Objective To discuss how to identify the nerve and prevent the injury of the nonrecurrent laryngeal nerve during thyroid surgery. Methods The clinical data of 3078 patients undergoing thyroid resection were retrospectively analyzed. Results From January 1981 to December 2001,3078 thyroidectomy was performed at our department with the routine exploration of the recurrent laryngeal nerve.4241 recurrent laryngeal nerves were identified,among them there were 12 nonrecurrent laryngeal nerves(0.28%,12/4241),ofwhich all were right-sided.One patient was male and 11 female.Of these 12 cases,there were 2 of type Ⅰ(16.67%,2/12),6 of type Ⅱ(50%,6/12)and 4 of type Ⅲ (33.33%,4/12).One ofthe type Ⅰ patients suffered from intraoperative injury of his nonreurrent laryngeal nerve.Conclusions The careful intraoperative identification of the nonrecurrent laryngeal nerve helps prevent it from the inadvertent injury.

Objective In China primary hyperparathyroidism is not a kind of common disease as in the wesyrn countries.This article reports the current status in the diagnosis and treatment of primary hyperparathyroidism in the mainland of China. Methods We collected 730 cages of primary hyperparathyroidism diagnosed and treated in 7 top hospitals for endocrine surgery from 1965 to 2005.Results In this study.652(89.3%)cases were clinically symptomatic while 78(10.7%)cases were asymptomatic:442 cases were positive on 99mTc-MIBI scanning.Bilateral explorations were undertaken in 377 patients and unilateral or uni-gland exploration through the conventional incision in 204 cases.Minimally invasive parathyroidectomy in 143 cases.Endoscopically assisted 2 cm incision was taken in 6 cases for unilateral gland exploration.Pathologically 632(86.6%)cases were identified as adenoma,58(8.3%)cases were of hyperplasia and 40(5.5%)cases were of carcinoma.There were no major postoperative complications.While 20 patients suffering from recurrence or persistent postoperative hyperparathyroidism,the others are of normal or depressed serum level of calcium. Conclusions Preoperative localization is very helpful: Unilateral exploration for parathyroid adenoma is feasible; minimally invasive parathyroidectomy throush minimal incision is a kind of improving procedure for the localized parathyroid adenoma.

OBJECTIVETo investigate best diagnosing methods and therapy for patients with biliary tract complications after liver transplantation and analyze related factors.

METHODSA review was made of data collected from 96 patients, and confirmed by retrospective case notes examination.

RESULTSA total of 94 patients (97 grafts) survived more than 2 days after transplantation; of whom, 92 had an end-to-end biliary anastomosis with a T tube. The average follow-up was 5.8 months (range: 0.3 - 10.2 months). Among the 94 patients, eight (8.5%, 8/94) had complications: leakage during T-tube removal (2 patients), leakage at an earlier stage (2), simultaneous stricture and leak (2) and just stricture (2). Six patients with biliary tract complications had predisposing factors including hepatic artery stenosis (2 patients, including one hepatic artery stenosis combined with severe rejection, hepatic artery thrombosis (3), and donor-recipient bile duct mismatch (1). There was no difference in cold ischemic time. With hepatic artery thrombosis and/or stenosis > 50%, five patients were re-transplanted; without hepatic artery thrombosis and/or stenosis < 50%, three patients required endoscopic stenting and radiological percutaneous drainage of bile collection with or without balloon dilation. All patients survived.

CONCLUSIONSBiliary strictures occur later than leaks after surgery. Without hepatic artery thrombosis and/or stricture, there is no need for surgery; with hepatic artery thrombosis and/or stricture > 50%, re-transplantation is needed as early as possible.

Adult ; Biliary Tract Diseases ; etiology ; therapy ; Female ; Humans ; Liver Transplantation ; adverse effects ; Male ; Middle Aged ; Postoperative Complications ; etiology ; therapy ; Reoperation ; Retrospective Studies

OBJECTIVETo investigate whether the impairment of grafted liver after transplantation was induced by the same inflammatory cells in cold and warm ischemia.

METHODSMale SD rats were divided into two groups randomly, 24 grafted livers in each group were stored for 120 or 240 min at 4 degrees Centigrade Ringer's solution. Also male SD rats were divided into three groups, in which 24 grafted livers in each group were experienced warm ischemia ranged from 90, 120 to 150 min from non-heart-beating donor. The recipients were killed after 1, 3, 6, and 24 hours of transplantation for sample collection.

RESULTSAlong with the prolongation of cold and warm ischemia time, the serum ALT and AST levels were increased gradually after transplantation. Light microscopy showed some necroses in hepatocytes after 3 and 6 hours of transplantation in cold ischemia, and some neutrophilic infiltration in sinusoids. There were a large number of hepatocytes necroses after 3, 6 hours of transplantation in warm ischemia from non-heart-beating donor and a lot of lymphocytic infiltration in sinusoids. The findings in electron microscopy were as the same as those found in light microscopy, and the lymphocytes which infiltrated in sinusoids in warm ischemia were identified as T lymphocytes in electron microscopy.

CONCLUSIONSThe impairment of grafted livers after transplantation seems to be induced by two different inflammatory cells in cold and warm ischemia, that is, neutrophils mediate the cold ischemia-reperfusion, and T lymphocytes mediate the warm ischemia-reperfusion from non-heart-beating donor.

Alanine Transaminase ; blood ; Animals ; Aspartate Aminotransferases ; blood ; Graft Survival ; physiology ; Hepatocytes ; pathology ; ultrastructure ; Liver ; blood supply ; physiopathology ; ultrastructure ; Liver Transplantation ; physiology ; Male ; Neutrophils ; physiology ; Rats ; Rats, Sprague-Dawley ; Reperfusion Injury ; physiopathology ; T-Lymphocytes ; physiology ; Temperature ; Time Factors

Objective To investigate the relationship between donor liver warm ischemia and postoperative cytokine expression in liver transplantation from non-heart-beating donors.Methods Rat orthotopic liver transplantation was performed in three groups (HB, NHBD-30 and NHBD-60) according to the non-heart-beating time of 0, 30 or 60 minutes before donor liver was harvested. The serum values of TNF-?, IL-6 and CINC in each group after transplantation were determined.Results Over time of warm ischemia to which the donor liver was exposed, the concentrations of TNF-?, IL-6 and CINC elevated with significant difference among those three groups. TNF-?, IL-6 and CINC reached its peak value at 3 hours, 6 hours and 6 hours after transplantation respectively.ConclusionsKG1 In liver transplantation from non-heart-beating donors, the upregulation of TNF-?, IL-6 and CINC was associated with warm ischemia injury.

The pattern of incidence and clin ic al presentation of primary hyperparathyroidism (PHPT) collected during the past 45 years were analysed. It showed that most of PHPT patients were young or mid- aged, and female patients were somewhat more than male patients. The duration of illness was longer and symptoms were more severe. The number of post-menopausa l female patients was increased in recent ten years.

ObjectiveTo elucidate the effect of portal decompression and FK506 (FK) pretreatment on porcine extended hepatectomy.MethodsForty pigs were equally devided into 4 groups. Group A underwent 80% hepatectomy and portacaval shunt with FK pretreatment, group B did 80% hepatectomy and portacaval shunt, group C did 80% hepatectomy and FK pretreatment and group D did 80% hepatectomy. ResultsThe 5 day survival rate in Group A and B was 80% and 60% respectively, higher than 30% in Group C and 20% in group D ( P 200 mm H 2 O ( P

Objective To discuss the diagnosis and surgical treatment of multiple endocrine neoplasia 1 (MEN1). Methods The clinical data of MEN1 from 1974 to 2005 were retrospectively analyzed. Results There were 17 cases of MEN1 in our group. Among them, 11 cases were from 4 families. MEN1 gene mutation was detected in 14 cases admitted after 1997. There were 11 cases of pHPT, 6 cases of insulinoma, 8 cases of pituitary adenoma, 6 cases of adrenal adenoma, 2 cases of thymic carcinoid and 2 cases of collagenoma. Two patients had respectively 4 glands involved, 3 patients had 3, 7 patients had 2 kinds of gland involved respectively. Four patients had only one kind of gland involved. A 12 year old girl had no clinical symptom and biochemical change. Six patients presented with nephrolithasis, 6 patients had impaired pancreatic endocrine function. Subtotal parathyroidectomy was performed in 4 patients of pHPT, and one patient received parathyroid adenoma enucleation. Insulinomas were enucleated in 4 patients. Two patients underwent thymus tumor extirpation. Conclusions MEN1 varies in symptoms, even those from the same family. Cermline mutation test helps establish diagnosis. Operations should be aiming at tumor resection as well as the improvement of life quality.

Objective To evaluate the diagnosis and surgical treatment of parathyroid carcinoma (PTC). Methods Clinical data of 8 PTC cases were analyzed retrospectively. Results PTC accounted for 5. 7% of patients with primary hyperparathyroidism (PHPT) in our hospital. There were 4 men and 4 women. Male patients had younger mean onset age compared with female patients. The disease history of PTC was shorter than PHPT of benign causes. Six patients were admitted for acute hypercalcemia. Seven patients complained of palpable neck mass. Calcium level was 3.75?0.34 mmol/L,and PTH level was 1429.47?841.75 pg/ml. Frozen section established diagnosis in only one case. Four patients underwent radical en bloc resection. Other 4 cases received routine simple parathyroidectomy, 3 patients developed recurrence in 12 - 18 months postoperatively. Conclusions Acute hypercalcemia is common in PTC. Frozen biopsy diagnosis is not satisfactory. An initial en bloc resection of tumor and adjacent structures contributes most to the prognosis.

Objective To discuss the diagnosis and surgical treatment of multiple endocrine neoplasia 2 (MEN2). Methods The clinical data of 28 MEN2 cases from Jun 1997 to Jun 2006 were retrospectively analyzed. Results There were 25 cases of MEN2a and 3 cases of MEN2b. Among the patients of MEN2a, 23 patients were from 7 families with mutation of codon 634, exon 11 of RET, 3 patients of MEN2b had mutation of codon 918, exon 16 of RET and no family history. Twenty-two cases of MEN2a had thyroid masses with elevated calcitonin level, in which 17 were pathologically diagnosed as medullary thyroid carcinoma (MTC) ,12 patients had pheochromocytomas. Among them, 5 were of multiple foci and 2 were malignant. Five patients presented hyperparathyroidism and 3 patients were asymptomatic without biochemical alterations. Three MEN2b patients had MTC and mucosal ganglioneuromatosis with Marfanoid, one patient had bilateral pheochromocytoma. Total thyroidectomy with bilateral dissection of regional lymph nodes was performed in 12 patients of MEN2a, and nodule enucleations was done in other 5 patients followed by persistent elevated calcitonin level. Nine MEN2a patients underwent pheochromocytoma enucleation including bilateral adrenal resection in 3 cases. Three MEN2b patients underwent total thyroidectomy with bilateral lymph node dissection. Conclusions MTC is the most often complications of MEN2. Germline mutation test helps to make early diagnosis. Radical total thyroidectomy in young patients may prevent MTC.