Objective To investigate clinical effect of Miccoli surgical thyroid bilateral subtotal resection for Graves disease,to provide a reference for clinical treatment.Methods 80 patients with Graves disease were selected, they were divided into the observation group and the control group according to the surgical approach.44 patients in control group were taken small incision under direct vision routine bilateral subtotal thyroid treatment,36 patients in the observation group took Miccoli surgical.Surgical success rate,surgical index were compared between two groups. Results The patients of the two groups were operated smoothly,the success rate was 100.00% in the observation group,the incision length,blood loss,operative time were (3.04 ±0.64)cm,(32.25 ±3.29)mL,(81.19 ±6.68)min respectively,which were significantly less than those of the control group,the differences were statistically significant (t =5.214,P =0.004;t =14.514,P =0.000;t =6.514,P =0.001).The VAS score,length of stay,incidence rate of complication in the observation group were (1.93 ±0.43),(3.82 ±0.79)d,5.26%,which were significantly better than those in the control group,the differences were statistically significant (t =5.697,P =0.003;t =4.654,P =0.009;χ2 =11.214,P =0.000).The hospitalization cost of the observation group was (9 043.65 ±565.76)Yuan, which was significantly higher than the control group,the difference was statistically significant (P <0.05).The cut rating of the observation group was (8.35 ±2.15)points,which was significantly higher than the control group,the difference was statistically significant (t =8.364,P =0.001 ).The hyperthyroidism relapse during follow -up,the incidence of thyroid dysfunction between the two groups had no significant difference (χ2 =0.568,P =0.311;χ2 =0.604,P =0.294).Conclusion Miccoli improved surgical incision and under direct vision thyroid bilateral subtotal resection both have similar clinical effects for Graves disease,Miccoli surgery has smaller trauma,more satisfaction incision,but under direct vision small incisions has lower treatment costs.

Objective To explore the MRI and pathologic characteristics of hippocampal sclerosis. Methods 16 patients with hippocampal sclerosis were examined with transvers and oblique coronal T 1 weighted,T 2 weighted and fluid attenuated inversion recovery(FLAIR) MR imaging. Results Of 16 patients,1 case had bilateral hippocampal sclerosis;15 cases were ipsilateral(left n =9,right n =6) proved by pathology.The MR features of hippocampal sclerosis were as follows:hippocampal atrophy present in all patients;hyperintensity on coronal FLAIR in all patients and on coronal T 2W images present on 15 sides; loss of superficial sulci hippcampal head seen in 11 sides;disruption of the internal structures present on 13 sides; atrophy of lateral white matter present on 7 sides; enlargement of the ipsilateral temporal horn present on 6 sides;atrophy of the ipsilateral temporal lobe seen on 2 sides. Conclusion Atrophy and hyperintensity on coronal FLAIR and T 2 weighted images were the most common features of hippocampal sclerosis and had positive diagnostic value. Combination of coronal FLAIR and T 2 weighted imaging could improve the diagnostic sensitivity and accuracy for hippocampal sclerosis.

Objective To observe the acute effects and symptom relief of radiofrequency hyperthermia combined with chemotherapy in treating advanced or metastatic gastrointestinal cancer.Methods 50 cases with advanced or metatatic gastrointestinal cancer that recurrent after operation or can not be resected were all treated by local radiofrequency hyper- thermia combined with chemotherapy.In every cycle of chemotherapy,radiofrequency hyperthermia was given 2 to 3 times,60 minutes per time.One case complete chemotherapy 3 to 6 cycles and the total times of radiofrequency hyper- thermia ranged from 6 to 16.Results In 50 cases,the rate of effects was 38% and the rate of symptom relief was 46%.Conclusion In the combined therapy for advanced or metastatic gastrointestinal cancer,the radiofrequency hy- perthermia has some value in relieving symptoms,improving living quality and controlling tumour.

Objective To explore the significance and value of loss of digitations of hippocampal head in diagnosis of hippocampal sclerosis.Methods Eighteen patients with hippocampal sclerosis comfirmed by histopathological examination and 18 cases to be matched control group were examined by MRI . The digitations,atrophic change and abnormal signals of hippocampal head were evaluated retrospectively.Results Of 18 patients with hippocampal sclerosis, loss of digitations was seen in 16 cases, poorly visible in 1 case and exist in 1 case. The sclerotic hippocampal heads all had atrophic change and were hyperintensity on T_2-weighted and FLAIR MR imagings. No loss of digitations were seen in the opposite side of the hippocampal sclerosis and all hippocampal heads in control group.Conclusion The loss of digitations of hippocampal head is a sensitive indicator for the diagnosis of hippocampal sclerosis.

BACKGROUND: At present, MRI is the key method to examine the hippocampal sclerosis of the patients with epilepsy. The main results are the abnormal signals of hippocampus, in addition, other symbols of MRI can also suggest the hippocampal sclerosis.OBJECTIVE: To study the significance and value of the loss of visualization of digitations of hippocampal head in diagnosis of hippocampal sclerosis through the analysis of MRI on patients with temporal lobe epilepsy.DESIGN: Non-randomized, blind procedure(data selection, result evaluation), blank controlled and clinical experiment.SETTING: Departments of radiology in two universities.PARTICIPANTS: Between September 1996 and December 2002, 18 patients with temporal lobe epilepsy were selected from the Department of Radiology,Xinhua Hospital Affiliated to Shanghai Second Medical University. Meanwhile,patients with headache were diagnosed with MRI. Eighteen healthy people,whose ages were matched, were as control group.METHODS: Among 18 patients, MRI of 16 patients and 18 people in the control group were performed with a GE 1.5T Horizon MR unit and another 2with a GE 1.5T Signa whole body MR unit. With the double blind procedure, whether the digitations of hippocampal head of 72 hippocampal heads of 36 people in both patient and control groups exist or not was recorded by two radiologists with knowledge of hippocampal dissection but without knowing the condition of clinical operation. The results were divided into 3 levels:loss, poorly visible and existing, and hippocampal atrophy and abnormal signals were also recorded.MAIN OUTCOME MEASURES: Image condition of digitations of head,size of hippocampal head and changes of signal.RESULTS: Of 18 patients with hippocampal sclerosis, the abnormal findings included smooth and the loss of visualization of digitations of hippocampal heads seen in 16 patients, poorly visible of digitations of hippocampal head in one patient, and existence of digitations of hippocampal head in one patient. Hippocampal atrophy and high signals on T2-weighted images and fluid-attenuated inversion recovery imaging were seen in all patients. The sensitivity of loss of digitations of hippocampal heads for diagnosis of hippocampal sclerosis was 88.9% (16/18), and the specificity was 100%.CONCLUSSION: The loss of visualization of digitations of hippocampal head is a sensitive indicator for the diagnosis of hippocampal sclerosis. Atrophic changes of hippocampus combining with the increase of T2-weighted signal can definitely diagnose the hippocampal sclerosis.

Objective To detect stunned myocardium using low-dose dobutamine stress (DBS)combined with two-dimensional speckle tracking imaging (2D-STI),and to evaluate the difference and characteristics of mechanical parameters in different conditions between stunned myocardium and adjacent normal myocardium.Methods The acute myocardium ischemia/reperfusion (I/R) of anterior wall of left ventricle(LV) was induced with 60 minutes ligation of left anterior descending coronary artery (LAD),and with reperfusion of 120 minutes in 10 open-chest beagle dogs.Dobutamine was administered continuously via vein with two different dose of 5 μg · kg-1 · min-1 and 10 μg · kg-1 · min-1.At baseline,post ischemia/reperfusion,after the first DBS and the second,the gray-scale dynamic images of three cardiac cycle of left ventricular short axis at the levels of mitral annulus,papillary muscle and apex were acquired.The systolic peak of circumferential strain (CS),radial displacement (RD) of eighteen segments of subendocardium and subepicardium were analyzed by Speckle tracking workstation.LV end-systolic dimension(LVIDS),LV end-diastolic dimension (LVIDD),LV eject fraction (LVEF),heart rate (HR),aortic valve forward flow velocity time integral(AV-VTI) were also measured.Results ①There was no statistical significance (P ＞0.05) under the conditions of baseline,post I/R,the first DBS and the second for LVIDD,LVIDS,LVEF,HR and AV-VTI.②Compared with baseline,the peak systolic subendocardium and subepicardium CS,RD decreased significantly at the apex and middle of short-axis anterior wall of LV under the conditions of post I/R;The parameters of the first DBS was significantly increased compared with the I/R (P ＜ 0.05) ; There was no difference between the two DBS and baseline(P ＞0.05).The peak systolic subendocardium and subepicardium CS,RD at the bottom segment of LV were no statistical significance under the four conditions.③There was no difference for anterolateral wall and anterior septum of LV at the level of papillary muscle under the four conditions.Conclusions ①Low-dose DBS combined with two-dimensional speckle tracking imaging can detect stunned myocardium accurately.② After the occurrence stunning myoeardium,the peak systolic subendocardium RD decreased slightly,subepicardium RD was normal,the subendocardium CS of the surrounding myocardium was still normal,and the peak systolic subepicardium CS decreased to some degree.

Objective To investigate the level of urinary protein in type 2 diabetic patients with different glucose excursion and investigation the effect of the glucose excursion on early diabetic nephropathy.Methods Fifty-six type 2 diabetes patients were divided into two groups by the level of glycosylated hemoglobin(HbA1c),good glycemic.Patients in control group with HbA1c ＜ 7.0％ and patients in poor glycemic control group with HbA1c ＜ 7.0％.Microalbuminuria,urine transferring (UTRF),α1-microglobulin (α1-MG) and 32-microglobulin(32-MG) were measured.All the patients were monitored using the continuous glucose monitoring system (CGMS),and mean amplitude of glucose excursions (MAGE) were analyzed.Patients were divided into two groups by MAGE,one group's MAGE was lower than 3.9 mmol/L,and another group's MAGE was higher than 3.9 mmol/L.Urinary proteins were measured and analyzed in the two groups.Results In the poor glycemic control group,the levels of microalbuminuria,UTRF and albunin/ creatinine(A/C) rate were (81.28 ±44.13) mg/L,(4.54 ± 1.54) mg/L and (22.17 ± 14.52) mg/mmol significantly higher than that in the good glycemic control group((21.63 ± 10.16) mg/L,(2.48 ±0.29) mg/L and (2.05 ± 0.76) mg/mmol; t =4.758,5.360,4.805 ; P ＜ 0.05).Fasting C peptide in the poor glycemic control group was (1.01 ± 0.13) ng/ml,significant lower than that in the good glycemic control group ((1.51 ± 0.21) μg/L;t =4.826;P ＜0.05).The levels of A/C rate,α1-MG and β2-MG in the group with MAGE above 3.9 mmol/L significantly higher than those in the group with MAGE below 3.9 mmol/L(t =4.358,8.641,12.702;P ＜ 0.05).Conclusion Both persistent hyperglycemia and blood glucose variability could influent diabetic nephropathy.

Objective To investigate clinical presentations,laboratory examinations,magnetic resonance imaging (MRI) appearances and treatment of hypertrophic cranial pachymeningitis (HCP).Methods The clinical data of 13 patients with HCP receiving comprehensive therapy in Huashan Hospital from January 2007 to January 2013 were analyzed retrospectively.Results The onset of HCP was mostly chronic with an average duration of 26.7 months.The main clinical manifestations of the 13 patients were chronic headaches (12/13) and cranial nerve paralysis (12/13).Inflammation markers and cerebro-spinal fluid (CSF) protein levels increased in patients with HCP and gradually became normal after the treatment.The MRI demonstrated local or diffused thickened dura located in tentorium (10/13),falx cerebrum (5/13),frontal lobe (4/13),temporal lobe (7/13) and parietal lobe (4/13).The signal intensity was isointense on T1-weighted MR images and hypointense on T2-weighted MR images.Enhanced MR images showed conspicuous enhancement of the dural edges.Corticosteroid therapy improved the clinical symptoms in 12 of 13 patients.Conclusions HCP typically causes headache and paralysis of multiple cranial nerves.Enhanced MRI shows characteristic manifestations.At present corticosteroid therapy is the treatment of choice followed by immunosuppressive agent and radiotherapy.

Objective To discuss the clinical effect of the phase-one treatment scheme for traumatic osteomyelitis in tibia by combining flap,vancomycin-loaded calcium sulfate and autogenous iliac bone.Methods From January,2009 to July,2014,49 patients which had traumatic osteomyelitis in tibia and met the inclusive criteria were investigated and treated.By taking these patients as treatment group A(34 cases),they were treated by adopting the phase-one treatment scheme of combing tissue flap,vancomycin-loaded calcium sulfate and autogenous iliac bone.Fifteen patients who were treated by using the phase-one treatment scheme,namely,removing the lesion,implanting vancomycin-loaded calcium sulfate and repairing the defect by means of tissue flap,were chosen as control group B.Concerning treatment group A,drainage fluid was collected after operation every day to measure the concentration of vancomycin until drainage tube was removed.All the patients were followed up to study the following indexes:the standing time of drainage tube,the healing time of fracture,infection control rate,bone nonunion rate and other complications.Results All cases were followed up during 17 to 40 months after operation and no amputation was conducted for the affected limb.To repair soft tissue defect,flap and direct suture were adopted for 25 and 9 cases respectively in group A;The results indicated that all flaps survived,the poor healing of flap defect was observed for 2 cases which were healed after dressing change.However,to repair soft tissue defect,all group B cases used flaps;results revealed that distal flap necrosis was found in 2 cases applying neurocutaneous flap,with defect exudation and infection while the 2 cases were cured after debridement and dressing change without performing a second flap operation.In group A,3 cases recurred during 5 months to 2 years after operation;in group B,it was 1;other complications included pintract infection,nonunion,numbness of anterolateral thigh,hematocele in iliac 1 region.In group B,refracture occurred for 2 cases at the original lesion location 18 and 25 months after healing and was cured after plate refixation and the graft of autogenous iliac bone;intraoperative pathology validated no recurrence of osteomyelitis.The standing time of drainage tube was (12.53±4.56) days on average for group A while (17.07±3.87) days for group B;The difference was statistically significant (P＜0.05).The healing time of fracture was (6.20±2.16) months on average for group A while(8.36±2.84) months for group B.The difference was statistically significant(P＜0.05).Conclusion In one stage treatment of localized and diffused traumatic osteomyelitis,the scheme of combining tissue flap,vancomycin-loaded calcium sulfate and autogenous iliac bone effectively shortened the healing time of fracture,increased the healing strength,and reduced the exudation after operation,without increasing infection recurrence rate.The scheme was superior to merely implanting vancomycin-loaded calcium sulfate.

Objective To investigate the therapeutic effect of low-dose and long-course homoharringtonine and cytarbine (HA) in treating atypical chronic myeloid leukaemia (aCML).Methods Twenty-seven patients diagnosed atypical chronic myeloid leukaemia(aCML) from Oct.2003 to May 2014.in the Affiliated Hospital of Logistics University of People's Armed Police Force were divided into treatment and control groups.Fourteen cases in the treatment group were given the chemotherapy of HA (H:1.5 mg/(m2 · d),A:100 mg/(m2· d) for two weeks,and 13 cases in the control group were given the combined therapy of Hydroxycarbamide(1-3 g/d) and recombined human interferon α-2b(3×106U by intramuscular injection every other day) for four weeks.The haemoglobin (Hb) level,the numbers of white blood cell count (WBC) and platelet count(PLT) were measured.Moreover,the clinical effects were evaluated through measured hemogram and myelogram at 4 weeks after treatment.Results The levels of Hb,the numbers of WBC and PLT at before and 1 and 2 weeks in treatment group were as same as those in control group(P＞0.05).While,the numbers of WBC and PLT at 2 weeks,as well as Hb and the numbers of WBC and PLT in 3 weeks,4 weeks in treatment group were significantly different from those in control group (P ＜ 0.05).Furthermore,repeated measurement ANOVA showed that the levels of WBC,Hb,PLT between two groups were significant (F between groups =833.16,145.59,143.11;P＜0.05),and there were significant differences at different time (F between groups =443.92,17.41,149.11;P ＜ 0.05),meanwhile with interaction (F across group =69.77,43.26,75.25;P ＜0.05).In treatment group,there was 8 cases were complete remission,2 cases were partial remission and 4 cases were not released,and the total effective rate 71.4％.While in control group,there were no one was complete remission,2 cases were partial remission and 4 cases were not released,and the total effective rate was 15.4％.And the different was significant (x2 =11.25,P＜ 0.05).Conclusion The therapeutic effect of lowdose and long-course HA in treating atypical chronic myeloid leukaemia is more efficient and practical than traditional treatment.And its side effects are tolerable.