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Objective:To investigate the clinicopathological characteristics and metastatic risk factors for patients with lymph node metastasis in central region of differentiated thyroid cancer, and to provide a basis for clinical treatment.Methods:A total of 200 patients with differentiated thyroid cancer from January 2017 to October 2018 in Jiangmen Central Hospital of Guangdong Province were selected. According to the central lymph node metastasis, the patients were divided into metastasis group and non-metastasis group. The clinicopathological features of the two groups were compared, including gender, age, tumor diameter, lesion gland lobe, the number of tumors, TNM staging, capsular infiltration, thyroid stimulating hormone (TSH), anti-thyroglobulin antibody (TG-Ab), operation mode, blood flow grading, microcalcification, thyroid peroxidase antibody (TPO-Ab) and pathological type. The relationship between central lymph node metastasis and clinical characteristics was analyzed. The risk factors of central lymph node metastasis were analyzed by using logistic regression model.Results:Of the 200 patients, 52 (26.00%) patients had central region lymph node metastasis and 148 (74.00%) patients had no central region lymph node metastasis. The tumor diameter ≥ 2 cm, capsule infiltration, microcalcification and grade Ⅲ blood flow in the metastasis group were all higher than those in the non-metastasis group, and the differences were statistically significant [86.5% (45/52) vs. 68.2% (101/148), 40.4% (21/52) vs. 16.9% (25/148), 34.6% (18/52) vs. 11.5% (17/148), 23.1% (12/52) vs. 7.4% (11/148), all P < 0.05]. There were no statistically differences in the proportion of patients stratified by other clinicopathological factors (all P > 0.05). Logistic regression model suggested that tumor diameter ≥ 2 cm ( OR = 1.424, 95% CI 1.041-1.948, P = 0.009), capsular infiltration ( OR = 3.541, 95% CI 1.378-9.099, P = 0.009), microcalcification ( OR = 4.058, 95% CI 1.693-9.727, P = 0.002) and grade Ⅲ of blood flow ( OR = 5.174, 95% CI 2.148-12.463, P < 0.01) were independent risk factors for lymph node metastasis in central region. Conclusion:Central lymph node metastasis in patients with differentiated thyroid cancer is related to tumor diameter, capsular infiltration, microcalcification and grade Ⅲ of blood flow, which should be paid more attention in clinic.
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Objective To study the curative effect and prognosis of malignant pleural effusion treated by staphylotoxoid injection and its effect on immune system.Methods A total of 65 patients with malignant pleural effusion from August 2012 to 2014 November in Lishui City Central Hospital were selected,and divided into observation group(n=33) and control group (n=32) in terms of different treating methods,two groups were implemented with thoracic closed drainage to drain pleural effusion up.The observation group was completely drained after 2 500 U intrapleural injection of staphylotoxoid injection,the control group to the traditonal method of bleomycin 1 mg/kg injection.The efficacy,prognosis and immune system were compared.Results The effective of rate of the observation group was significantly higher(72.7%) than the control group(43.8%);the adverse reaction rate of observation group was lower and its median survival time was longer;white blood cells counts of observation group was significantly more than control group ( P<0.05).Conclusion Compared with the traditional method of bleomycin intrapleural injection treatment of malignant pleural effusion, staphylotoxoid injection can be more effective control of the disease , reduce adverse reactions, and can improve their immunity and improve the body tolerance .
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Objective To evaluate the clinical superiority of transumbilical mini pure single-port laparoscopic Palomo's surgery on the treatment of primary teenage varicocele.Methods All operations were successfully completed using mini pure single-port laparoscopic Palomo's surgery.Its clinical effects were evaluated by the operative time,blood loss volume,intra-or post-operative complications,and hospital stay.Six to eighteen months after surgery,follow-up was made in 78 patients.Results All the operations were successful.The operation time was 5-15 (mean 8) minutes,the intra-operative loss blood was 1-5 (mean 1.5) mL,and the post-operative hospital stay was 2-4 (mean 3) days.No intra-operative or post-operative complications happened.Sperm analysis of 95％ patients came back to normal in 6-18 months.Conclusions The transumbilical mini pure single-port laparoscopic Palomo's technique has more obvious superiority and it is worthy of clinical application and generalized widely.
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Objective To study the effects of Bitong mixture on children with chronic sinusitis and nasal polyp in perioperative period.Methods 72 patients acquired for nasal endoscope were randomly divided into a combining traditional Chinese and western medicine treatment group and a control group.The control group was given traditional western medical treatment,and treatment group was given Bitong mixture on that basis.Results ①clinical effects:Total effective rate of postoperative 3 months、6 months、9 months was 94.59％、88.89％、80.00％ in the treatment group respectively and 88.57％、80.00％、66.67％ in the control group respectively.Compared the two groups after treatment at the same time,differences were statistically significant (x2=6.41 、6.81、7.22,P＜0.05).The efficacy of 12 months after operation in the treatment group and control group declined compared with that of 3 months after operation in each group,but still significant differences existed between groups (x2=6.08、6.98,P＜0.05).②symptom score:symptoms improvements such as alleviating headaches 、reducing pus stuff at 2 weeks 、1 months 、3 months after treatment in the treatment group was obvious than those before the treatment (P＜0.01),and also better than those in the control group at the same time.The improving blocked nose,sense of smell after three months treatment in the treatment group were better than those of the control group respectively at the time(P＜0.05).Conclusion Traditional Chinese medicine can effectively improve symptoms,enhance the curative effect in children with chronic sinusitis and nasal polyp at perioperative period,and it is worth of further clinical application and research.
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Objective To explore the comprehensive therapy of infants with urinary calculus induced by melamine.Methods Clinical data of 228 infants(aged from 4 months to 3 years,mean age 11 months)with urinary calculus induced by melamine were analyzed. Bilateral renal calculi were found in 144 cases and one-side renal calculus in 54 cases,of which the diameter ranged from 0.5-2.5 cm.Ureteral calculi with moderate to severe hydronephrosis were found in 15 cases,of which the diameter ranged from 0.4-1.1 cm. Bladder calculi with urinary retention were found in 5 cases and urethral calculi with urinary retention in 10 cases,of which the diameter ranged from 0.5-1.3 cm. All the urinary calculi were confirmed by B-uhrasound examination and CT. Group 1 : Of the 15 cases with acute renal failure, 13 underwent shattering and dissolving renal and ureternal calculus by pelvis clysis with alkalinity drug, detaining double J tubes through ureteroscope. After operation, these patients were treated with alkalinity drugs. Two cases were treated by percutaneous nephrostomy guided by B ultrasound and underwent shattering and dissolving renal calculus by intermittent pelvis clysis with alkinity drug. Group 2:15 cases of ureteral calculus with serious nephrohydrops underwent shattering and detaining double J tubes through ureteroscope, then treated with alkalinity drug. Group 3:15 cases of infant bladder and urethral caleus with acute urinary retention were treated by EMS through ureterscope per urethra. Group 4: The rest 183 cases without urinary obstruction received 1-8 week'surine alkalization therapy. Among them, 113 cases received sodium bicarbonate 0.15 g twice per day,23 cases received potassium sodium hydrogen citrate 2.4g/d, and 47 cases received 10% potassium citrate solution 5 ml 3 times per day. Sixty-one cases who were of no effect with alkalinity drug were treated by extracorporeal shock wave lithotripsy (ESWL) and dissolving calculus with sodium bicarbonate. During treatment with alkalinity drug, urine Ph was observed by urine analysis once per day.When it exceeded 7.5, alkalinity drug. Was withdrawn. All the patients were followed up for 1 to 3 months. Statistical analysis was done with the SPSS 13.0 software. ResultsHyperdiuresis emerged 12-24 h after operation in group 1. The duration of hyperdiuresis was 24-72 h with the urine volume of 800-2500 ml/24h. Urine volume revived gradually 48--96h after operation while serum BUN and Cr revived 1-5 d after operation. Four cases with renal and ureteral calculus became almost stone-free in 1-2 weeks and 14 cases became completely stone-free in 2-4 weeks after operation. Patients of group 2 became completely stone-free in 1-2 weeks. Patients of group 3 were cured by one EMS session through ureterscope per urethra and smooth urination was seen immediately after operation. No retained calculus in the bladder and urethra was found by B ultrasound 3 days later. In the sodium bicarbonate group, 4 cases became completely stone-free in 2 weeks, 18 cases in 4 weeks, 15cases in 13 weeks. The stones lessened and faded in 34 cases and had no changes in 42 cases. In the potassiun sodium hydrogen citrate group, 4 cases became completely stone-free in 1 weeks, 7 cases in 2 weeks, 10 cases in 4 weeks, 2 cases in 6 weeks. In the potassium citrate group, 3 cases became completely stone-free in 1 weeks, 5 cases in 2 weeks, 16 cases in 4 weeks, 11 cases in 8 weeks. The stones lessened and faded in 8 cases in 8 weeks and had no changes in 4 cases. The efficacy of the sodium bicarbonate group was significantly different with the efficacy of the citrate group (P=0. 001). No significant difference was found between the potassium sodium hydrogen citrate group and the potassium citrate solution group(P=0. 372). ConclusionsConservative treatment should be employed mainly in the earlier stage for the infant urinary calculus induced by melamine . When the diagnosis of acute renal failure, moderate to severe hydronephrosis and acute lower urinary tract obstruction are established, surgical intervention should be the main method to relieve obstruction, protect renal function and resume normal rnicturition. With the development of the characteristics of the stones later,the oral dissolution therapy with alkalirtity drug could not dissolve the calculi and ESWL should be employed.
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Objective To evaluate the efficacy and safety of direct renal chemolysis with alkaline drug through ureteral catheter or nephrostomy tube for the treatment of infantile renal calculus resul-ted from melamine. Methods Fifteen infants of acute post-renal failure resulted from bilateral renal calculi were treated. The age of the infants was 5--12 months(average, 9 months). Stone size varied from 0.4 to 1.5 cm (average, 0.8 cm). They were all fed on milk powder polluted with melamine for a long time and diagnosed with acute post-renal failure based on the imaging and chemical examination. Double-J stents insertion by ureteroscope was performed on 13 infants and direct renal chemolysis with alkaline drng(5% NaHCO3,20 ml)through ureteral catheter was performed during operation. Percuta-neous nephrostomy was performed on 2 infants to remove the obstruction of upper urinary tract and di-rect renal chemolysis with alkaline drug(1.4% NaHCO3, continuous perfusion by gravity) through ne-phrostomy tube was performed intermittently after operation. Results Direct renal chemolysis was performed successfully on the 15 infants. The urine volume recovered in 2--5 d, blood urea nitrogen and serum creatinine recovered in 2--3 d postoperatively. During the operation of the infants treated by direct renal chemolysis with 5%NaHCO3 throuth ureteral catheter, a large number of limous fluid spurted from ureterostoma. According to CT examination 2 weeks after operation, the stone frag-ments were removed thoroughly in 13 infants, the diameter of the stone lessened more than 50% in 2 infants. Conclusion Direct renal chemolysis with alkaline drug for eliminating infantile renal cal-culus resulted from melamine is sale and effective.
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Objective To investigate the clinical application of ureteroseope in the treatment of infant renal calculus with acute post-renal failure. Methods Thirteen cases of infant renal calculus with acute post-renal failure included 11 males and 2 females aging from 5 months to 1 years with a mean age of 9 months. Five cases showed bilateral renal calculi with hydronephrosis, 3 cases showed one side renal calculus with eontralateral uretal calculus incarceration, 3 cases showed bilateral uretal calculus incarceration, 2 cases showed bilateral renal calculi and hydronephrosis with urinary calculi. Anuria appeared in 11 cases for 1-3 d while oliguria appeared in 2 cases for 5-10 d. BUN and SCr were higher than normal level in all cases. Hyperuricemia was found in 8 cases, hyperkaliemia was found in 9 cases, pH values in urine of all infants were less than 6. 5(mean, 5. 5). Radiopague stone was not found in all cases by KUB. Hydronephrosis was found in 13 cases, and the diameter of hydro-nephrosis in 9 cases was more than 2.5 cm by B ultrasound. All cases were diagnosed as urinary stones with the diameter from 0.5 to 1.5 cm by CT. All cases were inserted with double J stents un-der ureteroscope for internal drainage, crushing, rinsing and eliminating stones. Results Hyperdi-uresis emerged within 24 h after operation in 13 patients. The duration of hyperdiuresis was from 24 h to 72 h. Urine volume revived gradually 48-96 h after operation while BUN and SCr revived 1-5 dafter operation. Serum uric acid revived 1-7 d after operation in 8 cases of hyperuricacidemia. Serum potassium revived 1-3 d after operation in 9 cases of hyperpotassaemia. Double J tubes were detained for 2-4 weeks. Renal calculus in 10 cases were found by B ultrasound to be discharged and conse-quently double J tubes were pulled out. Renal calculi in 2 cases became smaller and lighter. Conclu-sions For infant renal calculus with acute post-renal failure, upper urinary obstruction could be re-lieved immediately with revived urination and improved renal function by dissolution and crushing of calculus, and the placement of double J tube for internal drainage under ureteroscope. This operation is safe, high-efficient with less lesion, and would be the first option to relieve obstruction for infant re-nal calculus with acute post-renal failure.
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Objective To evaluate the effect of EMS through ureteroscope per urethra for the treatment of infant bladder and urethral stone with acute urinary retention. Methods Ten cases (9 boys, 1 girl)of infant bladder and urethral stone with acute urinary retention were treated by EMS through ureteroscope per urethra. Mean age of the patients was 9 months. Two cases suffered from bladder stones while the other 8 cases suffered from urethral stones. The size of stones varied from 0.5-1.1 cm with the average of 0.8 cm. All 10 cases underwent EMS through ureteroseope per ure-thra after general anaesthesia by using ketamine in vein. Wolf F8/9. 8 ureteroscope was used and mo-nitored by television. The EMS probe of ultrasound lithotripsy was sticked through operating passway of ureteroscope to shatter and eliminate bladder and urethral stone. During operation, 50-- 100 ml li-quid pressure was retained in the urinary bladder. The pressure of perfusion pump varied between 160 and 210 kPa(average, 180 kPa). The energy of ultrasound lithotripsy was 40%--60% with a ratio of 30%--70%. F8 type of 2 cavity aerocyst urethral catheter was indwelled after operation. Results The average operation time was 25 min. Urethral stones were rinsed into bladder. Stones were elimi-nated at one time by ureteroscope. Urethral catheters were removed after the patients revived from anesthesia and smooth urination was seen immediately after operation. No retained calculus in the bladder and urethra was found by B ultrasound 3 days later. Conclusions Low urinary obstruction could be relieved immediately after EMS through ureteroscope per urethra in patients of infant bladder and urethral stone with acute urinary retention. This operation is safe, high-efficient with less lesion, and would be the first option for the patients of infant bladder and urethral stone with acute urinary re-tention.