Purpose:To study the malignant probability of a solitary thyroid nodule,probable risk factor,the status of B-mode ultrasonography,computed tomography,fine needle aspiration and frozen section in the operation and other adjuvant examination in the diagnosis.Methods:In the retrospective analysis of 902 cases of solitary thyroid nodule treated by surger- y and diagnosed by pathology in the Cancer Hospital of Fudan University from March 1998 to May 2001,we analyzed the value of B-mode ultrasonography,computed tomography,fine needle aspiration and frozen section in the operation and com- pared them with the final pathological conclusion.Results:This disease occurred mostly in 20～50 years old women,while the malignant nodules occurred more frequently in men(P50 years) (P50 years) is a risk factor.B-mode ultrasonography can be used as routine preoperative examination.CT is valuable in the cases with metastasis to neck lymph nodules.With FNA the pathological diagnosis of the nodule suspected to be malignant can be made preoperatively.

Objective To investigate the fluid resuscitation strategies to craniocerebral injury patients combined with multiple trauma.Methods This retrospective review was made on 124 patients with combined craniocerebal injury (GCS 3-12 points) plus multiple trauma.Based on the fluid resuscitation strategies,63 patients were treated with aggressive fluid resuscitation (AFR),and 61 with limited fluid resuscitation (LFR).A restrictive rehydration principle was performed with intensive hemodynamic monitoring:mean arterial pressure was kept between 70-80 mmHg for 48 hours and central venous pressure between 6-8 cmH2O for 48 hours in LFR group; mean arterial pressure was kept in basic level and central venous pressure between 8-12 cmH2O in AFR group.No significant differences were shown in the rest of treatments.Parameters were compared between groups such as blood pressure,shock index,coagulation function,imaging data,GCS,and GOS at 6 months postinjury.Results Between-group differences were insignificant with regard to mean arterial pressure (MAP),shock indices,ISS,trauma severity indices (TSI),and GCS (P ＞0.05).Blood pressure fluctuation in LFR group was (18.5 ±9.9) mmHg vs (29.4 ± 11.1) mmHg in AFR group (P ＜ 0.01).Eight patients developed intracranial hemorrhage progression in LFR group,with 3 being treated with craniotomy.In comparison,19 patients developed intracranial hemmorrhage progression in AFR group,with 10 being treated with craniotomy (P ＜ 0.01).Improvement in coagulation disorders was better in LFR group than in AFR group.On days 7 after admission,GCS in LFR groups was (9.1 ± 3.6) points vs (7.2 ± 2.3) points in AFR group (P ＜0.05).At 6-month follow-up,results were 34 good and 27 poor in LFR group,better than 23 good and 40 poor in AFR group.Conclusion For moderate to severe craniocerebral injury combined with multiple trauma,LFR is effective to treat coagulation disorders and hemorrhagic shock,reduce the probability of delayed intracranial hemorrhage,and further improve the outcome.

Humans ; Neck Dissection ; methods

Humans ; Quality of Life ; Rhinitis ; Sinusitis

Objective To explore a surgical therapy on close depressed fracture of the skull.Methods Ni-Ti form memory-alloy cramps were fixed on between the depressed bone and the normal surrounding skull in 16 patients with close depressed fracture of the skull.Results The follow up was 5～54 months(average 26 months).It indicated that there was no displacement and depressing of the fixed bone, no subcutaneous collection of fluid, no reject reaction and inflammation, and no erosion. The fixed bone and skull density showed normal by X ray and the fixed cramp did not disturb CT and MR scaning. All patients declared no mental burden and felt safe.Conclusion The Ni-Ti form memory-alloy cramp has a good mechanical restoration force and a good plastic effect,but no complication,it can increase the ability to resist external force in fracture region, and the surgical procedure is very simple, therefore it is ideal to treat the depressed fracture of skull.

Objective To establish a rat model of chronic renal failure (CRF) by using 5/6 subtotal nephrectomy method , then observe and evaluate the effect of Turbidity‐reducing Granule on the intestinal immune function of rats with CRF .Methods CRF model Wistar rats were divided into high ,medium and low dose group ,sham operation group ,and model control group .respec‐tively given Turbidity‐reducing Granule 4 .05 ,8 .10 ,16 .20 g · kg -1 · d-1 .Benazepril group was given 2 mL/d (1 .2 mg/d) Benaze‐pril suspension fed;model control group and the sham group are saline 2 mL/d orally .The rats were observed before and after treat‐ment of signs and general condition ,serum BUN ,Scr changes ,and pathological changes were observed under microscope .ELISA method were used to detect serum and intestinal SIgA .Results Turbidity‐reducing Granule reduced the level of serum BUN ,Scr in rats with CRF ,there were statistically significant differences of Benazepril group and high ,medium ,low dose of Turbidity‐reducing Granule group compared with model group(P<0 .05) .Compared with the model group ,the intestinal SIgA of Benazepril group and low ,middle ,high dose of group increased significantly(P<0 .05);intestinal SIgA in ,middle and high dose group were significantly increased compared with Benazepril group(P<0 .05) .Conclusion Turbidity‐reducing Granule could improve renal function and in‐testinal immune function .

Small RNA (miRNA) can regulate post-transcriptional level of mRNA. miRNA is closely related to the occurrence and development of a variety of human diseases such as gastric cancer, lung cancer, breast cancer, ovarian cancer, prostate cancer, pancreatic cancer, liver cancer, etc. Many kinds of miRNAs in human cancers are significantly abnomadly expressed. miRNA can be regarded as a marker for many human cancers diagnosis.

Objective To discuss the opportunity of hemilateral craniotomy in treatment of a large area combined middle cerebral artery (MCA) infarction.Methods Thirty-two patients with a large area combined MCA infarction were performed by hemilateral craniotomy.Initial clinical presentation was evaluated by the Glasgow coma scale(GCS).All survivors were assessed three months after surgical decompression according to Barthel index(BI).The effects of pre-hemia decompressive surgery(before any signs of cerebral hernia,based on clinical status and CT or DWI findings)versus post-hernia surgery (after signs of hernia) on mortality,functional outcome.Results In 18 patients with pre-hernia decompressive surgery,3 patients (16.7%)were dead and average BI was (66.94±7.75)scores.The mortality was 57.1%(8/14)and average BI was (38.43±9.82)scores of post-hernia surgery with 3 cases severe aphasia.Conclusion Hemilateral craniotamy is performed before occurrence of cerebral hernia may decrease the mortality and improve outcome in these patients.

Objective To evaluate the role of contrast-enhanced color Doppler ultrasonography with Levovist in the diagnosis of liver tumors.Methods One hundred and twenty-five patients with 126 hepatic solid lesions were examined by conventional color Doppler and contrast enhanced ultrasonography.All hepatic lesions were confirmed by pathology.Of these,79 cases with hepatocellular carcinoma,4 cases with metastatic liver carcinoma,13 cases with hemangioma,7 cases with inflammatory pseudotumor of liver,7 cases with focal nodule hyperplasia,and 15 cases with other benign lesions.The Levovist with a concentration of 400 mg/ml was injected into an antecubital vein within approximately 2 minutes.Results All hepatic solid lesions with blood supply were differently enhanced by contrast-ultrasonography (I～IV grades).The color flow signals with grade III and grade IV were detected in one malignant lesion before contrast-enhancement and in 41 malignant lesions ( 49.4%) after contrast-enhancement.The color flow signals were detected by contrast-enhanced sonography in 26 malignant lesions ( 92.8%) with no color Doppler signals and in 33 benign lesions ( 76.7%).The mean resistive index of liver cancer group was much higher than that of benign lesion group before and after contrast-enhancement.The accuracy rate for diagnosing liver tumors was raised from 66.7% (84/126) in pre-enhancement to 94.4% (119/126) in post-enhancement.Conclusions The contrast-enhanced color Doppler ultrasonography is very useful in the differential diagnosis of liver tumors.