【Abstract】ObjectiveTo discuss the value of thyroglobulin (TG) in diagnosis and treatment of differentiated thyroid cancer (DTC) patients. MethodsLiteratures on measurement and clinical application of serum TG were reviewed. ResultsImmunometric assay (IMA) was adopted by most clinical lab.TG antibody （TGAb） should be measured in the same sample of DTC patient.TG detection before operation is of less value in confirming diagnosis of DTC, but is helpful in differential diagnosis of histopathological type of DTC.TG detection after operation is very important in patients who had undergone total thyroidectomy.Monitoring TG after thyroid hormone withdrawal or recombinant human TSH stimulation is more sensitive to identify tumor recurrence. ConclusionMonitoring TG after total thyroidectomy has great value in followup of DTC patients.
ObjectiveTo study the clinicopathologic features, diagnosis and treatment of papillary cystic and solid tumor of the pancreas (PCSTP).MethodsOne case with PCSTP in our hospital and a review of 60 others from the literatures of the People’s Republic of China, a total of 61 cases were analyzed retrospectively.ResultsThe patients (57 women, 4 men) were of mean age 24.6 (range 9~59) years. The main manifestations included abdominal mass (n=52), pain (n=22) and discomfort (n=10). They were distributed in the head (n=29), neck and body (n=2), body (n=1), body and tail (n=5), tail (n=16) and capsule (n=2) of the pancreas. The other 6 cases occurred outside the pancreas. All the patients underwent surgical therapy. The tumors were identified by postoperative histopathologic examination, 7 of which were malignant (11.5%). The total 1, 3, 5year survival rate was 100%, 96.1% and 86.5% respectively.ConclusionIt is difficult to correctly diagnose the PCSTP before operation because PCSTP is often lack of typical clinical manifestations. The correct diagnosis should depend on histopathologic examination.Complete removal of the PCSTP is the most perfect treatment. PCSTP has a good prognosis.
Objective To discuss the diagnosis and treatment of insulinoma, clinical characteristics and summarize our experiences. Methods The clinical, operative and pathologic findings from 15 cases of insulinoma of in our hospital from 1989 to 1998 were retrospectively studied. Results All 15 patients recieved surgical treatment. Fourteen patients were cured and the 15th patient died from hepatic failure six months later. Conclusion Insulinoma should be diagnosed and treated as early as possible. It can be cured by resection of the tumor.
Objective To investigate the etiology, diagnosis, and treatment of acute carpal tunnel syndrome (ACTS) after reduction of Colles’ fracture. Methods Between December 2006 and June 2010, 22 patients with ACTS after reduction of Colles’ fracture were treated with expectant treatment and surgical treatment. There were 9 males and 13 females with an average age of 46.2 years (range, 23-60 years). Fractures were caused by traffic accident in 9 cases, fall ing in 8 cases, fall ing from height in 2 cases, hitting in 2 cases, and crushing in 1 case. The mechanism of fracture was direct violence in 3 cases and indirect violence in 19 cases. According to Gartland ＆ Werley classification, there were 2 cases of type I, 5 cases of type II, 14 cases of type III, and 1 case of type IV. Closed reduction was performed in 19 cases and open reduction and internal fixation (ORIF) in 3 cases. The average symptom time of ACTS after reduction of Colles’ fracture was 11.6 hours (range, 1 hour 30 minutes to 48 hours) in patients undergoing closed reduction and was 24 hours in 1 patient and 2 weeks in 2 patients undergoing ORIF. Expectant treatment was performed first, the forearms were put in neutral position in closed reduction cases; if there was no rel ief of ACTS symptom 1 week later, the mixture of 1 mL glucocorticosteroid and 1 mL 2% l idocaine was injected into carpal tunnel once a week for 2 weeks. The mixture was injected into carpal tunnel directly once a week for 2 weeks in ORIF cases. In the patients who failed to expectant treatments, ORIF was performed. Results In 7 cases of type III that failed expectant treatment, ACTS symptoms were rel ief completely after ORIF. All the 22 patients were followed up 12 months on average (range, 8-18 months). The average time of complete disappearance of median nerve compression symptom was 11 days (range, 2-25 days). All the patients had normal finger motion, sensation, and opposition of thumb with no sensation of anaesthesia and pinprick. The results of Tinel test, Phalen test, and Reverse Phalen test were all negative. The X-ray film showed good fracture reduction and heal ing with an average heal ing time of 6 weeks (range, 3-14 weeks). According to GU Yudong’s criteria for functionalassessment, the results were excellent in 18 cases and good in 4 cases; the excellent and good rate was 100%. Conclusion Malposition, displacement of fracture fragments, and ulnar deviation of the wrist after plaster immobil ization are the mostimportant risk factors for ACTS. Expectant treatments are recommended in patients with Colles’ fracture of types I, II, and IV,but surgical treatment is the first choice for Colles’ fracture of type III.
【Abstract】ObjectiveTo report the diagnosis and treatment of hilar cholangiocarcinoma.MethodsThe relevant information about the hispathological feature, transfer ways, clinical manifestation, laboratory examination, imaging feature, immunohistochemical examination and treatment ways were gathered from previous original articles, and checking the latest issues of appropriate journals.ResultsThe clinical manifestation, laboratory examination, and imaging feature of hilar cholangiocarcinoma were due to the neoplasm obstructing bile duct and sequent infection of bile duct. The diagnosis was depanded on the combining clinical manifestation, laboratory examination and imaging feature. The value of immunohistochemical examination was not clear. Radical surgery was the best treatment of unique curing the neoplasm. By-pass surgery was used in the late phase patients to solve the obstruction of bile and digest duct. The effect of unique chemical treatment was not perfect. It did’t generally propose the treatment of orthotopic liver transplantation.ConclusionThe perfect prognosis of hilar cholangiocarcinoma is depended on early diagnosis and redical surgery.
【Abstract】ObjectiveTo investigate the causes of biliary tract complications after liver transplantation, and to put forward effective measures of prevention, diagnosis and treatment. MethodsThe literatures of recent years were reviewed and summarized. Results The causes of biliary tract complications after liver transplantation are very complex, and there are no standard preventive measures. Treatment differs according to causes. ConclusionOne of the most important causes leading to biliary complications is preservative and ischemic injury. Poorly operative techniques and blood supply to biliary tract are also disastrous. Improving T tube placement can reduce the incidence of biliary complications related with T tube. To prevent biliary complications, it is crucial to completely wash the biliary tract， avoid damaging the blood supply to donor biliary tract and manage perfect biliary mucosatomucosa anastomosis without tension. T tube cholangiography combined with noninvasive MRCP enables accurate depiction of the biliary tree and diagnosis of biliary complications. Doppler ultrosonography should be routinely applied postoperatively. Timely application of interventional radiological technique is a valuable nonoperative procedure for treatment of biliary complications. Meanwhile, biliary sludge or cholestasis and mixed infections of biliary tract should be handled actively and properly.
【Abstract】ObjectiveTo study the diagnosis and the treatment of gastrointestinal stromal tumor (GIST). Methods In this retrospective study, tissue slices, including immunohistochemical examinations, of 48 patients with GIST from January 1999 to December 2004 were collected. All of their clinical symptoms, pathologic characters, and surgical treatment and other information were also analyzed. ResultsTwenty-seven males and 21 females with a mean age of 68 were included in this report. All patients received tumor resections. Tumors were located in the stomach in the 29 cases (60.4%), and 11 cases (22.9%) were in the small intestine. The main clinical manifestations were alimentary tract hemorrhage (52.1%) and abdominal mass (35.4%). Immunohistochemical examination showed the positive rate of CD117 was 83.3%(40/48), and CD34 was 77.1%(37/48). Conclusion GIST mostly occurs at stomach and small intestine in aged people with clinical manifestations of alimentary tract hemorrhage and abdominal mass. The diameter of the mass is an important clinical index to distinguish malignant and benign tumors. The diagnosis of GIST depends on the combination of pathological and immunohistochemistry examinations. Complete regional resection of the tumor may be the most effective treatment.
Objective To investigate the diagnosis and treatment of the liver hydatidosis in nonpastureland. Methods Clinical features of 16 patients with liver hydatidosis were analyzed retrospectively. Results Only 8 of 16 patients possessed the clinical symptoms and 8 patients had had history of inhabitancy in epidemic area. Casoni test and indirect hemagglutination showed a sensitivity of 90% and the correct diagnostic rate of CT was higher than that of B-ultrasound examination. The main effective treatment of the liver hydatidosis was surgical, 15 out of 16 patients received surgical treatment. In this series, the curative effect was good without any death, allergic reaction and implantation. Conclusion The cystic lesion of liver should be considered as liver hydatidosis and Casoni test, indirect hemagglutination, together with CT and B-us examination can be used to comfirm the diagnosis though no clinical symptoms and history of inhabitancy in epidemic area presented. Surgical operation is the main effective treatment for liver hydatidosis.
Objective To study the diagnosis and treatment of portal hypertension in secondary biliary cirrhosis(PHSBC). MethodsTwenty-five cases of PHSBC within recent 16 years in our hospital were analyzed. Their clinical, pathological and follow-up data were reviewed retrospectively. They were divided into 4 groups according to their primary diseases:13 patients with hepatolithiasis, 6 with postoperative stricture of biliary duct, 4 with malignancy of biliary duct and 2 with others.Results All patients were diagnosed clinically, and 4 were further pathologically confirmed. Eight cases were treated conservatively, while the remaining 17 underwent operations according to their primary diseases, and one combined with splenectomy and esophagogastric devascularization. The rate of discharge with improvement by surgical and non-surgical treatment was 64.7% and 37.5%, and hospital mortality was 17.6% and 12.5% respectively. Conclusion The diagnosis of PHSBC mainly depends on its characteristic clinical manifestations. The early surgical resolution of bile duct obstruction is the key to good prognosis. If complicated with rupture and hemorrhage of oesophagofundal varices, the surgical procedure should be considered carefully.
【Abstract】ObjectiveTo summarize the experience in diagnosis and treatment for chronic lymphocytic thyroiditis or complicated with other thyroid diseases． MethodsSeventyseven patients were diagnosed as chronic lymphocytic thyroiditis or complicated with other thyroid diseases by operation and histological examination at this department from November 2002 to March 2005. All their clinical records including general information, the results of careful physical examination， thyroid correlated hormone tests， color Doppler, fine needle aspiration cytological examination and some intraoperative examinations have been retrospectively analyzed in this report. ResultsThere were 53 cases of simple chronic lymphocytic thyroiditis, 10 cases complicated by papillary carcinoma， 1 case complicated by follicular carcinoma， 2 cases complicated by nonHodgkin’s lymphoma, 6 cases complicated by nodular goiter, 4 cases complicated by follicular adenoma, and 1 complicated by parathyroid adenoma. Almost all the operations were successfull and the symptoms of the diseases were alleviated. Seventytwo patients had been followed up ranging from two months to two years differently and none of them relapsed. Sixtythree of these patients have received thyrine inhibition and vicariousness treatment, 2 patients who complicated by nonHodgkin’s lymphoma had been hospitalized and 7 patients complicated by carcinoma were treated with iodine131. ConclusionThe clinical manifestations of chronic lymphocytic thyroiditis are complex, and it often complicated with other thyroid disease, which make it difficult to diagnose the diseases before operation. However, some ancillary methods such as careful physical examination， thyroid correlated hormone tests， color Doppler and fine needle aspiration cytological examination may improve the accuracy of preoperative diagnosis. Intraoperative thyroid lamellar section and frozen histological examination are also very important for intraoperative diagnosis and operative modality selection．