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Objective:To investigate the value of jugulo-omohyoid lymph nodes(JOHLN) for the prediction of lateral cervical lymph nodes metastasis behind internal jugular vein in patients with papillary thyroid carcinoma(PTC) and its clinical significance.Methods:The clinical data of 220 patients who underwent lateral neck dissection in our center were retrospectively analyzed, and the early warning effect and clinical significance of JOHLN on lymph node metastasis of the posterior internal jugular vein were analyzed.Results:In this study, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of JOHLN for predicting lymph node metastasis in the posterior group of internal jugular vein were 83.5%, 46.4%, 82.0%, 49.1%, and 74.1%, respectively. The accuracy rate for JOHLN prediction of upper tumor was 84.3%; In this study, side neck skip metastasis was found in 11 cases, all of which were JOHLN metastasis, upper tumors were found in 9 cases and 2 were located in the middle. Among the skip metastases, 6 cases had lymph node metastasis in the posterior group of internal jugular vein, and they were all upper tumors.Conclusions:JOHLN can effectively predict the risk of lateral neck metastasis. Especially for the upper PTC, preoperative evaluation of JOHLN can help decision-making of lateral neck lymph node dissection.
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According to the cause of hyperparathyriodism (HPT) , it can be divided into three types: primary hyperparathyroidism (PHPT) , secondary hyperparathyroidism (SHPT) and tertiary hyperparathyroidism (THPT) . THPT is a state of excessive autonomous excretion of parathyroid hormone (PTH) after longstanding SHPT. In the past, reports of THPT is relatively rare in domestic, which may be related to the understanding and experience of clinicians. With the increase of kidney transplant cases all over the word, the incidence rate has also gradually increased. Therefore, it is especially important to deepen the knowledge of THPT, standardize the medical treatment, and strictly control the indications for surgery.
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Objective To explore the effect of intraoperative parathyroid hormone (IOPTH) examination on parathyroidectomy for primary hyperparathyroidism.Methods The clinical data of 41 PHPT patients who received IOPTH monitoring (IOPTH group) from Jan.2009 to Dec.2014 were retrospectively analyzed.The clinical manifestation,examination and changes of parathyroid hormone and calcium before and after operation were collected.Results There were 12 males and 29 females.36 cases had parathyroid adenoma,and 5 cases were parathyroid carcinoma.23 cases were positive in 24 cases of 99Icm-MIBI parathyroid adenoma radionuclide examination,and 2 cases were positive in 3 cases of parathyroid carcinoma radionuclide 99Tcm-MIBI inspection (P＝ 0.213).10 mins after tumor resection,PTH in all cases decreased by 50％ or more than that before tumor resection except for one case of parathyroid carcinoma.23 cases appeared hypocalcemia in 36 cases of parathyroid adenoma after surgery and 2 cases appeared hypocalcemia in 5 cases of parathyroid cancer patients (P＝0.361).No postoperative hoarseness,cough,bleeding occoured.Patients were followed up from 6 to 72 months.Hypocalcemia symptoms recovered 2 weeks to 3 months after surgery.No permanent hypoparathyroidism occured.One case of parathyroid carcinoma died of hypercalcemia 5 months after surgery.The remaining 40 cases survived without recurrence or death.Conclusions Intraoperative PTH monitoring can help doctors analyze whether all the hyperthyroidism glands have been removed,which can help to avoid miss diagnosis of multiple gland disease and unnecessary bilateral neck exploration.This method is highly accurate so it is recommended for routine use in PHPT surgery.
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Secondary hyperparathyroidism is the most common complication of patients with chronic kidney disease.For patients poorly responding to medical treatment,parathyroidectomy would be the best choice.This article reviews the indications and modalities of surgical treatment for secondary hyperparathyroidism in patients with chronic kidney disease.
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Objective To investigate the clinical characteristics,diagnosis and treatment for Graves' disease associated with papillary thyroid microcarcinoma(PTMC) by retrospectively analyzing domestic and foreign literatures.Methods 32 patients of Graves' disease associated with PTMC treated at the Department of Thyroid Surgery,the First Bethune Hospital of Jilin University from Jun.2008 to Jun.2013 were collected.32 cases of PTMC with normal thyroid function were randomly selected by a random number table method from the same period as control.Results The experimental group had 32 patients aging from 24 to 71 years old,among whom 3 were males,and 29 were females with the male to female ratio was 1∶9.7.15 cases in the experimental group had positive central lymph node metastasis and the other 17 cases were negative,while in the control group 7 cases were positive and 25 cases were negative.The mean number of positive lymph nodes was 3 ± 2.88 in the experimental group and 1.71 ± 1.25 in the control group.The ratio of positive lymph node metastasis(the number of positive lymph nodes/the total number of lymph nodes,and the total number of central lymph nodes was ＞3)was (50.34 ±27.09) ％ in the experimental group and(33.5 ±30.79)％ in the control group.For the above 3 values of central lymph node metastasis,the experimental group were all higher than those of the control group (P =0.035,0.039,0.018 respectively).Conclusions Compared with patients of PTMC,patients of Graves' disease associated with PTMC are more likely to have central lymph node metastasis,more number of positive lymph node and higher metastasis ratio.In order to prevent the postoperative recurrence of Graves' disease and thyroid carcinoma local lymph node,total thyroidectomy plus central lymph node dissection should be the ideal operation method.
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Hyalinizing trabecular tumor (HTT) is a primary thyroid tumor discovered 20 years ago. This tumor is usually misdi-agnosed as papillary thyroid carcinoma because of their many similar nuclear features. Although controversy has focused on the malig-nant potential of HTT, results show that this tumor has a favorable clinical prognosis. Improving the preoperative diagnosis of HTT can reduce the scope of operation because misdiagnosis before or during surgery may lead to unnecessary total thyroidectomy. This study re-viewed the pathology, diagnosis, therapy, and prognosis of HTT.
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Objective To investigate the characteristics of lymph nodes metastasis in papillary thyroid carcinoma (PTC) and to discuss surgical approach.Methods All patients underwent total thyroidectomy,central lymph nodes and lateral lymph nodes dissection in Department of Thyroid Surgery,the First Hospital of the Jilin University,from Dec.2011 to Dec.2012.Results With the increase of the number of positive central lymph nodes,lateral cervical lymph node metastasis rate increased as well and accompanied multi region metastasis trend.In 102 cases of lateral positive cervical lymph node patients,55 cases were in level Ⅱ,accounting for 53.92％,62 cases were in level Ⅲ,accounting for 60.78％,76 cases were in level Ⅳ,accounting for 74.51％,and 17 cases were in level V,accounting for 16.67％.In lateral lymph nodes metastasis,we found level Ⅳ was the most vulnerable area,followed by level Ⅲ,level Ⅱ and level Ⅴ.Conclusions Prophylactic central lymph node dissection should be performed in PTC patients.Patients with central lymph node metastasis especially with the number of positive lymph nodes ＞ 3 should be performed ipsilateral level Ⅱ-Ⅴ lymph node dissection.
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Objective To explore the effects of melatonin (MT) on the expression of interleukin (IL)-10,interleukin-6 and interleukin-8 as well as the inflammatory reaction and nerve repair after acute spinal cord injury (SCI).Methods One hundred and eight Sprague-Dawley rats were randomly divided into a spinal cord injury group (group A),an MT treatment group (group B) and a sham operation group (group C),each with 36 rats.SCI models were established in the rats of groups A and B using a version of Allen's weight drop method (50gcf at the T12 level).Group C had removal of the lamina only.Ten minutes later,group A was injected with 5％ ethanol in saline (the MT solvent) and group B with 100 mg/kg of melatonin preparation.At 6,12,18 and 24 hours,IL-6,IL-8 and IL-10 levels in serum were detected in 6 rats of each group.At 18 hours post-surgery,spinal cord specimens were taken from 6 rats of each group for hematoxylin eosin staining,morphological examination and immunohistochemical SP detection of IL-10 expression.Results The specimens of group A showed inflammatory reaction and ulceration at 48 h; groups B and C had no ulcers.Group B showed the highest levels of IL-10 in serum and IL-10 mRNA in the spinal cord,while group C showed the lowest level.The differences were statistically significant.Group A had the highest levels of IL-6 and IL-8 and group C had the lowest.The difference between group B and groups A and C was significant.The morpho-logical observation showed that after melatonin treatment the IL-10 levels in the spinal cord's central canal and around the gray matter improved.Conclusions Melatonin can improve nerve lipid peroxidation and inflammatory reaction in the treatment of spinal cord injury by increasing IL-10 expression and inhibiting IL-6 and IL-8 expression.
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Objective To discuss the metastasis principle of cervical lymph nodes in CN0 papillary thyroid carcinoma(PTC) and to define the proper surgery scope.Methods Clinical data of the 450 cases of CN0 PTC patients undergoing surgery from Feb.2008 to Feb.2011 in the First Hospital,Jilin University were retrospectively analyzed.Results There were 219 (48.67％) pN + cases and 231 (51.33 ％) pN0 cases.In CN0 PTC cases,lymph node metastasis was most commonly detected in area Ⅵ,about 46.22％ (208/450) (unilateral cancer 41.08％,bilateral cancer 58.09％).The lymph node metastasis rate was 4.44％ (20/450),6.00％ (27/450),and 8.89％ (40/450)respectively in area IIa,area Ⅲ,and area Ⅳ.The metastasis of lymph node was rare in Vb area,only about 2.22 ％ (10/450).No metastasis was found in the 2 cases undergoing area I lymph node dissection.When the tumor diameter was no less than 1.0 cm,capsule invaded or multifocal,male,＜ 45 years old,lymph node metastasis rate was significantly increased (P ＜ 0.05).In addition,when the tumor was located at the upper pole of the thyroid,the lymph node metastasis rate was 33.57％ (48/143) in Ⅱa,Ⅲ,Ⅳ areas in the affected side.When the tumor was at the lower pole of the thyroid,the lymph node metastasis rate was 10.48％ (13/124)in the contralateral area Ⅵ.Conclusion Lymph node metastasis occurs most commonly in area Ⅵ in PTC,followed by area Ⅱ a,area Ⅲ,area Ⅳ.Routine lymph node dissection in area Ⅵ is recommended for the initial surgery.When the tumor diameter is ≥ 1.0 cm,thyroid capsule invasion is involved or more than 3 metastasized lymph nodes were found in area Ⅵ,the range of lymph node dissection should properly be expanded to area Ⅱa-Ⅳ.When the tumor is located at the lower pole of the thyroid,area Ⅵ in the contralateral side should be cleaned.If the tumor is located at the upper pole of the thyroid,area Ⅱa,Ⅲ,Ⅳ in the affected side should be cleaned.
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OBJECTIVE@#To investigate effect of hyperbaric oxygen (HBO) therapy on treatment of late healed wounds after pharyngeal and laryngeal carcinomas surgery.@*METHOD@#Eighty-three patients with late healed wounds after pharyngolaryngectomy were divided into two groups, which were HBO treatment group (n = 48) and control group (n = 35) by random. 48 cases were treated with the general therapeutic measure along with HBO (the pressure is 2 x 10(5) Pa, 110 minutes per day for 5 to 10 days). The other 35 cases were treated with the general therapy without HBO as control.@*RESULT@#There were fresh granulation erupted from the wound of entry after 3 or 4 days of HBO) treatment, then the granulation and the new blood capillary erupted continually to fill the wound surface, and the wound of entry was healed over finally. In the HBO and the control groups, the average healing time was 27.50 and 45.00 days (P < 0.01) in the wound by necrosectomy of the myocutaneous flap or forearm flap, 8. 50 and 14.09 days (P < 0.01) in the pharyngeal fistula, 5.93 and 8.62 days (P < 0.01) in the infected or fluid-filled wound.@*CONCLUSION@#HBO therapy is an effective and powerful treatment for late healed postoperative wounds in pharyngeal and laryngeal carcinomas surgery.
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Adult , Aged , Female , Humans , Male , Middle Aged , Hyperbaric Oxygenation , Laryngeal Neoplasms , General Surgery , Therapeutics , Otorhinolaryngologic Surgical Procedures , Postoperative Period , Treatment Outcome , Wound HealingABSTRACT
Objective To improve the ultrasonic differential diagnosis of thyroid lump through analyzing pathological and ultrasonic features of papillary thyroid carcinoma. Methods Records of 173 cases papillary thyroid carcinoma were analyzed retrospectively in terms of preoperative ultrasonic manifestation, lesion size, echo,boundary, calcification, blood supply, lymph node metastasis and accompanying diseases etc. Results The avthe 173 papillary thyroid carcinoma cases, the number of cancer nodule was 203. There was no statistical difference between papillary thyroid carcinoma lesion and papillary thyroid microcarcinoma lesion in terms of low echo and ill-defined borders (P ＞ 0. 05). The former is higher than the latter in blood flow speed, microcalcification rate, and preoperative ultrasonic diagnosis rate (P ＜0. 01, P ＜0. 05, P ＜0. 01 respectively). The mulifocality rate for the 173 cases with papillary thyroid carcinoma is 33.53% (58/173). There was no statistical difference between papillary thyroid carcinoma and papillary thyroid microcarcinoma in cancer lesion(P ＞0. 05), while the former has a higher rate of lymph node metastasis than the latter(P ＜0. 01). Preoperative diagnosis rate is higher in papillary thyroid microcarcinoma cases without other thyroid diseases than in cases with other thyroid diseases (P ＜ 0. 05). No statistical difference of preoperative diagnosis rate was seen between papillary thyroid carcinoma patients with other thyroid diseases and those without other thyroid diseases (P ＞ 0. 05). Conclusions The overall evaluation of thyroid nodule diameter, boundary, echo, small calcification, lymph node metastasis, blood supply, accompanying diseases and so on can improve diagnosis of primary papillary thyroid carcinoma.
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Four hundred eighty patients with carbon monoxide poisoning were randomly assigned to receive hyperbaric oxygen alone or hyperbaric oxygen plus Nimodipine.Treatment outcomes and the incidence of delayed encephalopathy after acute carbon monoxide poisoning(DEACMP)were observed.We found that the incidence of DEACMP was 14.0％(67/480)in all cases,19.2％(46/67)in hyperbaric oxygen group,and 8.8％(21/67)in hyperbaric oxygen plus Nimodipine group(hyperbaric oxygen group vs hyperbaric oxygen plus Nimodipine group,P＜0.05).These results suggested that hyperbaric oxygen combined with Nimodipine could prevent the development of DEACMP.
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OBJECTIVE: To establish a RP-HPLC method for the simultaneous determination of chloramphenical,dexamethsone sodium phosphate and deoxyepinephrine in luxindi eye drops.METHODS: The determination was performed on Kromasil C18 column and the mobile phase consisted of methanol-water(containing 0.2% triethylamine and 0.15% octane sulfonic acid sodium,pH was adjusted to 3.8 with phosphoric acid,40∶60) with flow rate at 1.0 mL?min-1.The detective wavelength was set at 230 nm;the sample size was 20 ?L and the column temperature was set at room temperature.RESULTS: The linear ranges of chlormphenical,dexamethasone sodium phosphate and deoxyepinephrine were 125～1 000(r=0.999 3),25～200(r=0.999 6) and 12.5～100(r=0.999 2) mg?L-1,respectively,with the average recoveries rate at 99.53%,100.0% and 99.24%,and RSD at 0.51%,0.90% and 0.72%,respectively.CONCLUSIONS: This method is simple,rapid and accurate,and it is applicable for the content determination of this preparation.