The patient has found his neck mass for more than 30 years, and the neck mass has slowly growed into giant tumor. Five days ago, the neck giant mass suddenly burst, hemorrhage and overflow liquid. The giant mass with irregular in shape, surface uneven, skin highly tension and superficial venous engorgement, was seen in left lateral neck. CT scan demonstrates a mixture of solid, cystic and lobulated mass shadow within subcutaneous fat spaces of left lateral neck. Postoperative pathological examination proved that it is salivary gland pleomorphic adenoma.
Adenoma, Pleomorphic ; Aged ; Female ; Head and Neck Neoplasms ; Humans ; Salivary Gland Neoplasms

Objective To explore the change of function of adrenal cortex in patients with hyperthyroidism to provide theoretical evidence for clinical practice. Methods The reaction of adrenal cortex to small dosage of ACTH was detected and compared with each other in normal controls,in patients with mild hyperthyroidism,and patients with severe hyperthyroidism. Results The reaction to small dosage of ACTH was statistically different among the three groups \[F=278.3(15 min), 274.2(30 min), 469.8 (60 min), 273.3(min),866.2(AUC),P

Objective To study the expression of Gli1 protein and vascular endothelial growth factor (VEGF)-C in papillary thyroid carcinoma and their relationship with cervical lymph node metastasis.Methods The expression of Gli1 protein and VEGF-C were investigated by immunohistochemical EnVision method in 67 cases of papillary thyroid carcinoma and 32 cases of nodular goiter pathological specimen tissues.Nascent microvascular and micro-lymphatic of all pathological speimen tissues were examined by immunohistochemical monoclonal antibody CD34 and D2-40 staining assay respectively,and the microvascular density (MVD) and micro-lymphatic vessel density (MLVD) were calculated.The relationship between the positive expression of Gli1 protein and MVD,between the positive expression of VEGF-C and MLVD,and their relationship with cervical lymph node metastasis were analyzed.Results The positive rates of Gli1 protein,VEGF-C and MVD,MLVD were significantly higher in papillary thyroid carcinoma than those in nodular goiter [67.16％(45/67) vs.43.75％(14/32),70.15％(47/67) vs.31.25％(10/32),23.14 ± 2.06 vs.2.14 ± 0.31,13.36 ± 1.32 vs.3.53 ± 0.65,P ＜ 0.05].The positive expression of Gli1 protein was related to the patient' s age and the tumor size (P ＜ 0.05),while the positive expression of VEGF-C was not related to the patient' s age and the tumor size (P ＞ 0.05).The positive expression of Gli1 protein and VEGFC were significantly higher in TNM stage Ⅲ-Ⅳ of papillary thyroid carcinoma than those in TNM stage Ⅰ-Ⅱ (P ＜ 0.01) and also was significantly higher with cervical lymph node metastasis than without cervical lymph node metastasis (P ＜ 0.01).MVD and MLVD were significantly higher with cervical lymph node metastasis than without cervical lymph node metastasis (P ＜ 0.05).The positive expression of Gli1 protein was positively correlated with MVD (r =0.784,P＜ 0.01),the positive expression of VEGF-C was positively correlated with MLVD (r =0.529,P ＜ 0.01),the positive expression of Gli 1 protein was positively correlated with the positive expression of VEGF-C (r =0.586,P ＜0.01).Conclusions Gli1 protein which may participate in the formation of nascent microvascular is abnormally activated by the Hedgehog signaling pathway to express,VEGF-C which may be participate in the formation of nascent micro-lymphatic is mediated and started by the MAPK signaling pathways to express.Expressions of Gli1 protein is positively correlated with expressions of VEGF-C,therefore the Hedgehog signaling pathway may be associated with the MAPK signal pathway.Suppressing nascent microvascular and micro-lymphatic may become new target to blockingup papillary thyroid carcinoma cervical lymph node metastasis.

Objective To investigate the intraoperative intraperitoneal chemotherapy security with raltitrexed in advanced colorectal cancer surgical operation.Methods Sixty patients with colorectal cancer undergone surgery were randomly divided into trial group (n =30) and control group (n =30) according to the random number table method.The trial group was given surgical operation plus with intraperitoneal chemotherapy with raltitrexed.The control group was given surgical operation plus with intraperitoneal saline perfusion.Theroutine blood test,liver and kidney functions,toxic side effects and complications in two groups before and after surgery were investigated.Results The white blood cells in trial group before and after surgery was (6.36 ± 2.63) × 109/L vs.(8.20 ± 2.08) × 109/L,with statistically significant difference (t =3.06,P ＜0.05).The ratio of absolute neutrophil count in trial group before and after surgery was 65.17％ ± 10.36％ vs.72.21％ ± 10.53％ (t =3.22,P ＜ 0.05).The platelets in trial group before and after surgery was (261.03 ±84.74) × 109/L vs.(228.47 ± 58.69) × 109/L (t =2.07,P ＜ 0.05).The white blood cells,the ratio of absolute neutrophil count and the platelets after surgery had no statistically significant differeuces between the two groups (P ＞0.05).The trial group had higher 1,2 level vomiting (60.00％ vs.23.33％;x2 =8.30,P ＜ 0.05),and nausea (30.00％ vs.6.67％;x2 =5.46,P ＜ 0.05) incidence rates,but there was no statistically significant difference in other toxic side effects (P ＞ 0.05).The major complications post operation included intestinal obstruction,incision infection,abdominal cavity bleeding,and anastomotic fistula.There were equivalent complications in two groups (6.67％ vs.3.33％,x2 =0.35,P ＞0.05;10.00％ vs.6.67％,x2 =0.22,P＞0.05;0 vs.0;3.33％ vs.0,P＞0.05).Conclusion For patients with advanced colorectal cancer,intraoperative intraperitoneal chemotherapy with raltitrexed is safe and feasible,and the adverse reactions can be tolerated without increasing postoperative complications.

Objective To treat axillary osmidrosis by using three procedures (small incision apocrine curettage,cut-off operation and aspiration surgery),to observe the postoperative complications,efficacy and the pathological changes of skin,and to explore the advantages of these three procedures.Methods Seventy-five cases of evere bilateral axillary osmidrosis were involved in this study,totally 150 axillary surgery area,which was randomly divided into different group:Group A (curettage group); Group B (cut-off group) and Group C (aspiration group).Different surgical treatment was conducted in the three groups of operation area.Results Incidence of complications was 28.30 ％ and total effective rate was 94.34 ％ in Group A; in Group B,incidence of complications was 6.38 ％,and total effective rate was 97.87 ％ ; in Group C,incidence of complications was 4.00 ％ and total effective rate was 78.00 ％.The incidence of complications was significantly different between Groups A and B and between Groups A and C,but not significant difference between Groups B and C.The cure rate and efficiency were not significant difference between Groups A and B groups,but significant difference was found between Groups A and C and Groups B and C.HE staining results showed that the dermal tissues were partially destroyed in Group A and B,and no apocrine sweat glands were not seen within the dermis and subcutaneous tissues; in Group C,the dermal tissue was rarely destroyed,and a lot of apocrine sweat glands were reserved within the dermis and subcutaneous tissues.Conclusions Efficacy of curettage and cut-off procedures is better,but that of aspiration is worse in the treatment of axillary asmidrosis.The complications of cut-off surgery and aspiration are less,but urettage has more complications.Therefore,the efficacy of cut-off operation is the best with least complications among the three procedures.

Objective To investigate the difference between simple continued traction and areola dermal flap filling in inverted nipple correction surgery.Methods There were 60 nipples of 32 patients in simple continuous traction group and 62 nipples of 32 patients in dermal flap filling group.Follow-up was conducted for 12 months.The surgical results were compared with statistical analysis.Results Wound healing,nipple shape,blood supply,feeling and breast-feeding function in simple continuous traction group were better than those of the dermal flap filling group.There was no statistically significant difference in diameter and height of nipple,nipple retraction and relapse rate between the two groups.Conclusions Simple continuous traction is superior to dermal flap filling.Both methods are safe and effective for the treatment of various types of inverted nipple and two groups of patients have improved in symptoms and appearance.

Objective To summarze our experience and evaluate the therapeutic effect of hepatectomy for intrahepatic bile duct stones. Methods The clinical data of 316 patients suffering from intrahepatic lithiasis who underwent hepatectomy from Feb. 1985 to Dec. 2004 were retrospectively analyzed. Stones distribution, operation modality, postoperative complications, and therapeutic effect were evaluated. Among the 316 patients, 192 cases(60.76%) were treated with left lateral hepatectomy, 58 cases(18.35%) with left hemihepatectomy, 12 cases(3.80%)with quadarate lobectomy, 54 cases(17.09%) with right hemihepatectomy or segmentectomy, and 14 cases(4.43%)with left and right segmentectomy. Additional biliary procedures including common bile duct exporation and cholangio-enterostomy were performed in 184 patients(58.23%). Results Postoperative complications occurred in 56(17.72%)cases, including biliary fistula, hemobilia, and subdiaphragmatic infections. Three patients(0.95%)died. The follow-up study conducted in 258 patients(81.65%)for an average of 10.3 years showed that excellent results were achieved in 90.31% of the patients. Conclusions Regular hepatic lobectomy/segmentectomy is the most effective treatment for intrahepatic lithiasis.

Objective To evaluate the efficacy of multimodal-antiemetic therapy on postoperative dizziness,headache,nausea and vomiting (PONV) in patients undergoing thyroidectomy.Methods One hundred patients (39 males and 61 females,ASA physical status Ⅰ or Ⅱ) scheduled for thyroidectomy were randomly divided into two groups according to random number table: control group (group C) and multimodal-antiemetic therapy group (group M).Two groups received total intravenous anesthesia (TIVA) with propofol and remifentanil.Prophylactic dexamethasone 10 mg were given after anesthesia induction and palonosetron hydrochloride 0.25 mg was used 30 min before the end of surgery in both groups.Mannitol 2 ml/kg in group M and the same amount of normal saline in group C were given 30 min before the end of surgery.The incidence of dizziness,headache and PONV were observed for 24 h in two groups.Results The incidence of headache was 5 cases (10%)and PONV was 5 cases (10%) in group M,which were respectively significantly lower than that of group C of 15 cases (30%) and 12 cases (24%) in 24 h after surgery (P<0.05).The additional antiemetic therapy for 24 h after surgery in group M of 2 cases (4%) was significantly lower than that of group C of 9 cases (18%) (P<0.05).Conclusion The multimodal-antiemetic therapy: prophylactic dexamethasone,palonosetron hydrochloride and mannitol were used 30 min before the end of surgery could significantly reduce the incidence of dizziness,headache and PONV after thyroidectomy.

Objective To evaluate the efficacy and safety of radiation combined with targeted therapy of EGFR-TKI in the patients with stage IV non-small cell lung cancer ( NSCLC). Methods There were 17 female and 9 male patients with NSCLC enrolled into this study, which included 19 adenocarcinoma, 4 alveolar carcinoma and 3 uncertain carcinoma according to the iconography findings. Sixteen patients suffered from single or multiple bone metastasis,and 10 cases with brain metastasis. Gefitinib 250 mg or Erlotinib ISO mg per day were administrated during and after the process of radiation until the disease progressed. Results All patients had complete combined therapy, 12 of them suffered from diarrhea, 8 from emesia and 12 from erythra. The average score of ECOG improved from 3 to 2 after combined therapy. The bone metastasis control rate was 93.8% ,brain metastasis control rate was 70.0% , and the 6-month local lung lumps control rate was 84. 6%. Conclusion Palliative radiation combined with targeted therapy of EGFR-TKI is an effect and safe therapy for the patients with the stage IV of NSCLC, but the influence on survival shall be observed in further study.

OBJECTIVEthe aim of this study was to determine the clinicopathological characteristics of colorectal cancer (CRC) patients complicated with type 2 diabetes mellitus (T2DM ).

METHODSA total of 3, 202 patients with CRC confirmed pathologically in Tianjin Union Medicine Center from January 2005 to December 2009 were included in this study. We analyzed the differences in clinicopathological features between T2DM patients and non-diabetic patients according to age of diagnosis, gender, tumor site, stage, gross type, histological type, and differentiation.

RESULTSFrom 2005 to 2009, the number of CRC patients increased yearly. The high incidence age of all CRC patients was 51 to 80 years old. The male to female ratio was 1.18:1, showing that the number of female patients with CRC was increased significantly compared with males. The CRC distribution of T2DM patients and non-diabetic patients showed a predominance of rectal cancer (64.4%, 68.7%), followed by sigmoid colon cancer (12.5%, 13.0%), and moderately differentiated ulcer-type adenocarcinoma. Compared with non-diabetic patients, T2DM patients were older (66.2 years versus 62.7 years, P < 0.001) and had more multiple CRCs (3.5% versus 1.6%, P < 0.001). Moreover, the proportion of lymph node or organ metastasis in T2DM patients was higher than that in non-diabetic patients (52.6% versus 45.6%, P < 0.05). No significant differences were observed between both groups in terms of gender, gross type, histological type, and differentiation(P > 0.05 for all).

CONCLUSIONSCRC incidence shows an increasing trend with age. CRC patients with T2DM have an older age of onset, higher proportion of lymph node and distant organ metastasis than in non-diabetic patients.

Adenocarcinoma ; complications ; pathology ; Aged ; Colorectal Neoplasms ; complications ; pathology ; Diabetes Mellitus, Type 2 ; Female ; Humans ; Male ; Middle Aged