An accidental gallbladder schwannoma misdiagnosis as malignant cancer

<正>To the Editor: Schwannomas are mainly benign neurogenic tumors originating from the Schwann cells in peripheral nerves sheaths and occur in patients at any age and in every location [ 1, 2 ]. The most common occurring sites of schwannomas are the head, neck and extremities [3]. In the abdominal cavity, the most frequently involved sites are the retroperitoneum and stomach [4].     

Exaggerated glucagon-like peptide-1 and blunted glucose-dependent insulinotropic peptide secretion are associated with Roux-en-Y gastric bypass but not adjustable gastric banding

BACKGROUND: The aim of this study was to measure the circulating levels of glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic peptide (GIP), and glucagon in patients who had undergone adjustable gastric banding (BND) or Roux-en-Y gastric bypass (RYGB) to understand the differences in glucose and insulin regulation after these procedures. METHODS: This was a cross-sectional study of 3 groups of women matched for age and body mass index: group 1, overweight controls (n = 13); group 2, BND (n = 10); and group 3, RYGB (n = 13). Venous blood was drawn with the patient in the fasted state and throughout a 3-hour period after a liquid meal. RESULTS: The fasting glucose level was similar between the 2 surgery groups; however, the fasting insulin concentrations were greater in the BND (10.0 microU/mL) than in the RYGB (6.2 microU/mL; P <0.05) group. The glucose level at 60 minutes was significantly lower in the RYGB group (70 mg/dL, range 38-82) than in the BND group (83 mg/dL, range 63-98). The GLP-1 levels at 30 minutes were more than threefold greater in the RYGB group (96 pmol/L) compared with the BND and overweight control (28 pmol/L) groups. The GLP-1 and insulin concentrations correlated at 30 minutes only in the RYGB group (r = .66; P = .013). The glucose-dependent insulinotropic peptide levels at 30 minutes were lower in the RYGB group (20 pmol/L) than in the BND group (31 pmol/L) or overweight control group (33 pmol/L). The peak glucagon levels were similar among the 3 groups. CONCLUSION: Exaggerated postprandial GLP-1 and blunted glucose-dependent insulinotropic peptide secretion after RYGB might contribute to the greater weight loss and improved glucose homeostasis compared with BND.     

Comparison of effects of gastric bypass and biliopancreatic diversion with duodenal switch on weight loss and body composition 1-2 years after surgery.

BACKGROUND: Gastric bypass (GB) is the most common surgical procedure for weight loss in the United States. Biliopancreatic diversion with duodenal switch (BPD/DS) is less routinely performed, perhaps because of its technical difficulty and metabolic concerns. The objective of this study was to determine whether these procedures had differential effects on weight loss and body composition. METHODS: Body composition was measured by bioimpedance (Tanita 310) at the initial consultation, and follow-up measurements were completed 1-2 years after surgery. RESULTS: Of the 72 patients in the study, 50, aged 46.2 +/- 8.5 years, had undergone GB and were measured 15.5 +/- 5.2 months after surgery and 22, aged 40.6 +/- 7.9 years, had undergone BPD/DS and were measured 19.5 +/- 7.5 months after surgery. Patient age and time after surgery were significantly different between the 2 groups. The body mass index (BMI) for the BPD/DS group was 53.6 +/- 11.9 kg/m(2), significantly greater than the BMI of the GB group (48.0 +/- 6.3 kg/m(2); P = .009). However, the percentage of body fat did not differ between the 2 groups (P = .515). Postoperatively, the BMIs for the GB group (31.5 +/- 5.0 kg/m(2)) and BPD/DS group (30.3 +/- 6.1 kg/m(2)) were not significantly different (P = .384). The percentage of body fat for the GB and BPD/DS groups had changed from 49.2% +/- 8.3% to 32.1% +/- 10.6% and 47.9% +/- 5.9% to 23.8% +/- 10.4%, respectively (P = .002). The BMI had decreased by 16.5 +/- 4.8 kg/m(2)after GB and 23.3 +/- 6.8 kg/m(2) after BPD/DS (P <.001). The decrease in fat was 17.1% +/- 8.2% after GB and 24.2% +/- 7.2% after BPD/DS (P <.001). CONCLUSION: The BPD/DS procedure is more effective in reducing the BMI and promoting fat loss than is GB. The assessment of the impact of these two operations on an individualized basis offers additional information to assist in the evaluation of these procedures.     

Value of CT in the preoperative assessment of lung cancer: a survey of thoracic surgeons

Practicing thoracic surgeons were randomly surveyed to evaluate how computed tomography (CT) has influenced the preoperative evaluation of bronchogenic carcinoma. Thirty-six percent of the 529 respondents routinely requested CT and 62% did so selectively. Approximately 40% indicated that CT provided useful information in most cases. Nearly all surgeons (98.7%) do not rely on the identification of enlarged lymph nodes with CT to spare the patient surgical staging; however, 77.5% are influenced by CT results in their staging procedures. Fifty-seven percent reported that a negative CT study eliminates surgical staging entirely unless the patient has a "coin lesion," in which case 75% are willing to proceed directly to thoracotomy. For surgeons who use CT selectively, an abnormal mediastinal contour on the radiograph was the most frequent radiologic abnormality to prompt CT (85%). Thirty-seven percent are influenced by tumor histology in their decision to request CT. There was little difference in the pattern of CT use between university and community hospital surgeons.     

4-间氨基酚-4去甲表鬼臼醚诱导K562细胞凋亡

目的:鬼臼毒素具有抗炎作用,为限制其对机体产生不良反应,探讨经过结构改造的4-间氨基酚-4去甲表鬼臼醚对K562细胞生长抑制及诱导凋亡情况。方法:实验于2004-03/2005-01在兰州医学院完成。①实验材料:4-间氨基酚-4去甲表鬼臼酯由兰州大学应用有机化学国家重点实验室田暄教授惠赠,纯度98%。依托铂甙(连云港恒瑞药业产品,批号04060121,20g/L)临用前以5%二甲亚砜稀释至5g/L。K562细胞由兰州大学中药新药临窗前研究重点实验室传代保种。②细胞生长抑制率检测:取K562细胞,离心后调整浓度为1×108L-1,以100μL等量接种于96孔培养板。4-间氨基酚-4去甲表鬼臼醚组分别加入0.313,0.625,1.25,2.5,5,10,20,40mg/L的4-间氨基酚-4去甲表鬼臼醚药液10μL;依托铂甙组分别加入以上8种终浓度的依托铂甙药液10μL;正常对照组加入等量的溶媒;空白对照组不加细胞和任何药物,只加入等量的完全培养液。采用噻唑蓝法检测药物与细胞作用24,48,72h时K562细胞的生长抑制率。③细胞超微结构观察:取K562细胞,离心后调整浓度为1×109L-1,以2mL等量接种于24孔培养板。4-间氨基酚-4去甲表鬼臼醚组加入2.5mg/L的4-间氨基酚-4去甲表鬼臼醚药液200μL,正常对照组加入等量的溶媒。制作超薄切片,用醋酸双氧铀、柠檬酸铅染色,透射电镜观察细胞形态及细胞质、细胞核的变化。④细胞周期及凋亡检测:取K562细胞,离心后调整浓度为1×108L-1,以2mL等量接种于24孔培养板。4-间氨基酚-4去甲表鬼臼醚组分别加入1.25,2.5,5,10,20mg/L的4-间氨基酚-4去甲表鬼臼醚药液200μL,正常对照组加入等量的溶媒。在流式细胞仪上检测细胞周期,用Multicycle软件计算凋亡细胞百分率。结果:①4-间氨基酚-4去甲表鬼臼醚抑制K562细胞生长情况:在0.313～20mg/L范围内,其对K562细胞的抑制作用随浓度升高而增强,具有量效关系,同时抑制率随着作用时间的延长而升高,具有时效关系;超过20mg/L时抑制作用逐渐下降。依托铂甙对K562细胞的抑制情况与4-间氨基酚-4去甲表鬼臼醚类似。②细胞超微结构:正常对照组K562细胞核形状规则,核膜清晰可见,内质网丰富,内含大量线粒体,细胞表面微绒毛多,染色体分布于核中央。4-间氨基酚-4去甲表鬼臼醚组K562细胞出现明显的凋亡特征,微绒毛消失,细胞浆固缩,染色体凝集为团块状分布于核膜边缘,细胞内出现大量空泡,线粒体和内质网减少,细胞周围出现凋亡小体。③细胞周期及凋亡情况:1.25,2.5,5,10,20mg/L4-间氨基酚-4去甲表鬼臼醚作用24h,分别有19.4%,34.8%,34.0%,6.9%,4.5%的K562细胞发生凋亡,G0/G1期和S期K562细胞减少,于G2/M期明显增多。正常对照组凋亡率仅为0.3%。结论:①4-间氨基酚-4去甲表鬼臼醚能够抑制K562细胞的生长,呈时效、量效关系。②4-间氨基酚-4去甲表鬼臼醚可诱导K562细胞凋亡。