结节性筋膜炎10例临床病理分析

目的:探讨结节性筋膜炎的临床病理特点、诊断及鉴别诊断。方法:回顾性分析10例结节性筋膜炎患者的临床资料,结合以往文献资料对结节性筋膜炎的临床特点进行分析,HE染色,光镜观察。结果:结节性筋膜炎多见于青壮年,好发于上肢前臂,临床表现:肿块小、生长迅速、质硬或韧、边界不清。具有诊断意义的组织学特征为纤维母细胞形成"S"形漩涡,核分裂相易见,无病理性核分裂相;小裂隙形成;红细胞外渗、有少量的炎细胞及丰富的新生毛细血管;黏液样基质。结论:诊断结节性筋膜炎应抓住其临床特点、具有诊断意义的组织学特征,掌握其鉴别诊断,防止误诊为软组织肉瘤。     

甲状腺全切除术治疗多发结节性甲状腺肿的Meta分析

目的：系统评价甲状腺全切除术(包含近全切除术)对比次全切除术治疗多发结节性甲状腺肿的疗效和安全性。方法：计算机检索Cochrane Library、PubMed、Embase、中国生物医学文献数据库(CBM)、中国期刊全文数据库(CNKI)、中文科技期刊全文数据库等,检索时间截止2013年11月。纳入甲状腺全切除术(包含近全切除术)对比次全切除术治疗多发结节性甲状腺肿的随机对照试验,由两名研究员分别独立提取数据进行文献质量评价,并用RevMan5.1软件进行Meta分析。结果：最终纳入符合标准的相关文献7篇,共2 192例患者。Meta分析结果显示：与甲状腺次全切相比,全切除术(包含近全切除术)后结节复发率低(OR=0.13,95% CI：0.07~0.22,P<0.001),短暂性甲状旁腺功能减低发生率较高(OR=2.33,95% CI：1.72~3.17,P<0.001),而在永久性喉返神经麻痹(OR=0.81,95% CI：0.24~2.74,P=0.74)及永久性甲状旁腺功能减低(OR=2.94,95% CI：0.48~18.11,P=0.24)方面二者之间差异无统计学意义。结论：与甲状腺次全切除术相比,全切除术(包含近全切除术)治疗多发结节性甲状腺肿的术后结节复发率明显降低,并未增加永久性并发症。     

Diffuse amyloid deposition in thyroid gland: a cause for concern in familial Mediterranean fever

Thyroid gland is among the many organs that could be infiltrated in systemic amyloidosis. However, diffuse infiltration of the thyroid gland secondary to systemic amyloidosis associated with Familial Mediterranean fever (FMF) is rare. Here, we present a 49-year-old woman diagnosed with FMF and systemic amyloidosis, who had a large goiter and multiple nodules that developed slowly through the years and was complicated by tracheal compression symptoms and a mild thyroid dysfunction. Multiple fine needle aspiration biopsies of the nodules and the thyroid parenchyma revealed amyloid deposits. We would like to point out that amyloidosis may have a significant impact on the thyroid gland and fine needle aspiration biopsy is a valuable tool for diagnosis.     

Amyloid goiter as the first clinical sign of systemic amyloidosis in a patient with adult-onset Still’s disease

Abstract

We present a patient with amyloid goiter due to secondary amyloidosis which resulted from adult-onset Still’s disease. Amyloid goiter occurs as one of the rare manifestations of systemic amyloidosis. In our case the initial manifestation of amyloidosis was a fast growing goiter without other clinical abnormalities, which is unusual in the context of previously reported cases.     

甲状腺摄~(99m)锝直观指数定量测定法的应用

利用甲状腺摄99m锝直观指数(VITU)定量测定法对42 例正常对照组,50 例甲亢患者(包括突眼性甲状腺肿),8例格雷夫斯眼病(Graves眼病),11例甲低患者(包括甲状腺炎),4例甲亢治愈者观察检查的结果,表明它能弥补甲状腺吸碘率(RAIU)和T_3、T_4的不足,是一种可作为提高甲亢准确性诊断有较大价值的指标,可推荐给临床应用.     

甲状腺癌28例误诊原因分析

甲状腺癌误诊的常见原因是对其发病特点认识不足,术前临床资料不■实,术中处理不够慎重。为减少临床误诊应采取综合措施。包括提高对此病诊断的警惕性,认真行颈部触诊,综合分析各项检查结果,依靠穿刺细胞学检查和术中冰冻切片以及石蜡块组织学检查而最后确诊。     

利美达松治疗突眼性甲状腺肿的疗效

目的：观察甲状腺局部注射利美达松治疗突眼性甲状腺肿（ＧＤ）的疗效。方法：ＧＤ病人４２例（男性４例，女性３８例，年龄３６±ｓ１１ａ）为治疗组，另４５例为对照组（男性５例，女性４０例，年龄３４±１０ａ），前者在抗甲状腺药物治疗基础上，行利美达松甲状腺局部注射，２．５～５ｍｇ／次，１次／２ｗｋ，４次为一个疗程，治疗１～２个疗程。对照组仅行抗甲状腺药物治疗。结果：治疗组与对照组比较：前者甲状腺体积明显缩小，且质地变软；Ｔ３，Ｔ４，及ＴＳＨ复原时间缩短；病理显示甲状腺内淋巴细胞浸润明显减少，均Ｐ＜０．０１。无明显激素样副作用。结论：利美达松可作为治疗ＧＤ良好的辅助用药     

儿童临床甲状腺疾病特点及相关因素初步调查

目的探讨7-14岁儿童临床甲状腺疾病特点及相关因素。方法对门诊就诊的7-14岁儿童甲状腺疾病情况进行临床和实验室相关项目检查,记录检查结果,并确定诊断。结果共检查确诊7-14岁儿童甲状腺肿患者40例,其中男4例,女36例,男女之比为1∶9,并且随着年龄的增长,病人数有增长的趋势。Ⅰ度12例,Ⅱ度28例,甲状腺自身抗体阳性者27例,占67.5%。结论目前儿童甲状腺疾病的特点是以非缺碘性疾病为主,其中大部分为甲状腺自身免疫疾病,其发病机制可能与补碘过多,自身免疫障碍,精神紧张等因素有关。     

西宁市IDD监测结果分析

目的：了解西宁市4区碘缺乏病的现状及碘盐防治效果。方法：西宁市4区均采用PPS抽样方法对碘缺乏病现状进行调查。结果：1999年城东、城西两区肿大率为5．0％，非碘盐率1997年、1999年明显高于1995年，尿磺中位数只有1997年城北区低于10μg/L。结论：西宁市4区磺缺乏病防治取得了显效果，但从1995年、1997年碘盐监测结果反映，非碘盐冲击市场仍是制约防治效果的主要原因。     

Surgical management of mediastinal goiter: risk factors for sternotomy

BACKGROUND AND AIMS: Mediastinal goiter constitutes an indication for surgical management. The procedure can most commonly be performed using the cervical access, but at times, a sternotomy or thoracotomy is necessary. The objective of the investigation was to analyze the prevalence and therapeutic results in patients with mediastinal goiter and to assess factors that affect the need of performing sternotomy in the course of mediastinal goiter surgery. MATERIAL AND METHODS: In the years 1984-2004, i.e., over 21 years, 11,849 patients with various types of goiter were operated on in the department. Mediastinal goiter was detected in 88 (0.76%) individuals. The analyzed material included 64 (72.7%) females and 24 (27.3%) males. The age of the patients ranged between 19 to 81 years, with the mean age of 61 +/- 13 years of life. The material was statistically analyzed. Risk factors for sternotomy were assessed using the multidimensional logistic regression method. RESULTS: The highest percentage of mediastinal goiter was noted in patients operated on due to recurrent goiter (3.86%). Goiter situated in the anterior mediastinum was noted in 61 (69.3%) individuals, while 27 (30.7%) patients demonstrated goiter located in the posterior mediastinum; of the latter, nine were previsceral and 18 retrovisceral. In the majority of cases, these were primarily cervical goiters, which descended from the neck to the mediastinum (53 patients). Aberrant adenomas were diagnosed in 32 (36.4%) individuals. Four patients presented with the superior cava vein syndrome. Primary goiters evaluated intraoperatively with blood supply originating from the mediastinal vessels were observed in 12 (13.6%) cases. In 27 (30.7%) patients, sternotomies were necessary. In the majority of cases, these were individuals with goiters showing additional blood supply originating from the mediastinal vessels, patients with aberrant adenomas in the mediastinum, especially in recurrent goiters, or else subjects with goiters situated in the posterior mediastinum as compared to anterior mediastinal goiters. No postoperative mortality during stay in a hospital was noted. CONCLUSIONS: Surgical management of patients with mediastinal goiter is the therapeutic modality that requires considerable experience of the surgical team, performed in specialized centers, and appropriate preoperative diagnostic management. Statistically significant risk factors for sternotomy are as follows: recurrent goiter, primary mediastinal goiter, posterior mediastinal location of goiter, and the presence of an aberrant adenoma situated in the mediastinum.