Objective To investigate the perioperative management for patients of thyroid crisis complicating acute abdomen.Methods The clinical data of 11 acute abdomen patients combined with hyperthyroidism were analyzed retrospectively.Results In this study,the surgical procedures were appendectomy in 5 patients,perforation repair for duodenal ulcer in 2 patients,distal gastrectomy in 2 patients,choledochotomy in one patient and splenectomy in one patient.Thyroid crisis occurred postoperatively in 7 patients,intraoperatively in 2 patients and preoperatively in 2 patients.Emergency treatment succeeded in 8 patients,and death occurred in 3 patients,with a death rate of 27.3%,including the preoperative thyroid crisis patient complicating duodenal ulcer perforation,who died of heart sufficiency on the first day postoperation.The second patient suffering from intraoperative thyroid crisis during exploration for perforation of the small bowel died of muhiple organ dysfunction syndrome caused by intestinal fistula,intra-abdominal abscess and lung infection,in spite of successful rescue treatment of thyroid crisis.The third patient was of acute appendicitis with perforation who died of coma and multiple organ dysfunction syndrome on the postoperative 5th day because the concomitant thyroid crisis was overlooked.Conclusions The early recognizing thyroid crisis in perioperative surgical abdomen and adequate treatment is the key to rescue succesS,and the diagnosis mainly depends on comprehensive judgment of clinical presentation and laboratory examination.

Objective To investigate the expression of forkhead box protein P1(FOXP1)in gastric mucosa-associated lymphoid tissue(MALT)lymphomas and its relationship with histological morphology and prognosis. Methods In this study.samples of 43 MALT lymphoma were studied histologically and divided into monomorphic histology group and polymorphic histology group according to their cellular features.The expressions of FOXP1 and NF-κB in gastric MALT lymphoma were evaluated immunohistochemically by two-step method of Envision,and the clinicopathological features and prognosis were analyzed retrospectively.Results The nuclear expressions of FOXP1 in 43 cases with gastric MALT lymphoma were 44%(19 of 43),including strong immunoreactivity in 7 cases and moderate immunoreactivity in 12 cases.There were 4 cases with positive immunoreactivity in moninorphic histology group and 15 cases in polymorphie histology group,and the difference was statistically significant(15%vs.88%,P＜0.01).All the postoperative recurrent cases were strongly positive with FOXP1 stain,and it was closely with FOXP1 expression(P＜0.01).The median survival time(26 months)in polymorphic histology group was significantly shorter than that(123 months)in monmorphic histology group(P＜0.01),and the median survival time was significantly longer in negative FOXP1 expression group than that in moderate FOXP1 expression group and in strong FOXP1 expression group(115 vs.55 vs.12 months)(P＜0.05).similarly,the median survival time in nuclear factor kappa B(NF-κB)expression group was significantly shorter than that in negative NF-κB expression group(26 vs.131 months)(P＜0.01).The median survival time in stageⅠ(98 months)and stage Ⅱ(121 months)was significantly longer than that in stage Ⅱ E+Ⅳ(33 months)(P＜0.01).By multivariate COX regression analysis.FOXP1 nuclear expression and clinical stage were independently prognostic factom. Conclusion FOXP1 expression may be used as a biomarker for the assessment of malignant transformation to diffuse large B-cell lymphoma(DLBCL)and predicting prognosis.

Objective To explore the efficacy of breast-conserving therapy of ductal carcinoma in situ (DCIS),and to evaluate its safety.Methods 54 patients with DCIS receiving breast-conserving therapy(the experimental group) and 49 patients with DCIS treated with mastectomy(the control group) in the First Affiliated Hospital of Wenzhou Medical College from Mar.2010 to Mar.2013 were retrospectively analyzed.The follow-up results of the 2 groups were analyzed in terms of the local recurrence,distant metastasis and the 3-year diseasefree survival(DFS).The efficacy and safety of breast-conserving treatment were evaluated.Results All patients were followed up for 5 months to 39 months,with the average of(22.3 ± 8.5) months.No local recurrence happened in the experimental group.There was 1 case of chest wall recurrence in the control group.One case in the experimental group and 2 cases in the control group had distant metastasis.DFS rate in the 2 groups was 100％ and 95.9％ relatively.No statistically significant difference was found between the 2 group in terms of the above items (P ＞ 0.05).Conclusion For DCIS patients,the difference between breast-conserving therapy and mastectomy surgery in the rate of local recurrence and distant metastasis was not significant.Breast-conserving therapy is safe for DCIS patients and should be further promoted.

Objective To evaluate outcome of local excision of rectal cancer for curative purpose.Methods Fifty four patients with low rectal carcinoma undergoing local excision from 1975 to 2000 were analyzed retrospectively.Results In this study, 44 patients underwent trans anal resection (TAR), 6 did trans sacral resection (TSR), 2 each did trans sphincteric local resection (TSLR) and trans vaginal resection (TVR). Most tumors were within 8 cm from the anal verge, and the average distance was 6 6 cm in TSR, 5 2 cm in TVR, 4 7 cm in TAR and 4 5 cm in TSLR, respectively. Most tumors (89%, 48/54) were less than 3 cm in diameter, six tumors (11%) were larger than 3 cm. The mean size of tumor was 3 5 cm in TSR group, 3 5 cm in TSLR, 2 5 cm in TAR, and 2 5 cm in TVR. Tumors were in T 1 stage in 46 patients and in T 2 in 8 patients. Postoperative complications included anastomosis leakage in one, sphincteric dysfunction in 2, and anal bleeding in 2. Eight patients (15 1%) recurred locally during the period of postoperative follow up, at a mean time of 42 2 months ranging 10 to 84 months. Five, ten year overall survival rates were 86 7% (39/45) and 69 2% (27/39)for T 1 tumor, and 75 0% (6/8) and 33 3% (2/6) for T 2 tumor, respectively.Conclusions Local excision of rectal cancer is of less injury and early recovery in properly selected patients while not at the expense of long term survival.

Objective To explore the Clinicopathological characteristics of patients with primary adenosquamous and squamous carcinoma of stomach. Methods The clinical data of 12 cases of primary squamous and adenosquamous carcinoma of the stomach were reviewed retrospectively, and the immunohistochemical staining of CK17 and CKI8 protein were performed in primary gastric adenosquamous carcinoma. Results Primary adenosquamous and squamous carcinoma of the stomach accounted for 0.28% of all the 4352 patients with gastric cancer during the same period. Of the 12 patients, 10 were adenosquamous carcinoma and other two were squamous carcinoma. There were 10 males and 2 females in this group, with their mean age being 65 years. The main clinical presentation included epigastric pain and discomfort, followed by hematemesis and melena. The definite diagnosis rate was 33% (4/12) by gastroscopy and biopsy before operation. The tumors were less than 5 cm in diameter in 3 patients, and more than 5 cm in 9 patients. The surgical procedure was radical resection in 8 patients and palliative resection in 4 patients. There were 1 case of stage Ⅰ, 5 cases of stage Ⅲ, 6 cases of stage Ⅳ. 10 patients died of tumor recurrence and metastasis within 2 years after operation, one died of other unrelated disease, and one was alive for more than 5 months. The component of both adenosquamous and squamous carcinoma were more than 30% in 4 patients with adenosquamous carcinoma who underwent palliative resection and died within 6 months after operation. Conclusions Primary adenosquamous and squamous carcinoma of the stomach were rare, and had specific clinicopathological characteristics. Having both biological behaviours of adenocarcinoma and squamous carcinoma may lead to poor prognosis in adenosquamous carcinoma of stomach.

Objective To choose the best surgical procedure,the surgical results and clinical outcomes of inguinal hernia repair with either an open anterior or posterior approach,were studied.Methods The 366 cases of inguinal hernia patients according to surgical side approach in different ways,is divided into A,B groups,Among group A of 186 cases repaired with application of prolene hernia system (PHS) via anterior approach,while group B of 180 cases surgically treated with Kugel technique with a posterior approach,and surgical procedure,postoperative recovery and complications were compared between these two groups,respectively.Results No significant differences were found in operation time,hospital stay,incisional infection rate and the recurrence rate (P ＞ 0.05).However,compared with group,the group B patients had less pain of the wound,slight postoperative swelling response,less foreign body aesthesis and hydrocele(P ＜ 0.05).Conclusion Compared with the anterior approach surgery,the posterior approach (Kugel technique) has less traumatic,low complication rate and rapid recovery after operation.

Objective To investigate the expressions of CD133 and CD44 and their prognostic significance in gastrointestinal stromal tumors (GIST).Methods Streptavidin perosidase (SP) method of immunohistochemistry was used to detect expressions of CD133 and CD44 proteins in 42 cases of GIST, and the relationship between their expressions and tumor size, mitotic count were analyzed by univariate and multivariate factor analyses.Results The expressions of CD133 and CD44 proteins in GIST were 21.4％ (9/42) and 78.6％ (33/42), respectively.The expressions of CD133 and CD44 proteins were significantly correlated with tumor size and mitotic count (P ＜ 0.05).Univariate factor analysis showed that the overall survival of GIST patients with positive CD133 protein (23.2 months) was shorter than that of patients with negative CD133 protein(63.1 months) (P ＜ 0.05).The overall survival of GIST patients with negative CD44 protein (23.2 months) was shorter than that of patients with positive CD44 protein (63.3 months) (P ＜ 0.05).Multivariate factor analysis showed that tumor size, mitotic count and CD44 protein were independent prognostic indicators for survival time after operation.Conclusions The positive expressions of CD133 and CD44 proteins might be the prognostic factors of GIST patients.

Objective To investigate the clinical features,diagnosis and treatment of appendix tumor.Methods The clinical data of 58 cases with primary appendiceal tumor were analyzed retrospectively.Results In the 58 cases clinical presentation mimicked acute appendicitis in 22 cases,chronic appendicitis in 15 cases,appendiceal abscess in 12 cases,intra-abdominal mass in 7 cases,and gastrointestinal perforation in 2 cases.Primary appendiceal tumor was diagnosed intraoperatively by intraoperative frozen histopathological examination in 10 cases,and the diagnosis was made by postoperative histopathological examination in the other 48 cases.There was appendiceal carcinoid in 40 cases,adenocarcinoma in 6 cases,mucocele in 2 cases,mucous adenocystoadenoma in 5 cases,pseudomyxoma peritonei in 2 cases,malignant neurilemmoma in 1 case,and malignant lymphoma in 2 cases.Surgical procedures included appendectomy in 6 cases,ileocecal resection in 8 cases,and right hemicolectomy in 44 cases (including right hemicolectomy and intraperitoneal chemotherapy with 5-FU 1 000 mg for pseudomyxoma peritonei in 2 cases).Radical resection was achieved in 55 cases and palliative resection in 3 cases.The 2 cases with pseudomyxoma peritonei died of tumor recurrence at 36 months and 54 months after operation respectively.All the 5 cases of adenocystoadenoma and 2 cases of appendix cyst survived without an evidence of recurrence.7 of 49 cases of malignant appendiceal tumor suffered recurrence postoperatively,the recurrence rate was 14％,which included liver metastasis in 4 cases and intraperitoneal recurrence in 3 cases.The 1,3,5-year survival rates of malignant appendiceal tumors were 100％ (49/49),92％ (35/49) and 80％ (39/49),respectively,which were 100％,98％ and 92％ for carcinoid,and 100％,67％ and 33％ for adenocarcinoma,respectively.Conclusions The preoperative diagnosis of primary appendiceal tumor is very difficult,the intraoperative frozen histopathological examination is helpful for diagnosis,the prognosis of appendiceal carcinoid is fair after resection.

Objective To study the diagnosis and surgical treatment of primary sarcoma of liver in order to obtain a better understanding of this disease and to improve its clinical treatment.Methods The clinical data on the clinicopathological features,surgical treatments and prognosis of 17 patients with primary liver sarcoma who were treated from January 2001 to May 2016 were retrospectively analyzed.Results Of 17 patients with primary sarcoma of liver,elevation of preoperative serum AFP was detected in one patient (5.9％),HBsAg positivity in 3 patients (17.6％),elevation of CEA in 2 patients (11.8％) and abnormal liver function in 3 patients (17.6％).The main clinical symptoms included epigastric pain in 9 patients,epigastric distention in 7 patients,loss of appetite in 5 patients (including in one patient after resection of gastric carcinoma).Twelve of these 17 patients underwent resection (resection rate 64.7％).Five patients underwent laparotomy and biopsy.Among patients who were treated with surgical resection,10 patients had R0 resection and 2 patients had R1 resection.Postoperatively,5 of these patients underwent adjuvant selective hepatic arterial infusion chemotherapy (mitomycin + fluorouracil + epirubicin),and 4 patients were treated with adjuvant systemic chemotherapy (vincristin,cisplatin,cyclophosphamide and Doxorubicin).The postoperative 1,3 and 5-year overall survival rates for all the patients were 58.8％ (10/17),29.4％ (5/17) and 11.7％ (2/17),respectively.In patients with liver resection,the survival rates were 83.3％ (10/12),41.6％ (5/12) and 16.7％ (2/12),and for R0 resection,100.0％ (10/10),50.0％ (5/10) and 20.0％ (2/10),respectively.Condusions The diagnosis of primary sarcoma of liver was difficult before operation.High survival rate could be achieved by radical resection and adjuvant chemotherapy.

Objective To investigate the clinical characteristics,surgical treatment and outcome for patients with duodenal stromal tumor.Methods Data of 40 patients with stromal tumor of duodenum were reviewed retrospectively.Results All patients received resection including local resection in 14 cases,segmental resection of the duodenum in 17 cases,and pancreaticoduodenectomy in 9 cases.38 cases were followed-up,and two were lost.The median follow-up was 59 months (range 3-240 mos).The 1,3,and 5-year overall survival rates were 92％,76％ and 68％,respectively.No recurrence was found in very-low-risk tumor (n =1) and low-risk turmors (n =4).The 1,3,and 5-year overall survival rates for intermediate-risk tumors were 95％,80％ and 70％,respectively;and those were 69 ％,31％,and 0 for high-risk tumors,respectively.14 of 33 cases (42％) suffered from recurrence after radical resection for intermediate or high-risk tumors.33 postoperative cases received treatment with Imatinib (Glivec) for more than one year,and one case developed recurrence at 2.5 years after operation.4 patients with synchronous liver metastasis received palliative resection and Imatinib,and two survived more than 1 year.Conclusion Surgery is the first choice for duodenal stromal tumor,and Imatinib should be administered for high-risk disease after surgery.