ObjectiveTo explore the diagnosis and treatment features of parathyroid carcinoma (PTC). MethodsThe clinical data of 7 cases of parathyroid carcinoma treated from January 1993 to April 2014 were analyzed retrospectively. ResultsAll of the 7 patients had symptoms of hyperparathyroidism. Four patients had palpable neck mass. The average serum calcium level of preoperation was 3.07 mmol/L (2.35-4.98 mmol/L). The average parathyroid hormone (PTH) level was 1 181.5 pg/mL (78.4-2 061.7 pg/mL), which elevated 17 times the upper limit of normal. One case had operation in other hospital and six cases in Jishuitan hospital. The tumors located in the left inferior parathyroid gland in 3 cases, 2 cases of right lower parathyroid, and right superior parathyroid gland in 1 cases. One case underwent parathyroidectomy, parathyroidectomy including ipsilateral thyroid lobe or part of it was performed in 5 cases. Of 5 cases, 1 case was added central compartment lymphadenectomy. Three cases of postoperative tumor recurrence underwent reoperation, of which 1 case recurred 3 times. Two cases died. The remining 5 had survived until now, had survived for 5 years in 3 cases. ConclusionsA comprehensive approach with clinical presentation, serum calcium and PTH levels, B-ultrasonography, 99Tcm-MIBI, intraoperation aberrant findings, and histopathology offers help to accurate diagnosis of parathyroid carcinoma. Surgery is en bloc resection of the primary lesion. Recurrence needs reoperation, and long-term follow-up is advised.
Objective To compare the clinical features and surgical effect between ectopic and orthotopic parathyroid lesions. Methods The clinical data of 136 patients with parathyroid lesions who had undergone parathyroidectomy between May 2010 and May 2017 were retrospectively analyzed. Results The ectopic parathyroid location was detected in 20 patients (14.7%) of the 136 patients with parathyroid lesions. Of the 20 patients, prevalence of superior mediastinal ectopic lesions accounted for 30.0% (6/20), prevalence of thyrothymic ligament accounted for 20.0% (4/20), prevalence of intrathymic accounted for 15.0% (3/20), prevalence of tracheoesophageal groove accounted for 25.0% (5/20), prevalence of submandibular accounted for 5.0% (1/20), prevalence of carotid sheath accounted for 5.0% (1/20), respectively. Patients with ectopic lesions had significantly higher level of serum parathyroid hormone (PTH) and alkaline phosphatase (AKP) than patients with orthotopic parathyroid lesions (P≤0.05). In addition, osteitis fibrosa cystica of metabolic bone disease was significantly more frequent in patients with ectopic parathyroid lesions than those with orthotopic parathyroid lesions (P=0.04). Preoperative ultrasonography had a sensitivity of 50.0% (10/20) for ectopic lesions and 90.1% (100/111) for orthotopic lesions. Preoperative 99Tcm methoxyisobutylisonitrile (99Tcm-MIBI) had a sensitivity of 100% (19/19）for ectopic lesions and 95.3% (101/106) for orthotopic lesions. Preoperative CT had a sensitivity of 81.3% (13/14) for ectopic lesions and 93.6% (102/109) for orthotopic lesions. Preoperative combination examination had a sensitivity of 100% (20/20) for ectopic lesions and 99.1% (108/109) for orthotopic lesions. Of the 20 patients with ectopic leisions, 17 patients (85.0%) had undergone 1 time of operation, 2 patients (10.0%) had undergone twice operations, 1 patient (5.0%) had undergone trice operations. The onset of hypocalcemia happened in 13 patients (65.0%) after operation. Of 116 patients with orthotopic leisions, only 1 patient had twice operations, the onset of hypocalcemia happened in 74 patients (63.8%) after operation. The reoperation rate of orthotopic leisions was lower than that of patients with ectopic leisions (P=0.01), but there was no significant difference on the incidence of hypocalcemia (P=0.92). Excessive bleeding and recurrent laryngeal nerve injury didn’t happen after all operations. Of 136 patients, 111 patients had followed-up, among which 17 patients with ectopic leisions and 94 patients with orthotopic leisions. During the followed-up period, there were no recurrence happened. Conclusions The ectopic parathyroid lesions are associated with higher serum PTH and AKP levels and more frequent metabolic bone disease in comparison with the orthotopic parathyroid lesions, as well as high reoperation rate. Combined examination, including cervical ultrasonography, 99Tcm-MIBI, and cervical enhanced CT are needed for preoperative location. Parathyroid lesions resection is the main surgical approach, and patients with parathyroid lesions are prone to be onset of hypocalcemia.
Objective To analysis causes of reoperation for primary hyperparathyroidism and its clinical characteristics. Method The clinical data of the patients with primary hyperparathyroidism who had undergone reoperation from January 1993 to May 2017 were retrospectively analyzed. Results A total of 11 patients underwent reoperation were collected in the 226 patients with primary hyperparathyroidism. Of the 11 cases, 8 cases underwent twice operations, 2 cases underwent thrice operations, 1 case underwent quintic operation. After the initial operation, 3 cases were persistent diseases and 7 cases were recurrent diseases, 1 patient was not defined as the persistent or recurrent disease. The main clinical manifestations before the reoperation were fatigue, pain in joints, bones, or muscle. The reasons for reoperation included 3 cases of ectopic parathyroid lesions, 3 cases of recurrent parathyroid carcinomas, 1 case of enlarged operation extent for parathyroid carcinoma, 2 cases of regrowth of double parathyroid aedomas, 1 case of missing adenoma, 1 case of parathyroid hyperplasia. Among the location examinations, the 99Tcm-MIBI was most sensitivity (8/9). Eight cases were received reoperation on the original incision, and the remaining 3 ectopic parathyroid lesions on the new incision. After the reoperation, 2 patients were lost of follow-up, 1 patient died, and the remaining 8 patients had no recurrences during follow-up period. Conclusion A comprehensive approach with multiple imageology examinations which attribute to accurate location of lesions, experienced surgeons and well knowledge of parathyroid anatomy and embryology help to descend reoperation ratio and improve success rate of reoperation.
ObjectiveTo explore the relationship of the level of inflammation and nutritional status with the occurrence and prognosis of refractory diabetic foot.MethodsA total of 70 patients with refractory diabetic foot between August 2015 and August 2017 were randomly selected as the observation group. Another 70 patients with diabetes mellitus (without foot ulcer) who visited the hospital in the same period were set as the control group. The observation group was subgrouped into the non-amputation group and the amputation group according to the follow-up endpoint events, and into the grade Ⅲ, Ⅳ, and Ⅴ groups according to Wagner classification method. The blood levels of inflammatory markers and nutritional markers between groups were compared.ResultsIn the observation group, vascular cell adhesion molecule-1 (VCAM-1), fibroblast growth factor 2 (FGF2), fibrinogen (FIB), tumor necrosis factor-α (TNF-α), interleukin (IL)-6, IL-18, lipoprotein phospholipase A2 (LP-PLA2), C-reactive protein (CRP) levels were significantly higher than those in the control group, and albumin (ALB), prealbumin (PA), and transferrin (TRF) levels were significantly lower than those in the control group, with statistically significant differences (P<0.01). The blood levels of FGF2, FIB, IL-6, IL-18, LP-PLA2, and CRP in the amputation group were significantly higher than those in the non-amputation group, and the levels of TRF, ALB, and PA were significantly lower than those in the non-amputation group (P<0.01). There were statistically significant differences in the levels of FGF2, FIB, IL-6, IL-18, LP-PLA2, CRP, TRF, ALB, and PA in patients with diabetic foot with different Wagner grades (P<0.05). The result of multiple logistic regression analysis showed that IL-6 [odds ratio (OR)=1.487, 95% confidence interval (CI) (1.023, 2.120), P<0.001], IL-18 [OR=1.274, 95%CI (1.052, 1.665), P<0.001], LP-PLA2 [OR=1.478, 95%CI (1.126, 1.789), P<0.001], and CRP [OR=2.085, 95%CI (1.574, 2.782), P<0.001] were independent risk factors for the occurrence of refractory diabetic foot, and TRF [OR=0.645, 95%CI (0.002, 0.898), P<0.001], ALB [OR=0.838, 95%CI (0.429, 0.923), P<0.001], and PA [OR=0.478, 95%CI (0.201, 0.984), P<0.001] were independent protective factors for the occurrence of refractory diabetic foot.ConclusionIn the clinical treatment of diabetic foot, we should pay attention to the monitoring of the level of inflammatory factors and nutritional status, and it is necessary to timely carry out anti-inflammatory treatment and appropriate nutritional support treatment.
ObjectiveTo summarize the types of difficult cases and complications during interventional therapy for Budd-Chiari syndrome, and to propose solutions to these problems and complications. MethodsClinical data of 1 859 cases of Budd-Chiari syndrome (2 214 times) who underwent interventional diagnosis and therapy from Jan. 1990 to Sep. 2014 in our hospital were retrospectively analyzed. ResultsOf the 2 214 times, complications happened in 31 times, which were related to the interventional therapy, and the incidence of complication was 1.40% (31/2 214). Of the 31 times who suffered from complications, 25 times were successfully treated, and the successful rate was 80.65%. Three hundreds and seventy two times had been successful treated in 396 times with difficult situation (there were 9 times without treatment), and the successful rate was 96.12% (372/387). Seven patients abandoned inteventional therapy. Six cases died during the operation and hospital stay period, and the mortality was 0.32% (6/1 852). There were 1 553 cases were followed-up for 10-284 months (average of 100.9 months). During the follow-up period, 209 cases suffered from restenosis, and the restenosis rate was 13.46% (209/1 553). ConclusionInterventional therapy for Budd-Chiari syndrome has entered a mature stage, discover timely and correct handling of intraoperative complications are important to improve the successful rate and curative effect.