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In general, the volume of a parathyroid adenoma is small and rarely causes local symptoms of compression. This case of huge parathyroid adenoma presents with dyspnea as the chief complaint and does not have a series of symptoms of hyperparathyroidism, which deserves our attention.
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Objective To detect the oxidative and anti-oxidative imbalance of Hashimoto′s thyroiditis (HT) with specific thyroid function through specific serum.Methods 41 patients with normal thyroid function of Hashimoto′s thyroiditis and 43 healthy controls were enrolled in our hospital from May 2016 to May2017.Through specific serum tests, such as derived active oxygen metabolism (d-ROM) and biological antioxidant potential (BAP), advanced glycation end products (AGE) and advanced oxidized protein products (AOPP) were used to assess oxidative stress.Results The levels of d-ROM and AGEs were significantly increased (P＜0.05) and BAP was significantly lower in both groups compared with HT patients (P＜0.001).In univariate analysis, serum TSH, TgAb and TPOAb were significantly associated with d-ROMs (P＜0.05).HDL-C, serum TSH, TgAb and TPOAb were significantly associated with BAP (P＜0.05).Total cholesterol and LDL-C were significantly associated with AGEs (P＜0.05).Multivariate analysis showed that serum TPOAb was a predictor of d-ROMs (P＜0.001), BAP (P＜0.001), and AGEs (P=0.003).In addition, HDLC was also an independent predictor of BAP levels (P=0.012, R2=2.354, 95％CI:1.191-5.433).While LDL-C was an independent predictor of AGEs (P =0.004, R2=1.102, 95％CI:0.915-1.253).Conclusion HT patients increased oxidant, antioxidants decreased.And AGEs were significantly higher, AGEs levels can be used as a new HT oxidative stress a reliable biomarker.
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OBJECTIVE： To investigate the effects of Hericium erinaceus polysaccharide on the content of short-chain fatty acids （SCFAs） in the intestine of ulcerative colitis model rats. METHODS： A total of 40 SD rats were randomly divided into blank group， model group and H. erinaceus polysaccharide low-dose and high-dose groups （0.5， 1.0 g/kg）， with 10 rats in each group. Except for blank group， other groups were given acetic acid enema to induce ulcerative colitis model. The next day after modeling， H. erinaceus polysaccharide groups were given relevant medicine solution intragastrically； blank group and model group were given relevant volume of water intragastrically， for 10 consecutive days. Colon tissue was collected， and pathological changes of colon tissue were observed by HE staining. The pathological changes of colon in rats were observed with naked eyes and scored so as to evaluate the therapeutic efficacy. The contents of 6 kinds of SCFAs （acetic acid，propionic acid，butyric acid，isobutyric acid，pentanoic acid and isovaleric acid） in intestine of rats were determined by GC-MS. RESULTS： Compared with blank group， inflammatory lesions of colonic mucosal epithelium in model group rats were obvious； colonic mucosal ulcer score increased significantly （P＜0.01）； the contents of 5 kinds of SCFAs and the total amount of SCFAs in colon except for propionic acid were decreased significantly （P＜0.01）. Compared with model group， the degree of colonic histopathological damage in H. erinaceus polysaccharide groups was significantly reduced； colonic mucosal ulcer scores were significantly reduced （P＜0.05 or P＜0.01）； the contents of 5 kinds of SCFAs and the total amount of SCFAs in colon except for propionic acid were increased significantly （P＜0.05 or P＜0.01）. CONCLUSIONS： H. erinaceus polysaccharide can effectively improve the pathological condition of ulcerative colitis model rats； its regulation of intestinal SCFAs （especially acetic acid and butyric acid） may be an important mechanism of its anti-ulcerative colitis.
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Objective To evaluate the efficacy of ultrasound-guided combined blockade of bra-chial plexus and paravertebral block for postoperative analgesia in patients undergoing internal fixation of scapular fracture.Methods Sixty patients,48 males and 12 females,ASA physical Ⅰ or Ⅱ,who were scheduled to undergo internal fixation of scapular fracture were enrolled in the study,and ran-domized into two groups:group B (combined blockade of brachial plexus and paravertebral block) and group C (regular control).Patients in B group received combined blockade of brachial plexus nerve block (interscalene or supraclavicular blocks)and paravertebral block (in C7-T1 ,T2-T3 and T4-T5 levels),and underwent the procedure with general anesthesia 30 min later.Surgery for patients in group C were performed under general anesthesia without a previous nerve block.Following data were collected:consumption of sufentanil during surgery;agitation and length of stay in post-anesthesia care unit (PACU);complaint of pain and the need for supplemental analgesia in PACU;anesthesia-related complications such as nausea,vomiting,depression of respiration and retention.Results The mean total consumption of sufentanil was significantly increased in group C [(43.2 ± 7.1 )μg vs (12.3±5.2)μg,P <0.05];the length of stay,ratio of complaint of pain and need for supplemental analgesia in PACU were increased in group C (P <0.05).There was no statistical difference in post-operative complications.Conclusion We demonstrated that ultrasound-guided combined blockade of brachial plexus and paravertebral block provided feasible and reliable analgesia for patients underwent internal fixation of scapular fracture.
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Objective To explore the key points of anaesthetic management of bilateral lung transplantation treating severe idiopathic pulmonary arterial hypertension.Methods Clinical data of 20 cases with severe IPAH treated by bilateral lung transplantation were analyzed retrospectively, 2 males and 18 females, ASA physical status Ⅲ or Ⅳ.The hemodynamic changes were observed at various points (30 min after double lung ventilation, 15 min after ECMO, during one-lung ventilation, 30 min after pulmonary artery block, at the opening of pulmonary artery and at the end of surgery) and pre-and post-operative changes of cardiovascular morphology were analyzed with heart ultrasound.Results Compared with 30 min after double lung ventilation, PaO2 and SVV were significantly increased and PAP, PAWP and PaCO2 were decreased 15 min after extracorporeal membrance oxygenation (ECMO) (P<0.05).PAP and PAWP were significant higher and SVV was lower 30 min after pulmonary artery block than 15 min after ECMO (P<0.05).Opening of pulmonary artery had significantly increased SVV and reduced PAP and PAWP compared with pulmonary artery block (P<0.05).ECMO was removed in 4 cases at end of the surgery.The remaining 16 cases assisted by ECMO were transferred to ICU, 3 cases underwent thoracotomy for exploration and hemostasis 1 day after the operation while 13 cases suffered from different degrees of left heart dysfunction postoperatively, 4 of which had acute heart failure.Of the 4 cases, 2 were treated by right femoral vein-right femoral artery bypass (V-A ECMO bypass) and 2 underwent right femoral vein-right internal jugular vein bypass (V-V ECMO bypass).Moreover, 3 cases performed tracheotomy 5 days, 6 days and 13 days day after the operation, respectively.All the patients were cured and discharged.Their cardiovascular morphology was improved.Conclusion The key successful factors of IPAH treated by bilateral lung transplantation are to improving perioperative heart function, keeping stable hemodynamics during induction of anesthesia and the operation and using ECMO properly and postoperative support.
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Objective To summarize the perioperative clinical effect of extracorporeal membrane oxygenation (ECMO) technique in bilateral lung transplantation of patients with idiopathic pulmonary arterial hypertension.Methods Of 18 recipients with idiopathic pulmonary arterial hypertension receiving double lung transplantation,there were 11 cases of 11 grade Ⅲ (WHO cardiac function ratings) and 7 cases of grade Ⅳ.All patients were given ECMO technique after anesthetic induction,and the speed and volume of ECMO were adjusted according to oxygenation and cardiac function.At the end of the operation,the ECMO flow rate was decreased to 1 L·min-1 ·m-2.If the hemodynamics was stable and the oxygenation index was above 300,the ECMO could be removed.All data were Collected at 7 time points (preoperation,30 min after two lung ventilation,15 min after ECMO,the establishment of one lung ventilation,30 min after pulmonary artery occlusion,30 min after pulmonary artery open and at the end of the operation).The prognosis of the recipients was observed postoperatively.Results All patients successfully completed operation under the support of ECMO technique.As compared with preoperation,PaO2 and PaCO2 were significantly increased at 30 min after two lung ventilation (P＜0.05).As compared with 30 min after two lung ventilation,PaO2 was significantly elevated (P＜0.05),PaCO2 and PAP were reduced at 15 min after ECMO (P＜0.05).As compared with 15 min after ECMO,PAP was significantly increased at 30 min after pulmonary artery occlusion (P＜0.05).As compared with 30 min after pulmonary artery occlusion,PAP was significantly reduced at 30 min after pulmonary artery open (P ＜ 0.05).ECMO of 3 patients was removed after operation at once and of 15 patients were not removed until 3.3 ± 2.5 days in ICU.Tencases suffered from left cardiac insufficiency to varying degrees after removing ECMO (including 3cases whose ECMO was removed at once after operation),3 of them received ECMO bypass again and 7 of them were relieved after administration of cardiotonic,diuretics and vasodilators.Two cases sufferred from wound fat liquefaction and infection and 2 cases had moderate femoral artery thrombosis after postoperative ECMO.One case had renal failure 5 days after operation and thereafter died of multiple organ failure 2 weeks later after treatment with the continuous ECMO pipelines of hemofiltration,then 17 cases were cured.The pulmonary arterial pressure of all recipients was (30.79 ± 6.18) mmHg 2 months after operation and the cardiac function rating was significantly increased (P ＜0.01).Conclusion The application of ECMO technique in the lung transplantation patients with idiopathic pulmonary hypertension can reduce the pulmonary arterial pressure,improve the safety of operation and has obvious auxiliary effect on the perioperative cardiac function.
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Objective To investigate the utility of combined detection of procalcitonin(PCT ) ,C‐reactive protein(CRP)and preal‐bumin(PA)in elderly patients with acute respiratory infectious diseases .Methods Detected the serum procalcitonin(PCT) ,C‐reac‐tive protein(CRP) and prealbumin(PA) of 110 elderly patients with acute respiratory infectious diseases and 40 healthy people dur‐ing the same period as control group .The levels of PCT and CRP and PA among groups were compared before and after treatment . The 110 elderly patients with acute respiratory infections were divided into into bacterial infection group(n= 40) ,virus infected group(n=34) and mixed infection group (n=36) according to the pathogen type .Results Before treatment ,the PCT and CRP of bacterial infection group and mixed infection group were significantly higher than that of control group ,while the level of PA was lower ,and the difference were statistically significant(P0 .05) .After treatment ,there was no significant difference .The sensitivity ,spe‐cificity ,accuracy ,positive predictive value ,negative predictive value ,and Youden′s index of combined detection of the three indica‐tors were higher than those of single detection in acute respiratory infection .Conclusion PCT ,CRP and PA can be used as the di‐agnostic indexes for elderly patients with acute respiratory tract infection .The combined detection of the 3 indexes can improve the accuracy of early diagnosis of acute respiratory tract infections in elderly patients and can be used in therapeutic efficiency evalua‐tion .
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Objective To assess the application value of disposable syringe of low resistance (SLR) in epidural puncture.Methods One hundred and thirty-two patients scheduled to undergoing selective operation under epidural or combined epidural-spinal anesthesia were divided into glass syringe (GS) group and SLR group with 66 cases each by random digits table method.GS was applied in local anesthesia and epidural puncture with loss of resistance in GS group.While SLR was used in SLR group.The defect of the syringes' appearance was evaluated.The fastness between each sub-unit during the procedure was observed.The rupture,dropping,leakage,air leakage and blockage were also estimated.The heart rate,blood pressure,oxygen saturation and other adverse events were also observed.Results In SLR group,syringe excepted 1 case of slight resistance but did not affect the use,the rest of the components connected firmly,surface without defects,clear scale uniform color,not observed rupture,air leakage,leakage and blockage phenomenon,pump liquid and air resistance was small.In GS group,syringe surface without defects,clear scale uniform color,3 cases had loose connection,1 case with rupture when using,5 cases with air leakage and leakage,3 cases of pumping liquid or dry air resistance to 0.9％ sodium chloride and moist after use.There was significant difference in appearance and usage between two groups (x2 =10.324 5,P =0.001 3).There was no significant difference in a puncture success,first three puncture success and inject air negative pressure sensitivity between two groups (P ＞ 0.05).Conclusion SLR is worth to be applied in epidural puncture.
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Objective To compare the oxygen saturation between the blood of superior vena cava and mixed venous in lung transplantation and provide reference for monitoring method in anesthesia. Methods 30 patients who received lung transplantation were placed central venous catheter into superior vena cava and flotation catheter into the pulmonary artery in turn. The blood samples were collected from the superior vena cava and pulmonary artery for blood gas analysis simultaneously at the time of just followed the catheter placement (T1), before the resection of the first bad lung (T2), after the reperfusion of the first donor lung (T3), before the resection of the second bad lung (T4), after the reperfusion of the second donor lung (T5), before the end of the operation (T6). The oxygen saturation were compared between the blood of the superior vena cava and mixed venous. Results From T1 to T6, Bland-Altman analysis showed that the mean of deviation between the SpO2 measured in blood of superior vena cava and mixed venous were 0.5, 3.4, 2.3, 0.5, 0.27,-2.9, respectively, and the incidence beyond the upper and lowed limits of consistency zone was 3.3%, 0%, 0%, 3.3%, 3.3%, 0%respectively. The incidence of SpO2 within the consistent limits was 96.7%, 100%, 100%, 96.7%, 96.7%, 100% respectively. Conclusions The SpO2 of superior vena cava may be approximately reference as SpO2 of mixed venous during lung transplantation.
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Objective To discuss the appropriate excision area of the thyroid microcacinoma. Methods 46 patients with thyroid microcarcinoma confirmed by pathology result were analyzed, in which 28 patients under-went thyroid lobectomy of lesion side and subtotal lobectomy of the other;8 patients were treated with subtotal lo-bectomy of both side;3 patients were treated with lobectomy of one side and partial resection of the other, while the rest 7 patients underwent the surgery of lesion side lobectomy and neck dissection plus subtotal lobectomy of the other side. Results No complicaitons were observed. All patients were follow-uped for 1 ～ 5 years. 2 patients were disgnosed as recurrance 3 years and 4 years after the operation respectively. The rest survived without recur-rance. Conclusions The appropriate surgery approach for thyroid microcacinoma might be lesion side lobectomy and subtotal lobectomy of the other side.
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Objective To investigate the anatomic feature and exposing methods of recurrent laryngeal nerve(RLN) in thyroid surgery. Methods The data of 327 cases of thyroid tumor were analyzed retrospectively. The anatomic feature, injury and prevention of RLN were discussed. Of all the cases, 293 RLNs (242 cases) were anatomically exposed. Results The temporary injury rates of RLN was 1.65% (4/242) in the exposed group and 8.23% (7/85) in the unexposed group with a persistent injury rate of 2.35%(2/85). The differences of temporary injury rates and persistent injury rates between the two groups were statistically significant (P<0.05). 67.23% (197/293) of the RLNs had two branches before entering larynx, 61.09%(179/293) of RLNs were posterior to the inferior thyroid artery and 31.39% (92/293) anterior to the inferior thyroid artery, 4.09% (12/293) passed through the bifurcation of inferior thyroid artery, and 4. 13% (10/293) were not related to the inferior thyroid artery. The incidence of non-recurrent laryngeal nerve (inferior laryngeal nerve) was 0.68% (2/293). Conclusions The anatomic relation of RLN is relatively complicated along its journey. The injury of RLN could be reduced with designed exposal during the thyroid surgery.
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Objective To investigate the operation technique, feasibility and clinical outcome of endoscopic clearance of axillary lymph node with liposuction(E-ALNC) in 32 patients with breast cancer. Methods From January 2005 to December 2008, a total of 32 patients with breast cancer were treated with E-ALNC.The clinical data of the patients were analyzed retrospectively and compared with those of 46 patients who have undergone traditional axillary lymph node clearance(T-ALNC)during the same period. Results Both groups were Ⅰ～Ⅱ breast cancer. There were no interim open surgery, massive bleeding, subcutaneous emphysema,fat embolism and other complications in E-ALNC. There was no significant difference between E-ALNC and T-ALNC in lymph number removed(15.5 in E-ALNC) and operation time(80 min in E-ALNC). But there was less bleeding (380ml) and lower postoperation complication rate in E-ALNC. Conclusions The E-ALNC and T-ALNC can have the same effect in the breast conserving surgery.The method makes patients attain a physiological and psychological minimal invasiveness. Besides assuring the quality of axillary lymph node clearance, the method can reduce the occurrence of surgical complication and improve the patients'life quality. E-ALNC can replace the routine surgery and can be carried out in the qualified hospitals.
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Objective To investigate the pathogenic constitution of thyroid nodular diasease and it' s di-agnosis and treatment.Methods A retrospective analysis was performed on data of 576 patients accepted hospi-tal therapy with thyroid nodular diasease from January 2004 to June 2008.Results Definite diagnosis of all easeswere made by surgery biopsy or fine needle aspiration-cytology.529 eases were benign lesions, another 47 eases were malignant lesions.Condusions Ultra-sound , FNAC and frozen sections have important value in differenti-al diagnosis for the thyroid nodules, nodular goiter is most common, and which have a close relationship with thy-roid carcinoma.Regular surgical resection would reduce the recurrence of thyroid nodular diasease and avoid missed diagnosis for thyroid carcinoma.
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Objective: To investigate the prospect of applying technology of ultra fine powder (UFP) to TCM powders for external use. Methods: The morphocytology between UFP of Cortex cinnamomi , compared with its common powder, was observed; physical parameters of the UFP particles and the penetrating amount of cinnamaldehyde, through rat skin in vitro was determined with an improved Franz diffuse cell. Results: The diameter of the UFP particles detected was small (D 50 =12.72?m). and a typical microscopic characters of Cortex cinnamomi powder was not observed. The Cortex cinnamomi UFP have good transdermal effects. There existed the linear relationship between penetrating amount of cinnamaldehyde and penetrating time. The highest penetrating rate (0.25mg/cm 2/h) was within the first hour in the beginning, and then the rate became lower and sustained. The accumulating transdermal amount of the UFP was 1.0mg/cm 2 totally in 8 hours. Conclusion: It indicated that UFP might have a fine respect, applied in cosmetic or drug preparations for external use.