Changes of free amino acids in plasma and brain of rats with fulminanthepatic failure were measured with a Beckman 6300 amino acid analyzer.Results indicat-ed that as hepatic encephalopathy developed, concentrations of almost all amino acids inplasma and brain were increased.The levels of most amino acids in brain showed no cor-relation with their changes in the plasma.However,changes of concentrations of theseamino acids in brain that were related to the development of hepatic encephalopathy wereclosely correlated with their concentrations in plasma.Not any correlations between chan-ges of any amino acids in plasma and brain were found in normal control rats.Theseresults suggested that amino acid transport mechanisms appeared to be specific in the blo-cd-brain barrier during fulminant hepatic failure,a phenomenon that could contribute tothe neural disturbance of hepatic encephalopathy.

Objective To investigate the surgical method of transnasal operations on the sphenoidal sinus and the middle fossa under nasal endoscope combined with microscope. Methods The operation was performed under nasal endoscope on the side of larger nasal cavity. The middle nasal turbinate was pushed outwards. Then the Handy's expander was inserted between the middle nasal turbinate and the nasal septum in order to get a wide visualization. The sphenoidal frontal wall was opened directly. The nasal endoscope and microscope were utilized in turn to complete the resection of lesions. Results The symptoms disappeared postoperatively in 10 cases of solitary sphenoidal sinusitis. The lesions of 6 cases of sphenoidal cyst and meningioma were all surgically removed on one session. Among 32 cases of pituitary adenoma, a total resection was carried out in 17 cases, a subtotal resection in 12 cases, and a partial resection in 3. After surgery, a supplemental X-knife radiosurgery was employed. Postoperative follow-up in the 48 cases for 0.5~3.5 years (mean, 2.5 years) showed no recurrence of sphenoidal cyst, sphenoidal sinusitis, or meningioma, and 3 cases of recurrence of pituitary adenoma. No intracranial infection, adhesion of nasal cavity, or nasal bleeding was noted. Conclusions Transnasal operations on the sphenoidal sinus and the middle fossa under nasal endoscope combined with microscope has advantages of mild invasion, little blood loss, short operation time, and good outcomes.

Objective To discuss the surgical outcomes of atrial septal defects(ASD) by closing the ostium secundum via small chest incision.MethodsTotally 41 cases with ASD were treated by occlusion via a small incision(3-4 cm) at the right anterior chest.After cutting the pericardium,the right atrial was sutured with double ring and a special occluding device was inserted to close the ostium.Afterwards,under the guidance of transthoracical or transesophageal echocardiography,the satisfiable position for the occluder was confirmed by repeated testing with the protect string.After that,the right atrial and the occluder were sutured by a needle thread for fixation.ResultsOf the patients,the procedure was successfully completed in 39 cases.The mean operation time was 45 to 95 minutes(mean,60 minutes).The patients were discharged from our hospital in 3 to 6 days.No dislocation of the device or atrial shut was found in 2 to 24 months after the operation.Two patients were converted to open surgery because of failure in the occlusion.ConclusionOcclusion via small chest incision is safe,minimally invasive,and convenient procedure for ASD.

Objective To observe the efficacy and safety of tiopronin supplemented with chemotherapy in treating advanced breast cancer.Methods Sixty patients with advanced breast cancer were randomly divided into two groups:treatment group(n = 28) and control group (n = 32).Two groups were treated the same of NVB + DDP,the treatment group was supplemented with tiopronin,given for 10 days.Efficacy,toxicity in two groups were compared.Results The effective rate in the treatment group and the control group were 46.4% and 46.9% respectively, with no significant difference between the two groups ,P > 0.05.But the improved quality of life of patients in the treatment group was higher than that in the control group, P < 0.05.The rate of adverse reaction in liver function damaged (9.4%)and leucocyte lassitude(46.4%) were apparent lower than those in the control group(31.2% ,81.2% ),with significant difference between the two groups(P < 0.05, P < 0.01).Conclusion Tiopronin supplemented with chemotherapy show apparent effect in decreasing the adverse reaction of chemotherapy,improving the quality of life and not influence efficacy in advanced breast cancer.So tiopronln may act as protective drug for chemotherapy and deserve further testing in the clinic.

OBJECTIVE: To analyse the risk factors involved in local failure following radiotherapy and chemotherapy to nasopharyngeal carcinoma. METHOD: A retrospective analysis was carried out to review the histopathological data from 308 NPC patients who recieved medical treatment between 2004 and 2006. The incidence and the risk factor for local treatment failure were evaluated in a model that included the following factors: sex, age, T and N staging, histological grade of primary tumor, presence of cervical lymph node metastasis, size and laterals of positive neck nodes, levels involved, ways of radiation and condition of concurrent chemotherapy. Univariate chi2 test and multivariate stepwise logistic regression model were used for the analysis. Statistical analysis of survival of patients with local residues and recurrence was performed using Kaplan-Meier method. RESULT: Ninty-three cases (30.2%) presented local residues and recurrence in 308 patients of nasopharyngeal carcinomas. In the univariate analysis, it was confirmed that the following variables correlated to local failure, i. e., T staging (P < 0.01), N staging (P < 0.01), presence of cervical lymph node metastasis (P < 0.05), size and laterals of positive neck nodes (P < 0.05, respectively). In the multivariate analysis, the most ignificant risk factors for local failure were the T staging only. Kaplan-Meier analysis showed that overall survival rates of 71 NPC patients with local residues and recurrence who received re-treatment were 77.2% at 1 year, 40.4% at 3 years, 22.4% at 5 years, respectively. CONCLUSION T staging is the key risk factors in determining the development of local failure following radiotherapy or chemotherapy in NPC patients. Patients with primary tumor infiltrating bone have the higher risk of developing local residues and recurrence. Retreatment to the patients suffering from local failure can imrove survival rates.
Adult ; Aged ; Analysis of Variance ; Bone Neoplasms ; pathology ; Carcinoma ; Female ; Humans ; Lymph Nodes ; Lymphatic Metastasis ; Male ; Middle Aged ; Nasopharyngeal Carcinoma ; Nasopharyngeal Neoplasms ; drug therapy ; pathology ; radiotherapy ; Neck ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Neoplasm, Residual ; Retrospective Studies ; Risk Factors ; Survival Rate ; Treatment Failure ; Tumor Burden

OBJECTIVE To explore the surgical approach for recurrent or residual nasopharyngeal carcinoma after radiotherapy failure. METHODS The clinical data of 12 patients with recurrent or residualnasopharyngeal carcinoma after radiotherapy failure for salvage surgery were retrospectively analyzed. The 12 patients were underwent salvage surgery via transcervico-mandibulo-palatal approach. The residual and recurrent tumors were found in 2 and 10 patients (included 2 recurrent patients after re- radiation) after radiotherapy respectively. RESULTS The paranasopharyngeal region defects were repaired with submandibular gland flaps in 10 patients and with free inferior turbinate mucosal graft in 2 patients. All of the 12 patients were followed up for more than 2 years. Seven patients survived with no evidence of disease and one patient survived with tumor. Three patients died of local recurrence and one died of distant metastasis. The 2-year survival rate was 75 %. CONCLUSION Resection of the local recurrent nasopharyngeal carcinoma via transcervico- mandibulo-palatal approach provides wide field exposure of the central skull base. The tumors located in paranasopharyngeal region can be resected en bloc and the internal carotid artery can be identified by palpation under direct vision. The surgical defects can be repaired with submandibular gland flap. The transcervico-mandibulo-palatal approach is the suitable procedure for local recurrent nasopharyngeal carcinoma with less mortality and complications.

OBJECTIVE To explore the indication and effect of primary repair of the defects for stomal recurrence after total laryngectomy. METHODS A total of 18 cases with stomal recurrence after total laryngectomy were performed operation.The defect of hypopharynx and cervical oesophagus was repaired with free forearm flap (n=5),free jejunual interposition(n=3),pectoralis major myocutaneous flap (n=1)and pharyngogastric anastomosis(n=2).The defect of skin was repaired with pectoralis major myocutaneous flap.RESULTS All pectoralis major myocutaneous flaps were viable. Pharyngeal fistula occurred in 4 cases,one of whom had been performed free jejunual interposition,2 had been performed free forearm flap,and one with fistula bleeding had been performed pharyngogastric anastomosis.All cases could swallow after operation. During follow-up for 6 to 74 months,swallow obstruction occurred in 3 cases.CONCLUSION The methods of repair for surgical defect of stomal recurrence after total laryngectomy should depend on the bound of stomal recurrence and therapeutic procedure of primary tumor.

Objective To discuss the clinical features and prognostic factors of primary testicular lymphoma (PTL). Methods A retrospective review was performed based on the clinical records of 33 PTL cases treated at Tianjin Medical University Cancer Hospital from June 1977 to May 2009.Drawing survival curves by Kaplan-Meier method, using Log-rank test to the univariate analysis, and multivariate analysis by COX regression model to evaluate independent prognostic factors. Results The median age of patients was 62 years at presentation(range 33-81 years). Painless testicular swelling was the initial symptom. The majority of histological subtype was B cell lymphoma, 48% of which was diffuse large B-cell non-Hodgkin's lymphoma. By postoperative chemotherapy and/or radiotherapy, 23 patients achieved complete remission and 7 achieved partial remission, with a median follow-up of 23 months (4-231 months). The 5 years and 10 years of overall survival was 39.1% and 19.5%. The effect of patients who received chemotherapy≥4 cycles and B cell lymphoma patients combination with Rituximab were better. In multivariate analysis, Ann Arbor stage, B symptoms, age of patient and number of extranode site were independent prognostic factors of survival. Conclusions Primary non-Hodgkin lymphoma should be treated with multi-modality strategies. Treatment with doxorubicin-based chemotherapy after orchiectomy should be recommended. Ann Arbor stage, B symptoms, age of patient and number of extranode site were independent prognostic factors of survival in PTL.

Objective To investigate the prevalence of thyroid disorders and positive thyroid autoantibodies,and evaluate the necessity for universal thyroid screening during the second and third trimesters of pregnancy.Methods The pregnant women during the second and third trimesters who visited Shanghai Jiaotong University Affiliated First People's Hospital between June 2006 and February 2008 were chosen for thyroid screening by determining serum free triiodothyronine,free thyroxine,thyrotropin,thyroid peroxidase antibody (TPOAb),and thyrotropin receptor antibody.A personal and family history of thyroid disease and other autoimmune diseases was investigated by questionnaire.The pregnant women were divided into high risk or low risk groups for thyroid disease based on their personal or family histories.Results A total of 2 101 pregnant women were screened,712 ( 33.89％ ) of them were identified to suffer from thyroid disorders or with positive thyroid autoantibody.The prevalence of thyroid dysfunction was increased in high risk group.While in low risk group( n =1 983 ),the prevalence of clinical hypothyroidism was 2.27％ ( n =45 ),subclinical hypothyroidism 11.60％ ( n =230 ),clinical hyperthyroidism 0.20％ ( n =4 ),subclinical hyperthyroidism 1.06％ ( n =21 ),hypothyroxinemia 6.45％ ( n =128 ),and euthyroid with positive TPOAb 10.74％ ( n =213 ) in our study.Pregnant women with positive TPOAb were susceptible to thyroid dysfunction.It was shown that 79.74％ of pregnant women with thyroid disorders were diagnosed by universal thyroid screening.Conclusions 33.89％ of pregnant women in the second and third trimesters were identified to suffer from thyroid disorders or positive thyroid autoantibody by universal thyroid screening.Increased prevalence of thyroid dysfunction was found in pregnant women with positive TPOAb.79.74％ of pregnant women with thyroid disorders might be missed if screening was made only in the high risk cases.

Objective To discuss the treatment and clinical results of acetabular fracture. Method Clinical data of 78 cases of acetabular fracture was analyzed retrospectively on treatment methods and clinical effects from August 1988 to December 2007, 41 cases were performed operation and 37 cases were performed non-operative management. Result The treatment effects were excellent in 43 cases, good in 22 cases, fair in 10 cases, poor in 2 cases and dead in 1 cases, with a good rate of 83.3%, and 20 cases had complications: 1 posterior dislocations of hip, 13 posttraumatic arthritis, 1 incisional infection, 5 ectopic ossi-fication. Conclusions It is very important to choose appropriate treatment methods by judging the real state of acetabular fractureexactly. Acetabular reconstruction plate is convenient, safe, and reliable in treat-ment of posterior wall and superior wall fractures.