Objective To search and review the best clinical evidence to direct the use of ultrasound. Methods After developing clinical questions, we searched the following databases for evidence: PROQUEST (1984 to 2004), SUMSEARCH (1980 to 2004) and The Cochrane Library (Issue 4, 2004). The key words were “repeated ultrasound exposure and children development (outcome)”. Results We found 3 systematic reviews, 3 randomized controlled trials, 1 cohort study and 1 case-control study. Most of the trials concluded that the effects of ultrasound to fetus were to be identified, some of the trials showed that ultrasound exposure could have an effect on fetus growth and language ability after delivery. Conclusions The pregnant women should avoid ultrasound as much as possible.
ObjectiveTo summarize the new ideas and new instruments in thyroid surgery. MethodsRelated literatures were reviewed and analyzed. ResultsTotal thyroidectomy had become the preferred option for differentiated thyroid cancer and multiple nodule goiter. The key change of surgery was from recurrent laryngeal nerve-protection to parathyroid-protection. Harmonic scalpel, bipolar coagulation forceps and Ligasure were used to thyroid surgery, which could shorten operation time and reduce operative bleeding. ConclusionThe ideas and techniques of thyroid surgery have changed, total thyroidectomy and parathyroid protection are being paid more and more attentions, and new instruments are used more extensively in thyroid surgery.
ObjectiveTo investigate the relationship between p53 gene family and thyroid cancer.MethodThe related literatures in the database were reviewed and analyzed.ResultsThe p53 gene family included p53, p63, and p73. The p53 played an important role in the development of thyroid cancer, especially in the development of undifferentiated thyroid cancer. The different subtypes of p63 might have different roles in the thyroid cancer, so it couldn’t be generally said that the p63 was an oncogene or an anti-oncogene, and the function of its specific protein needed to be further studied. The biological role of p73 in the thyroid cells might be contradictory, depending on the interaction of many different factors, and the interaction between various p73 subtypes and members of the p53 molecular network was still unclear.ConclusionThere is still some controversy about role of p53 gene family in development of thyroid cancer.
Objective To compare the advantages and disadvantages of using the harmonic scalpel and bipolar coagulation forceps versus harmonic scalpel and conventional clamp-and-tie technique in open thyroid surgery.Methods One hundred patients indicated for thyroid surgery were randomly divided into two groups：the bipolar coagulation forceps group underwent surgery with harmonic scalpel and bipolar coagulation forceps，and the conventional clamp-and-tie group with harmonic scalpel and conventional clamp-and-tie technique，respectively.All operations were performed by the same group of doctors.The total operation time，intraoperative bleeding，mass diameter，postoperative drainage，and surgical complications （postoperative bleeding， postoperative recurrent laryngeal nerve paralysis，seroma，and permanent postoperative hypoparathyroidism） were compared.Results There were 48 valid cases in the bipolar coagulation forceps group， and 49 cases in the conventional clamp-and-tie group. There were no significant differences between two groups patients of age，gender，disease composition，and mass diameter（P＞0.05）.With the same operative approach， the total operation time，intraoperative bleeding，and the incidence of transient postoperative hypoparathyroidism in the bipolar coagulation forceps group were significantly lower than those in the conventional clamp-and-tie group （P＜0.001）.The postoperative drainage in the bipolar coagulation forceps group was more than that in the conventional clamp-and-tie group （P＜0.05）.There was no single case of postoperative bleeding，postoperative recurrent laryngeal nerve paralysis，seroma，and permanent postoperative hypoparathyroidism in both groups.Conclusions The combination of harmonic scapel with bipolar coagulation forceps provides significant advantages over the combination of harmonic scapel with conventional clamp-and-tie technique in open thyroid surgery.
Objective To assess the value and usage of real-time monitoring of the recurrent laryngeal nerve (RLN) during thyroid reoperation by RLN monitor. Methods One hundred and one patients were under general anesthesia and thyroidectomy. NIM-Response electromyographic (EMG) monitor system was used for assistant of dissection, exposure and protection of the RLN during the surgical procedures.Results There were 192 RLN were exposed during the surgeries in all 101 patients. The unilateral RLN injured in 10 patients was not specially explored the same side nerve. Among them 190 nerves were confirmed intact, the rest 2 nerves were resected because of tumor involving. Conclusions NIM-Response electromyographic monitor system is sensitive and accurate for preserving the integrity of RLN during the thyroid reoperations. It is valuable for protecting RLN against iatrogenic injury. This system deserves general utilization for thyroid surgery, especially reoperation.
Objective To compare the disadvantages and advantages of open thyroid surgery when using the harmonic scalpel (HS) vs conventional hemostasis (CH). Methods One hundred and fifty-one patients and 70 patients underwent thyroid surgery with HS or CH respectively. The tumor diameter, incisional length, the total operative time, thyroidectomy time, intraoperative bleeding volume, postoperative drainage volume and surgical complications were compared. The incisional length and the surgical complications in and after learning curve with harmonic scalpel were compared. Results There was no significant difference between the HS and CH group at baseline. Incisional length, total operative time, thyroidectomy time, intraoperative bleeding volume and postoperative drainage volume in HS group were significantly lower than those of CH group (P＜0.001); the surgical complications showed no significant difference between the HS and CH group (Pgt;0.05); the incisional length after learning curve was shorter than that in learning curve in HS group (P＜0.05); the surgical complications after learning curve were significantly lower than that in learning curve in HS group (P＜0.001). Conclusion HS provides significant advantages over conventional hemostasis in open thyroid surgery. However, it can’t be used in a blindly exclusive way but be combined with conventional knot tying appropriately.
Objective To explore the value of three-dimensional contrast-enhanced ultrasound angiography in the differential diagnosis of breast masses. Methods A total of 120 patients with breast masses who were treated in our hospital from July 2013 to February 2016 were selected as the research objects retrospectively, including 70 patients of benign tumor (benign group) and 50 patients of malignant tumor (malignant group) that confirmed by surgery and pathology. All patients were given conventional two-dimensional ultrasound and three-dimensional contrast-enhanced ultrasound angiography during the diagnosis. Compared the imaging features of benign group and malignant group, and compared the diagnostic value of two-dimensional ultrasound and three-dimensional contrast-enhanced ultrasound angiography for breast masses. Results Compared with benign group, the rates of irregular masses, unclear boundary, inhomogeneous echo, lateral shadowing, echo attenuation, and micro calcification in the malignant group were all higher (P<0.05). The three-dimensional contrast-enhanced ultrasound angiography scores in malignant group and benign group were significantly different with each other (P<0.05), the score of the malignant group was higher than that of benign group. The 2- and 3-score was common in benign group, but 4- and 5-score was common in malignant group. The diagnostic sensitivity of two-dimensional ultrasound and three-dimensional contrast-enhanced ultrasound angiography for breast masses were 97.1% (68/70) and 98.6% (69/70) respectively, and the specificity were 80.0% (40/50) and 96.0% (48/50) respectively, the specificity of three-dimensional contrast-enhanced ultrasound angiography was significantly higher than that of two-dimensional ultrasound (P<0.05). Conclusion Two-dimensional ultrasound and three-dimensional contrast-enhanced ultrasound angiography both have a certain diagnostic value in the differential diagnosis of breast masses, but the three dimensional contrast-enhanced ultrasound angiography can get more information through assessment of richness of the microvascular in tumor tissue, so as to improve the diagnostic specificity and is worthy of popularization and application.
Objective To summarize the research progress of the treatment of primary hyperparathyroidism (PHPT) in multiple endocrine neoplasm type 1 (MEN1). Method The literature about the treatment of PHPT in MEN1 in recent years was reviewed. Results When the symptoms of MEN1 related PHPT were obvious, surgery was an effective treatment. In addition to conventional total parathyroidectomy with autotransplantation and subtotal parathyroidectomy, less-than subtotal parathyroidectomy, and single gland excision had also been proved to be effective recently. Conclusions Combining the clinical manifestations with the actual involvement of the parathyroid of MEN1 related PHPT patients, personalized selection of appropriate timing and methods of parathyroidectomy can help MEN1 related PHPT patients obtain ideal parathyroid function and ensure the quality of life to the greatest extent.
ObjectiveTo understand the role of calcitonin testing for the diagnosis and treatment of medullary thyroid cancer (MTC) as well as recent research progress, so as to provide assistance in the early clinical diagnosis and treatment of MTC and improve patients’ prognosis. MethodThe literatures about the role of calcitonin testing in MTC in recent years were reviewed. ResultsIn recent years, both domestic and international scholars had extensively investigated the role of calcitonin in the early detection of MTC and accurate postoperative prognosis assessment. With respect to early diagnosis, advancements had been made in the three main measurement methods: basal calcitonin, stimulated calcitonin, and calcitonin measurement in the thyroid nodule fine-needle aspiration washout fluid. These developments in calcitonin levels had contributed to improved guidance in surgical treatment and prognosis evaluation. While calcitonin monitoring could inform treatment decisions and improve patients’prognosis, numerous challenges remain to be addressed. ConclusionThe study of calcitonin detection can deepen the understanding of MTC, further research on calcitonin related detection in the future will be of great significance for the diagnosis, treatment and prognosis evaluation of MTC.
ObjectiveTo summarize and analyze the possible association between thyroid diseases and alopecia areata. MethodThe literatures on the relationship between thyroid disease and alopecia areata in recent years were searched and reviewed. ResultsAmong individuals with alopecia areata, the risk of thyroid disease was heightened. They were more susceptible to autoimmune thyroid conditions, often accompanied by thyroid function abnormalities. Moreover, alopecia areata patients face an increased risk of thyroid cancer. However, in patients with thyroid disease, the change of the incidence of alopecia areata was not completely clear. The risk of alopecia areata was increased in patients with autoimmune thyroid disease, and abnormal thyroid function may be one of the potential reasons for the persistence of alopecia areata. ConclusionsAutoimmune thyroid disease and alopecia areata may have a common disease basis. Patients with alopecia areata are at greater risk of autoimmune thyroid disease and thyroid dysfunction. The increased risk of alopecia areata in patients with autoimmune thyroid disease may be related to abnormal thyroid function.