ABSTRACT
Pyriform sinus fistula is a rare clinical disease, often with recurrent acute suppurative thyroiditis or neck infection in children.The traditional method treatment is complete resection of the fistula with or without hemithyroidectomy in external cervical surgical approach, but in recent years, minimally invasive endoscopic occlusion of the internal opening for the treatment of pyriform sinus fistula is performed in many hospitals, including electrocautery, chemocautery, laser cauterization, biocauterization, and suture closure. Literatures about endoscopic management of pyriform sinus fistula in children are reviewed and various surgical methods, complications and success rate are evaluated.
ABSTRACT
BACKGROUND: The key to success in laryngeal transplantation is to control the infection. In practice, how to minimize the risk of infection should be considered first, so that the laryngeal allograft can survive after revascularization under the immunosuppressive state. Then the therapeutics methods should be focused on the functional recovery of respiratory, swallowing and phonation.OBJECTIVE: To explore the feasibility of staged allogeneic larynx transplant for dogs in order to decrease the infection rate.METHODS: Ten male conspecific Beagle dogs were assigned into five pairs of donor and receptor according to body mass and the size of larynx. The allogeneic larynx was embedded under the neck skin by allotransplantation. The dogs were treated with immunosuppressant daily to resist immnological rejection. The pharynx and trachea were contraposed after larynx survived to establishⅡstage laryngeal transplantation animal model.RESULTS AND CONCLUSION: InⅠstage of laryngeal transplantation, the laryngeal allograft survived well, blood supply was passable. Receptor dog 1 with vertical midline incision in the neck, receptor dogs 4 and 5 with transverse incisions in the neck grew well. No infection phenomena was found in receptor dogs 4 and 5. The lastⅡstage laryngeal transplantation was performed in the 4th week afterⅠstage laryngeal transplantation. Skin flap necrosis occurred in receptor dogs 2 and 3 with U-shape incisions. The donor larynx had different degree infection. Laryngeal allograft of receptor dog 2 died; laryngeal allograft of receptor dog 3 survived after treatment. The survival period of donor larynx in receptors was as long as 4 weeks. These findings indicate that the larynx infection is avoid or reduced by staged larynx transplantation with pre-embed laryngeal allograft after total laryngectomy. The receptor dog is tolerant; the donor larynx is easy to survive. The main histological change occurs in the epithelial mucosae which can be used as an inspect index of immunosuppressive agents. However, glandular organ secretion is a troublesome problem and immunodepressant must be continuously administrated for a long time.
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OBJECTIVE@#To investigate the therapeutic outcomes of Laryngectomy and prognostic factors in senile patients with laryngeal carcinoma.@*METHOD@#A retrospective study of long-term therapeutic outcomes was performed on 110 patients with laryngeal carcinoma over 65, treated mainly by surgery, from 1990 to 2005. Different kinds of operations were as follows: cordectomy(1 case) or stripping (2 cases) by suspended laryngoscope, laryngofissure (4 cases), vertical partial laryngectomy without tracheotomy (8 cases), vertical partial laryngectomy (8 cases), extended vertical partial laryngectomy (1 case), horizontal laryngectomy (4 cases), subtotal laryngectomy (4 cases), cricohyoidoepiglottopexy (30 cases), Arslan's procedure (8 cases), and total laryngectomy (40 cases). Forty-eight patients were treated with preoperative or postoperative radiotherapy, and five patients were treated with induction chemotherapy followed by radiotherapy.@*RESULT@#There were four missing cases among all 110 cases. The 5- and 10-year overall survival rate were 66.6% and 44.2%, respectively. The 5- and 10-year diseases-free survival rate were 57.0% and 38.4%, respectively. The median survival was 84 months. Decannulation rate was 87.1% (54/62). Well-differentiation, surgery alone, node-negative, glottic carcinoma, early stage, partial laryngectomy, non-recurrence and male were favorable prognostic factors with univariate analysis (P < 0. 05). Well-differentiation and surgery without combined therapy were also favorable prognostic factors with multivariate analysis.@*CONCLUSION@#Conservation laryngectomy was an efficient method to treat senile patients with laryngeal carcinoma. Combined therapy should better not be adopted to patients with negative surgical margins.
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Carcinoma, Squamous Cell , Diagnosis , General Surgery , Laryngeal Neoplasms , Diagnosis , General Surgery , Laryngectomy , Methods , Neoplasm Staging , Prognosis , Retrospective Studies , Survival Rate , Treatment OutcomeABSTRACT
OBJECTIVE To explore the feasibility of transnasal endoscopic surgery to treatment of intraorbital space occupying by ethmoidal-lamina papy-racea approach. METHODS The clinical data of 10 cases who underwent intraorbital surgery via transnasal endoscopic ethmoidal-lamina papyracea approach from June 2003 and Aug. 2006 were retrospectively studied. The patients included foreign body 1 case, cavernous hemangioma 2 case, lipoma 2 cases, inflammatory pseudotumor 2cases and hematoma 3cases. All intraorbital space occupying were operated by transnasal endoscopic ethmoidal-lamina papyracea approach but for one cavernous hemangioma which was dealt with through extra orbitectomy. The inflammatory pseudotumors were prescribed with glucocorticoid after operation.RESULTS Foreign body was removed successfully. One case of cavernous haemangioma was removed completely by transnasal endoscopic surgery and the other by extroorbital operation. All symptoms of proptosis and diplopia disappeared. One vision was enhanced from hand moving to 0.3 and another from light to hand moving. However, there was one hematoma which had been hindered about 14 days after damaged lost eyesight after operation. All cases were cured but one pseudotumor which recurred and was operated again. All cases were followed up 3 to 24 months. CONCLUSION Intraorbital surgery via transnasal endoscopic ethmoidal-lamina papyracea approach was available and feasible for the advantages of clear operation field, direct vision operation, less damage, rapid recovery and avoiding of facial scar, and intranasal endoscopic surgery can treat the rhino-orbital related diseases and nasal diseases at the same time.
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Objective To study the relationship of different histological types and degrees of infiltration of gastric adenocarcinoma on lymph node metastasis.Methods The clinical data of 1 615 cases of gastric adenocarcinoma were analyzed retrospectively,and the rate and number of lymph node metastasis in different histological types and with different depths of invasion were statistically analyzed.Results There were 46 227 lymph nodes collected from 1615 cases,with an average of 28.62 per case. Lymph node metastasis was found in 1046(64.77%) cases of gastric cancer and 10 173(22.01%) lymph nodes. Different TNM stages showed different rates of metastasis: T1(M)2.78%,T1(SM)13.61%,T2 55.59%,and T3 84.84% respectively,while the metastatic rate for histolgically well-differentiated carcinoma was 50.25%,and for low-differentiated earcinoma was 78.95%,and both had statistically significant difference(P