Objective To analyze the clinical characteristics of Hashimoto's disease(HD) accompanying with thyroid cancer,and to explore the experience of diagnosis and treatment.Methods Clinical data of 41 cases of HD accompanying with thyroid cancer were retrospectively analyzed.The patients were diagnosed by postoperative paraffin pathological examination from Jan.2002 to July 2011.Results 10 cases of HD,37cases of thyroid cancer,and 8 cases HD accompanying with thyroid cancer were diagnosed before operation.The rate of preoperative diagnosis was only 19.51％.All patients underwent surgical treatment,including 22 cases total thyroidectomy,14 cases subtotal thyroidectomy,and 5 cases lesion side lobe resection.24 cases underwent ipsilateral neck dissection,and 4 cases underwent bilateral neck dissection (ipsilateral radical resection,contralateral selective resection).Postoperative paraffin pathological examination proved that there were 39 cases of HD accompanying with thyroid cancer,1 case of focal cancer and 1 case of B-cell lymphoma of mucosa-associated thyroid.All patients were followed up.Conclusions The preoperative diagnosis rate of HD accompanying with thyroid cancer is low and great attention should be paid to its diagnosis.For HD patients,if carcinoma can not be excluded,surgical exploration is recommended.Appropriate surgical method should be chosen according to intraoperative frozen section results.Postoperative thyroid hormone treatment is usually taken.

Objective To investigate the development and the risk factor of hip dislocation about children with cerebral palsy. Methods 90 children with cerebral palsy were divided with Chinese version of Gross Motor Function Classification System （GMFCS） and type of cerebral palsy. Their femoral head migration percentage was measured. Results The quadriplegia children were in the biggest risk of hip dislocation, hemiplegia children were the minimum; GMFCS Ⅰ children were in the lowest risk of hip dislocation, GMFCS Ⅴ children were the highest. Conclusion The abnormal development of the hip is correlative with the type of cerebral palsy and motor function in spastic cerebral palsy children.

0.05). Positive expression of 2 or all 3 markers of neuroendocrine cell was detected in all 16 samples; negative expression of all 5 peptide hormones was observed in only 25% of samples. At a mean follow-up of 44.2 months (range 4 months-7 years ), the mean time from resection to relapse or metastasis was 29.8 months; 7 cases survived more than 5 years, of which 2 have survived for 7 years. Two cases, who subjected non-operative treatment, survired 39,61 months, respectively.Conclusions Clinical manifestations of NPNEC are non-specific. Only a few tumors in NPNEC patients do not yield peptide hormones. Treatment of NPNEC (including patients with liver metastasis) with aggressive surgical resection followed by interventional methods can result in excellent overall long-term survival.

Objective To evaluate the curative effect of selective decongestive devascularization shunt of gastrosplenic region(SDDS-GSR) for the treatment of portal hypertension. Methods From September 2000 to June 2008, 44 patients with portal hypertension had received SDDS-GSR in our hospital. Twenty-nine of them had been followed up for 12-85 months (mean=44months). Results Operative mortality was 0 %. Mesenteric area pressure(33.82±5.12 cm H_2O) was higher than splenic area pressure(24.57±4.63 cm H_2O)soon after the operation finished(P<0.01). No re-bleeding ca-ses were found, and the encephalopathy occurred in 2.27% of the patients in the early stage of post-operation. However, the rates of 3.45% for re-bleeding and 3.45% for encephalopathy were noticed in long-term follow-up. The 1-, 3- and 5-year survival were 100%, 95% and 95%, respectively. Dur-ing the long-term follow-up, the platelet counts markedly increased from (49.2±21.8 × 10~9/L) of preoperative value to (77.2±29.5×10~9/L) (P<0.01), while spleen size was significantly reduced.Conclusion SDDS-GSR is a reliable and reasonable surgical procedure for the management of portal hypertension.

Objective To explore the characteristics of gross motor development in 1～6-year-old children with cerebral palsy at different levels. Methods 708 children (487 males and 221 females, age range: 1～6 years, from 6 rehabilitation centers in Shanghai) with cerebral palsy (CP) were assessed with Chinese version of Gross Motor Function Classification System （GMFCS） and Gross Motor Function Measure (GMFM). Distributions of GMFM scores at different GMFCS levels in children with cerebral palsy were analyzed. Results The GMFM-66 scores increased most in children with GMFCS Level Ⅰ, and more than 75% of them would be greater than 67 points in GMFM-66 score after the age of 48～50 months. The children with GMFCS Level Ⅱ～Ⅳ appeared similar increasing range of GMFM-66 scores in 1～6 years old. Less than 25% of the children at GMFCS Level Ⅱ would be greater than 67 points in GMFM-66 score before the age of 6 years, more than 50% of those at GMFCS Level Ⅲ would be less than 56 points, more than 75% of those at GMFCS Level Ⅳ couldn't exceed 46 points （except groups of 54～56 months and 66～68 months）. Compared with the children with other GMFCS levels, the GMFM-66 scores were always at very low level in children with GMFCS Level V, and trended to decrease with time after 5 years old. Conclusion The characteristics of gross motor development are different in children with cerebral palsy at different GMFCS levels.

To comparatively evaluate the efficacy and post-operative complications of the Madigan's prostatectomy (MPC) and suprapubic prostatectomy (SPPC). Methods: A total of 43 patients with benign prostatic hyperplasia were divided into two groups: 21 underwent MPC and 22, SPPC. In all the patients, the international prostate symptom score (IPSS) and urinary pressure-flow studies were assessed before and 6 months after operation. The International Continence Society (ICS) nomogram, Abrams-Griffiths (AG) number and linear passive urethral resistance relation analysis (L-PURR) were used to diagnose and grade bladder outlet obstruction (BOO). The IPSS and the urodynamic parameters before and after operation, as well as the advantages and post-operative complications were recorded and compared. Results: Patients of both the MPC and SPPC groups had a significant improvement in IPSS and urodynamic parameters. Obstruction was relieved in 81.0% of MPC and 86.4 % of SPPC patients. MPC has the advantages of the absence of postoperative hematuria and post-catheter stricture, a shorter period of hospitalization, and lower incidence of retrograde ejaculation and erectile dysfunction. Conclusion: Both MPC and SPPC can effectively relieve BOO. MPC has certain advantages and a lower incidence of complications as compared with SPPC.

Objective To study the SCN1A gene in a family with partial epilepsy with febrile seizures plus ( PEFS+ ) and its characteristics of inheritance. Methods The clinical features of the 2 patients and their father were summarized. All 26 exons of SCN1A gene were screened with denaturing high performance liquid chromatography (DHPLC), and direct sequence analysis was pedormed on those with abnormal elution peak. Pyrosequencing was subsequently performed in those without abnormality in direct sequence analysis. Results The proband and his sister had the phenotype of PEFS+ . The same heterozygous mutations (AS768G) on exon 26 which caused the related amino acid change (Q1923R) were found among them. Their father had frequent febrile seizures (FS) in childhood, and seizures stopped spontaneously. No abnormality was found in direct sequence but mosaic mutation in the same site was discovered with pyrosequencing (mutation quantity was 25% ). Conclusions The mutatin of SCN1A could cause partial epilepsy. PEFS+ could be inherited, the relatives carrying the affected gene may have mild clinical symptoms, possibly resulting from the low concentration of the mutated gene due to mosaic mutation.

Objective To study the sodium channel α1-subunit (SCN1A) gene in a pair of monozygotic twins with borderland severe myoclonic epilepsy in infancy (SMEB) and its characteristic of clinical manifestations. Methods The clinical features of 2 monozygotic twins were summarized. All 26 exons of SCNIA genes were screened with denaturing high performance liquid chromatography (DHPLC), and direct sequence analysis was performed on those with abnormal elution peak. Results The proband and her sister showed typical clinical features of SMEB. The same heterozygous mutations on exon 26 which caused the related amino acid change were found among them (c. 5348C > T, A1783E). Conclusion Monozygotic twins with similar clinical phenotype of SMEB have same SCN1A gene mutation.

Objective To study the clinical characteristics of autism in febrile seizures plus (FS+) and the relationship between autism and SCN1A mutation. Methods Clinical data of 103 patients with FS+ treated in epilepsy centre of the Second Affiliated Hospital of Guangzhou Medical University were collected and analyzed. According to the international criteria, generalized epilepsy with febrile seizures plus (GEFS+), partial seizures with febrile seizures plus (PEFS+), Dravet syndrome (DS) and autism were diagnosed. Genomic DNA was obtained from blood samples. SCN1A were PCR amplified and mutations were detected by DHPLC and sequencing. Result Mental retardation was found in 53.8%of patients with GEFS+, 69.2%of patients with PEFS+, and all patients with DS, respectively. One in GEFS+, one in PEFS+and nine in DS patients were accompanied with autism (P<0.01). Among FS+patients with autism, one SCN1A mutation was found in PEFS+patients, while six SCN1A mutations were found in DS patients. Conclusions Majority of GEFS+and PEFS+patients showed mental retardation, while all the DS patients were accompanied with retardation. The occurrence of autism with DS is higher than GEFS+and PEFS+. No definite relationship between autism and SCN1A mutation was indicated.

OBJECTIVETo evaluate the safety and efficacy of oral endotracheal intubation in the patients with difficult laryngoscopy undergoing general anesthesia.

METHODSA total of 1 683 patients with difficult laryngoscopy, aged 1.5-67 yr, and scheduled for the elective plastic surgery were observed in this study from 1989-1997. All these patients were at American Society of Anesthesiologist physical status I. According to the preoperative predictive results for difficult laryngoscopy, we classified these patients into two groups: Group I included 1 375 patients, whose epiglottis could be viewed (laryngoscopic view grades II and III); and Group II, included 308 patients, whose epiglottis could not be viewed (laryngoscopic view grade IV). For group I, anesthesia was induced with thiopentone 4-5 mg/kg and succinylcholine 1 mg/kg; Laryngoscopy was carried out using modified Macintosh method. For Group II, anesthesia was induced with a total intravenous anesthesia or inhaled anesthesia; anesthetic depth was required to effectively inhibit laryngeal reflexes with reservation of spontaneous breathing. Tracheal intubation was performed by fiberoptic stylet laryngoscope (FOSL). During anesthesia induction and tracheal intubation procedures, electrocardiogram, arterial pressure, heart rate and pulse oxygen saturation (SpO2) were continuously monitored. Complications of intubation (arrhythmia, and so on) were observed and recorded. Immediately after laryngoscopy and successful intubation, patients were examined for any traumatic injuries at teeth, lips, tongue, and oropharyngeal tissues.

RESULTSIn group I, tracheal intubation was accomplished by the first attempt in 1 279 cases (93.0%) and the intubation time was less than 3 min in 1 304 cases (94.8%). In group II, tracheal intubation was accomplished by the first attempt in 114 patients (37.0%), and 123 patients (39.9%) had the intubation time of less than 3 min. Tracheal intubation was successful by the second or third attempt in 96 patients of group I and 156 patients of group II, respectively. Thirty-eight patients required four or more attempts, which only occurred in group II. Of all the complications of tracheal intubation, the traumatic complications were most common. The incidences of traumatic complications in the patients with laryngoscopic view grade II, III (group I ) and IV (group II) were 0.7%, 3.9% and 14.3%, respectively. Other complications such as respiratory depression were only seen in group II. A pooled incidence of the intubation complications was 6.7% (113/1 683).

CONCLUSIONAn anesthesiologist who is skillful in difficult airway management may safely manage the airway in the patients with difficult laryngoscopy under general anesthesia.

Adolescent ; Adult ; Aged ; Anesthesia, General ; Child ; Child, Preschool ; Dyspnea ; etiology ; Female ; Humans ; Infant ; Intubation, Intratracheal ; adverse effects ; methods ; Laryngoscopy ; Lip ; injuries ; Male ; Middle Aged ; Mouth Mucosa ; injuries