Objective To approach the effect of neck hyperextension position on hemodynamics of vertebral artery following thyroidectomy， and analyze the correlation between the change of hemodynamics and nausea and vomiting. Methods One hundred and fifty-eight patients with preparing for thyroidectomy （thyroidectomy group） and 89 patients with laparoscopic cholecystectomy （LC， LC group） were selected. The anesthesia method and the anesthesia drugs were the same in two groups. The indexes of hemodynamics of the bilateral vertebral artery at 6 h before and after thyroidectomy were measured. The difference of nausea and vomiting was observed and compared in two groups. Results The average blood flow velocity of the bilateral vertebral artery reduced and the blood flow decreased at 6 h after thyroidectomy as compared with at 6 h before thyroidectomy （P＜0.05）. The rates of nausea and vomiting of 0，2， 3， 4 times in the thyroidectomy group were significantly higher than those in the LC group （P＜0.05， P＜0.01）. The durations of nausea and vomiting of 1， 2， 3， 4 times in the thyroidectomy group were also significantly longer than those in the LC group （P＜0.01）. There was a positive correlation between the nausea and vomiting and the changes of blood flow velocity or blood flow （change of blood flow velocity：rs=0.697， P=0.03；change of blood flow：rs=0.897， P=0.01）. Conclusions There is a certain effect of the neck hyperextension position on hemodynamics of the bilatreal vertebral artery， and which might affect the nausea and vomiting following thyroidectomy.
Objective To investigate the optimal diagnosis and treatment strategy of occult carcinoma of the thyroid (OCT) with neck lymph node metastasis as the first symptom. Method In order to discuss the optimal diagnosis and treatment strategy of OCT with neck lymph node metastasis as the first symptom, we collected 35 cases and analyzed their characteristics, diagnostic methods, operative schemes, metastasis situation, and death situation. Results Of the 35 cases, 28 cases went to hospital because of swollen lymph nodes, and other 7 cases were discovered by color Doppler ultrasound in medical examination. Thyroid nodules were found by color Doppler ultrasound in 32 cases, 3 cases were found no thyroid nodule. Lymph node of 23 cases were determined by ultrasound-guided fine-needle aspiration biopsy (US-FNAB), and 16 cases (69.56%) were diagnosed as metastasis of thyroid carcinoma or suspicious metastasis by US-FNAB. Thyroid biopsy were done in 21 cases, and 11 cases (52.38%) were diagnosed as thyroid carcinoma or suspicious thyroid carcinoma by fine needle aspiration biopsy. Of the 35 cases, 19 cases were performed total thyroidectomy and functional neck lymph node dissection, 11 cases were performed resection of unilateral thyroid and isthmus and regional neck lymph node dissection, 5 cases were performed nonstandard operations. All cases were followed up for 3–10 years after operation, and the median time was 7-year. During follow up period, 10 cases suffered from reccurrence. Among them, 3 cases reoccurred in the nonstandard operation group, 5 cases reoccurred in resection of unilateral thyroid and isthmus and regional neck lymph node dissection group, 3 cases reoccurred in total thyroidectomy and functional neck lymph node dissection group. There were 3 cases died. Among them, there was 1 case in each group of nonstandard operation group, resection of unilateral thyroid and isthmus and regional neck lymph node dissection group, and total thyroidectomy and functional neck lymph node dissection group. The recurrence rate of total thyroidectomy and functional neck lymph node dissection group was markedly lower than those of resection of unilateral thyroid and isthmus and regional neck dissection group (χ2=4.751,P<0.05) and nonstandard operation group (χ2=5.874,P<0.05). While there was no significance difference of the recurrence rate between the resection of unilateral thyroid and isthmus and regional neck dissection group and nonstandard operation group (χ2=0.291,P>0.05). There was no significance difference in the mortality among the three groups (P>0.05). Conclusion US-FNAB and intraoperation rapid frozen pathological section are important methods for diagnosis of OCT with neck lymph node metastasis as the first symptom, and standard operation is an principal treatment method for it.
ObjectiveTo investigate the significance of the expression of vascular endothelial growth factor (VEGF) in portal vein thrombosis after operation in patients with portal hypertension.MethodsThe serum of 146 patients with portal hypertension treated in Dongfeng Hospital Affiliated to Hubei Medicial College from January 2014 to December 2018 and the surgically removed splenic vein and spleen specimens were collected. The serum VEGF level was determined by enzyme-linked immunosorbent assay, and the expressions of VEGF in splenic vein and spleen tissues were detected by immunohistochemistry. According to whether portal vein thrombosis was formed after operation, the patients were divided into thrombosis group and non-thrombosis group, and the differences between the groups were compared.ResultsThe serum VEGF level in the thrombosis group was significantly higher than that in the non-thrombosis group (P<0.05). In splenic vein wall and spleen tissues, VEGF staining indexes in the thrombosis group were significantly higher than those in the non-thrombosis group (P<0.05).ConclusionsPostoperative portal vein thrombosis in patients with portal hypertension may be related to the serum VEGF level. The high expressions of VEGF in splenic vein wall and spleen suggest that VEGF may participate in the formation process of portal vein thrombosis.
ObjectiveTo investigate the expression level of exosome microRNA-21 (miRNA-21) in the bile and its clinical diagnostic value for the patients with cholangiocarcinoma. MethodsIn this study, 45 cases of cholangiocarcinoma admitted to Dongfeng General Hospital from August 2019 to December 2021 and met the inclusion criteria were selected and 35 patients with benign diseases of bile duct (choledocholithiasis or benign stricture of bile duct) during the same period were selected as control. The exosome in the bile was extracted by hypervelocity centrifugation method and identified. The exosome miRNA was extracted from the bile using a kit, then the expression level of miRNA-21 was detected by real-time fluorescent quantitative PCR. The diagnostic value of exosome miRNA-21 in the bile for cholangiocarcinoma was analyzed by receiver operating characteristic curve (ROC). ResultsThe isolated exosome in the bile conformed to the characteristics of recognized exosome and the concentration was higher. The average expression level of exosome miRNA-21 in the bile of the patients with cholangiocarcinoma was statistically higher than that in the patients with benign diseases of bile duct (59.45 verses 25.41, t=3.445, P<0.001). The area under the ROC curve was 0.715 [95%CI (0.602, 0.827), P=0.001]. The sensitivity and specificity of miRNA-21 in the diagnosis of cholangiocarcinoma were 75.6% and 62.9%, respectively. ConclusionFrom the results of this study, exosome miRNA-21 expression in bile is higher and it may be a potential early diagnostic marker for patients with cholangiocarcinoma.