42 cases of hyperthyroidism had been operated from 1990-1993.In the preoperative treatment,antithyroid drugs were used togather with thyroxine.Some advantages have been observed,which are better than drugs were used togather with thyroxine.Some advantages have been observed,which are better than thoes of the usual preoperative preparaton.①Patient can be prepared to a complete euthyroid state.②The vascularity of the gland can be reduced to a least degree so that the operative risk of bleeding is will small.③The serum thyroid hormone will not be raised,therefore no thyroid crisis occurs.
Objective To determine the influence of combinative assessment of 64 multi-slice spiral computer tomography (MSCT) and serum amyloid A protein (SAA ) on the selection of operative procedures in lower rectal cancer.MethodsProspectively enrolled 130 patients diagnosed definitely as lower rectal cancer (distance of tumor to the dentate line ≤7 cm) at West China Hospital of Sichuan University from July 2007 to September 2008 were randomly assigned into two groups with 65 participants, respectively. In one group named MSCT+SAAgroup, both 64 MSCT and SAA combinative assessment were made for the preoperative evaluation. In another group named MSCT group, only the preoperative MSCT was made. Furthermore, the preoperative staging and predicted operation procedures were compared with postoperative pathologic staging and practical operation program, respectively.ResultsAccording to the criteria, 119 patients with colorectal cancer were actually included into MSCT+SAA group (n=58) and MSCT group (n=61). The baselines characteristics of two groups were basically identical. For MSCT+SAAgroup, the accuracies of preoperative staging T, N, M and TNM were 89.66%, 79.31%, 100% and 77.59%, respectively; For MSCT group, the corresponding rates were 86.89%, 70.49%, 100% and 65.57%, respectively. There was a statistically significant difference of the accuracy of prediction to operative procedures in two groups (93.10% vs. 80.33%, P=0.041). The clinical staging (P=0.001), preoperative T staging (P=0.000), M staging (P=0.016), TNM staging (P=0.013) and serum level of SAA (P=0.029) were related to the selection of operative procedures when analyzing the relationship between the operative procedures and multiple clinicopathologic factors in lower rectal cancer. ConclusionCombinative assessment of 64 MSCT and SAA could improve the accuracy of preoperative staging, thus provide higher predictive coincidence rate to operative procedures for surgeon.
Objective To investigate the task group’s effectiveness in language evaluation based on the task group's functional Magnetic resonance (fMRI) results’ agreement with the fixation side of the Wada language area. MethodsWe collected 90 patients with intractable epilepsy of 90 patients from December 13, 2018 to January 3, 2020 from the Epilepsy Center of Guangdong 999 Brain Hospital. We used two simple fMRI tasks. Among them, 25 patients completed the Wada experimental examination, and 8 patients completed the electrode implantation and subsequent preoperative language area mapping. Adopt block experimental design, ABBA style presentation, and use AFNI software to process fMRI data, lateralization index calculation, and multiple regression analysis. ResultsfMRI results from 90 patients showed that the results from both the sentence-completion task and the image-naming task were more stable than those from either task. The results were then compared with the results of the “gold standard” Wada test in 25 patients with fMRI-located language dominance in the hemisphere. The results showed that the accuracy of the single task was between 70% and 80%, but the accuracy of the combined results of the two tasks was 93.3%. Conclusions Compared with the results of a single task, the results of multiple fMRI tasks are more stable in the judgment of activation range and language dominance hemisphere. fMRI and Wada language area siding accuracy 93.3%, fMRI task siding valid and replicable.
Objective To summarize the current value of neoadjuvant chemotherapy (NAC) for potentially resectable gastric cancer. Methods The recent 5-year literatures searched through the PubMed with the key words: stomach neoplasm, gastric cancer/carcinoma, neoadjuvant therapy/chemotherapy and preoperative therapy/chemotherapy as well as the relevant reports presented in the ASCO Annual Meeting in 2007 and 2008 were analyzed. The present status of NAC for advanced gastric cancer was summarized, the necessity and feasibility were evaluated, and the patients features for selecting, the predictors for response, the mainly existing problems and development trend of NAC were analyzed. Results At present, there were 7 randomized control trails (RCT) published, and among them 3 were phase Ⅲ. It was safe, effective and feasible to most of trails in NAC for gastric cancer. However, it was still little to obtain survival benefit for NAC RCT, and short of randomized trial comparing strict preoperative chemotherapy to surgery alone or perioperative chemotherapy to surgery plus adjuvant chemotherapy. It remained lots of problems such as how to select the appropriate patients, the effective induced regimes and the predicted factors, the evaluated indices for response. Conclusion NAC is a safe, feasible and efficient method to potentially resectable gastric cancer, but strict phase Ⅲ randomized trials are needed. In the future, substantial improvements of treatment outcome will likely depend on the novel drugs and molecular biological targeted therapies.
ObjectiveTo summarize the clinical features and imaging features of CT in the omental torsion, and in order to reduce the misdiagnosis and missed diagnosis rate of imaging features. MethodsThe data of 16 cases of omental torsion (secondary 15 cases, primary 1 case) and 286 cases of acute appendicitis (eliminated the subhepatic and retroperitoneal ectopic appendix) in our hospital from 1998 to 2014 were retrospectively analyzed. ResultsEleven cases of omental torsion suffered from the shifting pain in right lower quadrant. No obvious shifting abdominal pain was observed in other 4 cases whose main manifestations were abdominal tenderness and rebound tenderness around umbilicus. The patient of the remaining 1 case had enclosed mass in the area of left groin with pain and suffered from continuous periumbilical pain. Abdominal spiral CT examination was performed in 16 patients before operation. Increased signal intensity of globular soft tissue, which deviating from McBurney's point, was found at level of distal umbilicus by preoperative spiral CT in 13 cases. One case of omental torsion associated with ncarcerated inguinal hernia was missed. ConclusionsOmental torsion manifests chiefly shifting pain in right lower quadrant, abdominal tenderness, and rebound tenderness around umbilicus. It is easily confused with appendicitis. Abdominal spiral CT should be chosen as a preferred means in preoperative diagnosis of omental torsion.
Objective To probe CT grading criteria of vascular invasion in pancreatic cancer. Methods Retrieved articles in CNKI and PubMed about value of CT in preoperative assessment of vascular invasion in pancreatic cancer last ten years. Results Multislice helical CT is considered the best imaging method to assess the invaded peripancreatic vessels in pancreatic cancer. There are different CT criteria of vascular invasion in pancreatic cancer based on extension of hypodense tumor and its relation to blood vessels, on the degree of circumferential contiguity of tumor to vessel, on the degree of lumen stenosis, and on the degree of contiguity between tumor and vessels combined vascular caliber. Conclusion CT grading criteria are not uniform, each one has defects.
ObjectiveTo systematically review the efficacy and safety of prophylactic use of intra-aortic balloon pump counterpulsation (IABP) before coronary artery bypass grafting (CABG) in high risk patients. MethodsDatabases including The Cochrane Library (Issue 2, 2014), PubMed, EMbase, CBM, CNKI, WanFang Data and VIP were electronically searched from inception to July 2014, to collect randomized controlled trials (RCTs) and cohort studies about prophylactic use of IABP before CABG in high risk patients. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed by using RevMan 5.2 software. ResultsA total of 6 RCTs and 6 cohort studies involving 1 359 patients were included, of which 633 prophylactically used IABP before CABG (the IABP group) and 736 didn't prophylactically use IABP before CABG (the control group). The results of meta-analysis showed that: compared with the control group, prophylactic use of IABP could significantly reduce perioperative mortality (RCT: OR=0.15, 95%CI 0.06 to 0.38, P<0.000 1; cohort study: OR=0.36, 95%CI 0.19 to 0.67, P=0.001) and postoperative LCOS (RCT: OR=0.23, 95%CI 0.12 to 0.43, P<0.000 01; cohort study: OR=0.21, 95%CI 0.10 to 0.43, P<0.000 1); there was no significant difference between two groups in incidence rate of postoperative myocardial infarction (MI) (RCT: OR=0.34, 95%CI 0.10 to 1.11, P=0.07; cohort study: OR=0.56, 95%CI 0.26 to 1.24, P=0.15); the results of combined analyses of RCTs showed that, prophylactic use of IABP could significantly reduce postoperative ICU stay (MD=-42.94, 95%CI -56.11 to -29.76, P<0.000 01) and postoperative hospital stay (MD=-3.83, 95%CI-5.82 to -1.85, P=0.0002), but these differences were not found in the results of combined analyses of cohort studies (MD=-4.68, 95%CI 20.69 to 11.33, P=0.57; MD=-0.77, 95%CI -1.80 to 0.26, P=0.14). ConclusionProphylactic use of IABP before CABG in high risk patients can significantly reduce the perioperative mortality, postoperative LCOS and the length of ICU stay, however it cannot reduce postoperative MI. Due to the limited quantity and quality of included studies, the above conclusions still need to be verified by more high quality studies.
Objective To determine the influence of combinative assessment of 64 multi-slice spiral computer tomography (MSCT) and serum amyloid A protein (SAA) on the selection of operative procedures of upper rectal cancer in multi-disciplinary team. Methods Prospectively enrolled 110 patients, who were diagnosed definitely as upper rectal cancer (distance of tumor to the dentate line gt;7 cm) at West China Hospital of Sichuan University from August 2007 to October 2008, randomly assigned into two groups. In one group named MSCT+SAA group, both MSCT and SAA combinative assessment were made for the preoperative evaluation. In another group named MSCT group, only MSCT was made preoperatively. Then, the pooled data were analyzed for the correlative relationship between the choice of surgery strategy and clinicopathologic factors. Furthermore, the preoperative staging and predicted operative procedures were compared with postoperative pathologic staging and practical operative procedures, respectively. Results According to the criteria, 106 patients with upper rectal cancer were randomly assigned into MSCT+SAA group (n=52) and MSCT group (n=54). The baseline characteristics of two groups were statistically identical. When analyzing the proportion of multiple clinicopathologic factors in different operative procedures of upper rectal cancer, there were statistical differences in the preoperative N staging (P=0.003), M staging (P=0.022), TNM staging (P=0.003), serum level of SAA (P=0.005) and general category of tumor (P=0.027). For MSCT+SAA group the accuracies of preoperative staging T, N, M and TNM were 84.6%, 86.5%, 100% and 86.5%, respectively; For MSCT group the corresponding rates were 83.3%, 2.9%, 100% and 64.8%, respectively. There were statistically significant differences accuracies of preoperative N staging and TNM staging (P=0.005, P=0.009, respectively) in two groups. There was a statistically significant difference of the accuracy of prediction to operative procedures in two groups (96.2% vs. 81.5%, P=0.017). Conclusion Combinative assessment of 64 MSCT and SAA could improve the accuracy of preoperative staging, and thus provide higher predictive coincidence rate to operative procedures for surgeon.
Objective We searched and reviewed medical evidence to find the guide of bowel preparation we should choose before large bowel preparation. Method Firstly, we put forward clinical questions. Secondly, we searched medical evidence from PubMed, MEDLINE, EMbase, Cochrane Library, Science and ACP in recent 10 years. And then we reviewed the results. Results We finally identified 17 literatures including 2 system reviews, 6 meta-analyses and 9 randomized control trials which included 4 multicentre randomized clinical trials. Most of literature suggested that there was no evidence showing the benefit of mechanical bowel preparation (MBP). No MBP before large bowel surgery would not increase rate of anastomotic leakage. On the contrary, MBP may increase the percentage of anastomotic leakage and wound infection. Considering the research with the clinical situation, we produced a new method of simplified MBP to treat the patient. It reached the predictive effect. Conclusion No evidence of systematic review and meta-analysis supports the benefit of BMP. The new simplified bowel preparation before surgery in West China Hospital was worthy to test.
Objective To determine the accuracy of endorectal ultrasonography (ERUS) in preoperative staging of rectal cancer and investigate the limitations and pitfalls of ERUS. Methods Ninety-four patients with rectal cancer were examined preoperatively by ERUS between September 2008 and November 2009 in this hospital. The size, shape, echo pattern, infiltration depth, and extra-rectal invasion of lesions were observed. The results of ERUS staging were compared with histopathology findings of the resected specimens. Results The overall accuracy of ERUS in T staging was 63.8% (60/94). The accuracies of ERUS for pT1, pT2, pT3, and pT4 tumor were 87.2% (82/94), 76.6% (72/94), 76.6% (72/94), and 97.9% (92/94), respectively. The sensitivity, specificity, and accuracy of ERUS for advanced rectal cancer (pT3+pT4) were 70.8% (34/48), 78.3% (36/46), and 74.5% (70/94), respectively. The sensitivity, specificity, and accuracy of ERUS in lymph node metastasis were 75.0% (42/56), 42.1% (16/38), and 61.7% (58/94), respectively. There was no significant difference of accuracy among various tumor locations above anocutaneous line (P＝0.495). The accuracy of ERUS for T staging improved with experience, the T staging accuracy improved from 40.0% after assessment of 30 cases to 81.3% after 94 cases were examined (P＝0.026). Conclusions The ERUS provides a good accuracy rate for assessment of the depth of tumor invasion and lymph node metastasis of rectal cancer, and has become an important imaging tool for preoperative staging rectal cancer. The operator experience, peritumoral inflammation mainly influences the accuracy of ERUS.