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@#AIM:To explore clinical characteristics of supracho-roidal hemorrhage(SCH)complicated by intraocular surgery and to observe visual prognosis. <p>METHODS:A total of 13 eyes(13 cases)with SCH related to intraocular surgery from June 2005 to June 2015 were included and respectively studied. The age of our cases ranged from 22 to 76. Of all, 4 eyes(31%)were concomitant with hypertension, 6 eyes(46%)with high myopia and 6 eyes(46%)with oculi hypertonia, respectively. Intraoperative expulsive SCH occurred in 8 eyes, while postoperative delayed SCH in 5 eyes. The most SCH(7 eyes)happened during the surgery of removing silicone oil, 4 eyes with SCH were related to extracapsular cataract extraction(ECCE), 1 SCH eye was complicated by ECCE combined with trabeculectomy and 1 SCH eye by lensectomy and vitrectomy. As for treatment, 5 eyes took medication alone, 4 eyes were performed drainage sclerotomy and gas tamponade, while the other 4 eyes were accomplished vitrectomy with adjunctive perfluoro-carbon liquids and silicone oil tamponade. <p>RESULTS:At the 10-month of follow-up, all eyes with SCH were resolved. Except 1 eye with no light perception owing to abandoning treatment, the sights of the other 12 eyes were between light perception and 0.4. <p>CONCLUSION:SCH complicated by intraocular surgery was rare but with devastating outcome. Aged patients, hypertension, high myopia and oculi hypertonia may be risk factors. In addition, surgical methods in the early years were likely correlated to the occurrence of SCH. Certain sight of the patients with SCH may be maintained after positive treatment.
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Diagnostic whole body scan (Dx-WBS) with 131I and serum Tg level are the main parameters to evaluate the effectiveness of thyroid remnant ablation in patients with DTC.Undetectable Tg and positive radioiodine uptake in the thyroid bed (Tg-/Dx-WBS+) may be found in some patients.However,the clinical significance is uncertain.A small amount of thyroidal remnant,a small DTC lesion,increased expression of NIS gene and autoimmune inflammation may all result in Tg-/Dx-WBS+.A wait-and-watch approach without rushing for high-dose radioiodine treatment might be a more reasonable approach for these patients.
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Objective To evaluate the association between iodine intake and treatment outcomes of radioiodine remnant ablation in patients with papillary thyroid cancer (PTC),and to investigate the determinants related to the ablation efficacy.Methods A total of 95 PTC patients (28 males,67 females;average age 39.8 years) without distant metastases from January 2013 to May 2014 were enrolled in this retrospective study.All patients underwent total thyroidectomy and 2-4 weeks of low iodine diet (LID) before initial 131I therapy.Patients were divided into 3 groups according to urinary iodine excretion (UIE):moderate-severe iodine deficiency group (0＜UIE＜50 μg/L,n =30),mild iodine deficiency group (50 μg/L≤UIE＜100 μg/L,n =26),adequate iodine group (100 μg/L ≤ UIE ＜ 300 μg/L,n =39).Patients were followed up for 3-6 months after radioiodine ablation,successful ablation was defined as no visible uptake in the thyroid bed on diagnostic 131I whole body scan and Tg level ＜2 μg/L (with negative TgAb),or no visible uptake in thyroid bed on posttreatment 131I whole body scan.x2 test,two-sample t test,Mann-Whitney u test and logistic regression analysis were performed.Results In all,84.2％ (80/95)of patients were successfully ablated.The successful rates in the three iodine intake groups were 96.7％ (29/30),84.6％ (22/26) and 74.4％ (29/39),respectively,with significant difference (x2=7.374,P＜0.05).Univariate analysis revealed that UIE,pre-treatment TSH,pre-treatment Tg and the amount of remnant thyroid tissue at ablation affected ablation efficacy (x2 =7.374,t =2.037,z =-2.966,x2 =4.144,all P＜0.05).Logistic regression showed that the level of pre-treatment Tg (P ＜ 0.05) and iodine intake (P ＜ 0.05) were independent factors of ablation efficacy.Conclusion Iodine intake before 131I remnant ablation is one of the important factors affecting treatment outcomes.Thyroid remnant could be more successfully ablated if reasonable LID protocols be adopted according to the iodine nutritional status before treatment.
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DTC in pediatric and adolescent patients has lower incidence and is generally reported to have better prognosis.However,compared with DTC in adults,it is more aggressive and the recurrence rate is higher.Surgery and adjuvant radioiodine therapy can minimize the risk of recurrence.Total or near total thyroidectomy combined with central compartment lymph node dissection is the preferred surgical procedure for most of these patients.Radioiodine therapy for ablation of thyroidal remnant or residual disease is recommended in order to reduce the risk of tumor recurrence,but there is slight chance of increased risk of a sec ond primary malignancy (SPM).Long-term follow-up is therefore recommended for the pediatrics and adolescents with DTC after treatment.Multi-disciplinary collaborative management is needed to optimize treatment efficacy and to minimize adverse effects.
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Objective To investigate the change of serum Tg levels of DTC patients with positive stimulated Tg (Tg ≥ 10.00 μg/L),negative 131I-diagnostic whole body scan(Dx-WBS) and no distant metastasis 6 months after initial 131I therapy.Methods Fifty-six DTC patients (20 males,36 females,average age 43.11 (21-70) y) with intermediate or low risk of recurrence according to American Thyroid Association (ATA) guideline were enrolled into the retrospective study.All patients were grouped according to stimulated Tg level after initial 131I therapy:group with positive Tg (Tg+ group,n =19) and group with negative Tg (Tgˉ group,n=37).Changes of suppressed Tg at 1 year and 2.5 years (Tg1ysup and Tg2.5ysup) after initial therapy were compared between the two groups.Serum TSH level,TgAb level,neck ultrasound and chest CT results were also evaluated.The two-sample t test and x2 test were used for statistical analysis with SPSS 17.0.Results Stimulated Tg and Tglysup levels in Tg+ group were remarkably higher than those in Tgˉ group:(24.27±4.10) μg/L vs (2.73±3.01) μg/L,t=7.191,P＜0.05(6 months after initial 131I therapy) ; (2.21±0.55) vs (0.48±0.10) μg/L,t=3.102,P＜0.05(1 year after initial 131I therapy),respectively.In Tg+ group,suppressed Tg level decreased with time in 68.4％ (13/19) of patients,of whom the Tg2.5ysup level was much lower than Tglysup level ((0.53±0.15) μg/L vs (1.38±0.50) μg/L).Tg2.5sup level in Tg+ group became comparable to that in Tgˉ group ((1.44±0.52) μg/L vs (0.38±0.07) μg/L; t =2.001,P＞0.05).In each group,one case of recurrence with suppressed Tg of 1.4 μg/L and 0.1 μg/L respectively,was observed using neck ultrasound after 2 years of follow-up.Conclusions Serum Tg levels decreased with time for Tg+/131I-Dx-WBS-DTC patients with intermediate or low risk of recurrence.It might not be necessary to follow up these patients with Tg and 131 I-DxWBS after 6 months of initial 131I therapy.
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Objective To investigate the value of 99Tcm-MDP imaging for the differential diagnosis between infection and aseptic loosening after total hip arthroplasty.Methods During February 2008 to August 2011,74 patients (32 males,42 females,average age (64.3±11.2) years) with hip pain after arthroplasty underwent 3-phase (blood flow,blood pool and bone phases) 99Tcm-MDP imaging.All patients had measurements of serum C reactive protein (CRP) and erythrocyte sedimentation rate (ESR).Joint infection was defined as either increased peri-prosthetic soft tissue activity during perfusion and blood pool phases or increased peri-prosthetic bone activity during uptake phase,or positive in all 3 phases.Aseptic loosening was defined as having negative 99Tcm-MDP in all 3 phases.Clinical diagnosis was chosen as the gold standard.The blood flow-pool imaging was compared with the serum examinations.x2 test was used for statistical analysis.Results There were 74 symptomatic joints in 74 patients,including 24 joint infections and 50 aseptic loosening.For the detection of peri-prosthetic infection,combined perfusion-blood-pool phase was more accurate than bone uptake phase (90.5％ (67/74) vs 55.4％ (41/74) ;x2=23.159,P＜0.001),with the sensitivity of 91.7％ (22/24)vs 70.8％ (17/24) and specificity of 90.0％ (45/50) vs 48.0％ (24/50),respectively.The blood flow-pool imaging was also more accurate than CRP (73.0％ (54/74) ;x2 =7.656,P＜0.05) and ESR (71.6％ (53/74) ; x2 =8.633,P＜0.05),respectively.Conclusion 99Tcm-MDP perfusion/blood flow-pool imaging is an accurate modality for differentiating peri-prosthetic infection from aseptic loosening in patients with hip pain after arthroplasty.
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Objective To investigate the clinical value of ~(99)Tc~m-ethylenedicysteine (EC) diuretic renography (DR) in pre-and post-operative pediatric congenital hydronephrosis.Methods The DR with injection of Furosemide at 15 min of forty children with hydronephrosis was retrospectively studied.The preoperative renal blood perfusion rate (BPR),effective renal plasma flow (ERPF),grade of hydronephrosis,renogram and renal dynamic imaging of pre- and post-operative kidneys were compared.The t-test and Mann-Whitney test were used for data analysis.Results (1) Of 40 pathological kidneys,the BPR increased 5.99% (t=-5.13,P＜0.01)from pre-operative to post-operative:(34.05±11.07)% to (40.04±8.56)%.The ERPF increased 12.48 ml/min(t=-4.35,P＜0.01) from pre-operative to post-operative:(57.81±34.32)ml/min to(70.29±5.37)ml/min.(2)The grade of hydronephrosis of 40 pathological kidneys improved significantly(Z=-2.64,P＜0.01) with the mean sum of ranks of 47.21 pre-operatively to 33.79 post-operatively.(3) As the hydronephrosis worsened,the collecting system became bigger,the renal parenchyma became thinner,the extent of intrarenal parenchymal photopenia became larger and the response to diuretic challenge in pathological kidneys decreased or became totally irresponsive.(4)Thirty-seven cases of obstruction at ureteropelvic junction (UPJO) and 3 cases at ureterovesical junction (UVJO) were diagnosed by DR,which were all confirmed by surgery.Conclusions DR is a reliable method to evaluate pediatric congenital hydronephrosis.It can accurately reflect the grade and (or) severity of the disease,guide therapy and assess the therapeutic success of operation.
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Objective To investigate the value of 99Tcm-methoxyisobutylisonitrile (MIBI) scintigraphy in assessing the preoperative chemotherapy response and multidrug resistance of osteosarcoma.Methods From January 2007 to October 2008, 12 patients (female:4, male:8; mean age:16.3 years,range:8-27 years) underwent early (10min) and delayed (120 min) 99Tcm-MIBI scintigraphy before and after preoperative chemotherapy.Seven cases had osteosarcoma at the distal femurs, 2 at the proximal tibias, 2 at the upper end of humerus and 1 at the fibula.The tumor-to-background ratio (T/B) and washout rate (WR) were calculated.Tumor necrosis was classified according to Huvos criterion after limb salvage surgery.Immunohistochemical staining for P-glycoprotein(gp) was examined.Spearman correlation analysis and t-test were performed.Results According to Huvos criterion, 7 patients were classified as good responders with more than 90% of tumor cell necrosis and 5 as poor responders with less than 90% of tumor cell necrosis.R value (ratio of early phase T/B after and before chemotherapy) was significantly lower in good responders than that in poor responders (0.473 ± 0.21 vs 0.998 ± 0.06, t= 5.342, P= 0.000 ).R value was significantly correlated with the degree of tumor cell necrosis ( rs=- 0.87, P= 0.000 ).WR was significantly higher in patients with positive P-gp expression than that in patients with negative P-gp expression ((38.36 ±18.64)% vs (6.40±5.87)%, t= -3.278, P=0.008).There was significant correlation between the WR and P-gp expression (rs = 0.91, P= 0.001 ).Conclusion 99Tcm-MIBI scintigraphy is a feasible non-invasive technique to assess the chemotherapy response and to detect P-gp expression of osteosarcoma.
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Objective To evaluate retrospectively the role of 18 F-fluorodeoxyglucose (FDG) PET/CT associated with MRI in the localization of epileptogenic foci. Methods Sixty-seven patients with medically resistant epilepsy were included from 2003 to 2008. All underwent 18F-FDG PET/CT and MRI for presurgical evaluation as well as post-surgical evaluation 12 to 65 months after operation. Based on postoperative seizure occurrence, patients were divided into two groups. One group was free of seizures ( Engel classification Ⅰ, Group 1) and the other was with postoperative seizure occurrence of any type ( Engel classification Ⅱ-Ⅳ, Group 2). X2-test or Fisher's exact test was used for the statistical analysis. Results About 71.6% (48/67) patients were defined as group 1, and 19 patients were group 2 ( 11 were Engel Ⅱ , 5 were Engel Ⅲ, and 3 were Engel Ⅳ ). In Group 1, no statistically significant difference was found between concordant (45/63) and discordant findings (3/4) with regard to 18F-FDG PET/CT and MRI images (Fisher's exact test, P ＞0.05). For 41 patients that showed focal abnormality both on MRI and 18F-FDG PET/CT, 80.5% (33/41) were found in group 1. For 20 patients that showed focal lesions on MRI while with multi-focal or generalized abnormal metabolism on 18F-FDG PET/CT, 11 (55.0%) were in group 1 and9 (45.0%) were group 2. There was no significant difference (33/41 vs 11/20, X2 =4.34, P ＜0.05 ). Conclusion 18F-FDG PET/CT associated with MRI may offer more helpful information for pre-surgical evaluation and prediction of prognosis of epileptic patients.
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Objective To evaluate the value of ventilation and perfusion scintigraphy for predicting the postoperative pulmonary function in patients with lung cancer. Methods Twenty-six patients with lung cancer, male 21 and female 5, aged from 44 to 86 ys, were recruited into the study. Before surgery, 21 patients underwent 99Tcm-DTPA aerosol ventilation and 99Tcm-macroaggregated albumin ( MAA ) perfusion scintigraphic imaging. The other five patients were studied with perfusion imaging only. Pulmonary function was measured as forced expiratory volume in the first second ( FEV1 ) at about one week before surgery for all patients, and at two months after surgery. The predicted postoperative FEV1 ( ppoFEVt ) was calculated by Neuhaus' formula based on the ventilation or perfusion function obtained from scintigraphy studies, and compared with the measured post surgery FEV1. Eighteen patients underwent the surgical resection successfully. The t-test and correlation analysis were used. Results The ppoFEV1 values of ventilation and perfusion were (1.347±0.539) Land (1.410±0.543) L, respectively (n=21, t =0.062, P＞0. 05). Both the ppoFEV1 values of ventilation and perfusion showed no significant difference with the respective post-surgeryFEV1(n=13, (1.545 ±0.588) Lvs (1.45 ±0.521) L, t=0.092, P＞0.05; n=18, (1.697±0. 546) L vs ( 1.457±0.488) L, t =0. 017, P ＞0.05, respectively). Both the ventilation ppoFEV1 (n =13) and perfusion ppoFEV1 (n = 13, n = 18) correlated well with the post-surgery FEV1 respectively (r =0. 950, 0. 937, 0. 922, all P ＜ 0. 01 ). Conclusion Ventilation and perfusion imaging can predict the postoperative pulmonary function for patients with lung cancer, especially for those with borderline pulmonary function, thus useful for selection of suitable candidates for surgical resection.
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Objective To explore the localization of epileptogenic focus and select the appropriate surgical procedures for post-traumatic epilepsy. Methods The clinical data of 21 patients with post-traumatic epilepsy were studied retrospectively. Epileptogenic focus was located by comprehensively analyzing data of electro-neurophysiology, neurological imaging and clinical manifestation. Surgical procedures were performed in all patients, including resection of lesion and peripheral cortex in 12 patients, epileptogenie focus resection plus low power bipolar coagulation in five, anterior temporal iobectomy plus amygdalohippocampectomy in three and corpus callosotomy in one. Results All patients were followed up from 6 months to 3 years, which showed satisfactory outcome in eight patients, marked improvement in six, improvement in five and slight improvement in two. The total effective rate was 90%. Conclusions Surgical procedure is important for intractable post-traumatic epilepsy. The good efficacy depends on precise localization of epileptogenic focus and combined application of various surgical procedures.
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Objective To compare curative effect of decompression and conservative treatment for traumatic superior orbital fissure syndrome to discuss the operation indications and the operative oppor-tunity for this syndrome. Methods Data of 12 patients (seven males and five females) with 14 sides were compared to evaluate different curative effect between decompression and conservative treatment so as to optimize the initial corresponding treatment. Results The patients were at mean age of 28 years and followed up for mean six months. All patients were complicated by one and more of following symptoms in-cluding ophthalmoplegia, ptosis, proptosis and anaesthesia in the distribution of V1 and a fixed dilated pupil. There was one patient complicated by orbital apex syndrome. CT showed involvement of the superi-or orbital fissure in seven patients. Of seven patients treated with decompression, six got recovery at dif-ferent degrees. Meanwhile, three out of five patients treated with conservative treatment recovered to some extent. Conclusions Early effective treatment can improve the functional rehabilitation of the injured nerve. Decompression of superior orbital fissure is proved to be effective in ameliorating symptome, re-ducing disability and improving quality of life.
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Objective To investigate the appropriate surgical approach in the management of cervical cord injury following ossification of the posterior longitudinal ligament. Methods The clinical data of 25 patients with cervical cord injury following ossification of the posterior longitudinal ligament who received surgical treatment were retrospectively analyzed. According to Frankel grades, two patients were at grade A, three at grade B, 14 at grade C and six at grade D. The surgical procedures consisted of anterior decompression (12 patients), posterior decompression (8 patients) and combined posteroanterior decompression (5 patients). Results No iatrogenic injury of great vessels, trachea, esophagus or spinal cord occurred. All the patients were followed up for 15-86 months (mean 38.3 months). All segments with anterior fixation attained solid fusion, without implants loosening or breakage. No reelosed open-door was found in patients who received posterior laminoplasty. The spinal function got improved in 21 patients, and a relief of pain or numb of the upper limb was attained in four patients whose spinal cord injury was not cured. Conclusions The surgical outcome of cervical cord injury following ossification of the posterior longitudinal ligament is satisfactory. It is important to select a suitable surgical approach according to the imaging manifestations associated with the general conditions of the patients.
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Objective To compare the efficacy of operation and non-operatlon in treatment of cervical whiplash injuries. Methods A retrospective sturly was carried out in 88 cases of cervical whiplash injuries, of whom 24 cases were treated with non-operation and 64 with operation. There were 44 cases treated via anterior approach and 20 via posterior approach. NNeural function was evaluated by using Frankh classifications and ASIA (American Spinal Injury Association) grades. Results All cases were followed up for 6-24 months, which showed that neural function was improved significantly in both operation and non-operation groups. However, the neural function was better improved in the operation group compared with the non-operation, with statistical difference. The anterior approach group had significantly better outcome in neural function than the posterior approach group (P<0.05). Conclusion Operation is a better method and anterior approach should be the choice of treatment for treatment of cervical whiplash injuries.
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Objective To discuss the surgical and interventional treatment of vascular injuries. Methods Clinical data of 85 patients with vascular injuries were retrospectively studied by grouping. Location of injury included jugular vein, vertebral artery, main extremity vessels and superior mesenteric artery. There were 25 patients with traffic injury and 60 with stah injury, of whom 62 patients underwent surgical operation (vascular grafting were performed in 37 and vascular repair in 25) and 23 received in-tervention therapy. Results There were one death and one amputation. Fifty-eight patients were fol-lowed up, which showed that all patients had good vascular patency. Conclusions Prompt and correct diagnosis is very important for treatment of vascular injury. Interventional treatment had merits of minor trauma, short operation duration, simple manipulation and quick postoperative recovery. Surgical opera-tion and endovascular intervention can be used together in treating vascular injury.
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Objective To perform literature search and review on the controversial relationship between therapies of hyperthyroidism due to Graves'disease(GD)and the course of Graves'ophthalmopathy(CA)).Methods We searched the database of MEDLINE(1966-2006.3),EMBASE(1984-2005),Cochrane Library(2006 No.1),CBMdisc(1978.1-2006.4)and CNKI(1994-2006).The methodological quality of the studies selected for review was assessed according to the quality assessment criteria suggested by the Cochrane systematic review guideline.Meta-analysis was performed by RevMan 4.2 software.Results Eight studies were included in the systematic review.Meta-analysis showed that there was statistically significant difference between 131I and other forms of therapy[surgery or antithyroid drugs(ATD)](test value:2.31,5.97,3.70,5.55;all P＜0.05)in aggravation of exophthalmos and symptom improvement in patients without receiving thyroxine during the early stage to prevent hypothyroidism.However,there was no statisti cally significant differenee in the above relationship between surgery and ATD therapy in those patients already receiving thyroxine supplement(test value:0.27,0.99;all P＞0.05).There were not yet any studies on the impact between early prevention of hypothyroidism after 131I therapy and GO.Conclusions Based on meta-analysis on literature data,if early measures are not performed to prevent hypothyroidism after 131I therapy,it may induce or aggravate GO more frequently than ATD or surgical treatment.Symptomatic relief of GO after 131I therapy is also less effective than the other 2 forms of therapy.Therefore.131I therapy should be delivered carefully in those patients with GO.
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Trigger finger is a common disease particularly in the middle aged women. A very rare case in which an adult man had 10 trigger fingers was experienced. He was treated with local steroid injections in both thumbs, but trigger finger disease has been aggravated in every digit of both hands. We performed an early operative treatment. Three months after the operation, the patient could perform his work without discomfort in his hands and showed normal range of motion in all fingers.
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Male , Humans , Adult , Tenosynovitis/genetics , Hand Deformities, Acquired/genetics , Fingers/physiopathologyABSTRACT
Summary: A total of 92 patients with benign prostatic hyperplasia (BPH) were subjected to modified Madigan prostatectomy (MPC) for a much satisfactory effect in open prostatectomy surgery. Exposing anterior prostatic urethra near the bladder neck and conjunct cystotomy modified the MPC procedure. This modified procedure preserved prostatic urethra intact and could also deal with intracystic lesions at the same time. The intact of prostatic urethra was kept completely or largely in 86 cases. The amount of blood loss during modified procedure was less. The mean operative time was 105 min. Seventy patients had been followed up for 3-24 months. The postoperative average Qmax was 19.2 ml/s. The cystourethrography revealed that the urethra and bladder neck were intact in 10 patients postoperatively. Furthermore, the prostatic urethra was obviously wider after modified MPC. The modified MPC can reduce the occurrence of urethra injury and enlarge the MPC indications. The modified technique is easy to perform with less complications and much satisfactory clinical result.
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Objective To assess the efficacy and safety of transurethral bipolar electrocautery resection of the superficial bladder tumor(Bipolar-TURBt).Methods 26 patients with superficial transitional cell carcinoma(13 with tumors appear at the lateral wall) were treated by bipolar TURBt. All patients were followed-up in 1～6 months postoperatively.Results The duration of the procedure was(19?10) min(8～35 min) with little bleeding. Bladder perforation was occurred in no case. No TUR-syndrom was found. The adductor reflex was not found even in the 13 cases with tumor located at the lateral wall.Conclusion Transurethral bipolar electrocautery resection of the superficial bladder tumor is effective and safe.
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Purpose:To evaluate the effect of cisplatin-based peri-operation chemotherapy (CT) on survival after completed resection of non small cell lung cancer (NSCLC)Methods:A prospective, randomized, multicenter study was conducted by Shanghai Lung Cancer Team since Feb 1995 to Dec 2003 for stage Ⅰ~ⅢA NSCLC with completed resection. Patients were randomly assigned to receive pre-operative CT or no pre-operative CT (pre-op CT). Post-operative CT (post-op CT) were used for majority of the patients, except for partial stage I patients. Accumulated survival, log rank, MST, Cox uni-variance and multi-variance analyses, HR were used as statistics for evaluation Results:A total of 337 patients underwent randomization, 169 cases received pre-operative CT, and 168 cases didn't receive pre-operative CT. There was statistical survival difference between the group with no pre-op CT and with pre-op CT, 5-yr survival rate were of 47.85%∶ 36.52%, MST were 56.63∶39.14(P=0.03), respectively. Stage and post-op CT were the only two meaningful parameters with statistical survival difference calculated by multi-variance analyses (P0.05). There were 121 cases received more than 3 cycles post-op CT, 216 cases received less than 3 cycles post-op CT. The patients received more than 3 cycles had better yr-survival and MST than those received less cycles (P=0.04).Post-op CT was not benefit to the survival rate of stage I. In stage Ⅱ and ⅢA ,the patients received ≥3 cycles post-op CT had better yr-survival than those received less cycles(P