Clinical characteristics of the patients with asymptomatic primary hyperparathyroidism / 中南大学学报(医学版)

OBJECTIVES@#The prevalence of asymptomatic primary hyperparathyroidism (PHPT) in China is lower than that in European and American countries and the study about the characteristics of asymptomatic PHPT was rare in China. This study aims to explore the characteristics of asymptomatic PHPT.@*METHODS@#Clinical data of 150 patients with PHPT confirmed by operation and pathological examination were retrospectively analyzed. The patients were assigned into a symptomatic PHPT group (@*RESULTS@#The proportion of adenomas was higher than that of adenocarcinoma in the asymptomatic PHPT group. The proportion of the first diagnosis due to hypercalcemia found via biochemical examination in the asymptomatic PHPT group was higher than that in the symptomatic PHPT group (76.92% vs 25.81%, @*CONCLUSIONS@#Only a minority of PHPT patients are asymptomatic. Compared with the symptomatic PHPT patients, the primary cause of diagnosis is hypercalcemia, the duration of diagnosis and the diameter of parathyroid gland are shorter, the levels of serum calcium, and PTH are lower, the proportion of adenomas, vitamin D, and the BMD of L

Perioperative localization of ectopic functioning parathyroid gland in patients with hyperparathyroidism / 中华普通外科杂志

Objective:To investigate the value and influence factors of preoperative and intraoperative localization of ectopic hyperparathyroidism (EHPT).Methods:Results of 99mTc-sestamibi ( 99mTc-MIBI), neck ultrasound, contrast CT and intraoperative local venous parathyroid hormone (IOLVPTH) were retrospectively analyzed in 205 patients with primary hyperparathyroidism (PHPT) suspected of EHPT. Results:Incidence of EHPT was 16.6% (34 cases), and 36 ectopic lesions were detected. The proportion of EHPT in antero-superior mediastinum, intrathyroidal, in the retropharyngeal region, in carotid sheath, in the prevertebral region and intrapericardial were 44.1% (15 cases), 29.4% (10 cases), 11.8% (4 cases), 5.9% (2 cases), 5.9% (2 cases) and 2.9% (1 cases), respectively. Contrast CT was the most sensitive (86.1%, 31 lesions/36 lesions) for EHPT, followed by 99mTc-MIBI (66.7%, 24 lesions/36 lesions), IOLVPTH monitoring (61.8%, 21 lesions/34 lesions) and neck ultrasound (55.6%, 20 lesions/36 lesions). Contrast CT was most sensitive,100% in detecting deep-located EHPT lesions, whereas IOLVPTH had advantages in detecting intrathyroidal EHPT lesions, with a sensitivity of 100.0%.The combined use of 99mTc-MIBI and neck ultrasound showed a sensitivity of 77.8% in the localization of EHPT. Conclusions:Contrast CT is highly sensitive in the localization of EHPT. The combined use of preoperative imaging and IOLVPTH monitoring helps to higher localization for EHPT.

Identification of two lncRNA scores in diagnosis of parathyroid tumors / 中华内分泌代谢杂志

Objective:Our previous micro-array study revealed that long non-coding RNA (lncRNA), such as ENST00000538790 and NR_125790, were differently expressed in parathyroid carcinoma compared with those in parathyroid adenoma. Diagnostic value of lncRNAs (ENST00000538790 and NR_125790) and scoring models derived from these lncRNAs in parathyroid carcinoma were investigated in this study.Methods:Fifty-seven fresh tissue samples from patients with hyperparathyroidism were collected. Eleven patients were diagnosed with parathyroid carcinoma, while 46 patients were found with parathyroid adenoma. The expression levels of five lncRNAs (ENST00000511928, ENST00000538790, ENST00000618339, NR_125790, and ENST00000485384) were detected with realtime quantitative PCR (RT-qPCR). LncRNA scores were calculated using these lncRNAs, and their value in parathyroid carcinoma diagnosis were also assessed.Results:It was found that expression levels of ENST00000511928 and ENST00000538790 were up-regulated in parathyroid carcinoma compared with parathyroid adenoma ( P<0.05), while the levels of ENST00000618339, NR_125790, and ENST00000485384 were decreased in parathyroid carcinoma ( P<0.05). Among these lncRNAs, ENST00000538790 and NR_125790 were independent risk factors for parathyroid carcinoma ( P<0.05). Hence, "log score" and "logistic score" were calculated with ENST00000538790 and NR_125790 levels. The areas under the receiver operating characteristic curve for "log score" and "logistic score" were up to 0.935 and 0.943 respectively in parathyroid carcinoma ( P<0.05), and were found to be greater than those from single lncRNA or classic clinical indices, such as serum calcium ( P<0.05). Conclusion:LncRNA scores with lncRNA ENST00000538790 and NR_125790 may play potential role in diagnosis of parathyroid carcinoma.

Analysis of preoperative predictive factors and clinical characteristics in patients with parathyroid carcinoma / 中华肿瘤杂志

Objective@#To evaluate the clinical characteristics and preoperative predictive factors in patients with parathyroid carcinoma.@*Methods@#From January 2010 to December 2016, 150 patients with pathologically and biochemically confirmed primary hyperparathyroidism were enrolled in this study. The clinical data were reviewed to define 28 cases of parathyroid hyperplasia, 14 cases of parathyroid carcinoma (PC), and 108 cases of parathyroid adenoma (PA). The clinical characteristics between PC and PA group were compared and analyzed to explore predictive factors for PC.@*Results@#Patients in PC group were significantly younger than those in PA group (47.9±13.9 vs 57.2±14.6 years, P=0.026). The diameter of tumor in PC group was larger than that in PA group (3.6±1.8 vs 2.2±1.4 cm, P=0.005). The levels of albumin-corrected serum calcium, parathyroid hormone (PTH), and alkaline phosphatase (AKP) were all higher in PC group than those in PA group (3.4±0.6 vs 2.9±0.3 mmol/l; 1 157.1 vs 201.6 pg/ml; 168 vs 97 IU/L; all P<0.05). PC correlated with age(r=-0.241, P=0.007), albumin-corrected serum calcium (r=0.324, P<0.001), PTH levels (r=0.301, P=0.001), serum AKP (r=0.217, P=0.019) and tumor size(r=0.238, P=0.011). Receiver operator characteristic curve analysis showed that the optimum cut-off values as follows: albumin-corrected serum calcium 3.15 mmol/L, serum PTH concentration 1 011 pg/ml and tumor diameter 3.35 cm. These indicators can be helpful in the preoperative diagnosis of PC.@*Conclusions@#Patients with PC were younger than the patients with PA. Albumin-corrected serum calcium, serum PTH concentration, and tumor diameter can be helpful in preoperative diagnosis of PC.

The influence of gender on clinical manifestations of primary hyperparathyroidism / 中华内科杂志

To explore the impact of gender on presentation of primary hyperparathyroidism (PHPT), clinical data of 150 histopathologically proven PHPT patients were collected and retrospectively analyzed. Most of the patients (72.0％) were parathyroid adenoma (PA), and 9.3％of them were parathyroid carcinoma (PC). In PA patients, albumin-corrected serum calcium levels (TASC) were lower in women than in men [(2.84±0.28)mmol/L vs.(3.03±0.34)mmol/L, P=0.006 ]. In all PHPT subjects, serum urea nitrogen, creatinine, uric acid levels were lower in women than in men. Bone pain was more frequent in women over 50 years old than in men (52.33％vs.29.17％, P=0.045). The incidence of PC was higher in men than in women (20.59％ vs. 6.03％, P=0.010). In conclusion, there are gender differences in the clinical presentation of PHPT. TASC was high in men with PA compared to women with PA. Bone pain was more common in the woman patients over 50 years old, and PC was more common in men.

Profile and clinical significance of long non-coding RNA GAS8-AS1 in papillary thyroid microcarcinoma / 中华内分泌代谢杂志

Objective To investigate the expression level and clinical significance of long non-coding RNA(LncRNA) growth arrest specific gene-antisense 1(GAS8-AS1) in papillary thyroid microcarcinoma(PTMC) patients. Methods We investigated the expression profile of GAS8-AS1 in tissue samples of patients with PTMC as well as nodular goiter(NG) by quantitative real-time polymerase chain reaction(RT-qPCR). Results GAS8-AS1 in cancer tissue was down-regulated in PTMC patients compared with adjacent thyroid tissue and NG samples(P<0.05). Lower level of GAS8-AS1 was also correlated with central cervical lymph node metastasis(CLNM, P<0.05). The area under the ROC curve for GAS8-AS1 was up to 0.717 3 in CLNM prediction(P<0.05). Conclusion GAS8-AS1 may act as a potential biomarker for PTC diagnosis and CLNM prediction.

Maxillary sinus carcinoma combined with maxillary sinus fungal sinusitis: one case report / 临床耳鼻咽喉头颈外科杂志

A 70 years old male patient complained a sense of swelling on right facial, mild pain, and the obstruction of right nasal, no complain of facial numbness and toothache. Physical examination showed the slight bulging on right facial with mild tenderness, purulent nasal secretions on the right middle nasal meatus, and no significant neoplasm. CT scan showed that soft density tissue in the right maxillary sinus,and the high density tissue in some period. Postoperative diagnosis: carcinoma of maxillary sinus with fungal sinusitis.

Efficiency of (99)Tc(m)-sestamibi in diagnosis of parathyroid diseases with primary hyperparathyroidism / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the efficiency of (99)Tc(m)-sestamibi (MIBI) in the diagnosis of parathyroid diseases with primary hyperparathyroidism.</p><p><b>METHODS</b>One hundred and four cases with primary hyperparathyroidism underwent MIBI and parathyroidectomy between May 2010 to November 2013 were reviewed. With MIBI, single adenoma was found in 91 cases, two adenomas in 5 cases, carcinoma and hyperplasia in 3 cases respectively. Primary hyperparathyroidism was diagnosed based on the associated symptoms and signs in 93 patients, while it was indicated in 11 asymptomatic patients due to the presence of hypercalcemia in health examination. Parathroid hormone levels ranged from 98 to 2 800 ng/L, and serum calcium levels were between 2.56-4.23 mmol/L.</p><p><b>RESULTS</b>The sensitivity of MIBI for total diseased parntyroids was 84.0% (100/119), and that for parathyroid adenoma, parnthyroid carcinoma, atypical adenoma and primary parathyroid hyperplasia was 87.1% (88/101), 3/3, 2/2 and 7/13, respectively.</p><p><b>CONCLUSIONS</b>MIBI is efficient in the diagnosis of parathyroid diseases with primary hyperparathyroidism. The size and cystic degeneration of parathroid disease are two common factors decreasing MIBI reliability, and thyroid nodule is additional source leading to false-positive results.</p>

Efficiency of carbon nanoparticles in level VI lymphadenectomy for thyroid carcinoma and prevention of postoperative hypoparathyroidism / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To assess the efficiency of carbon nanoparticle in guiding level VI lymphadenectomy and parathyroid preservation in thyroidectomy for carcinoma.</p><p><b>METHODS</b>One hundred and nine patients with well differentiated thyroid carcinoma, in whom thyroidectomy and bilateral lymphadenectomy for level VI were carried out at the same time, were prospectively studied. Fourty-five cases received carbon nanoparticle injecion in thyroid consistitued trial group, while sixty-four underwent conventional surgery as control group. The numbers of total dissected lymph nodes, metastasis lymph nodes, black-stained lymph nodes, detected parathyroids and mistakenly removed parathyroids were counted respectively. The PTH levels were measured at 1 d, 5 d and 30 d after surgery, respectively. Student's t test and Chi-square analysis were used for analyzing data.</p><p><b>RESULTS</b>The number of lymph node found in the trial group in level VI was checked out as (9.7 ± 1.7) each side, whereas that of the control group was (6.7 ± 1.9) each side. The discrepancy of two groups was statistical meaningful (t = 23.14, P < 0.001). The discrepancy of the rate of lymph node black-stained 90.5% (738/815), incidence of metastasis of the black-stained lymph nodes 45.9% (339/738) and that without black-staining 13.0% (10/77), was statistical meaningful (χ(2) = 30.91, P < 0.001). On average, the trial group showed (1.8 ± 0.9) parathyroid each side, and had 5.9% (5/84) of mistakenly removed incidence , on contrary, the control group showed (1.8 ± 1.0) parathyroid each side, and had 8.2% (11/134) of mistakenly removed incidence averagely as well. The discrepancy of two groups was statistical meaningful. In the trial group, the amount of PTH 1 d, 5 d and 30 d postoperatively were 7.30, 11.19 and 30.50 ng/L respectively, while that of the control group were 7.51, 10.90 and 28.30 ng/L respectively. The amount discrepancy between the two groups was not differences. No permanent recurrent nerve paralysis was found in both groups.</p><p><b>CONCLUSION</b>Carbon nanoparticle may improve the detected rate of metastasis lymph nodes, but may not be helpful to the prevention of postoperative hypoparathyrosim.</p>

Study on relationship between operation timing and clinical prognosis of cases with Bell palsy / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To study on relationship between diverse handling time following onset and clinical prognosis of cases with Bell palsy.@*METHOD@#Two hundred and sixteen cases with Bell palsy, who were admitted in our department between Jun. 2006 and Dec. 2009, were collected and divided into 6 groups according to disease time: 1-2 months, > 2 - 3 months, > 3 - 4 months, > 4 - 5 months, > 5 - 6 months, and > 6 months. Cases in all groups received subtotal course decompression of facial nerve and other compound treatment, and the relationship between handling timing and clinical prognosis were compared.@*RESULT@#It was found that the difference of prognosis and handling timing was statistically significant, after comparison between all groups with Facial Grading Standards (H-B) as the standard to assess prognosis.@*CONCLUSION@#Clinical prognosis of cases with Bell palsy was related to alternative handling time, and subtotal course decompression of facial nerve was recommended to be performed as early as possible for those cases who were irresponsive after conservative treatment for one month.

Diagnosis and surgical treatment of parathyroid tumors in elderly patients / 中华老年医学杂志

Objective To evaluate the clinical features and efficiency of surgical treatment in elderly patients with parathyroid tumor.Methods Clinical data of 12 cases (aged 60-83 years) was retrospectively analyzed.Their main complaints varies individually,including bone and muscle trouble in 9 patients,abdominal problem in 7 ones,and kidney stone in 6 ones.PTH level ranged from 78 to 2850 μg/L,and calcium level 2.6-4.5 mmol/L.Parathyroidectomy was carried out in 8 patients,while extended excision of suspected tissues in 6 ones.Intraoperative PTH determination was routinely performed.Results A drop by at least 50％ in PTH level was achieved in all cases after 10 minutes of tumor-bearing tissues excision.A much improvement of main complaints was shown in all cases about 1 week postoperatively.During the follow-up period from 18 to 48 months,both PTH and calcium levels were still in normal range in 9 patients,relapse was noticed in two cases 1 or 2 years after operation respectively.One patient died even after successful excision of parathyroid tumor.Conclusions PTH and calcium level determination is advised in elderly patients with suspected parathyroid tumor,and surgical treatment is generally safe and effective.

Surgical management of cervical anastomotic stricture of the esophagus / 中国耳鼻咽喉头颈外科

OBJECTIVE To study and evaluate the surgical management of cervical anastomotic stricture of the esophagus and its efficiency. METHODS Cervical anastomotic stricture resulted from colon by-pass for patients with esophagus stricture due to corosive in 5 cases,and gastric pull-up in 3 with esophagus carcinoma,one patient suffered serious esophagus stricture at its upper end because of previous radiation,and failed to the anastomoticplasty RESULTS All of them failed to respond to prior dilation. Anastomoticplasty was used in 6 of them,local flap,colon by-pass and jejunal free flap interposition was chosen based on the patient's situation. The operation got succeeded at its first time in seven patients,and at its second time in two cases. Normal oral feeding was restored in seven of them,and semiliguid feeding in the other two. CONCLUSION Surgical treatment is reliable in dealing with patients with problem of anastomotic stricture of the cervical esophagus.

Diagnosis and surgical management of tumors primarily in the pterygopalatine fossa / 中国耳鼻咽喉头颈外科

OBJECTIVE To evaluate the clinical features of tumors primarily in the pterygopalatine fossa, and the efficiency of surgical management for these lesions. METHODS The clinical data of 7 cases with tumors primarily in the pterygopalatine fossa were retrospectively studied. Three of them were primary diseases, i.e. fibrous histiocytoma, neurofibroma and cholesteatoma. The other 4 cases were secondary tumors mainly located in pterygopalatine fossa. There were 1 case with epithelial-myoepithelial carcinoma, 1 case with adenoid cystic carcinoma , 1 case with recurrent inverted nasal papilloma, 1 case with recurrent malignant fibrous histiocytoma. Approaches to tumors in pterygopalatine fossa lesions included lateral rhinotomy, and transnasal or transantrum approaches under the nasal endoscope. RESULTS The patient suffered from adenoid cystic carcinoma developed local recurrence 4 months after operation, and extended resection of the recurrent tumor with laser was performed again. No further recurrence was found after following-up for 3 years. Neither local recurrence nor regional metastasis was found in the remaining 6 cases with a follow-up period of 2 to 4 years. The main complication was oronasal fistula. CONCLUSION CT scan or MRI is the main method to the early diagnosis of pterygopalatine fossa tumors. Lateral rhinotomy, endoscopic trasnnasal or transantrum approaches are feasible procedures to resect the tumors.