39 cases underwent total thyroidectomy in our department since January 2009 to December 2012 were retrospectively analyzed. There were 9 males and 30 females who were in their age ranged from 19 years old to 68 years old with a middle age of 46 years old. There were 34 cases of papillary adenocarcinoma, 3 follicular adeno-carcinoma, 1 anaplastic carcinoma and 1 squamous cell carcinoma. Among the 37 cases who were initial surgical management patients, there were 11 T1,14 T2,6 T3,6 T4;and there were 19 N0,12 N1a,6 N1b,1 M1. There was no permanent hypocalcaemia. Temporary hypocalcaemia occurred in 11 cases, 2 cases had recurrent laryngeal nerve injury, 1 case with lung infection.

OBJECTIVE: To explore the changes of parathyroid hormone (PTH) and serum calcium alter total thyroidectomy and summarize the methods to prevent and treat the hypoparathyroidism and hypocalcernia. METHOD: Seventy-three patients with total thyroidectomy in our hospital were divided into three groups according to the scope of the operation. The serum concentrations of PTH and calcium were measured and compared before surgery and after surgery 1 h, 1 d, 3 d and 5 d. RESULT: In three groups, the serum concentrations of PTH and calcium were significantly decreased (P<0. 05) after surgery and low serum PTH and hypocalcemia occured. The severity of low serum PTH and hypocalcemia was as follows: total thyroidectomy with bilateral compartment lymph node dissection (CLND)>total thyroidectomy with unilateral CLND>total thyroidectomy. The differences were statistically significant. The levels of PTH after surgery 1 hour and 1 day were effective to predict hypocalcemia. CONCLUSION Total thyroidectomy can affect the parathyroid function. The greater the scope of surgery, the higher the possibility of postoperative hypoparathyroidism. The reasonable operative procedures and more protection of parathyroid during operation can reduce the incidence of hypoparathyroidism. The level of postoperative PTH can be used as a predictive index of hypocalcemia.
Calcium ; blood ; Humans ; Hypocalcemia ; blood ; Hypoparathyroidism ; blood ; surgery ; Incidence ; Lymph Node Excision ; Parathyroid Glands ; physiology ; Parathyroid Hormone ; blood ; Postoperative Period ; Thyroidectomy

Objective To explore the validity and security of Simulect (basiliximab) induction immunosuppressive therapy in terms of prevention of acute allograft rejection in sensitive recipients.Methods Thirty-six adult recipients of cadaveric kidney transplant with panal reactive antibody 30 %～ 50 % were assigned randomly in a 1∶1 ratio to receive either two doses Simulect or matching placebo. Both patient groups also received baseline triple immunosuppression with the cyclosporine microemulsion, MMF and steroids. A total 40 mg Simulect was given in two doses of 20 mg eachon day 0 about 2 h before transplantation and the day 4 after transplantation respectively.Results No hyperacute rejection and delayed graft function occurred in the two groups. No apparent adverse and toxic events were recorded in the Simulect group. The incidence of acute rejection 3 months after transplantation was 11.1 % in Simulect group compared with 50 % in the placebo group ( 77.8 % reduction, P

0.05).The graft function of high dose group returned to normal within 3 to 7 days after operation.Delayed recovery of graft function occurred in 2 cases of routine dose group;in 1 case it returned to normal on the 21st day after operation, in the other the serum creatinine level fell down to 300 ?mol/L on the 45th day.There was no severe adverse event such as fever,chill,headache,heart-throb,dyspnea during ATG intravenous perfusion.And no serious infection occurred in the 2 groups during the first 3 months postoperatively.Hepatic function damage occurred in 1 case of high dose group.Follow-up ranged from 4 to 14 months.All recipients of high dose group survived with good graft function;5 of them could do housework. Only one graft lost its function in routine dose group. Conclusions On the basis of optimal selection of the donor and recipient,preoperative single-bolus high-dose ATG is effective and safe for the sensitive recipients as immune induction therapy, which may become one of the new induction treatments before transplantation.

Objective To explore the teaching effect of acute poisoning course among students majoring in rescue medicine. Methods From March to June 2013, 30 students majoring in rescue medicine were randomly divided into two groups for the clinical practice. Case-based learning was used in experimental group and cases was tracked from one department to another in chronological order or in reverse order to explore the cause of poisoning and the development of disease and to ob-tain the complete medical records of patients. Traditional rotating internship was used in control group. Poisoning cases in the department were taken as the starting point and end point and the medical records of patients were obtained. The clinical teaching effect was compared between the two groups through questionnaire survey and final examination. The data were calculated by SAS 9.2 software, mean comparison between the two groups was conducted by t test and enumeration data were analyzed by chi-square test. P<0.05 stands for statistically significant difference. Results The number of cases in the experimental group was more than that in the control group during the same internship period ((15±3) vs. (9±5),P<0.01). Skill score of experimental group was significantly higher than that of the control group((79.1±6.9) vs. (66.2±6.7), P<0.01). Theory examination results between two groups had no obvious difference((88.4±5.7) vs. (87.8±6.3),P>0.05),however, theory examination results were increased significantly in this year compared with those of previous year((88.1±6.0) vs. (79.3±12.8), P<0.01). Questionnaire survey demonstrated that teachers and students' satisfaction were 95.3%(143/150) and 93.3%(140/150) respectively regarding the ten advantages of the track-ing type internship. Conclusions Tracking type internship with poisoning case-based learning is a good combination of lecture-based learning and problem-based learning. It is helpful to cultivate and exercise students' ability to apply the knowledge.

Objective To explore the influence of parenterai nutrition(PN) on nutritional status and immune function in breast cancer patients undergoing postoperative chemotherapy.Methods 94 patients with breast cancer postoperative patients were randomly divided into the treatment group(47 cases) and the control group(47 cases).All the patients were given chemotherapy with VBP.The treatment group was given glutamine fortified PN,and the control group was given normal nutrition support,respectively.The nutritional status and immune function before and after chemotherapy,and main toxicities were observed.Results Compared with those before chemotherapy,there were no significant decrease on the level of ALB,PA and HB in treatment group(all P ＞ 0.05),while those indicators in control group was significantly decreased (all P ＜ 0.05).After chemotherapy,CD4,CD8,CD4/CD8 and IgA,IgG,IgM levels of the two groups were lower than those before chemotherapy (all P ＜ 0.05),and the levels of immune indicators of the treatment group were significantly higher than those of the control group(all P ＜ 0.05).The main toxicities in two groups were nausea and vomiting,diarrhea and mild bone marrow suppression,and the body weight in control group decreased (0.91 ± 0.53)kg,while it increased (0.45 ± 0.21)kg in treatment group (t =5.53,P ＜0.05).Conclusion PN treatment for breast cancer patients during chemotherapy can improve nutrition status and immune function,enhance the tolerance of chemotherapy,so as to improve curative effect and prognosis.

Objective To investigate the complications of thyroid arterial embolization and their prevention and treatment.Methods 61 cases of thyroid disorders received the therapy of thyroid arterial embolization were retrospectively studied. The complications of arterial embolization during or after the procedure were analyzed. How to prevent and deal with these complications were discussed. Results Sensitivity to contrast media occurred in 1 case and surgical arterial injury in 2. After embolization thyroid storm occurred in 1 patient and all other complications including headache(23 cases), toothache(11 cases), neckache(13 cases), hoarseness(37 cases) were caused by non target arterial embolization with the most serious one of cerebral infarction(1 case) and another eyelid ptosis (1 case). The cerebral infarct one was treated with some vasodilating drugs and anti coagulant, all others were given anti symptomatics or no special treatment.Conclusions Proper treatment should be ready during thyroid arterial embolization and given in time with occurance of complications.

0.05). The diameters of left superior and inferior thyroid arteries ranged from 2.4mm to 6.0mm(3.7?0.9mm) and from 1.0mm to 5.2mm(2.9? 1.0 mm) respectively, showed statistically significant difference ( t=3.7796, P 0.05), but the right inferior thyroid arteries were larger than the left ones ( t=2.3 917, P

Objective To study the efficacy of thyroidal arterial embolization in treating hyperthyroidism by using different embolizing materials and the relationship between recurrence rate and the numbers of embolized arteries. Methods 56 cases with hyperthyroidism were divided into group A (25 cases) and group B (31 cases). Patients of group A had their thyroidal arteries embolized with gelfoam particles and stainless coils after arterial infusion of a total dosage of 24 mg of blemycin. Patients of group B had their thyroidal arteries occluded with polyvinyl alcohol (PVA) particles. The effectiveness and general complications of arterial embolization for these two groups were compared and the relationship between recurrence rate of hyperthyroidism after treatment and numbers of embolized thyroidal arteries was studied. Results It showed effectiveness in all patients within 2 3 months. The follow up records showed, the recurrence rate of hyperthyroidism was 28% and 16.1% for group A and group B respectively but without statistical difference. The recurrence rates were 46.7% for those patients with 2 thyroid arteries embolized and 12.2% for those with 3 4 arteries embolized, showing significant difference ( ? 2=7.751, P

Objective To establish a new technique isolating pancreatic islet of langerhans and evaluate the clinical efficacy and safety of adult islet transplantation.Methods Pancreases were stored using the "2-layer method" of the oxygenated perfluorochemical (PFC) and UW solution. The Pancreases were digested by Liberase collagenase enzyme and purified using continuous gradients of Ficoll-diatrizoic acid on a refrigerated COBE 2991 centrifuge to separate the islets. Cultured islets were infused by surgical approach to the liver via portal vasculature. Clinical metabolic data such as blood glucose, dose of insulin, C-peptide, HbA1c, liver function and renal function, was determined and compared with the pre-transplant data.Results Islets of langerhans were isolated successfully in 42 pancreases. The average of islet yield was 285000 islet equivalents(IEQ). Islet purity and viability were 95.7%, 93.2%, respectively. The stimulation index(SI) as assessing function of human islet was 2.43 and negative-etiology in vivo. Twenty clinical islet transplant infusions have been carried out in 11 subjects with type 1 diabetes mellitus(T1DM). The average islet mass for infusion was 11200 IEQ/kg. The treatment strategies for islet transplantation was glucocorticoid-free immunosuppressive regimen. During 7 months to 4 years follow-up, 7 recipients had insulin independence, the dosage of insulin decreased by 60% in 4 patients after islet transplantation. The level of blood glucose and HbA1c, liver and renal function were normalized throughout follow-up period. All patients had C-peptide positive after islet transplantation. No adverse effects and complications related to islet infusion procedure.Conclusions New technique has proved to be suitable for isolating pancreatic islet of langerhans. Adult islet transplantation can be used as an effective and safe way for treating T1DM.