桥本病误诊结节性甲状腺肿手术治疗25例分析

目的:探讨桥本病误诊结节性甲状腺肿原因,以减少临床误诊。方法:回顾性分析经手术及病理证实的25例桥本病误诊结节性甲状腺肿患者的临床资料。结果:本组均行病理检查:桥本病20例,桥本病合并甲亢2例,桥本病合并甲状腺癌3例,术后随访6个月～2a,平均12个月,其中18例有不同程度的甲状腺功能减退,均行甲状腺素替代治疗。结论:桥本病误诊率很高,提高对该病的认识、对于术中快速病理检查是获得正确诊断的有效方法,利于选择适当的手术方式,手术中应尽量保留正常的甲状腺组织,防止甲状腺功能低下旨在探讨其合理的诊疗方法及减少临床误诊。     

桥本病并发甲状腺肿块的外科治疗

目的总结并发甲状腺肿块的桥本病的外科治疗.方法回顾分析1990年1月至2002年12月手术并经病理证实的79例桥本病的发病情况及诊断、治疗.结果全组病例均以甲状腺肿块为主要症状而接受手术,病理证实并发甲状癌8例,恶性淋巴瘤1例,甲状腺腺瘤4例,结节性甲状腺肿10例,甲亢6例,并发症为29例,占36.7%.结论并发甲状腺肿肿块的桥本病,应予以手术治疗,术后密切随访,注意甲状腺功能减退症发生.     

桥本病20例手术后回顾分析

目的　探讨桥本病外科的诊治经验。方法　回顾分析 1993年 12月～ 2 0 0 3年 7月本院 2 0例外科手术并经病理证实为桥本病的临床资料。结果　本组术前误诊、漏诊率高 ,一些手术方式选择不合理 ,术后甲状腺功能减退(甲减 )发生 4例 ,为 2 0 %。 2例伴有甲状腺腺瘤和甲状腺肿 ,2例伴有甲状腺腺瘤和甲状腺功能亢进 (甲亢 ) ,4例伴甲状腺腺瘤 ,3例伴甲状腺肿 ,2例伴甲状腺囊肿 ,1例伴甲状腺腺癌。结论　桥本病可伴发其他甲状腺疾病 ,外科医生应加强该病不典型表现的认识。常规检测甲状腺蛋白抗体 (TG)、甲状腺微粒体抗体 (TM ) ,有选择地做细针穿刺细胞学检查(FNAC) ,诊断性药物治疗可降低误诊、漏诊率。术中快速冰冻切片有助于选择合理的手术方式     

结节性甲状腺肿并甲亢16例手术治疗临床分析

目的探讨结节性甲状腺肿并甲亢的手术治疗疗效。方法回顾性分析16例结节性甲状腺肿并甲亢手术治疗病人的临床资料。结果16例中11例采用硫脲类药物加碘剂进行术前准备，5例单用碘剂准备；11例采用甲状腺次全切除，5例行甲状腺叶切除。术后无甲状腺危象、甲亢复发及甲状旁腺损伤等并发症。结论手术治疗结节性甲状腺肿并甲亢是安全有效的治疗手段。     

桥本病并发其他甲状腺疾病的手术治疗

目的探讨桥本病合并其他甲状腺疾病的诊治策略。方法回顾性分析1984~1999年间收治33例桥本病合并其他甲状腺疾病资料。结果全部病人均行手术治疗,术后病理检查结果:桥本病合并甲状腺腺瘤9例,合并结节性甲状腺肿17例,合并甲状腺机能亢进3例,合并甲状腺乳头状癌4例。术后6例出现甲状腺功能减退。结论临床医师应重视对桥本病的认识。细针穿刺活检对于明确诊断有重要意义。甲状腺局部孤立实性结节是手术适应症。术中采用快速冰冻切片检查有助于确定手术方式,术中应注意尽量保留正常的甲状腺组织,以防形成甲状腺功能减低。     

桥本病并发其他甲状腺疾病的手术治疗

目的探讨桥本病并发其他甲状腺疾病的诊治策略。方法回顾性分析1984～1999年间收治33例桥本病并发其他甲状腺疾病资料。结果全部病人均行手术治疗,术后病理检查结果:桥本病并发甲状腺腺瘤9例,合并结节性甲状腺肿17例,合并甲状腺机能亢进3例,合并甲状腺乳头状癌4例。术后6例出现甲状腺功能减退。结论临床医师应重视对桥本病的认识。细针穿刺活检对于明确诊断有重要意义。甲状腺局部孤立实性结节是手术适应证。术中采用快速冰冻切片检查有助于确定手术方式,术中应注意尽量保留正常的甲状腺组织,以防形成甲状腺功能减低。     

消瘿胶囊治疗甲状腺肿伴甲状腺功能亢进

目的观察消瘿胶囊治疗弥漫性甲状腺肿伴甲状腺功能亢进和结节性甲状腺肿伴甲状腺功能亢进的效果。方法治疗组：中药采用消瘿胶囊治疗,西药采用丙基硫氧嘧啶片或他巴唑。对照组：仅用上述西药治疗,剂量、用法、疗程同治疗组。结果治疗组疗效明显优于对照组。结论消瘿胶囊治疗弥漫性和结节性甲状腺肿伴甲状腺功能亢进疗效确切,值得推广。     

结节性甲状腺肿合并甲状腺功能亢进症病人的围术期护理

目的：研究和总结结节性甲状腺肿合并甲状腺功能亢进患者在围手术期的护理要点。方法：收集结节性甲状腺肿合并甲状腺功能亢进患者共56例,对他们进行围手术期的心理护理、药物护理、饮食护理、并发症护理等,对患者的病情变化给予密切关注。结果：所有患者经过手术治疗和护理后均康复出院,仅有1例患者出现手足抽搐,1例患者出现声音嘶哑,1例患者切口出血。结论：对结节性甲状腺肿合并甲状腺功能亢进患者实施围手术期的护理,能够有效地降低术后并发症的发生率,值得推广运用。     

桥本病55例的外科治疗

[背景 ]总结桥本病的外科诊治经验 .[病例报告 ]对 5 5例桥本病的发病情况、诊断以及手术治疗方法进行分析 .5 5例均经手术治疗 ,术后病理检查结果示单纯性桥本病为 32例 ,桥本病合并甲状腺腺瘤为 6例、结节性甲状腺肿为 5例、甲状腺功能亢进为 9例、甲状腺癌为 3例 .[讨论 ]术中快速冰冻切片病理检查可明确桥本病诊断并可决定手术方式 .术中应多保留正常甲状腺组织 ,以防造成甲状腺功能低下 .     

甲状腺功能亢进外科治疗的探讨

目的：评价甲亢手术术前准备及甲亢手术治疗的安全性和有效性。方法：对2006年1月至2008年12月间南方医科大学附属南海医院接受双侧甲状腺大部分切除术的117例甲状腺功能亢进病人资料进行回顾分析。结果：117例病人中,原发性甲亢102例,结节性甲状腺肿并甲亢14例,高功能腺瘤1例（均病理确诊）。术后随访时间1～36月,监测1r3、T。正常,无甲亢复发。术后近期颈前肌群出血1例,低钙抽搐2例,并发症发生率为2．56％,无甲状腺危象等重大并发症。结论：随着甲亢术前准备,手术方法的不断改进,甲亢术后并发症发生率及术后复发率低。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.