Hypoglossal nerve palsy after gasless trans-axillary endoscopic thyroidectomy: a case report.

BACKGROUND: Gasless trans-axillary endoscopic thyroidectomy (GTAET) has satisfactory cosmetic effects for the patients who have benign goiter and small thyroid carcinoma, however the complications of this surgical procedure have not been fully documented. Ipsilateral hypoglossal nerve palsy (IHNP) associated with GTAET has never been reported before. CASE PRESENTATION: A 33-year old male patient presented with a 4 × 5 mm solid thyroid nodule in the right lobe. Papillary thyroid carcinoma was confirmed by the fine needle aspiration. He had strong cosmetic demand, therefore GTAET for right lobectomy and central cervical lymphadenectomy was performed in a supine position with cervical extension. Six hours after the operation, he developed tongue deviation to the right side, speech and swallowing difficulties, indicating IHNP. Head and cervical MRI showed no abnormality. The intravenous steroid was used for three days, and oral vitamin B1 and mecobalamin was prescribed for 1 month. Nine days after surgery, he was discharged. Three months after the operation, all the symptoms were completely resolved. CONCLUSIONS: To the best of the authors' knowledge, this is the first case of IHNP after GTAET, which will be valuable to add our knowledge to diagnose and treat rare complications of GTAET.

Ureteral obstruction and hydronephrosis caused by foreign body: A case report and literature review.

RATIONALE: Foreign bodies related ureteral obstruction and hydronephrosis is rare and usually cause numerous problems for clinical physicians. PATIENT CONCERNS: We report a 36-year-old female who was referred to our hospital due to a 4-year history of dull pain on the left back. DIAGNOSIS: X-ray and abdominal CT revealed a foreign body around the upper part of the left ureter with ureteral obstruction and hydronephrosis. INTERVENTIONS: Laparoscopy was performed and a 3-cm sewing needle was removed successfully. OUTCOMES: After 6 months' follow-up, the patient's ureteral obstruction and hydronephrosis were significantly reduced, and the double-J ureteral stent was removed. LESSONS: This case indicated that ureteral obstruction and hydronephrosis caused by foreign bodies needed to be early diagnosed and located. Invasive therapies rather than conservative treatments are preferred to remove the FBs and relieve obstruction.

Gastric cancer with severe immune thrombocytopenia: A case report.

BACKGROUND: Primary immune thrombocytopenia (ITP) is a rare autoimmune disease associated with a high bleeding risk. For those patients with gastric cancer, surgical treatment may be the only option for therapy. Here, we present the first case of gastric cancer with severe and medically refractory ITP treated by radical resection of the gastric cancer and splenectomy. CASE SUMMARY: A 54-year-old female patient was admitted to our surgical department with a 2 mo history of decreased appetite, nausea, vomiting, and weight loss, which progressed to difficulty in feeding 3 d prior to her visit. According to her medical history, she was diagnosed with refractory ITP [platelets (PLT), 3000-8000/µL] 10 years ago. After admission, the patient underwent a splenectomy and a distal subtotal gastrectomy (D2 radical resection) with Roux-en-Y reconstruction simultaneously. She had an uneventful postoperative course with a slight increase in her PLT count. This case is unique in terms of the patient's complication of severe and medically refractory ITP. CONCLUSION: Simultaneous splenectomy, preoperative PLT transfusion, and early enteral nutrition were important treatment methods for helping this patient recover.

A meta-analysis of the success rates of heartbeat restoration within the platinum 10 min among outpatients suffering from sudden cardiac arrest in China.

BACKGROUND: The optimal time to save a person who has had a sudden cardiac arrest is within the first few minutes of the incident. Early compression and early defibrillation should be performed at this time. Timeliness is the key to successful CPR; as such, Prof. He proposed the "platinum 10 min" system to study early CPR issues. This paper systematically evaluates the success rates of heartbeat restoration within the "platinum 10 min" among patients suffering from sudden cardiac arrest. METHODS: The clinical data of outpatients suffering from a cardiac arrest were retrieved from the China Knowledge Network (January 1975-January 2015), the Chongqing VIP database (January 1989-January 2015), and the Wanfang database (January 1990-January 2015). The success of the cardiopulmonary resuscitation (CPR) performed at different times after the patients had cardiac arrests was analyzed. Two researchers screened the literature and extracted the data independently. A meta-analysis was conducted using Stata12.0. A total of 57 papers met the inclusion criteria, including 29,269 patients. Of these patients, 1776 had their heartbeats successfully restored. The results showed high heterogeneity (X (2) = 3428.85, P < 0.01, I(2) = 98.4 %). The meta-analysis was conducted using a random-effects model. The combined effect size was 0.171 (0.144-0.199). RESULTS: (1) The success rate of heartbeat restoration did not differ among the four emergency treatment methods that patients received: the methods described in the 2000 Guidelines for CPR and Emergency Cardiovascular Care, that described in the 2005 version, 2010 version, and another CPR method. (2) The patients were divided into five groups based on the time when CPR was performed: the ≤1 min group, the 1- ≤ 5 min group, the 5- ≤ 10 min group, the 10- ≤ 15 min group and the >15 min group. The CPR success rates of these five groups were 0.247 (0.15-0.344), 0.353 (0.250-0.456), 0.136 (0.109-0.163), 0.058 (0.041-0.075), and 0.011 (0.004-0.019), respectively. The CPR success rates did not differ between the patients in the ≤1 min group and the 1- ≤ 5 min group. This success rate was higher for the patients in the 1- ≤ 5 min group than those in the 10- ≤ 15 min group, those in the 10- ≤ 15 min group, and those in the >15 min group. The CPR success rate was higher for the patients in the 5-10 min group than those in the 10- ≤ 15 min group and those in the >15 min group. CONCLUSIONS: The CPR success rate was higher for the patients in the 10- ≤ 15 min group than those in the >15 min group. In addition, the patients were divided into two groups based on whether CPR was performed within the first 10 min after the cardiac arrest occurred: the ≤10 min group and the >10 min group. The CPR success rate was higher for the patients in the ≤10 min group (0.189 [0.161-0.218]) than those in the >10 min group (0.044 [0.032-0.056]). (3) Differences were not found between the CPR success rates among the patients in the telephone guidance group (0.167 [0.016-0.351]) and those in the ≤1 min, 1- ≤ 5 min, 5- ≤ 10 min, 10- ≤ 15 min, and >15 min groups. (4) The CPR success rates did not differ among in the patients in the witness + public group (0.329 [0.221-0.436]), those in the ≤1 min group, and those in the 1- ≤ 5 min group. However, this success rate was higher in the patients in the witness + public group than those in the 5- ≤ 10 min, 10- ≤ 15 min, and >15 min groups. CONCLUSIONS: The success rate of heartbeat restoration did not differ among patients receiving CPR based on different guidelines. The success rate of CPR lies in its timeliness. The participation of the general population is the cornerstone of improving CPR. Providing complete emergency treatment equipment and perfecting comprehensive measures can improve the success rate of CPR among patients within the platinum 10 min. CPR research in China must be improved.