From 1972 to 1992, 333 patients underwent operations because of Graves’ disease in our hospital. Histological examination of resected thyroid tissue revealed carcinoma in 8 cases, which accounted for 2.4%(8/333). With reviewing the literatures basing on a lot of literature, we lay emphasis on the clinical feature of the disease, cause of misdiagnosis, and the diagnosis and treatment of the disease are discussed.
Objective To investigate the diagnosis and treatment of pulmonary arterial hypertension ( PAH) due to rare causes. Methods The clinical presentation, laboratory testing, diagnosis and treatment of 4 patients with PAH associated with rare causes in Beijing Anzhen Hospital from January 2001 to March 2008 were analysed retrospectively. Results Primary biliary cirrhosis, hyperthyroidism, antiphospholipid syndrome and pulmonary artery sarcoma may cause PAH, which were improved after corresponding diagnosis and management. Conclusion PAH can result from rare causes. The enhancement of its recognition will help earlier diagnosis and treatment and improve the prognosis.
Objective To evaluate the safety and tolerance of medicinal charcoal enteric-coated tablets in healthy volunteers. Methods A total of 44 healthy volunteers were randomly divided into 6 single-dose groups (0.5 g, 2 g, 4 g, 6 g, 8 g and 10 g) and a multiple-dose group (3 g, 3 times a day, for 14 days). The safety profile and tolerance were evaluated by observing symptoms, vital signs, and laboratory tests. Results No serious adverse event was reported for any volunteer. Abdominal distension occurred in 2 volunteers in the 4 g dose group and the 6 g dose group. One volunteer in the 8 g dose group experienced nausea and vomiting. Transient decrease in white blood cell count was observed in one volunteer in the 10 g dose group. Abdominal distension occurred in 2 volunteers of the multiple-dose group. Conclusion Based on our findings, the maximum tolerated dose of medicinal charcoal enteric-coated tablets in Chinese healthy volunteers is 10 g. The recommended dose for subsequent clinical trials is 3 g, 3 times a day.
目的 总结甲状腺功能亢进性肝功能损害 （ HLI ） 的临床特点和治疗方案。 方法 对2008年1月－2010年12月诊治的49例HLI患者临床资料进行回顾性总结分析，据其治疗方案的不同分抗甲状腺治疗组和单纯保肝治疗组，比较二组患者治疗后肝功能恢复情况。 结果 所有患者入院时均存在不明原因肝功能不全，而后明确为HLI。其中女29例（59.2%），男20例（40.8%），年龄10～70岁，平均45岁。 症状主要表现为体重下降（65.3%），心悸（51.1%），怕热多汗（49.0%）， 厌油纳差、食欲减退 （44.9%）。主要体征包括甲状腺肿大（36.7%），双下肢水肿（24.5%），心界扩大（16.3%），皮肤巩膜黄染（14.3%），肝脾肿大（12.2%）等。肝功能检验异常主要表现为谷丙转氨酶升高（68.9％），谷草转氨酶升高（57.8％）为主，其次是谷氨酰转移酶（69.4%）、直接胆红素（59.2%）、总胆红素（44.9%）、碱性磷酸酶（42.9%）、乳酸脱氢酶（26.5%）升高，以及白蛋白（32.7%）下降。死亡3例，病死率6.1%。采用Wilcoxon秩和检验结果提示抗甲状腺治疗组的总胆红素和直接胆红素低于单纯保肝治疗组，组间差异有统计学意义（P＜0.05）。 结论 此类患者可同时具备甲状腺功能亢进和肝功能不全的临床表现，肝功能常表现为淤胆型肝炎。HLI总体预后较好，抗甲状腺治疗是该病的关键。
目的 总结甲状腺功能亢进症（甲亢）并肝损害的临床特征与治疗转归。 方法 回顾性分析2009年6月－2010年6月入院诊治的119例甲亢并肝损害患者（肝损害组）的临床特点与治疗转归资料，并与同期247例甲亢不伴有肝损害患者（无肝损害组）作比较。 结果 肝损害组占同期甲亢患者的30.4%，其中108例（90.8%）无明显肝损害的临床表现，以丙氨酸氨基转移酶和天门冬酸氨基转移酶升高为主，多为轻、中度升高；患者高代谢症候群、突眼、甲状腺肿大发生率及肿大程度明显高于无肝损害组，心率明显快于无肝损害组，血清游离三碘甲状腺原氨酸、游离甲状腺素及吸131I率明显高于无肝损害组，而体质量指数则明显低于无肝损害组（P＜0.05）。两组性别、年龄、病程、甲亢类型、甲状腺球蛋白抗体及甲状腺微粒体抗体滴度差异无统计学意义（P＞0.05）。肝损害组患者随访18个月以上，101例131I治疗患者随着甲亢控制，肝功能恢复正常，未见有再发肝损害；18例抗甲状腺药物治疗，其中10例随着甲亢控制，肝功能逐渐恢复正常；8例随着甲亢控制，肝功能逐渐恢复正常，但随着甲亢复发，再出现肝功能损害。 结论 肝损害是甲亢的常见并发症之一，其肝损害症状较轻，多数患者不典型，但并随甲亢病情较重。护肝治疗结合恰当的抗甲亢治疗预后良好。