Objective Discussion of diagnosing insulinoma.Methods Retrospective analysis based on 45 cases of insulinoma patients that are collected by General Surgery Department in the First Affiliated Hospital of Zhengzhou University from June 2008 to October 2014.Results Forty-five cases of patients with insulinoma including 41 cases (91.11％) of functional insulinoma and 4 cases (8.89％) of non-functional insulinoma.Apply selective arteriography,preoperative ultrasound,intraoperative ultrasound and CT to diagnosis.Forty-five cases of patients with insulinoma,in which 18 cases with laparoscopic simple tumor resection,6 cases with laparoscopic splenectomy and tail of the pancreas resection;45 cases of insulinoma with laprotomy,in which 8 cases with pancreaticoduodenectomy,12 cases which the tumors were located in the neck,neck-line of the pancreas with local excision of the pancreas and pancreatic tail-jejunal Roux-en-Y anastomosis,one cases of laparotomy found no placeholder.Conclusions Surgery removal is currently the most successful way to eliminate insulinoma.And localization diagnosis can determine the outcome of the surgery.Co-operation of surgery removal and localization diagnosis can be the optimal approach to diagnose certain insulinoma.

Familial nonmedullary thyroid carcinoma means to two or more first-degree relatives of the family with NMTC,in the absence of other known family syndromes (such as Gardner's syndrome,Cowden disease,Carney complex,Werner syndrome,and so on),and common thyroid cancer risk factors including the neck radiation and iodine deficiency,and so on.The genes involved in the pathogenesis of familial nonmedullary thyroid carcinoma (FNMTC) are yet to be elucidated,although some recent studies identified several predisposition loci with a high degree of genetic heterogeneity.Several studies demonstrated that patients with FNMTC have increased rates of multifocal disease,extrathyroidal invasion,and involved lymph nodes compared with sporadic disease.It has been hypothesized that this increased aggressiveness translates into higher recurrence rates and decreased survival of patients with FNMTC.

Objective To analyze the value of PET/CT for diagnosis of recurrence and metastasis of dif-ferentiated thyroid carcinoma ( DTC) .Methods 65 patients with DTC in Thyroid Surgery Department of the First Affiliated Hospital of Zhengzhou University from Dec .2005 to Jan.2015 were collected.Based on the values of serum thyroglobulin(Tg),the patients were divided into 2 groups.29 cases with positive Tg were the observation group and 36 cases with negative Tg were the control group .All patients underwent PET/CT examination one year after surgery.Patients with positive findings from image studies underwent surgical excision and postoperative pathological diagnosis .Clinical data of the 2 groups were then summarized and discussed .Results There was no significant difference on the general conditions between the 2 groups(P>0.05).Tg values were statistically dif-ferent 6 months and 1 year after surgery between the 2 groups(P<0.05).Tg values of both groups decreased 1 year after surgery, but without statistical difference (P>0.05).9 cases in the observation group and 1 case in the control group had positive findings on image study .All the cases with cervical lymph nodes presented as high uptake of 18 F-FDG.All patients who had positive findings on PET/CT underwent surgical removal of the abnormal lymph nodes which confirmed by pathology as lymph node metastasis .Conclusion PET/CT is very important for diagno-sis of recurrence and metastasis on Tg(Tg>2μg/L)positive,131I Dx-WBS imaging and US negative patients.

Objective Explore the risk factors and prevention of HAP after surgical excision of Esophageal carcinoma in elderly Patients.Methods Two hundred and eight elderly patients with HAP after Surgical excision of Esophageal carcinoma from 2009 to 2012 were analyzed.Logistic regression analysis was used to find the related risk factors.Results The incidence of HAP was 25.9％.In several factors Logistic regression analysis,smoking,low lung function,postoperative non-epidural analgesia,injure of recurrent laryngeal nerve and fistula of anastomotic were the risk factors.Conclusions The preoperative evaluation,Intensive monitoring during the postoperative period and reducing the complication after operation can decrease the incidence of HAP.

Objective Analyzed the cause and time of hypokalemia complication that dexamethasone used for hyperthyroidism preoperative preparation.Methods The study consisted of 161 patients with hyperthyroidism disease,who were used the dexamethasone in his or her preoperative preparation at the First Affiliated Hospital of Zhengzhou University between August 2011 and July 2013.Results In the 161 hyperthyroidism patients,composed of 41 men and 120 women,twenty-seven patients happened hypokalemia and 92.6％ occurred after the first.Twenty-six men patients developed hypokalemia complication when used dexamethasone for hyperthyroidism preoperative preparation,while only 1 woman patient occurred the hypokalemia complication.Among the 11 patients who with a history of thyrotoxic periodic paralysis,10 cases occurred after given dexamethasone hypokalemia,only 1 case has no hypokalemia.Conclusion Dexamethasone and other drug used in hyperthyroidism preoperative preparation,which was rapid,safe and effective,but it can lead to hypokalemia complication,especial in the 24 hours after the first use,should be brought clinical doctors attentions,and give timely diagnosis and treatment.

Objective To investigate the risk for recurrent thyroid carcinoma.Methods Clinical data of 56 cases of recurrent thyroid carcinoma were retrospectively analyzed and summarized possible causes of relapse.Results Student's test revealed that age,initial operative approach,pathological types,postoperative medication and radionuclide therapy were associated with recurrence (P ＜ 0.05),but gender was not associated with recurrence (P =0.240),and resection of single gland was associated with recurrence (P =0.006),but resection of both gland was not so (P =0.153).Multivariate analysis indicated that initial operative approach was the dependent factors for recurrence(P ＜ 0.05).Conclusion Some patients that prone to recurrence should be strengthened regular follow-up.Standard treatment should be used for The recurrences diagnosed.

Objective To explore the timing of surgical intervention for severe acute pancreatitis (SAP). Meth-ods One hundred and fifty-seven cases with SAP treated in our hospital from March, 1998 to December, 2007 were analyzed retrospectively. Influence of surgical intervention and conservative treatment on curative rate were e-valuated in pancreatic necrotic area and with or without infected pancreatic necrosis. Results The overall curative rate of surgical treatment and conservative treatment was 80.4%, 87.1% respectively; the two methods had no sta-tistical difference. Conservative treatment was better than surgical treatment in patients with lesa than 30% necrotic area and surgical treatment was better than conservative treatment in patients with more than 50% necrotic area. But the two methods had no statistical difference in 30% ～ 50% necrotic area. Conservative management was better than surgical management in sterile pancreatic necrosis, but surgical management was better than conservative manage-ment in pancreatic necrosis with infection or suspection of infection. Conclusion Surgical intervention treatment plays an important role in SAP patients, we should combine pancreatic necrotic area and with or without infection to choose the timing of surgical intervention for severe acute pancreatitis.

Objective To evaluate the performance and feasibility of sentinel node biopsy(SNB) in male breast cancer patients using Methylthioninium Chloride Injection.Methods At the First Affiliated Hospital of Zhengzhou University,there are 11 patients in group from March 2010 to December 2014.The clinical stage was cT1-T2N0M0.All patients using Methylthioninium Chloride Injection as the tracer.11 patients are given with sentinel lymph node biopsy,while given the axillary lymph node dissection.Results In 11 cases of male breast cancer patients,10 cases obtained the sentinel lymph nodes,the detection rate was 90.9％ (10/11).The sentinel lymph node is in 1-3,the average is 1.7 gold.Non sentinel lymph nodes are in 8-14,the average is 10.5 gold.The coincidence rate is 90.0％ The sensitivity is 100％ and The precision is 60％.Conclusions Sentinel lymph node biopsy can accurately predict the metastasis of axillary lymph node of breast cancer in male patients.

Glutamine is not only a special nutritional substance but a conditional essential amino acid,which is the most abundant amino acids in plasma,representing about 60％ of free amino acids in the body,and it's normal plasma concentration is from 0.6 to 0.9 mmol/L.In recent years,with the increasing deepening study of the field of clinical nutrition,the concept of glutamine study has been gradually changed gradually changed it's concept from a simple nutritional support to immune nutrition therapy.Glutamine can not only improve the body's protein levels of nutrition,protect the gastrointestinal mucosa,but also reduce the incidence of infection and the inflammation in the body,improve immune function,reduce side effects of chemotherapy,and at the same time enhance tumor sensitivity to chemotherapy and promote gastrointestinal cancer patients' postoperative recovery,reduce surgical complications.This paper aims to review the application and research of glutamine in the gastrointestinal cancer patients after the operation.

Objective To compare the clinical-pathology features between male breast cancer ( MBC) and female breast cancer(FBC)patients.Methods Clinical data of 37 MBC and 300 FBC patients admitted in the First Affiliated Hospital of Zhengzhou University from Jun .2003 to Jun.2013 was retrospectively reviewed . Results The ratio of MBC to FBC was 54:10000.The age of MBC patients ranged from 39 to 80 years with the median age of 62 years old, older than FBC patients(t=3.117, P=0.002).The percentage of invasive ducal carcinoma was much higher in MBC patients than in FBC patients (χ2 =7.535,P=0.023).MBC patients in clinically stage III and IV were more than FBC patients (χ2 =16.471,P=0.000).The positive rate of estrogen receptor(ER)was significantly higher in MBC patients than in FBC patients (χ2 =6.294,P=0.043).The posi-tive rate of human epidermal growth factor receptor-2 ( HER2 ) was lower in MBC patients than in FBC patients (χ2 =11.222,P=0.004).The main surgical method of MBC was modified radical mastectomy , and there was no breast-conserving surgery for MBC, while the surgical method of FBC was various (χ2 =7.720,P=0.021). Conclusion There are significant differences between FBC and MBC patients in clinicopathological features , surgical method and even prognosis , which were important to guide the treatment of MBC and FBC .