Transoral radiofrequency coblation surgery for the treatment of hypopharyngeal carcinoma / 中华耳鼻咽喉头颈外科杂志

Objective@#To explore the feasibility and effectiveness of transoral surgery (TOS) for the treatment of hypopharyngeal carcinoma by means of the radiofrequency coblation(RFC).@*Methods@#Twenty-two patients with hypopharyngeal carcinoma who were treated with TOS using RFC during the years of 2010-2016 were enrolled. Among these patients, 15 suffered from pyriform sinus carcinoma, 4 suffered from postcricoid carcinoma, and 3 suffered from posterior hypopharyngeal wall carcinoma. According to the AJCC 2002 guideline, the tumor stages were T1N0M0 for 3 patients, T2N0M0 for 9 patients, T1N1M0 for 1 patient, T1N2M0 for 1 patient, T2N1M0 for 4 patients, and T2N2M0 for 4 patients respectively. All patients with N+ underwent concurrent neck dissection; 2 patients underwent concurrent prophylactic tracheotomy; 17 underwent post-operative radiotherapy for 50-66 Gy. The follow-up time was 6-72 months with a median 35 months.Two patients were lost to follow-up.@*Results@#All patients except 2 underwent the TOS successfully, while the two patients were treated with open approach surgery due to unsure safe margin. Most patients returned to oral feeding within one week. Among the 18 patients with complete follow up data, 3 had the local recurrence of the tumor (16.7%) and one died due to local recurrence, multiple primary esophageal carcinoma, and distant metastasis 4 years after surgery (5.6%). According to the Kaplan-Meier method, the 5-years local control rate and survival rate were 57.8% and 67.5% respectively. All patients had no disorders in speech, swallowing and respiration during the follow up.@*Conclusions@#The RFC can be applied in TOS for the treatments of hypopharyngeal carcinoma with high cutting efficiency and better control of intraoperative hemorrhage, which is useful in lowering the operation difficulty. The oncologic results are comparable to the open surgery with satisfactory postoperative organ function preservation.

Analyses prognostic factors relevant to sudden sensorineural hearing loss / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the prognostic factors relevant to sudden sensorineural hearing loss.</p><p><b>METHODS</b>The internationally accepted standardized clinical research methods, unified design, and unified program were adopted to conduct the prospective clinical multi-center study. The sudden deafness patients between 18 to 65 years old, with the course of this disorder less than two weeks, and without any medical treatments were collected, and then, divided into four types according to the hearing curve: type A, acute sensorineural hearing loss in low tone frequencies; type B, acute sensorineural hearing loss in high tone frequencies; type C, acute sensorineural hearing loss in all frequencies; and type D, total deafness. The factors, in terms of age, gender, type of initial audiogram, time delay before the first visit, and severity of hearing loss, were included in the analyses.</p><p><b>RESULTS</b>A total of 1 024 cases with single side sudden deafness were collected in the study from 33 hospitals in China from August 2007 to October 2011, inclusive of for 492 males (48.05%) and 532 females (51.95%). The average age was (41.2 ± 12.8) years old. There were 553 cases (54.00%) in left ear, and 471 cases (46.00%) in right ear. The curative effects of different types were shown as follows: the type in low tone frequencies had the highest rate of 90.73%, the type in all frequencies was 82.59%; the type of total deafness was 70.29%; and the type in high tone frequencies had the lowest rate of 65.96%. It had significant difference of the effective rate between different types (χ(2) = 231.58, P = 0.000). Age, time delay before first visit, and severity of initial hearing loss were significantly correlated with hearing improvement.</p><p><b>CONCLUSIONS</b>Initial audiogram of SSNHL might predict hearing recovery. The young in age and a short time delay before starting treatment are positive prognostic factors for hearing recovery in SSNHL. The initial severity of hearing loss is negative prognostic factor of hearing recovery.</p>

The replacement therapy of rPTH(1-84) in established rat model of hypothyroidism / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the replacement therapy of rPTH(1-84) (recombinant human parathyroid hormone (1-84)) to hypothyroidism in established rat model.</p><p><b>METHOD</b>Rat model of hypothyroidism was established by resecting parathyroids. A total of 30 rats with removal of parathyroids were divided into 6 groups randomly, 5 in each group, and applied respectively with saline injection (negative control group), calcitriol treatment (positive control group) and quadripartite PTH administration with dose of 20, 40, 80 and 160 µg/kg (experimental groups). Saline and rPTH(1-84) were injected subcutaneously daily. Calcitriol was gavaged once a day. Sham-operation was conducted in 5 rats of negative control group. To verify the authenticity of the rat model with hypothyroidism, the serum was insolated centrifugally from rat blood that was obtained from angular vein at specific time to measure calcium and phosphorus concentration. Urine in 12 hours was collected by metabolic cages and the calcium concentration was measured. After 10-week drug treatment, the experiment was terminated and bilateral femoral bone and L2-5 lumbar vertebra were removed from rats. Bone mineral density (BMD)of bilateral femoral bone and lumbar vertebra was analyzed by dual X-ray absorptiometry (DXA). The concentration of bone alkaline phosphatase (BALP) in serum was determined by radioimmunoassay.</p><p><b>RESULT</b>The rat model with hypothyroidism was obtained by excising parathyroid gland and was verified by monitoring calcium and phosphorus concentration subsequently. Administration of rPTH(1-84) in the dose of 80 or 160 µg/kg made serum calcium and phosphorus back to normal levels, with no significant difference between the doses (P>0.05). The BMD in each group of rats with rPTH(1-84) administration was increased significantly (P<0.05). The levels of urinary calcium and serum BALP in rats of maximum rPTH(1-84) injection group (160 µg/kg) were higher than those of normal control group (P<0.05). The rats treated with calcitriol had normal calcium levels and showed the increase of BMD and phosphorus concentration compared with normal control group (P<0.05). The amount of urinary calcium also exceeded the other groups (P<0.05), but no with significant difference in BMD of bilateral femoral bone and lumbar vertebra between negative control group and normal control group (P>0.05).</p><p><b>CONCLUSION</b>Calcium and phosphorus return to normal level by administration of rPTH(1-84) in the dose of 80 µg/kg or 160 µg/kg, with increase in BMD. Calcitriol can return the level of calcium to normal and increase BMD, but can not correspondingly decrease the phosphorus concentration and increase the excretion of calcium in urine.</p>

The function of tubomanometry in forcasting the progonosis of acute otitis media with effusion / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To evaluate the function of tubomanometry (TMM) in forcasting the progonosis of acute otitis media with effusion (OME).@*METHOD@#We used the technique of TMM to quantify the degree of eustachian tube (ET) dysfunction in 65 patients with OME. The opening of the ET and the transportation of gas into the middle ear were registered by a pressure sensor in the occluded outer ear after applying the stimulus of a controlled gas bolus into the nasopharynx during swallowing. Three excess pressure values were tested subsequently (30, 40, and 50 mbar). If tube opening was registered, the time of opening in relation to pressure applied was measured. The TMM calculated the opening latency index or index R. An R value of 1 indicated late opening of the tube occurring after the initial stimulus and was interpreted as suboptimal. Inability to calculate the index R value indicated that the tube was unable to actively open at all. The TMM results, were weighted as follows: no R with 0 points, R > 1 with 1 point and R < 1 with 2 points for the measurements at 30, 40, and 50 mbar, respectively. The points of these three tests were added so the ET score (ETS) ranges from 0 (worst value) to 6 (best value). According to the medical history, the patients were divided into two groups, chronic OME group (defined as positive control group), 30 cases with 38 ears; and acute OME group, 35 cases with 46 ears. The healthy ears of all patients were defined as normal control group, 46 cases with 46 ears. The same regular treatments, including classic medical treatments and intratympanic dexamethasone injections, were used to acute OME group in the following 1-2 months. On the basis of therapeutic effect, acute OME group was subdivided into valid group (26 cases with 33 ears) and invalid group (9 cases with 13 ears).@*RESULT@#The ETS of normal control group was 5.11 ± 1.32 while it was 1.08 ± 1.32 in positive control group. It was found marked differences between the two groups (P < 0.01). The ETS of both valid and invalid subgroup of actue OME group were significantly lower than normal control group (P < 0.01), but in valid subgroup it was significantly higher than positive control group (P < 0.01), and no marked difference was found between the invalid subgroup and positive control group. After treatments, a significant improvement of the ETS was found in both valid and invalid subgroup (P < 0.05) there was no marked difference between valid subgroup and normal control group. But in invalid subgroup it was still significantly lower than normal cohtrol group (P < 0. 01).@*CONCLUSION@#TMM could forecast the prognosis of acute OME. Patients with acute OME suffered from ET dysfunction of varied degrees. Those with high ETS could be cured by classic medical treatments and intratympanic dexamethasone injections. But those with poor ETS could not be cured in short period, tube insertion should be considered. If ETS could not be improved by ventilation tube placement, more active treatment, for example, balloon Eustachian tuboplasty (BET), should be used to prevent transforming into chronic OME.

Redefine the efficacy of surgical treatments for obstructive sleep apnea hypopnea syndrome / 临床耳鼻咽喉头颈外科杂志

Various surgical procedures are widely used for treating obstructive sleep apnea hypopnea syndrome (OSAHS) currently. The most prominent advantage of surgery is the excellent long-term adherence, which is just the main limitation for the first-line treatment of continuous positive airway pressure (CPAP). However, nearly all the surgical procedures used now usually could not cure this disease completely. The success rate of the uvulopalatopharyngoplasty, which is the most widely used procedure, can only reach to 40% - 50% in terms of AHI Therefore, there are some opinions that the surgery should not be applied for treating this disease. In fact, the outcomes of surgical treatments should not be only evaluated basing on some of the objective results. In this article, the clinical significance of surgery based on objective and subjective data, and the effects on long-term consequences, the combination of surgery with CPAP, and the possible prospects of surgical treatments for this disease will be discussed. This may help us to redefine the clinical efficacy of surgery for the treatment of OSAHS.

Congenital median dermoid fistula of nasal dorsum: one case report / 临床耳鼻咽喉头颈外科杂志

Congenital median dermoid is an uncommon disease. Surgery is the main curative treatment. To review a clinical case and to summarise the characteristics and treatment experience of this disease, referring to the related literature, it is expected that we can provide more clinical thought and therapeutic method for congenital median dermoid fistula of nasal dorsum.

Surgical treatment for advanced carcinoma of hypopharynx and laryngeal function preservation / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the treatment outcome advanced hypopharyngeal carcinoma by surgery with laryngeal function preservation.</p><p><b>METHODS</b>Twenty cases with squamous cell carcinoma of the hypopharynx who were treated by the function preserved surgery between January 2000 and March 2012 were reviewed. Of the patients 19 were males and 1 female, and their median age was 62.0 years. Eight cases were only applied with total or subtotal hypopharyngectomy, and others received total or subtotal hypopharyngectomy with partial-laryngectomy. Postoperative functional training was performed. Radiotherapy was used in all cases from 2 to 4 weeks after surgery.</p><p><b>RESULTS</b>Speech intelligibility remained in all 20 patients and 80.0% of the patients were extracted the trachea tube in the average 60 days.</p><p><b>CONCLUSIONS</b>Laryngeal functions of larynx can be preserved in advanced hypopharyngeal carcinoma by total or subtotal hypopharyngectomy alone or plus partial laryngectomy with functional reconstruction, and the patients can maintain their rational speech and swallowing functions.</p>

Suspension laryngoscopic surgery for laryngotracheal stenosis of 32 cases / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the efficacy of suspension laryngoscopic surgery for benign laryngotracheal stenosis (LTS).</p><p><b>METHODS</b>Thirty-two patients (aged from 5 to 70 years with a median of 36 years) with benign LTS were studied retrospectively who were treated by suspension laryngoscopic surgery with or without assistance of CO₂ Laser for LTS. Stents were placed in 17 cases. Among 32 patients, 13 cases were with LST in Cotton I, 8 cases in Cotton II, and 11 cases in Cotton III; 23 were with single level narrow, and 9 cases with multi-level narrow; the average narrow length was 1.3 cm and the average diameter at maximum stenosis was 0.5 cm; and 19 cases underwent tracheostomy before surgery.</p><p><b>RESULTS</b>Follow-up period ranged from 1 to 18 years with median time of 10 years. Twenty-six patients (81.2%) were successfully decannulated with good airway patency and effective phonation. Six cases failed and 1 case of them was changed to open surgery. Among 17 cases with stent placement, 4 cases were applied additionally with T tube (effective rate of 50.0%), 1 case with laryngeal keel, 12 cases with stents alone (effective rate of 66.7%). Stent-related complications occurred in 2 cases. Patients with cotton I-II had a successful rate of 100% (21/21), while patients with Cotton III showed poor effectiveness (5/11), with a statistical significant difference between two groups (χ² = 14.098, P = 0.001). The patients with single level LTS were successfully treated by suspension laryngoscopic surgery with 100% successful rate (23/23), while the patients with multi-level LTS showed poor effectiveness (3/9), with a statistical significant difference between two groups (χ² = 18.872, P = 0.000) .</p><p><b>CONCLUSIONS</b>Suspension laryngoscopic microsurgery can treat single level LTS with good results and also can be used as a pre-surgery in treatment of multi-level LTS with the virtue of minimal trauma and short recovery time. Application of stents can be helpful for suspension laryngoscope surgery for LST.</p>

Surgical treatment for cervicothoracic esophageal carcinoma with tracheal involvement / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the surgical treatment and outcome of cervicothoracic esophageal carcinoma with tracheal.</p><p><b>METHODS</b>Ten cases of cervicothoracic esophageal carcinoma with tracheal invasion underwent surgical treatment between 2004 and 2011 was reviewed. Operative methods, complications, pathology, and prognosis were analyzed.</p><p><b>RESULTS</b>The patients were divided into 2 groups, 5 patients with cervical tracheal invasion group and 5 patients with cervicothoracic tracheal invasion. Thoracotomy and anterior mediastinal tracheostomy (AMT) were required for 5 patients with cervicothoracic tracheal invasion. The median follow-up was 23 months (ranging from 6 to 76 months). Of 5 patients with cervical tracheal invasion, 3 patients survived with free of disease for more than 5 years postoperatively, 1 patient died of local recurrence at 14 months postoperatively, and 1 patient died of cardiac infarction at 26 months postoperatively. Among 5 patients with cervicothoracic tracheal invasion, 2 patients died during hospitalization, and 1 patient died of local recurrence at 16 months postoperatively, and 2 patients died of distant metastasis at 6 and 20 months after surgery respectively.</p><p><b>CONCLUSIONS</b>Tracheal invasion is not a contraindication to radical operation for the cervicothoracic esophageal carcinoma. Surgical treatment has a good outcome in cervicothoracic esophageal carcinoma with only cervical tracheal invasion. If thoracic trachea is involved, especially when the length of the distal trachea is less than 5 cm, operation should be performed with caution.</p>

Tumors originated from the inferior nasal turbinates: clinical features in 34 patients / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#The purpose of this study was to analyzed the histopathologic spectrum and clinical features of the tumors originated from the inferior nasal turbinates.@*METHOD@#Clinical data of 34 patients with tumours of the inferior nasal turbinates, treated from Jan. 1998 to Dec. 2012, were retrospectively reviewed. Of the 34 patients, 18 male and 16 female, aged from 25 years to 76 years (mean: 45.6yr).@*RESULT@#(1) Pathology : Of the 34 patients, 23 (67.6%) were benign and 11 (32.4%) were malignant. Hemangiomas were the most frequent benign tumour accounting for 18/23 (78.3%) in benign tumour and for 52.9% in all the tumors originated from inferior nasal turbinates. Other benign tumours included inverted papilloma, squamous papillomas and extrapleural solitary neurofibroma tumor. The most common malignant tumour was non-Hodgkin's lymphoma accounting for 6/11 (54.5%) in malignant tumour and for 17.6% in all the tumors. Other malignant tumour included squamous cell carcinoma, melanoma and undifferentiated carcinoma. (2) Distribution: Most tumors (31/34) arose from unilateral turbinates. Hemangiomas is the commonest tumor originated from anterior part of the turbinate in 14 cases of 18 (77.8%). NHL and melanoma involved through turbinates. 3. Symtoms: Nasal obstruction was the most common symtom (25/34, 73.5%). Epistaxis and bloody nasal discharge were the chief complaint in hemangiomas.@*CONCLUSION@#1. The most common benign and malignant tumors of the inferior turbinate were hemangioma and NHL. The majority of the hemangiomas (14/18) arose from the anterior part of the inferior turbinate. NHL or melanoma often presented progressive, unilateral or bilateral diffuse enlargement of the inferior turbinate with poor vascular contractile reactivity to the ephedrine.

Surgical management of cervical esophageal carcinoma in 16 cases / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the method of surgical management for cervical esophageal carcinoma and the feasibility of the operation with preservation of laryngeal function.@*METHOD@#Sixteen patients with cervical esophageal carcinoma who received surgical treatment were reviewed in our retrospective study. Removal of total hypopharynx and larynx and the inversion stripping esophagectomy were conducted in thirteen patients, of which one underwent the reconstraction with residual larynx and tracheal flap and the other twelve patients underwent the reconstraction with gastric-pharyngeal anastomosis. One patient received the cervical esophagectomy and partial hypopharyngectomy with laryngotracheal flap. The inversion stripping esophagectomy with laryngeal function preservation were conducted in two patients, who received the reconstraction with gastric-pharyngeal anastomosis and preserved total larynx. All the patients were carried out the bilateral neck dissections.@*RESULT@#The surgical resection rate was 100% and no operative death occurred. The postoperative complications included pulmonary infection in two cases, anastomotic fistula in two cases, anastomotic stenosis in two cases and congestive heart failure in one case. The retained rate of the laryngeal function is 12.5%. The 3-year survival rate is 30.7%, and the 5-year survival rate is 23.1%.@*CONCLUSION@#The surgical treatment of cervical esophageal carcinoma is possible. The inversion stripping esophagectomy without thoracotomy is performed to resect the tumor. The esophageal defect could be reconstructed by laryngotracheal flap or gastric-pharyngeal anastomosis. The laryngeal function should be remained as far as possible according to the location and extension of the tumor.

Management and classification of first branchial cleft anomalies / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#We aimed to identify the different courses of first branchial cleft anomalies and to discuss the management and classification of these anomalies.@*METHOD@#Twenty-four patients with first branchial cleft anomalies were reviewed. The courses of first branchial cleft anomalies and their corresponding managements were analyzed. Each case was classified according to Olsen's criteria and Works criteria.@*RESULT@#According to Olsen's criteria, 3 types of first branchial cleft anomalies are identified: cysts (n = 4), sinuses (n = 13), and fistulas (n = 7). The internal opening was in the external auditory meatus in 16 cases. Two fistulas were parallel to the external auditory canal and the Eustachian tube, with the internal openings on the Eustachian tube. Fourteen cases had close relations to the parotid gland and dissection of the facial nerve had to be done in the operation. Temporary weakness of the mandibular branch of facial nerve occurred in 2 cases. Salivary fistula of the parotid gland occurred in one patient, which was managed by pressure dressing for two weeks. Canal stenosis occurred in one patient, who underwent canalplasty after three months. The presence of squamous epithelium was reported in all cases, adnexal skin structures in 6 cases, and cartilage in 14 cases. The specimens of the fistula which extended to the nasopharynx were reported as tracts lined with squamous epithelium (the external part) and ciliated columnar epithelium (the internal part). According to Work's criteria, 9 cases were classified as Type I lesions, 13 cases were classified as Type II lesions, and two special cases could not be classified. The average follow-up was 83 months (ranging from 12 to 152 months). No recurrence was found.@*CONCLUSION@#First branchial cleft anomalies have high variability in the courses. If a patient is suspected to have first branchial anomalies, the external auditory canal must be examined for the internal opening. CT should be done to understand the extension of the lesion. For cases without internal openings in the external auditory canal, CT fistulography should be done to demonstrate the courses, followed by corresponding treatment. Two special cases might be classified as a new type of lesions.

Cervical necrotizing fasciitis caused by Klebsiella pneumoniae: three cases report and review of literature / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To analyze the clinical manifestations of three cases of cervical necrotizing fasciitis caused by klebsiella pneumoniae and to analyze the published articles concerning the relationship between invasive klebsiella syndrome and necrotizing fasciitis in Chinese Mainland.@*METHOD@#We have retrospectively analyzed three cases of cervical necrotizing fasciitis caused by klebsiella pneumoniae treated in our department between 2003 and 2012. We also reviewed the Chinese-language scientific literature included in the WanFang data by searching with the following key words: necrotizing fasciitis, klebsiella pneumoniae and liver abscess.@*RESULT@#These patients recovered uneventfully without obvious complications or disseminated infection foci. Sporadic cases of invasive klebsiella syndrome were reported without necrotizing fasciitis involvement in Chinese Mainland.@*CONCLUSION@#Cervical necrotizing fasciitis caused by klebsiella pneumoniae may give rise to disseminated infection but there has been no such case report in Chinese Mainland.

Selective neck dissection and the management of the hypopharyngeal cancer / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To determine the most appropriate form of selective neck dissection(SND) in the hypopharyngeal cancer with cervical lymph node metastasis.@*METHOD@#We have retrospectively analyzed the distribution and prevalence of cervical metastasis in 26 patients with hypopharyngeal squamous cell carcinoma from January 1998 to December 2008. All the patients underwent SND as part of the primary treatment. There were 34 elective SNDs and 17 therapeutic SNDs from 11 node-negative hypopharyngeal cancers and others node-positive.@*RESULT@#Occult metastasis was found in 6 patients (55%) with cervical metastasis confined to level II and III. Clinical node-positive necks were all pathologically identified with 6.7%, 66.7%, 86.7%, 46.7%, and 20.0% of the prevalence of metastasis to level I, II, III, IV and V respectively. The regional recurrences were found in 4 patients during the follow-up, which were all from cN+ patients. No patient experienced level I recurrence.@*CONCLUSION@#The results of this study suggest that SND (I-III) may be feasible for the treatment of cN0 hypopharyngeal cancer, which needs a larger sample to verify. Meanwhile, from our data, it has a satisfactory result to perform SND (II-V) with adjuvant radiotherapy for the cN+ patients.

Presentation and management of allergic fungal rhinosinusitis / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To assess the presentation of allergic fungal rhinosinusitis (AFRS) and describe the line of management in our setup.@*METHOD@#Twenty-six cases of AFRS from October 2002 to June 2006 were retrospectively analyzed for the study in Department of Otorhinolaryngology Head and Neck Surgery, Peking University First Hospital. Laboratory findings (especially total serum IgE level and special serum IgE level) and computed tomography were noted preoperation. Surgical specimens were sent for mycology and histopathologic analysis. The management included endoscopic sinus debridement, adequate sinus aeration, pre- and post-operative use of steroids and saline irrigations with antifungal drugs.@*RESULT@#Nasal obstruction and hyposmia were the commonest presentations. In 21 (80.8%) of 26 patients, AFRS was fund to be associated with allergic diseases. CT scan showed serpiginous or patchy increased attenuation within the completely opacified sinuses on reconstructed soft tissue window. Some of the involved sinuses had bone erosion and expansion. 84.6% (22/26) patients had elevated total IgE levels, 76.9% (20/26) had positive for sIgE levels to fungal allergen. Fungal smear were positive for all 26 patients. But only 14 surgical specimens were positive for fungal cultures. The most common causative agent was Aspergillus. The involved mucosa and allergic mucin with H & E staining contained clusters or sheets of degenerating eosinophils. Charcot-Leyden crystals was found in 8 surgical specimens. The follow-up after a year, the mucosa recovered epithelization in 19 patients.@*CONCLUSION@#The diagnosis of AFRS required to depend on history, CT scanning, histopathology, mycologic and immunologic monitoring. Comprehensive treatment with endoscopic sinus surgery, steroids and saline irrigations with antifungal drugs is effective method.

Cervical necrotising fasciitis--report of two cases and review of the literature / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the causes, clinical features, diagnosis and treatment of cervical extensive necrotizing fasciitis, a rare clinical occurrence, and to improve the clinical recognition and appreciation of it.@*METHOD@#Two cases of cervical extensive necrotizing fasciitis were studied and relevant literatures were reviewed. The causes, clinical manifestation, experience of diagnosis and treatment were summarized.@*RESULT@#One of two cases was secondary to foreign body of hypopharynx, and the other with unknown cause. Apathy, crepitation and diffuse swelling and rubor following with abscess formation on the neck are main characteristics. Mixed synergistic infection was confirmed by drainage culturing. All two cases were treated actively by large dosage and effective broad spectrum antibiotics, and sustaining therapy and surgical treatment, including local incision and drainage, aggressive surgical debridement and tracheotomy.@*CONCLUSION@#Cervical extensive necrotizing fasciitis is a potentially life-threatening soft tissue infection. The keys of successful treatment were early diagnosis and surgical intervention. Rational antibiotics application and systemic supporting therapeutics were also recommended.

Promoter effects of adeno-associated viral vector for transgene expression in the cochlea in vivo

The aims of this study were to evaluate the expression of enhanced green fluorescent protein (EGFP) driven by 6 different promoters, including cytomegalovirus IE enhancer and chicken beta-actin promoter (CAG), cytomegalovirus promoter (CMV), neuron-specific enolase promoter (NSE), myosin 7A promoter (Myo), elongation factor 1alpha promoter (EF-1alpha), and Rous sarcoma virus promoter (RSV), and assess the dose response of CAG promoter to transgene expression in the cochlea. Serotype 1 adeno-associated virus (AAV1) vectors with various constructs were transduced into the cochleae, and the level of EGFP expression was examined. We found the highest EGFP expression in the inner hair cells and other cochlear cells when CAG promoter was used. The CMV and NSE promoter drove the higher EGFP expression, but only a marginal activity was observed in EF-1alpha promoter driven constructs. RSV promoter failed to driven the EGFP expression. Myo promoter driven EGFP was exclusively expressed in the inner hair cells of the cochlea. When driven by CAG promoter, reporter gene expression was detected in inner hair cells at a dose as low as 3 x 10(7) genome copies, and continued to increase in a dose- dependent manner. Our data showed that individual promoter has different ability to drive reporter gene expression in the cochlear cells. Our results might provide important information with regard to the role of promoters in regulating transgene expression and for the proper design of vectors for gene expression and gene therapy.

Significance of Fas, FasL and FADD expression in squamous cell carcinoma of larynx / 中国耳鼻咽喉头颈外科

OBJECTIVE To investigate the expression and significance of Fas, FasL and FADD in laryngeal carcinoma. METHODS Immunohistochemical method was used to examine the expression of Fas, FasL and FADD in laryngeal carcinoma specimen and adjacent normal tissues. RESULTS The positive rates of Fas and FADD in laryngeal carcinoma tissue were significantly lower than that in adjacent normal tissue, while FasL in laryngeal carcinoma tissue was higher than that in adjacent normal tissue(P

Coblation inferior turbinate reduction versus inferior turbinectomy with debrider / 中国耳鼻咽喉头颈外科

OBJECTIVE To compare coblation inferior turbinate reduction with inferior turbinectomy by evaluating the differences in the degree ofintraoperative bleeding,degree of post-operative pain,and short-term efficacy in treating inferior turbinate hypertrophy. METHODS Thirty-nine patients were involved in this study. Twenty-five underwent coblation inferior turbinate reduction,and fourteen were treated with inferior turbinectomy with debrider. Subjective symptoms and the inferior turbinate scores were assessed prior to and at 1,3 and 6 months after treatment. In the coblation group,4-6 tunnels were made in each inferior turbinate with Reflex 45 wand under local anesthesia with endoscope. In the control group,debrider was used to remove the hypertropic mucosa of inferior turbinates under endoscope, after which nasal package were used for 2 days to stop the bleeding. RESULTS Coblation inferior turbinate reduction resulted in little intraoperative bleeding and a significant reduction in post-operative pain. At the month 1 follow-up,the severity and the frequency of nasal obstruction were significantly improved in both the coblation and control group. The inferior turbinates were found to have significantly decreased in size in both groups. There was no significant difference between the two groups. At the month 3 follow-up,these improvements were also significant,and the frequency of nasal obstruction was significantly more reduced in the coblation group. The results from the month 6 follow-up conformed to those from the month 3 follow-up. CONCLUSION Coblation inferior turbinectomy is a safe procedure that is easily performed under local anesthsia and results in a significant improvement of nasal obstruction in patients with turbinate hypertrophy. The volumes of the inferior turbinates were alsosignificantly reduced. This procedure is as effective as inferior turbinectomy with debrider. The clinical benefitpersists at 6 months after the procedure.

Objective Evaluation of Phonation in the Normal and Pathological States / 听力学及言语疾病杂志

Mean flow rate (MFR) ,vocal intensity (I) ,pitch frequency(P) ,pitch perturbation (PP) and vocal efficiency (I/F) were measured simutaneously during sustained phonation of the vowel [i] at wide range levels of intensities in 158 nor mal subjects and the same parameters were measured at moderate vocal intensity level in 136 patients with various kinds of laryngeal diseases. PP indicates the amount of irregular vibration of vocal folds and I/F represents efficient transition from MFR to acoustic energy. When phonation at different intensities ,MFR,P and I/F increase but PP decreases when I increases. At moderate intensity phonation, there are positive correlations between MFR and I,and between I and P but negative correlation between MFR and I/F,between I(male) and PP,and between P(fe-male) and PP.Most of the patients with laryngeal diseases showed higher MFR and PP but lower I/F than normal subjects.MFR, PP and I/F could be used as objective and quantitative parameters with I and P as reference parameters in assessing laryngeal function of phonation.