Treatment Strategies of Orbit in Sinonasal Malignancy Patients with Orbital Invasion / 肿瘤防治研究

Due to the paranasal sinuses adjacent to the orbit, the sinonasal malignancy is prone to invade the orbit, which is not only the advanced stage of the tumor, but also one of the poor prognostic factors. Preoperative CT and MRI scan and intraoperative frozen section analysis are used to evaluate the orbital invasion of the tumor. Orbital preservation is adopted if the periorbita is not transgressed by tumor. Orbital preservation can be considered if the tumor invades the periorbita and extraconal fat in a limited range, responds well to neoadjuvant chemotherapy, radiotherapy or other multimodality treatment, or has a negative section margin. Orbital exenteration is performed if the tumor extensively invades the periorbita, and invades the extraocular muscle, eyeball and orbital apex. Whether orbital preservation or orbital exenteration is adopted, it should be evaluated and made decision by a multidisciplinary team, and fully communicate with the patient.

Experience of Fusion image guided system in endonasal endoscopic surgery / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To review endonasal endoscopic surgeries aided by Fusion image guided system, and to explore the application value of Fusion image guided system in endonasal endoscopic surgeries.@*METHOD@#Retrospective research. Sixty cases of endonasal endoscopic surgeries aided by Fusion image guided system were analysed including chronic rhinosinusitis with polyp (n = 10), fungus sinusitis (n = 5), endoscopic optic nerve decompression (n = 16), inverted papilloma of the paranasal sinus (n = 9), ossifying fibroma of sphenoid bone (n = 1), malignance of the paranasal sinus (n = 9), cerebrospinal fluid leak (n = 5), hemangioma of orbital apex (n = 2) and orbital reconstruction (n = 3).@*RESULT@#Sixty cases of endonasal endoscopic surgeries completed successfully without any complications. Fusion image guided system can help to identify the ostium of paranasal sinus, lamina papyracea and skull base. Fused CT-CTA images, or fused MR-MRA images can help to localize the optic nerve or internal carotid arteiy . Fused CT-MR images can help to detect the range of the tumor. It spent (7.13 ± 1.358) minutes for image guided system to do preoperative preparation and the surgical navigation accuracy reached less than 1mm after proficient. There was no device localization problem because of block or head set loosed.@*CONCLUSION@#Fusion image guided system make endonasal endoscopic surgery to be a true microinvasive and exact surgery. It spends less preoperative preparation time, has high surgical navigation accuracy, improves the surgical safety and reduces the surgical complications.

Treatment of 22 Cases of Medication-Induced Rhinitis by Mometasone Furoate AqueousNasal Spray / 医药导报

Objective To assess the clinical efficiency and side effects of topical mometasone furoate aqueous nasal spray for patients with naphazoline-induced rebound rhinitis. Methods A prospective, non-randomized and self-controlled study was applied. A total of 22 patients with naphazoline-induced rhinitis received two spray-puffs of 50 μg mometason furoate twice daily to each nostril in the morning for one week, followed by two spray-puffs of 50 μg mometason furoate once daily to each nostril every morning for another three weeks after withdrawn of naphazoline therapy. Nasal congestion was evaluated by visual an-alogue scale (VAS) recorded before and after treatment. Side effects like nose bleeding and perforation of the nasal septum was detected with rhinoscope. Results The statistical difference of VAS before and after treatment was significant. No adverse reac-tions as nose bleeding and perforation of the nasal septum were observed by the end of treatment. Conclusion It is safe and effective to use mometasone furoate aqueous nasal spray for treating rebound rhinitis induced by misuse of naphazoline nasal drop.

3D computed tomographic analysis of frontal recess region / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#The purpose of the study was to observe the three-dimensional (3D) CT imaging features of the frontal recess region with 3D reconstruction, and obtain the real image of the important anatomical structures of the region to conduct surgery.@*METHOD@#Five patients were undergone spiral CT by 16 line high speed spiral CT, and multiplanar reconstruction images using standard 3D reconstruction protocol on a computer workstation. The structure of the frontal recess, the agger nasi cell and adhere style of the uncinate process were observed. The parameter of the important anatomic structure of frontal recess was measured precisely.@*RESULT@#After the reconstruction, we get the 3D model very close to the true state of the nasal cavity--sinuses cell, in which parts of the frontal recess can clearly identify the agger nasi cell, frontal cell and other important structures. In this patient, the height, width and depth of the agger nasi and frontal sinus were 12.3 mm, 12.1 mm, 38.5 mm, respectively.@*CONCLUSION@#This study tried to develop the standardized techniques and measurements from 3D reconstructed images of the frontal sinus and to ascertain the usefulness of the frontal sinus in identification of patients. The results in better preoperative patient counselling and in predicting postoperative improvement in clinical status.

Computed tomographic images analysis of frontal recess anatomy based on three-dimension reconstruction / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To observe the CT three-dimensional imaging features of the frontal recess region with advanced three-dimensional reconstruction, and develop the real image of the important anatomical structures around the region to conduct surgery.@*METHOD@#Thirty patients were undergone spiral CT by 16 line high speed spiral CT, and multiplanar reconstruction images using standard three-dimensional reconstruction protocol on a computer workstation. The structure of the frontal recess, the agger nasi cell and adhere style of the uncinate process were observed. The parameter of the important anatomic structure of frontal recess was measured precisely.@*RESULT@#After the reconstruction, we get the three-dimensional model very close to the true state of the nasal cavity-sinuses cell, in which parts of the frontal recess can clearly identify the agger nasi cell, frontal cell and other important structures. In these patients, the height, width and depth of the agger nasi and frontal sinus were (9.45 ± 3.60)mm, (8.08 ± 3.37)mm, (26.98 ± 6.82)mm and (26.86 ± 9.45)mm, respectively.@*CONCLUSION@#This study tried to develop the standardized techniques and measurements from three-dimensional reconstructed images of the frontal sinus and to ascertain the usefulness of the frontal sinus in identification of patients. The project results in better preoperative patient counselling and in predicting postoperative improvement in clinical status.

Expression and clinical significance of calcium-activated chloride channel and mucins in nasal mucosa with allergic rhinitis / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To evaluate the role of human calcium-activated chloride channel 1 (hCLCA1) and mucin MUC5AC in allergic rhinitis.@*METHOD@#The expression of hCLCA1 and MUC5AC were determined by RT-PCR and immunohistochemical assay in nasal mucosa on 20 patients with allergic rhinitis and 7 normal persons.@*RESULT@#The expression of hCLCA1mRNA in allergic rhinitis group was positive, whereas in normal control group was absent (P<0.01). The expression of MUC5AC mRNA and MUC5AC protein in the allergic rhinitis group were higher than that in the control, respectively (both P<0.01). The increased expression of hCLCA1mRNA in allergic rhinitis group were well correlated with the expression of MUC5ACmRNA and MUC5AC protein and the correlation coefficients were 0.752 and 0.694(both P<0.05).@*CONCLUSION@#Upregulation of hCLCA1 mRNA expression may play a pivotal role in mucus overproduction in allergic rhinitis group. The inhibition of HCLCA1 expression may provide a new strategy for the treatment of allergic rhinitis.

Retroperitoneal laparoscopic combined with resectoscopic radical nephroureterectomy for upper tract urothelial carcinoma / 中国综合临床

Objective To explore the therapeutic effect and application value of retroperitoneal laparoscopic combined with resectoscopic radical nephroureterectomy for upper tract urothelial carcinoma Methods From Jan.2006 to Jul.2009,fifteen upper tract urothelial carcinoma patients underwent excision of bladder cuff with resectoscope at first,and then retroperitoneal laparoscopic radical nephroureterectomy.All tumors were confirmed to be localized,stage T1-T3.Clinical outcomes of the patients were retrospectively analyzed.Results Mean operative time was 150 (range:120-180) minutes and blood loss volume was 200 (range:100-400)ml.The function of intestinal canal recovered after 24-48 hours,the drainage tube could be removed after 3-4 days.Catheter was kept for 7-10 days.During the follow up for 1-40 months,all the 15 patients survived with one retroperitoneal lymphatic metastasis.There were no severe complications in perioperative and postoperative period.Conclusions Retroperitoneal laparoscopic combined with resectoscopic radical nephroureterectomy may be a practical surgical procedure for upper tract urothelial carcinoma patients with less intraoperative blood loss and early recovery.

Computed tomographic analysis of frontal recess region / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#The purpose of the study was to observe the CT imaging features of the frontal recess regional.@*METHOD@#Eighty-two patients were undergone spiral computed tomography (CT). Then multiplanar reconstruction images were made using standard triplanar reconstruction protocol on a computer workstation.@*RESULT@#The prevalence of agger nasi cell was 87.8% (144/164). One hundred and forty-five (89%, 145/164) uncinate processes had one superior attachment for each uncinate process. The others had two superior attachments for each uncinate process. The uncinate process' single superior attachment of into the surrounding structures was identified to have the following distribution: 90/164 (54.9%): to the lamina papyracea, 50/164 (30.5%) to the middle turbinate, and 5/164 (3.0%) to the skull base. Of all the frontal cells were identified in 144 (87.8%) sides of frontal recesses, the prevalence of type I II, type III IV, were 30.5% and 9.8% respectively.@*CONCLUSION@#T Agger nasi cell and uncinate process play an important role in endoscopic frontal sinus surgery.

The expression of oncogene c-myc and its role on human laryngeal cancer / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To detect the expression of oncogene c-myc and explore its role on human laryngeal cancer.@*METHOD@#The mRNA and of oncogene c-myc levels were detected in human laryngeal cancer tissues and laryngeal normal tissues by the means of real-time PCR and immunohistochemistry, respectively.@*RESULT@#Compared with normal laryngeal tissues, the mRNA and protein levels of oncogene c-myc were both upregulated in laryngeal cancer tissues of all differentiation degree (P<0.05). Moreover, the level of c-myc was inverse correlated with the differentiation degree in human laryngeal cancer tissues.@*CONCLUSION@#The oncogene c-myc is overexpressed in human laryngeal cancer tissues, and c-myc may play an important role in carcinogenesis and progression of human laryngeal cancer tissues. It may provide a new target for gene therapy of human laryngeal cancer.

The expression of oncogene c-myc and its role on human laryngeal cancer / 临床耳鼻咽喉头颈外科杂志

Objective:To detect the expression of oncogene c-myc and explore its role on human aryngeal cancer.Method:The mRNA and of oncogene c-myc levels were detected in human laryngeal cancer tissues and iaryngeal normal tissues by the means of real-time PCR and immunohistochemistry,respectively.Result:Compared with normal laryngeal tissues,the mRNA and protein levels of oncogene c-myc were both upregulated in laryngeal cancer tissues of all differentiation degree(P＜0.05).Moreover,the level of e-myc was inverse correlated with the differentiation degree in human laryngeal cancer tissues.Conclusion:The oncogene c-myc is overexpressed in human laryngeal cancer tissues,and c-myc may play an important role in carcinogenesis and progression of human laryngeal cancer tissues.It may provide a new target for gene therapy of human laryngeal cancer.

Endoscopic removal of ethmoid osteoma: report of 13 cases / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To report 13 cases of ethmoid osteoma removed through an endoscopic approach and discuss the operative technique and clinical value.@*METHOD@#Thirteen cases with ethmoid osteoma were retrospectively reviewed in the study. All procedures were performed with CT image guidance-according to the site of attachment. The anterior ethmoid cell was resected, and the whitish osteoma found. A double blunt elevator was used to separate the osteoma from ethmoid cell, and to push the osteoma medially toward the nasal septum, and (or) inferiorly toward the middle meatus. This method was performed in 7 patients (8 sides), whose CT scan showed the osteoma bases were not attached to lamina papyracea, and (or) anterior skull base. The others were drilled out with a intranasal powered drill for its attached to lamina papyracea in 4 patients and to anterior skull base in 2 patients.@*RESULT@#Thirteen cases of ethmoid osteoma were removed completely through an endoscopic approach and there were no intraorbital or intracranial complication. Endoscopy showed normal epithelization at around 6 to 8 weeks after surgery.@*CONCLUSION@#Preoperative CT scans, including coronal and axial images, is very helpful to determine the sites of the osteoma attachment and plan the operation. Endoscopic removal of ethmoid osteoma is not only an ideal, less invasive surgical approach, but also no cosmetic alteration.

The perioperative glycemic control in chronic rhinosinusitis coexisting diabetes / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To evaluate the method of the perioperative blood glucose control in chronic rhinosinusitis coexisting diabetes.@*METHOD@#Twenty-two cases of chronic rhinosinusitis coexisting diabetes were investigated retrospectively, including one case of type 1 diabetes and 21 cases of type 2 diabetes. The study cohort was divided into two groups, the one was complication group and the other was non-complication group. The patients in complication group were injected insulin to control blood glucose level, and the patients in non-complication group were prescribed oral medicine.@*RESULT@#Blood glucose levels below 9.0 mmol/L in complication group and below 7.0 mmol/L in non-complication group were both the surgical indication for the patients in this research cohort. Twenty-one cases were completely recovered and one case made progress significantly.@*CONCLUSION@#The detection of blood and urine glucose levels must be the routine item before the nasal endoscopic surgery. To control blood glucose levels in type 2 diabetes with non-complication, oral medicine is the first choice, in type 1 diabetes and type 2 diabetes with complication, insulin should be first considered.

Effects of glucocorticoid and histamine on MUC5AC mRNA and protein expression in human nasal polyps / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To study the effects of dexamethasone and histamine on the expression of MUC5AC mRNA and protein in human nasal polyps.@*METHOD@#All samples were randomly divided into control group, histamine stimulating group and dexamethasone group. The expression of MUC5AC mRNA and MUC5AC protein in nasal polyps were respectively detected by the methods of reverse transcription-polymerase chain reaction (RT-PCR) and immunohistochemical assay.@*RESULT@#The expression of MUC5AC mRNA (0.6389 +/- 0.0526) and protein (0.1934 +/- 0.0137) in histamine stimulating group were significantly higher than those of control group (0.3495 +/- 0.0357 and 0.1172 +/- 0.0173, respectively) and reduced (0.4988 +/- 0.0603 and 0.1444 +/- 0.0075, respectively) after treatment with dexamethasone.@*CONCLUSION@#Histamine upregulates MUC5AC mRNA and protein expression. Dexamethasone downregulates MUC5AC mRNA and protein expression, which may be one of the mechanisms of downregulating mucus overproduction by dexamethasone in nasal polyps.

Clinical observation on inhalation of pulmicort in patients with chronic rhinosinusitis after surgery / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#Whether inhalation of pulmicort into the sinus of chronic rhinosinusitis patients could improve reepithelization after endoscopic sinus surgery was assessed.@*METHOD@#Prospective study 60 patients with chronic rhinosinusitis after endoscopic sinus surgery were divided into 2 groups randomized, the one was treatment group, and the other was control group. The patients in treatment group received inhalation of pulmicort 2 ml plus 0.5% Aeuromycin solution 10 ml by oxygen driving force, once a day, persisting for 3 weeks. The patients in control group received Rhinocort. Besides the different therapies above mentioned above therapy was different, two groups received the same conventional route therapy. To observe the time of reepithelization under nasal endoscope, was observed, respectively.@*RESULT@#The average time of reepithelization in treatment group was (5.3333 +/- 0.9942) weeks. The other group was (6.6667 +/- 1.3476) weeks, the statistical difference between the two groups was very significant.@*CONCLUSION@#Inhalation of pulmicort into the sinus can promote reepithelization and shorten the time of treatment.