淋巴细胞性甲状腺炎合并甲状腺癌

报告了经外科手术后病理证实为淋巴细胞性甲状腺炎合并甲状腺癌９例，合并率１３％。结合文献探讨了淋巴细胞性甲炎和甲癌之间的发病关系，以及二者在诊断２，治疗和预后等方面的一系列信为淋巴细胞性甲炎应视为甲癌发生的讽顾因素之一。     

慢性淋巴细胞性甲状腺炎合并甲状腺癌40例临床分析

目的 分析慢性淋巴细胞性甲状腺炎合并甲状腺癌患者的临床特征、治疗及预后.方法 回顾性分析2002年10月-2011年4月大连医科大学附属第一医院普外科收治的40例慢性淋巴细胞性甲状腺炎合并甲状腺癌病例,患者均为女性.结果 超声诊断或疑诊为慢性淋巴细胞性甲状腺炎2例;行CT检查11例,提示甲状腺腺瘤2例,甲状腺癌合并淋巴结转移1例,考虑慢性淋巴细胞性甲状腺炎3例,其余皆未明确诊断.40例患者均行手术治疗,39例病理类型为慢性淋巴细胞性甲状腺炎合并甲状腺乳头状癌,1例为慢性淋巴细胞性甲状腺炎合并甲状腺髓样癌.40例患者术后均口服左旋甲状腺钠片.随访36例,失访4例,复发1例,其余患者情况稳定.结论 淋巴细胞性甲状腺炎合并甲状腺癌术前较准明确诊断,需要通过甲状腺相关抗体、影像学及术中、术后病理检查等手段综合应用;术中、术后病理诊断是确诊手段.其主要病理类型是甲状腺乳头状癌,其中微小乳头状癌占有较大比例,手术治疗是最主要的治疗方式.     

慢性淋巴细胞性甲状腺炎的鉴别诊断:附108例报告

目的探讨慢性淋巴细胞性甲状腺炎（CLT）的诊断及鉴别诊断方法。方法回顾性分析20年间治疗的108例CLT患者的临床资料，诊断手段包括甲状腺功能测定、抗甲状腺抗体测定、影像学检查、细胞学穿刺、药物诊断性治疗及手术病理诊断；将94例手术患者的术前诊断与术后病理结果进行对比分析。结果108例中有14例未手术，其中9例经B超引导下行细胞学穿刺检查确诊，5例经泼尼松药物试验治疗而确诊。行手术治疗的94例中术前诊断为结甲57例。甲癌16例，结甲伴甲亢13例，CLT伴结甲8例。术后病理诊断为CLT59例（62．7％），CLT伴结甲19例（20．2％），CLT伴甲亢10例（10．6％），CLT伴甲癌6例（6．3％）。术前误诊率91．5％（86例）。结论CLT临床表现多样，容易发生误诊。对甲状腺功能、抗甲状腺抗体测定及影像学检查结果的仔细分析有助于CLT的确诊。细胞学穿刺检查和药物诊断性治疗是CLT确诊的较好方法。术前明确诊断可减少对CLT的不必要手术处理。     

慢性淋巴细胞性甲状腺炎的诊治(附77例报告)

目的总结慢性淋巴细胞性甲状腺炎及其合并甲状腺疾病的诊治经验。方法回顾性分析我院2002年11月至2005年3月期间手术治疗并经病理检查证实的77例慢性淋巴细胞性甲状腺炎及其合并甲状腺疾病的临床资料。结果单纯慢性淋巴细胞性甲状腺炎53例，慢性淋巴细胞性甲状腺炎合并乳头状癌10例，滤泡状癌1例，非何杰金氏淋巴瘤2例，结节性甲状腺肿6例，滤泡性腺瘤4例，甲状旁腺腺瘤1例。手术治疗效果良好。结论慢性淋巴细胞性甲状腺炎临床表现复杂，合并甲状腺其他疾病多，术前诊断困难。但仔细的体检，结合甲状腺相关激素、彩色多普勒以及细针穿刺细胞学检查可以提高术前诊断率，重视术中甲状腺薄层切片及冰冻切片检查有利于提高术中确诊率，从而选择正确的手术方式。     

桥本病合并甲状腺癌临床分析

桥本病又称慢性淋巴细胞性甲状腺炎,是一类自身免疫性疾病,随着目前甲状腺结节检出率的提高,桥本病合并甲状腺癌者发病率日益升高。本组回顾性观察本院2000～2008年178例手术治疗甲状腺结节合并桥本病患者中,26例甲状腺乳头状癌临床资料,分析桥本病合并甲状腺癌的诊断及治疗方法。     

桥本甲状腺炎并发甲状腺乳头状癌40例临床分析

目的 分析桥本甲状腺炎并发甲状腺乳头状癌的临床特征、诊断、治疗及预后情况。方法 回顾性分析1998年6月至2005年10月经病理证实为桥本甲状腺炎并发甲状腺乳头状癌40例，对其甲状腺功能指标、诊断及手术治疗进行分析。结果 桥本甲状腺炎并发甲状腺乳头状癌占同期291例经病理证实为桥本甲状腺炎的13．8％（40／291）。40例中7例发生淋巴结转移（7／40），随访发现对侧甲状腺乳头状癌1例，经再次手术无复发，其中7例病人随访5年以上，至今均存活。结论 桥本甲状腺炎并发甲状腺乳头状癌的发生率呈上升趋势；对于合并自身甲状腺抗体阳性的中青年女性桥本甲状腺炎病人，甲状腺不规则结节性肿大发生癌变的发生率大于弥漫肿大者；桥本甲状腺炎并甲状腺乳头状癌淋巴结转移率低，总体预后好。     

桥本甲状腺炎183例外科治疗分析

目的 总结桥本甲状腺炎（HD）及其并存病的外科诊治经验。 方法 回顾分析1999年1月至2007年10月浙江大学医学院附属第二医院经手术后病理证实183例HD病人的临床资料。 结果 183例均经手术治疗。其中单纯HD 104例,HD合并甲状腺癌49例（26.7%,其中局部癌变5例,微小乳头状癌32例,直径>1.0cm的甲状腺乳头状癌12例）,HD合并结节性甲状腺肿15例（8.2%）,HD合并腺瘤样结节8例（4.4%）,HD合并Graves病7例（3.8%）。手术方式据病变部位及性质和术中冰冻切片而定。以术后病理诊断为标准,术前诊断HD的正确率为78.7%,诊断甲状腺癌为53.1%;术中FS诊断HD的正确率为95.6%,诊断甲状腺癌为95.9%。1例微小乳头状癌行双侧甲状腺次全切除术后2年局部复发,1例HD行双侧甲状腺次全切术后4年结节复发,余无复发和转移现象。 结论 综合应用临床查体,自身抗体检测及影像学检查等资料有助于提高HD的术前诊断正确率;HD合并其他甲状腺疾病的发生率高,应警惕并存甲状腺癌,特别是微小癌的可能性。     

甲状腺疾病并存局灶性淋巴细胞性甲状腺炎57例临床分析

目的总结甲状腺疾病并存局灶性淋巴细胞性甲状腺炎的诊治方法，并探讨其与桥本病混淆的原因。方法对近25年间经手术治疗病理诊断为桥本病的207例患者中，143例桥本病合并其他甲状腺疾病的临床资料进行回顾性分析。结果143例中57例为甲状腺疾病并存局灶性淋巴细胞性甲状腺炎，占桥本病的27．5％（57／207），占桥本病合并其它甲状腺疾病的39．9％（57／143）。术中病理切片显示局灶性淋巴细胞浸润的阳性率为87．7％（50／57）。术后甲状腺功能减退（甲减）的发生率为19．3％（11／57）；其中亚临床型甲减7例，占12．3％（7／57）。结论甲状腺疾病并存局灶性淋巴细胞性甲状腺炎与甲状腺疾病并存桥本病两者病理改变的性质可能不同。术中切片检查有助于该病的诊断，并对指导手术切除腺体的范围具有重要的意义。     

慢性淋巴细胞性甲状腺炎的诊断与治疗

目的 探讨慢性淋巴细胞性甲状腺炎（CLT）的诊断，以及CLT合并其它甲状腺疾病的治疗选择。方法 对1986－1999年经治的63例CLT的临床资料进行回顾性分析。结果 经非手术诊断26例（其中11例为经细针穿刺病理学诊断），诊断率41．3％；其余37例分别误诊为其他甲状腺疾病而行手术治疗，其中合并结节性甲状腺肿2例，合并甲亢6例，合并甲状腺瘤1例，合并甲状腺癌2例，合并甲状腺恶性淋巴瘤1例。63例中19例予甲状腺素片治疗，3例未予治疗；4例服甲状腺素片后行手术治疗，37例予手术治疗。非手术治疗组均获得较满意的近期效果；而手术组中29例（78．4％）获随访1－6年，5例发生甲减。全面的血清免疫学检查，结合细钾穿刺病理检查可望提高CLT的诊断率及非手术诊断率。对可疑病例须谨防遗漏其它合并症。本病以非手术治疗为主，对合并其它病变者，根据病理学类型选择适当的手术或非手术处理方式。     

慢性淋巴细胞性甲状腺炎的鉴别诊断

慢性淋巴细胞性甲状腺炎一般不应手术干预，本文总结我科１０年中收治的３６例ＣＬＴ，其中３１例术前拟诊为甲癌，甲瘤或其它甲状腺疾病，而接受了不同范围的甲状腺切除手术，通过分析研究这些病例的临床特点，总结对其检查和诊断过程中的经验教训，提出了对ＣＬＴ的诊断对策。目的在于加强对ＣＬＴ的鉴别诊断，减少对ＣＬＴ不必要的手术处理。     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

A Teaspoon Pump for Pumping Blood with High Hydraulic Efficiency and Low Hemolysis Potential

Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

A comparison of the inhibitory effects of four volatile anaesthetics on the metabolism of chlorzoxazone, a substrate for CYP2E1, in rabbits

Background: Halothane inhibits in vitro and in vivo activity of cytochrome P-450 (CYP) 2E1. There are several fluorinated volatile anaesthetics besides halothane, and most of them are defluorinated by CYP2E1. It is unclear whether other fluorinated anaesthetics inhibit the in vivo activity of CYP2E1.
Methods: We compared the inhibitory effects of therapeutic concentrations of four inhalational anaesthetics, halothane, enflurane, isoflurane, and sevoflurane, on chlorzoxazone metabolism in rabbits receiving artificial ventilation.
Results: All four inhalational anaesthetics decreased arterial blood pressure and increased plasma chlorzoxazone concentration. However, no significant differences in the plasma chlorzoxazone concentration were found between the four anaesthetics. The estimated chlorzoxazone clearance increased after beginning inhalation with all four agents, but no significant difference in clearance was noted between agents.
Conclusions: At therapeutic concentrations, the in vivo inhibitory effect on chlorzoxazone metabolism was similar for all four inhalational anaesthetics examined, even though their chemical characteristics and extent of hepatic metabolism differ considerably.     

Tissue perfusion in relation to cardiac output during continuous positive-pressure ventilation and administration of propranolol or verapamil

Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H₂O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg⁻¹ followed by 0.15 mg · kg⁻¹ · h⁻¹, n=8) or verapamil (0.1 mg · kg⁻¹ followed by 0.3 mg · kg⁻¹ · h⁻¹, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Volatile anaesthetics reduce adhesion of blood platelets under low-flow conditions in the coronary system of isolated guinea pig hearts

Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.     

Synergistic interaction between the effects of propofol and midazolam with fentanyl on phrenic nerve activity in rabbits

Background: It has been shown that the depressive effects of both propofol and midazolam on consciousness are synergistic with opioids, but the nature of their interactions on other physiological systems, e. g. respiration, has not been fully investigated. The present study examined the effect of propofol and midazolam alone and in combination with fentanyl on phrenic nerve activity (PNA) and whether such interactions are additive or synergistic. Methods: PNA was recorded in 27 anaesthetised and artificially ventilated rabbits. In three groups, propofol, fentanyl and midazolam were administered intravenously in incremental doses to construct dose-response curves for the depressant effects of each one on PNA. In another two groups, the effect of pretreatment with either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. on the effects of propofol and fentanyl respectively on PNA were studied. Results: Propofol and fentanyl caused a dose-dependent depression of PNA with complete abolition at the highest total doses of 16 mg · kg^?1 i. v. and 32 μg · kg^?1 i. v., respectively. In contrast, midazolam in incremental doses to a total of 0.8 mg · kg^?1 reduced mean PNA by 63%, but approximately 12% of PNA remained at a total dose as high as 6.4 mg · kg^?1. The mean ED₅₀s, calculated from dose-response curves, were 5.4 mg · kg^?1, 3.9 μg · kg^?1 and 0.4 mg · kg^?1 for propofol, fentanyl and midazolam, respectively. Initial doses of either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. acted synergistically with subsequent doses of either propofol or fentanyl to abolish PNA at total doses of 8 mg · kg^?1 and 8 μg · kg^?1, respectively. Conclusion: Fentanyl has a synergistic interaction with both propofol and midazolam on PNA and hence potentially on respiration.     

Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery

Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg^?1 · min^?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min^?1 · m^?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO₂I) and oxygen consumption index (VO₂I) were also significantly increased in the dopexamine group (DO₂I: from 416±91 to 717±110 ml/m² · m²; VO₂I: from 98±25 to 157±22 ml/m² · m²), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.     

Systemic analgesia adapted to the children's condition

A concept of balanced analgesia using nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol (acetaminophen), opioids, and corticosteroids can also be used in patients with pre-existing illnesses. NSAIDs are the most effective treatment for acute pain of moderate intensity in children; however, these drugs should be avoided in patients at increased risk for serious side effects, e.g. patients with renal impairment, bleeding tendency, or extreme prematurity. NSAIDs can be given with minimal risks to the younger child with mild to moderate asthma, and, in these patients, the use of steroids can be encouraged; in addition to their antiemetic and analgesic action, a beneficial effect on asthma symptoms can be expected. In the non-intubated child with cerebral trauma, exaggerated sedation caused by opioids and increased bleeding tendency caused by NSAIDs must be avoided. In neonates and small infants, the oral administration of sucrose or glucose is helpful to minimize pain reaction during short uncomfortable interventions.