【摘要】目的 探讨亚急性甲状腺炎的诊断和治疗。 方法 回顾性分析吉林大学中日联谊医院1962年1月至2000年1月期间收治的372例亚急性甲状腺炎患者的临床资料。结果 372例亚急性甲状腺炎中129例误诊为其他甲状腺疾病，6例合并甲状腺乳头状癌。183例在发病前有上呼吸道感染病史，235例颈前区疼痛，348例发现颈前区包块，45例合并乙型肝炎病毒感染。 行彩色多普勒检查、甲状腺核素扫描检查、甲状腺吸131Ⅰ率测定及细针穿刺细胞学检查，其阳性率分别为95.62%、89.66%、69.70%及89.41%，T3、T4及TSH指标也有不同程度改变。107例患者行激素加甲状腺素治疗，133例行口服肠溶阿斯匹林连续2个月以上治疗，部分患者加服优甲乐100 μg/d。135例行手术治疗。 结论 无上呼吸道感染病史和无颈前区疼痛的亚急性甲状腺炎病例易误诊为其他甲状腺疾病。彩色多普勒、细针穿刺细胞学检查诊断率高，特异性强，是首选的检查手段； 甲状腺核素扫描可以准确地反映甲状腺功能状态； 检测血清中T3、T4及TSH水平可以协助诊断本病，判断疾病所处阶段。口服肠溶阿斯匹林加用优甲乐治疗本病效果良好。
目的 探讨结节性甲状腺肿与甲状腺癌并存时的诊治方法。 方法 回顾性分析我院1961～2000年手术治疗的4 622例结节性甲状腺肿病例中169例并存甲状腺癌患者的临床资料。 结果 患者平均年龄（42.71±12.96）岁，病程平均19.15年； 43例出现短期内颈部肿块快速长大，32例有气管受压症状，27例出现声音嘶哑； 行超声检查105例，提示甲状腺癌者52例； 行放射性核素扫描检查38例，24例显示甲状腺内凉结节或冷结节； 行术前细针穿刺细胞学检查18例，找到癌细胞11例。术前确诊率为12.43%。术中行快速病理检查57例，55例诊断为甲状腺癌。 结论 在结节性甲状腺肿临床表现的基础上出现颈部肿块增长迅速、气管受压、声音嘶哑等症状时应高度怀疑结节性甲状腺肿与甲状腺癌并存； 甲状腺彩色超声多普勒、甲状腺核素扫描、细针穿刺细胞学等检查对诊断本病有重要意义； 术前检查怀疑甲状腺癌者术中应行快速冰冻切片病理检查，可有效避免再次手术。
ObjectiveTo establish an animal model of anaplastic thyroid cancer with high metastatic activity as in human body. MethodsHuman anaplastic thyroid cancer cell line TAK was injected into one of the lateral lobes of the thyroid gland, as well as in the subcuitis in a series of nude mice. Mice were sacrificed when found moribund, and autopsy and histology were performed subsequently.ResultsThe implantation of human anaplastic thyroid cancer cells in an ectopic enviroment did not permit expression of metastasis potential. In contrast, intrathyroid implantation did. Lymph node (5/10), lung (3/10) and one metastasis (1/10) were noted upon histological examination. ConclusionAn animal model with high metastatic activity is established when human anaplastic thyroid cancer cell line TAK is implanted orthotopically into nude mice.
ObjectiveTo investigate the succession model for hyperthyroidism and thyroid carcinoma secondary to nodular goiter in iodine deficiency area. MethodsA total of 216 specimens of goiter patients from iodine deficiency area were collected in the former 3rd hospital of Norman Bethune Medical College from January 1980 to December 1994. Twentyfour heteroploid samples were selected by the method of Hedley with Flow cytometry (FCM) analysis. Paraffin-embedded tissues from the same position were used to perform immunohistochemical staining for proliferating cell nuclear antigen (PCNA), laminin (LN), factor Ⅷ related antigen (FⅧ-RAg), and p53. The proliferative activity, stroma change, and angiogenesis were observed. ResultsPCNA label index (PCNA-LI) and proliferation index (PI) consistent in 24 heteroploid samples with PCNA staining were significantly higher value. PCNA positive cells were mainly distributed over nonfollicular parenchymatous structures, small follicles, and multilayered structures with large bubbly follicles. Destroyed basement membrane and necrosis were found by LN staining in PCNA positive position with vigorous reproductive capacity. Combining FⅧ-RAg staining with LN staining, interstitial proliferation and angiogenesis were obvious in follicular epithelial cells with vigorous reproductive capacity, providing nutrition and superior environment for them. ConclusionsThe reproduction of thyroid follicular epithelial cells, interstitial proliferation, and angiogenesis are all involved in tuberosis and hyperthyroidism, forming precancerous lesion, which suggest the succession model of goiter in iodine deficiency area.
Objective To determine whether regional arterial infusion (RAI) of 5-Fu and imipenem could decrease infection and mortality of acute necrotic pancreatitis (ANP) or not. Methods Fifty three patients with ANP were devided into three groups, group A, 16 patients who received intravenous 5-Fu and imipenem, group B, 22 patients who received 5-Fu by RAI and imipenem intravenously, and group C, 15 patients who received both 5-Fu and imipenem by RAI. Results The incidence of infection of ANP in group C (0%) was significantly lower than that in group A (50.0%) and B (27.2%), and the mortality rates in group B (18.1%) and C (13.3%) were significantly reduced as compared with group C (43.8%). Conclusion RAI of 5-Fu and imipenem was effective in reducing ANP infection and mortality rates.
【Abstract】Objective To study the relation between iodine and experimental autoimmune thyroiditis(EAT). Methods Establishment of animal model was performed with iodine and thyroglobulin(TG).The rats were randomly divided into 5 groups: normal control group(NC), low iodine group (LI,500 μg/L), high iodine group(HI,500 mg/L), TG+Freund adjuvant group(TG) and TG+Freund adjuvant+HI group(TG+HI). The rats in TG group and TG+HI group were rejected hypodermically with TG emulsified by complete Freund adjuvant, and strengthen immunity was conducted with TG emulsified by incomplete Freund adjuvant on 15 days. After that, strengthen immunity was done weekly till the end of the experiment. Serum TGAb and TPOAb were measured by radioimmunoassay. Observation of the pathological changes of thyroid gland was also done. Results Thyroid follicular destruction and lymphocytic infiltration in the TG+HI group (3.83±1.72) and HI group (3.00±0.89) were significantly higher than that of the NC group(0.67±0.82)，P＜0.05. The results of the TG group were higher compared with the NC group, but there were no significant differences between them（Pgt;0.05）. The levels of TGAb in the TG+HI (4.990±1.505)，HI (3.589±1.240) and TG group (4.883±1.198) were significant higher than those of the NC group (0.642±0.454) and the LI group (0.707±0.240)，P＜0.01. The levels of TPOAb in TG+HI group (1.475±0.523) and TG group (1.316±0.606) were significantly higher than those of the NC group (0.365±0.196) and the LI group（P＜0.01）. Serum TGAb and TPOAb levels were positively correlated with the histological grades of lymphocytic thyroiditis(r=0.9,P＜0.05）. Conclusion Excessive iodine intake may induce the occurrence of EAT. The induction of EAT with excessive iodine and TG may be more efficient.