Abstract:Abstract:Objective:To investigate the method of surgical therapy in patients with differentiated thyroid cancer.
Methods :The clinical data of 759 patients with differentiated thyroid cancer treated in our hospital in recent 4 years were retcospectively analysed.
Results:Bilateral thyroidectomy was undertaken in all our patients.Pathological investigation indicated that multifocal differentiated thyroid carcinoma was found in 179 cases (23.6%), and co-existence of multinodular goiter, Hashimoto disease or Grave′s disease was found in 381 cases (50.2%). Among the 638 cases who received lymph node dissection of different extents, metastasis in cervical lymph nodes was found in 487 cases (76.3%). Complications after surgery were found in 26 cases (3.4%) .
Conclusions:Combining the guidelines from abroad and outcome of this group, it is recommended that bilateral thyroidectomy should be employed as routine therapy for differentiated thyroid carcinoma in China. The decision for lymph node dissection can be considered according to the stage of the tumor.

Abstract:Abstract:Objective:To evaluate the rate of residual tumor after local resection of thyroid carcinoma, and provide theoretical basis to determine the indications for re-operation.
Methods :The clinical data of 56 patients, who had re-operation in our hospital after local resection of thyroid carcinoma, were summarized.
Results:As confirmed by pathology, the rate of residual tumor of patients was 42.8% at re-operation. When the tumor was larger than 4 cm, or smaller than 2 cm before the first operation, the residual tumor rate was 80% and 11.1% respectively. The residual tumor rate was 86.3% in patients with tumor invading thyroid capsule, 14.7% in patients without capsule invasion, 47.6% in patients who had only nodule resection, 50% after ipsi-lateral partial lobectomy, and 12.5% after subtotal thyroidectomy. The sensitivity of finding residual tumor by CT and doppler ultrasound examiination before re-operation was 64.0% and 60.0% respectively, and the positive predictive value was 80.0% and 30.0% respectively.
Conclusions:The rate of residual tumor is high in patients with thyroid cancer operated by local resection. And it′s necessary to re-operation. The condition of tumor before the first operation and CT examination are significant for selection of patients to have re-operation.

Abstract:Abstract:Objective:To explore the diagnosis and surgical treatment of primary parathyroid tumor (PTT).
Methods :The clinical data of 12 patients with primary parathyroid tumor and treated by operation were analyzed retrospectively.In this group, 1 patient with parathyroid carcinoma complicated with goiter and was diagnosed as MEN-Ⅰ; 1 case with parathyroid cyst;10 cases with parathyroid adenoma (PTA), one of which was complicated with goiter, and one MEN-1 case with bilateral parathyroid adenoma, and 1 was ectopic PTA.
Results:The diagnosis were made before operation based on the result of blood calcium and phosphorous, B-type ultrasound, CT and 99mTc-MIBI in 10 cases. Unilateral neck exploration (UNE) was performed in 8 cases with parathyroid adenoma and in 1 case with parathyroid cyst; the case of parathyroid carcinoma with MEN-1 and the MEN-1 case of parathyroid adenoma with goiter had bilateral neck exploration (BNE) and the case with parathyroid carcinoma underwent radical operation. All of the cases were followed up for average 38 months. In the followup time, the level of serum calcium was normal in 11 cases and 8 patients were asymptomatic; only 1 case with parathyroid adenoma who underwent UNE developed parathyroid hyperplasia in the opposite side, and was cured by re-operation.
Conclusions:UNE for single parathyroid adenoma or cyst is feasible, if accurate image localizations is available; the cases with parathyroid carcinoma or parathyroid adenoma with goiter or MEN-Ⅰshould undergo BNE. By close follow up of the cases, the effect of surgical treatment can be determined, and also has the advantage of early find of cases with recurrence or with MEN-1.

Abstract:Abstract:Objective:To summarize the experience for diagnosis and treatment of parathyroid carcinoma(PTC).
Methods :The clinical data of 6 patients with PTC were retrospectively analyzed.
Results:Five patients complained of primary hyperparathyroidism, 3 patients had manifestations of palpable neck mass, 4 patients were admitted for hypercalcemia with calcium level of (3.62±0.56 )mmol/L, and in 4 patients the parathyroid hormone(PTH) level was higher than two fold of the normal upper limit. Frozen section histopathology established diagnosis in 3 patients, routine histopathology combined with immunohistochemistry established the diagnosis in 2 patients, and routine histopathology combined with immunohistochemistry and clinical data established the diagnosis in 1 patient. Parathyroidectomy and ipsilateral subtotal thyroidectomy was performed in 5 patients, who were followed up for 1-5 years, recurrence in 1 patient 3 years after operation; tumor resection alone was performed in 1 patient with parathyroid cancer complicated with multiple bone metastasis, and the patient died of MOF 16 days postoperation.
Conclusions:The diagnosis of PTC is difficult before operation. Routine blood examinations, blood PTH , 99mTc-MIBI scintigraphy, ultrasonography, CT, observation of specimen, and frozen section histopathology during operation are helpful to diagnosis. The surgical procedure of choice is parathyroidectomy and ipsilateral subtotal thyroidectomy.

Abstract:Abstract:Objective:To analyze the clinical significance of modified thyroidectomy by trans-isthmus approach.
Methods :The clinical data of 5 751 patients who underwent thyroidectomy from Jan.1996 to Jan.2006 were retrospectively analyzed. All cases were divided into two groups. The modified operation group (n=3288) was treated by trans-isthmus thyroidectomy. Another group (n=2463) was treated by routine approach. The operation time, bleeding volume, and complications were observed and compared.
Results:In modified operation group, the mean operation time, bleeding volume, temporary injury of recurrent laryngeal nerve, tracheal discomfort, and hypocalcemia were significantly decreased than those in routine approach group (P<0.01). The patients in the modified operation group tolerated the operation better as compared to the routine approach group. There was no statistical difference in postoperative bleeding between the two groups.
Conclusions:The modified thyroidectomy by trans-isthmus approach could obviously decrease the operation time, bleeding volume, and rate of injury of recurrent laryngeal nerve and hypocalcemia.

Abstract:Abstract:Objective:To evaluate the diagnosis and differential diagnosis methods for chronic lymphocytic thyroiditis (CLT).
Methods :One hundred and eight patients with CLT were treated in our department during recent 20 years, the clinical data were analyzed retrospectively. The diagnostic methods included thyroid function measurement, anti-thyroid antibody measurement, image detection, fine needle aspiration, diagnostic drug therapy and biopsy exam during operation. The preoperative examinations and diagnoses of 94 patients, who had received operation, were compared with postoperative pathological results.
Results:Forteen of the 108 cases did not receive any operation, of whom, 9 had a definite diagnosis of CLT by fine needle biopsy under color ultrasound and 5 by drug(prednisone) diagnostic treatment. Before operation, 57 patients were diagnosed as nodular goiter,16 as thyroid cancer and 13 as nodular goiter associated with hyperthyroidism. Only 8 patents were diagnosed as CLT with nodular goiter. Postoperative pathological reports were simple CLT in 59 cases（62.7%）,CLT with nodular goiter in 19（20.2%）, CLT with hyperthyriodism in 10（10.6%）and CLT with thyroid cancer in 6（6.3%）.The preoperative misdiagnosis rate reached 91.5%(86cases).
Conclusions:It is easy for CLT to be misdiagnosed because of the complex clinical manifestations. Careful analysis of examination results, especially thyroid function measurement,anti-thyroid antibody measurement and image detection is significant for confirming the diagnosis. The fine needle biopsy and diagnostic drug treatment are better methods for CLT diagnosis. Unwarranted operation should be avoided in patients with CLT.

Abstract:Abstract:Objective:To explore the clinical characteristics，diagnosis, treatment，and prognosis of male breast cancer.
Methods :The clinical data of 38 cases of male breast cancer, who were treated in the two hospital during the past 10 years, were analyzed retrospectively.The diagnosis was mainly based on preoperative B-ultrasound，radiography with molybdenum target tube and fine needle aspiration. Among the 38 cases, radical mastectomy was conducted in 3 cases，modified radical mastectomy in 27 cases，simple mastectomy in 5 cases，and operation was refused in 3 cases. Postoperatively, radiotherapy was adopted in 4 cases，simple endocrinotherapy in 7 cases，radiotherapy plus chemotherapy in 9 cases，and chemotherapy plus endocrinotherapy in 8 cases.
Results:Median age at treatment was 58.5 (53-82)years.TNM staging included stageⅠin 13 cases，stageⅡ in 19 cases，stageⅢ in 4 cases，and stageⅣ in 2 cases. Median follow-up was 73.8 months (2 months-10 years)，and follow-up rate was 73.6% (28/38). During the follow-up，13 cases died including 8 cases died of local recurrence and metastasis, and 5 cases died of heart and brain disease. The 5-and 10-year overall survival rate was 71.6% and 55.3% respectively;5-and 10-year disease-specific survival of stageⅠ，Ⅱ was 92.6% and 78.9% respeoively;among 6 cases of stageⅢ，Ⅳ 4 were followed，and all 4 cases died with in 3 years.
Conclusions:Male breast cancer has a long course，poor prognosis and low survival rate. Combined therapy with modified radical mastectomy, as its basis, is the treatment of choice for male breast cancer.There is a certain correlation between the prognosis of male breast cancer and clinical stage of the disease.

Abstract:Abstract:Objective:To explore the clinico-pathological characteristics of primary breast lymphoma(PBL).
Methods :The clinical data of 36 cases of PBL were analyzed retrospectively.
Results:Among the 36 cases of PBL，16 patients presented with stage Ⅰa disease, 14 patients with stage IIa disease,2 patients with stageⅡb disease, and 4 patients with stage Ⅳ. All of the patients underwent surgery and chemotherapy, and 20 cases had radiotherapy.
Thirty three patients (91.7%) were followed up for 3-193 months, during which time, 12 patients died, including 2 patients died of brain metastases，five patients died of bone metastasis，and five patients died of diffuse hepatic and pulmonary metastasis. In the 21 surviving patients, the survival time was 3～192 months, and the median survival time was 43.5 months.The overall 3-and 5-year survival rate was 70.1％ and 49.0％, respectively.
Conclusions:Most PBL are NHL.PBL is diagnosed basically by methods of pathology and immunohistochemistry，and operation combined with chemotherapy and/or radiotherapy is the best treatment method.

Abstract:Abstract:Objective:To evaluate the correlation between mammographic calcifications and HER-2/neu overexpression in breast carcinomas (BC) and its clinical significance.
Methods :A retrospective study of preoperative mammograms in patients with breast carcinoma, and immunohistochemical staining of excised tumor specimens was carried out by using monoclonal antibody against HER-2/neu in 152 patients with BC to evaluate the correlation of mammographic calcifications with HER-2/neu overexpression.
Results:There was a significant correlation between mammographic calcifications and HER-2/neu overexpression (P＜0.01). In the 73 cases of carcinoma with calcifications on mammography, HER-2/neu overexpression was statistically higher in calcifications associated spiculated mass than in simple calcifications (P＜0.05). According to morphologic aspects of calcifications, vermicular calcifications were more common in carcinomas with HER-2/neu overexpression than in those without HER-2/neu overexpression (P=0.01). The carcinomas with calcifications ≥25 mm in diameter were much more commonly associated with HER-2/neu overexpression (P＜0.05), whereas the number of calcifications less than 20/cm2 was more common in HER-2/neu negative expression (P＜0.01).
Conclusions:Mammographic calcifications are significantly correlated with HER-2/neu overexpression and may offer reference for planning a therapeutic stategy and predicting prognosis of breast cancer.

Abstract:Abstract:Objective:To investigate the role of complete endoscopic axillary lymphadenectomy in axillary lymph node dissection (ALND) in early breast cancer patients.
Methods :A total of 21 patients with breast cancer underwent mastectomy and complete endoscopic axillary lymph node dissection (E-ALND) with liposuction in recent 2 years. All available data relating to endoscopic axillary surgery were compared with traditional ALND.
Results:No E-ALND had to be converted into open procedures. Compared with traditional ALND, there was no obvious difference in the number of lymph nodes removed ［（18.26±4.62) vs. (17.15±3.83）］, but the operating time was remarkably longer ［（82.21±28.12)min vs. (138.42±36.06) min］. the drainage time shorter ［（10.1±3.2) d vs. (6.8±2.8) d］, and operative blood loss lower ［（192.16±60.27)mL vs. (115.31±32.18)mL］. After three months follow-up, the occurrence of upper arm numbness in E-ALND group was notably lower than that in traditional ALND group (32.2% vs. 4.78%),but the pain and edema of are were no significant difference between the 2 groups (P>0.05). In E-ALND group there were epidermic blisters in 2 cases, chest wall cellulitis in 1 case, and axillary seromas in 2 cases after operation. No port-site metastasis occurred during follow-up with a median of 8.9 (2-21) months.
Conclusions:Endoscopic liposuction can be safely and feasibly applied for complete axillary lymph nodes dissection (ALND) because it is associated with acceptable minimal skin incision, less complications in the upper limb, while offering a better cosmetic result to the patients in comparison with the traditional ALND, and it represents an attractive alternative for ALND.

Abstract:Abstract:Objective:To investigate the expression of Pirh2mRNA in breast cancer tissue and its correlation to genesis and development of breast cancer.
Methods :A retrospectively analysis of pirh 2 mRNA expression in 87 cases of stage I and II breast cancer, 27 cases of stage III and IV breast cancer was made, and 10 cases of fibroma tissue and 6 cases of normal lacteal gland tissue as control, all of which were from Department of Breast Surgery, XiangYa Hospital in recent 10 years. The in situ hybridization was used to detect the expression of Pirh2mRNA.
Results: The positive rate of Pirh2mRNA in breast cancer tissue was 43.9 %(50/114), 1 positive in 10 cases of fibroid tumor, and no expression in normal lacteal gland tissue. The expression of Pirh2mRNA in breast cancer was significant higher than that in fibroid tumor and normal lacteal gland (P=0.004). The positive rate of the stage I or II breast cancer group and was 37.9% (33/87) and of stage III or IV was 63% (17/27) respectively, with a significant difference (P=0.022). In the 60 cases with metastasis occurred in less than 5 years the positive rate of Pirh2mRNA was 63.3% (38/60), and the positive rate of the 54 non-tumor survivors was 22.2% (12/54)（P=0.000）.
Conclusions:Pirh2mRNA is more highly expressed in breast cancer, while there is almost zero expression in lacteal gland fibroid and normal tissue. The positive expression in stage III or IV is significantly higher than breast cancer of stage I or II. Pirh2mRNA is probably closely correlated to the genesis and development of breast cancer.

Abstract:Abstract:Objective:To explore the correlation between the expression of EMA and EGP-2mRNA with tumor micrometastases in peripheral blood of breast cancer (BC).
Methods :EMA and EGP-2mRNA were detected by RT-PCR in 53 patients with breast carcinoma， and 24 patients with benign breast lesions. The relationship between EMA and EGP-2mRNA expression and clinical indexes was analyzed.
Results:The positive rate of EMA and EGP-2mRNA expression in the cancer group was 33.96%and 28.30% respectively， and no case of positive EMAmRNA expression and only one case of EGP-2mRNA expression was found in peripheral blood in 24 patients with breast benign lesions (all P<0.05). A significant correlation was found between expressions of EMA and EGP-2mRNA with axillary lymph node metastasis and TNM stage in B C group. The sensitivity and accuracy rate of combined detection of EMA and EGP-2mRNA was 52.83% and 66.23% respectively and was much higher than that of EGP-2mRNA detection.
Conclusions:Combined detection of EMA and EGP-2 obviously can improve the accuracy rate in B C. Both of them can be used as tumor markers to detect micrometastases of breast cancer. This may have an impact upon therapeutic recommendations and prognostic judgment in breast cancer patients.

Abstract:Abstract:Objective:To study the selective expression and eradicating effect of recombinant plasmid vector DTA containing transcriptional regulation sequence of human breast cancer DF3 /MUC1 promoter (PGL3-DF3-DTA) on DF3 positive breast carcinoma cell lines.
Methods :The MCF-7 and MDA-MB231 breast carcinoma cell lines were transplanted into the dorsal subcutaneous tissue of nude mice in different groups. The mice was subcutaneously injected with recombinant plasmid PGL3-DF3-DTA 7 days after transplantation and the animals were sacrificed 29 days after transplantation. The tumors were excised and the weight and volume were determined. The expression of DTA was detected by reverse transcription-polymerase chain reaction (RT-PCR).
Results:Recombinant plasmid vector PGL3-DF3-DTA was expressed in xenograft of MCF-7 breast carcinoma cell lines, and the growth of tumor was significantly inhibited.
Conclusions:Recombinant plasmid vector PGL3-DF3-DTA has selective expression and eradicating effect on DF3-positive breast cancer cell lines.

Abstract:Abstract:Objective:To investigate the expression of BRMS1 in different metastatic breast cancer cells and its relation to HDAC activity.
Methods :The gene expression of BRMS1 in 3 types breast cancer cell lines〔non-metastasis MCF-7（A cell line）, low metastasis MDA-MB-453（B cell line）and high metastasis MDA-MB-231（C cell line）〕 was determied by RT-PCR technique; the protein expression of BRMS1 was measured with Western blot technique and HDAC activity by enzyme linked immunosorbent assay.
Results:（1） Gene expressive ratio of BRMS1 was 3.1∶2.0∶1.0 in the A、B、C cell lines, respectively. The gene expression of BRMS1 in the C cell line decreased 210% compared to A cell line, and expression of BRMS1 was markedly reduced as the degree of metastasis increased (P＜0.001). （2）protein expression ratio of BRMS1 was 3.2∶1.9∶1.0 in the A、B、C cell lines. The protein expression of BRMS1 in the C cell line decreased by 220% compared to A cell line, and protein expressive of BRMS1 was reduced in relation to metastasis degree of breast cancer cell line (P＜0.001). （3）HDAC activity ratio was 1.0∶1. 8∶2.6 in the A、B、C cell lines . HDAC activity in the C cell line increased 160% compared to A cell line,HDAC activity increased in relation to metastasis degree of the cell line (P＜0.001).
Conclusions:（1）Gene and protein expression of BRMS1 is reduced according to the metastasis degree increasing of the cell line. （2）HDAC activity increases with increase of degree of metastasis of the 3 cell types，and suggests that BRMS1 may regulate breast cancer metastasis via HDAC activity.

Abstract:Abstract:Objective:To study the interfering effect of short hairpin RNA(shRNA) expressing plasmid vectors on STAT3 gene expression of human gastric carcinoma cells.
Methods :Specific shRNA plasmids to STAT3 were constructed, and then transfected into MKN-45 cells by lipofectamine methods. Semi-quantitative RT-PCR and Western blotting were used to detect the expression of STAT3 mRNA and protein respectively. Cells were divided into three groups: control group (A group), psiRNA-H1 group (negative group, B group) and psiRNA-H1/STAT3 group (C group).
Results:The synthesized strands of oligonucleotide contained correct and complete sequence of the shRNA, and the STAT3 specific shRNA was inserted into eukaryotic expression．Compared with the A and B group cells, semi-quantitative RT-PCR and Western blotting showed the expression of STAT3 mRNA and protein was down-regulated in the C group (P<0.05).
Conclusions:The recombinant plasmid psiRNA-H1/STAT3 shRNA has been constructed successfully, and it can specificly inhibit not only the expression of STAT3 mRNA, but also the protein expression in gastric carcinoma cells in vitro.It provides certain experimental basis for STAT3 gene target therapy.

Abstract:Abstract:Objective:To evaluate the effect and significance of the smart capsule monitoring system in measuring the pressure of colon and the transmission function of colon in patients with slow transit constipation.
Methods :The smart capsule monitoring system, which was manufactured by ourselves, was taken by 30 healthy volunteers and 30 patients with slow transit constipation. In all the cases, the smart capsule was taken orally at 9:00, and something was eaten at 12:00 and 18:00 in order to stimulate gastrocolic reflex. From 9 o′clock, ultrasound was used to locate the position of the smart capsule every 7 hours until the capsule was eliminated from the body moved by stool. The main parameters of observation were the time of the capsule remaining in the body, time of the capsule passing through the colon, total high amplitude propagated contractions (HAPCs), cluster HAPCs , average contraction amplitude and physiological response rate.
Results:All the cases that took the oral smart capsules eliminated the capsules in stool naturely, and without any discomfort. The silicon envelopes of the capsules were not broken. In constipation group, the time for the capsule remaining in the body and passing through the colon was longer than those in the healthy volunteer group ［(110.2±13.0)h vs. (29.7±6.5)h, (86.4±15.0)h vs. (14.8±4.6)h, the P value was 0.000 and 0.000 , respectively］. The total number of HAPCs and constitutional waves were both less than those in the healthy volunteer group ［(12.4±3.4) vs. (18.5±3.7), (4.5±2.8) vs. (12.3±2.1), the P value was 0.012 and 0.004, respectively］; The average contraction amplitude and physiological response rate were both lower than those in the healthy group ［(8.7±0.5) kPa vs. (9.5±0.7) kPa, (42.10% vs. 63.60%), the P value was 0.028 and 0.012, respectively］.
Conclusions:The smart capsule monitoring system is a non-traumatic, safe, convenient, and physiological method. It not only can measure the dynamics of the total colonic tract and its transmission time, but also can provide strong evidence to assess the cause of constipation and its severity.

Abstract:Abstract:Objective:To study the diagnosis and treatment of chronic colonic pseudo-obstructon.
Methods :The clinical data of 17 cases of chronic colonic pseudo-obstructon were analysed retrospectively.
Results:All cases underwent surgical operation. Five cases had right hemicolectomy and transverse colectomy; 8 cases had right hemicolectomy, transverse colectomy and descending colectomy; 1 case had sigmoid colectomy; 1 case had sigmoid colostomy; and two cases had intestinal decompression procedures. After operation, 2 cases had infection of incisional wound, and 1 case had left subdiaphragmatic abscess,and the 3 patients recovered after treatment; 1 case had gastroplegia and recovered after expectant treatment for 30 days; 1 case undergoing intestinal decompression procedures died of septicaemia and septic shock 19 days after operation. Symptoms of 2 patient underwent sigmoid colectomy and one patient undergoing intestinal decompression procedures were not relieved after operation. The other patients recovered completely with normal passage of gas and defecating functions and no abdominal distension.
Conclusions:Chronic colonic pseudo-obstructon is a rare disease. Excising dilated and nonfunctional colon can relieve the symptoms in most patients.

Abstract:Abstract:Objective:To evaluate the application of the spleen-preservation technique in splenic injury.
Methods :The clinical data of 208 cases with splenic trauma were analysed retrospectively. There were, 20 cases treated with non-surgical therapy; 20 cases treated with simple splenorrhaphy, 48 cases with ligation of splenic artery, splenorrhaphy and/or partial splenectomy, 20 treated with splenectomy and autologous spleen transplantation, and 100 cases with simple splenectomy.
Results:In 108 splenic preservation cases, who were operated or non-operated (SP group), the value of lgM and CD3 was significantly higher than that in the splenectomy group (P<0.01); CD8 and CD4 were significantly higher that those of splenectomy group (P<0.05); the percentage of pockmark red cells was lower than that splenectomy group (P<0.01). CT, BUS and 99mTc nuclide scan confirmed that the structure of the preserved spleen had recovered to normal, and the ruptured surface of the spleen had completely healed I mouth after operation.
Conclusions:Most cases of traumatic rupture of spleen can be treated by splenic preservation methods, and the splenic structure and function can recover to normal postoperatively.