甲状腺乳头状癌及相关病变Jab1、Skp2和p27蛋白的表达及意义

目的 探讨细胞周期有关的因子c-Jun激活区域结合蛋白-1(Jab1)、S期激酶相关蛋白2(Skp2)和细胞周期素依赖激酶抑制剂p27蛋白在结节性甲状腺肿、桥本甲状腺炎和甲状腺乳头状癌中的表达及意义.方法 采用免疫组织化学方法检测结节性甲状腺肿、桥本甲状腺炎、伴结节性甲状腺肿的甲状腺乳头状癌和伴桥本甲状腺炎的甲状腺乳头状癌中Jab1、Skp2和p27蛋白的表达.结果 Jab1、Skp2蛋白的阳性表达率在伴结节性甲状腺肿的甲状腺乳头状癌者(86.9℅、82.6℅)和伴桥本甲状腺炎的甲状腺乳头状癌者(83.3℅、66.7℅)均分别明显高于结节性甲状腺肿者(26.3℅、0℅)和桥本甲状腺炎者(23.8℅、4.8℅)(P<0.01).p27蛋白的阳性表达率在伴结节性甲状腺肿的甲状腺乳头状癌者(39.1℅)和伴桥本甲状腺炎的甲状腺乳头状癌者(45.6℅)均分别明显低于结节性甲状腺肿者(89.5℅)和桥本甲状腺炎者(100℅)(P<0.01).甲状腺乳头状癌中,癌组织?>1 cm者Jab1蛋白阳性表达率明显高于癌组织?≤1 cm者(P<0.01);Jab1和Skp2蛋白表达与p27蛋白表达均呈负相关性(rs=-0.344,P=0.028;rs=-0.421,P=0.006);Jab1蛋白表达与Skp2蛋白表达呈正相关性(rs=0.43,P=0.005);肿瘤侵袭区域Jab1蛋白表达阳性的细胞百分率(61.22±8.99)℅明显高于肿瘤中心区域(42.61±9.46)℅(P<0.01).结论 Jab1、Skp2和p27蛋白表达可能参与结节性甲状腺肿和桥本甲状腺炎癌变为甲状腺乳头状癌的过程,甲状腺乳头状癌中Jab1、Skp2和p27蛋白表达之间可能存在相互调节的关系,Jab1蛋白表达可能与甲状腺乳头状癌细胞的迁移和侵袭有关.     

LigaSure versus clamp-and-tie thyroidectomy for benign nodular disease

BACKGROUND: LigaSure is an alternative bipolar diathermy system (BDS) combining vessel sealing with reduced thermal spread, which has been successfully used in many abdominal operations; however, there is a little experience in open thyroidectomy. This study compares the efficacy and the advantages of the LigaSure BDS when used for total thyroidectomy for benign thyroid disease with the conventional clamp-and-tie technique. METHODS: Between May 1998 and October 2002, 517 patients underwent total thyroidectomy for benign thyroid multinodular goiter. Among them, from May 1998 until May 2000, 247 patients (group I) were operated on with the conventional clamp-and-tie technique, whereas from May 2000 until October 2003, 270 patients (group II) underwent total thyroidectomy for benign multinodular goiter with LigaSure BDS through a 4-cm transverse suprasternal incision. Demographics, pathologic characteristics, gland mass, operative time, blood loss, and complications were assessed. RESULTS: There were no intraoperative complications. Thyroid mass was similar in both groups, but the operative time was shorter in group II than in group I (mean +/- standard deviation, 71 +/- 14 minutes vs 86 +/- 22 minutes; p < .01). Intraoperative total blood loss was similar between the two groups, but postoperative drain volume was less in group II than in group I (21 +/- 15 mL; p < .01). Major post-thyroidectomy complications (ie, laryngeal nerve palsy, hematoma, and hypocalcemia) occurred less frequently in the LigaSure group than in the clamp-and-tie group (0.7%, 0.4%, 1.1% vs 4%, 2%, 4.8%, respectively; p < .05). The mean +/- standard deviation postoperative hospital stay was significantly less for the patients in group II than for those in group I (2.3 +/- 1.7 days vs 2.8 +/- 1.3 days; p < .05). CONCLUSIONS: The use of the LigaSure vessel sealer for thyroid surgery is an effective and safe alternative that reduces the overall operative time and could be successfully applied through a narrow surgical incision.     

Results of Upfront Therapy for Marginal Zone Lymphoma

BackgroundMarginal zone lymphomas (MZLs) are indolent disorders composed of 3 subtypes: extranodal marginal zone lymphoma (MALT), splenic marginal zone lymphoma (SMZL), and nodal marginal zone lymphoma (NMZL). Early-stage MALT is treated with radiotherapy or antibiotics, and advanced MALT and NMZL are managed with either watch and wait or chemotherapy. SMZLs are treated with splenectomy or rituximab. However, because these approaches have failed to cure patients with SMZL and NMZL, we have systematically used upfront chemotherapy for them, as well as for advanced MALT. We report the outcomes of this approach.Patients and MethodsA total of 44 patients with MZL were identified from our database and divided into 2 groups. Group 1 (22 with early-stage MALT) patients received either radiotherapy (n = 17) or antibiotics with or without surgery (n = 5). Group 2 included 9 patients with advanced MALT, 9 with SMZL, and 4 with NMZL. Group 2 was treated with FND-R (fludarabine 25 mg/m² on days 1 to 3, mitoxantrone 10 mg/m² on day 1, dexamethasone 20 mg on days 1 to 5, and rituximab 375 mg/m² on day 1; n = 14) or CHOP-R (cyclophosphamide 750 mg/m² on day 1, doxorubicin 50 mg/m² on day 1, vincristine 2 mg intravenous push on day 1, prednisone 100 mg/m² orally on days 1 to 5, rituximab 375 mg/m² on day 1; n = 8), followed by maintenance rituximab for 70%.ResultsAll patients achieved complete remission, and only 2 patients in group 1 had developed a relapse at 70 and 75 months. Both relapses were stage I MALT that had initially been treated with radiotherapy. Both were salvaged with FND-R and remained free of disease at 27 and 39 months after the relapse. At 10 years, the failure-free survival for the 44 patients was 80% and the overall survival was 100%. None of the patients in group 2 developed a relapse. The long-term toxicities have been acceptable.ConclusionsThe excellent responses using upfront chemotherapy for MZL suggests that this disorder is curable. Our results should be confirmed in a prospective trial.     

Hodgkin Lymphoma of the Oral Mucosa

In this report, we describe a rare case of relapsed nodular sclerosing Hodgkin lymphoma presenting as a lesion of the oral mucosa. Although this is an uncommon clinical scenario, health care professionals should be aware of this possibility. A brief differential diagnosis and review of Hodgkin lymphoma is discussed.     

结节性甲状腺肿和甲状腺腺瘤的鉴别诊断

目的:探讨结节性甲状腺肿和甲状腺腺瘤的鉴别诊断。方法:回顾性分析兰州军区总医院2004年10月～2006年9月手术并经病理诊断的结节性甲状腺肿和甲状腺腺瘤病历资料。结果:结节性甲状腺肿112例,甲状腺腺瘤168例,术前结节性甲状腺肿正确诊断者7例,占6.25%,误诊为甲状腺腺瘤者105例,占93.75%,甲状腺腺瘤正确诊断者162例,占96.43%,误诊为结节性甲状腺肿者6例,占3.57%。结论:结节性甲状腺肿易误诊为甲状腺腺瘤,对结节性甲状腺肿大体形态认识上的偏差,查体不仔细,临床医师不认真分析或不认识结节性甲状腺肿和甲状腺腺瘤的B型超声波的回声特点是结节性甲状腺肿和甲状腺腺瘤误诊的主要原因。     

胸骨后甲状腺肿临床分析

目的 探讨胸骨后甲状腺肿的诊断和治疗。方法 对1991年1月～2005年12月该院手术治疗的21例胸骨后甲状腺肿的临床资料进行回顾性分析。结果胸骨后甲状腺肿21例全部手术治疗成功。其中经颈手术16例，颈胸联合切口4例，单纯开胸1例。良性病变20例，占95％，其中结节性甲状腺肿18例，甲状腺肿瘤2例；恶性1例，为甲状腺未分化癌。无术后大出血、呼吸困难、声音嘶哑和低钙抽搐等严重并发症。结论胸骨后甲状腺肿多为良性病变，CT和甲状腺核素显像是术前重要诊断手段。手术切除是胸骨后甲状腺肿惟一有效治疗方法，首选颈部切口，操作有困难时需果断加行胸部切口。     

Nodular mucinosis of the breast: A case report with clinical and imaging findings

We present a very rare case of nodular mucinosis of the breast. A 30-year-old woman noticed a right breast lump and consulted at our hospital because it gradually increased in size. On physical examination, the lump was 30 x 25 mm in size, and was located in the upper outer quadrant close to the nipple of the right breast. It was well-demarcated, mobile and hard. Ultrasonography (US) showed a clearly circumscribed, lobulated, and homogeneous hypoechoic lesion. Mammography (MMG) showed a round-lobular-shaped radiopaque mass without microcalcifications or spicula formation. Fine needle aspiration cytology (FNA) revealed no malignancy and mucin. Histologically, the excised tumor consisted of an abundant myxoid substance with scattered spindle cells without epithelial elements in the mucous lake. The mucinous substance stained positively with Alcian blue. Nodular mucinosis, simulating mucinous carcinoma or phyllodes tumor on clinical and imaging examinations, should be included in the differential diagnosis in cases of mucinous lesions occurring near the nipple in a young woman.     

2004年临朐县部分中小学生健康状况调查

[目的]了解临朐县中小学生的健康状况，为制定有效的预防保健措施提供依据。[方法]2004年3～12月对临朐县部分中小学生67036人进行健康查体。[结果]调查学生67036人，视力不良20433人，患病率30、48％；龋齿患病人数11887人，龋患率17．73％；生理性甲状腺肿大14715人，肿大率21.95％；色弱1811人，患病率2．70％；扁桃体炎488人，患病率0．73％。城区与乡村、男生与女生、小学生、初中生和高中生间各种患病率的差异均有统计学意义。[结论]临朐县中小学生视力不良、生理性甲状腺肿大、龋齿患病率仍然较高，预防视力不良、生理性甲状腺肿大是当地学校卫生工作的重点。     

碘缺乏地区补碘后儿童智力发育及尿碘调查分析

采用希－内智力测验对碘缺乏地区山西省沁源县白孤窑乡１４８名儿童补碘后智力发育调查。结果显示，智商均值９９．９３±１９．２４，智力低下者占３．３８％，超出正常地区水平。学龄期男童智商显著高于学龄前期儿童及学龄期女童。地方性甲状腺肿患病率９．４６％，尿碘中位数３９９．７３ｎｍｏｌ／Ｌ，小于１９６．９９ｎｍｏｌ／Ｌ者占１３．８９％，超出国家碘缺乏病基本控制标准     

Simultaneous coronary artery bypass grafting, replacement of the innominate artery and subtotal thyroidectomy in a 61 year-old patient: a case-report

The management of patients with coexisting diseases who undergo cardiac surgery is a subject to controversial discussions as the operative mortality is thought to be increased by simultaneous procedures. Traditionally, the surgical procedures have been staged with the cardiac surgery performed first followed by the visceral operation at a later date. However, especially in cases of malignant disease (e. g. pulmonary or abdominal) the curative treatment is delayed and the additional costs of two settings have to be considered.