Abstract:Objective:To study the causes of thyroid reoperation and the prevention of operative complications. Methods:The clinical data of 96 cases who underwent reoperation of thyroid were retrospctively analysed. Results:There were 31 cases of thyroid carcinoma(14.0%, P<0.05) undergoing reoperation, which was higer than that of total thyoid reoperation. There were 14 cases suffered postoperative complications in this series(14.6%), which was higher than for the patients undergoing primary operationrate(5.3%)(P<0.05). 11 of 51 patients who underwent two operative interventions on the same side thyroid suffered postoperative complications(21.6%), the rate was higher than for patients in whom both operations involved different sides(6.7%)(P<0.05). The interval between the two operations did not affect the rete of postoperative complications(P>0.05). Conclusions:Thyroid reoperation is more difficult than primary operation, and has a higher postoperative complications rate. Thyroid reoperation should be avoided or decreased, so the operator should do the best at the time of the primary operation, and timely reoperation should be performed when necessary. Thyroid reoperation should be performed carefully to decrease complications as much as possible.

Abstract:Objective:To evaluate the methods of diagnosis and treatment of thyroid disease with concomitant focal lymphocytic thyroiditis(FLT), and explore the reasons for its confused with Hashimoto′s disease(HD).Methods:During the recent 25 years, 207 patients underwent surgical trearment for pathologically diagnosed HD.Among this group, 143 cases of HD with other concomitant thyroid disease were retrospectively analysed.Results:Of the 143 cases, 57 cases were found to have thyroid disease with concomitant FLT, and this was 27.5%(57/207) of the total HD group, or 39.9%(57/143) of the group with thyroid disease and concomitant HD.Intraoperative pathologic section revealed that focal lymphocytic infiltration was positive in 87.7%(50/57) of cases. The postoperative hypothyroidism occurrence rate was 19.3%(11/57), of which, 7 cases(7/57, 12.3%) were subclinical hypothyroidism.Conclusions:The character of pathologic changes of thyroid disease with FLT and with HD was different. Intraoperative pathologic section can be helpful in the diagnosis of this condition and can have important significance as a guide to the scope of surgical resection of the thyroid gland.

Abstract:Objective:To investigate a method to detect the sentinel lymph nodes(SN) of thyroid papillary carcinoma and its predictive value for cervical metastasis of carcinoma. Methods:Intraoperative methylene blue dye mapping was performed in 24 cases of thyroid papillary carcinoma. The coincidence rate of frozen section pathology and routine section pathology of SN was observed,and the predictive value of SN for metastasis of the cervical lymph nodes was noted. Results:SN was successfully detected in 21(87.5%) of 24 cases. The average number of SN was 3 nodes. There was one false negative case, the false negative rate was 4.8%(1/24), and no false positive cases were found. The predictive value of sentinel lymph nodes to cervical lymph node metastasis was 83.3%.Conclusions:Methylene blue staining to identify sentinel lymph nodes could accurately predict the status of cervical lymph node metastasis of thyroid papillary carcinoma.

Abstract: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.

Abstract:Objective:To investigate the different clinical behavior and the diagnosis and trearment of primary hyperparathyroidism(PHPT). Methods:Clinical data of 53 patients with PHPT treated in Beijing Jishuitan Hospital from May 1977 to April 2004 were collected and analyzed. Results:53 patients with PHPT were confirmed by operation and pathology. The majority of the patients were aged 20~50 years. There were more female than male patients. There were various clinical manifestations, and the duration of illness was protracted. Many cases were misdiagnosed. There were bone pathologic changes of varying extent in all patients, stones in urinary system plus bone pathology in 11 cases, serum level of calcium was raised in 51 patients(96.2%) and parathyroid hormone (PTH) was elevated in all examined 48 cases. Ultrasound, MIBI and CT were done before operation after 1991, and accurate preoperative localization diagnosis was obtained. Minimally invasive parathyroidectomy (MIP) was successfully completed in 39 of 45 cases, and the primary operation cure rate was 97.4%. At postoperative followup of 10 months to 10 years, with the exception of 15 cases of severe bone deformity that had no obvious improvement, the other symptoms and signs were all relieved to varying extents, the laboratory markers returned to normal, and there was no permanent hypoparathyroidism or recurrent nerve injury or other complications.Conclusions:Early diagnosis of PHPT and effective early treatment by surgical removal of the pathologic lesion can alleviate the occurrence of severe bone changes and deformity. The preoperative combined use of imaging localization technique and overall assessment can improve the accuracy of diagnostic localization of the lesion.

Abstract:Objective:To investigate the expression of CMET in papillary thyroid carcinoma(PTC) with cervical lymph node metastases, PTC without cervical lymph node metastases,follicular thyroid carcinoma and benign thyroid disease and the clinical significance. Methods:The expression level of CMET was examined by immunohistochemical analysis with CMET monoclonal antibody in 62 cases of PTC with cervical lymph node metastases, 50 cases of PTC without cervical lymph node mestastases, 10 cases of follicular thyroid carcinoma and 30 cases of benign thyroid disease. Results:PTC with cervical lymph node metastases expressed significantly greater level of CMET than the other forms of thyroid carcinoma and benign thyroid disease(P<0.001). CMET expression was significantly different for the following pairs of thyroid specimens:PTC with cervical lymph node metastases versus PTC without cervical lymph node metastases, P<0.001; PTC with cervical lymph node metastases versus follicular thyroid carcinoma, P<0.001; PTC with cervical lymph node metastases versus benign thyroid disease, P<0.001; PTC without cervical lymph node metastases versus follicular thyroid carcinoma, P=0.002; PTC without cervical lymph node metastases versus benign thyroid disease, P<0.001. The distributions of CMET expression were not significantly different for follicular thyroid carcinoma versus benign thyroid disease, P=0.015. Conclusions:Intense CMET expression is indicative of the presence of the cervical lymph node metastases and a marker of extracapsular spread and direct extension of PTC.It is significance for preoperative assessment of cervical lymph node metastases of PTC and in the choice of operative methods.

Abstract:Objective:To explore the effect of breastconserving therapy for breast cancer(BCT) and its prognosis. Methods:The clinical data of 69 cases of BCT admitted from January 1992 to December 2003 were analyzed retrospectively. The cases included those who had BCT without radiotherapy and those who had BCT with adjuvant radiotherapy, chemotherapy and hormonal therapy. The patients were followed up for 12 to 140 months. Results:The 3year recurrence rate for patients without radiotherapy (11.54%) was higher than that for those with radiotherapy (3.03%) (P＜0.05). In nodepositive patients, the 5year distant metastasis rate for patients without chemotherapy(49.21%) was higher than that for those with chemotherapy (7.81%) (P＜0.05) . Conclusions:Radiotherapy must be given after BCT. Patients who are young or nodepositive, or have histological grade III tumor should receive adjuvant chemotherapy.

Abstract:Objective:To evaluate the effect of different skin flap management methods on post operative subcutaneous fluid collection and skin flap necrosis after modified radical mastectomy for breast cancer. Methods:A retrospectively analysis of clinical data of 119 cases of breast cancer operated by modified radical mastectomy in our hospital in recent four years. Statistically analyse the relationship between 4 different skin flap management methods to postoperative subcutaneous fluid collection and skin flap necrosis. Results:43 out of 119 cases developed postoperative subcutaneous fluid collection and/or skin flap necrosis. There were 13 cases with complication of subcutaneous fluid collection, 3 cases with skin flap necrosis among 79 cases treated by transverse incision；20cases with complication of subcutaneous fluid collection, and 7 cases of skin flap necrosis among 40 cases treated by longitudinal incision; 23cases with complication of subcutaneous fluid collection, and 8 cases of skin flap necrosis among 60 cases treated by “skin flap management type one”; 23cases with complication of subcutaneous fluid collection, and 2 cases of skin flap necrosis among 59 cases treated by “skin flap management type two”. Conclusions:A transverse incision after subcutaneous injection of 1∶〖KG-*2〗〖KG(*7〗400 adrenaline saline solution, plus the use of scalpel dissection and the technique of skin flap fixation by the “rivet” method can effectively decrease postoperative development of subcutaneous fluid collection and necrosis of incisional skin margins.

Abstract:Objective:To explore the diagnostic and therapeutic methods for male breast cancer. Methods:Clinical data of 11 cases of male breast cancer treated in our hospital from 1992 were analyzed retrospectively. Results:2 patients were diagnosed at advanced stage and survived 6 and 8 months respectively after biopsy. The other 9 patients received radical mastectomy. 3 were lost to followup, 1 was found to have pulmonary metastasis after 5 years and combined treatment of traditional Chinese medicine and western medicine was given. Nodules were found under the axillary fossa in another patient at five years after surgery and the nodules were recurrent carcinoma as confirmed by biopsy. The patient has survived for 7 years with radiotherapy and chemotherapy. The other 4 cases have survived 0.5 to 7 years respectively, and are undergoing treatment. Conclusions:Early diagnosis of male breast cancer should be emphasized. Aggressive surgery combined with other auxiliary treatments are effective.

Abstract:Objective:To observe the serum VEGF/ES ratios before and after operation and at clinical relapse in patients with breast cancer, and to discuss the potential effect of tumor surgery and postoperative relapse on the angiogenesis balance. Methods:The serum VEGF and ES levels of 59 cases of breast cancer before and after operation and at clinical relapse were determined using competitive enzyme immunoassays and ELISA, respectively, and compared with the results of 30 cases of benign breast tumors and 59 cases of normal controls. Results:(1) Preoperatively, the serum ES and VEGF levels of breast cancer patients were significantly elevated, as compared to the other 2 groups, and the VEGF/ES ratio was 9.1. Postoperatively, at 3 weeks, VEGF level decreased significantly and ES remained at a high level. The VEGF/ES ratio was 3.3. (2)At the time of clinical relapse, serum VEGF level was followed by marked elevation, and the VEGF/ES ratio increased up to 14.2. Multivariate analyses showed that the postoperative VEGF/ES ratio was an independent factor related to the postoperative recurrence of breast cancer. Conclusions:Breast cancer surgery may affect the balance between serum VEGF and ES, and the determination of VEGF/ES ratio can have auxiliary value in the assessment of prognosis of breast cancer patients.

Abstract:Objective:To investigate the effect of CDAII on apoptosis of breast cancer cells. Methods:The effects of CDAII on growth curve, cell apoptosis and morphology of breast carcinoma cell lines MCF7 and MDAMB231 were observed by in vitro cultures, and compared with the classical cell differentiation inducer ATRA. MCF7 and MDAMB231 cell lines have their different biologic characteristics. Results:CDAII can reduce growth and proliferation ability and induce cell apoptosis of breast cancer cell lines( MCF7 and MDAMB231). Conclusions:CDAII has remarkable effect of anticellproliferation and induction of apoptosis on breast cancer cells MCF7 and MDAMB231 . Our results provide experimental bases for the treatment of breast carcinoma with CDAII.

Abstract:Objective:To investigate the growth inhibition and apoptosis induction effect of vitamin E succinate on MCF7 human breast cancer cells and to analyze the modulation of Fas expression in this process. Methods:Estrogen receptor positive MCF7 human breast cancer cells were treated with VES for 12h, 24h and 48h. The concentrations of VES were 5μg/mL, 10μg/mL and 20μg/mL. The inhibitory effect was measured with MTT method and the cell cycle and cell surface Fas expression were analyzed with flow cytometry. Fas protein level was detected by Western blotting assay. Results:VES had significant inhibitory effect on the growth of MCF7 human breast cancer cells and the effect was dependently related to time and dosage. The apoptotic rate rose from 1.2% to 11.2%、16.4%和41.2%,after treated with VES for 48h at the concentrations of 5μg/mL，10μg/mL和20μg/mL respectively. Fas protein level and cell surface Fas expression in cancer cells increased after the administration of VES. Conclusions:VES had significant growth inhibition and apoptosis induction effect on MCF7 estrogen receptor positive breast cancer cells. The mechanism was related to Fas upregulation on the surface of cancer cells.

Abstract:Objective:To explore the role of Bcl2 and Caspase3 in modulating apoptosis of ERnegative breast cancer cells induced by tamoxifen. Methods:ERnegative breast cancer cell lines MDAMB231 were treated with 10.0μM tamoxifen for 12, 24, 36、48, 60 hours. The rate of cell apoptosis with or without caspase3 inhibitor AcDEVDCHO, and protein expression of Bcl2，Bax were determined by flow cytometry, and the activity of Caspase3 was examined with fluorophotometry. Results:The expression of Bcl2 was downregulated, the activity of Caspase3 and the rate of cell apoptosis were increased by TAM timedependently, and the rate of apoptosis reached its peak at 48 hours. The expression of Bcl2 was negatively correlated with activity of caspase3. Tamoxifen, however, did not affect Bax protein expression. AcDEVDCHO, a caspase3 inhibitor, blocked the activation of caspase3 and inhibited cell apoptosis induced by tamoxifen. Conclusions:TAM could induce apoptosis in ERnegative breast cancer cells via mitochondria pathway by downregulating Bcl2 expression, and the activation of Caspase3 might play an important role in the process of tamoxifeninduced apoptosis of ERnegative breast cancer cells.

Abstract:Objective:To investigate the expression of FHITmRNA and WWOXmRNA in human breast cancer tissues and its relation to clinicopathological and other molecular parameters. Methods:With reference to the expression of βactin，the expression of FHITmRNA and WWOXmRNA was determined by reverse transcriptionpolymerase chain reaction(RTPCR) in 51 breast cancer and adjacent breast tissue, and semiquantitative analysis of band densities was performed. The protein expression of estrogen receptor(ER), progesterone receptor (PR), Her2 gene in the 51 breast cancer lesions was detected by immunohistochemical method. Results:FHITmRNA and WWOXmRNA expression was significantly different in 54 breast cancer tissue compared to adjacent breast tissue (P<0.01). The expression of FHITmRNA and WWOXmRNA in 51 breast cancer tissue was reduced and was related to the clinicopathological stage(P>0.05); of FHITmRNA and WWOX mRNA was related to axillary lymph node metastasis (P<0.05). There are correlations between the low expression of FHITmRNA and WWOXmRNA in breast cancer tissue. Conclusions:FHIT and WWOX are candidate tumor suppressor genes. Detected coordinately with other molecular parameters, they can make the prognosis of therapy more accurate to predict.

Abstract:Objective:To explore the suppressive effect of survivin antisense oligonucleotide on transplanted human breast cancer in nude mice. Methods:30 nude mice were transplanted with human breast cancer MCF7 cells to construct tumor models, which were divided into three groups (10 mice per group): Lipofectin, ASODN/Lip, and NODN/Lip were injected in to the tumor or around the tumor, respectively. A total of 3 injections were given, once every five days. Observations were made on tumor suppression rate, tumor volume and changes in weight of the animals. TUNEL method and transmission electron microscopy were used to investigate cell apoptosis of the tumor; western blot was used to detemine the expression of survivin protein in the 3 groups. Results:The subcutaneous tumor model in nude mice was successfully established. The tumor volume in the group of ASODN/Lip decreased during treatment, the rate of tumor suppression reached 70.10%; while the tumor volume of the other two groups increased. There was no statistical difference among the groups in weight changes of the 3 groups mice, the apoptosis rate in ASOND/Lip group was 38.6% detected by TUNEL and the rate was markedly higher than the other two groups(P<0.05). The expression of survivin protein in ASODN/Lip group decreased significantly. Conclusions:Survivin antisense oligonucleotide can effectively suppress human breast cancer cells growth rate in subcutaneous tumor of nude mice and accelerate the induction of apoptosis of tumor cells.

Abstract:对内镜下鼻胆管引流治疗胆囊切除术后胆漏的10例患者的临床资料进行回顾性分析。全组胆漏发生在胆囊切除术后3～5d,均予以ERCP确诊并行鼻胆管引流治疗。10例全部愈合，愈合时间为5～15（平均11.6）d。提示内镜下鼻胆管引流术是治疗胆囊切除术后并发胆漏的安全、有效的非手术治疗方法。