Objective To explore the feasibility and advantages of endoscopic thyroidectomy via breast areola approach.Methods Endoscopic thyroidectomy via breast areola approach was performed in 113 cases between August 2002 and May 2005.Preoperative diagnosis included 46 cases of adenoma,62 cases of nodular goiter,and 5 cases of Graves' disease.Results The operation was successfully completed endoscopically in 112 cases,and was converted to conventional thyroidectomy in 1 case because of bleeding.The tumor was 2.3?1.6 cm in diameter(range,0.8~7.0 cm).The operating time was 136.7?58.0 min(range,50~310 min),the intraoperative blood loss was 42.5?62.7 ml(range,10~200 ml),the postoperative drainage volume was 87.1?78.1 ml(range,15~310 ml),the time to resume normal activities was 2.2?0.9 d(range,1~4 d),and the length of postoperative hospital stay was 5.5?1.9 d(range,2~9 d).Out of the 113 cases,analgesic requirement was necessary in 18 cases (15.9%).Postoperative complications occurred in 6 cases,including 2 cases of recurrent laryngeal nerve injuries,1 case of superior laryngeal nerve injuries,1 case of hemorrhage,1 case of hypocalcemia,and 1 case of recurrence of Graves' disease.Pathological results showed 43 cases of thyroid adenoma,58 cases of nodular goiter,5 cases of Graves' disease,3 cases of thyroid cancer,and 4 cases of Hashimoto's thyroiditis.Conclusions Endoscopic thyroidectomy via breast areola approach is a technically feasible and safe procedure.It can be employed as the first choice for indicated patients.

ObjectiveTo evaluate the rationale of combined evisceration for the treatment of advanced gastric cancer.MethodsThe clinical data of 137 cases with advanced gastric cancer treated with combined evisceration from 1994 to 2001 were analyzed retrospectively.ResultsEleven cases underwent combined hepatectomy, 25 cases with splenectomy, 13 with transverse colectomy, 15 with cholecystectomy, 4 with auxiliary adrenalectomy, 38 with splenectomy plus distal pancreectomy, 13 with pancreatoduodenectomy, 18 with other adjecent evisceration. The operative mortality rate was nil. The 1-,3-,5-year survival rate were 60.2%,26.3% and 16.6% respectively.Conclusions Combined evisceration for treating advanced gastric cancer was feasible and yielded a longer survival.

OBJECTIVE: To explore the diagnostic role of computed tomographic dacryocystography (CTDCG) in lacrimal path damage and provide operative approach guidance for the endoscopic transnasal dacryocystorhinostomy (DCR). METHOD: Twenty-eight cases with lacrimal path damage underwent CTDCG. The following reconstruction techniques including volume rendering (VR), multiple planar reconstruction (MPR), maximum intensity projection (MIP) and three-dimensional reconstruction (3-d R) were done on the real-time workstation. The morphology of dacryocyst, displacement fracture of the lacrimal fossa (FS) and the relationship between the uncinate process (UP) and the FS were observed. The thickness of inner walls of anterosuperior and posteroinferior aspects of lacrimal fossa was measured. RESULT: The morphology of dacryocyst, the displacement fracture of the lacrimal fossa and the block site of the lacrimal passage could be displayed clearly by CTDCG with the following reconstruction techniques including VR, MPR, MIP and 3-d R, 6 cases of canaliculus obstruction, 14 cases of lacrimal sac obstruction, 8 cases of lacrimonasal duct obstruction were showed. Meanwhile the relationship between the UP and the FS could also be showed clear. The average bony thickness of the anterosuperior part of FS was (2.96 +/- 0.30) mm, while the bony thickness of the posteroinferior half was (0.02 +/- 0.005) mm, and the distance between the top and bottom of dacryocyst to the operculum of the middle turbinated (OMT) are (6.80 +/- 1.50) mm, (4.00 +/- 1.80) mm respectively (P < 0.05). CONCLUSION The morphology of dacryocyst, the displacement fracture of the lacrimal fossa, block site of the lacrimal passage and the relationship between the UP and FS can be clearly displayed by CTDCG, which provide operative approach guidance for the endoscopic transnasal dacryocystorhinostomy.
Adolescent ; Adult ; Dacryocystorhinostomy ; Endoscopy ; Female ; Humans ; Lacrimal Apparatus ; diagnostic imaging ; injuries ; Male ; Middle Aged ; Tomography, X-Ray Computed ; methods ; Young Adult

Objective To study the feasibility and safety of laparoscopic anatomical liver lobectomy for liver tumor. Methods The feasibility and therapeutic effect of laparoscopic anatomical liver resection on 67 patients were analyzed in our hospital from January 2005 to February 2010. Results Laparoscopic anatomical liver lobectomy was carried out successfully on all the patients. The operative time was 50.6± 16.2 min and the blood loss was 220. 8±76.5 ml. We did not use Pringle's manoeuvre. There was no postoperative complication. The patients were able to be ambulated out of bed within 24 hours and they started to take in food 1-3 days after surgery. The mean hospital stay was 5-7 days after surgery (mean 6.6±1.1 d). The total hospital cost was 30767.4±150. 1 Yuan. Conclusions Laparoscopic anatomical liver resection is feasible and safe. It has the advantages of minimal trauma and quick recovery for tumors located superficially, in the left liver, and in the inferior part of the right liver. Clinically, it should be used more widely.

Objective To compare the feasibility and safety of laparoscopic versus open hepatectomy.Methods The data of 165 patients who underwent laparoscopic hepatectomy were compared with 170 patients who underwent open hepatectomy in our hospital from November 2002 to December 2010.Results Laparoscopic hepatectomy was successfully carried out in 159 patients and 6 patients were converted to open operation because of intra-operative hemorrhage.The 170 patients in the open operative group had open hepatectomy successfully carried out.The hospital stay and cost in the laparoscopic group(7.6±1.3 d,31767.4±220.1(￥))were less than the open operation group(14.6±3.3 d,35127.3±392.2(￥))(t=-12.657,P＜0.001; t=-78.859,P＜0.001).There was no significant difference in Pringle's manoeuvre time,blood loss and postoperative complications(20.6 ±8.5vs.18.6±6.5 min,t=2.108,P=0.068),(420.8±76.5 vs.395.9±96.1 ml,t=2.157,P=0.063),(0 vs.4 cases,t=2.011,P=0.156))between the 2 groups.The operative time in the laparoscopic group was significantly longer than the open group(59.6 ± 12.2 vs.42.7 ± 22.6 min)(t=6.941,P＜0.001).Conclusions Laparoscopic hepatectomy is feasible and safe.It has the advantages of having less trauma and quicker recovery for tumors which were located superficially in the left liver and in the inferior part of the right liver.The operative time was longer than open hepatectomy,but there was no significant difference between the 2 groups in Pringle's manoeuvre time,blood loss and postoperative complications.The hospital stay and total hospital cost in the open operation group were higher than the laparoscopic hepatectomy group.

A 44-year-old male presented with a neoplasm on the buccal side of the right nasolabial fold for more than two months.Dermatological examination showed a hemispherical bulge sized 1.5 cm × 1.5 cm with central crater-like ulceration on the buccal side of the right nasolabial fold,as well as a crescent-shaped elevation measuring 1.5 cm × 2.5 cm above the hemispherical lesion.Histopathology of the hemispherical lesion revealed irregularly downward proliferation of epidermis,crater-like holes filled with eosinophilic keratinous plug in the center which were surrounded by collar-shaped epithelial cell projections.Small neutrophil abscesses were found in the clumps of epithelial cells,and massive lymphocyte infiltration with a clear bottom boundary was observed around the proliferating epithelial cells.Histopathologic examination of the crescent lesion showed multiple irregularly-shaped lobular-like structures of various sizes with sebaceous glands at different degrees of maturity in the mid dermis,which were surrounded by proliferating connective tissue.Immunohistochemical studies showed that the squamous cells stained positive for cytokeratin (CK),CK5,CK14,CK17,carcinoembryonic antigen (CEA) and epithelial membrane antigen (EMA) in the keratoacanthoma,and the sebaceous cells for CK,CK5,CK14 and EMA in the sebaceous adenoma.The pathological diagnosis was keratoacanthoma and sebaceous adenoma.The patient was diagnosed with moderately and poorly differentiated rectal adenocarcinoma in 2008.A diagnosis of Muir-Torre syndrome presenting as keratoacanthoma and sebaceous adenoma was finally made.

BACKGROUND:Understanding the difference of miRNA-34s expression in normal tissue and tumor tissue wil contribute to screen out a miRNA with high sensitivity as the specific tumor molecular marker.
OBJECTIVE:To investigate the differential expression of miRNA-34s (miR-34a/b/c) between normal skin and keloid tissue using real-time fluorescent quantitative PCR, and to evaluate the role and mechanisms of miRNA-34s in keloid formation and development.
METHODS:Ten cases of keloid tissue and two cases of normal skin tissue were col ected as specimens. Total RNAs were extracted from keloid and nomal skin tissue by Trizol method, and miRNA-34s were further isolated by Ambion’s miRNA Isolation Kit. Real-time fluorescent quantitative PCR was applied to verify expression levels of microRNA-34s (miR-34a/b/c) in keloid tissue and normal skin tissue.
RESULTS AND CONCLUSION:miRNA-34s (miRNA-34a/b/c) expression was down-regulated in keloid tissue compared with normal skin tissue (P<0.01). The findings showed that miRNA-34s (miRNA-34a/b/c) are involved in keloid formation and development, and down-regulation of the family member may result in neoplastic growth of keloid.

Objective To determine the safety and feasibility of laparoscopic dissection of hepatic pedicle in liver resections.Methods Laparoscopic dissection of hepatic pedicle was performed to achieve selective hepatic vascular inflow occlusion during anatomical hepatectomies in 43 patients with liver lesions.The average age was (46.1 ± 3.5) years.The hepatic pedicle was dissected precisely with sharp and blunt dissections to expose the portal vein,hepatic artery,and their branches.The hepatic ischemic area was judged after selective hepatic vascular inflow occlusion and the liver lesions were then resected.Results All 43 patients received anatomical hepatectomies successfully using the technique of laparoscopic hepatic pedicle dissection for selective hepatic vascular inflow occlusion.The mean operative time was (63.6 ± 11.2)minutes.The average blood loss was (243.8 ± 35.5)ml,and the mean hospital stay was (7.1 ± 1.6) days.Conclusion Laparoscopic dissection of hepatic pedicle in liver resection was feasible and safe.

ObjectiveTo investigate the influences of routine-dose loratadine on the positive patch test reaction to nickel sulfate.MethodsA double-blind,controlled and randomized study was carried out.A total of 121 patients with a positive patch test reaction to nickel sulfate were divided into two groups to receive loratadine 10 mg (experimental group,n =61 ) or placebo (control group,n =60) once daily for 14 days.The patch testing of nickel sulfate was performed on day 11,and clinical evaluation of the test was carried out on day 14 after the start of treatment.The intention to treat population was used for data analysis.ResultsNo changes were observed in the intensity of patch test reaction to nickel sulfate in 55 patients in the experimental group or 53 patients in the control group,and there was no significant difference between the two groups in the percentage of patients showing changes in the intensity of patch test reaction(9.8％ vs.11.7％,x2 =0.11,P ＞ 0.05).ConclusionThe routine-dose loratadine has no inhibitory effect on the intensity of skin patch test reaction to nickel sulfate.

Objective To explore the feasibility and therapeutic effect of total laparoscopic hepatectomy(LH) for treating hepa‐tolithiasis .Methods 75 consecutive patients with hepatolithiasis operatively treated in our hospital from November 2003 to Novem‐ber 2012 were retrospectively analyzed .Among them ,35 cases underwent laparoscopic hepatectomy(LH group) and 40 cases under‐went open hepatectomies(OH group) .The operative modes in the two groups included the left liver lateral lobe resection ,left hemi‐hepatecomy ,common bile duct incision exploration ,choledochoscopy exploration for calculi extraction ,T tube drainage and cholecys‐tectomy .The clinical indicators including the operation time ,intraoperative blood loss ,analgesic drug use situation ,ambulation time , diet recovery time ,postoperative complication rate ,postoperative hospital stay time ,stone clearance rate and recurrence rate were analyzed and compared between the two groups .Results The operation time of the LH group was longer than that of the OH group[(205 .0 ± 40 .9) min vs .(155 .0 ± 26 .6) min ,P< 0 .01] and the postoperative hospital stay time of the LH group was shorter than that of the OH group[(12 .3 ± 2 .6) d vs .(15 .6 ± 4 .3)d ,P< 0 .01] .The intraoperative blood loss of the LH group was slightly more than that of the OH group[(330 .0 ± 259 .7) mL vs .(151 .5 ± 137 .0) mL ,P< 0 .01] .However ,the blood loss of last 10 cases in the LH group was similar to that of the OH group[(81 .0 ± 19 .70)mL vs .(78 .0 ± 22 .0)mL ,P> 0 .05) .The use rate of analge‐sic drugs in the LH group was lower than that of the OH group (0 vs .62 .5% ) .The ambulation time and the diet recovery time in the LH group were shorter than those in the OH group[(1 .5 ± 0 .5)d vs .(3 .6 ± 0 .7)d ,P< 0 .01 ;(2 .4 ± 0 .5)d vs .(4 .0 ± 0 .7) d , P< 0 .01] .No differences between the two groups were found in the occurrence rate of postoperative complications (2 .9% vs . 16 .0% ) ,stone clearance rate(instant clearance rate 91 .4% vs .90% ;final clearance rate 97 .1% vs .100% ) and the opeartion ex‐cellent rate(97 .1% vs .100% ) .No case of perioperative death occurred in the two groups(P > 0 .05) .Conclusion LH combined with choledochoscopy for treating hepatolithiasis is feasible and safe in the patients conforming to the selected standard with an e‐qual therapeutic effect to that of open hepatectomy .LH has the advanteages of minimally invasive surgery such as small incision , less pain ,fast recovery ,less complications ,etc .