Objective To investigate the clinical feature and misdiagnosis of 128 patients with Wilson’s disease and proposed the points of diagnosis for this disease. MethodsOne hundred and twenty eight patients with Wilson’s disease from Jan. 1983 to Apr. 2000 of our hospital were reviewed. Their clinical feature and diagnosis condition, such as the first onset symptoms, misdiagnosis conditions and hypersplenism were studied. Results①The first onset symptoms: 64 showed liver dysfunction and 52 presented manifestation of central nerves system (CNS) (Pgt;0.05). ②The age of liver dysfunction was significantly younger (13 years) than that of CNS involved patients (23 years, P＜0.05). ③Patients with the liver damage had enlarged liver (3 cm below the right rib) and hypersplenism and 12 patients had to receive splenectomy. ④Gastroscopy or barium meal showed that esophageal varicose rate was 30.8%（12/39） and 7 patients had large upper gastrointestinal bleeding. Conclusion The age of liver involved patients is significantly younger than that of the CNS involved patients. The liver cirrhosis, hypersplenism and portal hypertension are very common complications of Wilson’s disease and some prevention and cure measures should be taken for these complications.
Objective To explore the causes and treatment of rebleeding after operation on portal hypertension patients. Methods The clinical data of 41 rebleeding cases underwent the operational between January 2000 and December 2009 in Peking Union Medical College Hospital were retrospectively analyzed. Results All 13 cases who got rebleeding after shunt operation received lienectomy, but for those who got rebleeding after lienectomy, 23 patients received Phemister or modified Phemister or expanded lienectomy and 5 patients received shunt operation. Surgical related complications occurred in 7 cases (17.1%) at 2 weeks after operation, including abdominal bleeding (3 cases), gastrointestinal bleeding (2 cases), and intractable ascites (2 cases). After the follow-up of 3-60 months (mean 39 months), all patients were still alive. During the follow-up, 3 cases of recurrent esophageal varices were observed and one of them got rebleeding.Conclusion The majority of rebleeding after lienectomy tend to be ascribed to the wrong operations chose, while bad operation skill often contribute to the rebleeding after shunt operation, suggesting ideal therapeutic effect for rebleeding can benefit from appropriate operation choose.
Objective To analyze and summarize clinical characteristics, diagnostic method, choice of treatment, and prognosis of metastatic lung cancer to thyroid gland. Method The clinical materials of the 15 patients presenting with secondary thyroid cancer were analyzed retrospectively. Results There were 10 females and 5 males in the 15 patients, with the female to male ratio of 2 : 1. The age ranged from 36 to 79 years old with an average 59 years old. The diagnoses of 12 cases were made by the surgery or the fine needle aspiration biopsy (FNAB), 3 cases by the clinic. The interval from the diagnosis of the primary tumor to the thyroid metastasis varied from 0 month to 21 months with an average 4 months. Three patients received the thyroidectomy, 5 patients received the chemotherapy or chemoradiotherapy, and 7 patients gave up the treatment. The average survival time was 10 months. Conclusions Metastatic lung cancer to thyroid gland is rare, and FNAB is a useful tool for diagnosis. Thyroidectomy may not be recommended because of poor prognosis.
Objective To investigate the anatomical character and variation of non-recurrent laryngeal nerve （NRLN）， and to explore measurement to identify and prevent injury of this nerve during thyroidectomy. Methods Clinical data of 2 211 patients who underwent thyroidectomy from Jan. 2007 to Jun. 2012 in Peking Union Medical College Hospital were analyzed retrospectively， and 114 patients with NRLN of related literature reviews were analyzed too. Results There were 3 479 recurrent laryngeal nerve （2 211 cases） which were exposed during thyroid operation in Peking Union Medical College Hospital， of which 11 cases were confirmed to be right NRLN （0.32%， 11/3 479）. Of the 11 cases， 3 cases were typeⅠ， 7 cases were typeⅡA， and 1 case was typeⅡB， one case was also found to have a recurrent branch. None of them injured during operation. One hundred and fourteen cases of NRLN （0.14%-4%） were found in literature reviews. Of the 114 cases， 109 cases were confirmed to be right NRLN， of which 4 cases were typeⅠ （3.7%， 4/109）， 75 cases were typeⅡA （68.8%， 75/109）， 9 cases were typeⅡB （8.3%， 9/109）， 21 cases were unclear （19.3%， 21/109）， 3 cases were also found to have a recurrent branch （2.8%，3/109）. Five cases were confirmed to be left NRLN， of which 2 cases were typeⅡA， 3 cases were unclear， 1 case was also found to have a recurrent branch. Of all the 104 cases reported by treatises and case reports， 16 cases injured during operation， of which 1 case was typeⅠ， 9 cases were typeⅡA， 6 cases were unclear. Conclusions NRLN， which is a rare anomaly， usually happens on the right， and very vulnerable during thyroid surgery. The most usually injured type is typeⅡA. Fully acknowledgment of the NRLN and its variant types is very helpful to avoid damage during thyroid surgery.
Objective To study the incidence，clinicopathological characteristics,diagnosis，treatment， and prognosis of synchronous or metachronous primary cancers in patients with gastric cancer． Methods The clinical data of 103 gastric cancer patients with synchronous or metachronous primary cancers from January 1983 to December 2010 were collected and reviewed．Results The incidence of synchronous or metachronous primary cancer in addition to gastric cancer was 2.26％（103/4 552）.The age of these patients was （63.98±11.93） years （30～84 years） when gastric cancer was diagnosed.There were 29 cases of synchronous primary cancer and 74 cases of metachronous primary cancer,in which there were 46 pre-metachronous cancer patients and 28 post-metachronous cancer patients.All the patients had 113 primary tumors of other organs.Colorectal cancer was the most common type of primary cancer in other organs （27.43%, 31/113）,followed by lung cancer （15.04%, 17/113）.The time interval between gastric cancer and metachronous primary cancer was （87.95±92.98） months （7～506 months）,and 65.49% （74/113） of other primary tumors were diagnosed within 5 years before or after gastric cancer. The overall 5-year survival rate was 48.43%. The 5-year survival rate of post-metachronous group （69.52%） was significantly better than synchronous cancer group （36.40%, P=0.009） or pre-metachronous group （42.31%, P=0.023）.In 33 patients who had definite cause of death, 20 patients died of gastric cancer.Conclusions Primary cancer of other organs should be considered in treatment of gastric cancer.Gastric cancer may be the most important factor impacting the prognosis of these patients.
Objective To explore the effect of multi-disciplinary treatment of the Graves’ disease (GD) with huge-size thyroid during perioperative period. Methods Retrospectively analyzed the clinical data of 8 GD patients with huge-size thyroid who got treatment in Pekin Union Medical College Hospital during Jan. 2006 to Dec. 2016. All patients underwent comprehensive preparation before operation and underwent total thyroidectomy. To explore the changes of thyroid function and culture after anti-thyroid drug (ATD)/iodine preparation/arterial embolization before operation, and to summarize situation of the bleeding loss intraoperation, neck-drainage, thyroid function, and relapses after operation. Results All cases got a satisfactory operation result after standard ATD, iodine preparation (Lugol’s solution 10–15 drops for 3–4 weeks, combined with ATDs for 2–3 weeks ), and main arterial embolization of thyroid in 24 h preoperation. They got shorter operative time (2.5–4.5 h), less bleeding intraoperation (4 cases≤100 mL), less neck-drainage, and almost normal retention time. No severe or permanent complications, for example thyroid storm, abnormal voice, and hypoparathyroid occurred. They were followed as outpatients for 18–133 months, and were found a perfect long-term effect without complication and relapse. Conclusions Perioperative period management is very important to those GD patients with huge-sized thyroid, and multi-disciplinary treatment can decrease theintraoperation bleeding, as well as occurrence of thyroid storm effectively. In addition, operated subtly during surgery can protect the recurrent laryngeal nerve and parathyroid effectively.