妊娠剧吐合并甲状腺功能异常的初步研究

目的探讨妊娠剧吐患者甲状腺功能变化以及妊娠剧吐合并甲状腺功能亢进(甲亢)对妊娠结局的影响。方法选取2014年1月至2015年3月因妊娠剧吐入院的单胎妊娠患者58例为研究组,同期单胎正常妊娠妇女239例为对照组,分析所有研究对象游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺素(TSH)、甲状腺过氧化酶抗体(TPOAb)及甲状腺球蛋白抗体(TgAb)情况,并对两组进行比较;同时随访并分析24例妊娠剧吐合并甲亢患者的妊娠结局。结果妊娠剧吐组FT3[(5.533±2.725)pmol/L]、FT4[(23.269±12.090)pmol/L]及甲亢发生率(41.38%)均显著高于正常妊娠组[FT3(4.478±0.653)pmol/L、FT4(15.069±2.545)pmol/L及甲亢发生率4.60%](P0.01);妊娠剧吐组TSH[(1.019±1.583)mU/L]低于正常妊娠组TSH[(2.194±1.980)mU/L](P0.01);24例妊娠剧吐合并甲亢患者中,1例发生重度子痫前期,2例发生自然流产。结论妊娠剧吐患者易出现亚临床甲亢,尤其是妊娠甲亢综合征,建议常规进行甲状腺功能的检测,但对于妊娠剧吐合并甲亢是否给予抗甲状腺药物治疗仍需进一步研究。     

微波消融术结合定向皮内透药法治疗甲状腺结节30例

目的:探讨微波消融术结合定向皮内透药法治疗甲状腺结节的近期疗效。方法:对30例甲状腺结节患者实施微波消融术,术后均给予中药制剂消瘿方敷片定向皮内透药法治疗,术前、术后检查甲状腺功能及彩超,并记录并发症及不良反应情况。结果:术后1个月随访,彩超显示30例共59枚甲状腺结节均完全消融灭活,术后体积[(1787.54±5381.55)mm~3]比术前体积[(3596.36±9649.14)mm~3]明显缩小,比较差异有统计学意义(P0.05)。55个甲状腺结节内部均无血流信号,2个结节(3.64%)周边点状血流信号,与术前(90.91%)比较,差异有显著统计学意义(P0.01)。术后1个月4例(13.33%)颈部淋巴结肿大,与术前(23.33%)比较,差异无明显统计学意义(P0.05)。术前、术后1 d及术后1个月3个时间点FT3、T3、TgAb、TpoAb和TRHAb各自相比,差异均无统计学意义(P0.05)。TSH术后1 d[(0.66±0.47)μIU/mL]比术前[(1.81±0.96)μIU/mL]降低,术后1 d FT4[(16.50±2.97)pmol/L]比术前[(14.07±1.23)pmol/L]升高,术后1 d T4[(110.29±24.66)nmol/L]比术前[(93.05±13.64)nmol/L]升高,及术后1 d Tg[(1738.38±2880.85)ng/mL]比术前[(64.82±138.59)ng/mL]升高。术后1个月TSH[(1.59±1.03)μIU/mL]比术后1 d升高,术后1个月FT4[(14.27±1.72)pmol/L]、T4[(94.62±14.54)nmol/L]及Tg[(102.04±186.10)ng/mL]均比术后1 d降低,差异均有统计学意义(P0.05)。整个研究过程无1例发生严重并发症,未引起全身或局部不良反应。结论:微波消融术结合定向皮内透药法治疗甲状腺结节近期临床疗效好,无明显不良反应。     

超声引导下微波消融术在甲状腺良性肿瘤治疗中的研究

目的 探讨超声引导下微波消融术在甲状腺良性肿瘤治疗中的疗效。方法 选取2017年1月至2022年1月收治的32例甲状腺良性肿瘤患者进行研究，按照不同的治疗方式分为对照组和观察组，各16例。对照组实施常规甲状腺切除术；观察组实施超声引导下微波消融术。比较两组术中术后指标、甲状腺功能和并发症发生率。结果 观察组患者手术时间（15.38±1.14） min和住院时间（3.27±0.53） d均少于对照组（42.72±4.29） min、（7.58±1.01） d(P<0.05)；观察组患者术中出血量（3.42±0.83） mL少于对照组（22.63±2.52） m L，术后VAS评分（3.63±0.52）低于对照组（5.79±0.71），差异显著（P<0.05）；观察组患者术后FT3(5.58±0.89) pmol/L和FT4(15.26±1.81) pmol/L水平高于对照组（4.52±0.79） pmol/L、（12.83±1.25） pmol/L,TSH水平（2.26±0.26） mIU/L低于对照组（3.42±0.41） m IU/L (P<0.05)；观察组术后并...     

甲状腺腺叶切除术治疗不同年龄甲状腺良性肿瘤患者的临床疗效比较

目的 分析甲状腺叶切除术治疗不同年龄甲状腺良性肿瘤患者的临床效果.方法 行单侧甲状腺腺叶切除术的甲状腺良性肿瘤患者150例,按照其年龄大小将其分成青年组、中年组以及老年组,每组各50例,比较三组患者术后1周,术后1、3、6、12个月的游离三碘甲腺原氨酸(FT3)、游离甲状腺素(FT4)以及促甲状腺素(TSH)水平与术前的差异,并比较术后并发症的发生情况以及生活质量评分差异.结果 青年组患者FT3水平术后1周[(3.76±0.98) pmol/L]、1个月[(4.08±1.11) pmol/L]与术前[(4.99±0.87) pmol/L]比较明显降低(P＜0.05),TSH水平在术后1周以及术后1、3个月与术前比较,差异有统计学意义(P＜0.05);中年组患者的FT3、FT4以及TSH水平与术前比较,差异无统计学意义(P＞0.05);老年组患者的FT3水平在术后1周以及1、3个月明显降低,FT4水平在术后1、3、6个月明显降低,TSH水平在术后1周以及1、3、6个月明显增高(P＜0.05).青年组术后并发症的发生率(8.0％)显著低于老年组(28.0％,P＜0.05).青年组和中年组患者的术后生活质量与术前比较差异无统计学意义(P＞0.05),但老年组患者术后生理职能、一般健康状况、精力以及精神健康等方面评分,与术前比较明显降低(P＜0.05).结论 甲状腺腺叶切除术治疗不同年龄甲状腺良性肿瘤患者的临床效果较好,但术后甲状腺功能恢复存在差异,尤其老年患者较差.     

超氧化物歧化酶在甲状腺相关疾病外周血中的水平及意义

目的:研究超氧化物歧化酶(SOD)在甲状腺相关疾病外周血中水平,分析与甲状腺疾病的关系。方法:甲状腺癌患者84例,结节性甲状腺肿患者21例,甲状腺功能亢进患者75例,甲状腺功能低下患者56例和正常人对照组63例,酶法检测外周血清中SOD活性,电化学发光法检测游离甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)水平,分析各组SOD活性差异及SOD活性与甲状腺激素相关性。结果:SOD活性在甲状腺癌组(164.536±18.095)U/mL,明显低于甲状腺功能亢进症组的(173.376±15.942)U/mL、甲状腺功能低下症组(174.827±19.895)U/mL和正常对照组的(179.529±11.625)U/mL(P0.05),SOD活性在结节性甲状腺肿组(157.667±15.189)U/mL,明显低于甲状腺功能亢进症组的(173.376±15.942)U/mL、甲状腺功能低下症组(174.827±19.895)U/mL和正常对照组的(179.529±11.625)U/mL(P0.05)。甲状腺癌组FT3、FT4水平与SOD活性成呈正相关(r=0.346、0.328,P0.05),正常对照组FT3水平与SOD活性成呈负相关(r=-0.552,P0.05)。结论:甲状腺发生结节和肿瘤后SOD活性降低,观察SOD活性变化可了解甲状腺组织损伤的情况并作为甲状腺肿瘤发生辅助指标。     

吲哚菁绿荧光显像在免充气腔镜腋窝入路甲状腺切除术中对甲状旁腺的保护作用

目的探讨吲哚菁绿荧光显像技术应用于甲状腺手术中识别甲状旁腺并保护甲状旁腺功能的可行性。方法回顾性分析2021年10月至2022年5月间浙江省中医院42例免充气腔镜腋窝入路甲状腺切除术患者的临床资料, 对术中使用荧光显像技术(研究组)和常规腔镜甲状腺切除术(对照组)的患者进行比较。结果研究组术中发现的甲状旁腺数为(1.57±0.61)枚, 明显多于对照组的(0.56±0.59)枚(t=-5.472, P<0.05)。研究组术后第1天血清甲状旁腺素值为(2.88±1.23)pmol/L, 高于对照组的(2.16±0.10)pmol/L(t=-1.844, P<0.05);第3天的血清甲状旁腺激素值为(3.22±1.31)pmol/L, 较对照组的(2.55±0.81)pmol/L高(t=-2.041, P<0.05)。研究组术后发现甲状旁腺功能低下2例, 少于对照组的5例, 但两组比较差异无统计学意义(χ2=0.942, P>0.05)。研究组术后出现低钙血症1例, 对照组出现3例, 差异无统计学意义(χ2=0.731, P>0.05)。结论应用吲哚菁绿荧光显...     

长效促性腺激素释放激素激动剂降调时间对体外受精临床结局的影响

目的探讨长效促性腺激素释放激素激动剂(GnRH-a)垂体降调后促性腺激素(Gn)启动时间对体外受精-胚胎移植(IVF-ET)结局的影响。方法回顾性分析2011年1月~2012年6月本院生殖中心776个长方案IVF/卵胞浆内单精子注射(ICSI)新鲜移植周期的临床资料,按照Gn前垂体降调节的时间分为:A组8~10d,B组11~12d,C组13~15d,D组16~18d,比较各组的临床结局。结果四组间受精率、卵裂率、优质胚胎率均无统计学差异(P0.05);启动日A组雌二醇(E2)水平为(57.36±52.79)pmol/L,显著低于C、D组[(79.45±62.23)pmol/L、(85.56±74.07)pmol/L],(P0.05),A组黄体生成素(LH)为(1.85±1.36)IU/L,显著低于C组(2.16±1.11)IU/L,(P0.05);从A组到D组Gn用量分别为(28.58±8.25)支、(27.66±7.16)支、(27.30±8.23)支、(27.19±9.26)支和使用时间分别为(11.19±3.34)d、(10.99±1.58)d、(10.81±1.64)d、(10.90±1.99)d,有逐渐减少趋势,但各组间差异无统计学意义(P0.05);人绒毛膜促性腺激素(HCG)日A组LH水平(1.48±1.21)IU/L显著低于B、C、D组[(1.82±1.53)IU/L、(1.91±1.29)IU/L、(2.27±1.62)IU/L],(P0.05);A组孕酮(P)为(8.85±5.93)pmol/L,则显著高于其它3组[(6.32±3.67)pmol/L、(6.20±3.73)pmol/L、(5.53±3.23)pmol/L),(P0.05);四组临床妊娠率分别为42.37%、45.24%、52.16%和48.18%;胚胎种植率分别为25.19%、27.91%、33.06%、30.54%,组间差异均无统计学意义(P0.05);四组早期流产率分别为12.0%、13.16%、7.42%和1.89%,B组显著高于C、D组(P0.05)。结论在长效GnRH-a长方案控制性超排卵周期中,垂体降调节时间对妊娠结局有一定影响,适当延迟Gn启动时间(≥13d)有提高IVF临床妊娠率及种植率的趋势,并可降低早期流产率。     

少见甲状旁腺腺瘤2例

1病例报告例1男,31岁。以“双下肢无力,起立困难1年,骨痛2个月,加重1个月”为主诉入院。体查:神清;左侧颈部可触及一约3cm×2cm结节,质中等,触痛(-)随吞咽上下移动,未闻及血管鸣音。辅助检查:血PTH>263pmol/L,血钙4.51mmol/L,血磷0.29mmol/L,TSH 1.4385mIU/L,FT46.02pmol/L,FT34.55pmol/L,Anti-Tg 0.50IU/mL,Anti-TPO 0.14IU/mL,血BUN5.47mmol/L,Cr74μmol/L。B超示结石,钙化;甲状腺增生结节,甲状腺左叶下极占位性病变不除外来源于甲状旁腺。颈部CT:左侧甲状腺占位病变,可疑甲状旁腺占位病变,所见部分骨质有粗糙疏松等改变…     

短期营养不良对雌性小白鼠生殖能力的影响

目的 研究短期营养不良对雌性小白鼠生殖能力的影响.方法 将40只10周龄雌性小白鼠随机均分为研究组及对照组.研究组取卵前36 h仅供给饮水；对照组正常饮食.采用体外受精(IVF)的方法,观察两组小鼠的获卵数、卵母细胞成熟度及卵裂率,取卵前检测两组小鼠卵泡刺激素(FSH)、黄体生成素(LH)以及雌二醇(Ez)水平.结果 研究组雌鼠平均获卵数(2.80±1.24),对照组雌鼠平均获卵数(4.00±1.17)；卵母细胞第一极体排出率及卵裂率研究组分别为12.5％、14.3％,对照组分别为88.8％、70.4％.研究组FSH、LH及E2分别为(1.32±0.49)IU/L、(2.08±0.39)IU/L及(13.03±1.68)pmol/L,对照组分别为(4.45±0.72)IU/L、(15.72±2.38)IU/L及(133.69±6.95)pmol/L.两组所有观察指标均具有极显著差异(P＜0.01).结论 短期营养不良可明显降低小白鼠获卵数及卵子成熟度,减弱卵母细胞的IVF能力.     

甲状腺癌术后短期甲状腺机能减退对骨密度及脂肪分布的影响

目的观察短期甲状腺机能减退对患者骨密度及脂肪分布的影响,探讨二者之间的相关性。方法选择甲状腺癌患者22例,均行甲状腺全切术或近全切术,术后4~8周或停用左甲状腺素后3~6周均行131I去除治疗(去除治疗后48小时即开始使用左旋甲状腺素),对该组病例术前、131I治疗前,131I治疗后3~6个月,分别行全身骨密度测定及脂肪分布测定。结果22例甲癌患者,术前游离三碘甲状腺原氨酸(FT3)平均为(4.55±0.91)pmol/L,术后4~6周平均为(1.21±0.41)pmol/L,131I治疗后3~6个月平均为(5.70±1.17)pmol/L;三次骨密度测定,无明显变化;三次体脂含量分别为21.75±8.01 kg,23.05±7.96 kg,21.53±7.73 kg,甲减状态时,体脂含量明显增加(第二次减去第一次,P0.01);甲减恢复后,体脂含量亦随之基本恢复(第三次减去第一次,P=0.36)。结论短期甲减对患者骨密度无明显影响,但可使患者体脂含量明显增高,且该改变随着甲状腺机能减退的纠正而逐渐恢复。     

Perianal Paget's disease-Report of a rare case

INTRODUCTIONPerianal extra-mammary Paget's disease is a rare skin disorder of unknown aetiology, which is frequently associated with malignancy. This case report draws attention to this rare condition and comments upon its diagnosis and treatment.PRESENTATION OF CASEA 64-year-old otherwise fit man, presented to us in 2006 with one-year-long history of perianal irritation. On examination there was an erythematous discoid skin lesion in the right perianal area. The lesion was excised with wide margins and the defect closed with a local transposition flap. Histology confirmed extra-mammary Paget's disease (EMPD) with a focus of invasion showing a well-differentiated mucinous adenocarcinoma. Adjuvant therapy was not advised. On follow-up in 2011, a small irregular skin lesion, well away from the previous excision site was noted on the left perianal area. Biopsies from this lesion confirmed EMPD with no focus of invasion. Once again wide local excision with closure using local transposition flap was undertaken. Long term follow up has been advised.DISCUSSIONThe optimal treatment for Perianal Paget's disease (PPD) remains controversial. Surgery is the commonest modality used with wide local excision being the treatment of choice for resectable disease. We report herein a short review of various therapies reported so far in the management of this rare disorder.CONCLUSIONA thorough initial evaluation and long-term follow-up is essential to identify recurrence and the development of other related malignancies.     

A large incarcerated Meckel's diverticulum in an inguinal hernia

INTRODUCTION

Littre''s hernia is a rare finding consisting of a Meckel''s diverticulum inside of a hernia sac. Clinically, it is indistinguishable from a hernia involving small bowel and therefore may be difficult to diagnose pre-operatively.

PRESENTATION OF CASE

We report a case of an inguinal hernia involving an unusually large Meckel''s diverticulum measuring 15 cm in length. The diverticulum was resected using a linear GI stapler and the hernia was repaired without complication.

DISCUSSION

Meckel''s diverticulum is an embryologic remnant of the vitelline duct occurring in 1–3% of the adult population with an estimated 4% becoming complicated and presenting with intestinal obstruction, infection, bleeding or herniation. Surgical resection is the recommended treatment for any Meckel''s diverticulum causing symptoms. In the case of a Littre''s hernia, resection of the diverticulum should be followed by repair of the fascial defect in a standard fashion.

CONCLUSION

Littre''s hernia, although rare, should be a consideration at the time of repair for any abdominal hernia involving small bowel as resection of the Meckel''s diverticulum is critical in avoiding recurrent complications.     

Minimally invasive management of achalasia cardia: results from a single center study.

BACKGROUND: Since the performance of the first laparoscopic cardiomyotomy for achalasia cardia in 1991, the popularity of the minimally invasive approach for this troublesome disease has been growing. We present our experience of 226 patients who underwent laparoscopic cardiomyotomy and discuss the relevant issues. METHODS: A retrospective analysis was carried out of 226 patients who have undergone laparoscopic cardiomyotomy since 1993. The preoperative workup, surgical technique, and postoperative management are described. RESULTS: Patients included 146 males and 80 females; average age was 36.4 years (range, 6 to 85). Mean duration of symptoms was 1.4 years. Nearly half of the patients (112) had undergone prior pneumatic dilatation. In 20 patients, myotomy alone was done, 44 patients had a Dor's fundoplication, and 162 had Toupet's fundoplication. The average operating time was 96 minutes. Mean postoperative hospital stay was 2.2 days. Dysphagia was eliminated in 88.9% of the patients with an overall morbidity of 4.4% and nil mortality over a mean follow-up of 4.3 years. CONCLUSION: Laparoscopic cardiomyotomy with Toupet's fundoplication is a safe and effective treatment of achalasia cardia. Dor's fundoplication is done selectively, especially when suspicion is present of mucosal injury.     

Cullen's sign - Case report with a review of the literature

IntroductionCullen's sign is described as superficial oedema with bruising in the subcutaneous fatty tissue around the peri-umbilical region. It is also known as peri-umbilical ecchymosis.Presentation of caseWe report a case of a fifty-three year old gentleman who presented with non-specific abdominal pain. Significant bruising was present within the subcutaneous fatty tissue on the anterior abdominal wall in keeping with ‘Cullen's sign.’ Of note he denied any alcohol intake and his amylase was normal. A diagnosis of pancreatitis was made following a CT scan of his abdomen.DiscussionA search of the entire English literature using PubMed with the phrase ‘Cullen's sign’ has been performed. Papers were reviewed in relation to recognition of this clinical sign, differential diagnosis, and management.ConclusionOur case and review of the literature highlights the rarity of this clinical sign which a clinician may encounter. In addition we draw to attention the importance of having knowledge of the underlying possible conditions which may lead to this sign, and can be vital in successful acute management.     

Laparoscopy for treating a small bowel obstruction due to a Meckel's diverticulum.

A Meckel's diverticulum is one cause of small bowel obstruction in the virgin abdomen. A 17-year-old female presented with a 24-hour history of lower abdominal pain and emesis. Radiological imaging studies revealed a high-grade partial small bowel obstruction. A diagnostic laparoscopy was performed revealing a bowel obstruction secondary to a Meckel's diverticulum. The diverticulum was resected using an endovascular GIA stapler. The patient was discharged on postoperative day 3, tolerating a regular diet. Laparoscopy is a useful diagnostic and therapeutic tool for a patient with a small bowel obstruction with an unclear etiology.     

Corticosteroid Injection for Morton's Interdigital Neuroma: A Systematic Review

BackgroudThis review aimed to evaluate the effects of corticosteroid injections on Morton''s neuroma using an algorithmic approach to assess the methodological quality of reported studies using a structured critical framework.MethodsSeveral electronic databases were searched for articles published until April 2020 that evaluated the outcomes of corticosteroid injections in patients diagnosed with Morton''s neuroma. Data search, extraction, analysis, and quality assessments were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). guidelines, and clinical outcomes were evaluated using various outcome measures.ResultsWith 3–12 months of follow-up, corticosteroid injections provided satisfactory outcomes according to Johnson satisfaction scores except in two studies. Visual analog scale scores showed maximal pain reduction between 1 week and 3 months after injection. We found that 140 subjects out of 469 (29.85%) eventually underwent surgery after receiving corticosteroid injections due to persistent pain.ConclusionsCorticosteroid injections showed a satisfactory clinical outcome in patients with Morton''s interdigital neuroma although almost 30% of the included subjects eventually underwent operative treatment. Our recommendation for future research includes using more objective outcome parameters, such as foot and ankle outcome scores or foot and ankle ability measures. Moreover, studies on the safety and effectiveness of multiple injections at the same site are highly necessary.