Management and prognosis of differentiated thyroid carcinoma with tracheal invasion / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate treatment modalities and prognosis differentiated thyroid carcinoma (DTC) with tracheal invasion.</p><p><b>METHODS</b>Clinical data were reviewed and analyzed in 50 patients treated for DTC with tracheal invasion between January 1990 and June 1998. The different surgical modalities were applied according to the extent of tracheal invasion: shave excision (20 cases), tracheal sleeve resection or tracheal partial resection (23 cases), total laryngectomy or laryngeal closure surgery (7 cases). Thirty-eight cases received postoperative (131)I therapy. Survival rate was evaluated using the Kaplan-Meier analysis.</p><p><b>RESULTS</b>The 5-, 10- and 15-year survival rates of all the cases were 90.0%, 74.0% and 56.0%, respectively. The 5-, 10- and 15-year survival rates were 94.7%, 81.6% and 65.8% respectively in 38 cases with postoperative (131)I therapy and were 75.0%, 50.0% and 25.0% respectively in 12 cases without postoperative (131)I therapy, with statistically significant differences in 5-, 10- or 15-year survival rates between the patients of two groups.</p><p><b>CONCLUSIONS</b>The tumors can be resected radically by corresponding surgery based on the extent of tracheal invasion. Postoperative (131)I therapy can enhance the survival rate of the patients with differentiated thyroid carcinoma involving in trachea.</p>

Treatment of esophageal perforation complicated with lethal massive hemorrhage induced by foreign body / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the clinical characteristics and therapies for esophageal perforation complicated with lethal massive hemorrhage caused by esophageal foreign body.@*METHOD@#To retrospective analysis the treatment of massive hemorrhage at the carotid artery or aorta caused by esophageal foreign body in forty seven patients, Foreign body characters, surgical approaches, and postsurgical management were summarized.@*RESULT@#Among 24 patients with cervical esophageal foreign body, the object was removed either by esophagoscopy or through lateral cervical incision. After controlling carotid artery hemorrhage and repairing Fistula of artery from cervical incision, 19 patients survived. For the 23 patients with thoracic esophageal foreign body accompanied with aorta hemorrhea, thoracotomy was performed to remove the foreign body and repair the aortic fistula. Only 3 of these 23 patients recovered from the emergent surgery, other 20 patients died.@*CONCLUSION@#For the patients with esophageal foreign body inducing large vessel impingement, the most reliable therapeutic method is surgical repairing of arterial perforation and extraction of the foreign body via cervical or thoracic incision. Carotid ligation should be considered in patients with recurrent carotid hemorrhage. For the patient with mediastinitis, esophageal exclusion is recommended to prevent infection and to promote healing of aortic perforation after aortic fistula repairing.

One case report of carotid body tumor resected with hemorrhage and artery repair / 临床耳鼻咽喉头颈外科杂志

Carotid body tumors (CBT) were rare. One case with a mass in the right neck side suspected as CBT after preoperative examination was reported with hemorrhage, and artery repair in the resection of the mass, which was finally diagnosed as CBT by pathological examination. Its resection methods, postoperative complications and artery repair methods were discussed.

Clinical diagnosis and treatment of nasal sinus mucoceles with visual loss / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To review the clinical manifestations and management of nasal sinus mucoceles with visual loss.@*METHOD@#Medical records for 23 patients of paranasal sinus mucoceles with visual impairment were re viewed retrospectively during 8-year period (from 2002 to 2010). Ten mucoceles were found in the frontal or fronto-ethmoidal sinuses, 6 in the ethmoidal sinuses, 7 in the sphenoidal or spheno-ethmoidal sinuses. Because the majority of early chief complaints were problems related to vision, patients were often seen by ophthalmologists first. Poor vision was more common in patients with sphenoid or spheno-ethmoidal sinus mucoceles because of their proximity to the optic nerve. CT and MRI were important tools for diagnosing nasal sinus mucocele. The patients received endoscopic surgery to remove mucocele and to decompress the optic nerve. Steroid therapy was given postoperatively and routine examination with endoscopy were carried out during follow-up.@*RESULT@#Postoperatively, the majority of symptoms, such as exophthalmos, epiphora, diplopia and headache, disappeared in all patients. However, vision recovery was observed only in some patients. Recovery of vision depended on the timing of surgery and severity of initial visual loss. Delay in treatment can seriously compromise recovery of vision impairment. Moreover, patients without light perception before surgery had poor visual recovery even if optic nerve decompressions were performed.@*CONCLUSION@#Endoscopic surgery is effective to nasal sinus mucocele with visual loss. Because visual recovery depends on prompt diagnosis and surgical intervention, a good understanding of the disease and prompt imaging studies are important.

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 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.

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 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.

Clinical study on the treatment of juvenile recurrent laryngeal papilloma / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To study and evaluate the feasibility and effect of the treatment for juvenile recurrent laryngeal papilloma by nasal endoscopy electric suction cutting and laser surgery.@*METHOD@#The clinical data of 26 cases with juvenile recurrent laryngeal papilloma from 2002-2007 years were retrospectively analyzed. Six cases were treated by electric suction cutting under nasal endoscopy, 20 cases were treated by electric suction cutting under nasal endoscopy and synergizing laser, and postoperative wound with sodium hyaluronate gel treatment.@*RESULT@#The juvenile recurrent laryngeal papilloma were only operated by electric suction cutting with nasal endoscopy, laryngeal papilloma relapsed with fibrolaryngoscope examination at 4 weeks after operation, and were operated again during 2 to 3 months. The juvenile recurrent laryngeal papilloma were treated by electric suction cutting synergies laser treatment with the help of nasal endoscopy, and they were also treated repeatedly with laser at 2 or 3 weeks after operation. Sixteen cases cured perfectly with no reappearance after an 3 to 8 years follow up, and the other 4 cases showed the prolongation of recurrence interval.@*CONCLUSION@#Electric suction synergy laser treatment could effectively reduce the recurrence of the laryngeal papilloma, and it also needs laser treatment several times after operation to improve the treatment effect. The sodium hyaluronate gel is adopted on the wound of vocal cords, it can avoid the vocal cords scar and adhesion, and improve the quality of pronunciation. Some patients can be cured by this treatment method, and it should be advocated in the clinical work.

Pregnantal ultrasonography on fetus' complicate congenital heart diseases / 中华超声影像学杂志

Objective To discuss the value of pregnantal ultrasonography(US) on fetus' complicate congenital heart diseases(CHD). Methods The uhrasonographic fetures of fetus complicate CHD were analyzed and compared with the pathological diagnosis. Resells Twenty fetus' complicate CHD were diagnosed by pregnantal US. Four cases with single ventricle, two eases with transposition of great arteries,two eases with double outlet right ventricle,two cases with truncus arteriosus,three cases with hypoplastic left heart syndrome, three cases with endocardial cushion defect, two cases with hypoplastic right heart syndrome,one case with tetralogy of Fallot and one case with pulmonary atresia were included. The diagnosing according rate was 100%. Conclusions Pregnantal US can fully evaluate the fetus' complicate CHD.

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.

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.

Diagnosis and management of lipogranuloma of the eyelids from nasal endoscopic surgery / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To enhance the safety of nasal endoscopic surgery and decrease its complications of eyes.@*METHOD@#Three patients of chronic rhinosinusitis and nasal polyposis with lipogranulomas of the eyelids after nasal endoscopic surgery and nasal packing of petrolatum gauze were reported and analyzed, and their treatment results were presented during the last 2 years.@*RESULT@#The medial orbital wall injury occurred in all three patients during endoscopic sinus surgery. The patients developed an ipsilateral periocular swelling, eyelid hematoma and palpebral conjunctival edema during 2 to 3 hours after surgery. Nasal packs petrolatum gauze were removed 10-24 hours after surgery. The patients were discharged from hospital when periorbital swelling and eyelid ecchymoma disappeared, and nasal cavity obstruction was improved 6 to 8 days after surgery. The swelling and nodular mass of ipsilateral eyelids (one in left upper eyelid and two in right lower eyelid) were found 12-15 days after surgery, and their eye movement and eyesight were normal. Antibiotic and corticosteroid were administered for 3 4 weeks with only improvement in eyelid swelling. These masses of eyelids were completely excised through palpebral margin 1-6 months after surgery. The histopathological examination of the surgical specimens showed lipogranuloma. No recurrence and symptom of the eyes had been observed during 4-18 months follow up.@*CONCLUSION@#The lipogranuloma of the eyelid is a rare and late complication after nasal endoscopic surgery and nasal packing with vaspetrolatum gauze. The medial orbital wall injury and bleeding during surgery, and vaseline of nasal packing permeated into the eyelid are the direct causes of this complication. The application of petrolatum gauze should be avoided when the medial orbital wall trauma is identified. The complete excision of granulomas is a best effective therapy.

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.

Clinical analysis of extramedullary plasmacytomas in the head and neck / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To summarize the clinical features and the experiences of diagnosis and treatment of extramedullary plasmacytomas (EMPs), and to enhance the cure rates of EMPs.@*METHOD@#Clinical data of 8 patients with EMPs in head and neck, who treated in our hospital from Jan. 1990 to Dec. 2004, were reviewed. Of 8 cases, 3 cases with the tumors occurred in nasal cavities, 1 in maxillary sinus, 2 in nasopharynx, 1 in posterior wall of oropharynx.@*RESULT@#Eight patients who were all pathologic confirmed EMP accepted surgical resections of the tumors, and 4 of 8 cases were boosted radiation therapy post-operation. Four cases were still alive disease-free for more than 1, 5, 10 and 12 years after treatments, respectively. One died of local recurrence in 2 years, 1 died of multiple myeloma in 3 year, and 1 died of heart attack in 2 years after treatments, respectively. One lost follow-up.@*CONCLUSION@#EMPs in head and neck are low potential malignancy tumors. The diagnosis of EMPs mainly depends on clinical manifestations and pathological results. Surgery and radiation therapy are the main treatments for EMPs in head and neck.

Treatment Outcome of 1800 Cases of Endoscopic Sinus Surgery / 中国医师杂志

Objective To evaluate the curative effect of endscopic sinus surgery (ESS) and to investgate the causes and prevention of the complication of ESS.Methods 1800 patients with chronic sinusitis and nasal polyps were retrospectively analyzed by ESS treatment from Aug 1993 to Jun 2001.Results Patients with clinical types and stages from Ⅰ to Ⅲ were 171 cases(9 5%),1003 cases (55 7%),626 cases(34 8%) respectively.The clinical cure rate from Ⅰ to Ⅲ were 91 2%,71 1%,36 2% respectively.The total cure rate was 61 0%,complications were noted in 96 cases(5 3%).The types of complication included papyraceous lamina injury in 15 cases(0 83%),hemorrhage in 16 cases(0 89%),adhesion in 63 cases(3 5%),transient blindness in 2 cases(0 11%).Conclusions ESS is effective and safe in the treatment of chronic sinusitis and nasal ployps.The operation outcome is directly related to the typing and phasing of the disease.It is important to find and treat complications timely and accurately.