast cancer cells. The mechanism of this effect may be via the enhancing Cdc42 expression and decreasing the accumulation of chemotherapeutic drugs in the cancer cells.</p>

The characteristics of papillary thyroid cancer lymph node metastasis and the clinical significance of central region cervical lymph node dissection / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the necessity of the central region cervical lymph node dissection for patients with papillary thyroid carcinoma.</p><p><b>METHODS</b>Clinical data of 457 papillary thyroid cancer patients underwent bilateral thyroidectomy with cervical lymph node excision from June 2003 to September 2007 were retrospectively reviewed. There were 86 male patients and 371 female patients. The age was 17 to 73 years old.</p><p><b>RESULTS</b>There were no death for operation or in hospital. The total rate of central region cervical lymph node (VI region) metastasis was 59.1% (270/457), and bilateral metastasis was 42.2% (114/270). The total rate of III + IV region cervical lymph node metastasis was 29.8% (136/457). For unilateral papillary thyroid cancer, when tumor diameter over 1 cm and tumor breaking through thyroid caps, the central region cervical lymph node metastasis was 64.5% (178/276) and 81.6% (120/147) respectively. When the tumor diameter < or = 1 cm and tumor confining in thyroid, central region cervical lymph node metastasis was 23.4% (11/47) and 39.2% (69/176) respectively. There were 5 cases with lymph node jumping metastasis. During the follow-up of 7 to 59 months, 1 case died of lung metastasis. Four cases occurred local recurrence, 3 cases occurred distant metastasis. There was no case of hypothyroidism under the thyroxine replacement therapy.</p><p><b>CONCLUSIONS</b>For papillary thyroid cancer, the most common cervical lymph node metastasis is central region. It is necessary to dissect bilateral central region lymph node following the original surgical procedures.</p>

Outcome of reoperation for thyroid cancer: clinical analysis of 72 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze the indication of reoperation of thyroid cancer and to explore the timing, surgical pattern of reoperation.</p><p><b>METHODS</b>Protocols of 72 patients underwent reoperation of thyroid cancer from June 2003 to August 2006 were reviewed retrospectively. Causes for reoperation were as follows: residue of the tumor locally as the inappropriate initial operation; local recurrence and cervical lymph node metastasis; before (131)I ablation which differentiated thyroid cancer with distant place metastasis. The reoperation style included residual lobectomy plus isthmus with single tumor below 2 cm, total thyroidectomy in most the other conditions and selective lymph node dissection in finding or suspected cervical lymph node metastasis.</p><p><b>RESULTS</b>The rate of residual in thyroid confirmed by postoperative pathology was 47.1% (32/68). The rate of residual in cervical lymph node was 81.4% (35/43). The rates of temporary and permanent laryngeal recurrent nerve injury were 5.6% (4/72) and 1.4% (1/72) respectively. The rates of temporary and permanent hypocalcemia were 26.4% (19/72) and 1.4% (1/72) respectively.</p><p><b>CONCLUSIONS</b>Inadequate operation, local recurrence and cervical lymph node metastasis of thyroid cancer need revision surgery undoubtedly. The optimal treatment was total thyroidectomy and level VI, VII central compartment lymph node dissection plus intraoperative frozen-section evaluation.</p>

Clinical analysis for iatrogenic injuries in the distal part of common bile duct / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the early diagnosis on iatrogenic injuries in distal part of common bile duct and the prevention of severe retroperitoneal infection.</p><p><b>METHODS</b>From 1990 to 2004, 17 patients with bile duct injures in the distal part of common biliary tract were admitted. And the clinical data of the 17 cases were retrospectively analyzed.</p><p><b>RESULTS</b>Of the 17 cases, the injuries of 15 cases were caused by the operation, and the injuries of the other 2 cases were caused in the process of removing the stone by endoscopic retrograde cholangiopancreatography (ERCP). The injuries of 14 cases were found during the operation, but the other one was not found in time. Before the operation, 16 cases were examined by B-type ultrasonography, 2 by MRCP and 6 by intraoperative choledocho-endoscope after the biliary tract exploration. Ten cases underwent perforating suture repair and T-tube drainage; 2 with Odd's sphincter incision and shaping; 2 with choledochojejunostomy; 1 with duodenum wall and bile duct repair and drainage. When the bile duct injured, the major findings during operation were bile duct explorer located out of the duodenum wall and bile duct, two or more than cleft in the distal part of common biliary tract found by choledocho-endoscopic examination, retroperitoneal edema and liquid accumulation found by irrigating water through T-tube, and/or retroperitoneal tissues stained blue by irrigating methylthioninium chloride through T-tube. The clinical manifestations after injuries were abdominal distention, abdominal pain, pain in the waist and back, fever and shock, et al. Thirteen cases were cured. And the syndromes included 1 case with intestinal fistula, 1 with incisional infection, 4 dead (3 died from infectious shock; 1 from bleeding in gastrectomy).</p><p><b>CONCLUSIONS</b>The postoperative clinical manifestations for iatrogenic injuries in the distal part of common biliary tract lack specificity, CT examinations are necessary to doubtful patients. Early diagnosis and timely management can obtain better results, and can effectively lower severe retroperitoneal infection. The perfect preoperative imaging examinations and intraoperative choledocho-endoscopic examinations before the biliary tract exploration maybe reduce iatrogenic injuries in the distal part of common biliary tract.</p>

Surgical treatment of massive rebleeding after gastrectomy for bleeding gastroduodenal ulcer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To summarize the reoperation experiences in treatment of massive rebleeding after subtotal gastrectomy for bleeding gastroduodenal ulcer.</p><p><b>METHODS</b>From 1980 to 2002, clinical data of 26 cases with massive rebleeding after subtotal gastrectomy for bleeding gastrorenal ulcer were analyzed retrospectively.</p><p><b>RESULTS</b>Preoperative gastroscopy was performed in 6 cases, intraoperative gastroscopy in 11, and preoperative superselective angiography in 2 cases. Eleven cases with left ulcer or post- bulb ulcer bleeding underwent resection of the left ulcer or longitudinal incision of the duodenal descending part and direct hemostasis. Thirteen cases with anastomotic stoma bleeding underwent local suture hemostasis or resection of the stoma plus Billroth II or Roux- en- Y gastrojejunostomy. Two cases with gastric bleeding received reexcision of the stomach remnant. Twenty- four cases (92.3% ) were cured and 2 cases (7.7% ) died of gastric bleeding.</p><p><b>CONCLUSION</b>Preoperative superselective angiography and intraoperative gastroscopy are beneficial to clarify the bleeding position and causes for massive rebleeding after gastrectomy. It is very important to select proper operative method to prevent postoperative rebleeding.</p>

Early superselective angiography and transarterial embolization for massive bleeding after gastrectomy / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy of early superselective angiography and embolization in the diagnosis and treatment of massive bleeding after gastrectomy.</p><p><b>METHODS</b>The clinical data of 28 patients with massive bleeding after surgery from 1980 to 2001 were retrospectively analysed. All patients underwent emergency angiography and 27 of them were treated by transcatheter embolization.</p><p><b>RESULTS</b>Bleeding was controlled in 26 of the 28 patients (93%), recurrent bleeding occurred in 1, an recognized bleeding in 1, and abdominal pain in 1. There was no death.</p><p><b>CONCLUSIONS</b>Transarterial embolization for massive bleeding after gastrectomy is safe and effective. It is suggested that early emergency angiography should be considered in all patients with massive gastrointestinal bleeding after gastrectomy.</p>