Abstract:

Objective:To understand the trend of occurrence, diagnosis, and prognosis of breast cancer in the cases treated in Peking Union Medical College Hospital (PUMCH) between 1975 and 2006.
Methods:A total of 1092 cases of breast cancer treated in the PUMCH from 1975 to 2006 were classified into six groups by time span and reviewed for a comparative study on the parameters of gender, age, menstruation status, tumor size, mumber of positive axillary nodes,pathologic stage,recurrence and metastasis and  disease-free survival rate.
Results:The average age of breast cancer patient has risen from 50.90 to 53.92, while 40-49 year-old group was the largest age group of breast cancer patients, and the percentage of menopause female was the highest.  Tumor size has gradually been smaller especially since 2000.  The number of positive axillary nodes showed no significant change during the time periods.  In all 6 groups, stage-II cases were more frequent,although the percentage of stage-0 and stage-I cases was on the rise, while the percentage of stage-III declined, and that of stage-IV remained stable.  In all 6 groups, the 5-year and 10-year disease free survival rate had steadily increased.
Conclusions:The early diagnostic rate of breast cancer has been improving and subsequently the prognosis has improved as well.

Abstract:

Objective:To summarize our experience in the diagnosis and treatment of male breast cancer（MBC）.
Methods:A total of 41 patients with MBC treated in our hospital from 1985-2006 were analyzed restrospectively. Forty patients underwent surgery，including radical mastectomy（11 cases），modified radical mastectomy（25 cases），and simple mastectomy（4 cases）.
Results:Clinical TNM stage of the cancer was stage Ⅰ（8cases），stageⅡ（19 cases），stage Ⅲ（11 cases）and stage Ⅳ（3 cases）.The median follow-up period was 7.2 years（range，1-20 years），and the follow-up rate was 95.1%. The total 5-year overall survival was 65.9%. The 5-year survival after radical mastectomy, modified radical mastectomy, and simple mastectomy was 25%, 72%and 72.7% respectively.
Conclusions:The modified radical mastectomy is the surgical method of first choice for MBC. The influential factors on prognosis of MBC include type of operative procedure，the status of axillary lymph node， TNM tumor stage，the pathological type and the ER status.

Abstract:

Objective:To investigate the effect of crescent-shaped incision for modified radical mastectomy.
Methods:We retrospectively analyzed the clinical data of 129 cases of breast cancer. Modified radical mastectomy was done in all cases, of which, crescent-shaped incision was used in 51 caes (group A) and steward transverse incision was nsed in 78 cases (group B). Postoperatively, incision healing, the number of axillary lymph nodes which were dissected, and the satisfaction rate of shoulder function were observed.
Results:The success rate of wound healing in group A was 90.2% (46/51),and in group B was 75.6%(59/78)(P<0.05). Satisfactory rate of shoulder function in group A was 96.1% (49/51), and in group B was 84.6% (66/78)(P<0.05).
Conclusions:The crescent-shaped incision has low skin tension, good healing outcome, satisfactory exposure of axilla and minimal impairment of shoulder function, and thus is an ideal incision for modified radical mastectomy.

Abstract:

Objective:To study the expression of small breast epithelial mucin(SBEM) in the peripheral blood of  the patients with breast cancer, and explore the correlation between micrometastasis and SBEM.
Methods:Peripheral blood samples were obtained from 92 patients with breast carcinoma, 20 patients with benign breast diseases,10 patients with malignant tumor not originating from breast,and 10 normal healthy volunteers. SBEM-mRNA expression was detected by nested reverse transcription-polymerase chain reaction (Nested-RT PCR).
Results:Among 92 breast carcinoma patients, 43 (46.7%) were Nested-RT-PCR positive for SBEM-mRNA, but it was negative in all the other groups. The expression of  SBEM-mRNA in peripheral  blood did not  correlate  with ER or PR status, menstruation state or primary tumour size. but correlated  with  patient′s age, the state of Her-2,CEA, CA15-3 and axillary lymph node metastasis of breast cancer.
Conclusions:The expression of  SBEM-mRNA in peripheral blood of  breast cancer can be of potential use to monitor the micrometastasis of  breast cancer.

Abstract:

Objective:To examine the level of expression of microRNA-21(miR-21) in breast cancer and its adjacent non-cancerous tissues, and analyze the miR-21 expression with the clinicopathological factors of breast cancer.
Methods:Specimens of breast cancer and adjacent tissues were collected from 60 patients. Their miR-21 expression was detected by Stem-loop real-time RT-PCR, and levels of miR-21 expression in tumor size, TNM clinical stage, histology, lymph node involvement, and hormone receptor status were compared.
Results:High sensitivity, specificity and precision of Stem-loop real-time RT-PCR allowed for direct analysis of expression of miR-21 in breast cancer tissues and adjacent tissues. The expression of miR-21 in breast cancer tissues was markedly higher than in adjancent tissue （P＜0.001). Elevated miR-21 expression was also positively correlated with advanced TNM stage, lymph node metastasis, and low PR levels（P=0.007,0.001,and 0.012 respectively）. Moreover, the levels of expression of miR-21 in triple-negative breast cancer（TNBC）were higher than those in non-TNBC types（P=0.029）.
Conclusions:High levels of expression of miR-21 are correlated with degree of malignancy of breast cancer.

Abstract:

Objective:To explore the expression  and the significance of aquaporin 1 (AQP1) in breast carcinoma tissues.
Methods:Specimcns of breast carcinoma tissues of 40 cases and the non-cancerous adjacent tissues of 10 cases were obtained immediately after surgery, and expression of aquaporin1 in htese tissues was examined by RT-PCR technique.
Results:AQP1 mRNA expression level in breast tumor tissues was 0.8957±0.0428, that in non-cancerous adjacent tissues was 0.3401±0.0549, and there was significant difference between them (P＜0.05).
Conclusions:The expression of AQP1 is increased in breast carcinoma tissues compared to normal breast tissues.It suggests that AQP1 may be related to the growth and metastasis of breast carcinoma.

Abstract:

Objective:To investigate the diagnosis and treatment of bilateral thyroid carcinoma.
Methods:The clinical records of 72 cases of bilateral thyroid carcinoma from 2000 to 2008 were retrospectively analyzed.
Results:All cases were confirmed as bilateral thyroid carcinoma by paraffin section post-operatively. They included 17 cases of bilateral micro-carcinoma, 41 cases of one lateral  micro-carcinoma and other lateral non-microcarcinoma, and 14 cases of non- microcarcinoma. Pathological type was divided into 4 types: papillary carcinoma (67 cases,93.1%), follicular carcinoma(2 cases,2.8%), medullary carcinoma(2 cases,2.8%),poorly differentiated carcinoma(1 case,1.4%).Among them, 62 cases were treated with total thyroidectomy, 2 cases with near total thyroidectomy, and 8 cases with a lobectomy and a sub-total thyroidectomy. Central region lymph nodes were resected in all cases, and additional unilateral functional lymph nodes resection was performed in 19 cases. Central region lymph nodes metastasis rate was 33.33%（24/72）,and for bilateral micro-carcinoma of thyroid it was 17.65%（3/17）. There was some relationship between central region lymph nodes metastasis rate and cancer diameter, but no significant difference was shown(P>0.05). Seventy patients were followed up from 3 months to 8 years post-operatively, with tumor-free survival in 67 cases, and cervical lymph nodes metastasis in 3 cases. No permanent hypo-parathyroidism or paralysis of recurrent laryngeal nerves occurred.
Conclusions:Total thyroidectomy is advised for bilateral thyroid carcinoma. It is necessary to emphasize the importance of resection of the central region lymph nodes.

Abstract:

Objective:To analyse and explore the situation and causes of misdiagnosed primary hyperparathyroidism (PHPT), so as to develop some strategies for preventing and reducing misdiagnosis.
Methods:Clinical data of 94 misdiagnosed patients with PHPT treated in Beijing Jishuitan Hospital from November 1992 to April 2009 were collected and analyzed retrospectively.
Results:All cases were confirmed by operation and pathology. Among the 94 cases, 90 cases were of parathyroid adenoma,and 4 cases of parathyroid carcinoma. The rate of misdiagnosis was 97.9%（94/96）.The length of time of misdiagnosis was 2 months to 20 years; ＜1year: 24.4%, 1-2 years: 29.8%, 2-3 years: 12.8%, ≥3 years: 33.0%. The 94 cases were misdiagnosed as 16 sorts of diseases, mainly including osteoporosis (17.6%), pathologic fracture(15.3%), urinary stones (11.1%), bone tumor (8.3%), bone cyst （7.8%）,and rheumatic or rheumatoid  arthritis（7.4%）.The main causes of misdiagnosis were the complexity of clinical manifestations of primary hyperparathyroidism, and lack of the knowledge of primary hyperparathyroidism by some doctors.
Conclusions: The key of preventing and reducing misdiagnosis of primary hyperparathyroidism is to improve the  knowledge of PHPT in clinical doctors, especially in general surgeons, orthopedists, urologists and physicians. Serum calcium should be conducted as a routine examination, and it should be examined repeatedly in high-risk group. Blood PTH should be examined in patients with hypercalcemia.

Abstract:

Objective:To retrospectively evaluate the necessity to dissect the recurrent laryngeal nerve in operation of thyroid gland.
Methods:From Jan  2004 to Jan 2009, there were 512 patients in our hospital who underwent operation of thyroid gland, and they were divided into two groups aecording to whether or not the recurrent laryngeal nerve was dissected during the operation. The rate of injury of recurrent laryngeal nerve between the two groups was compared.
Results:Among the 189 cases in dissection of recurrent laryngeal nerve group, 3 cases (1.59%) had hoarseness after operation,and in the 323 cases without dissection of the recurrent laryngeal nerve group,5 cases (1.55%) had hoarseness after operation, but the difference was not significant（1.59% vs.1.55%）. However,in the high risk cases between the two groups, the difference was significant（1.02% vs. 3.95%）.
Conclusions:Whether oe not to dissect the recurrent laryngeal nerve should be decided by the specific circumstances.For most benign lesions, one should, if possible, not expose the recurrent laryngeal nerve; but for large thyroid neoplasms, second or multiple operations and thyroid cancer, exposure of recurrent laryngeal nerve is necessary.

Abstract:

Objective:To study the clinical value of endoscopic surgery for thyroid disease.
Methods:In 66 patients with thyroid disease, endoscopic thyroidectomy was performed, including 7 cases of thyroid adenoma,55 cases of nodular goiter,3 cases of thyroid cancer, and1 case of toxic nodular goiter.
Results:Among the 66 cases, endoscopic thyroidectomy was performed sucessfully in 65 cases, but 1 case was changed to open thyroidectomy. The operations  included unilateral sub-total thyroidectomy in 42 cases,and bilateral sub-total thyroidectomy in 21 cases; 3 in cases of thyroid cancer,total thyroidectomy was done in 1 case and unilateral total thyroidectomy plus isthmectomy was performed in 2 cases.The average operation time was 94(50-180)mins,while bleeding volume was 21（10-200）mlls and hospital stay was 9（5-19）days.There were no complications sucahs neural injury indavertent removal of parathyroid glands.No recurrence was found in 1 to 11 months follow up in all the cases（including 3 cases of thyroid cancer）.
Conclusions:Laparoscopic thyroidectomy can be carried out safely and effectively with minimal trauma and rapid recovery,and is the nethod of choice for benign lesion of thyroid.

Abstract:

Objective:To explore the safety,minimal invasion and cosmetic effect of endoscopic thyroidectomy.
Methods:From May 2007 to April 2008, among 413 cases of thyroid operations, 238 cases were operated by endoscopic techniguc and 175 cases were operated by traditional methods. the operation time, intra operative blood loss, incision cosmetic score, postoperative hospitalization time, cost of  hospitalization, and surgical complications between the two mehods  were compared.
Results:Both groups of patients were operated successfully without postoperative bleeding, hoarseness, or hypocalcemia. Compared with traditional thyroid surgery,endoscopic thyroidectomy had less blood loss, shorter operation time,and higher-satisfaction cosmetic effect without significant  scars or skin color changes.
Conclusions:Compared with traditional thyroid surgery,endoscopic thyroidectomy has the desired advantages of excelent cosmetic result, safety, and quick recovery. It is an ideal operation method for treatment of benign thyroid diseases.

Abstract:

Objective:To explore the expression and effect of the recombinant vector of human PAX8/ PPARγ fusion gene (PPFP) in human thyroid follicular epithelial cell Nthy ori 3-1.
Methods:The PAX8 gene was isolated and amplified by PCR technique from PAX8- pOTB7 plasmid. The PPARγ gene was isolated and amplified by PCR technique from PPARγ- pCMV-SPORT6 plasmid. Then the two genes were directionally united and this united gene was subcloned into the eukaryotic expression plasmid of pEGFP-C1 vector to generate the eukaryotic expression recombinant vector, pEGFP-C1-PAX8/ PPARγ.The correct PPFP gene was confirmed by PCR, edoenzyme digestion, sequencing, analysis, and contrast. After the co-transfection of pEGFP-C1-PAX8/ PPARγ and lipofectamine 2000 into human thyroid follicular epithelial cell Nthy ori 3-1,the expressions of PPFP fusion gene on the levels of mRNA and protein were detected by RT-PCR and Western blot.
Results:The correct eukaryotic expression recombinant vector, pEGFP-C1-PAX8/ PPARγ,was confirmed by verification.After the pEGFP-C1-PAX8/ PPARγ and Lipofectamine 2000 were transfected into Nthy ori 3-1 cells, the expressions of PPFP fusion gene on the levels of mRNA and protein were successfully detected.
Conclusions:The PPFP fusion gene and the eukaryotic expression recombinant vector pEGFP-C1-PAX8/ PPARγ have been constructed successfully. After this recombinant vector is transfected into Nthy ori 3-1 cells,it could successfully express PPFP protein，and provides an experimental basis for further exploring the molecular mechanisms of PPFP′s tumorigenesis.

Abstract:

Objective: To establish nude mice model of bone metastasis of breast cancer, and study the best method to evaluate the model.
Methods:The human breast cancer cell, MDA-MB-231PEGFPN, was injected into left ventricule of nude mice to construct the bone metastasis of breast cancer animal model. Methods of X-ray, whole body optical imaging and pathology were used to evaluate the bone damage after six weeks.
Results:After six weeks, the result of pathology showed that breast cancer cells had already spread to brain, bone marrow and lung of nude mice. The degree of bone destruction was seen clearly in X-ray, and location of breast cancer cells was observed by whole body optical imaging system.
Conclusions:The results showed that combined application of X-ray, whole body optical imaging and pathology are the best modalities to evaluate bone metastasis of breast cancer in nude mice.

Abstract:

Objective:To study the expressive levels of KAI-1 mRNA，Kiss-1 mRNA and MTA1 in  the benign and malignant lesions of breast, and their clinicopathological significance.
Methods:We detected the expression levels of KAI-1 mRNA，Kiss-1 mRNA and MTA1 in the  sections from 60 cases of breast cancer and 30 cases of benign lesions of breast.
Results:The positive rates and scores of KAI-1 mRNA and Kiss-1 mRNA were significantly lower in breast cancer than those in benign lesions(P＜0.05 or P＜0.01); but MTA1 were the opposite(P＜0.05 or P＜0.01).  The positive rates and scores of KAI-1 mRNA and Kiss-1 mRNA were significantly higher in those with intra-ductal  breast cancer, histological tumor grade I or II, non-metastasis of lymph node, positive expression of ER, and negative expression of CA15-3 than in those with ductal invasive breast cancer, histological tumor grade III, metastasis of lymph node, negative expression of ER, and positive expression of CA15-3(P＜0.05 or P＜0.01) ;but MTA1 expression was the opposite(P＜0.05  or P＜0.01). Highly close correlations were found among the expressive levels of Kal-1 mRNA and Kiss-1 mRNA, but negative correlation between expression of MTA1 and expressions of Kal-1 mRNA and kiss-1 mRNA  in breast cancer tissues(P＜0.01). The  Kaplan-Meier survival analysis showed the five-year survival rates and median survival times were significantly higher in the positive cases of Kal-1 mRNA or Kiss-1 mRNA expression than those in the negative ones of Kal-1 mRNA or Kiss-1 mRNA expression in the breast cancer(P＜0.01); but those of  MTA1 were the opposite (P＜0.01).
Conclusions:The expressive levels of Kal-1 mRNA, Kiss-1 mRNA and MTA1 might be important biological markers on the carcinogenesis, progression, biologic behaviors and prognosis of  breast cancer.

Abstract:

Objective:To evaluate the therapeutic value of minimally invasive excision of benign breast lesions using stereotactic mammotome minimally invasive surgery system.
Methods:Under ultrasonographic image monitoring, 1160 breast masses of 310 patients were excised using mammotome minimally invasive stereotactic excision system and sent for pathologic examinations immediatly. Patients′condition was follow-ed up and recorded  post-operative. Their clinical data were retrospectively analysed.
Results:Accurate and complete resection of all of  the 1160 breast masses was achieved. The resected tissues were large enough to make pathologic diagnosis. The pathologic diagnoses were all found to be benign, and included: fibroadenoma (n=672), fibroadenosis (n=451), intraductal papilloma (n=12), cyst (n=6),  cystic hyperplasia (n=17) and tubular adenoma (n=17). Regular follow up every 6-12 months was done. Postoperative surgical scars were unremarkable, the skin incisions were small and concealed, breast appearance and skin sensation were normal and ultrasonography did not reveal residual lesions or recurrences.
Conclusions:Complete resection of benign breast lesions can be done with mammotome technique. This technique is safe, accurate and effective. Moreover, there is little trauma, low complication rate, and the breast appearance is not affected. This minimally invasive excision technique for benign breast lesions is suitable for wide use.

Abstract:

Objective:To explore the treatment of type 2 diabetes mellitus (T2DM) patients by modified laparoscopic Roux-en-Y gastric bypass.
Methods:The clinical records of 11 patients with T2DM who underwent modified laparoscopic Roux-en-Y gastric bypass were retrospectively analyzed. The clinical parameters such as oral glucose tolerance test (OGTT), C-peptide releasing test (CPRT) and insulin releasing test  (IRT) were evaluated pre-and postoperatively.
Results:At one mnth after operation, there were no significant changes in BMI (P>0.05), but glycosylated hemoglobin，OGTT, CPRT and IRT were significantly ameliorated (P<0.05), and the diabetic symptoms were markedly relieved. Among them, 2 patients were followed up for more than 9 months, and 3 patients for more than 3 months.In these patients, there were no significant changes in BMI, but glycosylated hemoglobin，OGTT, CPRT and IRT were significantly ameliorated compared to before operation.
Conclusions:The modified laparoscopic Roux-en-Y gastric bypass is an effective treatment modality for non-and mild-obesity T2DM.

Abstract:

Objective:To study the safe distal resection margin in low anterior resection with total mesorectal excision for rectal cancer.
Methods:Between January 2003 and December 2007, 412 patients with rectal cancer ≦10 cm from the anal verge underwent low anterior resection with total mesorectal excision, and the rates of pstoperative complications, distal metastasis, tumor recurrence and survival in different distal resection margin lengths were compared.
Results:The rates of post-operative complications and distant metastasis were similar and no significantly differentin in patients with distal margins <2 cm, 2-3 cm or >3 cm. Distal margins <2 cm had significantly higher local recurrence rate (19.30%) when compared with 2-3 cm (8.37%, P=0.015) or >3 cm (7.69%, P=0.029). Kaplan-Meier estimates of survival rates at 3 years for the <2 cm, 2-3 cm and >3 cm groups were 69.4%, 86.5% and 89.9%, respectively, and those at 5years were 63.0%, 70.7% and 71.1%, respectively. Survival was significantly worse when distal margins were <2 cm compared with 2-3 cm (P=0.030) and >3 cm (P=0.040). Survival for the 2-3 cm versus >3 cm groups was not significantly different (P=0.707).
Conclusions:Our data suggest that for patients undergoing low anterior resection with total mesorectal excision for rectal cancer, distal margins less than 2 cm are associated with compromising oncological outcome, and at least 2 cm distal margin seems to be acceptable.