Diagnosis and surgical treatment of primary hyperparathyroidism in the elderly people / 中华内分泌外科杂志

Objective:To analyze the clinical characteristics of PHPT in elderly patients, as well as the safety and effectiveness of surgical treatment.Methods:179 patients with PHPT treated from Jan. 2000 to Dec. 2020 were analyzed retrospectively. They were divided into elderly group ( n=51) and non-elderly group ( n=128) according to whether they were over 60 years old at the time of operation. The clinical data of symptoms, complications, preoperative and postoperative blood calcium, phosphorus, ALP, PTH, surgical cure rate and complication rate of the two groups were analyzed retrospectively. T-test was used for measurement data comparison. χ2 test was used for enumeration data comparison and single factor analysis. Logistic regression analysis (forward method) was used for multivariate analysis. Results:The proportion of non-specific symptoms in the elderly group, including fatigue, dizziness, loss of appetite, memory decline, was higher than that in the non-elderly group (21.6% vs 8.6%, P=0.019) . Elderly patients had lower blood ALP level[ (163.4±229.8) U/L vs (325.9±449.2) U/L, P=0.016], higher proportion of preoperative hypertension (47.1% vs 21.1%, P=0.001) , diabetes (31.4% vs 10.9%, P=0.001) , coronary heart disease (13.7% vs 3.1%, P=0.013) and tumor (13.7% vs 3.9%, P=0.025) . High proportion of non-specific symptoms was related to higher blood calcium [ OR=4.936 (95% CI 1.126-21.637) , P=0.034] and lower blood phosphorus[ OR=0.011 (95% CI 0.000-0.650) , P=0.030]. Between the two groups there was no significant difference in cure rate (94.1% vs 96.1%, P=0.564) or complication rate (27.5% vs 44.5%, P=0.127) . Conclusions:The surgical treatment of elderly patients with PHPT also has high effectiveness and safety. More attention should be paid to surgical diagnosis and treatment of elderly patients.

The diagnosis and prognosis of primary duodenal tumors / 中华普通外科杂志

Objective To evaluate the diagnostic procedures and treatment choice of primary malignant tumor of the duodenum.Methods The clinical data of 170 cases with primary malignant tumor of the duodenum at Peking University People's Hospital from 1996 to 2015 were analyzed retrospectively.Results Tumors located in the first,second,third and fourth parts in 14 cases (8.2％),144 cases (84.7％),9 cases (5.3％),and 3 cases (1.8％) respectively,and among them,tumors within papillary area accounted for 62.4％ (106 cases).The main clinical presentations included jaundice,upper abdominal pain,abdominal distention,nausea and vomiting.Among the 170 cases,125 cases obtained accurate tumor stages,with 34 cases on stage Ⅰ (27.2％),45 cases on stage Ⅱ (36.0％),30 cases on stage Ⅲ (24.0％),16 cases on stage Ⅳ (12.8％).The accuracy rate of ultrasound and CT in preoperative diagnosis was 27.6％,and 72.3％ respectively.The pathological type of 144 cases (84.7％) was adenocarcinoma.The postoperative 1-,3-and 5-year survival rate was 69.1％,48.6％ and 33.9％.Conclusions Most primary malignant duodenal tumors are located in papillary region,necessitating radical pancreaticoduodenecomy,early diagnosis remains the key for longterm survival.

The expression of myosin heavy chain 9 in colorectal adenocarcinoma / 中华普通外科杂志

Objective To determine the expression of myosin heavy chain 9 (MYH9) in colorectal adenocarcinoma tissues and its clinical significance.Methods Immunohistochemistry and tissue-array were used to determine MYH9 expression in human colorectal adenocarcinoma tissues and matched adjacent tissues.A statistical analysis was performed to establish the potential correlation between MYH9 expression and the patients' clinicopathological characteristics,tumor progression,and prognosis.Results MYH9 is up-regulated in colorectal adenocarcinoma tissues compared with matched adjacent tissues (P =0.000),and it was shown that MYH9 expression is significantly correlated with age (P =0.050),clinical stage (P =0.000),lymph node (P=0.010) and distant (P =0.000) metastasis,but not with sex,primary sites,grade,infiltration,clinical stage (all P ＞ 0.05);it was also shown that MYH9 expression had a significant influence on prognosis (x2 =20.437,P =0.000).Multivariate analyses showed that high MYH9 expression is an independent poor prognostic factor for overall survival (P =0.013).Conclusions The up-regulation of MYH9 in colorectal adenocarcinoma closely correlates with age,clinical tumor stage,metastasis and patient's survival.

The expression of G-protein coupled receptor in hepatocellular carcinoma / 中华普通外科杂志

Objective To determine the expression of G-protein coupled receptor 34 (GPR34) in hepatocellular carcinoma tissues.Methods Immunohistochemistry and tissue-array were used to determine GPR34 expression in human hepatocellular carcinoma tissues and matched adjacent tissues.A statistical analysis was performed to establish the potential correlation between GPR34 expression and the patients'clinicopathological characteristics,tumor progression,and prognosis.Results GPR34 is up-regulated in primary hepatocellular carcinoma tissues compared with matched adjacent tissues (P =0.003),and it was shown that GPR34 expression is significantly correlated with tumor size (P =0.024),small hepatocellular carcinoma(0.030) and infiltration(P =0.012),but not with sex,age,grade,chnical stage (all P ＞0.05) ; it was also shown that GPR34 expression had a significant influence on prognosis (X2 =5.617,P=0.018).Multivariate analyses showed that high GPR34 expression is an independent poor prognostic factor for overall survival (P =0.037).Conclusions The up-regulation of GPR34 acts as an potential prooncogene in the development and progression of hepatocellular carcinoma.GPR34 may be a useful diagnostic or prognostic molecular biomarker,and a potential target for therapeutic intervention.

Combined analysis of AFP and HCCR-1 as an useful serological marker for small hepatocellular carcinoma: a prospective cohort study.

Hepatocellular carcinoma (HCC) is one of the most frequent malignant tumors in the world. The only serological marker widely used for the diagnosis of HCC is alpha-fetoprotein (AFP). Despite that AFP is widely used for the diagnosis of HCC, it has a limit as a serological marker due to its low sensitivity and specificity. The human cervical cancer proto-oncogene 1 (HCCR-1) was previously reported as a new biomarker for HCC. To further evaluate the HCCR-1 as a biomarker for HCC, we conducted the prospective cohort study. We evaluated the significance of simultaneous measurement of 2 tumor markers in the diagnosis of HCC in China, Japan and Korea. Two markers for HCC, AFP and HCCR-1, were measured in the sera obtained from 1,338 patients at the time of initial diagnosis of HCC. Of the 1338 HCC patients, 616 (46%) and 686 (51.3%) were sero-positive for AFP and HCCR-1, respectively. The positive rate for HCC was increased up to 74.1% in combined use of AFP and HCCR-1. Many cases (54%) for AFP-negative HCC were positive for HCCR-1 and vice versa. More importantly, the diagnostic rate for small HCC (< 2 cm) was significantly improved in the combined analysis of AFP and HCCR-1 to 56.9% although it was only 40.1% and 23.4% in the single analysis of HCCR-1 and AFP, respectively. Our result suggests that the HCCR-1 could be an useful biomarker for HCC while the diagnostic rate could be significantly improved in the combined use of HCCR-1 and AFP.

Clinical utility of alpha fetoprotein and HCCR-1, alone or in combination, in patients with chronic hepatitis, liver cirrhosis and hepatocellular carcinoma.

Serum alpha fetoprotein (AFP) is the most widely used tumor marker in detecting patients with hepatocellular carcinoma (HCC). However, it has been indicated that HCCR-1 (human cervical cancer oncogene 1) might be supplementary to AFP in the detection. We conducted a prospective study in 120 normal and 524 liver disease patients to evaluate the significance of simultaneous measurement of 2 tumor markers (AFP and HCCR-1) in the diagnosis of HCC through the cohort study in Korea and China. We also performed immunohistochemical studies using 25 normal subjects (N), 32 liver cirrhosis (LC) and 116 HCC tissues. The sensitivities of AFP (20 ng/mL) and HCCR-1 (10 ng/mL) in HCC were 55.8% (164/294) and 44.2% (130/294), respectively. When AFP was combined with HCCR-1, sensitivities increased to 4.2% (N), 12.7% (chronic hepatitis; CH), 50.0% (LC), and 77.2% (HCC), respectively. Although there was no significant difference in the diagnostic rate for HCC between AFP and HCCR-1, many cases for AFP-negative HCC were positive for HCCR-1 and vice versa. Moreover, the combined use of AFP and HCCR-1 improved the diagnostic rate to 70.8% in small HCC (< 2 cm) and 81.6% in large HCC (⩾ 2 cm), respectively. AFP and HCCR-1 are independent markers. Our result suggests that the HCCR-1 could be an useful biomarker for HCC while the diagnostic rate could be significantly improved in the combined use of HCCR-1 and AFP.

The diagnosis and treatment of primary duodenal carcinoma / 中华普通外科杂志

Objective To evaluate the diagnostic procedures and treatment choice of primary malignant tumor of the duodenum.Methods The clinical data of 54 cases with primary malignant tumor of the duodenum at Peking University People's Hospital from 1995 to 2005 were analyzed retrospectively.Resuits Tumors located in the first,second,third and fourth parts in 6 cases(10%),44 cases(82%),2 cases(4%),and 2 cases(4%)respectively,and among them,tumors within papillary area accounted for 86%(38 cases)of all cases.Fifty cases(92%)were of adenocarcinoma,2 cases(4%)of mucinous adenoearcinoma carcinoid and undifferentiated carcinoma for 1 case each(2%)respectively.The main clinical presentations included jaundice,upper abdominal pain,weight loss,abdominal distention,nausea and vomiting.gastrointestinal obstruction and abdominal mass.The accuracy rate of duodenoscopy and ERCP in preoperative diagnosis was 94%,and 78%respectively.Preoperative associated cholecystopathy accounted for 37%.Panceaticoduodenectomy was performed in 38 cases,duodenectonmy in 1 ease,palliative resection of tumor in 9 cases,and tumor was inoperable in 6 cases.Resection rate was 89%,and radical resection rate was 72%.The postoperative 3-and 5-year survival rate was 41%and 22%respectively.Patients after palliative resection died from 3 months to 24 months and all patients who did not undergo a surgery died within 6 months.Conclusions Tumors located in papillary region account for the majority of primary malignant tumors of the duodenum and are mainly of adenocarcinoma.Specific signs on abdominal examination are few.The symptoms of advanced stage are complicated,associated cholecystopathy is relatively frequent.Endoscopy and ERCP examination are the main diagnostic tools.the pancreatoduodenectomy is the first choice of therapy for patients with primary duodenal carcinoma.

Microwave ablation in combination with TACE for the treatment of primary hepatic carcinoma / 中华普通外科杂志

Objective To evaluate the therapeutic effect of microwave ablation in combination with TACE for the treatment of primary liver carcinoma (PLC). Methods From Jan. 2004 to Dec. 2008, 63 PLC patients underwent ultrasound-guided microwave ablation (percutaneous or open) under general anesthesia. Repeated microwave ablation or TACE was used when an incompleted ablation or recurrence was found during postoperative regular follow-up. Results These 63 PLC patients have received a total of 82 sessions of microwave ablation procedure (1 to 5 sessions for each patient). There were 2 early postoperative deaths with a procedure-related mortality of 3.2%. At the end of the follow-up, 22 patients were alive and 38 died,and the other one was lost to follow-up. The survival rates in 1,2 and 3 years were 63.3%,42.1% and 26.5%, respectively, with a median survival of 20 months for all patients. The survival for PLC patients with early stage (TNM Ⅰ and Ⅱ) was significantly longer than that of advanced stage (TNM Ⅲ and Ⅳ). The 1,2 and 3 year's cumulative survival rate was 93.3%,86.7% and 65.0% respectively in those 15 cases with only single tumor and the diameter≤3 cm, which were significantly longer than that of other PLC patients. Of 23 patients with recurrence,9 had solitary tumor without lymphnode and distal metastases, for which the survival rates in 1,2 and 3 years were 100%,88.9%, and 35.6%, respectively, whereas in other recurrent patients the survival rates in 1,2 and 3 years were 21.4%, 10.7% and 0%, respectively(P< 0.01). Conclusions Ultrasound-guided microwave ablation in combination with TACE is effective for PLC patients with early stage. In recurrent PLC patients after ablation therapy with solitary tumor and no lymphnode and distal metastases the survival is significantly longer than that of the others.

Pathophysiological effect of excess iodine on the thyroid / 中国普通外科杂志

Objective To determine the relationship between excess iodine and the thyroid diseases. Methods The effects of excess iodine on rat thyroid and human thyroid cell were observed . Results All the rats in the experimmental group had diffuse colloidal goiter.With the increase of iodine levels,the relative and absolute weight of the goiter increased and revealed atypical abnormal hyperplasia as compared with the control group. The heights of thyroid follicular epithelial cells were decreased and the areas of thyroid follicular spaces were enlarged(p

Relationship between thyrotropin receptor gene mutation and toxic multinodular goiter / 中华内分泌代谢杂志

DNA was extracted from thyroid nodular tissue in 16 patients with toxic multinodular goitor (TMG). After PCR, the product of PCR was sequenced, and 3 cases with point mutation (A1964T) and 2 cases with insertion mutation (a G was inserted after nucleotide 1928) in TSH receptor gene were found. It is postulated that these mutations may play an important role in the pathogenesis of TMG.