Medicine
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Comparative Study
Comparison of tracheal intubation with controlled ventilation and laryngeal mask airway with spontaneous ventilation for thoracoscopic bullectomy.
General anesthesia with double-lumen endobronchial intubation is considered mandatory for thoracoscopic bullectomy. We assessed the safety and feasibility of thoracoscopic bullectomy for treatment of primary spontaneous pneumothorax (PSP) under intubating laryngeal mask airway (ILMA) with spontaneous breathing sevoflurane anesthesia combined with thoracic paravertebral block (TPB). From January 2018 to December 2018, some 34 consecutive patients with PSP were treated by thoracoscopic bullectomy under ILMA with spontaneous breathing sevoflurane anesthesia combined with TPB (study group). ⋯ The PaCO2 value was significantly higher in the intraoperative stage in the study group than in the control group (mean, 57.0 mm Hg vs 42.0 mm Hg, P = .015). In the study group, no cough reflex was found, and the level of collapse of the operative lung was excellent in 31 cases and good in 3 cases. Our study demonstrated that thoracoscopic bullectomy for treatment of PSP can be safely and feasibly performed in highly selected patients under ILMA with spontaneous breathing sevoflurane anesthesia combined with TPB.
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Type 2 diabetes mellitus is a common health problem in the world. The overall goal of diabetes management is to control blood glucose and lipids, so as to reduce the incidence of complications. Pueraria, scutellaria, and coptis decoction (PSCD) is 1 of the representative Traditional Chinese medicine formula in the treatment of diabetes, which is widely used in clinical practice in China. At present, there are many clinical reports about this formula, but these reports have their own defects.Therefore, there is an urgent need for a systematic review and meta-analysis to synthesize the current clinical evidence. ⋯ DOI 10.17605/OSF.IO/WVDE5.
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Case Reports
De-differentiation of papillary thyroid carcinoma into squamous cell carcinoma in an elderly patient: A case report.
The unpredictability of thyroid cancer can be striking, as the disease may rapidly progress to death in some individuals. Herein, we reported a rare case of aggressive papillary thyroid cell carcinoma (PTC) in an elderly patient de-differentiated into squamous cell carcinoma (SCC). ⋯ This case clearly demonstrated that SCC transformed from a pre-existing PTC. The clinician should consider a possible transformation of papillary thyroid cancer into more aggressive histological types in elderly patients who present with rapidly progressive clinical behavior. However, some patients could have long-term survival if the tumor did not transform into anaplastic thyroid cancer.
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Case Reports
Femoral pseudotumor secondary to injury in a patient with idiopathic thrombocytopenic purpura: Case report.
Idiopathic thrombocytopenic purpura (ITP) is the condition of having a low platelet count of unknown causes and is a poorly understood acquired hemorrhagic disease involving destruction of platelets in the reticuloendothelial system induced by antiplatelet antibodies. Patients with ITP can have traumatic intra-articular, intraosseous or soft tissue hemorrhage which may present as a rare intraosseous pseudotumor on medical imaging. ⋯ The diagnosis of a pseudotumor of ITP relies mainly on imaging findings of the lesion and, in particular, knowledge of the underlying bleeding disorders. Radiologist and pathologist should be aware of the characteristics of this rare complication of ITP and other bleeding disorders like hemophilia in order to avoid misinterpretation of the lesion as a tumor or infection disease.
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Observational Study
Clinical implications of perineural invasion in patients with colorectal cancer.
Perineural invasion (PNI) is a prominent characteristic of multiple solid tumors and indicates poor prognosis. Previous data concerning the impact of PNI on prognosis of patients with colorectal cancer (CRC) are conflicting, and little is known about risk factors of PNI. The aim of our study was to reveal the clinical implication of PNI on survival outcome and identify risk factors for the poor prognosis in patients with CRC. ⋯ Cox proportional hazards regression model revealed that age and N2/3 classification were independent prognostic factors for poorer OS and DFS. M1 stage (95% confidence interval [CI] = 0.228-0.585, P = .000), III/IV stage (95% CI = 0.335-0.920, P = .022), and number of sampled lymph nodes (95% CI = 0.951-0.987, P = .001) were independently prognostic for poorer OS, while history of other malignancy (95% CI = 1.133-2.813, P = .012) was identified as an independent prognostic factor for poorer DFS. Our study indicates that PNI is not an independent poor prognostic factor in patients with CRC and those patients with PNI may not benefit from postoperative adjuvant chemotherapy.