Objective To summary the experience in diagnosis and managements for primary hyperparathyroidism（PHPT）. Methods The clinical data of 73 patients with PHPT who underwent parathyroidectomy in our hospital from Jan. 2003 to Dec. 2010 were analyzed retrospectively. Results There were 1 case of hyperplasia （1.4%）， 67 cases of adenoma （91.8%）， and 5 cases of adenocarcinoma （6.8%） among the 73 cases of PHPT. The common presentations involved with pain in bones and joints in 63 cases （86.3%）， pathologic fractures in 17 cases （23.3%）， osteoporosis in 59 cases （80.8%）， fatigue in 28 cases （38.4%）， abdominal pain in 4 cases （5.5%）， urolithiasis in 17 cases （23.3%）， malignant hypertension in 1 case （1.4%） who suffered multi-endocrine neoplasm （MEN）Ⅱa， and so on. The preoperativeserum parathyroid hormone （PTH） abnormally elevated in all 73 patients， and serum calcium abnormally elevated in 59 patients （80.8%）， and alkaline phosphatase abnormally elevated in 62 patients （84.9%） before operation. The positive rate of lesion locations by ultrasonography， CT， 99Tcm-sestamibi （MIBI） scan， and the combination of 3 kinds of tests were 82.8% （53/64）， 83.3% （20/24）， 90.2% （46/51）， and 91.8% （67/73） respectively， but 6 cases were not traced preop-eratively. Parathyroidectomy was conducted to all the cases， besides， regional neck lymphadenectomy was performed for those 5 adenocarcinoma cases. Tetany in 16 cases， hoarseness in 2 cases， acute pancreatitis in 1 case， acute left heart failure in 1 case were observed after operation. Sixty nine cases were follow-up for 3-72 months （average 17.3 months）. During the followed-up period， most of them were alleviated from bone pain （43 cases） and fatigue （18 cases）within 1 month. However， the recovery of PTH and serum calcium back to normality were relatively slow. One case ofadenoma recurred， 1 case of adenocarcinoma suffered lung metastasis， 1 case of adenocarcinoma survived for 37 monthsprior to death for postoperative lung and bone metastasis， the other cases （including 1 case of adenocarcinoma developed from adenoma） were still alive and had no metastasis or recurrence by the end of follow-up. Conclusions The symptoms of PHPT vary and lack of specificity， hence， the enhancement of knowledge to this disease and screenings conducted for parathyroid function and serum calcium will increase the rate of diagnosis. Parathyroidectomy is the effective management for PHPT， and preoperatively accurate position contribute to minimal exploration.
Objective To discuss the CT appearances and clinicopathologic features of gastrointestinal neuroendocrine neoplasms (GI-NENs). Method The clinical and CT materials of 33 cases of GI-NENs who treated in our hospital from Jan. 2013 to Dec. 2015 were retrospectively analyzed. Results Of the 33 cases, 25 males and 8 females were enrolled. The median age was 62-year old (27–78 years), and the age at diagnosis mainly focused in the 50–70 years period. GI-NENs situation: 12 cases in the stomach, 11 cases in the rectum, 3 cases in the esophagus and colon respectively, 2 cases in the duodenum and appendix respectively. The main clinical symptoms included: abdominal pain in 13 cases, dysphagia and obstruction in 9 cases, hematemesis and hematochezia in 8 cases, abdominal distention in 5 cases, stool and bowel habits change in 5 cases, subxyphoid pain in 3 cases, belching in 2 cases, diarrhea in 1 case, protrusion of the neoplasm when defecation in 1 case, obstructive jaundice in 1 case. Seven cases of G1 grade, 6 cases of G2 grade, 15 cases of G3 grade, and 5 cases of mixed adenoneuroendocrine carcinomas were found according to pathologic grading. The immunohistochemical marker: synaptophsin was positive in 31 cases, cytokeratin A was positive in 23 cases, and cytokeratin was positive in 9 cases. The CT appearances of GI-NENs were mainly thickening of the walls and formation of nodules or masses in local area. Moderately homogeneous enhancement (in 20 cases) and irregularly heterogeneous enhancement (in 13 cases) were both commonly seen. In addition, 13 cases of lymphadenophathy, 6 cases of liver metastasis, and 3 cases of lung metastasis were also detected by CT. Conclusions GI-NENs have a preference for elderly male. The most common site of onset is the stomach. Its clinical symptoms and CT appearances are nonspecific, however, the enhancement pattern of the tumors has a certain characteristic.
Objective To summarize the diagnosis and treatment for primary hepatic neuroendocrine carcinoma. Methods The clinicopathologic data of three patients with primary hepatic neuroendocrine carcinoma from June 2010 to June 2011 in this hospital were analyzed retrospectively. Results Three cases were difficult to diagnose primary hepatic neuroendocrine carcinoma before operation. All the treatments were resection. Three patients were diagnosed as neuroendocrine carcinoma by pathology and immunohistochemistry after operation. All of them were treated by octreo-tide after operation and discharged from hospital successfully. There was no relapse one year later. At present， 3 patients were still continue to follow-up. Conclusions The diagnosis of primary hepatic neuroendocrine carcinoma is very difficult before operation， the assessment of treatment and curative effect is exploring.
ObjectiveTo explore the use of comprehensive treatment including drugs, devices and electrophysiology for heart failure patients with surgical indications. MethodsWe collected the clinical data of 65 consecutive cardiac surgical patients with chronic left ventricular dysfunction in our department between March 2014 and May 2016. There were 49 males and 16 females with an average age of 61.3±11.4 years ranging from 37 to 80 years. Their left ventricular ejection fraction was less than 40%. Patients with ventricular dysfunction caused by acute myocardial infarction were excluded. A comprehensive treatment strategy was performed according to patients’ individual disease.ResultsFourty patients underwent cardiopulmonary bypass with asisting time of 55-400 (148.1±69.8) min; 35 patients needed cross-clamping with time of 44-203 (95.7±39.6) min. Intra-aortic balloon pump (IABP) was assisted in 3 patients. Two patients died in hospital. During the follow-up of 13.4 months, the patients’ cardiac function significantly improved and the heart size reduced. Two patients died and two were readmitted for heart failure. Four patients underwent cardiac pacemaker implantation. Other patients with unstable symptoms were stabilized after medical dose adjustment.ConclusionUnder the concept of neuroendocrine inhibition, the comprehensive treatment for heart failure can effectively reduce surgical mortality and improve the patient’s quality of life.
ObjectiveTo explore the clinical features and the prognostic factors of neuroendocrine carcinoma of the esophagus. MethodsWe retrospectively analyzed clinical data of 41 cases of neuroendocrine carcinoma of the esophagus admitted in the First Affiliated Hospital of Nanjing Medical University between March 2008 and March 2014. There were 37 males and 4 females at a mean age of 61.1±7.9 years (ranged from 40 to 79 years). All patients underwent surgical resection and lymph node dissection. ResultsNo severe complications occurred during the perioperative period, and no death occurred during the period of hospitalization.Thirteen patients received postoperative chemotherapy and radiotherapy. Eleven patients received simple postoperative chemotherapy. One patient received postoperative radiotherapy. The remaining 16 patients did not receive any special treatment. The patients were followed up for 6 to 61 (24.0±13.6)months. Twenty-two patients survived, the other 19 patients died. The 1-year, 2-year, 3-year, 4-year, and 5-year survival rate was 80.49%, 39.02%, 21.95%, 7.32%, and 4.88%, respectively. The median survival of single surgical treatment and postoperative comprehensive treatment was 12.0 months and 25.0 months, respectively. The median survival of T2-T4 and T1 was 20.0 months and 37.5 months, respectively. The difference was statistically different (P<0.05). Cox regression analysis showed that the depth of tumor invasion, postoperative adjuvant chemotherapy and radiotherapy were independent factors of prognosis (P<0.05). ConclusionsNeuroendocrine carcinoma of the esophagus is rare and with a high degree of malignancy. It is expected to increase the long-term survival rate after surgical and postoperative comprehensive treatment.
Objective To summary the pathogenic site, clinical manifestations, endoscopic and radiographic features, pathologic characteristics, diagnosis, treatment, and prognosis of gastroenteropancreatic neuroendocrine neoplasm(GEP-NEN). Methods Clinical data of 70 cases of GEP-NEN who were treated in Nanjing Drum Tower Hospital from Jan. 2003 to Dec. 2012 were collected and retrospectively analyzed. Results Of the 70 cases, 35 cases(50.0%) were in pancreas, 18 cases(25.7%) were in rectum, 10 cases(14.3%) were in stomach, and 7 cases(10.0%) were in appendix; 55 cases(78.6%) were nonfunctional tumors, while 15 cases(21.4%) were functional; 50 cases(71.4%) were neuroendocrine tumor, 15 cases(21.4%) were neuroendocrine carcinoma, and 5 cases(7.2%) were mixed adenoendocrine carcinoma; 43 cases(61.4%) were in grade 1, 7 cases(10.0%) were in grade 2, and 20 cases(28.6%) were in grade 3 respectively. The detection rate of endoscopy, type-B ultrasonic, CT, and MRI were 90.0%(27/30), 67.9% (19/28), 86.0%(43/50), and 70.0%(7/10) respectively. A total of 67 patients(95.7%) were underwent surgery, including endoscopic resection, and 3 cases (4.3%) didn't receive surgery. Forty cases were followed-up for 6 months to 9 years(the median survival time was 3 years), and the 1-, 3-, and 5-year survival rates were 82.5%(33/40), 47.5%(19/40), and 35.0%(14/40) respectively. Conclusion GEP-NEN occurs mainly in pancreas, and the clinical manifestations are variable. Endoscopy and radiographic examination methods play an important role in diagnosis of GEP-NEN, but final diagnosis is mainly based on pathological detection. Surgery is the main treatment method for it.
Objective To investigate patients in gynecological endocrinology clinic with the following three pieces of information: how did they provide their symptom information, how did they understand diagnostic and therapeutic information, and what was their attitude towards the visit, and to get to know about the situation and problems in doctor-patient communication, so as to aim directly at improving the efficiency of diagnosis and treatment. Methods A total of 403 patients, who visited Prof. HAN Zi-yan’s clinic in the hospital from April to August 2010, were evaluated using self-edited Assessment on Doctor-patient Communication in Gynecological Endocrinology Outpatient Clinic. Results a) As to the situation of patients providing symptom information as well as understanding diagnostic and therapeutic information, when doctor asked, only 29% (118/403) of patients could narrate their treatment history clearly, and 38% (152/403) could tell their examination history exactly. After doctors’ explanation, only 21% (86/403) understood their examination results correctly, and 27% (108/403) understood management and therapeutic advice. The result of correlation analysis showed the accuracy of patients in providing disease information and accepting diagnostic and therapeutic information was higher in patients aged from 21 to 40 rather than those younger than 20, in patients well- educated rather than those with little education at the primary school, and in patients who were also engaged in medical work, All differences were significant (all Plt;0.05); and b) As to patients’ attitude towards visit, 55% (222/403) of patients hoped to get more attention from doctor, and 37.5% (151/403) overly expected the visit. Conclusion In the professor’s gynecological endocrinology outpatient clinic, many patients can’t clearly provide their treatment and examination history, neither understand exam situation and therapeutic advice at that visit, which are influenced by their age, education and occupation. In addition, psychological needs of patients should be concerned, too
Endocrinology is closely related to lipid metabolism. Lipotoxicity affects the abnormal function of various endocrine organs, and leads to diabetes, fatty liver, metabolic syndrome and other endocrine and metabolic diseases. It is an important strategy to prevent the lipid toxicity. Endocrine disorders can also cause dyslipidemia. Studies have found that thyroid and gonadal glands play an important role in lipid metabolism. Their molecular mechanisms are gradually revealed and will be a new therapeutic target for dyslipidemia. Lipid metabolism disorders play an important role in the development of endocrine and metabolic diseases.