原发性甲状旁腺功能亢进性骨病

目的提高原发性甲状旁腺功能亢进性骨病的早期诊断及治疗效果。方法回顾分析4例骨型原发性甲状旁腺功能亢进症患者的临床资料及随访结果。其中男性2例,女性2例;平均年龄35岁(21～51岁)。临床症状包括疼痛、肿胀,伴有乏力、胃肠不适及体重下降,1例发生病理性骨折,X线表现多发溶骨性病损,核素扫描显示多部位骨骼核素浓聚。实验室检查:血钙:2.23～3.99mmol/L,甲状旁腺素:644～1664pg/ml。全部患者转入头颈部肿瘤外科,手术后确诊甲状旁腺腺瘤3例,甲状旁腺腺癌1例。结果平均随访42个月(8～96个月)。所有患者骨科症状好转,3例术后1.5年骨病损痊愈。甲状旁腺肿瘤无复发及转移。结论早期诊断、及时手术治疗可避免骨型原发性甲状旁腺功能亢进症引起的骨病损加重。除预计可能出现严重的骨相关事件外,骨病损可不作特殊骨科治疗。     

异位甲状旁腺肿瘤合并原发性甲状旁腺功能亢进症的研究进展

甲状旁腺肿瘤是引起原发性甲状旁腺亢进症的主要因素。异位甲状旁腺肿瘤较为少见,多数肿瘤无典型的临床症状,隐匿性高而在临床中易被忽视。对异位性肿瘤的定性、定位是目前临床诊治难点,99Tcm-MIBI闪烁扫描术是诊断甲状旁腺肿瘤的金标准,通常与其他影像方法联合应用。手术治疗是最有效也是唯一可以治愈的方式。     

甲状腺乳头状腺癌合并甲状旁腺腺瘤原发性甲旁亢一例

患者女 ,2 9岁。因颈部、胸背及四肢疼痛 5年入院。查体 :心率、血压正常 ,颈部未查见异常。实验室检查 :血钙3.0mmol L(正常值 2 .1～ 2 .7mmol L) ,血磷 0 .8mmol L(正常值 0 .6～ 1.6mmol L) ,PTH 4 4 .7pmol L(正常值 1.5 9～ 6 .89pmol L) ,甲状腺功能检查无异常。彩超 :甲状腺右叶上极实质内查见 0 .5cm× 0 .5cm× 0 .4cm弱回声团块 ,边界较清楚 ,形态较规则 ,内部回声欠均匀。甲状腺左叶下极后方查见 2 .6cm× 1.8cm× 1.7cm弱回声团块 ,边界清楚 ,形态规则 ,内部回声均匀。术前诊断 :右下甲状旁腺腺瘤伴原发性甲旁亢 ;甲状腺右…     

99mTc-MIBI显像在原发性甲状旁腺功能亢进定位诊断中的应用价值

目的:评价99mTc-甲氧基异丁基异腈(99mTc-MIBI)显像在原发性甲状旁腺功能亢进症(PHPT) 定位诊断中的临床应用价值。方法:回顾性分析57例疑似PHPT患者99mTc-MIBI显像、血清PTH测定及B超检查结果,以术后病理为金标准,对99mTc-MIBI双时相显像、血清PTH测定及B超检查三种诊断方法的灵敏度、特异度、准确度进行比较和评价。结果:术后病理证实,57例患者99mTc-MIBI显像与血清PTH测定两种诊断方法比较,灵敏度、特异度、准确度分别为91.49%（80.85%）、50.00%（80.00%）、84.42%（80.70%）;99mTc-MIBI显像与B超检查两种诊断方法比较,灵敏度、特异度、准确度分别为91.49%（76.60%）、50.00%（70.00%）、84.21%（75.44%）。结论:99mTc-MIBI显像对PHPT定位诊断的灵敏度、准确度都高于血清PTH测定及B超检查结果,但特异性较低。99mTc-MIBI显像联合血清PTH测定及B超可以提高PHPT的诊断准确性,具有更高的临床应用价值。     

100例甲状旁腺腺瘤的临床表现和首诊因素分析北大核心CSCD

目的探讨甲状旁腺腺瘤(parathyroid adenoma,PA)的首诊因素、临床表现、治疗和预后。方法回顾性分析100例PA的临床资料。结果 100例PA的术前血钙(2.84±0.34)mmol/L;术前甲状旁腺素(PTH)中位数201 pg/ml。在首诊因素中,骨骼系统、泌尿系统症状的比例分别为17%、12%(P=0.000),血钙高、甲状旁腺占位的比例分别为32%、16%(P=0.000)。骨型、肾型、骨肾型分别为62%、43%、33%(P=0.000)。^(99)Tc^m-MIBI、B超、核磁、CT定位检查的阳性率分别为93.61%、82.52%、77.78%、74%(P=0.057)。19例双侧探查;23例单侧探查;58例未探查,术中均联合PTH监测。术后第1天PTH、血钙明显下降,血磷明显上升(P=0.000)。永久性的甲状旁腺功能减退5例。结论血钙检测应列为常规筛查。骨痛、骨折、泌尿系结石、甲状旁腺占位应筛查PTH。^(99)Tc^m-MIBI作为定位诊断的首选。术中PTH监测可提高甲状旁腺瘤手术的成功率。     

48例甲状旁腺腺瘤和腺癌的临床分析

目的探讨甲状旁腺腺瘤(PTA)和腺癌(PTC)的诊断和外科治疗。方法回顾性分析48例PTA和PTC的临床资料。48例患者中,腺瘤46例,腺癌2例,平均病程为(3．65±2.83)年;血钙和血清甲状旁腺素(PTH)均高于正常;在多普勒彩超和99mTc-甲氧基异丁基异腈(MIBI)定位明确且吻合的31例单侧单发病例中,18例行单侧甲状旁腺探查,无肿瘤遗漏;13例仍行双侧探查,但对侧探查均阴性。全部病例均行肿瘤切除,2例腺癌另行同侧甲状腺腺叶切除及改良颈淋巴结清扫。结果全部患者的临床症状在术后均得到缓解,随访1个月至10年,无复发病例。术后血钙较术前有显著降低,在术后3 d时,血钙及PTH平均水平甚至低于正常,呈一过性低钙表现;在术后1周至3个月,血钙及PTH水平逐渐恢复正常。多普勒彩超的敏感性和阳性预测值分别为97．0％和94.1％, 99mTc-MIBI分别为100％和97．3％。结论慢性骨病、反复发作的泌尿系结石、溃疡病及胰腺炎患者,应作为PTA及PTC的疑诊对象;血钙检查作为筛查手段应列为常规;血钙和血清PTH测定是可靠的定性诊断手段;多普勒彩超和99mTc-MIBI相结合可获得准确的定位诊断;定位明确的腺瘤结合术中冰冻病理检查行单侧甲状旁腺探查是可行的。     

甲状旁腺增生手术治疗分析

目的:总结甲状旁腺增生致甲状旁腺功能亢进症的外科治疗经验.方法:回顾性分析2000年-2012年在广西医科大学第一附属医院胃肠腺体外科行外科手术治疗的10例甲状旁腺增生致功能亢进症患者的临床资料.全组病例均行甲状旁腺切除术,其中5例曾在外院行1~3枚甲状旁腺切除,5例在本院初次手术.结果:10例患者中骨、关节病变6例(骨棕色瘤2例),泌尿系结石病变4例,骨和泌尿系结石病变3例,病理性骨折1例.全组血钙均升高,在2.81~7.37mmol/L之间,平均3.57mmol/L.10例患者术前测定甲状旁腺激素升高在153~296ng/L之间,平均206ng/L.术后全组均随访6~18个月,术后患者临床症状缓解,骨质疏松改善,骨折愈合,有3例患者出现短期低血钙,出现面部、手足麻木,1例出现手足抽搐;术后有7例患者血钙正常,低血钙者经钙剂和骨化三醇治疗1~4周均可改善,血钙恢复正常.术后9例患者甲状旁腺激素均在1个半月内恢复到正常,1例略高于正常值.结论:甲状旁腺切除术是治疗甲状旁腺增生致甲状旁腺功能亢进症的有效方法.而手术切除增生的甲状旁腺范围是手术疗效的关键.     

骨科首诊原发性甲状旁腺功能亢进症的临床特征分析

目的探讨骨科首诊原发性甲状旁腺功能亢进症（PHPT）患者的临床特征,提高对此类患者的诊断水平。方法回顾性分析骨科首诊并经组织学证实的32例PHPT患者的临床、影像、病理资料。结果所有患者均证实患有甲状旁腺腺瘤并行腺瘤切除术。所有患者骨骼X线片均表现为广泛性骨密度减低,不同程度的局灶性溶骨性改变,15例（46．88％）合并病理性骨折并经手术治疗。实验室检查显示所有患者血钙、碱性磷酸酶（ALP）、骨钙素（BGP）和甲状旁腺激素（FFH）明显高于正常,血磷明显低于正常。患者甲状旁腺腺瘤切除术后第一天血钙即恢复正常,术后7d内PTH恢复正常。长期随诊12例患者骨骼状况恢复良好。结论部分以骨科症状首诊的PHPT患者,如能正确认识PHPT造成的骨损害,及时行甲状旁腺外科治疗可治愈此病。     

甲状旁腺腺瘤引起严重骨质破坏1例分析

原发性甲状旁腺功能亢进症(甲旁亢),在西方本病人群发病率较高[1],在我国相对较低,多数为甲状旁腺腺瘤(80%左右),其次为甲状旁腺增生,而甲状旁腺癌仅占1%-2%,因甲旁腺腺瘤体检时不易触及,临床表现多样化,无特征性,易引起误漏诊,误漏诊率高达76.95%[2]。原发性甲状     

甲状旁腺功能亢进误诊为多发性骨髓瘤一例并文献复习

目的 探讨甲状旁腺功能亢进(简称甲旁亢)所致的骨质异常与浆细胞性骨髓瘤(MM)引起的骨质异常的病理形态及影像学表现的差别.方法 回顾性分析1例甲旁亢误诊为MM患者的临床及病理资料并复习相关文献.结果 该患者甲状旁腺激素水平明显升高、病理检查及影像学检查均支持甲状旁腺腺瘤伴发甲旁亢引起的骨质异常,而非MM.结论 甲旁亢的诊断不仅需要内分泌、影像学的相关检查,更需要与MM的病理活组织检查及影像学结果相鉴别,以明确诊断.     

原发性食管腺癌45例临床病理分析

目的 :了解原发性食管腺癌的生物学特性 ,探讨合理的综合治疗措施。方法 :对 4 5例原发性食管腺癌患者的临床病理资料进行回顾性分析。结果 :其中食管单纯腺癌 32例 ,腺鳞癌 13例 ,1、3、5年生存率分别为 71 1%、53 1%和 4 7 0 %。结论 :因食管腺癌粘膜下浸润能力强 ,恶性程度高 ,有早期扩散和转移倾向 ,预后差 ,手术是其首选的主要治疗手段 ,以胸段食管全切、食管胃端侧颈部吻合术为宜 ,同时应最大限度的清除区域淋巴结     

Malignancy and concomitant primary hyperparathyroidism

Hypercalcemia is associated with a few primary malignant neoplasms and with a variety of tumors that have spread by metastases. Hyperparathyroidism is a diagnosis that is usually not considered in these patients. At our institution, 18 patients with malignant tumors presented over a 6-year period with hypercalcemia caused by hyperparathyroidism. There were five men and 13 women with a mean age of 48 years (range 24-87 years). Primary tumors in these patients included colon carcinoma (four cases), breast carcinoma (four cases), lymphoma (four cases), thyroid carcinoma (four cases), Paget's disease (one case), and lung carcinoma (one case). Metastases of the primary tumor occurred in seven patients, and in 11 patients the tumor was not metastatic or recurrent. Serum levels of calcium, phosphate, and chloride averaged 11.8 mg/dl, and 100 mEq/liter, respectively. C-terminal parathyroid hormone (PTH) levels ranged from 300 to 1,900 pg/ml with an average of 1,150 pg/ml (normal 50-340 pg/ml). At operation, a single parathyroid adenoma was discovered in 15 patients, and four-gland hyperplasia was noted in three patients. In all cases, serum levels of calcium returned to normal after operation. We conclude that patients with malignant tumors and concomitant hypercalcemia should be evaluated for the possibility of hyperparathyroidism. In cases of primary hyperparathyroidism, elevated C-terminal PTH level should be diagnostic. If hyperparathyroidism is determined to be the cause of hypercalcemia, neck exploration and parathyroidectomy are indicated.     

Diffuse large B-cell lymphoma in the thyroid gland associated with primary hyperparathyroidism

We report a case of primary hyperparathyroidism associated with a malignant lymphoma in the thyroid gland. A 68-year-old woman was admitted to hospital with a cervical mass. Ultrasound and computed tomography (CT) revealed a hypoechoic, multinodular tumor in the left thyroid gland. A gallium-67 citrate scintigram revealed intense radioisotope uptake in the thyroid tumor. Histological examination of biopsy specimens indicated that this tumor was a large B-cell lymphoma. The coexistence of parathyroid adenoma in this patient was revealed by a sestamibi scintigram, performed prior to chemotherapy. Following the complete remission of the lymphoma by chemotherapy, we carried out an excision of the single parathyroid adenoma. To our knowledge, this is the first report to describe a malignant thyroid lymphoma associated with primary hyperparathyroidism.     

Fusion imaging for parathyroid localization in primary hyperparathyroidism

Primary hyperparathyroidism, most commonly due to a solitary parathyroid adenoma, has become an increasingly diagnosed condition and is one with great potential for cure following appropriate surgical intervention. Functional imaging with Tc-99m-based radiopharmaceuticals has contributed significantly to increased success in preoperative adenoma localization but the advent of fusion of this functional information with anatomical details obtained with computed tomographic imaging has yielded a potentially more powerful clinical tool and one that is particularly well suited to ectopic adenomas and cases of prior failed surgery. Aspects of this modality are discussed with reference to software- and hardware-based fusion techniques and evidence for efficacy. The allied technique of PET/computed tomography is also discussed.     

Predictive value of clinical features at initial presentation in pancreatic adenocarcinoma: a series of 308 cases

Pancreatic cancer is the fourth leading cause of cancer death in both men and women with a mortality: incidence ratio of 0.99. In an effort to describe the role of clinical features at initial presentation, we conducted a retrospective observational study in patients with a biopsy-proven diagnosis of adenocarcinoma of the pancreas. Between 1986 and 2001, 308 patients (160 males, 148 females) were diagnosed with pancreatic adenocarcinoma. The mean age at diagnosis was 70.1 yr (range: 34–96 yr). The mean survival was 7.6 mo (range: 0–97 mo). Statistical analysis was performed using log-rank tests and analysis of variance. As expected, age at diagnosis was a significant factor affecting survival, with older patients doing relatively poorly (p<0.05). Patients with a good performance status performed significantly better than those with a poor performance status (p<0.01). In addition, the presence of the tumor in the head of the pancreas was a predictor for improved survival (p<0.01). Although smoking increased the chances of detection at an earlier age, neither diabetes mellitus nor a positive smoking history had a statistically significant effect on the survival. Pancreatic adenocarcinoma is a disease of the elderly associated with a poorer outcome. Knowledge of possible clinical predictors of survival may lead to better patient counseling regarding prognosis.     

Surgery for primary hyperparathyroidism

In the Western world, primary hyperparathyroidism is now a relatively common disorder that is diagnosed in 0.7% of the general population and in 2% of postmenopausal women. Although patients today typically present with less severe manifestations of disease, the evaluation and management of patients with parathyroid disease remains challenging. Primary hyperparathyroidism is a complex disease process that requires careful diagnosis and thoughtful medical and surgical management. The surgical management of patients with persistent or recurrent disease, inherited primary hyperparathyroidism syndromes, and parathyroid carcinoma is particularly challenging. High‐quality imaging and reliable intraoperative adjuncts are critical to success. Cancer 2014;120:3602–3616 . © 2014 American Cancer Society.     

Sestamibi scan-directed unilateral neck exploration for primary hyperparathyroidism due to a solitary adenoma

AIM: To evaluate the accuracy of Tc-99m sestamibi scintography in pre-operative localization of a single parathyroid adenoma and to determine if neck exploration can be limited to the side of the adenoma. METHODS: Over a period of 4 years, 30 patients with primary hyperparathyroid disease underwent surgical treatment in the form of unilateral neck exploration after localization by Tc-99m sestamibi scintigraphy. The scan findings were interpreted by one radiologist with a special interest in parathyroid imaging and the operative findings were correlated with scan findings. RESULTS: Tc-99 sestamibi scan localized a single parathyroid adenoma in 29 patients. There was doubtful uptake of isotope in one patient. Unilateral cervical exploration confirmed isotope scan findings in 29 patients with a positive scan, and these were subsequently proven by histology. In the patient with doubtful sestamibi scan, bilateral neck exploration was undertaken and three enlarged glands were excised. All the three glands were reported to be abnormal, consistent with either adenomas or hyperplasia. All the patients were normocalcaemic after 6 months follow-up. CONCLUSIONS: Our results demonstrate that Tc-99m sestamibi scintigraphy is highly accurate in pre-operative localization of a single parathyroid adenoma when performed by an experienced radiologist. Unilateral cervical exploration, as directed by a positive Tc-99m sestamibi scintigram, seems to be a logical approach for the patients with primary hyperparathyroid disease due to solitary adenoma.     

6例原发肺腺癌乳腺转移的临床特征分析

目的：探讨原发肺腺癌乳腺转移的临床特点。方法回顾性分析6例经病理证实的原发肺腺癌乳腺转移患者的临床资料。结果6例均为女性,5例患者的乳腺转移病灶表现为无痛性、生长迅速的乳腺单发结节,1例表现为弥漫性乳房红肿。乳腺转移可以是原发肺腺癌的首发症状,也可在病程中出现。6例患者乳腺转移灶的病理均为腺癌,免疫组化结果显示：5例患者的雌激素受体为阴性,1例为弱阳性;孕激素受体均为阴性;5例患者甲状腺转化因子1表达强阳性,1例阳性。结论有原发肺腺癌病史和快速增长的乳腺结节患者需考虑乳腺转移。免疫组化是鉴别原发或继发乳腺恶性肿瘤的关键。