A 22-year-old female patient complained of neck discomfort for one week. Examination revealed bilateral neck masses. Color doppler ultrasound showed bilateral thyroid masses,which resulted in two thyroid lobes asymmetry. Bilateral cervical enlarged lymph nodes were not found. Thyroid function was normal. Complete left lobe and subtotal right lobe of thyroid gland were resected. The pathological results showed poorly differentiated carcinoma of left thyroid and papillary carcinoma of right thyroid with bilateral Hashimoto's thyroiditis. The patient received resection of residual thyroid and lymph nodes in another hospital, with no tumor or metastasis found. The patient without radiotherapy or chemotherapy was followed up for 34 months, and no progressive lesions were found.
Carcinoma, Papillary ; pathology ; Female ; Hashimoto Disease ; pathology ; Humans ; Lymph Nodes ; surgery ; Neck ; Thyroid Neoplasms ; pathology ; Thyroidectomy ; Young Adult

The rat c-erbA? cDNA fragment was used as probe to investigate the expression of T3 receptor gene in brain, heart and kidney in hyperthyroid and hypothyroid rats. There were three types of c-erbA? mRNA-6. 0kb, -5. 0kb and -2. 0kb in all examined tissues. In heart and kidney, the levels of c-erbA? mRNA decreased in hyperthyroid rats and increased in hypothyroid rats. It might be a compensatory mechanism. In brain, however, the level of c-erbA? mRNA was unaffected by thyroid status. The results suggest that the T3 receptor gene may have an auto-regulatory mechanism in rat heart and kidney under different thyroid status.

Objective To investigate the methods and efficacy of coronary stent placement in patients with myocardial bridge. Methods 4 patients with angina and ST-T changes in ECG were involved in the study. Coronary angiography showed there were 75%～90% systolic stenosis of LAD in all patients. Two of them were regarded as isolated myocardial bridge, and the others were regarded as myocardial bridge associated with atherosclerosis. The length of artery pressed by myocardial bridge was in the range of 10～18 mm. All patients who had repeated angina accepted stenting therapy. One of the stents was Crossflex, three were Nir stents. Stents size: (3.0～3.5)?(12～20)mm. All stents were expanded with 8～10 atm for 30～40 seconds. Results After stenting, coronary angiography showed no residual stenosis. In the follow-up 6～18 months there were no complaints of angina. In two of them, coronary angiography showed there were no restenosis after one year.Conclusion Coronary stenting is an optional method to treat patient who have myocardial bridge and have no efficacy after taking medicines, especially for the patients who have both myocardial bridge and atherosclersis. But futher study in large populations is still necessary.

ObjectiveTo comprehend the clinical presentation s of systemic amyloidosis in respiratory tract MethodsThe rec ords of all patients with biopsy-confirmed systemic amyloidosis admitted to our hospital between 1985 and 2003 were retrospectively reviewed All relevant info rmations of respiratory tract,such as clinical,image,and demographic,were an alyzed ResultsAmong 46 cases of systemic amyloidosis,respira tory amyloidosis was diagnosed in 37 patients (27 men and 10 men) clinically,in vovling upper respiratory tract,tracheobronchial,lung parenchyma,pleura,medi asteinal and hilar,with a mean age of 51 49 years 12 cases were confirmed by the characteristic Congo-red staining of respiratory biopsies The most common sites at presentation were lung parenchyma and pleura ConclusionsThe respiratory tract was involved in about 80 4% of patients with systemic amylodosis meaning a higher prevalence than previously reported It is necessar y to pay more attention to respiratory amyloidosis to diagnose and treat early

Objective To compare the clinical efficacy of different doses of ultrafine extracted granule preparation (EGP) and traditional herbal decoction (THD) of Li Zhong Tang in treatment of epigastric pain. Methods Sixty cases of epigastric pain patients in accordance with the diagnostic criteria of deficiency and cold pattern of spleen and stomach in TCM were randomly divided into THD group, 1/3 dose group and 1/5 dose group, and were given THD, 1/3 dose of ultrafine EGP and 1/5 dose of ultrafine EGP, respectively. The clinical efficacy of the three groups after one course of medication was comparatively analyzed. Results There were no significant differences in age, course of disease, symptom score before treatment, epigastric pain efficacy and syndrome curative effect among the three groups, the differences had no statistical significance (P>0.05). The severity, frequency and duration of epigastric pain were all reduced in the three groups, with significant differences between before and after treatment (P<0.05). Conclusion There are no significant differences in the clinical efficacy on epigastric pain among THD, 1/3 dose of ultrafine EGP and 1/5 dose of ultrafine EGP. In addition, the effect of 1/3 dose group is very close to the THD group.

Objective To investigate the impact of surgical resection on patients with Ⅱ-Ⅲ A stage small cell lung carcinoma (SCLC). Method Data of 61 in-patients who diagnosed as Ⅱ-ⅢA stage SCLC from Jan 1st 2009 to Feb 1st 2014 were analyzed. 23 patients underwent surgical resections were enrolled as the treatment group, while 38 patients without surgical resection were enrolled as the control group. Disease progression was confirmed by monthly examination. The grouping is balanced by propensity score match. The progression-free survival (PFS) time and overall survival(OS) were analyzed with Kaplan-Meier survival method and Cox regression is applied to analyze the covariates. Fisher's exact test was applied to compare one-year survival rate and two-year survival rate. Results The PFS and OS of the treatment group is longer than that of the control group (P < 0.05). Both one-year and two-year survival rates of the treatment group outnumber those of the control group (P < 0.05). Cox regression indicates that surgical resection is an independent prognostic factor (P < 0.05). Conclusion Surgical resection on tolerable patients with stage Ⅱ-Ⅲ A small-cell lung carcinoma is effective on improving the progression-free survival time,one-year and two-year survival rates,and also shows a propensity of a higher overall survival time.

Objective To investigate the consistency in 18F-deoxyglucose positron emission tomography (18F-FDG PET-CT) examination and histopathological analyses in the diagnoses of resectable lung tumors. Methods Retrospective reviews over the clinical data of lung tumor patients by preoperative PET-CT diagnosis and postoperative histopathological diagnosis were conducted to investigate the effects of the two diagnostic methods in terms of lung tumor properties , mediastinal lymph node metastasis , and pulmonary hilar lymph node metastasis. Results The diagnoses by preoperative PET-CT was consistent in differentiation of non-malignancy and malignancy of pathologic lung tumors by 87.3%, at a medium level (κ = 0.401, P < 0.001). McNemar test showed P = 0.508, indicating the two diagnostic methods were insignificantly different in the diagnosis of pulmonary tumors. The preoperative PET-CT was consistent in the diagnosis of the metastasis of pathologic mediastinal lymph node by 85.9%, at a medium level (κ = 0.697, P < 0.001). McNemar test showed P =0.754, indicating no significant difference between the diagnostic methods. The preoperative PET-CT was consistent with postoperative pathological examinations in the differentiations of the metastasis of pulmonary and hilar lymph node by 77.4%, at a medium level (κ=0.523, P < 0.001). McNemar test showed P = 0.454, indicating the two diagnostic methods were no significantly different. Conclusion Preoperative PET-CT and histopathologic examinations may be consistent in lung tumor diagnosis , which provides a basis for a certain significance in the surgical options.

Objective:To discuss the reconstuctive strategy of the defect of anterior rectus fascia and rectus abdominus muscle in the clinical practice.Methods:Between November 2009 and Janurary 2020, clinical data of 24 female patients that underwent 29 anterior rectus fascia and rectus abdominus muscle reconstructions of defect were reviewed retrospectively. The median age was 42.5 years (range, 35-60 years), including 20 breast reconstructions, 2 pelvic reconstructions, 1 thoracic defect after tumor resection and 1 abdominal defect after tumor resection. According to the location and size of the anterior rectus fascia and rectus abdominus muscle defect, three reconstructive methods were applied: 6 direct clousres were applied if the width of defect was less than half of the anterior rectus fascia, 21 polypropylene mesh onlay reconstructions were applied for which the width of defect was or more than half of the anterior rectus fascia, and 2 direct suture closure were applied for the simple rectus abdominus muscle defect.Results:All the patients healed eventfully without abdominal wound complications, such as infection, hematoma, dehiscence. The patients were followed up for a median period of 30 months (range, 5-126 months). 1 patient died of breast cancer recurrence and matastasis at 36 months postoperatively. No patient developed a mesh infection or required mesh removal secondary to infection or foreign body reaction. There was no abdominal wall hernia, 1 patient developed abdominal bulge without further treatment because of no abdominal wall discomfort.Conclusions:The key of successful operation is different reconstructive methods applied to reconstruct the integrity and stability of abdominal wall, based on the location and size of the anterior rectus fascia and rectus abdominus muscle defect.

The paper analyzed the impact of the trial for "lump-sum prepayment practice of medical insurance" on tertiary hospitals in Shanghai initiated by Shanghai Medical Insurance Bureau since 2009. Based on the analysis, the authors recommended that the hospitals should adapt to the changes by raising quality of care, improving cost accounting, informationizing and refining medical insurance information management, as well as controlling expenses on a rational basis. These approaches will help them adapt to and promote the ongoing health reform in China.