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Objective To summarize the experience on diagnosis and treatment of primary hyperparathyroidism(PHPT).Methods Clinical data of 91 PHPT patients treated in Beijing Jishuitan Hospital from November 1992 to December 2008 were analyzed retrospectively.Results Among 91 PHPT cases,88 were diagnosed as parathyroid adenoma(96.7%),3 were diagnosed as parathyroid carcinoma (3.3%).Serum calcium and PTH levels increased in all cases.Main clinical manifestations were osteodynia and kidney stones.The accuracy rate of preoperative B-ultrasound.CT and ECT~(99m)Tc-MIBI on location was 83.5%(76/91),60.9%(14/23)and 98.6%(69/70)respectively.Parathyroidectomy was performed in all but one cases,in which parathyroid carcinoma was managed by ipsilateral hemithyroidectomy and modified neck dissection.The cure rate of primary operation was 97.8%(89/91).Ninety cases were followed-up from 8 months to 14 years postoperatively,87 cases with parathyroid adenoma achieved complete remission,2 with parathyroid carcinoma suffered from tumor recurrence and 1 died.Conclusion Patients with chronic bone diseases,repeatedly recurrent nephrolithiasis,peptic ulcer disease should be a suspect of PHPT.The routine examinations of serum calcium and phosphorus are to be conducted.UItrasonography and ECT~(99m)Tc-MIBI should be considered as the methods of first choice for preoperative localization.
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Objective To investigate the therapeutic effects of glucocorticoids(GC)on brain damage in rats with severe acute pancreatitis(SAP).Methods Thirty two rats were randomized into the normal control group(Group A),acute pancreatitis group(Group B),common carotid therapeutic group(Group C)and lateral ventricle therapeutic group(Group D).The rats in group C and D were respectively given methylprednisolone through common carotid artery and lateral ventricle. All rats were killed 24r h later to determine the weight of water content in the brain.The pancreatic and brain tissues were stained with HE.Meanwhile,the brain samples were immunohistochemically stained and the medulla sheath specially stained to determine TNF-α and IL-2.Histopathological scoring of pancreas and counting of leukocytes in the brain were conducted.Results Group A had no obvious pathologic changes.Group C and D had fewer TNF-α positive cells in the brain than Group B.IL-2 was negative in each group.Brain edema,leukocyte number and demylination of myelinated nerves in Group C and D were significantly different from those in Group B(P＜0.05).Conclusion Demylination of myelinated nerves is the characteristic change in SAP.Brain edema,leukocyte infiltration and nerve cell degeneration would happen as well.TNF-α plays an important role in the development of SAP.GC has effects on prevention and therapy of brain damage in rats with SAP.
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Objective To study the feasibility of local resection for the tumor of the ampulla of Vater. Methods The result of 14 cases with carcinoma of the ampulla of Vater treated by local resection and 18 cases undergoing Whipple procedure in this hospital between 1988.5～1999.5 was analyzed. Results The postoperative morbidity for local resection was 7% and 39% for Whipple procedure respectively, P 0 05,and 5 year survival rate was 30% and 62% respectively, P
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Objective To explore the early diagnosis and optimum operative approach of traumatic diaphragma rupture (TDR) . Methods The clinical dada of 23 patients with TDR admitted to our hospital in recent 10 years were retrospectively analyzed. Results The diagnosis of TDR was made before operation in 12 cases1 (52.2%), and intraoperation in 8 (34.8), and misdiagnosed in 3 cases (13.1%). All the 23 patients underwent operation. Of the 23 patients, the operation was performed via thorax approach in 12 patients , via abdominal approach in 8, and via thorax-abdominal approach in 3. Hernation of the abdominal viscera into the thorax was observed in 18 cases, and single TDR in 5 cases.Empyema occurred after operation in 2 patients. 3 cases(13.1%) dead of hypovolemic shock and multiple organs failure. Conclusions The diagnosis of TDR may be difficult. The key of the diagnosis of TDR is to think of it. Once the diagnosis is made or suspected, the operation should be taken as early as possible. The choice of operative approach should be according to the injury mechanism and location; the choice of the operative procedure should be according to the intraoperative findings.
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ObjectiveTo evaluate nonoperative management of adult blunt hepatic injury. MethodThe outcome of 132 cases with adult blunt hepatic trauma admitted in this hospital between Oct 1982 and Oct 2002 was analyzed. Thirty-four cases (25.8%) were treated by nonoperative management. Before 1995, only a portion of patients underwent CT scan and after 1995, diagnosis of liver injury was established by CT scan in all cases. ResultThe nonoperative management rate before 1995 was 16.7% (14/84) and after 1995, it was 41.7% (20/48)(P0.05). ConclusionWith the progress of image monitoring and life support system, some patients of blunt hepatic injury could be managed by conservation therapy.
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Objective To investigate the different clinical behavior and the diagnosis and trearment of primary hyperparathyroidism(PHPT). Methods Clinical data of 53 patients with PHPT treated in Beijing Jishuitan Hospital from May 1977 to April 2004 were collected and analyzed. Results 53 patients with PHPT were confirmed by operation and pathology. The majority of the patients were aged 20~50 years. There were more female than male patients. There were various clinical manifestations, and the duration of illness was (protracted). Many cases were misdiagnosed. There were bone pathologic changes of varying extent in all (patients), stones in urinary system plus bone pathology in 11 cases, serum level of calcium was raised in 51 patients(96.2%) and (parathyroid) hormone (PTH) was elevated in all examined 48 cases. Ultrasound, MIBI and CT were done before operation after 1991, and accurate preoperative localization diagnosis was (obtained). Minimally invasive (parathyroidectomy) (MIP) was successfully completed in 39 of 45 cases, and the primary operation cure rate was 97.4%. At postoperative follow-up of 10 months to 10 years, with the (exception) of 15 cases of severe bone deformity that had no obvious improvement, the other symptoms and signs were all relieved to varying (extents), the laboratory markers returned to normal, and there was no permanent hypoparathyroidism or (recurrent) nerve injury or other complications.Conclusions Early diagnosis of PHPT and effective early (treatment) by surgical removal of the pathologic lesion can alleviate the occurrence of severe bone changes and deformity. The preoperative combined use of imaging localization technique and overall assessment can improve the accuracy of diagnostic localization of the lesion.
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Objective To explore the effect of thrombolysis with anticoagulation treatment for early stage of posttraumatic and postoperative deep vein thrombosis of lower extremity. Methods The clinical data of 38 palients with early stage of posttraumatic and postoperative deep vein thrombosis(DVT) of lower extemity treated by thrombolysis with anticoagulation and dispersion drugs were analyzed retrospectively. Results The thrombolytic effect was significant. After the treatment, the deep veins were recanalization without regorging in 71.0% of patients. The total effective rate was 100%. Only one patient had hemorrhagic complication, two patients had symptomatic pulmonary embolism,but none of the patients died. Conclusions Thrombolysis with anticoagulation is an effective and safe method for posttraumatic and postoperative DVT in the early stage.
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Objective To evaluate the result of unilateral ex ploration for the treatment of hyperparathyroidism caused by parathyroid adeno ma. Methods Clinical data of 20 case s from 1986 to 1999 were retrospectively analysed. Preoperative imaging examinat ion was suggestive of unilateral lesion and unilateral exploration was performed accordingly.Results were compared with that of bilateral exploration. Results In 19 out of 20 cases the result of u nilateral exploration was satisfactory making bilateral approach unnecessary exc ept for one whose symptom was later proved to be caused by bilateral lesions.Conclusions The authors came to the c onclusi on that solitary adenoma is the most common cause of hyperparathyroidism in Chin ese patients,hence unilateral exploration is of advantages.
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ObjectiveTo investigate the effect of nitric oxide(NO) in preventing postoperative adhesion formation in rats .MethodsForty rats were randomly assigned to 2 different treatment groups.All animal models of postoperative adhesion formation were made in a standard manner. 0.9% NaCl and L-arginine were administered into intraperitoneal cavity before closure and during 3 consecutive days after surgery. On the 3 rd postoperative day,blood was collected to evaluate NO levels and the inserted abdominal walls were removed to assess pathology in some rats.On the 14 th postoperative day,the remaining rats were sacrificed by ether overdose before relaparotomy,and the extent of adhesion formation were assessed.ResultsMore severe adhesions developed in 0.9% NaCl control group(mean score of adhesions 3.7?0.7) than L-arginine group(mean score of adhesions 0.9?1.1)( P
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ObjectiveTo study the etiology, preoperative diagnosis and treatment of nonocclusive mesenteric ischemia(NOMI). MethodsClinical data of 3 cases of NOMI from 1992 to 1998 were analyzed retrospectively. ResultsMajor clinical presentations were abdominal pain, gastrointestinal bleeding and abdominal irritation. None was correctly diagnosed preoperatively. Partial ileectomy in 2 cases and right colectomy in 1 case was performed with a mortality of 2/3. Conclusion Early diagnosis and accurate assessment of the bowel viability in exploration were quite difficult. Resection of the infarcted bowel or ′second-look procedure′ were recommended if necessary.
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Objective To analyse and explore the situation and causes of misdiagnosed primary hyperparathyroidism(PHPT),so as to develop some strategies for preventing and reducing misdiagnosis.Methods Clinical data of 94 misdiagnosed patients with PHPT treated in Beijing Jishuitan Hospital from November 1992 to April 2009 were collected and analyzed retrospectively.Results All cases were confirmed by operation and pathology.Among the 94 cases,90 cases were of parathyroid adenoma,and 4 cases of parathyroid carcinoma.The rate of misdiagnosis was 97.9%(94/96).The length of time of misdiagnosis was 2 months to 20 years;
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Objective To investigate the effects of hyperoxic-hyperosmotic sodium chloride solution(HHSCS) on arterial blood gas and blood lactate in rabbits with hemorrhagic shock, and evaluate the HHSCS effects on hemorrhagic shock resuscitation.Methods Hemorrhagic shock models were induced in 30 male rabbits.The median arterial pressure(MAP) was declined to 40mmHg within 10 minutes,then maintained for 60(minutes).The animals were then randomly divided into 3 groups:normal saline hyperoxic solution(NSO)group,hyperosmotic sodium chloride solution(HS)group and HHSCS group.Sixty minutes later,NSO,HS or HHSCS 6ml/kg was infused intravenously in 5 minutes.Heart rate(HR) 、respiratory rate(RR)、 MAP and urine drops(UD) before shock and after fluid infusion were recorded;blood lactate(BL) and blood gas were measured before shock,60min after shock,and 30min,60min,120min postinfusion.Finally,the(rabbits) were killed by bleeding,the lungs were observed in autopsy,and the lung coefficient was measured.Results HS and HHSCS more effectively raised MAP,enhanced heart function,and increased UD than NSO.HHSCS group significantly reduced BL.At 60,120min after infusion,SaO_2 in HHSCS group was(significantly) higher than that in HS group and NSO group(P
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How to handle the relationship between doctors and patients is currently a hot spot of society. The author first expounds the fundamental propositions in the theories of the science of value. Then, using the theories of the science of value, he first describes the relationship between the object and subject of value, viz. who comes first, the patients or the staff, arguing that in the mind of the hospital director there should always be an unbiased balance of value benefiting both sides. Then he describes the realistic form in which value exists, viz. which is more important, the value of utility or the value of effectiveness, arguing that the hospital director should lay equal emphasis on the staffs value of utility and the patients value of utility, thus satisfying both sides. Thirdly, the author describes value accounting and the cost of value, viz. the dual unity of the values of effects and effectiveness, arguing that creating value while paying cost indicates the dual nature of the practice of hospital administration. Hence the need to lower cost as much as possible and create greater value.
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Objective [WT5”BZ]To evaluate the result of unilateral exploration for the treatment of hyperparathyroidism caused by parathyroid adenoma.[WT5”HZ]Methods[WT5”BZ] Clinical data of 20 cases from 1986 to 1999 were retrospectively analysed. Preoperative imaging examination was suggestive of unilateral lesion and unilateral exploration was performed accordingly.Results were compared with that of bilateral exploration.[WT5”HZ]Results[WT5”BZ] In 19 out of 20 cases the result of unilateral exploration was satisfactory making bilateral approach unnecessary except for one whose symptom was later proved to be caused by bilateral lesions.[WT5”HZ]Conclusions[WT5”BZ] The authors came to the conclusion that solitary adenoma is the most common cause of hyperparathyroidism in Chinese patients,hence unilateral exploration is of advantages. [WT5”HZ]
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Objective To investigate the polymorphism of the vitamin D receptor(VDR)gene in relation to primary hyperparathyroidism(PHPT). Method Polymerase chain reaction and restriction analysis were used to determine VDR genotypes in 30 patients with PHPT and in normal subjects.ResultsThe frequency distribution of VDR genotypes in PHPT patients was 0 in BB,1(3.3%) in Bb, 29(96.7%) in bb; and in normal persons was 2(3.3%) in BB, 11(18.4%) in Bb, and 47(78.3%) in bb. There was a significant difference between PHPT patients and normal persons in distribution of BB, Bb, bb genotypes (P≤0.05).ConclusionsThere is some distribution alterations of VDR gene polymorphism in PHPT patients.