Hypercalcemic crisis caused by a parathyroid adenoma with hemorrhage and cystic degeneration: A case report / 中华内分泌代谢杂志

This paper reported a rare case of hypercalcemic crisis caused by a parathyroid adenoma with hemorrhage and cystic degeneration. Preoperative imaging examination of the patient was unable to determine the histological origin of the cervical cystic lesion. Despite aggressive medical treatment and hemodialysis, hypercalcemic crisis could not be relieved. Therefore, surgical exploration and excision of the cervical lesion were performed, and final diagnosis of parathyroid adenoma with hemorrhage and cystic degeneration was confirmed by pathology. Blood calcium level and renal function returned to normal after the surgery.

Transition analysis in the clinicopathology and prognosis of 2 682 papillary thyroid carcinoma cases over a 15-year period / 中华普通外科杂志

Objective To evaluate the change of clinicopathological features and prognosis of papillary thyroid cancer over a 15-year period.Methods The clinicopathological features and outcomes of papillary thyroid cancer patients were analyzed in three groups according to the time of diagnosis:group Ⅰ (1997-2001),group Ⅱ (2002-2006),and group Ⅲ (2007-2011).Results As time advanced,the average age of papillary thyroid cancer patients increased,tumor stage,like size,extrathyroid invasion and lymph node metastasis decreased dramatically (P ＜ 0.01).The percentage of multifocality and bilaterality increased.The long-term follow up data (median follow up time was 6.6 years),indicated that the 15-year over all survival was 97.8％ and the 15-year disease-free survival was 90.2％.Tumor ≥3 cm,bilaterality,extrathyroid invasion,lymph node metastasis and AJCC stage were correlated with tumor recurrence.By multivariate COX-regression analysis only lymph node metastasis and bilaterality were independent risk factors.Conclusion The clinicopathological features of papillary thyroid cancer changed over 15 years,with the percentage of early-staged patients increased.Lymph node metastasis and bilaterality are two risk factors for tumor recurrence.

Detection of Mesentery Circumferential Margin Invasion of Middle and Low Rectal Cancer with Large Slices and CK20 / 华中科技大学学报(医学版)

Objective To study the rules of circumferential margin invasion(CMI)in middle and(or)lower rectal cancers by pathological large slices stained with HE and labeled with CK20,and provide a pathological basis for clinical therapy of rectal cancer.Methods Forty-one patients with middle or low rectal cancer were randomly selected in 8 months.The surgically resected specimens were detected after they were made into the pathological large slices stained with HE and labeled with CK20.Results The mesentery CMI positive rate in the pathological slices with HE staining and CK20 labeling was 21.95%,and 29.27% respectively.The mesentery CMI positive rate in moderately-and well-differentiated group was lower than in poorly-differentiated group(P＜0.05).Moreover,the mesentery CMI rate was higher in the specimens with lower edge less than 5 cm away from the dentate line than that in those with lower edge more than 5 cm away from the dentate line(P＜0.05).There was no significant correlation between CMI with the factors such as gender,age,pathological general types,tumor infiltration depth,lymph node metastasis,and surgical procedures(all P＞0.05).Conclusion There were risk factors for the CMI such as low location,poor differentiation and so on.The CMI patients should be treated with standardized adjunctive therapy after operation.

Thyroid microcarcimoma / 中华普通外科杂志

Objective To investigate the clinicopathologic features and treatment of thyroid microcarcinoma (TMC). Methods From January 1997 to December 2006,311 patients who underwent surgery and defined as TMC(tumor size≤1 cm)were enrolled. Results TMC was identified incidentally by frozen pathologic examination on thyroidectomy specimens in tentative benign goiters in 181 patients; another 130 patients with clinically detectable primary tumors or suspected nodal metastases were grouped to as clinically overt TMC. The clinically overt TMC had a higher incidence of bilateral multifocal tumors (18.5%vs.9.4%,P=0.03),and cervical lymph node metastases(27.7%vs.10.5%,P=0.000)than that in clinically occult TMC group. Conclusion TMC may vary considerably in clinical and biologic behaviors between these two subtypes: clinically overt and occult. Lobectomy for single lesion, total or near total thyroidectomy for multifocal with central compartment nodal dissection should be performed, lateral nodal dissection was not carried out unless US or physical examination detected nodal metastases. Lobetomy, subtotal or more limited thyroidectomy for occult TMC, diagnosed incidentally following thyroid surgery for initially tentative benign thyroid disease, could all be treatment of choice depending on the preference of surgeons.

Prognostic value of CLIP score system for patients with resection of hepatocellular carcinoma / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the prognostic value of CLIP score system for patients with resection of HCC.</p><p><b>METHODS</b>A retrospective survey was carried out in 174 patients undergoing resection of HCC from January 1986 to June 1998. 153 of 174 patients with curative resection were followed up for at least three years. Disease-free survival rate was defined as the time relapsed from the date of image diagnosis and either the date of death or the date of the latest follow-up visit, with final evaluation at June 30, 2001. Recurrences were classified into early (</= 3 year) and late (> 3 year) recurrence. Risk factors for recurrences and prognostic factors for survival in each group were analyzed by the chi-square test, the Kalain-Meier estimation and the COX proportional hazards model respectively.</p><p><b>RESULTS</b>The 1-, 3-, 5-, 7-, and 10-year cumulative disease free survival rates were 57.2%, 28.3%, 23.5%, 18.8% and 17.8%, respectively. The associated factors with early recurrence were as fellows: tumor size > 5 cm, microsatellite, venous invasion, tumor morphology, tumor extension, advanced TNM stages, CLIP scores, radical resection, and resection margin, respectively. But both CLIP scores and Child stage were associated with late recurrence. Univariate survival curves analysis expressed that Child grades, radical resection, resection margin, tumor size, microsatellite, venous invasion, tumor morphology, tumor extension, TNM stages, and CLIP scores were associated with prognosis. The multivariate analysis by COX proportional hazards model, the independent prognostic factors for survival were radical resection, resection margin, and TNM stages.</p><p><b>CONCLUSIONS</b>CLIP score, which takes into account both liver function and tumor extension, has displayed a unique superiority in predicting the tumor early and late recurrence and prognosis. It could be an useful tool in predicting the patient recurrence and prognosis with resection of HCC. Meanwhile, it may help physicians to decide the more appropriate management in advance for patients with HCC.</p>

Prognostic factors of patients with hepatocellular carcinoma after hepatectomy / 中国普通外科杂志

Objective To study the prognostic factors in patients of HCC after hepatectomy by Cox proportional hazard.Methods 145 patients operated on for HCC from 1986 to 1996 were followed up to the end of 1999. Seventeen possible factors associated with long survival were analyzed by Kaplain Meier Log rank estimation. A multivariative survival analysis of these individual variables was undertaken using the cumulative survival rate by the computer′s Cox proportional hazard. Results The overall cumulative survival rate at 1?3?5?7?10?12 years was 75 0%?44 4%?29 5%?23 5%?21 2%? and 16 9%, respectively. Results showed that the way by which a tumor was found?tumor size?portal thrombi?satellite nodule?UICC TNM stage?cutting margin?radical resection were the prognostic factors by individual variable analysis;A multivariative analysis showed that tumor finding mode?UICC stage?cutting margin?recurrence?radical resection were associated with prognosis.Conclusion The prognostic factors of HCC focused on two aspects: early diagnosis and treatment method. UICC TNM stage is most predictive for prognosis. Cutting margin of more than 1 cm is needed for long term survival.

Prognostic evaluation of China Classification System compared with TNM stage in liver cancer patients undergoing resection / 中国普通外科杂志

Objective To evaluate the prognostic value of China Classification System and TNM staging in patients with liver cancer undergoing resection. Methods From Jan 1986 to Dec 2000, 246 patients underwent resection of liver cancer. At least three years of follow-up was made in these 246 cases. Results The 1, 3, 5, 7, and 10-year disease-free survival rates were 55%, 30%, 25%, 20% and 18%, respectively. The 1,3,5,7,and 10-year disease-free survival rates predicted by China Classification System and TNM staging were statistically different and positively correlated with each other. Differences of survival rate between stageⅠa、Ⅰb、Ⅱa 、Ⅱb and Ⅲ by China Classification System were all statistically significant. Conclusions Based both on tumor extension and liver function, China Classification System was more accurate in than TNM stage predicting the prognosis of liver cancer patients undergoing resection.