Objective:To investigate the causes, diagnosis and treatment of postoperative pulmonary changes in patients with thyroid cancer.Methods:Data of 378 patients with thyroid cancer surgery admitted from Oct. 1, 2019 to Jan. 31, 2020 were retrospectively analyzed. SPSS 23.0 statistical software was adopted to analyze the effect of gender, age, smoking history, BMI, operation way and the surgical approach on postoperative changes in the lungs. The two groups of counting data were compared using χ2 method. Results:Age, gender, smoking history and surgical approach had no significant influence on postoperative pulmonary change ( P>0.05) . Lung changes in patients receiving thyroid cancer plus lateral neck dissection were greater than those receiving radical thyroid cancer alone ( P=0.001) , and lung changes in patients receiving bilateral neck dissection were greater than those receiving unilateral neck dissection ( P=0.027) . The pulmonary changes in patients with underweight and obesity were greater than those in patients with normal weight and hyperreorganization ( P=0.019) . Conclusions:Lateral neck dissection and patients’ body mass index are important factors affecting the postoperative lung changes in thyroid cancer patients. Thyroid cancer patients undergoing lateral neck dissection should actively check their lung changes through chest radiographs after surgery, especially for lean and obese patients, and patients undergoing bilateral neck dissection.

Objective:To study the safety, validity and practicability of the modified trans-cricothyroid needle electrode method for neurmonitoring during thyroidectomy.Methods:115 patients from the Department of Thyroid Surgery in Peking University Shenzhen Hospital scheduled for thyroid surgery were recruited into the group. Two paired needle electrodes were obliquely inserted into the cricothyroid membrane from the angle between the rectus cricothyroid muscle and the inferior margin of thyroid cartilage. The function of recurrent laryngeal nerve (RLN) was localized, exposed and evaluated by standard four-step method (V1-R1-R2-V2) . The vocal cord movement was evaluated by electronic laryngoscope before and after operation, and t-test was used to compare the difference of EMG signal amplitude before and after operation.Results:A total of 130 RLN from 115 patients were recorded effective electromyographic (EMG) signals, including 12 cases of giant goiter with tracheal compression stenosis; 13 cases had repeated adjustments of the position of tracheal intubation electrode during operation, but EMG signals were not satisfactory; 15 cases were with of accidental findings during operation and requiring neurmonitoring, but tracheal intubation electrodes were not used in advance. 75 cases were volunteers. The signals of 3 RLN were lost during operation. On the second day after operation, electronic laryngoscope showed that 2 cases had normal vocal cord movement and 1 case had vocal cord paralysis and no recovery for 6 months follow-up. The EMG signals of other 127 nerves were V1/R1=1857±1718μV/2347±2323μV, V2/R2=1924±1705μV/2450±2345μV. There was no significant difference in EMG signals between pre-operation and post-operation ( t=0.31/0.35, P=0.755/0.725) . The electronic laryngoscope showed normal vocal cord movement before and after operation. During the operation, 2 patients had a little bleeding at the needle electrode insertion point, which stopped after 5 minutes of compression. No electro-acupuncture breakage, infection or local hematoma occurred. Conclusions:The modified trans-cricothyroid needle electrode method had been proved to be safe and feasible for evaluating the function of recurrent laryngeal nerve in thyroid surgery. Besides of unaffected by tracheal conditions, it has good stability, simple implantation and low cost. In thyroid surgery, it can be used as a useful supplement to endotracheal intubation electrode.

OBJECTIVEThe aim of this study was to assess the impact of radiotherapy on patients with postoperative residual or recurrent papillary thyroid cancer (PTC).

METHODSWe retrospectively reviewed the medical records of 34 patients with PTC, who underwent surgery and radiotherapy in other hospitals, and treated at the Department of Head and Neck Surgery at Cancer Institute & Hospital CAMS from January 2011 to January 2014. Among the 34 cases, 22 were in stage I, 5 in stage II and 7 in stage IVa. The 34 patients received 1.5 times of surgery before radiotherapy in average. All the cases received radiotherapy (mean, 56 Gy; range, 50-70 Gy). The patients were re-operated in our hospital, and the specimens were examined by pathology. The pre- and post-radiotherapy images (CT and B-ultrasound) were compared, and the changes of tumor volume were examined. The objective effect of treatment on the tumor residual focus was evaluated using RECIST, and analyzed by t-test (SPSS 17.0).

RESULTSAll the re-resected lesions after radiotherapy were proved by pathology to be papillary thyroid cancer (PTC) or metastatic PTC in cervical lymph nodes. Among the 34 patients, 22 cases showed mild or moderate cell degeneration and the other 12 cases showed no obvious degeneration. The largest tumor diameter was 27.18 mm before radiotherapy and 27.76 mm after radiotherapy, with a non-significant difference between them (t=-1.618, P>0.05). Among the 34 patients, only 3 patients received reoperation, all other 31 cases had complete resection, and no severe complications were observed except recurrent laryngeal nerve injury in one case.

CONCLUSIONSRadiotherapy has few therapeutic benefit to PTC patients after surgery with residual tumor or local recurrence. It should be used in the PTC patients, in which the tumor invasion involves important organ tissues and is difficult for a single operation to achieve safe resection margin, or in patients who can't bear a surgery because of severe coronary heart disease or others.

Carcinoma ; pathology ; radiotherapy ; surgery ; Carcinoma, Papillary ; Chronic Disease ; Humans ; Lymph Nodes ; Lymphatic Metastasis ; Neck ; Neck Dissection ; Neoplasm Recurrence, Local ; radiotherapy ; Neoplasm, Residual ; Postoperative Period ; Radiotherapy Dosage ; Reoperation ; Retrospective Studies ; Thyroid Neoplasms ; pathology ; radiotherapy ; surgery ; Thyroidectomy ; Tumor Burden

OBJECTIVETo assess the efficacy of radioactive iodine (RAI) for the treatment of residual papillary thyroid cancer (PTC) after surgery.

METHODSA total of 20 patients diagnosed with PTC and underwent 2-6 courses of RAI therapy for residual PTC after surgery in other hospitals were included our study. Of these, 13 were in stage I, 3 in stage III and 4 in stage IV. All the cases were operated again due to the presence of suspicious residual tumors indicated by CT. Excision of thyroid tumor residue was performed in 5 cases and neck dissection in 15 cases (20 sides). The suspicious thyroid or neck residual tumors were examined pathologically after surgery. Response Evaluation Criteria in Solid Tumors (RECIST) was used to evaluate the efficacy of surgery treatment on residual tumor. T-test was used to identify variables associated to RAI and to calculate the propensity score to receive RAI after surgery.

RESULTSThe patients aged 22-58 years, with a median age of 40 years. The mean times of surgeries received before RAI was 1.5 and the mean dose of applied RAI was 318 mCi (210-660 mCi). No significant difference in tumor size between pre-RAI and post-RAI was found (t = 1.177, P > 0.05). With postoperative pathological examination, the suspicious thyroid or neck residual tumors were confirmed as PTC or the cervical lymph metastasis of PTC.

CONCLUSIONSFor the residue or metastasis of PTC after operation, reoperation should be a priority, while RAI therapy has no obvious therapeutic effect and it should be limited to selected cases such as those with distant metastasis or unsuitable for operation but with iodine uptake function, or taken as an adjuvant treatment after radical resection of cervical lesions.

Adult ; Carcinoma ; radiotherapy ; surgery ; Carcinoma, Papillary ; Humans ; Lymphatic Metastasis ; Middle Aged ; Neck ; Neck Dissection ; Neoplasm, Residual ; radiotherapy ; Reoperation ; Thyroid Neoplasms ; radiotherapy ; surgery ; Thyroidectomy ; Young Adult

AIM: In this study, we assessed the safety and efficacy of generic and branded atorvastatin in patients with ischemic stroke/transient ischemic attack in real-world practice. METHODS: Patients admitted for ischemic stroke/transient ischemic attack between January 1, 2018 and March 31, 2021 who continually received atorvastatin for ≥6 months after diagnosis were included. Safety and efficacy endpoints in patients receiving the generic atorvastatin were compared with those of patients receiving the branded medication. Propensity score matching was applied to control con-founders. RESULTS: There were 665 patients in our final analysis, 302 in the branded group and 363 in the generic group. After propensity score matching, patients who received generic atorvastatin did not show a greater incidence of Ischemic Stroke/transient ischemic attack recurrence or onset of coronary heart disease. Similar changes in NIHSS and mRS scores were observed between the generic and branded groups. Consistent results were found in rates of hepatobiliary laboratory abnormalities and the compound adverse event profile of an elevated creatine kinase level, elevated aspartate aminotransferase/alanine aminotransferase levels, and intracranial hemorrhage. Results were consistent before and after propensity score matching. CONCLUSION: Both generic and branded atorvastatin are equally effective in preventing stroke recurrence and improving neurological deficits in patients with ischemic stroke/ transient ischemic attack. Both treatments are generally well tolerated by patients.

OBJECTIVETo analyze the factors affecting prognosis of the carcinoma arising from nasal and sinonasal inverted papilloma.

METHODSThe clinicopathological data of sixty-two patients treated in our hospital from January 1974 to February 2012 were retrospectively analyzed. Of the 62 cases, 10 were at stage I or II, 24 at stage III, and 28 at stage IV. Twenty-six patients were treated with surgery alone, and 36 with surgery combined with radiation therapy. Kaplan-Meier method and log-rank test were used for the survival analysis.

RESULTSThe overall 5-years survival rate was 39.6%. The 5-years survival rate was 67.5% in the stage I or II patients,51.3% in the stage III patients, and 18.3% in the stage IV patients (P<0.05). The 5-years survival rate was 65.7% in patients who had no surgical history, and 29.9% in patients who had surgery (P<0.05). The 5-year survival rate was 17.6% in the group who relapsed after the treatment, and 49.6% in the non-relapsed patients (P<0.05). The 5-year survival rate was 23.4% in the patients who had involvement of cranial base and (or) orbit, and 47.6% in the patients whose cranial base and (or) orbit were clean (P<0.05). Of the patients at the same stage (III-IV), the 5-year survival rate of patients treated with surgery alone was 32.4%, and those treated with combination therapy was 36.2%(P=0.89). The univariate analysis showed that clinical stage, surgical history before malignization, involvement of the cranial base and (or) orbit organs, and post-operative relapse are significantly correlated to prognosis of the patients (P<0.05 for all). Multivariate analysis showed that age, clinical stage, and previous history of surgery were independent factors affecting the prognosis of the patients. Distant metastasis was the major cause of death, mostly lung metastases.

CONCLUSIONSAge, clinical stage and surgical history are the main factors affecting the prognosis of the patients. The history of recurrence and involvement of cranial base or orbit also play an important role for the prognosis. Distant metastasis is the main cause of death in the patients with carcinoma arising from nasal and sinonasal inverted papilloma.

Carcinoma ; diagnosis ; therapy ; Combined Modality Therapy ; Head and Neck Neoplasms ; Humans ; Lung Neoplasms ; Multivariate Analysis ; Neoplasm Recurrence, Local ; Papilloma, Inverted ; diagnosis ; therapy ; Papillomavirus Infections ; Prognosis ; Retrospective Studies ; Skull Base ; Survival Rate