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Objective To analyze the factors associated with postoperative surgical site infection(SSI)in patients with oral and maxillofacial malignancy. Methods A retrospective study was performed on 240 patients after surgical treatment of oral and maxillofacial malignancies. The incidence of postoperative SSI was calculated in terms of the location of tumor. Preoperative serum albumin level, preoperative periodontal calculus, surgical approach, intraoperative antibiotic use, intraoperative blood loss, length of surgery, duration of indwelling catheter, length of hospital stay, postoperative drainage tubes, and length of ICU stay were considered as potential risk factors for SSI in patients with oral and maxillofacial malignancy. These factors were compared between the patients with SSI and those without SSI by univariate analysis. The significant factors identified by univariate analysis(P<0.05)were included in multivariate logistic regression analysis to identify the independent risk factors. Results The highest incidence of SSI was found in patients with tongue cancer, followed by patients with carcinoma of buccal mucosa, carcinoma of lip, and carcinoma of gingiva. No infection was found in the patients with carcinoma of palate(P<0.05). Univariate analysis identifid that preoperative serum albumin level ≤ 35 g/L, preoperative periodontal calculus level 3, surgical approach III(extended resection + cervical lymph node dissection + flap repair), intraoperative use of antibiotics, duration ofindwelling catheter ≤ 24 h, length of hospital stay>18 days, postoperative drainage tube were significant factors of SSI(P<0.05). There were no statistically significant differences between the non-infected group and the infected group in intraoperative blood loss, duration of surgery and ICU stay(P>0.05). Multivariate logistic regression analysis found that preoperative periodontal calculus level 3(OR=7.149, P=0.014), preoperative serum albumin level ≤ 35 g/L(OR = 0.059, P=0.034), surgical approach III(OR=4.135, P=0.024), hospital stay>18 days(OR=24.845, P=0.009)were the independent risk factors for postoperative SSI in patients with oral and maxillofacial malignancy. Conclusions Preoperative periodontal calculus level 3, preoperative serum albumin level ≤ 35 g/L, surgical approach III, and hospital stay>18 days are independent risk factors for SSI in patients with oral and maxillofacial malignancy. Such SSI is relatively more prevalent in patients with tongue cancer. Corresponding measures should be taken for prevention of postoperative SSI in such patients.
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Objective To study the clinical and pathologic factors for prognosis of children and adolescents with thyroid carcinoma.Methods Clinicopathological data of 110 children and adolescents with thyroid carcinoma at the Affiliated Tumor Hospital of Zhengzhou University from January 1984 to March 2008 were collected and reviewed in this study.Univariate analysis was performed by using Log－rank test to determine predictors of survival,and multiva-riable analysis was performed by a Cox regression model.Results The overall 5－ year and 10 －year survival rates were 95.5%,88.2%,respectively.Gender and histopathologic typing were not related to prognosis.The 5 －year and 10－year survival rates in group ≤12 years old were 91.7% and 81.3%,and those in group ＞12 years old were 98. 4% and 93.5%,respectively.The 5－year and 10－year survival rates in stage T1 and T2 were 100.0%,in stage T3 were 100.0% and 66.7%,respectively,and those in stage T4 were 58.3% and 0.The 5－year and 10－year sur-vival rates in N0 group and N1a group were 100.0%,and those in N1b group were 93.4% and 82.9%,respectively. For patients without the distant metastasis group,the 5－year and and 10－year survival rates were all 96.9%,which were significantly higher than those in the distant metastasis group(84.6%,23.1%).The 5－year and 10－year sur-vival rates in groupⅠwere all 97.8%,those in groupⅡwere 84.6% and 23.1%,respectively,and those in groupⅣwere all 75. 0%.The 5－year and 10－year survival rates in the solitary lesions group were 98.7%,in the multiple le-sions group were 88.2% and 64.7%,respectively.For differentiated thyroid carcinoma,the 5－year and 10－year sur-vival rates in low,and medium risk groups were all 100.0%and those in high risk group were 83.3% and 50.0%,re-spectively.There was a significant relationship between survival and age group,T stage,N stage,M stage,TNM stage, the number of lesions,and risk stratification(all P＜0.05).The Cox regression analysis showed that T stage and M stage were the independent prognostic factors.Conclusions The primary tumor and distant metastatic are important factors affecting the prognosis of children and adolescents.Earlier diagnosis for primary tumor and aggressive manage-ments for metastatic lesions are critical to the survival rate of children and adolescents with thyroid carcinoma.
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In recent years, with the improvement of the incidence of thyroid tumors and the extensive development of thyroid surgery in primary hospitals, the proportion of thyroid cancer patients requiring reoperation has continued to increase. In spite of different reasons of reoperation, the risk of serious complications will increase after reoperation compared with first operation. Undoubtedly, the doctors will have to face new challenges to make more appropriate surgery program. Before reoperation, both the operation benefits and the corresponding risks should be considered comprehensively. As far as possible, the individual treatment should be recommended on the basis of standardized treatment, and it will be better to strike a balance between radical surgery and function protection. Consequently, low-grade doctors should be cautious to perform these reoperations.
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Objective To explore the lateral neck lymph node metastasis (LNM) in patients affected by papillary thyroid carcinoma(PTC) with clinically negative neck (cN0-PTC) and to discuss the necessity of prophylactic lateral neck lymph node dissection.Methods Clinical data of 651 cN0-PTC patients who underwnt surgical procedure in Tumor Hospital of Zhengzhou University from Jan.2012 to May.2015 were retrospectively analyzed.Chi-square test was used for univariate analysis.Results Of the 651 cN0-PTC patients,62.9％ had LNM (51.3％ in central neck,41.0％ in lateral neck,and 11.7％ with "skip" metastasis).The lateral neck metastasis rate was 50.9％ in men and 37.7％ in women (P＜0.05),61.9％ in patients with tumor diameter ＞1.0 cm and 25.9％ in patients with tumor diameter ≤ 1.0 cm (P＜0.001),47.2％ with multifocal cancer and 40.3％ with unifocal tumor(P＜0.05),63.1％ with extrathyroidal extention and 34.3％ without extention (P＜0.001),64.1％ with ≥3 positive nodes in central neck and 48.3％ with ＜3 positive nodes (P＜0.05),52.4％ with upper lobe cancer and 32.9％ with other locations(P＜0.001),41.0％ in patients ≤45 years and 40.9％ in patients ＞45 years(P＞0.05).Conclusion Central neck dissection should be performed in all cN0-PTC patients.Prophylactic lateral neck dissection should beselectively performed in cN0-PTC patients with following high-risk factors:male,tumor diameter ＞1.0 cm,multifocal cancer,extrathyroidal extention,≥ 3 positive nodes in central neck and upper lobe cancer.
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OBJECTIVE@#Through preoperative temporary balloon occlusion of internal carotid artery and monitoring of carotid artery stump pressure variation, in order to further predict the risk of carotid artery ligation and resection, evaluation operative risk and provides the reference for the choice of surgical approach.@*METHOD@#Continuous monitoring and recording the carotid artery stump return pressure,before clamping and in the process of blocking, close observation the patients mental state and the nervous systemof all kinds of signs, in the process of blocking, to understand the dynamic change of stump artery pressure return in patients and whether can the smooth passage of carotid artery balloon occlusion test.@*RESULT@#Of the 19 patients, 4 cases were positive, 15 negative cases, Blocking immediate the positive patients and negative patients with stump pressure drop was (57. 35 ± 1. 89) % and (38. 99 ± 12. 23) %, with statistical significance between the two, in the process of blocking, the mean stump pressure of the positive patients and the negative patients was (37. 29 ± 3. 15) mmHg and (61. 36 ± 14. 69) mmHg, with statistical significance between the two.@*CONCLUSION@#Approximately 21. 05% of patients can not tolerate carotid artery balloon occlusion test, theory for carotid artery reconstruction operation. After blocking the stump pressure is less than 40. 44 mmHg, the theory for reconstruction of the internal carotid artery operation. Blocking instant artery stump pressure dropped more than 55. 46%, in theory the need for internal carotid artery reconstruction.
Subject(s)
Humans , Balloon Occlusion , Blood Pressure , Carotid Artery, Internal , General Surgery , Feasibility Studies , Ligation , Preoperative Care , Risk Assessment , Vascular Surgical ProceduresABSTRACT
Objective To study the rule of lymph node metastasis rate in cN 0 papillary thyroid microcar-cinoma( cN0-PTMC) and to evaluate an appropriate region of neck dissection .Methods Data of 233 cases of cN0-PTMC were retrospectively analyzed .Univariate analysis with chi-square test was used to analyze the statisti-cal correlation between gender , age, tumor diameter and lymph node metastasis respectively .Results 81 out of 233 patients(34.8%)had cervical lymph node metastasis (30.0%in central region and 9.9%in lateral region). For patients with tumor diameter ( D)≤5 mm and D>5 mm, lymph node metastasis rate in central region was 21.6%and 36.6%(χ2 =6.199,P45 years old was 37.9% and 21.1% respectively (χ2 =7.792, P 5 mm should receive the lateral neck lymphoid tissue exploration during surgery in order to find subclinical metas -tasis.
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Objective To investigate the distribution of human papillomavirus (HPV) genotypes in male patients with anogenital warts in Lishui area,Zhejiang province.Methods Tissue specimens were obtained from the lesions of 150 male patients with anogenital warts.PCR-reverse dot blot hybridization was performed to detect the presence of 3 low-risk HPV types (HPV 6,11,and 43) and 16 moderate-or high-risk HPV types (HPV 16,18,31,33,35,39,45,51,52,53,56,58,59,66,68 and CP8304) in these specimens.Chi-square test was used for statistical analysis.Results HPV was detected in 91 (60.67％) of the 150 male patients.Of the 91 positive patients,74 (81.32％) were infected by single or multiple low-risk HPV types,whereas 17 (18.68％) by single or multiple high-risk HPV types.Thirty-one (34.07％) patients harbored 2-5 HPV genotypes,including 20 (64.52％)patients infected with both low-risk and high-risk HPV types,and 6 (19.35％) patients infected with two low-risk HPV types.The coexistence of moderate-or high-risk HPV types with HPV 6 was observed in 13 (41.94％)patients,and that with HPV 11 in 6 (19.35％) patients.The most prevalent genotype was HPV 6 (28.68％,39/136),followed by HPV 11 (26.47％,36/136),16 (8.09％,11/136),52 (5.15％,7/136),53 (5.15％,7/136),51 (4.41％,6/136),58 (4.41％,6/136) and 43 (4.41％,6/136).Conclusions Low-risk HPV genotypes predominate in male patients with anogenital warts,and there are large differences in the distribution of multiple infections and HPV genotypes.
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Objective To probe the biological effect of multiple intraepithelial injections of recombinant adenovirus-p53(rAd-p53)on inducing the apoptosis in patients with dysplastic oral leukoplakia.Methods 18 patients clinically and histopathologically diagnosed as dysplastic oral leukoplakia were recruited for this study.Intraepithelial injections of rAd-p53 were administered.Immunohistochemistry was used to examine the protein expression of p53 and bcl-2.TUNEL was performed to detect apoptotic cells.Results In the post-treatment patients,p53 protein expression were significantly enhanced(100 ％,18/18),yet bcl-2 protein presented low expression(17 ％,3/18).Statistical analysis revealed the expression of p53 protein had a negative correlation with that of bcl-2 protein(r =-0.837,P ＜ 0.01).15 post-treatment samples (83 ％)were detected obvious apoptotic cells,especially in the samples that were strong p53-positive(r =0.684,P ＜ 0.01).Conclusion Intraepithelial injections of rAd-p53 can induce apoptosis for patients with dysplastic oral leukoplakia.It may be a promising treatment for oral leukoplakia.
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Objective To study the anatomic landmarks of recurrent laryngeal nerve (RLN) in minimally invasive video-assisted thyroidectomy (MIVAT), and to evaluate the operative skills to avoid nerve injury. Methods 106 patients were enrolled in the study dated between August 2008 and August 2010, in which 8 patients were converted to the conventional thyroidectomy. Intraoperative anatomic landmarks for location of RLN were the gap between trachea and carotid artery (GTC), as well as the middle and posterior portion of tracheal wall. Results 98 RLN were at risk, and 97 (98.98 %) nerves were recognized by means of two landmarks. 1 nerve failed to locate which was non-recurrent laryngeal nerve. Temporary RLN paralysis happened to 1 nerve(1.02 %), and no permanent RLN paralysis appeared. Conclusion GTC combined with middle and posterior portion of tracheal wall are safe and effective anatomic landmarks to locate RLN in MIVAT.
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@# ObjectiveTo study the effects of rehabilitation training on the expression of brain derived neurotrophic factor(BDNF) around the cerebral infarcted area of rats.Methods60 SD rats were randomly divided into rehabilitation group and immobilization group 24 hours after cerebral infarction.The rehabilitation group were given water maze training,rotating bar and rolling cage exercises everyday while the immobilization group were fixed in cages. Histochemistry was used to detect the BDNF expression around the cerebral infarcted area at the 1st,3rd,7th,10th and 14th day after infarction respectively.ResultsAt 1st day after the infarction, the expression of BDNF increased obviously around the infarcted area in both group. More BDNF positive neurons were found in the rehabilitation group than that in the immobilization group at 3rd day (P<0.01). BDNF positive astrocytes showed obvious increasing in both group. BDNF positive neurons decreased with time going, and the color became lighter at the same time .At the 7th day after infarction, there were only a few positive neurons, and seldom obvious positive neurons could be seen around the infarcted area at 10th and 14th day. Great deal of BDNF positive astrocytes were found at 3rd,7th,10th and 14th day, and the rehabilitation group showed more expression than that of the immobilization group(P<0.01).ConclusionsThe rehabilitation training may increase the expression of BDNF which might take an active part in the recovery of the central nervous system injury and the rebuilding of its function.