A 56 years old female was admitted to our department with complaint of a painless cervical mass. Clinical feature:there was a painless mass above left lobe of thyroid gland, which was about 3.0 cm x 2.5 cm in size, and could move with swallowing action. B-mode ultrasound features: there was a solid mass in left lobe of thyroid gland, which was about 3.2 cm. Nodule was found in isthmus, accompanied with lymphadenovarix on the left neck possibly be MCA. fT3: 4.64 pmol/L, fT4:16.56 pmol/L,TSH:3.74 mIU/L, anti-TG:17.75 U/ml, anti-TPO:40.77 U/ml. Pathological result of the neoplasm: papillocarcinoma. Clinical diagnosis: papillary thyroid carcinoma.
Carcinoma ; diagnosis ; pathology ; Carcinoma, Papillary ; diagnosis ; pathology ; Deglutition ; Female ; Humans ; Middle Aged ; Neck ; pathology ; Parathyroid Glands ; pathology ; Recurrent Laryngeal Nerve ; pathology ; Thyroid Cancer, Papillary ; Thyroid Neoplasms ; diagnosis ; pathology

Objective To investigate the features of the enhancement of SHCC at triple-phase spiral CT scanning and compare its sensitivity in different phase.Methods The pre- and post-contrast CT scanning of the entire liver in 70 patients with SHCC was carried out with a helical CT scanner. The contrast material was infused at a rate of 3ml/s, followed by sequential arterial-, portal- and equilibrium- phase scans of the liver. The number of the detected lesions was calculated in each phase, the characterization of lesions in each phase was observed.Results Of the 82 detected SHCC, the sensitivity in three phases was 92.68%, 70.73% and 73.17% respectively. The sensitivity increased significantly to 95% by combining the detection of three phases. Conclusion Triple-phase contrast enhanced spiral CT can fully demonstrate the patterns of SHCC and improve its detection rate.

Objective To study the CT findings of late onset intracranial hemorrhage in vitamin K(Vit K) deficiency.Methods 56 cases of late onset intracranial hemorrhage in Vit K deficiency proved clinically were presented.There were 42 male and 14 female,age ranging 28～60 days.Brain CT scans were obtained in all 56 cases. Results Subarachnoid hemorrage(SAH) in 33 cases,subdural hemorrage(SDH) in 32 cases,intracerebral hemorrage(ICH) in 19 cases and inraventricular hemorrage(IVH) in 8 cases were found.The hemorragic amount was ranged 2～150 ml.Simple hemorrage was demonstrated in 26 cases,and multiple mixed hemorrage in 30 cases.The cerebral edema was displaied in 16 cases.Conclusion SAH,SDH and multiple mixed hemorrage are common seen in the late onset intracranial hemorrage in Vit K deficiency.

Objective To observe the clinical efficacy of Qingre Liangxue Recipe (QLR), a herbal prescription with the actions of clearing heat and cooling blood, for the treatment of gouty arthritis. Methods Sixty-five cases of gouty arthritis patients were randomly divided into treatment group (N=32) and control group (N=33). Both groups were given oral use of colchicine during the acute stage and being suspended when the pain was relieved, and then were given oral use of allopurinol tablets during the remission stage. Additionally, the treatment group was given oral use of QLR all through the acute stage and remission stage. The treatment lasted for 4 weeks in both groups. After treatment, clinical efficacy was evaluated in the two groups. The number of acute relapse cases and the changes of blood uric acid level were observed. Results At the end of the first treatment week, the treatment group had a total effective rate of 96.9%, significantly higher than that (81.8%) of the control group. At the end of the fourth treatment week, the treatment group had a total effective rate of 100.0%, significantly higher than that (90.9%) of the control group. The treatment group had better therapeutic effect than the control group at the end of the first or the fourth treatment week, the difference being significant ( P<0.01). The number of acute relapse cases and the serum uric acid level were lower in the treatment group than those in the control group during 4 treatment weeks or 12 weeks after treatment suspension, the difference being significant ( P<0.01). Conclusion QLR combined with anti-gout medicines can effectively relieve symptoms of gouty arthritis, reduce incidence of acute relapse, and have long-term effect on lowering blood uric acid level.

Objective To study the diagnostic value of contrast-enhanced CT patterns in focal hepatic lesions.Methods Contrast-enhanced CT patterns in 44 patients with focal hepatic lesions (54 foci) were retrospectively analysed.Results (1)78% of the hepatocellular carcinoma presented "rapid-filling and rapid-washout" feature.(2)All hepatic hemangioma presented "rapid-filling and slow-washout", progressive opacification from the periphery to center. (3)All cholangiocarcinoma presented "slow-filling and slow-washout" .(4)Metastatic hepatocarcinoma in 14 cases and hepatic abscesses in 5 cases were presented a enhanced ring around the lesion, metastatic hepatocarcinomas showed single ring,however, hepatic abscesses showed multi-ring. (5)Focal nodular hyperplasia in 3 cases and hepatic adenomas in 1 case presented "rapid-filling and slow-washout".Conclusion The contrast-enhanced patterns at spiral CT can fully reflect the blood supply of focal hepatic lesions, it has significant value in diagnosing focal hepatic lesions.

The clinical prescription application of pinellia was investigated in a hospital, and the overdose phenomenon and underlying reasons and objectives were preliminarily analyzed. The resources current situation and industry characteristics of pinellia were also overviewed. A series of strategies for the resources problems of pinellia were provided in the paper as well.

Objective To explore the role of improved cranioplasty plus ventriculoperitoneal shunt in early treatment of hydrocephalus secondary to decompressive craniectomy for patients with severe craniocerebral injury. Methods A retrospective study was performed on 45 patients complicated by hydrocephalus after decompressive craniectomy for severe craniocerebral injury treated with early stage improved cranioplasty plus ventriculoperitoneal shunt from January 2006 to December 2010.Then,the clinical data,complications and outcomes were summarized. Results All operations were carried out 38-80 days after injury.The postoperative complications were distal obstruction of ventriculoperitoneal shunt in two patients and intracranial infection in one.The clinical symptoms were obviously improved in 36 patients (80％) and the cerebral ventricle was diminished in 34 (76％) one month postoperatively.The Glasgow Outcome Scale (GOS) at discharge was good in eight patients,moderate disability in 19,severe disability in 13 and prolonged coma in five,where better recovery (good recovery and moderate disability) in 27 patients (60％) showed significant improvement compared with preoperation ( x2 =23.47,P ＜0.01 ). Conclusion Early cranioplasty plus ventriculoperitoneal shunt is an effective and safe method for treatment of the complicated hydrocephalus after decompressive craniectomy for severe craniocerebral injury.

Objective To investigate the clinical outcome of modified large decompressive craniectomy in treatment of severe traumatic brain injury combined with acute subdural hematoma. Methods A retrospective analysis was carried out to compare the clinical outcome of large decompressive craniectomy (treatment group) for 81 patients with severe traumatic brain injury combined with acute subdural hematoma from July 2007 to June 2010 and that of standard large trauma decompressive craniectomy (control group) for 65 patients with same injuries from July 2004 to June 2007. Results According to the Glasgow outcome scale at the end of month 6 after injury, there were 21 patients (GCS 5 points) with good recovery, 19 (GCS4 points) with moderate deficit, 24 (GCS 3 points) with severe deficit, five (GCS 2 points) under persistent vegetative status and 12 (GCS 1 points) deaths in the treatment group,with good prognosis rate (good recovery and moderate deficit) of 49% (P ＜ 0.05) and poor prognosis rate of 51%. However, only 21 patients got favorable outcome, including 12 patients (GCS 5 points)with good recovery and nine (GCS 4 points) with moderate deficit; 44 patients got unfavorable outcome (68%), including 22 patients (GCS 3 points) with severe deficit, three (GCS 2 points) under persistent vegetative status and 19 (GCS 1 points) deaths in the control group (P ＜0.05). Furthermore, the incidences of delayed intracranial hematomas and subdural collection of fluid in the treatment group were significantly lower than those in the control group (P ＜ 0.05). Conclusion Modified large decompressive craniectomy can significantly improve the outcome and reduce complications of patients with severe traumatic brain injury combined with acute subdural hematoma.

Objective To observe the clinical characteristic and prognosis of primary lung cancer patients with venous thromboembolism (VTE).Methods 589 primary lung cancer patients were selected and divided into VTE group(n =49) and non VTE group(n =540).49 cases with VTE were divided into pulmonary thromboembolism (PTE) group(n =15),including single PTE and PTE combined with deep venous thrombosis(DVT) and DVT group (n =34).Single factor and multiple logistic regression analysis were performed to determine the factors influencing primary lung cancer patients with VTE.Clinical manifestation,time of onset and prognosis of patients with VTE were analyzed.Results 49 patients with VTE included 10 patients(20.4％) with single PTE,34 patients(69.4％) with single DVT and 5 PTE patients combined with DVT(10.2％).D-dimer(OR =1.560,95％ CI =1.018 ～ 2.392,x2 =4.161,P =0.041),interleukin-1 (IL-1,OR =1.846,95％ CI =1.054-3.234,x2 =4.594,P =0.033),tumor necrosis factor (TNF OR =1.486,95％ CI =1.014-2.178,x2 =4.126,P =0.042),adenocarcinoma (OR =2.854,95％CI=1.217-6.695,x2 =5.812,P=0.016) and phase Ⅲ-Ⅳ(OR =2.198,95％CI=1.122-4.305,x2 =5.272,P =0.022) were the factors influencing primary lung cancer patients with VTE.Chest tightness,coughing,accelerated heart rate,swelling and pain in lower limb were common clinical manifestations of primary lung cancer patients with VTE.Most patients with VTE occurred within 3 months after a diagnosis of primary lung cancer.There was no significant difference in the time of onset between PTE group and DVT group(P ＞0.05).As of July 2014,31 cases (63.2％) died,12 cases (24.5 ％) survived,and 6 cases (12.2％) lost in 49 patients with VTE.The median survival time of 49 patients with VTE was 9.5 months.The median survival time of PTE group was 5.8 months,while DVT group was 15.2 months,but no significant difference between them (P ＞ 0.05).Conclusion Increased D-dimer,increased IL-1,increased TNF,adenocarcinoma and phase Ⅲ-Ⅳ could increase the risk of primary lung cancer patients with VTE.There were little typical.clinical symptoms in most patients with VTE,which occurred with in 3 months after a diagnosis of primary lung cancer.They had high mortality and needed to take early diagnosis and treatment through auxiliary examination.

Objective To investigate the atypical appearances of small hepatocellular carcinoma(SHCC) with triple-phase spiral CT enhanced scan, and its correlation with the histopathology .Methods The atypical CT signs in triple-phase and histopathologic changes of SHCC confirmed pathologically in 30 cases (32 lesions) were analysed.Results 32 atypical lesions were found in 30 patients,of them,14 lesions were hypodense in hepatic arterial phase(HAP),portal venous phase(PVP) and delayed phase(DP).10 lesions enhanced markedly in the AP,while these lesions became isodense or slight hyperdense in the PVP and DP.8 lesions were enhanced as ring like or punctual shape in the AP,and constant enhancement in PVP and DP.Conclusion The atypical appearances are present in triple- phase spiral CT scan in SHCC,the pattern of blood supply and the base of histopathology are usually the cause of these findings .