Objective To compare the mean operative time and complications between the LigaSure device and Harmonic Scalpel during video-assisted endoscopic approaches thyroidectomy. Methods The clinical data of 684 cases performed Miccoli thyroidectomy by the same operation team from January 2007 to December 2011 in the department of general surgery，Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University were analyzed. Three hundred and forty-nine patients were used Harmonic Scalpel，335 patients were used LigaSure device. The mean operative time and complications （such as hematoma，transient hoarseness，permanent recurrent laryngeal nerve injury，and hypocalcemia） were compared between two groups. Results A total of 684 patients were included in the study，of whom 263 underwent total thyroidectomy and 421 underwent lobectomy. There were not significant differences of the operative time and the complications in both thyroidectomy and lobectomy between the LigaSure device and Harmonic Scalpel（P＞0.05）. Conclusions The uses of the LigaSure device and Harmonic Scalpel in thyroid surgery are safe and reliable，surgeons may choose surgical instruments by habits and medical equipments.
ObjectiveTo evaluate the value of preoperative risk assessment of papillary thyroid carcinoma with ultrasound for clinic diagnosis and treatment.MethodsThe data of 400 patients with papillary thyroid carcinoma received operative treatment in 2017 were retrospectively analyzed. Recorded and analyzed the ultrasonic risk assessment and postoperative grading of clinic risk assessment, to evaluate coherence and correlation between them.ResultsThere were 400 lesions with an average size of (12.8±8.5) mm. Among 400 lesions, diameter of 214 lesions less than 10 mm, diameter of 178 lesions were between 10 mm and 40 mm, and diameter of 8 lesions were larger than 40 mm. A total of 242 cases had lymph node metastasis and 309 cases had capsule invasion. Clinical and ultrasoud risk assessment was performed on 400 lesions. There were 224 lesions with low risk of clinical risk stratification vs. 111 lesions with low ultrasonic risk, 148 lesions with intermediate risk of clinical risk stratification vs. 270 lesions with intermediate ultrasonic risk, and 28 lesions with high risk of clinical risk stratification vs. 19 lesions with high ultrasonic risk. The consistency of postoperative recurrence risk stratification and preoperative ultrasound recurrence risk stratification was moderate (κ=0.414, P<0.01). In addition, the consistency between ultrasound examination and clinical lymph node metastasis was poor (κ=0.291, P<0.05), and the consistency of invasion of the capsule was moderate (κ=0.402, P<0.05).ConclusionPre- operative evaluation of recurrence risk grading before thyroid ultrasound, focusing on individualized preoperative assessment, the assessment is more detailed and detailed, and is helpful for follow-up treatment and early screening for recurrence risk.
Objective To evaluate the quality of controlled trials on 131I therapy for thyroglobulin positive and radioactive iodine negative metastases（131I WBS-/Tg+）. Methods We electronically searched MEDLINE (1966 to Mar. 2004), EMBASE (1984 to 2003), The Cochrane Central Register of Controlled Trial, CENTRAL (Issue 2, 2004), CBMdisc (1978 to 2004) and CNKI (1994 to 2004), and handsearched 5 radiotherapy and endocrinology journals (Jan. 1980 to Apr. 2003). The methodological quality of included studies was assessed by using quality assessment criteria of the Cochrane systematic review guideline. Results Three non-randomized controlled trials were included. One was historical controlled trial, and two prospective trials. The sample sizes of three trials were 26, 60 and 70 respectively without mentioning the calculation base. The comparability of baseline was mentioned but not comparable across the trials. No double blind studies were used in the assessment of 131I efficacy. The time of follow-up varied from 2 to 15 years. None studies mentioned the side effects of 131I therapy for 131I WBS-/Tg+ metastases. Only two studies applied statistical methods properly. Conclusions Problems about allocation of groups, double blind, sample size, and follow-up period continue to exist in published controlled trials. RCT or prospective controlled trials of high quality are urgently needed in order to define the efficacy and safety of 131I therapy for 131I WBS-/Tg+ metastases.
ObjectiveTo investigate the expression of tumor suppressor gene Tat interacting protein 30 (TIP30) gene in papillary thyroid carcinoma and it’s clinical significance in treatment of thyroid carcinoma. Methods Thirty cases of pathological specimens wax pieces of papillary thyroid carcinoma from 2003 to 2006 in our hospital were selected, in which there were 7 male, 23 female； and the age was from 15 to 70 years old, average 44.7 years. Six cases were nodular goiter with carcinomatous change in local area (papillary), 2 cases were thyroid capsular invasion. Distant lymph node metastasis and lesions surrounding the thyroid tissue were not confirmed by pathology. Every specimen was divided into tumor tissue and adjacent tissue (1-2 cm far away from tumor and non-cancerous tissue was confirmed by pathology). The expression of TIP30 in specimen was detected by immunohistochemical method with staining index and the average absorbance. ResultsTIP30 was expressed in the cell membrane and cytoplasm, which was showed as brown particles. ①Staining index: TIP30 in adjacent tissues was expressed highly with 21 (70.0%) positive cases (gt;2 points) and 9 (30.0%) negative cases (≤2 points), while its expression in cancer tissues was reduced or missed with 11 (36.7%) positive cases (gt;2 points) and 19 (63.3%) negative cases (≤2 points). There was a statistical difference between them (P＜0.05), and it was not related to age and gender of patients (Pgt;0.05). ②The average absorbance of TIP30 in cancer tissues was significantly lower than that in adjacent tissue (P＜0.05). ConclusionThe expression of TIP30 in papillary thyroid carcinoma is reduced or deleted, which can supply some theory support for its gene therapy.
ObjectiveTo analyze the clinicopathologic features of thyroid tumors with RAS gene mutation.MethodThe clinicopathologic data of thyroid tumor patients who underwent surgical treatment or biopsy and were diagnosed pathologically at the Department of Pathology of the Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2021 to June 2023, were collected. ResultsA total of 798 patients with thyroid tumors who met the inclusion criteria were collected, including 747 cases of follicular epithelial tumors and 51 cases of medullary thyroid carcinoma (MTC). Among 798 patients, the RAS gene mutations were detected in 36 cases (4.5%), including 25 (69.4%) patients with NRAS mutations, 8 (22.2%) patients with HRAS mutations, 3 (8.3%) patients with KRAS mutations, and 4 (1.1%) patients accompanied with TERT promoter mutations. Among 36 patients with RAS mutant thyroid tumors, the male to female ratio was 7∶11, with a median age of 48.5 years, with an average tumor diameter of 2 cm. The mutation rate of RAS gene in different histological types of thyroid tumors, from high to low, was highest in the thyroid follicular carcinoma (FTC, 25.9%), followed by differentiated high grade thyroid carcinoma (20.0%), anaplastic thyroid carcinoma (20.0%), noninvasive follicular thyroid neoplasm with papillary like nuclear features (18.2%), follicular variant of papillary thyroid carcinoma (FVPTC, 16.0%), and well-differentiated thyroid tumour of uncertain malignant potential (WT-UMP, 12.8%), the mutation rates of RAS gene in the FTC, FVPTC, and WT-UMP were significantly higher than that of the classical papillary thyroid carcinoma (P<0.001 1), and the mutation rate of RAS gene was the lowest in the classical papillary thyroid carcinoma (1.5%). A total of 35 patients were effectively followed up with an average follow-up period of 21.4 months, 6 of whom had cervical lymph node metastasis, 4 patients developed distant metastasis, and 1 patient with anaplastic thyroid carcinoma died. ConclusionsRAS gene mutation can occur in thyroid follicular differentiated tumors and MTC. NRAS mutation is more common. The mutation rate is the highest in FTC, is the lowest in classical papillary thyroid carcinoma. Differential diagnosis combined with tissue morphology and other molecular changes can provide a reference for guiding treatment and evaluating prognosis.
Objective To investigate the value of bipolar coagulation forceps combined with meticulous capsular dissection technique in thyroidectomy. Methods Information of 203 patients with thyroid neoplasms who underwent thyroidectomy in Longyan First Hospital from January 2014 to July 2015, were collected retrospectively. Patients were divide into control group (98 patients who had received conventional thyroidectomy) and observation group (105 patients who had received bipolar coagulation forceps combined with meticulous capsular dissection technique in thyroidectomy) according to the surgery type. Then comparison of 2 groups in incidence of recurrent laryngeal nerve injury, temporary hypocalcemia, temporary or permanent hypoparathyroidism, serum parathyroid hormone (PTH) and serum calcium was performed. Results All the operation of 203 patients went smoothly, and no operative death happened. Operation time of control group and observation group showed no obvious difference〔(68.24±16.59) minvs. (64.78±14.20) min,P>0.05〕, but the intraoperative blood loss of control group was more than observation group〔(25.44±8.35) mLvs. (16.58±5.44) mL,P<0.05〕. There were 25 patients suffered from temporary hypocalcemia after operation, including 18 patients in control group and 7 patients in observation group. There were 38 patients suffered from temporary hypoparathyroidism after operation. including 24 patients in control group and 14 patients in observation group. The incidences of temporary hypocalcemia (χ2=6.426,P<0.05) and temporary hypoparathyroidism (χ2=4.147,P<0.05) were both lower in observation group than corresponding index of control group. But no one suffered from permanent hypoparathyroidism. There were 17 patients existent hoarseness in the control group and 14 patients in observation group, but no one had cough caused by superior laryngeal nerve injury of all the patients, and the incidence of hoarseness of 2 groups had no significant difference (χ2=0.637,P>0.05). Conclusions Bipolar coagulation forceps combined with meticulous capsular dissection technique in thyroidectomy could reduce the temporary hypocalcemia and temporary hypoparathyroidism, and provide the better protection to the blood supply of parathyroid. In addition, bipolar coagulation forceps could reduce thermal injury and heighten hemostasis. So, it is worthy to perform bipolar coagulation forceps combined with meticulous capsular dissection technique in thyroidectomy.
ObjectiveTo investigate the correlation between the expressions of bone morphogenetic protein 4 (BMP4) and sma and mad homologue 4 (Smad4) and their clinicopathological features in papillary thyroid carcinoma (PTC).MethodsEighty patients with PTC confirmed by pathology in the Pingdingshan Second People’s Hospital from March 2018 to March 2020 were selected as the research objects, the cancer tissues and adjacent tissues removed during surgery were collected. The mRNA expression levels of BMP4 and Smad4 were detected by real-time quantitative PCR (qRT-PCR). The correlation between BMP4 and Smad4 mRNA expression levels was analyzed by Pearson method. The expressions of BMP4 and Smad4 protein were detected by immunohistochemistry. The correlation between the expressions of BMP4 and Smad4 protein and clinicopathological features of PTC was analyzed.ResultsThe mRNA expression levels of BMP4 and Smad4 in PTC tissues were lower than those in adjacent tissues (P<0.05). Pearson analysis showed that there was a positive correlation between expressions of BMP4 mRNA and Smad4 mRNA in PTC cancer (r=0.660, P<0.05). BMP4 and Smad4 protein were localized in cytoplasm, and the cytoplasm was stained yellow or brown yellow. The results of immunohistochemistry showed that the expression positive rate of BMP4 in cancer tissues of PTC patients was lower than that in adjacent tissues (18.8% vs 97.5%, χ2=101.916, P<0.05), and the expression positive rate of Smad4 protein in cancer tissues of PTC patients was also lower than that in adjacent tissues (11.3% vs 93.8%, χ2=109.173, P<0.05). The expressions of BMP4 and Smad4 protein in PTC patients were correlated with the tumor size, TNM stage, lymph node metastasis, degree of infiltration and multiple foci (P<0.05).ConclusionsThe expression levels of BMP4 mRNA and Smad4 mRNA in PTC tissues are decreased, and the expression of BMP4 protein and Smad4 protein are closely related to tumor size, TNM stage and lymph node metastasis, which may be used as new therapeutic targets.
ObjectiveTo study the expressions of BRAF gene in papillary thyroid microcarcinoma (PTMC) and papillary thyroid carcinoma (PTC) >1 cm in diameter, and the invasiveness of PTMC and PTC. MethodsThe data of 275 patients with PTC received surgical treatment and with BRAF gene mutation results in West China Hospital of Sichuan University from 2011 September to 2013 September were retrospectively analyzed. According to the size of tumors, the patients were divided into three groups, was the diameter <1 cm group, 1 cm< diameter≤2 cm group, and diameter >2 cm group,respectively. The ratio of BRAF gene mutation, and the degree of risk of extrathyroidal invasion and lymph node metastasis were compared. ResultsUnivariate analysis showed that tumor size was not related with the age, gender, and BRAF gene mutation rate (P>0.05), while the tumor size was related with the extrathyroidal invasion and lymph node metastasis (P<0.05), and the ratio of BRAF gene mutation was related with the extrathyroidal invasion and lymph node metastasis (P<0.05). Multivariate analysis showed that tumor size was associated with extrathyroidal extension (P=0.009) and lymph node metastasis (P=0.000). ConclusionsBRAF gene mutation can increase the extrathyroidal invasion and lymph node metastasis risk of PTC, and it is no significantly correlated with tumor size of PTC. The invasiveness of PTC increases with the increased of tumor size, but the PTMC of BRAF gene mutation positive is still require positive treatment.
ObjectivesTo explore if epilepsy and idiopathic hypoparathyroidism could be coexisted in one patient.MethodsCollected clinical data of two epilepsy children with idiopathic hypoparathyroidism from the Second Affiliated Hospital of Xi’an Jiaotong University in January 2009. We record the clinical material in detail. The follow-up of two cases is oven 9 years. The diagnosis of idiopathic hypothyroidism is mainly based on the typical history, hypocalcemia, hyperphosphatemia, and hypoparathyroid hormone concentrations. The CT scans show calcifications at the junction of the basal ganglia and cortex and medulla.ResultsDuring 9 years of follow-up, both cases had recurred of convulsions due to reduced use of anti-epileptic drugs under conditions of normal serum calcium and phosphorus levels. Spontaneous slow wave can be found during 24 hours of EEG monitoring in the awake or sleep period. They continue oral antiepileptic drugs.ConclutionsWe suggested that children with idiopathic hypoparathyroidism can be combined with epilepsy. And the mechanism may be related to abnormal intracranial calcification. In addition to calcium and active vitamin D, anti-epileptic drugs which have little effect on metabolism of calcium and phosphorus should be selected for treatment.
From May 1982 to September 1994, 13 cases patients with acute suppurative thyroiditis were treated. Their ages ranged from 6 to 39 years with a mean of 13. 9 years (nine of them were children). In this group, 8 cases had a pre-existing thyroid mass. Correct diagnosis were made preoperatively in 11 cases and the other two were misdiagnosed before operation. Eleven patients underwent incision and drainge, amony them 6 cases had been followed up with no recurrence. Based on this result and re-viewing literatures, the author draw the conclusion that acute suppurative thyoiditis is related with fistula of pyriform fossa, incision and drainage must be carried out and if there is fistula present, fistulectomy should be performed.