Objective To describle mammographic features of breast architectural distortion in order to improve its diagnostic accuracy.Methods Mammographic manifestations of 33 breasts with histropathologic proved breast structure deformation, which occurred in 18 benign diseases and 15 malignant diseases, were retrospectively analyzed. Density, margin and structure of lesion were assessed. The underling entities included post-operation change (n=5), fat necrosis companied with stromal fibrosis(n=1), versicle hyperplasia (n=6) and inflammation (n=4), invasive ductal carcinoma(n=6), DCIS(n=2), infiltrating lobular carcinoma(n=3), mucinous carcinoma(n=2) and Paget (n=2). Results On mammogram, breast architectural distortion was high in 17 cases and iso-density in 16 cases. The margin of the lesions was infiltrating in 10 cases, poor defined in 12 cases, spiculatted changes in 11 cases. Structure of the lesions was disappeared in 17 cases, and was discriminable in 16 cases. They were hard in 14 cases, pliable in 11 cases and of patch thickness in 8 cases on palpate. Statistically significant mammographic findings favoring a diagnosis of companied with malignant lesion included infiltrating margin and structure disappearance with a P value of 0.01 and 0.025 respectively, while the other signs showed no statistic significant difference between benign and malignant lesions. Conclusion Although mammographic manifestations of breast architectural distortion can be variety, analysis of its margin and structure can be helpful for the differentiate diagnosis for benign and malignance of its underlying diseases.
Objective: To study the clinical treatment of breast cancer in women ≥70 years old. Methods: The clinical data of 21 patients aged 70 years and elder who were treated from Jan. 2002 to Oct. 2005 were analyzed retrospectively and literatures were reviewed.Results:The percentage of stage Ⅱ～Ⅲ was 85.7%(18/21). Tumor diameters were about 1.3～6cm, and the average diameter was 4.13cm. Of all the patients 17 cases had comorbidities. Curative resection was performed in 19 of the 21patients, including 15 modified radical mastectomy(78.9%) . Two cases refuse treatment. Thirteen cases had ER-positive tumor and 9 of them accepted adjuvant endocrine therapy. Conclusion: Elder women with breast cancer should be diagnozed and treated as early as possible. Sugical operation is the major means for the treatment of operable breast cancer and we should emphasize the importance of adjuvant endocrine therapy .
Objective:To study the clinical effect of occult incision of benign breast tumor in young women.Methods:The clinical data of 283 patients aged 35 years and younger who were performed by occult incision from Mar.2002 to Feb.2006 were analyzed retrospectively.Results:OF all the 283 patients who were performed by occult incision,251 cases were operated with areolar incision,23 cases were operated with inframammary plica incision,9 cases were operated with axillary anterior plica incision.All the 283 cases were benign tumor patients.The incision healings were all in stage Ⅰ with little scar and good concealing.Conclusion:Using occult incision is safe and practicable.It can not only achieve therapeutic purpose,but also have aesthetic effect.It is worthy of being used widely.
Objective:Cancerate factors and treatment methods of colorectal polyps were investigated. Methods: The documents of 124 patients with colorectal polyps detected by video colonoscope in past 5 years were retrospectively reviewed and analysed.Cancerate factors of colorectal polyps were analysed.Results: Most polyps were circular single adenomatous and were found mainly left colon . 19 of 20 malignant colorectal polyps and coexisting carcinoma occured in adenomatous polyps. The rate of malignant change of colorectal polyps was higher numerous than single in number, was higher ≥2.0cm than 2.0cm in size . Polypectomy in colonoscopy or colotomy and coloproctectomy operated on 99, 4 and 21 patients with colorectal polyps respectively.Conclusion:The rate of malignant change seemed dependent on number and dimension of colorectal polyps. Canceration occured easily in big, numerous colorectal adenomatous polyps . Pedicellate and small colorectal polyps can be resected in colonoscopy . Coloproctectomy can be operated on patients with big malignant colorectal adenomatous polyps and coexisting carcinoma .
[Objective] To examine the therapeutic effects of perioperative management for tertiary hyperparathyroidism (THPT). [Methods] The diagnosis and treatment for one case of a woman with tertiary hyperparathyroidism after kidney transplantation was reported, and the perioperative managements were analyzed retrospectively by reviewing the literatures. [Results] The patient's parathyroid hormone (PTH) decreased to 50% rapidly after the removal of three parathyroids, the hypocalcemia and low of parathyroid hormone occur after operation. The hypocalcemia and low of parathyroid hormone return to normal by the supplementary calcium two months later. [Conclusions] Tertiary hyperparathyroidism was rarely reported in domestic literatures, among whom part of them need surgical treatment. It is necessary to emphasize perioperative management in treatment of tertiary hyperparathyroidism, and the immediate treatment must be considered in any patients with hypercalcemic crisis in order to protect the function of the allograft and to save the patient′s life.
Objective To analyze the histological underestimation of stereotactic core needle biopsy (SNCB).and tO attract clinicians' attention.Methods SNCB was performed in 146 patients with 179 lesions from September 2000 to June 2005.and 21 lesions were underestimated histologically.0f 21 nonpalpable breast lesions(NPBL).6 lesions were diagnosed as BI-RADS nl,12 8S BI-RADS Ⅳ,3 as BI-RADS V according to BI-RADS before biopsy.Mammography showed 16 lesions with calicification, 2 cases with masses,1 case with asymmetry density and 2 cases with stellate sign.Results Eleven lesions diagnosed as fibrocystic disease with atypical ductal hyperplasia by biopsy were proved to be ductal carcinoma in situ (DCIS)in 7 lesions and early infiltration in 4 lesions by pathology.3 lesions diagnosed as severe atypical hyperplasia by biopsy were finally proved to be 1 carcinoma in situ and early infiltration in 2 lesions by pathology.3 lesions diagnosed as DCIS by biopsy were invasive carcinoma.4 lesions diagnosed papillary lesions by biopsy and finally were 1 carcinoma in situ,1 early infiltration,1 infiltrating ductal carcinoma and l intraductal papillary adenocarcinoma.Conclusion The histological underestimation of SCNB Was related to the stereotactic location technology,lesion and doctor'S understanding,the radiologist should master the biopsy skills.
[Objective] To study the diagnosis and treatment of substernal goiter. [Methods] A retrospective analysis was made on 21 cases of substernal goiter surgically treated in our department from 1991. 1 to 2005. 12. [Results] Twenty-one thyroid neoplasms had been successfully removed. Resection via cervical collar incision was adopted in 16 cases. Median sternotomy combined with a collar insion was adopted in 4 cases and only 1 case was resected simply by thoracotomy. Twenty of them were of benign pathology (95%), which include 18 goiters and 2 adenomas. One malignant pathology is substernal thyroid anaplastic carcinoma. There were no serious complications such as bleeding, dyspnea, dysphonia and convulsion. [Conclusions] Most substernal goiter were of benign pathology. CT and 131I thyroid scaning were the most important diagnostic means. Surgical removal of the tumor is the only effective treatment method. Cervical collar incision should be the first choice and median sternotomy should be combined immediately if simple cervical collar incision is difficult to remove the tumor.
Objective To explore the clinical efficacy of subtotal parathyroidectomy for secondary hyperparathyroidism. Methods Thirty-seven uremic patients with secondary hyperparathyroidism were analyzed retrospectively.All patients underwent subtotal parathyroidectomy.Perioperative symptom improvement and changes of serum iPTH,calcium,phosphate and alkaline phosphatase were observed. Results After operation,bone pain and pyruitus were relived, and serum intact parathyroid hormone(iPTH)and serum phosphate were declined markedly.Of 37 cases,30 had successful operation,and 7 had persistent hyperparathyroidism.No statistic difference was found in the decline of serum iPTH 10 min after operation between the successful and persistent cases.Of 30 cases of successful subtotal parathyroidectomy,15 had no recurrence after followed-up for 6 months.One case of calciphylaxis died at month 3 after successful subtotal parathyroidectomy. Conclusion Subtotal parathyroidectomy may be a good option for treating patients with sympto-matic or refractory secondary hyperparathyroidism.
Objective:To introduce the method,curing criterion and clinical character of intraoperative quick parathyroid hormone assay in the surgical management of hyperparathyroidism.Methods:Plasma samples were obtained from 3 patients with hyperparathyroidism before skin incision and 20 minute after removal of abnormal parathyroid tissue.Intraoperative quick parathyroid hormone assay was performed.The criterion of operative success was defined by a decrease of PTH greater than 50% of pre-excision value.Results:In 3 patients with hyperparathyroidism,a 50% decrease of PTH in 1 case,normal of PTH falling in 1case,lower normal of PTH drop in 1case(tertiary hyperparathyroidism) occurred.In 1case with tertiary hyperparathyroidism,PTH value changed slightly after excising two parathyroid tissue and PTH value decreased below normal after excising third parathyroid tissue.The hypocalcemia in 3 patients represented after operation.Hypocalcemia return to normal by supplementary calcium.There were normal blood calcium and PTH after half a year of follow-up.Conclusion:Intraoperative quick parathyroid hormone assay is a useful tool to determine whether all hyperfunctioning parathyroid tissue has been removed during Parathyroidectomy.
Objective To analyze the manifestation,reason,the processing method of the steel wire implantation with the sereotactic mammography to improve the accuracy of the preoperative positioning.Methods Seventy-nine cases which got the stereotactic steel wire implantation.In 96 lesions, 13 had steel wire displacement.Among them,5 cases got steel wire displacement during the sereotactic process,5 cases got steel wire displacement after the stereotactic process,2 cases got steel wire displacement during the operation,one case did not show the calcification on the postoperative radiography.Results The steel wire displacement occurred in 5 cases during the stereotactic process came from the patients and doctors respectively and the repositioning was needed.The steel wire displacement after the stereoscopic positioning was attributed to the overdose injection of local anesthesia,which led to the mismatch between the depth of Z axis of the mammary gland and the actual depth the computer given,the incorrect method for needle placement,and,neglecting whether the steel wire have got the lesion anchored when pulling out the needle set of steel wire hood,besides,these three kinds of instances above were all exaggerated by the accordion effect.For the displacement within 2 cm,the lesion can be excised toward the pathological change direction according to the position that steel wire prompted and re-place the second steel wire,putting the J-shaped steel wire into the needle hood and taking it out of the body.After repositioning,2 cases had the steel wire prolapse during operation,which resulted from the over-lifting of the steel wire.After placing the steel wire, the radiologist should give an accurate description on the depth and direction to the surgeon and the notch should be taken for incision from the steel wire head end which is proximate to skin.The postoperative specimen from one case had no calcification,which might be related to the condition that the calcification was located in the gland body,which got destruction from the surgical electrical electrotome.The excisionscope should be extended and the short term reexamination is recommended to make sure the complete excision of the calcification.Conclusion It is the gold standard method that implanting the steel wire with the stereotactic mammography to guide the surgical dissecting technique to diagnose non-palpable breast lesion(NPBL).Thorough understanding of the displacement manifestation of implanting steel wire with stereotactic technique and the treatment methods will be helpful in the surgical dissecting guidance.
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