非功能性甲状旁腺囊肿6例临床分析

目的探讨非功能性甲状旁腺囊肿的临床特点,总结其诊治经验。方法回顾性分析6例非功能性甲状旁腺囊肿临床资料,结合该病的临床症状、辅助检查、随诊情况,讨论其诊断、治疗与预后。结果6例患者均行手术治疗,术后病理确诊为非功能性甲状旁腺囊肿,术后均获得随访,随访时间6个月～5年,平均42个月,无复发。结论非功能性甲状旁腺囊肿术前诊断困难,确诊依靠病理检查,手术切除为主要治疗手段。     

无功能性甲状旁腺囊肿：附15例报告

目的 了解无功能性甲状旁腺囊肿的临床特点,探讨其诊治方法.方法 对近16年来收治的无功能性甲状旁腺囊肿15例患者的临床资料进行回顾性分析研究.结果 术前均未获得诊断,均经术后病理检查证实.全组均行手术切除获得治愈,随访无复发.结论 对无功能性甲状旁腺囊肿,病理学检查是最可靠的诊断方法,针刺抽液测定PTH或细胞学检查有助于术前诊断.手术切除是最理想的治疗方法.     

无功能性甲状旁腺囊肿的诊断和治疗

目的探讨无功能性甲状旁腺囊肿（NFPTC）的诊断和治疗方法。方法回顾性分析中国医科大学附属第一医院2008年3月至2012年10月期间手术治疗的6例NFPTC患者的临床资料。结果6例患者中术前明确诊断3例;术后病理学检查证实均为甲状旁腺囊肿。术后无并发症发生;随诊7个月～5年,平均32个月,无复发。结论NFPTC术前确诊困难,超声影像学特点对诊断有参考价值,手术切除是首选治疗方法。     

非功能性甲状旁腺囊肿的鉴别诊断与治疗

目的探讨非功能性甲状旁腺囊肿的鉴别诊断与治疗。方法回顾性分析中国医科大学附属盛京医院普外科2003年1月至2013年4月期间收治的6例非功能性甲状旁腺囊肿患者的临床资料。结果6例患者术前均未确诊,其中4例诊断为甲状腺囊肿,1例笼统诊断为颈部肿物,1例仅注意了甲状腺病变。6例均行手术治疗,其中5例行左甲状旁腺囊肿切除术,1例同时行甲状腺癌根治、左甲状旁腺囊肿切除术。术后病理报告5例为甲状旁腺囊肿,1例为甲状旁腺囊肿合并右甲状腺乳头状微小癌。2例患者失访;4例患者随访9～24个月,平均19个月,均无甲状旁腺囊肿及甲状腺癌的复发或转移。结论非功能性甲状旁腺囊肿是真正意义上的甲状旁腺囊肿,临床少见,术前确诊率低。甲状旁腺囊肿切除术是一种安全而有效的治疗手段。     

功能性甲状旁腺囊肿的诊断及外科处理

目的了解功能性甲状旁腺囊肿（ＦＰＴＣ）的特点,总结其诊治经验。方法回顾性研究了我院１９８４～１９９６年收治功能性甲状旁腺囊肿６例的临床表现及血钙、甲状旁腺素、Ｂ型超声和ＣＴ等辅助检查的特点;并结合文献讨论了功能性甲状旁腺囊肿诊治的有关问题。结果本组６例患者均经手术切除、病理检查证实为ＦＰＴＣ;其中囊实性２例,合并甲状旁腺腺瘤１例,位于纵隔１例;术后均恢复正常。结论功能性甲状旁腺囊肿应手术切除,避免囊肿穿刺活检。     

无功能性甲状旁腺囊肿的外科诊治

目的:探讨无功能性甲状旁腺囊肿的临床特征、诊断及治疗方法 ,提高对无功能性甲状旁腺囊肿的诊治水平。方法:回顾性分析1995年4月至2014年8月期间我院收治的无功能性甲状旁腺囊肿8例病人的临床资料。结果:共有8例病人,中位年龄56(26~73)岁。肿瘤平均直径(3.4±0.4)(2.1~5.6)cm。术前甲状腺功能、血清钙检测均在正常范围。术前B超检查8例病人均提示囊性占位。术中行冷冻检查,7例提示囊肿为甲状旁腺来源。所有8例术后病理均证实为甲状旁腺囊肿。所有病例均完整切除囊肿。其中1例伴有结节性甲状腺肿行甲状腺大部切除术,1例因同时伴有甲状腺乳头状癌,行根治性切除手术。术后1例病人出现声音嘶哑,在术后3个月时恢复正常。中位随访时间8.4年,随访期间无囊肿复发。结论:术前超声和CT检查可初步诊断无功能性甲状旁腺囊肿,确诊需待病理检查。完整的囊肿切除是无功能性甲状旁腺囊肿的有效治疗方法。     

原发性甲状旁腺肿瘤的诊断和外科治疗:附12例报告

目的探讨甲状旁腺肿瘤的诊断和外科治疗方法。方法回顾性分析近5年余中山大学附属第三医院手术确诊、年龄11～71岁的12例甲状旁腺肿瘤临床资料。包括甲状旁腺癌并甲状腺肿及多发性内分泌腺瘤I型（MEN-1）1例；甲状旁腺囊肿1例；甲状旁腺瘤10例，其中1例为双侧甲状旁腺瘤并MEN-1，1例合并甲状腺肿，1例为异位腺瘤。结果依靠血钙、血磷、B超、CT及99mTc-MIBI等检查10例在术前确诊（2例术后确诊）。8例腺瘤和1例囊肿行单侧探查及甲状旁腺瘤切除；行双侧探查3例，其中1例甲状旁腺瘤并甲状腺肿行双侧甲状腺大部分切除（包括旁腺瘤），1例甲状旁腺癌为MEN-1行根治性切除及切除垂体肿瘤手术，1例甲状旁腺瘤并MEN-1术前行胰岛素瘤和肾上腺皮质瘤切除。平均随访时间38个月。随访期间11例血钙正常，8例无症状生存；1例腺瘤术后对侧甲状旁腺增生，再次手术。结论定位明确的单发甲状旁腺瘤或囊肿可单侧探查，MEN-1和腺癌或伴结节甲状腺肿者应双侧探查。术后密切随访不仅可确定手术效果，而且有利于早期发现复发患者和MEN-I患者。     

原发性甲状旁腺功能亢进35例诊治分析

目的探讨原发性甲状旁腺功能亢进（PHPT）的诊断和治疗方法。方法回顾性分析15年间收治的35例PHPT患者的临床资料。结果26例行超声检查的阳性准确率为88.5％（23／26）。22例行放射性计算机X线断层扫描（ECT）检查的阳性准确率为95.5％（21／22）。27例甲状旁腺腺瘤均行单侧探查；3例甲状旁腺癌均参照甲状腺癌行根冶性切除和颈部淋巴结功能性清扫术；4例甲状旁腺增生中2例单侧探查，2例行双侧探查术；1例甲状旁腺腺瘤恶变行患侧的甲状腺和甲状旁腺全切除。其中1例腺瘤并发甲状旁腺危象者经内科紧急处理后急诊手术切除腺瘤，症状缓解。手术后均发生不同程度的低血钙症，应用钙剂后症状缓解。部分患者骨痛缓解或消失。结论超声和ECT可作为首选的定位诊断方法。定性诊断主要依据血钙和血甲状旁腺素的同步升高，一旦明确即应手术治疗。定位明确的甲状旁腺腺瘤可行单侧探查。定位不明确或异位者可在放射性核素指导下行手术探查。甲状旁腺危象应在内科治疗控制症状后积极手术探查。     

普通外科——甲状腺、甲状旁腺

甲状腺良性病变术中损伤喉返神经的原因及预防（附2266例分析）；腔镜乳晕径路甲状腺良性肿瘤手术101例分析；颈部非甲状腺肿块2236例临床分析；无功能性甲状旁腺囊肿：附15例报告；超声检查对钙化的甲状腺结节的诊断意义；甲状腺癌的外科治疗；甲状腺结节的诊治进展（综述）；乳晕入路腔镜甲状腺切除术安全可行性的探讨；     

甲状腺舌管囊肿与瘘的诊断和治疗

目的 探讨甲状腺舌管囊肿与诊治问题。方法 回顾性分析我院手术治疗67例甲状腺舌管囊肿与瘘患者的临床资料。结果 本组术前诊断率为92．5％，行B超检查者诊断准确率为96．1％；全组均行手术治疗，其中作单纯切除14例，连部分舌骨膜切除12例，连舌骨中段切除（Sistrun′s手术）41例。54例获随访，其中随访舌管囊肿患者43例，复发4例，复发率9．3％；随访瘘管患者11例，复发2例，复发率18．2％。结论 高频超声检查对甲状腺舌管囊肿的诊断及鉴别诊断具一定特征性及临床价值。术后复发原因与手术方式以及术前感染是否控制有关，在囊肿未感染前正确施行Sistrunk′s手术可降低要后复发率。     

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.     

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.     

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.     

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.     

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.     

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.     

Intraoperative autotransfusion is associated with modest reduction of allogeneic transfusion in prosthetic hip surgery

Background: The efficacy of intraoperative salvage and washing of wound blood and the predictors of allogeneic red cell transfusions in prosthetic hip surgery are insufficiently known.
Methods: In 96 patients, undergoing primary or revision surgery, salvaged and washed red cells and, if necessary, allogeneic blood were used to keep haematocrit not lower than 33%. The bleeding of red cells during hospital stay was calculated from the red cell balance. The preoperative red cell reserve (millilitres of red cells in excess of a haematocrit of 33%) was estimated and the difference between this volume and the total bleeding of red cells was retrospectively used to classify patients with regard to the need for red cells. Stepwise regression analysis was used to define patient-related variables associated with allogeneic blood transfusion.
Results: Preoperative knowledge of the type of operation (primary, revision), the preoperative red cell reserve, and the body mass could predict roughly half of the need for banked blood (r²=0.45). Only one-third of the total bleeding of red cells was retransfused. For complete avoidance of allogeneic blood, autotransfusion was most effective in patients with a moderate need (0–4 u). However, 32% of such patients required allogeneic blood.
Conclusions: Autotransfusion has a limited efficacy to decrease the need for allogeneic blood, and other blood-saving methods should be added for this purpose. It is difficult to predict the need for allogeneic blood preoperatively.     

缺氧对肾小管上皮细胞分泌外泌体的影响

目的    观察缺氧对肾小管上皮细胞分泌外泌体的影响,探讨外泌体在缺氧致肾脏损伤中的作用及机制。 方法    （1）常氧（21% O₂）及缺氧（1% O₂）分别处理大鼠肾小管上皮细胞（NRK-52E）48 h,收集细胞上清液并使用高速梯度离心法分离外泌体。采用透射电镜、纳米示踪分析、Western印迹、蛋白浓度定量鉴定并比较两组外泌体的基本特性。（2）在共培养实验中,以不同浓度（1、10、50、100、300 mg/L）的常氧外泌体、缺氧外泌体分别干预脂多糖（LPS）诱导的大鼠原代腹腔巨噬细胞,使用实时荧光定量PCR与酶联免疫吸附试验（ELISA）法分别检测巨噬细胞白细胞介素6（IL-6）、肿瘤坏死因子α（TNF-α）、诱导型氮氧化物合酶（iNOS）水平;使用Western印迹法检测巨噬细胞磷酸化（p）STAT/STAT及细胞因子信号传导抑制蛋白1（SOCS1）的蛋白表达;最后,使用实时荧光定量PCR法检测常氧外泌体与缺氧外泌体中炎性反应相关微RNA（microRNA,miR）的表达差异。 结果    （1）离心得到的囊泡具有外泌体典型的结构,粒径小于150 nm,表达外泌体标志蛋白CD63,说明分离得到外泌体。缺氧对肾小管上皮细胞分泌的外泌体形态、粒径分布比例无明显影响,但提高了外泌体的分泌量。（2）缺氧外泌体相比于常氧外泌体促进了LPS诱导的M1型巨噬细胞IL-6、TNF-α、iNOS 的表达和分泌（均P＜0.01）,同时提高STAT的磷酸化水平并减少SOCS1的蛋白表达（均P＜0.01）;对炎性反应相关microRNA检测发现缺氧外泌体中miR-155、miR-27a表达量较常氧外泌体明显升高（P＜0.05）。 结论    缺氧可改变外泌体的生物学功能,表现为协同促进LPS诱导的M1型巨噬细胞的表型转化,这可能是慢性肾脏病微炎性反应状态持续的原因之一。     

In Vitro Function and Durability Assessment of a Novel Polyurethane Heart Valve Prosthesis

Abstract While flexible-leaflet, central-flow prosthetic heart valves promise relief from anticoagulation therapy, they continue to be restricted by inadequate durability. In consequence, a novel trileaflet valve, made entirely from polyurethane, has been developed. A batch of 6 consecutively manufactured polyurethane valves was subjected to hydrodynamic function and accelerated fatigue testing. Computerized data acquisition and control systems have been introduced to improve valve testing methodologies. In terms of hydrodynamic function, the polyurethane valve demonstrates transvalvular pressure gradients similar to those for a bioprosthetic valve (Carpentier-Edwards) and levels of retrograde flow significantly less than those for either the bioprosthetic valve or a bileaflet mechanical valve (St Jude Medical). The equivalent of 10 years of cycling without failure has been exceeded by all 6 polyurethane valves in accelerated fatigue tests with 2 valves remaining intact after 674 million cycles (equivalent to approximately 17 years) in continuing tests. Highspeed photography revealed considerable differences in leaflet motion between valves cycled at accelerated and physiological rates.