[Clinical features of 123 patients with hyperinsulinemic hypoglycemia auxiliarily diagnosed by 18F-DOPA-PET CT scanning].

Objective: To summarize the clinical features and therapeutic outcomes of patients with hyperinsulinemic hypoglycemia (HH) auxiliarily diagnosed by 18F-DOPA positron emission tomography (PET) CT scanning. Methods: The clinical data of 123 patients who were diagnosed with hyperinsulinemic hypoglycemia by comprehensive clinical diagnostic procedures in the Department of Pediatric Endocrinology and Inherited Metabolic Diseases, Children's Hospital of Fudan University between January 2016 and December 2020 were retrospectively analyzed. Clinical data such as gender, age of onset, province, concurrent serum insulin level measured during hypoglycemia, lesion type of pancreas by 18F-DOPA-PET CT scanning, genetic test results, and treatment were collected successively. The clinical features and therapeutic outcomes were compared between patients with focal and diffuse pancreatic lesions. T test, Rank sum test, and χ² test were used for comparison between groups. Results: A total of 123 patients with hyperinsulinemic hypoglycemia (72 males and 51 females), whose average age of onset was 3 days (ranging from 1 day to 4 860 days), were recruited from 24 provinces. The concurrent serum insulin level was 7.1 (0.4-303.0) mU/L during hypoglycemia. 18F-DOPA-PET CT scanning identified focal lesions in 25.2% (31/123) and diffuse lesions in 74.8% (92/123) of the patients; 64.2% (79/123) of the HH cases were found to have pathogenic gene variants, in which 88.6% (70/79) were found to have KATP channel related genes (61 in ABCC8 and 9 in KCNJ11 mutations). Thirty-seven patients (17 focal and 20 diffuse) received surgical treatment with a success rate of 67.6% (25/37). The effective rate of diazoxide for children with diffuse type was significantly higher than that of children with focal group (28.3% (26/92) vs. 9.7% (3/31), χ²=10.31, P=0.001). Conclusions: 18F-DOPA-PET CT scan can improve the success rate of surgery. Comprehensive diagnosis of the etiology of hyperinsulinemic hypoglycemia by genetic analysis and 18F-DOPA-PET CT scanning can result in better treatment and prognosis.

[Feasibility of domestic (18)F-DOPA PET/CT scanning in the differential diagnosis of pancreatic lesions in children with hyperinsulinemic hypoglycemia].

Objective: To study the feasibility of (18)F-fluoro-L-dihydroxyphenylalanine positron emission tomography/Computed tomography ((18)F-DOPA PET/CT) scanning in the localization and differential diagnosing of focal versus diffuse form of pancreas lesions in patients with hyperinsulinemic hypoglycemia (HH). Method: Twenty-four patients were diagnosed with HH between January, 2016 and February, 2017 in the Department of Pediatric Endocrinology and Inherited Metabolic Diseases, Children's Hospital of Fudan University using an integrated clinical and biochemical diagnostic protocol, domestic (18)F-DOPA PET/CT imaging technique were applied after MRI and ultrasound failed to detect pancreas lesions. Pancreas (18)F-DOPA standardized uptake values (SUV) were measured, and pancreas' lesions were dually analyzed via visual method and pancreas percentage SUV method. Among these patients, 9 patients received surgical pancreatic lesion resections, the correlations among surgical outcomes, histopathological findings and (18)F-DOPA PET/CT scan results were analyzed. Result: Seven patients were detected with focal form of pancreas lesions, the mean peak of SUV was 4.7±1.7(2.6-7.1), and 17 patients were found to have diffuse form lesions after (18)F-DOPA-PET/CT scanning. Among the 24 cases, 9 patients (7 showed focal and 2 showed diffuse (18)F-DOPA PET/CT pancreatic uptake)were euglycemic without any medical support after surgery; the resected pancreatic tissue histopathological results were consistent with that of PET/CT imaging. Only one patient, who responded to medical treatment before surgery, had temporary hyperglycemia after operation. Conclusion: Domestic (18)F-DOPA PET/CT could successfully locate and differentiate the pancreatic lesions and thus improve the success of surgery.

[Operations for laryngeal carcinoma with reservation of laryngeal function].

OBJECTIVE: To study the long term results and functional recovery of partial laryngectomy in the treatment of glottic and supraglottic types of laryngeal carcinoma. METHOD: A series of 70 cases operated on between July 1978 and August 1998 were analysed, of whom 60 were glottic, 10 were supraglottic type laryngeal carcinoma. Among them, 22 cases underwent vocal cord resection, 22 vertical hemilaryngectomy, 17 Majer-Piquet's operation, 7 horizontal hemilaryngectomy, 2 Arslan's operation. RESULT: 1, 3, 5-year survival rates were 98.53%, 87.04% and 78.26% respectively. Decannulation rate was 100%. All patients could finally take food by mouth without inspiration, and could speak as soon as decannulated. Complication and recurrence rates were 15.71% and 13.04% separately. CONCLUSION: Partial laryngectomy is an effective operation on laryngeal carcinoma with reservation of laryngeal function. It not only can totally excise neoplasm and prolong life, but also can better reserve laryngeal function and improve the quality of patient's life.

Clinical observation on guillotine tonsillectomy without anesthesia.

Ten years ago, tonsillectomy was the most common operation in ENT service. Guillotine tonsillectomy without anesthesia is a simple, fast, and safe operative procedure. From 1958-1981, 34,000 non-anesthetic guillotine operations were performed at our university. This method gives fairly satisfactory results. More than 93% of the patients experienced no pain or slight pain during operation. There was no mortality or morbidity in the 34,000 cases. It is distinctly safe and, therefore, is far superior to the anesthetic dissection method.