Reoperative Thyroid Surgery

Reoperative thyroid surgery is an uncommon operation associated with a high complication rate. We retrospectively reviewed the data of 115 patients to study the incidence of complications after reoperative thyroid surgery. There were 107 women and 8 men (13.4:1.0) with an average age of 42.8 years (range 18–80 years). The most frequent indication for reoperation was completion thyroidectomy for a carcinoma identified by permanent sections (50 patients, 43.5%). Reoperative surgery was performed on 13 (11.3%) patients with recurrent thyroid cancer. The remaining 52 patients underwent reoperation for recurrent thyrotoxicosis (12 patients, 10.4%), recurrent nodular goiter (28 patients, 24.3%) or recurrent multinodular goiter (12 patients, 10.4%). Seven patients with recurrent nodular goiter and one patient with recurrent thyrotoxicosis underwent total thyroidectomy for the presence of malignancies that were identified by frozen sections. Overall, the interval between the initial and reoperative procedures ranged from 1 day to 33 years (2335 ± 272 days). The length of hospital stay was 5.8 ± 0.5 days. The length of time needed for reoperative thyroid surgery was 122.0 ± 6.2 minutes. There was no 30-day perioperative mortality. The postoperative complications consisted of transient hypoparathyroidism in six patients (5.2%), permanent hypoparathyroidism in two patients (1.7%), transient RLN palsy in 3 patients (2.6%), and permanent recurrent laryngeal nerve palsy in two patients (1.7%). Reoperative thyroid surgery can be performed safely with little morbidity to the patient.     

Fracture of the porous-coated metal tray of a biologically fixed knee prosthesis. Report of a case

It has been assumed that, when properly implanted, a biologically fixed device is less prone to loosening and probably to fatigue failure as well. This case demonstrates that many of the known risk factors of loosening or fatigue fracture of cemented tibial replacement devices must be considered when using devices designed for biologic fixation. Age, weight, axial alignment, and bone substrate have been identified as probable contributing factors to failure in the case reported here. Manufacturing technique and changes in material properties associated with porous coating should also be carefully tested for factors predisposing the components to fatigue failure.     

Rupture of the tendon of the long head of the biceps brachii. Surgical versus nonsurgical treatment

Twenty-seven shoulders (in 26 patients) that had surgical repair of a rupture of the long head of the biceps tendon between 1962 and 1981 were evaluated at three to 22 years after injury (mean, 13 years). Thirty similar patients had been treated nonsurgically and were evaluated two to 15 years (mean, 4.6 years) after tendon rupture. Biomechanical testing was performed on ten patients in the surgical group and 13 in the nonsurgical group. Residual arm pain was infrequent in both surgically and nonsurgically treated groups. Residual subjective weakness at the elbow was reported in four of the surgical group and in 20 of the nonsurgical group. Surgically treated patients returned to work later than nonsurgical patients; however, 11 in the nonsurgical group were not able to return to full work capacity, versus only two in the surgical group. On biomechanical testing, the nonsurgical group had lost a mean of 21% of supination strength and 8% of elbow flexion strength but had no weakness in grip, pronation, or elbow extension. The surgical group had lost no strength in any of these testing modes.     

黄连细胞二步法悬浮培养生产黄连生物碱类成分的探索

为提高用植物细胞培养生产镒生代谢产物的单位产量，作者对黄连细胞采用二步法悬浮培养生产黄连生物碱进行了探索。结果显示：黄连细胞采用一步法悬浮培养６周，细胞干，鲜重产率分别为２０．９６ｇ／Ｌ和１７４．９２ｇ／Ｌ，增重约７００％，细胞中总生物碱含量为１４．７９ｍｇ／ｇ．ｃｅｌｌ ｄｗ，培养基中生物碱量为１２．９６ｍｇ／Ｌ，每升培养液共可收获生物碱３２３ｍｇ。采用先在生长培养基中培养３周，在合成碱量为１２     

替米沙坦治疗原发性高血压的疗效和安全性

目的 :观察替米沙坦治疗原发性高血压的疗效和安全性。方法 :进行随机、双盲、双模拟、平行分组对照试验。符合条件的轻中度高血压患者随机分为 2组 :替米沙坦组和氯沙坦组。每天一次口服替米沙坦 40mg或氯沙坦 5 0mg ,每 2周随访 1次。 4周后 ,如患者舒张压 (DBP)≥ 90mmHg则增加剂量 ,每天一次口服替米沙坦 80mg或氯沙坦 10 0mg。治疗前后分别查心电图 ,血、尿常规 ,血生化检查和常规查体。 结果 :(1)治疗 8周末 ,替米沙坦组和氯沙坦组患者的DBP均显著降低 ,2组下降幅度相似 (11.9mmHgvs 10 .4mmHg) ;(2 )治疗8周末 ,替米沙坦组收缩压 (SBP)下降幅度稍大于氯沙坦组 (9.5mmHgvs 6.2mmHg) ;(3 )替米沙坦降压有效率为 83 .3 % ,稍高于氯沙坦组 69.2 % ,无统计学差异 ;(4 ) 2组的不良事件发生率相似 (替米沙坦组 3 3 .3 % ,氯沙坦组 3 4.6% )。最常见的不良事件是头晕、头痛 ,多为轻度 ,可迅速缓解。结论 :替米沙坦 40mg～ 80mg ,每天一次口服治疗轻中度高血压安全有效     

食管平滑肌瘤的微创手术治疗

目的探讨微创手术在食管平滑肌瘤治疗中的临床应用价值. 方法回顾性分析1996年9月～2002年10月26例食管平滑肌瘤采用微创手术治疗的临床资料. 结果电视胸腔镜食管平滑肌瘤摘除术23例,其中3例(2例胸膜腔紧密粘连,1例肿瘤无法定位)中转开胸(胸腔镜辅助小切口);经颈部食管平滑肌瘤摘除术2例;经食管镜食管平滑肌瘤切除1例.26例手术顺利,术后恢复平稳,无手术死亡及严重并发症,术后病理诊断均为平滑肌瘤.随访2～73个月,平均32.3个月,无复发. 结论电视胸腔镜肌瘤摘除术可作为食管固有肌层平滑肌瘤的首选治疗方法,对于食管粘膜肌层的平滑肌瘤,可考虑经食管镜切除.     

环氧合酶-2及其选择性抑制剂塞来昔布对结肠癌肝转移瘤VEGF、FGF-2影响的实验研究

目的 :研究环氧化酶 2及其选择性抑制剂塞来昔布和血管生成因子VEGF、FGF 2间的关系 ,从而探讨环氧化酶 2对结肠癌肝转移瘤血管形成的影响。方法 :以细胞培养法建立稳定的结肠癌细胞株HT 2 9和HCT 116 ,利用脾切除法建立结肠癌肝转移动物模型 ,免疫组化检测结肠癌肝转移瘤VEGF、FGF 2蛋白表达。结果 :结肠癌肝脏转移率 ,HT 2 9组、HCT 116组、塞来昔布组分别为 83 33%、16 6 7%、33 33%。肝脏转移瘤VEGF、FGF 2的表达 ,HT 2 9组与HCT 116组、塞来昔布组比较均表达增强 ,有显著统计学意义 (P <0 0 1～ 0 0 5 ) ;塞来昔布组与HCT 116组比较无显著性差异 (P >0 0 5 )。结论 :环氧合酶 2与结肠癌肝转移瘤血管生成密切相关 ,其高表达促进了结肠癌肝转移瘤新生血管生成。其机制可能是上调促血管生成因子VEGF、FGF 2的表达     

肝移植患者术后早期精神症状的观察

目的探讨肝脏移植术后早期精神系统并发症发生的原因和防治经验。方法回顾性分析 12 5例原位肝脏移植患者的临床资料 ,以术后 2周作为观察时点 ,分析肝脏移植术后早期精神系统并发症发生的原因 ,总结防治经验。结果有症状组和无症状组在性别、年龄、肝功能以及血环孢素A浓度方面无明显差异 ;但有症状组的无肝期时间 (93 74± 2 8 98)min和手术时间 (4 14 6 5±6 1 92 )min却长于无症状组 (P <0 0 5 ) ;另外 ,术前有无肝性脑病、术后感染以及静脉使用免疫抑制剂和术后精神症状的发生明显相关。结论肝脏移植术后早期精神系统并发症发生的原因是多方面的 ,通过积极的对症支持治疗 ,预后良好。     

儿童肺吸虫病79例临床分析

目的：通过分析儿童肺吸虫病的临床特征，提高对儿童肺吸虫病的认识，减少误诊。方法：对79例不同类型儿童肺吸虫病进行回顾性分析。结果：治疗后患者自觉症状消失，治愈率较高。结论：儿童不同类型肺吸虫病临床表现虽然复杂，但结合流行病学，经临床及血清学检查，就能及时确诊，79例儿童肺吸虫病药物治疗，疗效满意。