Analysis on the factors affecting the efficacy of 131Ⅰ remnant ablation in patients after thyroidectomy for differentiated thyroid carcinoma

Objective 131Ⅰ is the most effective treatment for thyroidal remnant ablation after thy-roidectomy in patients with differentiated thyroid carcinoma (DTC). Ways to improve its therapeutic efficacy have been a major clinical concern. This study was designed to assess the efficacy of thyroid ablation by finding out its leading factors. Methods Eighty cases of post-operative DTC patients who had undergone first 131Ⅰ remnant ablation therapy were retrospectively reviewed. The efficacy of the therapy was assessed by a diagnostic 131Ⅰ whole body follow-up scan 3- 6 months later. The ablation therapy was considered to be suc-cessful only if no conceivable radioactivity was detected in the thyroidectomy bed. The χ2 test and multi-vari-ance Binary Logistic regression were used to analyze 9 variances which might affect the therapeutic efficacy, including gender, age (<45 years and ≥45 years), type of pathology (papillary or follicular carcinoma), metastasis, residual thyroid weight (low, median, high), 24 h radioiodine uptake ratio (< 10%, 10%-20%, >20%), thyroglobulin (Tg, negative or positive), thyroid stimulating hormone (TSH, <30 mU/L, 30-60 mU/L, >60 mU/L), and radioiodine dose (<1850 MBq,1850-3700 MBq, >3700 MBq). Results 131Ⅰ remnant ablation therapy was successful in 58 of 80 DTC patients (72.5%). Three variances were found to have affected the therapeutic efficacy: residual thyroid weight, 24 h radioiodine uptake ratio and 131Ⅰ dose. The corresponding intra-groups statistical difference of those 3 variances was significant by χ2 test (χ2 = 8.892, 9.528, 15.085, P = 0.012, 0.009, 0. 001), while the intra-group statistical differences of the remaining variances were insignificant (χ2 =0.486, 0. 051, 0. 322, 0. 010, 0. 006, 2. 575, all P > 0. 05). All 9 variances were analyzed by the multi-variance Binary Logistic regression model through for-ward stepwise. The variance of residual thyroid weight (X1) and 131Ⅰ dose (X2) were finally selected as the 2 key parameters in the formula, P=e(-0.865-0.868X1+1.677X2)/[1-e(-0.865-0.868X1+1.677X2)] , by the Binary Logistic regression analysis (Wald values were 3.752 and9. 130, P=0.049, 0.003). Conclusions The efficacy of 131Ⅰ ablation of thyroidal remnant in post-operative DTC patients was mainly determined by the re-sidual thyroid weight and the therapeutic 131Ⅰ dose. The other 7 factors included in this study were not found to be statistically significant.     

应用OCT观察视盘小凹的特征

目的：应用OCT观察视盘小凹的特征。方法：3例(3眼)视盘小凹病人行光学相干断层扫描(OCT)及眼底荧光血管造影(FFA)检查：3眼的视力分别为0．8．0．8和1．2。两例女性病人年龄分别为42和52岁，一例男性病人年龄为30岁。结果：OCT显示3眼小凹处均有神经纤维缺损黄斑区无神经上皮脱离：第1例女性病人的视野显示旁中心暗点，第2例女性病人为向心性视野缩小，眼底荧光血管造影显示双侧黄斑区均有窗样缺损，有黄斑前膜并伴有水肿。眼底荧光血管造影显示三个小凹均表现为晚期高荧光。结论：OCT对于诊断视盘小凹是非常有用的，并且可以有助于发现有无神经上皮脱离和黄斑水肿，以便及早给予激光治疗。     

新的利尿合剂治疗慢性肺心病难治性心力衰竭73例

自2000年1月～2003年2月。我科试用低分子右旋糖酐、多巴胺、速尿组成一种新的利尿合剂治疗慢性肺心病难治性心力衰竭。取得了较好疗效。现报道如下：     

石景亮治疗肾衰验案举隅

石景亮教授系国家级名老中医,悬壶4 0余载,内科临证建树颇多,尤以肾脏病最为擅长,现就石教授治疗急慢性肾衰验案介绍如下。1　肾病综合征(下称“肾综”)出血热致急性肾衰柴某,女,38岁。2 0 0 2年11月2 4日入院。发热、水肿月余。患者于10月2 5日在他院确诊为肾综出血热并急性肾衰,并经综合治疗及血液透析等措施,症状无明显改善。刻下:神志清,精神差,纳差,乏力,恶心、呕吐,2 4小时尿量约80 0ml,体温正常,贫血貌,睑唇苍白,爪甲不华,畏寒怯冷,腹膨隆,腹水征阳性,双肾叩击痛,双下肢水肿。舌淡胖大苔白腻,脉沉细。化验:血红蛋白6 2 g/L ;尿素氮1…     

中医临床"药动学"浅论

作者从5个方面对中医的临床药动学进行了探索。1、药物在煎煮过程中的整合作用:煎煮过程中,各成分之间可能发生一系列变化,可能生成新的化合物,其作用趋势会转达向一个方向或多种方面,按照医生组方侧重而达到其治疗目的。2、药物经胃肠内吸收后的分布与作用:汤药经胃肠道吸收后,首先应该是在上述正常水液代谢过程中的参与者,同时由于汤药在胃肠内的机体二次整合作用,使整个汤剂在机体内部发     

高渗氯化钠溶液治疗失血性休克效果观察

失血性休克抢救关键是补充血容量.传统方法是用(林格氏液+输血).因输液量大,操作麻烦,效果欠佳.笔者遇到失血性休克患者,采用少剂量高渗氯化钠溶液快速输入,效果佳.     

肘部肱动脉及皮肤软组织缺损的显微外科治疗

目的探讨应用小腿内侧皮瓣修复肘部肱动脉及皮肤软组织缺损的临床疗效。方法采用吻合血管的小腿内侧皮瓣一期修复肘部肱动脉及皮肤软组织缺损8例,对伴有神经缺损者同时给予修复。结果8例肢体及皮瓣均成活,随访7~16个月,8例患者肘部无瘢痕挛缩及皮瓣臃肿现象,肘关节功能恢复正常。结论小腿内侧皮瓣移植是治疗肘部肱动脉及皮肤软组织缺损的较好方法。     

FK506-壳聚糖膜与体外培养雪旺细胞生物相容性的研究

目的 探讨FK506-壳聚糖膜片与培养的雪旺细胞生物相容性.方法 将生长状况和纯度较好的第3代雪旺细胞,分别传代接种于含有FK506-壳聚糖膜片、单纯壳聚糖膜片的培养皿中培养,以盖玻片作为对照组.计算3组雪旺细胞倍增时间、雪旺细胞纯度;用MTT法比较不同膜片上雪旺细胞的生长活力,绘制生长曲线;S-100免疫荧光染色.结果 雪旺细胞倍增时间对照组为5.9 d,单纯壳聚糖膜片及FK506-壳聚糖膜片组均为4.0 d;雪旺细胞纯度分别为80%、89%,93%;雪旺细胞增殖情况以FK506-壳聚糖组最佳,单纯壳聚糖组次之,对照组最差;各组雪旺细胞均呈S-100阳性,FK506-壳聚糖组与单纯壳聚糖组雪旺细胞排列呈典型的漩涡状或栅栏状.结论 FK506-壳聚糖膜片具有更显著的组织相容性与生物功能性,并保持了雪旺细胞的生物学特性.     

1086例住院新生儿临床分析

为了提高新生儿疾病诊治水平，降低病死率及致残率，笔者统计1985—12～2004-09住院的新生儿住院病历1086例，现报告如下。