Abstract:Objective：To observe the clinical effect of surgical treatment combined with 131I therapy on differentiated thyroid carcinoma (DTC). Methods：One hundred and forty-two patients with DTC undergoing subtotal or total thyroidectomy along with selective neck dissection from January 2000 to December 2004 in our hospital were included. After operation 90 cases given 131I ablative therapy combined with replacement therapy of thyroxine tablets were assigned as group A, and 52 cases given thyroxine tablets alone without 131I therapy were assigned as group B. Results：In group A, the thyroid remnants of patients were all fully ablated after 1-4 courses of 131I treatment and the success rate of first course was 71.1%; the total response rate of metastasis therapy was 91.1%, in which the response rates were 95.1%, 88.9% and 72.7% for lymph nodes metastasis, lung metastasis and bone metastasis, respectively. The incidence of adverse reactions was significantly different between the patients with total thyroidectomy (42.0%) and with subtotal thyroidectomy (77.5%) (P＜0.01). The recurrence and survival rate for 10 years following surgery was 6.7% and 94.4% in group A and 19.2% and 80.8% in group B, and both were significantly different beween the two groups (both P＜0.05). Conclusions：Surgical treatment combined with 131I treatment and thyroid hormone replacement therapy have good efficacy for thyroid ablation and metastasis therapy, which effectively reduces recurrence and metastasis rate of DTC after surgery and also shows good long-term effects.

Abstract:Objective：To evaluate the necessity of neck dissection for papillary thyroid microcarcinoma. Methods：The clinicopathologic data of 69 patients with papillary thyroid microcarcinoma treated in our hospital from May 1999 to October 2009 were analyzed. Of the patients, 42 cases were unifocal and 27 cases were multifocal. All patients underwent thyroidectomy and central compartment (level Ⅵ) and ipsilateral or bilateral deep lymph nodes (levels Ⅲ and Ⅳ) dissection. Results：In patients of unifocal and multifocal tumor, the metastasis of central compartment lymph nodes was found in 2(4.8%) and 7(25.9%) cases, and of deep lymph nodes was in 0 (0) and 3 (11.1%) cases, respectively. The metastasis rates of central compartment and deep lymph nodes were both significantly different between patients with unifocal and multifocal tumor (both P＜0.05). Four cases of temporary hypocalcemia, three cases of temporary recurrent laryngeal nerve paralysis and one case of lymphatic fistula occurred postoperatively. Recurrence occurred in one unifocal case 42 months later and one multifocal case 7 months later. No death occurred during the follow-up period of all patients. Conclusions：Neck dissection should be aggressively performed in patients with multifocal papillary thyroid microcarcinoma. However, prophylactic neck dissection is not necessary for unifocal cases under regularly follow-up care, because that has no influence on the survival rate but can improve quality of life.

Abstract:Objective：To investigate the clinicopathocogical features, diagnosis and treatment of thyroid microcarcinoma (TMC) accidentally found in patients with nodular goiter during surgery. Methods：The clinical data retrospective analyses was conducted in 68 cases of accidental TMC during operation for nodular goiters from Jan. 2004 to Jan. 2010. Results：In all the cases, the largest benign nodules had an average diameter of (1.89±0.68) cm. The diameter of TMC was 0.1-0.8 cm with average (0.38±0.14)cm，in which the nodule diameter ≤0.5 cm was found in 43 cases (63.24%). Six cases (8.82%) were multifocal (1-4 centers), 62 cases（91.18%）were unifocal. Fonty-seven cases (69.12%) were diagnosed as TMC by rapid frozen section during surgery and underwent Ⅵ lymph node dissection. Other 21 cases (30.88%) had missed diagnosis during surgery, but was diagnosed as TMC by postoperative patholgy and did not undergo a second surgery for additional lymph node clearance. All the patients were followed up for 12-84 (average 52.47±13.26) months, and no recurrence or metastasis was found. Conclusions：Thyroid microcarcinoma is often discovered accidentally in patients with nodular goiter undergoing operation. Its preoperative diagnosis is difficult, but the prognosis is always favorable. For nodular goiter, wider surgical indication and larger resection extent is recommended.

Abstract:Objective：To evaluate the value of ultrasound-guided minimally invasive biopsy in diagnosis of thyroid nodules. Methods：The records of 528 patients with thyroid nodules (a total of 591 nodules, diameters ranged from 0.4 to 1.5 cm with the average diameter of 0.76 cm) undergoing ultrasound-guided minimally invasive biopsy (Bard Access Systems), from Oct. 2008 to Apr. 2010, were retrospectively analyzed. Results：Of the 528 patients, the biopsy specimens were succeesfully obtained from 525 patients, and the success rate was 99.4% (525/528). There were 161 cases of thyroid carcinoma and 367 cases of benign lesion diagnosed by biopsy. A total of 226 cases underwent surgical treatment after biopsy and the postoperative pathological consistency rate was 98.7%, in which false negative rate was 1.3% (3/226), and no false positive cases were found. In 27 cases, preoperative cervical lymph node minimally invasive biopsy was performed at the same time, and their biopsy pathologies were completely consistent with the results of postoperative pathological examination. All patients had no apparent discomfort after biopsy except for hematoma occurring intramuscularly or on the surface of the gland in 22 cases, which spontaneously resolved after about 1 month without special treatment. Conclusions：Preoperative diagnosis of thyroid nodules and cervical lymph node using ultrasound-guided minimally invasive biopsy has high clinical consistency, especially for small nodules, which not only avoids unnecessary over-treatment but also reduces the misdiagnosis of thyroid cancer.

Abstract:Objective：To explore the clinical paticularities and experiences in diagnosis and treatment of elderly patients with thyroid nodules. Methods：The clinical records of 144 patients more than 60 years old and 1412 young or middle-aged patients less than 60 years old with thyroid nodules admitted to Ruijin hospital were retrospectively analyzed. Results：Compared with the young or middle-aged patients, the elderly patients with thyroid nodules presented the following particularities: bilateral and multifocal lesions were the main manifestations and usually with larger nodules in diameters; compression symptoms and secondary hyperthyroidism were the main surgical indications; the reoperation rate was higher due to recurrence; the preoperative ASA score was poor; near-total thyroidectomy for bilateral and multifocal nodules under gereral anaesthesia was the main procedure; fat depositions were frequently found around the recurrent laryngeal and parathyroid glands during surgery, and the calcification rate of benign nodules was high (P>0.05). Except for higher incidence of transient hypocalcemia in the elderly patients, no significant difference was noted in terms of postoperative complication between the clderly and younger patients. Conclusions：In elderly patients with thyroid nodules, the surgical risks or complications can be reduced or avioded as long as their clincal particularities are fully understand and proper treatment is employed.

Abstract:Objective：To investigate the preventative measures against recurrent laryngeal nerve (RLN) injury in surgery of benign thyroid tumor, with the purpose of reducing the incidence of RLN injury. Methods：Four hundred and eighty cases of benign thyroid tumor diagnosed before surgery were randomly divided into two groups, of which, 232 cases underwent RLN dissection (group A) and the other 248 cases did not undergo RLN dissection (group B). The occurrence rate of RLN injure was compared between the 2 groups. Results：Temporary and permanent nerve injury rates were 1.72% (4/232) and 0.86% (2/232) respectively in group A, and were 6.45% (16/248) and 2.82% (7/248) respectively in group B. The differences of both rates between the two groups were statistically different (P＜0.05). Conclusions：Meticulous surgical dissection and take care of RLN during surgery for benign thyroid diseases can reduce the incidence of RLN injury. Thus RLN dissection is recommended to be performed routinely during operation of near-total thyroidectomy or lobectomy.

Abstract:Objective：To study the influences of the expression of estrogen receptor (ER) and progestogerone receptor (PR) on neoadjuvant chemotherapeutic (NACT) efficacy of breast cancer (BC). Methods：The expressions of ER and PR in 52 cases of breast cancer tissue were detected by immunohistochemical staining before and after NACT, and the correlation between the expression of ER and PR and the efficacy of NACT on BC were analysed. Results：After NACT, the efficacy rate of ER (-) BC patients was 85.0%, which was significantly higher than that of ER (+) patients (56.3%) (P﹤0.05)； the efficacy rate of PR (-) BC patients was 80.0%, which was significantly higher than that of ER (+) patients (51.6%) (P﹤0.05). Conclusions：NACT has more beneficial effects on ER (-) and PR (-) BC patients than those of ER (+) and PR (+) patients. The levels of ER and PR may predict the efficacy of NACT and may be as a guide to the individualized adjuvant chemotherapy for breast cancer patient.

Abstract:Objective：To evaluate the clinical efficacy of neoadjuvant endocrine therapy (NET) for multidrug resistant (MDR) proteins positive breast cancer. Methods：Sixty-two postmenopausal women with locally advanced breast cancer (LABC) and estrogen receptor (ER) and MDR protein positive were randomly devided into two groups: Neoadjuvant chemotherapy (NCT) group, receiving 4 courses of TEC (taxotere, epirubicin and cyclophosphamide) chemotherapy regimen, and NET group, receiving 3 months of letrozole therapy. The therapeutic effect of the two groups was compared. Results：The overall response ［OR, complete response (CR) + partial response (PR)］ rate and CR of NCT group was 58.8% (20/34) and 5.9% (2/34) evaluated by physical examination, and was 47.1% (16/34) and 2.9% (1/34) by ultrasonic method, respectively; no pCR was noted in the patients of NCT group. The OR and CR of NET group was 67.9% (19/28) and 28.6% (8/28) evaluated by physical examination, and was 57.1% (16/28) and 25.0% (7/28) by ultrasonic method, respectively; the pCR was 3.6% (1/28) in NET group. No significant difference was found in OR (both by physical examination and ultrasonic method) between NCT and NET group, but the CR (both by physical examination and ultrasonic method) of NET group was significantly higher than that of NCT group (P＜0.05), while breast-conserving rates of two groups were similar. Conclusions：NET with letrozole may be a preferable choice for ER (+) and MDR (+) postmenopausal patients with LABC.

Abstract:Objective：To compare the clinicopathologic features and prognosis between tubular carcinoma (TC) and invasive ductal carcinoma (IDC) of the breast. Methods：The clinical data of 41 patients with stage I/II TC and 2 568 patients with stage I/II IDC, treated with breast surgery, from 1996 to 2009, were analyzed retrospectively, and the clinicopathologic features and prognosis between the 2 groups were compared. Results：Compared with IDC, TC was more likely to be detected by mammographic screening (71% vs. 22.9%, P<0.05), and had smaller median size and showed less lymph invasion (8.6% vs. 22.9%, P<0.05). The rate of recurrence in TC and IDC was 7.9% and 25.7% (P<0.05), respectively. The disease-free survival of TC was higher than IDC (P<0.05). Conclusions：TC is associated with more favorable clinicopathologic features and outcome. In addition, the life expectancy of patients with TC is similar to that of normal individuals, and as a consequence, adjuvant systemic chemotherapy may not be justified as routine management for TC.

Abstract:Objective：To explore the clinical characteristics, pathology, prognosis and proper treatment of medullary carcinoma of the breast（MBC）. Methods：Retrospective analysis was carried out on the clinical data of 28 patients with MBC who admitted to our hospital from January 2004 to December 2010. Results：The incidence of MBC accounted for 2.9% of the breast cancer patients admitted to our hospital during the same period. The mean age was（50.68±12.63）years. The tumor size was 1-5 cm and axillary lymph node involvement was 47.6%. The overexpression of estrogen receptor（ER）, progesterone receptor（PR）, HER-2 / neu and p53 was 35.7%, 32%, 32%and 67.9%, respectively. All patients underwent operation and polychemotherapy（cyclophosphamide +Adriamycin, Paclitaxel+Adriamycin）; endocrine therapy was applied in five patients, and three cases received postoperative irradiation. All the patients were followed up from 1 month to 6 years, and the overall survival rate was 100%. Conclusions：MBC is an invasiveless histological type of breast carcinoma with good prognosis. Proper surgical and adjuvant therapy is important to improve the survival and quality of life. Attension should be paid to investigation of MBC associated antigens to provide new ideas for its treatment.

Abstract:Objective：To evaluate the therapeutic effect and surgical technique of mastoscopic axillary lymph node dissection (MALND). Methods：The clinical data of 100 patients with breast cancer undergoing mastoscopic (50 cases) or conventional (50 cases) axillary lymph node dissection since Dec. 2008 were retrospectively analysed. The parameters including the operating time, bleeding volume, number of lymph nodes removed, lymph node metastasis, hospital stay and occurrence of postoperative complication were compared respectively between the two groups. Results：No differences were noted in the average number of lymph node harvested, lymph node metastasis and hospital stay between the two groups (P＞0.05). Although the mastoscopic procedure showed longer operating duration than conventional procedure［(221.85±19.61) min vs. (140.05±13.95) min］ (P=0.000), it had less bleeding (P=0.012) and lower postoperative complication rate (P=0.034) than that of conventional surgery. Conclusions：MALND is worth being promoted for broad clinical applications owing to its advantages of minimal invasion, simple procedure, low complication rate, rapid recovery and invisible scar. However, the surgical technique of MALND remains to be further improved to reduce the prolonged operating time.

Abstract:Objective：To investigate the protective effect of lipolysis and liposuction on intercostobrachial nerve (ICBN) during breast cancer open surgery. Methods：The incidences of ICBN injury between observation group including 29 patients with lipolysis and liposuction and control group consisting 31 patients without lipolysis and liposuction were compared. Results：In observation group, one patient′s ICBN was directly injuried during lipolysis, and one patient′s ICBN was injuried due to unsatisfactory lipolysis during open surgery. In control group, ICBN injury was found in 8 cases. Conclusions：It is feasible and effctive to perform lipolysis and liposuction first for protecting ICBN during open surgery of breast cancer, if the operator can proficienctly perform the procedure.

Abstract:Objective：To explore the clinical value of strain ratio measurement with ultrasound elastography (UE) for diagnosis of breast neoplasm. Methods：A total of 109 breast masses in 103 patients for diagnosis in our hospital were randomly examined with 2-dimensional ultrasonography and elastosonography. The strain ratio of the lesion and nearby breast tissue was calculated, and the results were compared with final pathological findings. Results：There were 71 benign and 38 malignant lesions in the 109 breast masses. The strain ratios between benign lesion (2.26±1.39) and malignancy (6.95±4.08) were significantly different (P<0.05). The sensitivity, specificity and accuracy of 2-dimensional ultrasonography and strain ratio for breast cancer detection was 81.58%, 80.28%, 80.73% and 86.84%, 88.73%, 88.07% respectively (P>0.05). The rate of diagnostic sensitivity and accuracy was increased to 97.37% and 93.58% respectively (P<0.05) by combination of 2-dimensional ultrasonography and strain ratio measurement. Conclusions：Combined 2-dimensional ultrasonography with ultrasonic elastographic diagnostic method can elevate the coincidence rate of preoperative diagnosis of breast neoplasm.

Abstract:Objective：To study the expression and clinicopathological relevance of chemokine receptor 5 (CCR5) in breast cancer tissues and metastatic axillary lymph nodes. Methods：The paraffin specimens of 72 cases of invasive ductal carcinoma (IDC) along with the invoved axillary lymph nodes, 50 cases of breast fibroadenoma and 40 cases of normal mammary gland were collected. The expression of CCR5 protein in those specimens was detected by immunohistochemical staining. Meanwhile, the expressions of C-erbB-2, P53, Ki-67, ER and PR in the specimens of IDC were also measured with immunohistochemical method. Finally, the immunohistochemical results were statistically analyzed with regard to correlations with their clinicopathological data. Results：(1) The positive expression of CCR5 in IDC was 84.72% (61/72)， breast fibroadenoma tissue presented low positive expression of CCR5 (14%, 7/50)， and no CCR5 expression was found in normal breast tissue. (2) The expression of CCR5 in IDC had a positive correlation with lymph node metastasis (χ2=4.982, P=0.026, r=0.305). (3) Of the 50 cases with axillary lymph node metastasis, CCR5 was simultaneously expressed both in primary cancer and its invoved axillary lymph nodes in 39 cases, which showed a high homology. (4) There was a low positive correlation between CCR5 and breast cancer oncogene C-erbB-2 (P<0.05, r=0.291). (5) CCR5 showed no relationship with age of onset, maximum diameter of tumor, mensis status or clinical stage (P>0.05). (6) CCR5 had no direct correlation with the expression of p53, Ki-67, ER, PR (P>0.05). Conclusions：CCR5 plays an important role in occurrence and development as well as axillary lymph node metastasis of breast cancer. CCR5 may be one of the indirect indicators to predict axillary lymph node metastasis and prognosis of breast cancer.

Abstract:Objective：To investigate the effects of survivin siRNA on angiogenesis of human breast cancer MCF-7 cell xenografts in nude mice. Methods：The animal model of tumor xenograft was established by transplantation with MCF-7 cells into nude mice. The models were randomly assigned to 3 groups: PcDNA3-Survivin siRNA treatment, PcDNA treatment and control group, which were respectively injected with PcDNA3-siRNA plasmid, PcDNA3 empty plasmid or saline solution into the xenograft tumor after tumor formation in the mice. Survivin mRNA and protein levels were examined by RT-PCR and Western blot. Microvessel density was measured by immunohistochemistry staining. Results：Survivin mRNA, protein levels and microvessel density in PcDNA3-Survivin siRNA treatment group were significantly decreased compared with PcDNA treatment and control group (P﹤0.05)； whereas no significant difference was noted between PcDNA treatment and control group (P﹥0.05). Conclusions：Survivin siRNA not only decreases survivin expression, but also inhibits angiogenesis in MCF-7 xenografts.

Abstract:Objective：To study the effects of RASSF1A gene on activity of NF-κB in human gastric carcinoma cell line SGC7901. Methods：NF-κB activity was measured by EMSA( electrophoretic mobility shift assay).Expression of P65 protein was detected by Western blotting and immunocytochemistry. Results：Compared with the non-transfected and vector transfected cells, NF-κB activity of RASSF1A-SGC7901 cells was lower. The expression of P65 protein in RASSF1A-SGC7901 cells was lower than that of non-transfected and vector transfected cells. Conclusions：RASSF1A gene could suppress the activity of NF-κB in SGC7901 cells.

Abstract:Objective：To investigate the surgical procedures for establishing a reliable murine model of heterotopic small bowel transplantation (SBTx), with the purpose of providing a good experimental tool for the rejective reaction study in SBTx. Methods：C57BL/6 mice were used as donor and the BALB/c mice used as recipient animals. The procedure of segmental heterotopic SBTx in allogenic mice was performed as following: the donor′s portal vein was anastomosed end-to-side to the recipient′s inferior vena cave (IVC), and then the donor′s superior mesenteric artery (SMA) with an aortic patch was anastomosed end-to-side to the recipient abdominal aorta. Subsequently, proximal end of the graft intestine was ligated and the distant end was anastomosed end-to-side to the recipient′s jejunum. The mice were fasted for 3 days, but free access to water after the operation. In addition, the mice were given 5% glucose-saline solution (2 mL) twice daily by subcutaneous injection, but without use of antibiotic and immunosuppressive therapy. The models survived beyond 5 days were considered to be successful. Results：Segmental SBTx were perfomed in 30 mice, with a postoperative day (POD) 5 survival rate of 70 % (21/30). The operating time in donor was (41±5.5) min, the graft warm ischemic time was about 0.5 min, the time for trimming the aortic patch in SMA was 3 min and cold preservation of donor′s small bowel was (30±7.5) min. The time of recipient preparation and transplantation was (90±7.5) min, in which the abdominal aorta and IVC blockage time was (40±3.0) min, the average time for the vein anastomosis and the arterial anastomosis was (10±2.0) min and (15±2.5) min, respectively. The average bleeding volume was 0.2 mL. The operation failed in 9 cases, due to arterial anastomotic thrombosis and anastomosis stenosis (6 cases), massive hemorrhage (2 cases) and intraperitoneal infection (1 case). Conclusions：The high quality of the donor′s small bowel segment harvesting, excellent vascular and intestinal anastomosis as well as adequate supplement of liquid to both donor and recipient are all crucial factors to ensure the efficiency and success of SBTx.

Abstract:Objective：To test the hepatoprotective effects of puerarin on brain death rats. Methods：The male SD rats were randomly divided into 3 groups: brain death group (brain death models were established using progressive intracranial compression methods), puerarin treated group (rats were treated with puerarin after brain death was established) and sham-operated group (rats underwent sham operation without brain death insult). Blood and liver samples of the rats were harvested at 2 h and 4 h after brain death to measure the serum levels of ALT, AST, TNF-α and IL-6, and to examine morphological changes of liver, respectively. Results：The serum levels of ALT, AST, TNF-α and IL-6 were significantly increased in both brain death group and puerarin treated group compared with sham-operated group (both P＜0.05). The above parameters showed progressive increase in both brain death group and puerarin treated group compared with themselves at the different time points (both P＜0.05). However, the above parameters in puerarin treated group were significantly lower than those in brain death group at the same time point (P＜0.05). The pathological examination demonstrated that the liver tissues were damaged to different extents in both brain death group and puerarin treated group, but the injuries in puerarin treated group were remarkably milder than those in brain death group. Conclusions：Puerarin has hepatoprotective effects on rats after brain death.

Abstract:Objective：To construct and identify a recombinant survivin-shRNA expression vector, for making a foundation of keloid gene therapy via RNA interference. Methods：According to survivin cDNA gene sequence in the gene bank, a pair of 65 nt oligonucleotides each containing the sites of restriction endonuclease at both ends were designed and synthesized by Reynolds design principles. Oligonucleotides were annealed and ligated with linedrized RNAi-Ready pSIREN-DNR-DsRed-Express by T4DNA ligase. The recombinants were transfected into Escherichia coli strains DH-5a. Finally, it was sequenced and identified by restriction endonuclease digestion. Results：The size of the target gene fragment amplified by PCR was 465 bp and in accordance with the expected results. Double digested section showed a target gene band of about 65 bp identitfied by double endonuclease digestion. Sequence analysis of inserted fragment revealed the same sequence as synthesized shRNA oligonucleotides. Conclusions：A survivin-shRNA expression vector has been successfully constructed, which can be as the groundwork for future study of liposome mediated transfection into scar or tumor cells.

Abstract:Objective：To investigate the diagnostic value of fiberoptic ductoscopy (FDS) for cases of bilateral multiple ductal nipple discharge with intraductal space occupying lesions. Methods：The clinical data of 135 cases of bilateral multiple ductal nipple discharge with intraductal space occupying lesions treated in our center, from June 2004 to May 2009, were analyzed retrospectively. Results：The coincidence rate between FDS and pathological diagnosis was 75.0% for bilateral intraductal papilloma and 78.2% for unilateral intraductal papilloma. The total coincidence rate between FDS and pathological diagnosis was 82.2%. In cases of bilateral intraductal papilloma, the yellow nipple discharge was significantly more frequent than other qualities of discharges (χ2=23.5675, P<0.05). Conclusions：FDS diagnosis for intraductal space occupying lesions has high consistency with the postoperative pathological diagnosis, and it can be used as the first choice for nipple discharge diagnosis. Special attention shoud be paid to the yellow nipple discharge, which accounts for a larger proportion of bilateral multiple ductal nipple discharge due to bilateral intraductal papilloma.

Abstract:Objective：To investigate the surgical technique of reducing scar and maintaining the mammary shape in resection of benign breast tumor. Methods：In these patients, a curved incision was made over the tumor or around the mammary areola if the tumor was close to the mammary areola; the residual breast cavities preserved without suturing; 4-0 absorbable sutures were used for subdermal continuous suturing, then a pressue package was made; and no drains were used. Results：A total of 542 patients with 613 benign breast tumors were resected. No incision infection and dehiscence occured after operation and only linear scars were left at the surgical sites. Hematoma occrred in 26 patients (4.24%) and it resolved after conservative treatment. Skin depression due to relatively larger resection area developed in 3 patients (0.49%). Conclusions：This operative procedure not only simplifies the process and reduces the operating time, but also ensures a natural outline of the breast.

Abstract:Objective： To explore the feasibility and efficacy of supraclavicular oblique incision approach for unilateral thyroidectomy. Methods：The clinical data of 233 patients undergoing unilateral thyroidectomy from September 2009 to July 2010 at our department were analyzed retrospectively. The operation was performed by a supraclavicular oblique incision in 113 patients and by a conventional transverse incision in 120 patients. The preoperative, intraoperative and postoperative data of the two groups were compared and analyzed. Results：The average length of incision, operation time, blood loss and postoperative drainage volume of supraclavicular oblique incision group was (4.98±0.70) cm, (68.5±15.2) min, (15.2±8.9) mL, (23.7±8.6) mL, respectively, which was significantly less than that of conventional incision group which was (6.03±0.82) cm, (79.5±20.0) min, (18.5±12.7) mL and (28.5±10.9) mL, respectively (P﹤0.01). Conclusions：Compared with conventional approach, supraclavicular oblique incision for unilateral thyroidectomy has the advantages of shorter incision length and operation time, and less blood loss and postoperative drainage volume. It has better concealing effect and cosmetic result.

Abstract:Objective：To investigate the safety and clinical practice of a modified total thyroidectomy technique. Methods：The clinical data of 62 patients undergoing total thyroidectomy with the modified technique which comprised a series of improvements including vascular management of “vessel skeletonized-carryover coagulation-vessel block”, meticulous capsular dissection and en bloc excision (group A), from May 2009 to December 2010, were retrospectively analyzed. The other 81 patients undergoing the traditional total thyroidectomy from January 2005 to April 2009 were used as a control group (group B). The incidence of postoperative complications including temporary and permanent hypocalcemia, temporary and permanent vocal cord paralysis were compared between the two groups. Results：No permanent hypoparathyroidism or permanent recurrent laryngeal nerve palsy occurred and the incidence rates of temporary hypocalcemia and temporary vocal cord paralysis were 4.8% and 3.2% in group A, which were significantly lower than those in group B (14.8%, 13.6%, respectively) (χ2 =5.341, P=0.021; χ2 =2.346, P=0.033). Conclusions：Total thyroidectomy by modified procedure is safe and reliable compared with traditional total thyroidectomy.

Abstract:Objective：To investigate the effects of intraperitoneal drug perfusion for treating exudative tuberculous peritonitis. Methods：The clinical data of 69 patients with exudative tuberculous peritonitis treated in our hospital within three and a half years were analyzed retrospectively. Thirty-six cases in the observation group were given systemic antituberculotic therapy combined with intraperitoneal perfusion of isoniazid, mikacin and defibrase. The other 33 cases in control group received systemic antituberculotic tharapy only. The indexes including duration of fever, time for abdominal pain remission and ascites elimination, and incidence rate of intestinal obstruction between two groups after treatment was compared. The levels of C-reactive protein (CRP), adenosine deaminase (ADA) and serum-ascitic albumin gradient (SAAG) 1 and 2 week after treatment were also analyzed. Results：The duration of fever, time for abdominal pain remission and ascites elimination as well as the incidence rate of intestinal obstruction in the observation group were significantly decreased compared with those of the control group (P＜0.01). No differences were observed in the levels of CRP, ADA and SAAG between two groups at the time point of 1 week after treatment (P>0.05), but the levels of CRP and ADA were significant lower, while SAAG level was singnificantly higher in the observation group than that of the control group at the time point 2-week after treatment (P＜0.05). Conclusions：Systemic therapy combination with intraperitoneal perfusion with antituberculotic drugs is beneficial for the healing of tuberculous peritonitis, and along with defibrase can effectively lessen adhesion formation, thus reducing the incidence of adhesive intestinal obstruction.