【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.
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 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.
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 investigate the prophylaxes, diagnosis and treatment of pelvi-peritoneal hernia (PPH) after Miles operation for rectal carcinoma. Methods Three hundred and nine patients who underwent Miles operation from January 1986 to June 1999 were collected and analysed retrospectively, 11 of them were complicated with PPH. Results The morbidity of PPH after Miles operation was 3.6% (11/309). The main manifestations included abdominal distention to some extent (11 cases), pain (3 cases), vomiting (2 cases), gastric liquid more than 500 ml a day by gastric tube (3 cases), and non-exsufflation of the stoma of colostomy (11 cases). Two cases had pea green small intestinal liquid by perineal tube. The signs were slight abdominal tender (5 cases), active or excessive intestinal gurgling sound (7 cases), and diminished intestinal gurgling sound (4 cases). Abdominal plane films, showing the distant small intestinal obstruction, were taken in all 11 cases. Only 2 patients were correctly diagnosed before reoperation, and other patients were regarded as adhesive intestinal obstruction. The average observational time following appearance of the clinical manifestations after Miles operation was 7.4 days. All patients were diagnosed by laparotomy, 3 of them underwent adhesion lysis and reposition, and 8 patients partial ileum resection and anastomosis. The content of the hernias was ileum. The morbidity after reoperation was 27.3% (3 cases), and the complication was wound infection. All 11 patients were cured and left hospital. Conclusion The PPH after Miles operation is often lack of typical clinical manifestations. The early diagnosis and laparotomy in time is key to management. It is important to prevent the complication.
【Abstract】Objective To investigate the diagnosis and treatment of primary small intestinal tumor (PSIT). MethodsEighty-eight cases of PSIT were analyzed in our hospital retrospectively. Results Thirty-six cases were diagnosed before operation, 52 cases were misdiagnosed and the percentage amounted to 59.1%. The major clinical manifestations of PSIT were abdominal pain (66 cases, 75.0%), obstruction (56 cases, 63.6%), abdominal mass (51 cases, 58.0%) and stool with blood (48 cases, 54.5%).The major pathological types of PSIT were adenocarcinoma (55.7%), sarcoma of smooth muscle (25.0%), lymphoma (13.6%), fatty sarcoma (5.7%). The tumors of 36 cases located in jejunum (40.9%), 34 cases in ileum (38.6%) and 18 cases in duodenum (20.5%).Conclusion It is difficult to diagnose PSIT before operation. The following advice could help to get a correct diagnosis: ① Surgeons should be alert when meeting a patient with the above symptoms, and then collect and analyze the clinical data comprehensively. ②Patients over 40 years with complaints of inexplicable abdominal pain, weight loss, anemia, dyspepsia and abdominal mass should be examined appropriately by gastrointestinal X-ray, gastrointestinal endoscopy, ultrasonography, CT and angiography of superior mesenteric artery. ③When the diagnosis can’t be confirmed, an exploratory operation should be performed immediately to avoid the delay of treatment. ④The treatment of PSIT includes radical resection of small intestine and chemotherapy according to the pathological results of tumor.
【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 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．
【Abstract】ObjectiveTo facilitate a better understanding of the progress in the research, diagnosis and treatment of PeutzJeghers syndrome (PJS).MethodsAlmost all the papers related to PJS from various magazines published in English and Chinese in recent years were reviewed. Current progresses in PJS research and related diagnosis and treatment were discussed in this review.ResultsPJS is a rare inherited disease with autosomal dominant trait, which is characterized by the presence of hamartomatous gastrointestinal polyps and mucocutaneous pigmentation of the lips, buccal mucosa, and digits. This syndrome is commonly complicated with intestinal obstruction, bleeding, or intussusception,and patients with this disease are at high risk for the development of both GI and extraintestinal malignancies. STK11 on chromosome 19p13.3 are responsible for most cases of PJS. The polyps of PJS tend to have a high incidence of malignant change, and the recurrence of malignancy after treatment is also high. ConclusionThe STK11 has been identified as one of the main genes responsible for PJS and has close correlation with formation and development of tumors. Patients with PJS are at high risk for the development of both GI and extraintestinal malignancies.
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.