Cardiac Surgical Procedures ; adverse effects ; Circadian Rhythm ; physiology ; Cognition Disorders ; etiology ; Humans ; Hydrocortisone ; blood ; Melatonin ; blood ; Postoperative Complications ; etiology

Objective:To evaluate the sonographic characteristics of primary lymphoma of the thyroid gland and to analyze histo-pathologic findings and other imaging features to improve the diagnostic accuracy of this disease. Methods: We retrospectively re-viewed the records of 20 patients with histologically proven primary lymphoma of the thyroid gland. The clinical, pathologic, sono-graphic, CT, and MRI features were analyzed. Results:Histology revealed non-Hodgkin lymphoma in 20 patients. Ultrasound revealed lateral thyroid lobe disease in 12 cases and the presence of unilateral masses in 8 cases. The main features seen were diffusely enlarged thyroid gland. The lateral or unilateral thyroid lobe was with hypoechoic masses intermingled with echogenic structures. A total of 16 cases showed enlarged lymph nodes, 5 cases showed invasion of trachea, and 1 case involved the trachea and esophagus. Conclusion:Primary lymphoma of the thyroid gland usually presents with clinical and sonographic findings mimicking a carcinoma or benign tu-mor. If clinical features revealed rapidly enlarging neck masses and sonographic characteristics represented by malignant features of Hashimoto thyroiditis, then we should consider lymphoma. However, the final diagnosis depends on histopathology.

[Objective] To investigate the effectivity and reliability of individualized method to localize the entrance point of the lumbar pedicle screws by vertebral plate borderline.[Methods]Four vertebra specimen were taken the X-ray film of anterior-posterior views as the center of L2.On the X-ray film,the distance between the centre-point of the pedicle to the lateral and superior margins of the vertebral plate were measured,after applied barium at the centre-point of the pedicle,the specimen were taken the X-ray film once more,the relation of the barium to the centre-point of the pedicle was measured;the distance between the centre-point of the pedicle to the lateral and superior margins of the vertebral plate were measured on the normal lumbar X-ray film in 107 cases,the data in different sex and different projection 's center were compared;the method were applied to 40 patients of lumbar pedicle internal fixation,the information in hospital were reviewed to 30 patients of the lumbar pedicle screw localization by transverse process and transverse process.[Results]All(except L5)of lumbar plate borderline were displayed clear in the experiment,accurate rate of setpoint to be 92.5%.The principal X-ray affected scarely to the relation of the pedicle with the plate borderline of nearby two segment,but affected obviously far from three segment on the normal lumbar X-ray film;the accurate rate of one time 's setpoint in clinical application was 96%,average operation 's time being 96 minute,average lose blood being 212 ml,transverse articular process 's group showed significant difference.[Conclusion]Individualized localization of the lumbar pedicle screw entrance points by vertebral plate borderline is one of feasible method,displayed less trauma and accurate rate highly in the clinical application.

[Objective]To evaluate the radiographic and clinical results of locking compression plate and interlocking intramedullary nail in the treatment of distal tibial shaft fracture(4 to 11cm proximal to tibiotalar joint).[Method]A total of 65 cases of distal tibia shaft fractures were retrospectively reviewed from 2003 to 2007.Thirty-seven cases were treated with locking compression plate as group A,and 28 cases were treated with interlocking intramedullary nail as group B.According to AO classification system,32 cases were type A,12 were type B,21 were type C.[Result]All cases were followed up for 12-24 months(mean,16.5 months).Five cases were found delayed or nonunion,with 1 case in group A and 4 cases in group B.One case in group A and 2 cases in group B were found developed deep infection.Two cases in group A and 8 cases in group B received second operation.The good-to-excellent rates of ankle joint function were 91.9% in group A and 71.4% in group B.The good-to-excellent rates of knee joint function were 97.3% in group A and 78.6% in group B.[Conclusion]Distal tibial shaft fracture could be treated successfully with either percutaneous plates or intramedullary nails.Percutaneous locking plate is better than intramedullary nail in aspect of prevention of delayed union,malunion and second operation.

Objective:To compare the effects of repetitive transcranial magnetic stimulation (TMS) at three different relatively high frequencies on neuropathic pain so as to find the best frequency.Methods:One hundred Sprague-Dawley rats were randomly divided into a sham operation group, a model group, a TMS group and a control stimulation group. The TMS group was further divided into a 5Hz group, a 10Hz group, and a 20Hz group. The rats in the model, control stimulation and TMS groups received constriction injury of the sciatic nerve, while the rats in the sham group were given a sham version of the operation. On the third day after the operation the rats in the TMS group and the control stimulation group began to receive TMS treatment. Neuropatic pain was evaluated on the day before the operation, and on the 3rd, 5th, 7th, 10th and 12th days after the operation. The evaluations included the paw withdrawal thermal latency (PWTL) and the paw withdrawal mechanical threshold (PWMT).Results:The average PWTLs and PWMTs in all of the TMS groups increased with the TMS treatment. Those of the 10Hz and 20Hz groups were significantly higher than the 5Hz group′s average, while there were no significant differences between the 10Hz group and 20Hz group.Conclusions:High-frequency TMS at different frequencies has different effects on neuropathic pain, at least in rats. The treatment efficacy at 10 and 20Hz is superior to that at 5Hz.

Objective To explore the effect of early comprehensive rehabilitation therapy on dysphagia after stroke. Methods A total of 120 stroke patients with dysphagia were collected from December 2006 to May 2009 and divided into 3 trial groups and a control group randomly.No treatment was given to patients in the control group.Patients in trial group 1(T1)were given rehabilitation training,while patients in trial groups 2(T2)and 3(T3)were treated with VitalStim and electrical acupuncture,respectively,in addition to the rehabilitation training.A standardized swallowing assessment (SSA) and the swallowing quality of life(SWAL-QOL) scale were used to evalu-ate all the patients before and after 4 weeks of treatment. ResuIts No statistically significant difference was re-vealed before the treatment among the groups in terms of the patients'sex,age,course of disease,SSA or SWAL-QOL results.Statistically significant improvement was observed after treatment in the 3 trial group,but not in the control group with regard to the SSA and SWAL-QOL scores compared with those before treatment.The trial groups all had higher scores than the control group after treatment.while T2 and T3 had higher scores than T1 after treatment.There was no statistically significant difference between groups T2 and T3.Conclusions Early compre-hensive rehabilitation therapy can improve swallowing and the quality of life of stroke patients with dysphagia.Reha-bilitation combined with neuromuscular electrical stimulation provides effects similar to that of training combined with electrical accupuneture,and is more effective than simple training in treating dysphagia.

Objective To evaluate the electrocardiographic(ECG)-gated 4-dimensional computed tomographic angiography (4D-CTA) in the determination of pulsation of unruptured cerebral aneurysms (URCAs).Methods This study included 48 patients with 62 URCAs.Examinations of ECG gated 4D-CTA of dual-source CT were performed.Twenty sets of image data with the time intervals of 5％ in a cardiac cycle were obtained after postprocessing on the workstation.The convex was defined as the point of pulsation if small bubble or small pointed convex could be found in continuous three or more images at the same location.The 62 URCAs were divided into two groups based on whether having a point of pulsation.All the URCAs were scanned at the follow-up by 3D-CTA or ECG gated 4D-CTA more than 120 days later.The diameters of aneurysms and aspect ratio between the two groups were compared with independent t test,while neck of aneurysms and follow-up time were compared with two-independent samples Mann-Whitney U test.The other variables including history of hypertension,type 2 diabetes,smoking et al between the two groups were analyzed by x2 test.The sensitivity and specificity of aspect ratio for diagnosis of pulsation were analyzed by receiver operating characteristic (ROC) curve.Results Pulsation was observed in 28 of the 62 URCAs.Aspect ratios in whose pulsation was or was not detected were 1.5±0.3 and 1.1±0.3,respectivelyThe difference between the two groups was statistically significant (t=-2.274,P＜0.001).The sensitivity and specificity of the aspect ratio were 75.0％ and 70.6％.After follow-up more than 3 months,of the 28 URCAs in which pulsation was observed,11 showed a change in shape,while in 34 URCAs without visible pulsation,5 showed a change in shape.The aneurysms with detectable pulsation were more likely to show a change in shape (x2=4.891,P=0.027),with an odds ratio of 3.753.Conclusions URCAs with a large aspect ratio are easily to show the pulsation by ECG gated 4D-CTA.Besides,the aneurysms with visible pulsation are more likely to show a change in shape after follow-up,which suggests a higher risk of rupture.

Objective To explore the value of miniprobe sonography (MPS) in differentiating Crohn??s disease (CD) and ulcerative colitis (UC). Methods 46 patients with active inflammatory bowel disease (IBD) were included into the patient group (16 patients with CD and 30 cases with UC). 20 healthy cases ( underwent physical examination in outpatient department) were recruited as the control group. All cases underwent MPS and high sensitive C-reactive protein (Hs-CRP) test.The MPS measurement index include thetotalwallthickness(TWT), mucosal thickness (MT), submucosal thickness (SMT), muscularispropria thickness (MPT), and the number of enlarged colic and paracolic lymph nodes. Results TheTWT, M, SM, MP(mm)and Hs-CRP(mg/L)in CD, UC and control group are 5.84 ± 1.42, 1.48 ± 0.23, 1.88 ± 0.28, 2.31 ± 0.85, 40.58 ± 19.33, 4.74 ± 1.01, 1.79 ± 0.35, 1.41 ± 0.25, 1.32 ± 0.34, 22.41 ± 15.25,2.86 ± 0.23, 0.97 ± 0.13, 1.06 ± 0.11, 0.64 ± 0.0 and 1.70 ± 0.65. TWT, MT, SMT, MPT and Hs-CRP in UC group has significant different with those in controp group(P<0.05). The mean value of TWT, MT, SMT, MPT and Hs-CRP in CD group are higher than those in UC group. M in UC group is higher than that in CE group. The difference is significant(P<0.05). 5 cases in CD and 2 cases with UC had enlarged colic or paracolic lymph nodes. Conclusions The MPS can distinctly observe the changesof different colonic tissue layers and the surrounding tissue structures in IBD patients,which helps for distinguishing active CD from UC.

Objective To observe the therapeutic effect of acupuncture combined with rehabilitation on dysphagia after stroke at differentstage. Methods According to the randomized trial principle, 155 cases were divided into two groups: control group (n=80) and observationgroup (n=75). The control group was treated with rehabilitation training, and the observation group was treated with acupuncture and rehabilitationtraining, 5 times every week for 4 weeks. The two groups were assessed by TCM swallowing assessment scores and Kubota testbefore and after treatment. Results According to Kubota test, the total rate was 66.67% in the control group and 89.33% in the observationgroup with a significant difference between the groups (P<0.001). In the observation group, the total rate was 90.48% at acute stage and88.89% at the convalescence stage with a significant difference (P<0.01). According to TCM swallowing assessment, the total rate was64.00% in the control group and 74.67% in the observation group with no significant difference between the groups (P<0.05). In the observationgroup, the total rate was 90.48% at acute stage and 68.52% at the convalescence stage with a significant difference (P<0.001). ConclusionAcupuncture combined with rehabilitation facilitates to improve the swallowing function in stroke patients following dysphagia especiallyat acute stage.

OBJECTIVETo evaluate the lumber plexus blockade as anesthesia technique for hip fracture repair in elderly patients.

METHODSWe retrospectively analyzed the peri-operative data of 87 hip fracture patients, aged 70 years or older, who underwent surgical repair at our hospital between 2003 and 2006. Patients were divided into three groups according the anesthesia techniques applied: general anesthesia (GA) group (n=21), epidural anesthesia (EA) group (n=37), and lumber plexus blockade (LPB) group (n=29).

RESULTSThe peri-operative data were comparable among three groups, except that intra-operative the dosage of fentanyl was significantly lower in LPB group compared with in GA group(P0.05), and the blood urea nitrogen 1 day after surgery was significantly increased in GA group(P0.05).

CONCLUSIONLumber plexus blockade combined with small-dose intravenous anesthesia is an optional anesthetic technique for elderly patients undergoing hip fracture repair.

Aged ; Aged, 80 and over ; Female ; Hip Fractures ; surgery ; Hip Joint ; surgery ; Humans ; Lumbosacral Plexus ; Male ; Nerve Block ; Retrospective Studies