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 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.
Objective To summarize recent advances on preoperative staging strategies in rectal cancer. Methods Relevant references about preoperative staging strategies were collected and reviewed. The multimodal preoperative evaluation (MPE) system recently documented was focused on. Results The comparably accurate T and M stage could be achieved preoperatively by following an appropriate available method; however, the N stage’s accuracy was still not satisfying. The MPE system， incorporating with the advantages of transrectal ultrasound， computerized tomography and serum amyloid A protein in a multi-disciplinary mode could display the most accurate preoperative staging for rectal cancer currently. Conclusion The MPE has potential prospects in preoperative staging of rectal cancer， and can provide the most accurate preoperative staging for rectal cancer at present.
Objective To investigate the application and curative effect ofnasoalveolar molding plate in the presurgical orthodontic treatment of completeunilateral cleft lip and palate in infants. Methods From January 2003 to March 2004, 100 infants with complete unilateral cleft lip and palate received presurgical orthopedics by using nasoalveolar molding plate. According to the age, 100 infants(aging 10 days to 3 months, including 60 males and 40 females) were divided into the test group (10 days to 1 month) and the control group (1.3 months). The widths of lip cleft and dentoalveolar cleft and the rate of satisfaction for nose wing were compared between 2 groups before treatment and after the treatment.Results The widths of cleft lip and dentoalveolar cleft before orthodontic (5.0±1.6 mm,6.9±2.6 mm) and after orthodontics (4.1±2.7 mm, 6.4±29 mm）in the test group were less than those in the controlgroup（7.5±3.1 mm, 12.5±4.0 mm and 8.3±3.0 mm,10.8±2.6 mm）, being statistically different(Plt;0.05). The satisfactory rate of nose wing inthe test group (86.3%) was significantly higher than that in the control group(62.4%，Plt;0.05). Conclusion The advantagesof presurgical orthodontic treatment of complete unilateral cleft lip and palate in infants are as follows: repositioning the premaxillary segment, reducing the width of palate cleft, correcting the nasal deformities and facilitating surgical repair of cleft lip and palate.
Objective To determine the influence of combinative assessment of transrectal ultrasound (TRUS) and serum amyloid A protein (SAA) on the assessment of preoperative staging selection of operative procedures in the middle and lower rectal cancer. Methods Prospectively enrolled 130 patients, who diagnosed definitely as middle and lower rectal cancer at West China Hospital of Sichuan University from June 2008 to February 2009 were randomly assigned into two groups with 65 participants, respectively. In one group named TRUS combined SAA group, both TRUS and SAA combinative assessment were made for the preoperative evaluation. In another group named TRUS group, only the preoperative TRUS was made. The preoperative staging and predicted operative procedures were compared with postoperative pathologic staging and practical operation program, respectively.Results Of 118 patients with rectal cancer were actually included into TRUS combined SAA group (n=59) and TRUS group (n=59). The baselines of characteristics of two groups were basically identical. For TRUS combined SAA group， the accuracies of preoperative T and N staging were 79.7% (47/59) and 77.8% (42/54) respectively; For TRUS group the corresponding rates were 86.4% (51/59) and 57.7% (30/52), respectively. There was no statistically significant difference of the accuracy of preoperative T staging （P=0.609） while preoperative N staging had statistical difference (P=0.027) between two groups. There was a statistically significant difference of the accuracy of prediction to operative procedures in two groups 〔96.6% (57/59) vs. 83.1% (49/59), P=0.015〕. The preoperative T staging was related to the selection of operative procedures (P=0.037) when analyzing the relationship between the operative procedures and the multiple clinicopathological factors in middle and lower rectal cancer. ConclusionCombinative assessment of TRUS and SAA could improve the accuracy of preoperative staging in middle and lower rectal cancer, thus provide higher predictive coincidence rate to operative procedures for surgeon.
Pulmonary rehabilitation therapy is gaining more attention. The recent systematic review of domestic and foreign relevant literature indicates pre-operative pulmonary rehabilitation exercise training performs an important role in per-operative period. The rehabilitation therapy can efficiently improve exercise tolerance and quality of life of patients with lung cancer, reduce post-operative complications, shorten hospitalization time, and increase opportunity of operation. However, the evidence comes from small samples reported by present clinical study, and a standard treatment guideline of pulmonary rehabilitation has not been established until now. Further researches are expected to provide demonstration and promote pulmonary rehabilitation. It is an important part of comprehensive treatment of lung cancer. The therapy will benefit more patients suffering from lung cancer.
ObjectiveTo investigate the preoperative localization of pulmonary glabrous nodules.MethodsA total of 192 patients admitted to General Hospital of Northern Theater Command from April 2012 to September 2019 were selected for the study. There were 95 males and 97 females at an age of 56.47±11.79 years. All patients completed preoperative examination, and were divided into a positioning group (n=97) and a non-positioning group (n=95) according to whether the preoperative positioning was performed. And the surgical indicators between the two groups were compared. According to the substance of ground-glass opacity, they were divided into a pure ground-glass nodules group (n=23) and a mixed ground-glass nodules group (n=74) in the positioning group and a pure ground-glass nodules group (n=14) and a mixed ground-glass nodules group (n=81) in the non-positioning group . According to the size and distance of the nodules from the pleura and whether the nodules could be detected, the corresponding linear function was obtained.ResultsThe operative time of methylene blue localization group was shorter than that of the no localization group. In the scatter plot, the corresponding diameter and depth of the nodules and the corresponding coordinate points which can be explored were described. And linear regression was performed on all the coordinate points to obtain the linear function: depth=0.648×diameter–1.446 (mm). It can be used as an indication for the preoperative localization of pure ground-glass nodules in Da Vinci robotic surgery. Linear function: depth=0.559 5×diameter+0.56 (mm). It can be used as an indication of preoperative localization of mixed ground-glass nodules in Da Vinci robotic surgery.ConclusionThis equation can be used as a preoperative indication for clinical peripheral pulmonary ground-glass nodules.