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09 March 2008, Volume 28 Issue 03 Previous Issue    Next Issue
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Diagnosis and treatment of primary hyperparathyroidism:a report of 48 cases LI Yu-ji,ZHOU Jian-ping,KONG Fan-min,et al. 2008, 28(03): 187-188.  Abstract ( )   PDF (1663KB) ( )   Objective:To summarize the experience in the primary hyperparathyroidism. Methods:The clinical data of 48 cases of the PHPT admitted from 1991 to 2005 in the First Affiliated Hospital of China Medical University were analyzed retrospectively. Results:For ultrasonography,the positive rate was 81.1%(30/37).For ECT,the positive rate was 91.4%(32/35).Unilateral neck explorations (UNE) was performed in 38 cases with parathyroidoma.Four cases of parathyroid hyperplasia were treated by UNE and the other 2 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.All cases developed hypocalcemia in various degrees after operation,but the symptoms were relieved with the use of calcium gluconate. Conclusion: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.

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Prediction of parathyroid hormone assay for hypocalcemia in patients after thyroidectomy:a report of 592 cases HU Xiao-lei,CHEN Li-ping,CHAO Lin,et al. 2008, 28(03): 189-191.  Abstract ( )   PDF (2282KB) ( )   Objective:To investigate the relationship between hypocalcemia and parathyroid hormone(PTH) level during thyroidectomy,and discuss the prevention and treatment of hypocalcemia after thyroidectomy. Methods:The clinical data of 592 cases performed thyroidectomy bdtween January 2004 and August 2007 were analyzed and serum calcium level was observed closely.PTH was checked before,during and after the operation. Results:Hypocalcemia occurred in 86 cases during the postoperative period.The morbidity of hypocalcemia of the patients with serum PTH level less than 15 ng/L (10 minutes after the thyroidectomy) was 1419%,which was significant different with that of patients with serum PTH level more than 15 ng/L (0.34%).The morbidity of hypocalcemia of the patients with serum PTH level less than 10 ng/L(1 day after the operation) was 8.28%,which was significant different with that of patients with,serum PTH level more than 10 ng/L(6.25%).The PTH level reduced more than 75% 10 min after the ectomy was a predictor of hypocalcemia with the sensitivity and specificity of 100% and 9451%. Conclusion:The PTH level reduced more than 75% 10 min after the ectomy,as a predictor,was reliable.The serum calcium level changed significantly within the first 3 days after the operation.The PTH level should be observed during the operation for the patients accepted unilateral lobectomy with contralateral subtotal lobectomy or even larger lobectomy,Which is useful for preventing hypocalcemia.

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Papillary carcinoma of thyroid:a clinical analysis of 136 cases RAO Nan-yan,XIE Min,HU Xiao-yun,et al. 2008, 28(03): 192-193.  Abstract ( )   PDF (1688KB) ( )   Objective:To evaluate the diagnosis and the treatment of thyroid papillary carcinoma and its complications. Methods:The clinical data of 136 cases of thyroid papillary carcinoma confirmed by surgery and pathology from 1995 to 2004 in the Second Affiliated Hospital of Nanchang University were analyzed retrospectively. Results:The coincidence rate of diagnosis for thyroid papillary carcinoma by intraoperative frozen section was 98.2% (111/113).It was significantly higher than that by ultrasonography (25.8%,16/62),CT (80.0%,24/30) and fine needle aspiration biopsy (78.1%,25/32).Hypocalcemia after surgical event could be documented in 8.8% of 136 cases,recurrent laryngeal nerve injury in 2.2% of cases and chyle leakage in 1.5% of cases. Conclusion:The intraoperative frozen section can provide reliable evidence for the diagnosis of thyroid papillary carcinoma. The peripheral tissues of thoracic duct fistulagreat saphenous veininternal jugular vein anastomosis is a good way to treat high flow of chyle transudation.

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Diagnosis and treatment of solidpseudopapillary tumor of pancreas:an analysis of 29 cases ZHANG Jian-wei,BAI Xiao-feng,WANG Cheng-feng,et al. 2008, 28(03): 194-196.  Abstract ( )   PDF (2448KB) ( )   Objective:To assess the diagnosis,treatment and prognosis of solidpseudopapillary tumors of the pancreas(SPT). Methods:The clinical,imaging,and pathologic data of 29 SPT patients admiffed from January 1999 to November 2006 in the Department of Abdominal Surgery of Cancer Hospital Peking Union Medical College were analyzed retrospectively. Results:All cases received laparotomy,but only 28 had the tumor resected.Surgical procedures included pancreaticoduodenectomy,distal pancreatectomy with splenectomy,regional pancreatectomy and enucleation.Four patients had pancreatic fistula and one digestive tract bleeding postoperation,who recovered by conservative treatment.The patient with unresection tumor had Chemotherapy and interventional therapy,however he dead one year after operation.No recurrent or metastases had been found in fellowup. Conclusion:Most of SPT has been found in young female,and symptom is unspecial.CT is the most accurate image modalitary.Diagnosis can be made preoperatively combination with clinical features.Because of the SPT low grade malignant potential,surgery is the first choice of treatment,the prognosis is good if the tumor is resected completely.

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Laparoscopic minigastric bypass for the treatment of morbid obesity CAI Jing-li,ZHENG Cheng-zhu,CHEN Dan-lei，et al. 2008, 28(03): 197-199.  Abstract ( )   PDF (2400KB) ( )   Objective:To investigate the preliminary experience and clinical effect of laparoscopic minigastric bypass in the treatment of morbid obesity. Methods:Laparoscopic minigastric bypass was performed for a patient with morbid obesity accompanied with type 2 diabetes mellitus in November 2007 in the Minimally Invasive Srugery Center of Changhai Hospital of Second Military Medical University. Results:The operation was successfully performed without any complications.The operation time was 135 min,and 20 mL blood was lost.After 30 days,the patient’s body weight reduced by 15 kg and BMI decreased 4.9kg/m2.Diabetes indicators returned to normal in the 8th postoperative day without any medication. Conclusion:Laparoscopic minigastric bypass is a relatively safe and simple procedure.The shortterm effects for weight reducing are optimal,and the procedure has good therapeutic effect on type 2 diabetes mellitus.

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Surgical technique in biliary reconstruction of orthotopic liver transplantation MA Yi,HE Xiao-shun,ZHU Xiao-feng,et al. 2008, 28(03): 200-202.  Abstract ( )   PDF (2561KB) ( )   Objective:To approach the surgical technique in biliary reconstruction and the affecting factors of its quality. Methods:Three hundreds and sixtyeight cases of the clinical data of allograft orthotopic liver transplantation in the First Affiliated Hospital of Sun Yatsen University from 2004 to 2005 were analyzed retrospectively. Results:Of the 368 cases,36 cases (9.8%) encountered the biliary tract associated complications.Twentythree cases were cured by nonsurgical therapies.Thirteen cases needed abdominal surgical intervention with 7 cases receiving retransplantation.And 5 cases died of biliary complications,accounting for 13.9% death in the series.The causes of death were severe biliary infection and abdominal infection. Conclusion:Adequate blood supply for both donor and recipient biliary endings,correct choices of methods for biliary reconstruction,subtile microsurgical anatomosis technique to ensure the patency of biliary tract are important for elevated quality of biliary reconstruction and decreased biliary complications.

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Usage of new type ultrasonically activated scalpel in radical resection of gastric carcinoma LU Wei-qi,ZHAO Gang,LU Wei,et al. 2008, 28(03): 203-205.  Abstract ( )   PDF (2476KB) ( )   Objective:To investigate the clinical value of new type (curved shears with pistol/scissor handle and hand control) ultrasonically activated scalpel (UAS) in radical resection of gastric carcinoma. Methods:Forty-nine cases undergoing radical resection of gastric carcinoma during April.2006 to March 2007 in the Department of General Surgery of Zhongshan Hospital of Fudan University were enrolled and their clinical data were analyzed．They were divided into two groups randomly before operation:26 cases in ultrasonically activated scalpel (UAS) group and 23 cases in conventional procedure group．Blood loss volume,operating time in lymphadenectomy，drainage volume of first 72 hours after operation,and the number of lymph node retrieval were recorded and compared between two groups. Results:Operating time，blood loss volume,drainage volume of first 72 hours in UAS group were significantly less than those in the conventional procedure group．However the number of lymph node retrieved had no obvious difference between the two groups. Conclusion:Using new type UAS in lymphadenectomy of gastric carcinoma radical resection is a safe and effective surgery procedure,and the new method has its superiority according to radical resection principle of malignant tumor．

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Clinical evaluation of the transverse abdominal incision sutured by onelayer outside peritoneum in open appendectomy LV Hui-zeng,CHEN Tu-feng,XU Ming,et al. 2008, 28(03): 206-208.  Abstract ( )   PDF (2341KB) ( )   Objective:To assess the transverse abdominal incision sutured by onelayer outside peritoneum in open appendectomy. Methods:In a randomcontrolled study,724 patients underwent open appendectomy for appendicitis from August 2004 to December 2006 were analyzed.The patients were operated randomly with the transverse incisions sutured by onelayer outside peritoneum in the downright abdominal part(group A)or with the routine McBurney's incision (or transverse abdominal incision ) sutured by multilayer(group B). Results:In the patients with suppurative or gangrenous appendicitis,those in group A had significantly shorter operating time,shorter length of hospital stay and lower rates of incision infection than those in group B (P＜0.01);however,the differential postoperative pain in the two groups was not found (P＞0.05).In the patients with simple acute appendicitis,those in group A got no more advantages than that in group B (P＞0.05),but also accompanied with more severe postoperative pain (P＜0.01). Conclusion:In the patients underwent open appendectomy for suppurative or gangrenous appendicitis,the transverse incision sutured by onelayer outside peritoneum in the downright abdominal part is safe and simple,and can provide more advantages than the routine incision sutured by multilayer,which should be taken as a standard incision.However,in the patients with simple acute appendicitis,the routine McBurney’s incision (or transverse abdominal incision) sutured by multilayer should be selected firstly.

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Aortic dissection：an analysis of 80 cases ZHOU Min,LIU Chang-jian,QIAO Tong,et al. 2008, 28(03): 209-210.  Abstract ( )   PDF (1635KB) ( )   Objective:To investigate the clinical manifestation,diagnosis and treatment of aortic dissection. Methods:According to the clinical data of continuous 80 patients with aortic dissection between August 1999 and April 2006,it analyzed the clinical characteristics,imaging diagnosis,treatment methods and outcomes. Results:Twentythree patients were treated by traditional open operations,of which 3 patients (13.0%) died of postoperative complications.Fiftytwo patients were performed endoluminal stentgraft implantation,and one patients（1.9%）died 1 day after the procedure due to false luminal rupture.No death occurred during follow up time.Additionally，3 patients （3.8%）died before operation,and 2 gave up treatment. Conclusion:The accurate diagnosis as early as possible and active therapy are the key to improve the prognosis of aortic dissection.

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Distribution on immune function of the axilla lymph nodes in breast cancer. LU Yun-fei，ZHANG Xiao-bin. 2008, 28(03): 211-212.  Abstract ( )   PDF (1646KB) ( )   Objective:To investigate the immune function of Axilla lymph nodes which cancer cells metastasis and not metastasis in breast cancer. Methods:It used flow cytometry to calculate the percent of lymphocyte subsets of the axilla lymph nodes and compare the result with each other between August 2004 and July 2005. Results:Whether cancer cells metastasis to the axilla lymph nodes or not,the percentage of lymphocytes CD3+T、CD4+T、CD8+T、CD16+NK、CD19+B had no statistical difference (P>0.05).When cancer cells metastasis to SLN,the percentage of lymphocytes CD4+T、CD8+T、CD16+NK had statistical difference (P<0.05),and the percentage of CD3+T、CD19+B had no statistical difference (P>0.05). Conclusion:When the axilla lymph nodes has no cancer cells metastasis,it’s immune function is natural.Once lymph nodes has cancer cells metastasis,it’s immune entironment is transformation,and so the immune function is bated.

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Construction of recombinant lentivirol expression vector carrying human HLA-E gene and Its expression in HepG2 cells ZHANG Tong,FANG Tian-ling,LI Hua,et al. 2008, 28(03): 213-215.  Abstract ( )   PDF (2175KB) ( )   Objective:To construct the lentiviral expression vector of HLA-E gene and investigate its significance for further study on tumor immunity. Methods:After the lentiviral expression vector of HLA-E gene (pGC-E1-GFP-HLA-E) was transduced HepG2 cell lines,the transduction efficiency，the HLA-E mRNA level by RT-PCR and the expression of HLA-E by immunohistochemistry were detected between October 2006 and November 2007 in the Liver Transplautation Center of Third Affiliated Hospital of Sun Yat-sen University. Results:The transduction efficiency of HepG2 cell lines using the lentiviral vectors was 95.0%±1.3% which allowing the stable expression of HLA-E after 72 hr.The HLA-E-mRNA level in vitro was detected more 8.73±1.05 times and 293.48±42.01 times than normal level by RT-PCR (P＜0.01).The expression of HLA-E by immunohistochemistry was displayed significant enhancement. Conclusion:The lentiviral expression vector is ideal vetor of gene therapy and made genes transducted stable expression in target cell.