Effects of encephalo-duro-arterio-synangiosis on childhood moyamoya patients--swift disappearance of ischemic attacks and maintenance of mental capacity.

The effect of encephalo-duro-arterio-synangiosis (EDAS) upon chronic cerebrovascular ischemia in 65 pediatric moyamoya patients was evaluated by the postoperative interval before complete disappearance of ischemic attacks and changes in pre- and postoperative intelligence (IQ) or development quotients (DQ). The ischemic attacks disappeared after a mean period of 239 days, in three-fourths of patients within a year and in about one-fourth within the second year. This was very fast compared with the natural course of the disease. There was no significant difference in DQ/IQ before and after the operation. The mentally normal (IQ/DQ greater than or equal to 86) population in the postoperative patients was greater than in the natural course of the disease, although fewer in the preoperative group. This shows that EDAS delayed or prevented the deterioration in mental capacity usually present but often overlooked in the natural course of pediatric moyamoya disease.     

结节性甲状腺肿术后促甲状腺激素抑制治疗研究进展

结节性甲状腺肿是普通外科领域常见疾病之一,外科手术后有较高的复发率,为后续治疗提出了挑战。而通过术后规范的甲状腺素治疗,可以使患者的术后促甲状腺激素(TSH)抑制,并控制在一个合理的水平,能明显减少结节性甲状腺肿术后的复发。笔者就结节性甲状腺肿术后TSH抑制治疗的进展进行综述。     

T and B lymphocyte function of patients with infectious complications after surgery for congenital heart defects

The parameters of T- and B-lymphocyte system were studied in 65 patients with congenital heart defects aged from 2 to 31 years with infectious complications after operation. The investigation was performed before operation and in the course of the postoperative period. Patients with infectious complications were shown to have more considerable suppression of cell and humoral immunity before operation than those without infectious complications. The parameters concerned were found to be distinctly decreased in the early postoperative period. Two weeks after operation no normalization of the immune parameters were noted.     

结节性甲状腺肿术后复发原因及防治

目的 分析结节性甲状腺肿术后复发的原因，并探讨防治其术后复发的有效方法。方法 回顾性分析1988～2000年我院收治的结节性甲状腺肿术后复发病人76例。结果 76例中首次手术表现为结节性甲状腺肿58例，甲状腺腺瘤样改变18例。行单纯结节切除16例，腺叶部分切除34例，一侧次全切除加对侧结节摘除18例，双侧腺叶次全切除8例。再次手术均行双侧甲状腺叶次全切除术。术后无严重并发症。再次术后给予甲状腺素片治疗。随访2～10年，无一例复发。结论 结节性甲状腺肿术后复发与病变性质，手术适应证的掌握以及手术方式密切相关。严格掌握手术指征，正确选择手术方式以及术后系统的服用甲状腺素，可以降低结节性甲状腺肿术后复发。     

Changes in cell immunity indexes under the influence of thymalin, thyroxine and fibronectin in patients with hyperplastic diseases of thyroid gland before and after the surgery

Changes in the cell immunity indexes under the influence of thymalin, thyroxin and fibronectin in vitral loading models were studied up in patients with hyperplastic diseases of the thyroid gland. Disbalance of the cell link immunity was revealed before the operation and, in particular, in the main subpopulations of lymphocytes as well as immunoregulating index lowering, which had intensified after the operation. In patients with toxic, nodose euthyroid goiter and chronic autoimmune thyroiditis the existence of (thyroxin- and thymalin) dependent control of the cell link immunity was determined. Application of fibronectin substituting therapy for correction of the hormone depending functional activity of lymphocytes in the early postoperative period in patients with hyperplastic diseases of thyroid gland was pathogenetically substantiated.     

Surgical treatment of recurrent goiter

The authors have analyzed and generalized their 20-years experience with surgical treatment of 247 patients with recurrent goiter. Among them 48 patients had recurrent toxic goiter and 199 patients had nontoxic goiter. Postoperative complications developed in 8.3% of the patients with recurrent toxic goiter and in 6% of the patients with nontoxic goiter. The overall postoperative lethality was 1.2%. Operative treatment is recommended by the authors for recurrent toxic and nontoxic goiter, conservative treatment with radioactive iodine is thought to be expedient for a repeated recurrence. For preventing recurrences of toxic and nontoxic goiter after the first operation the administration of small does of the thyroid hormones is considered to be expedient during 1.5-2 months.     

Prevention of postoperative hypothyroidism in surgical treatment of diffuse toxic goiter

Experience of treatment of more than 1000 patients with diffuse toxic goiter (DTG) is presented. Complex of measures performed before and after operation for reduction of hypothyroidism rate is developed. Histology examination during operation permits to determine volume of residual thyroid tissue. Local laserotherapy improves long-term results of surgical treatment. Rate of postoperative hypothyroidism in patients with DTG has decreased from 43.6 to 3.3%.     

Diagnosis of aortocoronary bypass complications

Thirty-four patients with ischemic heart disease were examined during operation for revascularization of the myocardium. The blood flow in the shunts was measured during the change from extracorporeal to natural circulation. In rise of venous and arterial pressure the blood flow in the shunts increased (positive dynamics) in some patients and decreased (negative dynamics) in others. Positive dynamics were associated with a favourable course of the postoperative period, negative dynamics--with ischemic-type complications. Factors invalidating the myocardium aggravated the initial condition of patients with positive dynamics of the blood flow less than that of patients with negative dynamics. Comparison of dynamic and short-term measurement of the blood flow in the shunts as a diagnostic test for perioperative complications showed the advantage of the dynamic test.     

剖腹胆囊切除术与腹腔镜胆囊切除术胰岛素抵抗的差异

目的对比剖腹胆囊切除术(OC)和腹腔镜胆囊切除术(LC)的胰岛素抵抗程度和持续时间,以确定LC有更小的组织创伤。方法将53例择期手术病例分为OC组(28例)和LC组(25例),对比两组的生理学评分、住院时间及在术前、手术结束、术后24h、72h的胰岛素敏感性(IS)改变。结果LC组IS下降最多仅为8%,而OC组IS下降可达20%。两者有统计学差异(P<0.01)。结论LC术后IS改变较OC术后少,对机体的损伤小,有利于病人的康复。     

Endocrine disorders in toxic goiter in the postoperative period

The disturbances of endocrinous functions in patients with toxic goiter in the early postoperative period were more pronounced in the critical state and in the average gravity of the disease. The endocrinous disorders revealed were well corrected by antithyroid drugs, corticosteroids, neuroleptics and beta-adrenoblockers and in most of the patients they were found to disappear or to reduce to the preoperative level within 8 days after operation.     

Dynamics of the cytokines, homocysteine contents, indices of oxydative and nitrosative stress and cytopathic hypoxia in patients after cholecystectomy for acute cholecystitis. Connection with rate of postoperative purulent-inflammatory complications

At examination of 160 patients with acute cholecystitis (ACH) it was stated that on 1st-2nd day after cholecystectomy the patients with complicated course of ACH have had a real increase of levels of interleukin-6, tumor necrosis factor-alpha, homocysteine, metabolites of nitric oxide, indexes of cytopathic hypoxia (hypoxanthine and xanthine, activity of adenosine deaminase, xanthine oxidase and xanthine dehydrogenase). These alterations were the most significant and lingering at the patients who has postoperative complications. Addition of levels of proinflammatory cytokines was over 50% and of indexes of cytopathic hypoxia--over 30-40% on the 1st-2nd day after operation what makes it possible to prognose the postoperative pyoinflammatory complications appearance at more that 60% of patients and to forecast favourable course of postoperative period with reliability over 90%--for its absence.     

甲状腺良性结节手术后复发的再治疗

目的 探讨甲状腺良性结节手术后复发的相关因素和再治疗原则。方法 对我院18年中51例甲状腺良性结节手术后临床复发者的病理、手术适应证、术式以及再治疗进行回顾性分析。结果 甲状腺良性结节手术后复发与病变性质、单发或多发、手术适应证的掌握及术式的选择密切相关。51例复发者中结节性甲状腺肿29例,甲状腺瘤22例;其中行结节摘除21例,腺叶部分切除16例,一侧腺叶次全切除9例,一侧腺叶切除5例。再手术38例,行一侧腺叶切除19例,一侧叶切加对侧次全切除3例,一侧次全切除7例,双侧次全切除9例;无严重手术并发症。随访32例再手术者,平均7年,仅1例结节性甲状腺肿再复发。结论 对甲状腺瘤和结节性甲状腺肿的正确诊断、明确病变的单发或多发,严格掌握多发性结节性甲状腺肿的手术适应证,并废弃结节摘除和腺叶部分切除术可降低复发率和再手术率。     

结节性甲状腺肿术后复发原因分析及应对策略

摘要 目的： 探讨结节性甲状腺肿术后复发的相关因素和应对策略,降低结节性甲状腺肿再手术率。 方法： 回顾分析我院1998~2008年术后复发性结节性甲状腺肿45例的临床资料。 结果： 结节性甲状腺肿术后复发与病变类型、手术方式选择及术后无规律TSH抑制治疗等密切相关。45例患者给予再次手术加甲状腺激素治疗后无一例复发。 结论： 首次手术应重视术前检查和术中探查、正确选择手术方式及规范化术后辅助甲状腺激素替代治疗,可降低复发率。     

Postoperative thyroidal insufficiency in patients with polynodous euthyroid goiter

Results of surgical treatment of 150 patients with polinodous euthyroid goiter were studied up. The influence of various factors on course of hypothyrosis in postoperative period was shown.     

Paralyses of the recurrent laryngeal nerve following strumectomy in late follow-up

Over a period of 5 years, 323 patients underwent an operation on a goiter. A postoperative paralysis of the recurrent laryngeal nerve occurred in 31 patients, most in malignancies and recurrent goiters. 26 patients were controlled at least 1 year after operation. 65% of the patients have a fully recovered voice and normal vocal cord function. Another 14% showed a normal voice for daily use by functional compensation of the paralysis. Only in 4 patients (16%) the operation resulted in a permanent modest or severe hoarseness as consequence of a thyroidectomy in cancer.     

Functional state of the liver in patients with an acute destructive pancreatitis in the early postoperative period

The efficacy of conventional complex treatment and such, including pentoxyphylline, lipoic acid and the aminoacids mixture, was studied in early postoperative period in 64 patients with an acute destructive pancreatitis. The highest levels of general and direct bilirubins, the aminotransferases activity were established initially in those patients, in whom the polyorgan insufficiency syndrome (PIS) occurred subsequently. More significant normalization of the indexes under the influence of treatment was observed in patients without PIS, in patients with PIS the pharmacological resistance was registered. More favourable course of postoperative period was observed in patients, in whom pentoxyphylline, lipoic acid and the aminoacids mixture were included in complex of treatment.     

Dunhill手术治疗双侧结节性甲状腺肿的临床疗效分析

目的:探讨Dunhill手术(一侧甲状腺全切加对侧次全切除术)治疗双侧结节性甲状腺肿的临床效果。方法:收集哈尔滨医科大学附属第四医院2011年1月—2017年1月间开展的58例Dunhill手术与60例双侧甲状腺次全切除术的患者临床资料进行回顾性分析,所有患者术中病理均证实为双侧结节性甲状腺肿。结果:两组患者术前一般资料均无统计学差异(均P0.05)。与双侧次全切除术组比较,Dunhill手术组的平均手术时间明显延长(95.41minvs.52.48min,P=0.000),术后第1天低血钙发生率明显升高(12.1%vs.1.7%,P=0.031),两组术中出血量、甲状旁腺移植例数、喉返神经损伤发生率、术后第3天低钙血症发生率、甲状旁腺功能低下发生率均无统计学差异(P=1.000)。随访期间,Dunhill手术组患者复发率明显低于双侧甲状腺次全切除术组患者(P=0.027)。结论:Dunhill手术治疗双侧结节性甲状腺肿安全、有效,且能有效降低术后复发,推荐其临床应用。     

Low-dose ketamine affects immune responses in humans during the early postoperative period

Background: Anaesthesia and surgery are associated with impairment of theimmune system expressed as an excessive proinflammatory immuneresponse and suppression of cell-mediated immunity that mayaffect the course of the postoperative period. Addition of anaestheticagents capable of attenuating the alterations in perioperativeimmune function may exert a favourable effect on patients’healing. We have assessed the effect of preoperative administrationof a sub-anaesthetic dose of ketamine on the mitogen responseand production of interleukin (IL)-1ß, IL-2, IL-6,and tumour necrosis factor (TNF)- by peripheral blood mononuclearcells (PBMCs), as well as natural killer cell cytotoxicity (NKCC)in patients undergoing abdominal surgery. Methods: Seventeen patients admitted for elective abdominal surgery weregiven ketamine 0.15 mg kg^–1 i.v. 5 min before inductionof general anaesthesia. Nineteen patients received a similarvolume of isotonic saline 5 min before induction of the anaesthesia.PBMCs were isolated from venous blood before and 4, 24, 48,and 72 h after operation for IL-1ß, IL-2, IL-6, andTNF- secretion, and NKCC assessment. Results: Four hours after operation, the cells from patients in the ketaminegroup showed a significantly suppressed production of IL-6 (P< 0.01) compared with controls. The production of IL-2 didnot change from that of the preoperation samples. TNF- secretionwas significantly elevated in the control group 4 h after operation(P < 0.05). Conclusions: Addition of small doses of ketamine before induction of anaesthesiaresulted in attenuation of secretion of the proinflammatorycytokines IL-6 and TNF-, and in preservation of IL-2 productionat its preoperative level. It is suggested that this anaestheticmay be of value in preventing immune function alterations inthe early postoperative period.     

The course of the postoperative period in patients with cerebral gliomas after different volumes and kinds of surgery

The investigation included 340 patients with cerebral gliomas. Under analysis there were age, gender, neurological status and Karnovsky status before and after operation, localization of the tumor, type and volume of surgical intervention, postoperative complications. It was shown that radical extirpation of glial formations facilitated more favorable course of the postoperative period. Partial ablation of gliomas is associated with greater risk of the development of postoperative complications and neurological dysfunctions. As the main method of surgical treatment of patients with gliomas located in the functionally significant and deep areas of the brain stereotaxic cryotomy is thought to be indicated.     

Use and abuse of iodine in the management of goiter

The answers to this questionnaire reveal that 96 per cent of the physicians suggest the use of iodine in the form of Lugol's solution (10 drops weekly) or one 10 mg. idostrone tablet weekly, alone or with dessicated thyroid extract in the treatment of colloid goiter.Eighty-eight per cent find it necessary to correct mild diffuse (exophthalmic) goiter by subtotal thyroidectomy, and another 8 per cent suggest surgery if the condition is not cured in a reasonable period of time with iodine medication.The opinion is practically unanimous (99 per cent) that nontoxic nodular (adenomatous) goiter should not be treated with iodine medication. As many as 79 per cent of the physicians agree that the promiscuous administration of iodine produces activation or toxicity in this type of goiter.In toxic goiter, we note the greatest abuse in the use of iodine medication. Almost 90 per cent of the patients treated by goiter surgeons have had previous iodine medication, which produces an increase in the operative risk, and a very definite increase in the morbidity, especially since stage operations are often necessary in order to prevent an increased mortality. Practically all postoperative thyroid crises occur in patients who have had long continued iodine medication before consulting the goiter surgeon.