Pharmaceutical care for patient with schizophrenia combined with pulmonary tuberculosis： a case report / 四川精神卫生

This paper reported a case of schizophrenia combined with pulmonary tuberculosis treated with clozapine in combination with rifampicin. Due to the induction of hepatic drug enzyme of rifampicin， plasma concentration of clozapine could not reach the effective concentration and the patient still had psychotic symptoms such as persecutory delusion. After discontinuation of rifampicin， plasma concentration of clozapine were in the effective concentration range and the patient's psychiatric symptoms improved. By analysing the therapeutic regimen for the patient with schizophrenia combined with pulmonary tuberculosis， this case suggested a possible interaction between clozapine and rifampin， and provided a reference for the treatment of this type of patients.

Clinicopathological significance of Musashi 2 expression in human colorectal cancer / 中华普通外科杂志

Objective To study the clinicopathological signiticance of the expression of musashi2 (MSI 2) protein and mRNA levels in human colorectal cancer (CRC).Methods The expression of MSI 2 protein in 85 CRC specimens and paired adjacent non-cancerous tissues were detected by immunohistochemistry (IHC).The relationship between the protein expression and clinicopatho]ogical features was analyzed.Immunoblotting and real time quantitative PCR were used to examine the expression of MSI 2 protein and mRNA levels in 12 paired fresh CRC and adjuvant non-cancerous tissues.Results MSI 2 overexpression was found in 45 cases of 75 CRC tissues,which was much higher than that in noncancerous tissues (59％ vs.30％,P ＜ 0.01).MSI 2 overexpression had a positive correlation with tumor size (x2 =7.682,P =0.006),T stage (x2 =4.218,P =0.040),Dukes stage (x2 =8.590,P =0.014),and Ki67 expression (x2 =6.412,P =0.011).Moreover,CRC patients with MSI 2 overexpression had a worse prognosis (x2 =4.855,P =0.028).Both MSI 2 protein and mRNA levels in 12 cases of CRC tissues were much higher than that in non-cancerous tissues (t =3.323,P ＜ 0.01;t =2.673,P =0.022,respectively).Conclusion MSI 2 overexpression is closely related with tumor size,T stage,Dukes stage,Ki67 expression and poor prognosis of CRC patients.

Clinicopathological significance of Musashi 2 expression in human colorectal cancer / 中华普通外科杂志

Objective To study the clinicopathological signiticance of the expression of musashi2 (MSI 2) protein and mRNA levels in human colorectal cancer (CRC).Methods The expression of MSI 2 protein in 85 CRC specimens and paired adjacent non-cancerous tissues were detected by immunohistochemistry (IHC).The relationship between the protein expression and clinicopatho]ogical features was analyzed.Immunoblotting and real time quantitative PCR were used to examine the expression of MSI 2 protein and mRNA levels in 12 paired fresh CRC and adjuvant non-cancerous tissues.Results MSI 2 overexpression was found in 45 cases of 75 CRC tissues,which was much higher than that in noncancerous tissues (59％ vs.30％,P ＜ 0.01).MSI 2 overexpression had a positive correlation with tumor size (x2 =7.682,P =0.006),T stage (x2 =4.218,P =0.040),Dukes stage (x2 =8.590,P =0.014),and Ki67 expression (x2 =6.412,P =0.011).Moreover,CRC patients with MSI 2 overexpression had a worse prognosis (x2 =4.855,P =0.028).Both MSI 2 protein and mRNA levels in 12 cases of CRC tissues were much higher than that in non-cancerous tissues (t =3.323,P ＜ 0.01;t =2.673,P =0.022,respectively).Conclusion MSI 2 overexpression is closely related with tumor size,T stage,Dukes stage,Ki67 expression and poor prognosis of CRC patients.

Efficacy of Laparoscopic Total Mesorectal Excision for Treatment of Patients with Rectal Cancer / 中国医科大学学报

Objective We aimed to investigate the efficacy of laparoscopic total mesorectal excision (TME) for treatment of rectal cancer.Methods We studied 90 patients with rectal cancer admitted to our hospital between March 2012 and March 2014.Patients enrolled for the study were divided into an experimental and control group.The control group underwent a TME procedure,while laparoscopic TME was performed in the experimental group.Efficacy of procedures performed and stress response indices were compared between the two groups.Results The bleeding volume,postoperative anal exhaust time,and duration of hospitalization were significantly lower in the experimental group than that noted in the control group (P ＜ 0.05),as was the incidence of complications (P ＜ 0.05).Assessment of stress indicators showed that the postoperative day 1 (1d) and day 3 (3 d) values were increased in the control group,while the experimental group showed significantly lower values across the same time frame (P ＜ 0.05).Conclusion Laparoscopic TME can reduce the incidence of complications in patients with rectal cancer,and reduce the stress response,which is beneficial for postoperative recovery of patients,and must therefore be promoted as a feasible treament option in patients with rectal cancer.

Analysis of risk factors of pulmonary metastasis and prognosis of patients after anterior resection of rectal cancer / 中华消化外科杂志

Objective To investigate the risk factors of pulmonary metastasis and prognosis of patients with rectal cancer after anterior resection of rectal cancer.Methods The retrospective case-control study was adopted.The clinical data of 421 patients with rectal cancer who underwent anterior resection at the First Hospital of China Medical University from August 2010 to December 2014 were collected.The patients were followed up by outpatient examination and telephone interview once three months in the first postoperative year,once half a year in the second postoperative year,and then once a year.The follow-up included satuses of pulmonary metastasis and survival of patients after anterior resection of rectal cancer.The end point of follow-up was death of the patients or 31 December,2014.The risk factors of pulmonary metastasis and prognosis in patients after anterior resection of rectal cancer were analyzed.Measurement data with normal distribution were presented as x-± s and measurement data with skewed distribution were presented as M(range).The pulmonary metastasis rate/curve and survival rate/curve were calculated and drawn by the Kaplan-Meier method.The comparisons of pulmonary metastasis rate and survival rate were done using the Log-rank test.The univariate analysis was done using the chi-square test and Log-rank test.The multivariate analysis was done by Logistic regression model and COX regression model.Results Of the 421patients,389 patients were successfully followed up with a median time of 34 months (range,11-53 months) and a follow-up rate of 92.40％ (389/421).Ninety-four,168 and 127 patients were detected in Ⅰ,Ⅱ and Ⅲ stages of TNM stage.There were 29 patients diagnosed with postoperative pulmonary metastasis with the diagnosis time of (21 ± 9) months.The 3-year cumulative incidence of pulmonary metastasis after anterior resection of rectal cancer was 2.2％ in patients of Ⅰ stage,3.0％ in patients of Ⅱ stage and 17.4％ in patients of Ⅲ stage,showing significantly increase trend as the increase of the TNM stage (x2=19.927,P ＜ 0.05).The 29 patients with pulmonary metastasis did not receive chemoradiotherapy including 6 patients receiving pulmonary metastatic nodule recection.Nineteen patients were survived and 10 patients were dead.The survival time of patients diagnosed with pulmonary metastasis was (13 ±9)months and the 3-year cumulative survival rate was 75.7％,whereas the survival time of patients without postoperative pulmonary metastasis was (35 ±9)months and the 3-year cumulative survival rate was 94.3％,showing significant difference between the 2 kinds of patients (x2 =25.219,P ＜ 0.05).The univariate analysis showed that the preoperative carcinoembryonic antigen (CEA) level,degree of tumor differentiation,depth of invasion and lymph node metastasis were risk factors affecting pulmonary metastasis after anterior resection of rectal cancer (x2=4.745,7.250,5.379,18.796,P ＜ 0.05),and the multivariate analysis showed that lymph node metastasis was an independent risk factor affecting postoperative pulmonary metastasis [OR =4.167,95％ confidence interval (CI):1.608-10.801,P ＜ 0.05].The univariate analysis showed that the preoperative CEA level,distribution and number of pulmonary metastatic nodule and lymph node metastasis were risk factors affecting the prognosis of patients with pulmonary metastasis after anterior resection of rectal cancer (x2=13.793,7.246,6.284,4.076,P ＜ 0.05),and the multivariate analysis showed that the preoperative CEA level ＞ 5 μg/L was an independent risk factor affecting the prognosis of patients (HR =13.489,95 ％ CI:1.407-129.297,P ＜ 0.05).Conclusions Pulmonary metastasis after anterior resection of rectal cancer is common.Lymph node metastasis is a high risk factor affecting postoperative pulmonary metastasis,and preoperative CEA level ＞ 5 μg/L is an independent risk factor affecting the prognosis of patients with postoperative pulmonary metastasis.

Gastrointestinal stromal tumors of the duodenum: a clinical analysis of 39 cases / 中华普通外科杂志

Objective To investigate the clinical characteristics and surgical treatment of gastrointestinal stromal tumors (GIST) of the duodenum.Methods The clinical data of 39 patients with duodenal GISTs from 1992 to 2010 were analysed retrospectively.Results The most common symptoms of duodenal GISTs were alimentary tract hemorrhage,occuring in 18 cases of the 39 cases (46％).Clinical diagnosis established by CT in 22 cases (69％).Duodenoscopy performed in 18 cases established the definite diagnosis of GIST in 15 (83％).Duodenal GISTs were most commonly located in the descending portion of the duodenum in 27/39 cases (69％).All 39 cases received surgical treatment,with R0 resection in 34 cases,including partial resection of the duodenum in 47％ (16/34),pancreaticodenectomy in 35％(12/34),segmental resection of the duodenum in 3 cases,subtotal gastrectomy in 3 cases; One died perioperatively and postoperative complications developed in 9 cases,which were cured by conservative therapy.The 1,3,5 year survival rate was 90％,72％,41％ for those receiving R0 resection.Conclusions The abdominal CT scan with contrast and duodenoscopy are helpful to establish the diagnosis of duodenal GISTs.Surgical procedures depend on the size and site of the lesion for R0 resection.To decrease postoperative recurrence and prolong survival adjuvant therapy with Imatinib is necessary.

Experience in diagnosis and treatment of ectopic ACTH syndrome / 中华预防医学杂志

<p><b>OBJECTIVES</b>To increase the diagnosis and treatment of ectopic ACTH syndrome.</p><p><b>METHODS</b>The data of 12 ectopic ACTH syndrome patients treated from 1985 to 1999 were retrospectively analyzed.</p><p><b>RESULTS</b>Twelve patients were diagnosed as having ACTH syndrome by endocrinary test and primary tumors were ascertained by imaging examination. Follow-up from 7 months to 8 years showed 3 out of 5 patients with radical resection of primary tumor died. One patient with bilateral adrenorectomy was still alive. All patients received only chemotherapy except one died.</p><p><b>CONCLUSIONS</b>Patients with Cushing's syndrome should be evaluated by endocrine test and followed up by imaging screen examination. The key points to increase treatment effect include early detection, localization and resection of primary tumors.</p>

Analysis of the diagnosis and surgical treatment of primary hyperparathyroidism in 35 patients / 中国普通外科杂志

Objective To explore the diagnosis and treatment of primary hyperparathyroidism (PHPT). Methods Clinical data of 35 cases of PHPT were retrospectively analyzed. Results 23 out of 26 cases (88.5%) undergoing preoperative ultrasonography with a positive result were verified by intraoperative (findings). For ECT, the positive rate was 21 out of 23 cases (95.5%). Unilateral neck explorations (UNE) was performed in 27 cases of parathyroidoma. Two cases of parathyroid hyperplasia were treated by UNE and the other two cases by bilateral neck exploration (BNE). The procedure for 3 cases of parathyroid carcinoma was the same as that for papillary thyroid carcinoma. Unilateral resection of thyroid and parathyroid was done in a case of parathyroidoma with malignant change. Emergency excision of parathyroidoma, after (emergency) medical management, was performed in a patient with parathyroid storm, and the symptoms (subsided) postoperatively. All cases developed hypocalcemia in various degrees after surgery, but the symptoms were relieved with the use of calcium gluconate. Conclusions PHPT could be diagnosed according to (co-elevated) calcemia and PTH. Ultrasonography and ECT should be considered as the methods of first choice for preoperative localization. UNE of parathyroidoma could be feasible if accurate image localizations are (available). Radionuclear guided parathyroid resection could be performed in the patients with ectopic parathyroid disease or lesions without accurate localization. Aggressive surgical exploration after medical control of (symptoms) is the first choice of treatment when parathyroid storm is diagnosed.

Localizing diagnosis of primary hyperparathyroidism / 中国普通外科杂志

Objective To evaluate the diagnostic value of US, ECT, CT and MRI in primary hyperparathyroidism (PHPT). Methods Data of 34 PHPT patients with diagnosis confirmed by postoperative pathology were retrospectively reviewed from January 1, 1990, through March 31, 2004. Results The preoperative diagnosis in 22 out of 25 cases (88%) undergoing preoperative ultrasonography of the neck with a positive result was verified by intraoperative findings. For 99m Tc-MIBI, CT and MRI, the positive results were 95%, 69% and 100% respectively. Conclusion Ultrasonography and 99m Tc-MIBI should be considered as the first choice for preoperative loci localization in patients with PHPT. Ultrasonography and 99m Tc-MIBI in combination is more sensitive and accurate for the localization of PHPT.

CT diagnosis of non-functional islet cell tumor / 中国普通外科杂志

Objective To explore the CT manifestations of non-functional islet cell tumor(NFICT)Methods The findings of plain and enhancement CT scanning from 17 cases with NFICT,which were confirmed by the surgeries and pathological sections,were analyzed retrospectively.Ninty ml of non-ioniodine contrast reagent with 3ml/s injection flow rate was employed as the enhancer for measuring the arteriovenous double phase CT value of the pancreas and tumor.Results Tumors were found in all the cases who received CT scan.Compared with pancreatic substance in the CT plain scan,tumors with low density were found in 2 cases,tumors with mixed low density in 11 cases and tumors with isodensity in 4 cases.Local calcification in tumor was found in 5 cases.Various degrees of strengthening were showed in 17 cases with enhancement scanning.Obvious enhancement in arterial phase presented in 5 cases,moderate enhancement in 6 cases and slight enhancement in 6 cases.Conclusions CT plain scan of NFICT shows that the tumor margins are clear and some tumors have calcification.All tumors in the CT enhancement scanning show various degrees of enhancement,the persistent enhancement from arterial phase to portal vein phase is the characteristic manifestation of NFICT.

Prevention and treatment of accessory hepatic duct injury during biliary operation:a report of 26 cases / 中国普通外科杂志

Objective To summarize our experience in the prevention and treatment of accessory hepatic duct injury during operation on biliary tract.Methods The clinical data of 26 cases with accessory hepatic duct were retrospectively reviewed.Results Of 26 cases,the accessory hepatic duct were type I in 38.5%(10/26),and no complications including bile leakage,biliary infection and obstructive jaundice developed after division and ligation of the accessory hepatic duct;26.9%(7/26) were type II,among which,the accessory hepatic duct were injured in 3 cases,but no case developecl complications after relevant treatment;23.0%(6/26) were type III,among which,injury of accessory bile duct occurred in 2 cases.Of them,1 case developed bile leakage and was cured by reoperation.7.7%(2/26) were type IV and 3.9%(1/26) was type V.The cases of type IV and V were not damaged.Conclusions To prevent injury of accessory hepatic duct,pre-and intra-operation identification of the condition is very important,and especially by intraoperative cholangiography.Different types of accessory hepatic duct injury should be treated by different approaches. Accessory hepatic duct of type I might be cut and ligated.Type II accessory bile duct which(enters) the cystic duct and should be protected,but,if damaged,different methods of treatment are used,(depending) on the caliber of accessory hepatic duct.Type III and IV also should be protected,but,when damaged,the accessory hepatic duct should be repaired or performed an internal draining.