OBJECTIVETo evaluate a minimally invasive technique of parotidectomy in treatment of benign parotid tumors.

METHODSThis retrospective review included 49 patients with benign parotid gland tumors. The modified technique included incision, flap elevation, facial nerve dissection, the great auricular nerve preservation and postoperative disposal.

RESULTSAll tumors were resected completely. The operation lasted 1.5 approximately 2.5 h; the average length of incisions was from 5.5 cm to 7.5 cm, and the average postoperative hospital stay was 4 days. There were no permanent facial nerve injury, no obvious scars and no depressed deformity observed postoperatively. During the 6 months approximately 5 years following-up, no tumor recurrence was found.

CONCLUSIONThe minimally invasive technique of parotidectomy reduces the disadvantages of the traditional procedure, and improves the quality of operation.T.

Adenoma, Pleomorphic ; surgery ; Adolescent ; Adult ; Female ; Humans ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; methods ; Parotid Gland ; surgery ; Parotid Neoplasms ; surgery ; Retrospective Studies ; Treatment Outcome

Objective: To investigate the sonographic features of primary thyroid lymphoma (PTL) and to evaluate the clinical significance of ultrasound-guided core needle biopsy (US-CNB) in PTL. Methods: A total of 24 patients with suspected PTL in Sir Run Run Shaw Hospital from January 2013 to June 2018 were analyzed retrospectively. All cases were confirmed by pathology, of them 23 patients received US-CNB and 1 patient chose operation without US-CNB, including 5 males and 19 females, aged from 39 to 75 years old. The effectiveness and safety of 23 patients with US-CNB were evaluated, and the sonographic features of 20 patients with PTL diagnosed by pathology were analyzed. Descriptive statistical methods were used in the study. Results: In the 23 patients with suspected PTL underwent US-CNB, 18 patients were diagnosed as PTL, 4 patients were respectively diagnosed as subacute thyroiditis, anaplastic carcinoma, Hashimoto's thyroiditis, and fibro thyroiditis, and the another patient was hard to diagnose by US-CNB and then was diagnosed as PTL by surgical biopsy. The success rate of US-CNB for diagnosis of PTL was 18/19, and no severe complications occurred in the patients with US-CNB. The other case was diagnosed as PTL by surgical biopsy without US-CNB. Sonographic features of 20 cases with PTL (18 cases diagnosed by US-CNB and 2 cases by surgery or surgery biopsy) were as follows: (1) Most nodules had irregular shapes and unsmooth margins; (2) Hypoechoic or markedly hypoechoic nodules with honeycombed or cord structures were observed in most cases; (3) Calcification was rare; (4) Multiple lesions were common; (5) Abundant intralesional vascularization was commonly observed; (6) Most cases had intensification of posterior acoustic enhancement; (7) Thyroid gland enlargement or with irregular shape; and (8) PTL often accompanied with lymph nodes enlargement in lateral neck or central region. Conclusion: PTL has certain sonographic features, with assistance of US-CNB, more accurate diagnosis of PTL can be obtained.
Adult ; Aged ; Biopsy, Large-Core Needle ; Female ; Humans ; Image-Guided Biopsy ; Lymphoma/diagnostic imaging* ; Male ; Middle Aged ; Retrospective Studies ; Thyroid Gland ; Thyroid Neoplasms/diagnostic imaging* ; Thyroid Nodule ; Ultrasonography, Interventional

OBJECTIVETo analysis clinical characteristics of the multiple organ dysfunction syndrome (MODS) caused by acute paraquat poisoning (APP).

METHODClinical data of 68 APP cases from Jan 2006 to Jun 2009, including age, gender, poisoning time and dosage, and MODS time, were compared in two groups, i.e. the death (37 cases) and survived (31cases) groups. It was less than 24 hours from poisoning to rescue in all cases.

RESULTSAmong the 68 cases, the incident rate of ARDS was 51.47% (35 cases). The rate of acute lung injure was 97.1% (66 cases). The mortality was 54.4% (37 cases). There was no significant difference in age and gender between both groups (P > 0.05). The dosages and times from poisoning to rescue were significant different between two groups (P < 0.05, P < 0.01). In the death group, proportion of amounts (> 3) of organs related with MODS was 70.29%, which was significantly higher than that (38.71%) in survived group (P < 0.01). MODS and ALI/ARDS occurred in death group earlier than those in survival group (P < 0.05). On the other hand, cardiac, hepatic and renal damage occurred earlier than the lung injure.

CONCLUSIONMODS in APP patients occurred earlier, were more sever, and caused higher mortality. The poisoning dosage and time were important prognostic factors.

Adult ; Female ; Humans ; Male ; Middle Aged ; Multiple Organ Failure ; chemically induced ; diagnosis ; Paraquat ; poisoning ; Prognosis ; Respiratory Distress Syndrome, Adult ; chemically induced ; diagnosis ; Retrospective Studies ; Young Adult

OBJECTIVE: To evaluate the value of virtual colonoscopy in diagnosis of colorectal neoplasia. METHODS: Virtual colonoscopy was performed in 29 patients with colorectal neoplasia confirmed by colonoscopy. The results were compared with colonoscopy for each case. RESULTS: Virtual colonoscopy was successfully performed in each patient without any complications. All colorectal carcinomas detected by colonoscopy were identified by virtual colonoscopy. Twenty-five polyps were detected with colonoscopy, whereas only 16 identified by virtual colonoscopy. Compared with the results of colonoscopy, detection rate of polyps greater than 1.0 cm between 0.5 approximate, equals 0.9 cm and less than 0.5 cm in size was 90.0% 62.5% and 28.6% respectively. CONCLUSION: Virtual colonoscopy is fast, minimal invasive and well tolerated. This technique is a valuable clinical method in diagnosis of colorectal cancer and polyps larger than 0.5 cm in size.

Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Stomach Neoplasms ; diagnostic imaging ; Tomography, X-Ray Computed ; methods

OBJECTIVETo evaluate the effect of adenosine on endothelin-1 (ET-1) after acute myocardial infarction (AMI) and reperfusion and explore the possible mechanism of no-reflow.

METHODSTwenty-four mini-swine were randomized into three study groups: control group (n=8), adenosine treated group (n=8), and sham-operated group (n=8). The mini-swine in the groups were subjected to 3 hours of coronary occlusion, followed by 60 minutes of reperfusion except those in the sham-operated group. The levels of ET-1 in blood sample, normal, infracted reflow and no-reflow myocardium were evaluated by radioimmuno-assay (RIA). The gene expressions of ET-1 in normal, infracted reflow and no-reflow myocardium were quantified by reverse transcription-polymerase chain reaction.

RESULTSIn both control group and adenosine group, compared with that at the baseline, ET-1 in blood sample significantly increased at 5 minutes and 180 minutes of left anterior descending coronary artery occlusion, as well as 5 and 60 minutes of reperfusion (all P < 0.01). In adenosine group, the levels of ET-1 were significantly lower than those in the control group (P < 0.05, P < 0.01). In both control group and adenosine group, compared with that in normal myocardium, ET-1 levels in both infarcted reflow and no-reflow myocardium significantly increased (both P < 0.01), with the level of ET-1 in no-reflow myocardium significantly higher than that in infarcted reflow myocardium (P < 0.01). In adenosine group, the level of ET-1 in infarcted reflow myocardium was significantly lower than that in the control group (P < 0.01). In both control and adenosine groups, compared with that in normal myocardium, the gene expression of ET-1 in infarcted reflow myocardium was significantly up-regulated (P < 0.01), while that of ET-1 in. no-reflow myocardium significantly down-regulated (P < 0.01). In adenosine group, the level of ET-1 in infarcted reflow myocardium was significantly lower than that in the control group (P < 0.01).

CONCLUSIONThe endothelium injury may be one of the important mechanisms for no-reflow phenomenon. Adenosine cay prevent endothelium from injury to reduce no-reflow.

Adenosine ; pharmacology ; therapeutic use ; Animals ; Disease Models, Animal ; Endothelin-1 ; genetics ; metabolism ; Female ; Male ; Myocardial Infarction ; drug therapy ; physiopathology ; Myocardial Reperfusion ; Swine ; Swine, Miniature

OBJECTIVETo evaluate the relationship of expressions of nucleoside diphosphate kinase (nm23) and proliferating cell nuclear antigen (PCNA), as well as apoptosis, with the prognosis of HCC patients by analyzing their pathological and clinical data.

METHODSThe expressions of nm23 and PCNA were analyzed by immunohistochemistry and the apoptotic phenomena were detected by TUNEL technique in the liver samples from 43 HCC tissues, 39 para-neoplastic tissues, and 10 normal tissues. The mean apoptosis index (AI) and proliferative index (PI) in individual sample were calculated.

RESULTSAs shown by the detection, 32.6% of carcinomas had negative nm23 signal in tumor tissues, whereas all para-neoplastic and normal tissues had positive nm23. The AI in nm23 positive HCC was significantly higher than that in nm23 negative one, with statistical difference (P<0.05). Furthermore, the expressions of nm23, and the values of AI and PI were contrastively analyzed with some main pathological and clinical data of HCC. It revealed that HCC with extrahepatic metastasis showed remarkable correlation with the negative nm23 (P=0.013) and higher PI values of HCC (P=0.015). The disease-free survival in HCC patients with negative nm23 expression was significantly poorer than that in patients with positive nm23 expression.

CONCLUSIONSThese data suggest that expressions of nm23 protein in tumor tissues are correlated with occurrences of metastasis and length of survival of the HCC patients, which may be an indicator for their prognosis.

Adult ; Aged ; Apoptosis ; Biomarkers, Tumor ; biosynthesis ; Carcinoma, Hepatocellular ; enzymology ; mortality ; pathology ; Case-Control Studies ; Cell Proliferation ; Disease Progression ; Disease-Free Survival ; Female ; Humans ; Immunohistochemistry ; In Situ Nick-End Labeling ; Kaplan-Meier Estimate ; Liver ; enzymology ; pathology ; Liver Neoplasms ; enzymology ; mortality ; pathology ; Male ; Middle Aged ; NM23 Nucleoside Diphosphate Kinases ; biosynthesis ; Neoplasm Metastasis ; Proliferating Cell Nuclear Antigen ; biosynthesis

BACKGROUNDWhether final kissing balloon (FKB) dilatation after one-stent implantation at left-main (LM) bifurcation site remains unclear. Therefore, this large sample and long-term follow-up study comparatively assessed the impact of FKB in patients with unprotected LM disease treated with one-stent strategy.

METHODSTotal 1528 consecutive patients underwent LM percutaneous coronary intervention in one center from January 2004 to December 2010 were enrolled; among them, 790 patients treated with one drug-eluting stent crossover LM to left anterior descending (LAD) with FKB (n = 230) or no FKB (n = 560) were comparatively analyzed. Primary outcome was the rate of major adverse cardiovascular events, defined as a composite of death, myocardial infarction (MI) and target vessel revascularization (TVR).

RESULTSOverall, The prevalence of true bifurcation lesions, which included Medina classification (1,1,1), (1,0,1), or (0,1,1), was similar between-groups (non-FKB: 37.0% vs. FKB: 39.6%, P = 0.49). At mean 4 years follow-up, rates of major adverse cardiovascular events (non-FKB: 10.0% vs. FKB: 7.8%, P = 0.33), death, MI and TVR were not significantly different between-groups. In multivariate propensity-matched regression analysis, FKB was not an independent predictor of adverse outcomes.

CONCLUSIONSFor patients treated with one-stent crossover LM to LAD, clinical outcomes appear similar between FKB and non-FKB strategy.

Aged ; Angioplasty, Balloon, Coronary ; methods ; Drug-Eluting Stents ; Female ; Humans ; Male ; Middle Aged ; Treatment Outcome

BACKGROUNDRandomized clinical trials have demonstrated equivalent safety to bare-metal stents after drug-eluting stents (DES) implantation. However, the DES thrombosis in randomized trials could not be comparable to those observed in clinical practice, frequently including off-label indications. This study sought to assess the incidence of DES thrombosis after implantation of DES in patients with real world coronary artery disease (CAD) in China.

METHODSFrom December 2001 to April 2007, 8190 consecutive patients received the treatment with DES, 5412 patients completed one year follow-up: 2210 with sirolimus-eluting stent Cypher, 1238 with paclitaxel-eluting stent Taxus and 1964 with Chinese sirolimus-eluting stent Firebird. After two years of follow-up, there were 2176 patients (1245 Cypher, 558 Taxus and 373 Firebird). All patients were treated with aspirin and clopidogrel over at least 9 months.

RESULTSAmong 8190 patients, 17 patients had acute stent thrombosis (0.24%): 7 in the Cypher group, 4 Taxus and 6 Firebird; 23 patients had subacute stent thrombosis: 8 Cypher, 6 Taxus and 9 Firebird. The incidence of acute and subacute thrombosis was 0.49%: 0.50% Cypher, 0.63% Taxus and 0.41% Firebird. The incidence of late thrombosis at one year followup was 0.63%: 0.63% Cypher, 0.88% Taxus and 0.46% Firebird; at two year follow-up the incidence was 0.74%: 0.72% Cypher, 0.90% Taxus and 0.54% Firebird. There was no significant difference among three groups at 1 year and 2 years follow-up.

CONCLUSIONThe first generation DES in the treatment of complex lesions are safe and effective if patients are aggressively treated with dual antiplatelet agents.

Acute Disease ; Angioplasty, Balloon, Coronary ; adverse effects ; Coronary Angiography ; Coronary Artery Disease ; therapy ; Drug-Eluting Stents ; adverse effects ; Female ; Humans ; Incidence ; Male ; Thrombosis ; etiology

BACKGROUNDPatients with multivessel coronary artery disease and depressed left ventricular ejection fraction (LVEF) represent a high risk group of patients for coronary revascularization. There are limited data on percutaneous coronary intervention treatment in this population.

METHODSAmong a cohort of 4335 patients with three-vessel disease with or without left main disease undergoing percutaneous coronary intervention, 191 patients had LVEF < 40% (low ejection fraction (EF)) and 4144 patients had LVEF ≥ 40%. In-hospital and long-term outcomes were examined according to LVEF.

RESULTSThe estimated two-year rates of major adverse cardiac events, cardiac death, and myocardial infarction were significantly higher in the low EF group (19.64% vs. 8.73%, Log-rank test: P < 0.01; 10.30% vs. 1.33%, Log-rank test: P < 0.01, and 10.32% vs. 2.28%, Log-rank test: P < 0.01 respectively), but there was no difference in the rates of target vessel revascularization (6.18% vs. 6.11%, Log-rank test: P = 0.96). Using the Cox proportional hazard models, LVEF < 40% was a significant risk factor for cardiac death, myocardial infarction, and major adverse cardiac events (OR (95%CI): 4.779 (2.369 - 9.637), 2.673 (1.353 - 5.282), and 1.827 (1.187 - 2.813) respectively), but was not a statistically significant risk factor for target vessel revascularization (OR (95%CI): 1.094 (0.558 - 2.147)).

CONCLUSIONAmong patients undergoing percutaneous coronary intervention for multivessel coronary artery disease, left ventricular dysfunction remains associated with further risk of cardiac death in-hospital and during long-term follow-up.

Aged ; Angioplasty, Balloon, Coronary ; Coronary Disease ; physiopathology ; therapy ; Female ; Humans ; Male ; Middle Aged ; Ventricular Function, Left ; physiology