Clinical features and treatment of closed rupture of cervical trachea / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To study the clinical manifestations and treatments of closed injuries of the cervical trachea.@*METHOD@#We carried out a retrospective study of the clinical manifestations, diagnosis and treatment of patients with closed injuries of the cervical trachea that have been treated in our hospital over the last ten years. We analyzed commonly occurring clinical problems, key points of surgical treatment, and postoperative recovery. Fourty-one patients with acute closed injuries of the cervical trachea underwent emergency tracheotomy or anesthesia orotracheal intubation and surgical repair of the trachea within 24 to 48 hours. Twenty six patients had their tracheotomy tubes extubated after surgery and had their anesthesia orotracheal tubes extubated within 48 hours postoperatively; tracheotomy tubes remained in the airway in 15 patients postoperatively, and of them, 12 had extubation successfully in 2 weeks postoperatively, while the remaining 3 were left intubated due to laryngotracheal stenosis. Among the 3, 2 underwent further surgical repair and recovery, and 1 had a stent inserted.@*RESULT@#Twenty-eight patients fully recovered postoperatively. Ten patients mostly recovered postoperatively exception for hoarseness, and their fundamental phonation function recovered within 2 to 3 months but with poor movement of the vocal cords. The breathing and swallowing function of the other 3 patients recovered after the surgery, but they suffer from hoarseness.@*CONCLUSION@#In the treatment of closed disruption of the cervical trachea, prompt diagnosis and timely surgical repair of the structure and function of the trachea are key to saving the patients' lives and avoiding tracheal stenoses.

Clinical features and treatment of closed rupture of cervical trachea / 临床耳鼻咽喉头颈外科杂志

Objective:To study the clinical manifestations and treatments of closed injuries of the cervical trachea.Method:We carried out a retrospective study of the clinical manifestations, diagnosis and treatment of patients with closed injuries of the cervical trachea that have been treated in our hospital over the last ten years. We analyzed commonly occurring clinical problems, key points of surgical treatment, and postoperative recovery. Fourty-one patients with acute closed injuries of the cervical trachea underwent emergency tracheotomy or anesthesia orotracheal intubation and surgical repair of the trachea within 24 to 48 hours. Twenty six patients had their tracheotomy tubes extubated after surgery and had their anesthesia orotracheal tubes extubated within 48 hours postoperatively; tracheotomy tubes remained in the airway in 15 patients postoperatively, and of them, 12 had extubation successfully in 2 weeks postoperatively, while the remaining 3 were left intubated due to laryngotracheal stenosis. Among the 3, 2 underwent further surgical repair and recovery, and 1 had a stent inserted.Result:Twenty-eight patients fully recovered postoperatively. Ten patients mostly recovered postoperatively exception for hoarseness, and their fundamental phonation function recovered within 2 to 3 months but with poor movement of the vocal cords. The breathing and swallowing function of the other 3 patients recovered after the surgery, but they suffer from hoarseness.Conclusion:In the treatment of closed disruption of the cervical trachea, prompt diagnosis and timely surgical repair of the structure and function of the trachea are key to saving the patients' lives and avoiding tracheal stenoses.

Expression of S-phase kinase associated protein 2 (Skp2) and E2F1 and its clinicopathological significance with rhinosinus squamous cell carcinoma / 中国医师杂志

Objective To study the clinicopathological significance of Skp2 and E2F1 in the rhinosinus squamous cell carcinoma and chronic sinusitis. Methods Immunohistochemical method was used to detect the expression of Skp2 and E2F1 in the routinely paraffin-embed-ded sections of specimens from patients with rhinosinus squamoas cell carcinoma (n=49), chronic sinusitis (n=28). Results The expres-sive positive rates and scores of Skp2 and E2F1 in rhinosinus sqnamous cell carcinoma were significantly higher than those in chronic sinusitis (P<0.01). The expression positive rates and scores were significantly decreased in middle-differentiated rhinosinus squamous cell carcino-ma. The maximal diameter of mass was less than 3cm, and no-metastasis of lymphnode or no-infiltration of regional rhinosinus can be found in T1N0M0. While in the low-differentiated rhinosinus squamous cell carcinoma, the maximal diameter of mass was larger than 3cm, and metasta-sis of lymphnode or infiltration of regional rhinosinus can be found(T3N1M0,T3N2M0) (P<0.01). The closely positive correlation was found between the expression of Skp2 and E2F1 in the rhinosinus squamoas cell carcinoma. Conclusions Skp2 and E2F1 might be important biologi-cal markers for carcinogenesis, progression, biological behaviors and prognosis of rhinosinus squamous cell carcinoma.

Study on clinical manifestations and treatment of primary cervical tracheal malignant tumor of children / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To study the clinical manifestations and treatment of the primary cervical tracheal malignant tumor of children.@*METHOD@#Five cases diagnosed as primary tracheal malignant tumor with fibrolaryngoscopy, CT scan and pathology were retrospectively analyzed and reviewed. Extraction of malignant tumor was performed with tracheoscopy and nasal endoscope after emergent tracheotomy below the tumor in 4 cases, and tracheotomy after intubation in 1 case. After operation, 4 children received radiotherapy, and 1 case received laser therapy add radiotherapy.@*RESULT@#Five cases were followed up for three to eight years, and no recurrence was found.@*CONCLUSION@#There was no specific manifestation in early tracheal malignant tumor, but it was critical and emergent during symptoms appear. Imaging examination was a very invaluable diagnosis method. Optimal and effective therapeutic protocol is tracheostomy under local anesthesia to keep upper airway patency followed by surgical extraction and radiotherapy. It was not appropriate to have tracheal wall resection for children.

Prevention and management of blindness following endonasal sinus surgery / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the causes and the management of serious eye complications occurring in the endoscopic sinus surgery.@*METHOD@#Three patients of chronic sinusitis and nasal polyps suffered with blindness in endoscopic sinus surgery and in nasal packing with iodoform and petrolatum gauze were treated.@*RESULT@#Orbital wall and structure were injured in 2 cases during endoscopic sinus surgery, among which, 1 case blinded with deformation of the eyeball during operation underwent optic nerve exploration and orbital muscle reparation immediately. One case developed periocular swelling, eyelid hematoma, conjunctiva edema and blinded 2 days later, and was treated with hematoma clearance and optic nerve decompression. Another 1 case blinded immediately after ethmoid packing, and vision recovered after nasal pack removed. Antibiotics, corticosteroid and nerve growth factor were administered for 4 weeks in all patients. After 6-month follow-up, 1 case was blinded with eyeball atrophy, 1 case was only photonasty, another regained normal vision.@*CONCLUSION@#The causes of blindness in endoscopic sinus surgery are directly related to orbital structure trauma and orbital hematoma. The optic nerve during operation should be protected carefully, if ethmoid sinus over development is demonstrated by CT scan. The application of gauze should be avoided when the medial orbital wall is injured. Decompression of optic nerve should be performed as early as possible, if vision damaged.

Study on clinical manifestations and treatment of primary cervical tracheal malignant tumor of children / 临床耳鼻咽喉头颈外科杂志

Objective:To study the clinical manifestations and treatment of the primary cervical tracheal malig-nant tumor of children. Method:Five cases diagnosed as primary tracheal malignant tumor with fibrolaryngoscopy, CT scan and pathology were retrospectively analyzed and reviewed. Extraction of malignant tumor was performed with tracheoscope and nasal endoscope after emergent tracheotomy below the tumor in 4 cases, and tracheotomy after intubation in 1 case. After operation, 4 children received radiotherapy, and 1 case received laser therapy add radiotherapy. Result:Five cases were followed up for three to eight years, and no recurrence was found. Conclu-sion: There was no specific manifestation in early tracheal malignant tumor, but it was critical and emergent during symptoms appear. Imaging examination was a very invaluable dignosis method. Optimal and effective therapeutic protocol is tracheostomy under local anesthesia to keep upper airway patency followed by surgical extraction and radiotherapy. It was not appropriate to have tracheal wall resection for children.

Study on the surgery treatments in patients with maxillary osteofibrous hyperplasia of bone / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the clinical features, diagnosis and the surgery therapy of maxillary fibrous hyperplasia of bone.@*METHOD@#The clinical data of 37 cases with maxillary fibrous hyperplasia of bone from 1987-2006 years were retrospectively analyzed. 19 cases of male and 18 cases of female, their average age is 22.5 years (17-35 years). Twenty-one cases were operated by Caldwell-lud or lateral rhinotomy operation. After 1997, 16 cases were operated by Caldwell-lud operation with endoscopy so as to strip hyperplasia bone.@*RESULT@#Thirty-six cases were cured within 2-4 years follow-up, 1 case was reoperated by Caldwell-lud operation with endoscopy after recurrence. The patients who received operation by Caldwell-lud operation with endoscopy had less symptoms in the inflation deformity of maxillofacial region and dysfunction of neighbouring structures than those who received traditional operation.@*CONCLUSION@#The diagnosis can be made by history, signs and radiography. Caldwell-lud operation with nasal endoscopy is more effective treatment, and advocated in clinical practice.

Clinical features and treatment of nasal mucosa-associated lymphoid tissue lymphoma / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the clinical features and treatment of nasal mucosa-associated lymphoid tissue lymphoma (MALTL).@*METHOD@#The data of 11 patients with nasal MALTL were analyzed retrospectively during 9 years, including their clinical features and effectiveness of treatment. Nine cases were male and 2 female, their age arranged from 18 to 49 years with an average age of 39 years. All cases underwent endoscopic sinus surgery, and were diagnosed by HE staining and immunohistochemistry. After operation, 7 cases were cured with immunotherapy and antibiotic therapy. Other 4 patients were treated by chemotherapy, radiotherapy, immunotherapy and antibiotic therapy.@*RESULT@#During follow up 6-36 months, 4 patients died and other 7 patients achieved complete remission.@*CONCLUSION@#Clinical manifestations of nasal MALTL are not typical,which is apt to be misdiagnosed and mistreated. The suspected lesion tissues under endoscopy should be completely resected and submitted to pathology investigation. Nasal MALTL is a subtype of non-Hodgkin lymphoma which is characterized by occult onset, long course, slow progression and low cure rates in the advanced stage.

Expression of connective tissue growth factor (CTGF), osteopontin (OPN) and clinical significances in the laryngeal squamous cell carcinoma tissues / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To study the expressions of CTGF and OPN and detect their clinical value and correlation in the laryngeal squamous cell carcinoma tissues and paracancerous tissues.@*METHOD@#SP immunohistochemical method was used for the assays of CTGF and OPN on the routinely paraffin-embedded sections of surgical operated specimens of 41 cases with laryngeal squamous cell carcinoma and 20 ones with paracancerous tissues.@*RESULT@#The positive rate of CTGF and the score were significantly lower in cancer tissues than those in paracancerous tissues (61.0% vs 90.0%, P < 0.05; 2.41 +/- 1.60 vs 4.24 +/- 1.42, P < 0.01), but those of OPN were opposite (61.0% vs 15.0%, P < 0.01; 3. 10 +/- 1.63 vs 1.12 +/- 0.84, P < 0.01). The positive rates and scores of CTGF were significantly higher in the cases without-metastasis of lymph node and clinical stage T1 than those in the ones with-metastasis of lymph node and clinical stage T3 (P < 0.01) . The positive rates and scores of OPN were significantly lower in the cases without-metastasis of lymph node, clinical stage T1 and histological grade I those that in the ones with-metastasis of lymph node, Clinical stage T3 and histological grade III (P < 0.01). The closely negative correlation was found between the score of CTGF and that of OPN.@*CONCLUSION@#The expression of CTGF and/or OPN might be important biological markers in reflecting the progression, biological behaviors, metastatic potential and prognosis of the laryngeal squamous cell carcinoma.

Round window catheter placement with dexamethasone perfusion for intractable sudden sensorineural hearing loss / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the efficacy of round window catheter placement with dexamethasone perfusion for 13 patients with intractable sudden sensorineural hearing loss (SSNHL).@*METHOD@#Dexamethasone (2.5 mg) was perfused transtympanically through round window catheter by Micro-infusion pump. The perfusion was taken twice a day and continued for an hour each time, for a total of 7 days.@*RESULT@#Thirteen patients have been followed up for 1 month. Five of them (38.5%) were demonstrated a 17-54 dB improvement in pure-tone threshold average (PTA). The other 8 patients (61.5%) had no effect.@*CONCLUSION@#Round window catheter placement with dexamethasone perfusion is a cost-effective and useful treatment for SSNHL patients who had no effect through conventional therapy, although hearing thresholds of these patients had hardly improved to normal levels.

Study of blood dynamics of ophthalmic artery in patients with sudden sensorineural hearing loss using color doppler flow imaging / 临床耳鼻咽喉头颈外科杂志

Objective: To investigate the relationship between the pathogenesis of sudden sensorineural hearing loss (SSHL) and the disorder of blood circulation in inner ear. Method :Blood dynamics of the ophthalmic artery were studied quantitatively using color doppler imaging in 34 patients with SSHL. Result:Compared with 34 self-controls and 15 normal controls, 28 patients (82.4％) with SSHL had significantly lower blood flow velocities and higher resistance indices (P＜0.05),and there was no significant difference between the selfcontrol group and the normal control group (P＞0.05). Conclusion: The study suggested that the blood situations－the decreased blood flow velocities and perfusion and increased resistance of ophthalmic artery in patients with SSHL maybe play a role in the pathogenesis of SSHL.

Detection of Plasma Endothelins and Serum Nitric Oxide in the Patients with Sudden Sensorineural Hearing Loss / 中国医师杂志

Objective To investigate the roles of endothelins and nitric oxide in the pathogenesis of sudden sensorineural hearing loss(SSHL). Methods 26 patients with SSHL in Changsha area from October 2000 to April 2001, and 18 healthy subjects in the same period were enrolled in this study. Plasma endothelins level was detected by radioimmunoassay, and serum nitric oxide(NO) level was detected by cadmium-reduced spectrophotometry. Results The plasma endothelins level in the SSHL patients was significantly higher than that in the healthy subjects, and the serum NO level in the SSHL patients was significantly lower than that in the healthy subjects(P0.05). Conclusion The increase of ET level and the decrease of NO level may play an important role in the pathogenesis of SSHL, which may serve as an index to predict the hearing improving or not, but were not related to the degree of hearing loss.

Juvenile onset recurrent respiratory papillomatosis in 38 children / 中国耳鼻咽喉头颈外科

Objective:To evaluate the feature of juvenile onset recurrent respiratory papillomatosis (JORRP).Methods:Thirty-eight cases with JORRP were analyzed retrospectively from June,1986 to June,2000.Results:The average age was 3.5 years before diagnosis.Average 3.45 operations had been performed per patient .Of 38 cases ,eight had comlications of laryngeal dysfunction after operations.Peristomal and tracheal papilloma were spread in six of the nineteen cases with tracheotomies.Conclusion:JORRP is the most common laryngeal tumor in children. Most patients have frequent recurrences and multiple operations. Care should be taken to avoid damaging the normal laryngeal structure during surgical excision.

Evaluation of the effect of streptomycin perfusion of the labyrinth in the treatment of Meniere′s disease and endolymphatic hydrops / 临床耳鼻咽喉头颈外科杂志

Objective:To investigate the clinical effect of streptomycin perfusion of the labyrinth (SPL) inthe treatment of Meniere's disease. Method: 13 patients with Meniere′s disease and 3 patients with delayedendolymphatic hydrops (DEH) underwent SPL. The follow－up time was between 5 and 7 years (average 6.3years). Result:Vertigo was completely controlled in 9 patients, substantialy controlled in 4, limitedly controlledin 2 and not controlled in 1. Hearing was improved in 1 patients, stabilized in 5 and worse in 10. Tinnitus wasimproved in 3 patients, stabilized in 5 and worse in 8. Conclusion:SPL is a safe and effective method in thetreatment of Meniere′s disease and DEH, but the hearing may be insulted and tinnitus may be worse in somepatients.