Clinical retrospective study on the efficacy and safety of endoscopic ear surgery for adhesive otitis media.

Background: Currently, the optimum surgical approach for treating adherent otitis media is debatable. The traditional treatment is usually performed by microscopic tympanoplasty combined with temporal myofascial tympanic tube placement. In recent years, the application of whole ear endoscopic surgery in the treatment of middle ear diseases has gradually increased, otoendoscopy has been used in the operation of adhesive otitis media, but its safety and effectiveness are still controversial. Methods: This study retrospectively analyzed 17 patients with adhesive otitis media treated by endoscopic ear surgery (EES) in our hospital from January 2018 to July 2021 over a 6-month period post-surgery. Of the 17 patients, 8 were males and 9 were females (mean age, 53 years; age range, 24-70 years). There were 12 and 5 cases of adhesive otitis media involving the left and right ear, respectively. The patients had follow-up evaluations 1 week, 2 weeks, 1 month, 3 months, and 6 months after surgery. Results: A total of 17 patients with adhesive otitis were enrolled, including 1 patient with Dornhoffer stage II; 6 patients with stage III; and 10 patients with stage IV. Adhesive otitis media was combined with middle ear cholesteatoma in 4 patients (24%). Fourteen patients (82%) had disruption or interruption of the ossicular chain (8 malleus, 14 incus, and 4 stapes lesions), 11 of whom had artificial ossicular chain reconstruction [8 with partial ossicular reconstruction prosthesis (PORP) and 3 with total ossicular reconstruction prosthesis (TORP) implantation]. All patients had good tympanic membrane and graft morphology, no invaginations, and no perforations. The mean postoperative air-conduction hearing threshold [49.06±22.15 dB hearing level (dB HL)] and mean air-bone gap (19.94±10.00 dB HL) were significantly improved compared with the preoperative values (65.29±21.53 and 32.53±8.21 dB HL, respectively; P<0.05). No recurrences, secondary cholesteatomas, or secondary surgeries were reported. Conclusions: EES seems to be a safe and effective surgical method for the management of adhesive otitis media. The study has limitations due to its small sample size and lack of controlled studies. It still needs to be proven in clinical randomized controlled trials.

Clinical Analysis of 85 Cases of External Auditory Canal Cholesteatoma Surgery under Specialized Endoscopy.

Objective: To investigate the clinical characteristics, surgical experience, and surgical outcomes of external auditory canal cholesteatoma (EACC) surgery under endoscopic otolaryngoscopy. Methods: A retrospective analysis of 85 EACC cases admitted to the Department of Otolaryngology, Renji Hospital, Shanghai Jiaotong University School of Medicine, from January 2016 to February 2021 was performed, followed by retrospective analysis of clinical data to explore the feasibility and clinical characteristics of all-oral endoscopic EACC surgery. A total of 85 EACC patients (90 ears) with a mean age of 49.93 ± 14.87 years were included in the study. According to Udayabhanu staging, 43 ears (47.78%) were stage I, 40 ears (44.44%) were stage II, and 7 ears (7.78%) were stage III. All patients underwent transendoscopic surgery. Results: 79 ears (87.78%) underwent endoscopic EACC resection alone (+external auditory canal tumor resection/tympanostomy tube insertion), 9 ears (10%) underwent endoscopic EACC resection+tympanostomy+tympanoplasty, 1 ear (1.11%) underwent endoscopic EACC resection+tympanoplasty, and 2 ears (2.22%) underwent EACC resection+otolaryngotomy+tympanoplasty+auditory chain reconstruction endoscopically. Of these, 7 ears (7.78%) underwent auricular cartilage-chondroplasty and 2 ears (2.22%) underwent auricular cartilage membrane repair. All patients were reviewed at 1 week, 2 weeks, 1 month, 3 months, 6 months, and 1 year postoperatively. One patient with stage II external auditory atresia had a recurrence after 6 months and underwent endoscopic ear surgery (ESS) again. One patient with stage 2 atresia recurred after 1 year and again underwent endoscopic ear surgery. The rest of the patients recovered well after the surgery, and the grafts healed well. Conclusion: EACC surgery through the external ear canal under a dedicated endoscope is a safe, reliable, and effective method. Patients with stage I and II external auditory canal cholesteatoma surgery under endoscopy have a rapid postoperative recovery with significant hearing improvement, and stage IIIA patients can also achieve good results under strict evaluation of indications.

Dose-Dependent Pattern of Cochlear Synaptic Degeneration in C57BL/6J Mice Induced by Repeated Noise Exposure.

It is widely accepted that even a single acute noise exposure at moderate intensity that induces temporary threshold shift (TTS) can result in permanent loss of ribbon synapses between inner hair cells and afferents. However, effects of repeated or chronic noise exposures on the cochlear synapses especially medial olivocochlear (MOC) efferent synapses remain elusive. Based on a weeklong repeated exposure model of bandwidth noise over 2-20 kHz for 2 hours at seven intensities (88 to 106 dB SPL with 3 dB increment per gradient) on C57BL/6J mice, we attempted to explore the dose-response mechanism of prolonged noise-induced audiological dysfunction and cochlear synaptic degeneration. In our results, mice repeatedly exposed to relatively low-intensity noise (88, 91, and 94 dB SPL) showed few changes on auditory brainstem response (ABR), ribbon synapses, or MOC efferent synapses. Notably, repeated moderate-intensity noise exposures (97 and 100 dB SPL) not only caused hearing threshold shifts and the inner hair cell ribbon synaptopathy but also impaired MOC efferent synapses, which might contribute to complex patterns of damages on cochlear function and morphology. However, repeated high-intensity (103 and 106 dB SPL) noise exposures induced PTSs mainly accompanied by damages on cochlear amplifier function of outer hair cells and the inner hair cell ribbon synaptopathy, rather than the MOC efferent synaptic degeneration. Moreover, we observed a frequency-dependent vulnerability of the repeated acoustic trauma-induced cochlear synaptic degeneration. This study provides a sight into the hypothesis that noise-induced cochlear synaptic degeneration involves both afferent (ribbon synapses) and efferent (MOC terminals) pathology. The pattern of dose-dependent pathological changes induced by repeated noise exposure at various intensities provides a possible explanation for the complicated cochlear synaptic degeneration in humans. The underlying mechanisms remain to be studied in the future.

Audiometric Phenotypes of Noise-Induced Hearing Loss by Data-Driven Cluster Analysis and Their Relevant Characteristics.

Background: The definition of notched audiogram for noise-induced hearing loss (NIHL) is presently based on clinical experience, but audiometric phenotypes of NIHL are highly heterogeneous. The data-driven clustering of subtypes could provide refined characteristics of NIHL, and help identify individuals with typical NIHL at diagnosis. Methods: This cross-sectional study initially recruited 12,218 occupational noise-exposed employees aged 18-60 years from two factories of a shipyard in Eastern China. Of these, 10,307 subjects with no history of otological injurie or disease, family history of hearing loss, or history of ototoxic drug use were eventually enrolled. All these subjects completed health behavior questionnaires, cumulative noise exposure (CNE) measurement, and pure-tone audiometry. We did data-driven cluster analysis (k-means clustering) in subjects with hearing loss audiograms (n = 6,599) consist of two independent datasets (n = 4,461 and n = 2,138). Multinomial logistic regression was performed to analyze the relevant characteristics of subjects with different audiometric phenotypes compared to those subjects with normal hearing audiograms (n = 3,708). Results: A total of 10,307 subjects (9,165 males [88.9%], mean age 34.5 [8.8] years, mean CNE 91.2 [22.7] dB[A]) were included, 3,708 (36.0%) of them had completely normal hearing, the other 6,599 (64.0%) with hearing loss audiograms were clustered into four audiometric phenotypes, which were replicable in two distinct datasets. We named the four clusters as the 4-6 kHz sharp-notched, 4-6 kHz flat-notched, 3-8 kHz notched, and 1-8 kHz notched audiogram. Among them, except for the 4-6 kHz flat-notched audiogram which was not significantly related to NIHL, the other three phenotypes with different relevant characteristics were strongly associated with noise exposure. In particular, the 4-6 kHz sharp-notched audiogram might be a typical subtype of NIHL. Conclusions: By data-driven cluster analysis of the large-scale noise-exposed population, we identified three audiometric phenotypes associated with distinct NIHL subtypes. Data-driven sub-stratification of audiograms might eventually contribute to the precise diagnosis and treatment of NIHL.

Acute Recreational Noise-Induced Cochlear Synaptic Dysfunction in Humans With Normal Hearing: A Prospective Cohort Study.

OBJECTIVES: The objective of the study was to identify the acute high-intensity recreational noise-induced effects on auditory function, especially the cochlear synaptopathy-related audiological metrics, in humans with normal hearing. METHODS: This prospective cohort study enrolled 32 young adults (14 males and 18 females); the mean age was 24.1 ± 2.4 years (ranging from 20 to 29). All participants with normal hearing (audiometric thresholds ≤25 dB HL at frequencies of 0.25, 0.5, 1, 2, 3, 4, 6, and 8 kHz for both ears) had already decided to participate in the outdoor music festival. Participants were asked to measure the noise exposure dose and complete auditory examinations, including the air-conduction pure-tone audiometry (PTA), distortion product otoacoustic emission (DPOAE), contralateral suppression (CS) on transient evoked otoacoustic emission (TEOAE), auditory brainstem response (ABR) test and Mandarin Hearing in Noise Test (MHINT), at baseline and 1 day and 14 days after music festival noise exposure. RESULTS: The mean time of attending the music festival was 7.34 ± 0.63 h (ranging from 6.4 to 9.5), the mean time-weighted average (TWA) of noise exposure dose was 93.2 ± 2.39 dB(A) (ranging from 87.9 to 97.7). At neither 1 day nor 14 days post exposure, there were no statistically significant effects on PTA thresholds, DPOAE amplitudes, CS on TEOAEs, or MHINT signal-to-noise ratios (SNRs) of acute outdoor music festival noise exposure, regardless of sex. While the ABR wave I amplitudes significantly decreased at 1 day after exposure and recovered at 14 days after exposure, the exposed/unexposed ABR wave I amplitude ratio was significantly correlated with MHINT SNR change at 1 day after exposure, although it was not correlated with the noise exposure dose. CONCLUSION: In young adults with normal hearing, we found the self-compared decrement of ABR wave I amplitudes at 1 day post acute recreational noise exposure at high intensity, which also contributes to the change in speech perceptual ability in noisy backgrounds. This study indicated that auditory electrophysiological metric changes might be a more sensitive and efficient indicator of noise-induced cochlear synaptic dysfunction in humans. More attention should be paid to the recreational noise-induced cochlear synaptopathy and auditory perceptual disorder.

The effects of aging on peripheral and central auditory function in adults with normal hearing.

This study was designed to investigate the effects of the aging process on peripheral and central auditory functions in adults with normal hearing. In this study, 149 participants with normal hearing were divided into four groups: aged 20-29, 30-39, 40-49 and 50-59 years for statistical purposes. Electrocochleography (EcochG), transient evoked otoacoustic emissions (TEOAE), Mandarin Hearing in Noise Test (MHINT) and the Gap Detection Test (GDT) were used. Our study found: (1) MHINT is significantly associated with aging (left ear R2=0.29, right ear R2=0.35). (2) TEOAE amplitude, TEOAE contralateral acoustic stimulation (CS) amplitude, EcochG action potential (AP), EcochG AP latency, EcochG summating potential (SP) and GDT progressively declined with age. (3) The EcochG SP/AP has no statistically significant difference among different age groups. (4) The peripheral auditory function of the right ear declines more slowly than that of the left ear. (5) Hypofunction of the central auditory system accelerates after age 40. The results demonstrate: (1) The age-related decline in the ability of speech recognition in a noisy environment may be the most sensitive indicator that reflects auditory function. (2) The decline of central auditory function is independent of peripheral auditory function, according to the auditory characteristics of the right ear. (3) Auditory function needs to be assessed individually to allow early prevention before age 40.

An In Vitro Study on Prestin Analog Gene in the Bullfrog Hearing Organs.

The prestin-based active process in the mammalian outer hair cells (OHCs) is believed to play a crucial role in auditory signal amplification in the cochlea. Prestin belongs to an anion transporter family (SLC26A). It is densely expressed in the OHC lateral plasma membrane and functions as a voltage-dependent motor protein. Analog genes can be found in the genome of nonmammalian species, but their functions in hearing are poorly understood. In the present study, we used the gerbil prestin sequence as a template and identified an analog gene in the bullfrog genome. We expressed the gene in a stable cell line (HEK293T) and performed patch-clamp recording. We found that these cells exhibited prominent nonlinear capacitance (NLC), a widely accepted assay for prestin functioning as a motor protein. Upon close examination, the key parameters of this NLC are comparable to that conferred by the gerbil prestin, and nontransfected cells failed to display NLC. Lastly, we performed patch-clamp recording in HCs of all three hearing organs in bullfrog. HCs in both the sacculus and the amphibian papilla exhibited a capacitance profile that is similar to NLC while HCs in the basilar papilla showed no sign of NLC. Whether or not this NLC-like capacitance change is involved in auditory signal amplification certainly requires further examination; our results represent the first and necessary step in revealing possible roles of prestin in the active hearing processes found in many nonmammalian species.

Increased metabolic activity and hysteretic enhanced GABAA receptor binding in a rat model of salicylate-induced tinnitus.

Tinnitus is relevant to neural hyperactivity in the central nervous system (CNS). Normal quantity and functioning of the γ-aminobutyric acid (GABA) receptor are crucial for maintaining the balance between excitation and inhibition in the brain. In this study, we applied a rat model of tinnitus via long-term salicylate administration. The combination of the gap pre-pulse inhibition of acoustic startle (GPIAS) and pre-pulse inhibition (PPI) tests were used to detect tinnitus-like behavior, and rats receiving 7 or 14 consecutive days of salicylate administration showed evidence of tinnitus. After positron emission tomography (PET) scan, we found that the metabolic activity was increased after salicylate treatment followed by enhanced GABAA receptor binding with cessation of salicylate administration in the auditory cortex (AC), medial prefrontal cortex (mPFC), hippocampus (HP), cingulate cortex (CiC) and insular (InC). The inferior colliculus (IC) showed an elevated metabolic activity with no change in the GABAA receptor binding. All the alterations returned to baseline several days after cessation of salicylate treatment despite a mismatch between the time-course of them. By contrast, we found alterations in neither the metabolic activity nor the GABAA receptor binding in the amygdala (AMY) and cerebellum (CRB). These findings indicate that enhanced neural activity in the auditory and limbic system may contribute to the development of tinnitus, while the hysteretic increase of GABAA receptor binding in specific areas of the CNS may be a compensation for hyperactivity, which may be involved in tinnitus relieving.

[Molecular pathogenesis of Waardenburg syndrome type II resulting from SOX10 gene mutation].

OBJECTIVE: To explore the molecular mechanism of Waardenburg syndrome type II (WS2) resulting from SOX10 gene mutation E248fs through in vitro experiment. METHODS: 293T cells were transiently transfected with wild type (WT) SOX10 and mutant type (MT) E248fs plasmids. The regulatory effect of WT/MT SOX10 on the transcriptional activity of MITF gene and influence of E248fs on WT SOX10 function were determined with a luciferase activity assay. The DNA binding capacity of the WT/MT SOX10 with the promoter of the MITF gene was determined with a biotinylated double-stranded oligonucleotide probe containing the SOX10 binding sequence cattgtc to precipitate MITF and E248fs, respectively. The stability of SOX10 and E248fs were also analyzed. RESULTS: As a loss-of-function mutation, the E248fs mutant failed to transactivate the MITF promoter as compared with the WT SOX10 (P<0.01), which also showed a dominant-negative effect on WT SOX10. The WT SOX10 and E248fs mutant were also able to bind specifically to the cattgtc motif in the MITF promoter, whereas E248fs had degraded faster than WT SOX10. CONCLUSION: Despite the fact that the E248fs has a dominant-negative effect on SOX10, its reduced stability may down-regulate the transcription of MITF and decrease the synthesis of melanin, which may result in haploinsufficiency of SOX10 protein and cause the milder WS2 phenotype.

[Diagnosis and treatment of primary ectopic thyroid carcinoma: report of 3 cases and literature review].

OBJECTIVE: Discuss the clinical features of primary ectopic thyroid carcinoma. METHOD: The clinical data of three cases diagnosed of primary ectopic thyroid carcinoma in our department since 1990 were analyzed ret respectively and related literature was reviewed. RESULT: All three patients were young females that had cervical lumps before surgery. The pathology results confirmed the diagnosis of ectopic thyroid papillary carcinoma. All cases had followed up till now and no relapse signs occurred. CONCLUSION: Ectopic thyroid tissue is resulting from developmental defects at early stages of thyroid gland embryogenesis. They can cancerization, the treatment of ectopic thyroid carcinoma is also controversial. Here,we report 3 cases of primary ectopic thyroid papillary carcinoma, all of which were removed by surgery, take thyroxin orally after surgery and have a great prognosis.

[Detection of Runx2 mRNA expression using relatively real-time RT-PCR in papillary thyroid carcinoma].

OBJECTIVE: To relatively detect the Runx2 mRNA expression in papillary thyroid carcinoma (PTC) and thyroid adenoma, then to investigate the role of Runx2 in the development and progression in PTC and the relationship with the micro calcification in PTC. METHOD: The expression of Runx2 mRNA in 14 samples of PTC and 14 samples of thyroid adenoma was examined by relatively real-time RT-PCR. RESULT: The deltaCT value of the carcinoma group and adenoma group was 2.395 +/- 0.302 and 5.028 +/- 1.179 respectively (P<0.01). The 2(-deltadeltaCT) value of the carcinoma group and adenoma group was 7.826 +/- 5.004 and 1 respectively (P<0.01). The carcinoma group was divided into two groups by calcification and there was no statistical difference (P>0.05), and the adenoma group as well. The carcinoma group was divided into two groups by the size of carcinoma (<1 cm and > or = 1 cm). The deltaCT value was 2.629 +/- 0.300 and 2.212 +/- 0.124 respectively (P<0.05) and the 2(-deltadeltaCT) value was 167.33 +/- 33. 823 and 221.69 +/- 18.843 respectively (P<0.01). The TSH level in carcinoma group and adenoma group had no statistical significance (P>0.05). CONCLUSION: The expression of Runx2 mRNA was high in PTC, and was related to the size of carcinoma which was higher in bigger size carcinoma. The role of Runx2 may contribute to the formation of the micro-calcification and the development and progression in PTC and other malignant tumors, such as breast cancer, prostatic carcinoma and osteosarcoma.

[Clinical analysis of granulomatous capillary hemangioma of the larynx].

OBJECTIVE: To improve the acknowledgement of clinician on granulomatous capillary hemangioma of the larynx. METHOD: Collect patients in our hospital who were treated with granulomatous capillary hemangioma of the larynx from 2006 to 2011 and the clinical data, treatment and follow-up consequence were retrospectively analyzed. RESULT: There are 10 cases of laryngeal granulomatous capillary. Eight patients with hoarseness as the chief complaint, in the eight patients three cases associated with foreign body sensation in the throat. One patient with hemoptysis as the main performance. The left one patient to hospital because of pharyngeal foreign body sensation associated with blood in the sputum. All were treated with surgery, there are several cases supplemented by CO2 laser treatment, so far no case of postoperative recurrence. CONCLUSION: Granulomatous capillary hemangioma is a benign, vascular proliferation of the skin or mucosa, rather than ture tumor. Recurrence is rare if completely excised. The prognosis is encouraging.

[The significance of calcification in the thyroid papillary carcinoma].

OBJECTIVE: To study the significance of calcification in the thyroid papillary carcinoma. METHOD: Retrospectively analyze 88 cases of thyroid papillary carcinoma. RESULT: There was no association between calcification with age,TSH and TNM. But calcification was related to the size of tumor (P < 0.05). In addition, the level of TSH has no relationship with the size of tumor. CONCLUSION: Calcification especially microcalcification may have significant relationship with thyroid papillary carcinoma and be directly related to the size of tumor. The larger size of tumor implies the higher possibility of calcification.

[The significance of middle thyroid vein in the VI region neck dissection].

OBJECTIVE: To investigate the effect of VI region neck dissection in thyroid papillary carcinoma surgery and to prompt the key matters in such surgery. METHOD: Retrospectively analyzed 213 cases of thyroid papillary carcinoma treated by Renji ENT Department from 2003 to 2009. Under each case, we implemented the VI region neck dissection after marking recurrent laryngeal nerve with middle thyroid vein. RESULT: Among the 213 cases of thyroid papillary carcinoma performed with VI region neck dissection, 82 cases were positive, 3 cases incurred recurrent laryngeal nerve injury with 2 cases of permanent RLN injury and 2 case of temporary injury, 2 cases showed permanent Hypoparathyroidism, and 6 cases showed temporary Hypoparathyroidism. In 3 cases the metastasis of neck lymph arose within 3 years. CONCLUSION: Marking recurrent laryngeal nerve with middle thyroid vein not only helps to lower the possibility of injuring RLN and parathyroid glands in thyroidectomy, but also makes the VI region neck dissection an feasible treatment for thyroid papillary carcinoma.

[The significance of p63 expression in thyroid neoplasm].

OBJECTIVE: To explore the significance of p63 expression in thyroid carcinoma, thyroid papillary carcinoma, thyroid follicular carcinoma, squamous cell carcinoma and medullary thyroid carcinoma in order to find the possible causes of such thyroid-related diseases and if there is some kind of relation among them. METHOD: The expression of p63 was examined in 10 thyroid carcinomas, 20 thyroid papillary carcinomas, 4 thyroid follicular carcinomas, 2 squamous cell carcinomas and 2 medullary thyroid carcinomas using direct immunofluorescence. RESULT: It was shown that p63 expressed in all the thyroid-related diseases mentioned above. In squamous cell carcinoma, p63 has the highest expression and the expression of p63 in thyroid papillary carcinoma has no obvious relationship with the patients age, sex, the size and location of tumor and neoplasm metastasis. CONCLUSION: The p63 masculine stem cells in thyroid could be one of the causes of some thyroid papillary carcinomas and thyroid follicular carcinomas. Thyroid papillary carcinoma, thyroid follicular carcinoma and squamous cell carcinoma may have similar origins.

[Management of the sentinel lymph node of papillary thyroid carcinoma in surgery].

OBJECTIVE: To investigate the value of sentinel lymph node of papillary thyroid carcinoma exploring and measuring in the metastasis of the cervical lymph node of thyroid carcinoma. METHOD: The sentinel lymph node were investigated by injecting the methylene blue around 25 cases of thyroid tumors. The lymph nodes dyed in blue and obtained from selective lymph node dissection were examined by pathology, respectively. The value of the sentinel lymph nod were evaluated. RESULT: The sentinel lymph nodes dyed in blue were identified in 22 cases which account for 88.0% of all the 25 cases. Nineteen cases of the sentinel lymph node were positive by pathology, of whom 13 cases were verified positive in other area. Six cases were negative. CONCLUSION: It is of great value that sentinel lymph node of thyroid carcinoma can indicate the metastasis of the cervical lymph node of thyroid carcinoma.

[Clinical analysis of 122 cases of non-thyroid related neck cyst].

OBJECTIVE: To investigate the characteristic of non-thyroid-related neck cyst for the purpose of im proving the accuracy of diagnosis of neck cyst preoperatively. METHOD: Retrospectively analyzed 122 cases of non thyroid related neck cyst during 1999 2005 in our department. RESULT: Congenital mass (n=84) constitute the main part of total cases (n 122), among which thyroglossal cyst is the most common reason. Infective cyst is the second cause of neck cyst (n=30), among which the number of submaxillary gland cyst is 25. Tumor is the most rare cause of neck cyst (n=8). Timing and position of cysts, auxiliary examination of physical sign and puncture cytological analysis lead to more accurate diagnosis preoperatively. CONCLUSION: Accurate diagnosis of neck cyst reduce the blindness and minimize the risk preoperatively.

[The clinical significance of molecular findings in surgically resected margins of the primary tumor laryngeal carcinoma].

OBJECTIVE: To study the relationship at molecular level between the resection range of laryngeal squamous cell carcinoma (LSCC) and prognosis. METHOD: Immunohistochemistry method was used to detected the expression of EGFR, p27,Bcl-2 and p53 in surgically resected margins of the 23 patients with LSCC. The relationship between the genes and tumour recurrence were observed by the follow-up. RESULT: Seven margin tissues of tumors had detectable Bcl-2 expression; eleven margin tissues overexpressed p27; and three expressed p53 and EGFR. Four of the 23 patients have had tumor recurrence and their expression of p27, p53 and EGFR were negative; the expression of Bcl-2 was positive in two patients of the four recurrences patients. The rest were alive unrelated causes without clinical (good outcome). Expression of neither EGFR nor p53 was associated with recurrence. Only p27 was significantly associated with outcome and disease-free survival. CONCLUSION: These data indicate that assessing expression of multiple genes with immunohistochemistry in margin tissues is likely to be useful for surgically treated advanced laryngeal carcinoma. The expression of the p27 is more important.

[Clinical research on 2228 cases of thyroid gland tumors].

OBJECTIVE: To discuss outcome of thyroid tumor patients treated with surgery. METHODS: Total number of patients was 2228. These patients of thyroid tumors from 1992-2004 (2072 cases of benign thyroid diseases and 156 cases of thyroid carcinoma) were recruited. The clinical and follow-up datum were retrospective analyzed. RESULTS: (1) Benign thyroid tumors with near-total thyroidectomy including 1761 thyroid adenoma, 207 nodular goiter and 104 Hashimoto thyroiditis, the incidence of recurrent laryngeal nerve paralysis was 0.2%, 55 cases (2.6%) received secondary surgery. All the patients have no hypocalcemia or hemorrhage after operation. (2) Eighty-one cases of papillary carcinoma of the thyroid ( > 1 cm) and 60 cases of microcarcinoma. Unilateral thyroidectomy, contralateral near-total thyroidectomy and ipsilateral modified neck dissection were performed in unilateral papillary carcinoma of thyroid. Among the 9 cases of follicular carcinoma of thyroid, 7 were performed of near-total thyroidectomy without neck dissection, others were the same as papillary carcinoma. Bilateral total thyroidectomy and bilateral modified neck dissection were performed in 2 cases of the medullary thyroid cancer and 1 case of the undifferentiated thyroid cancer. By direct method the 5-year survival was 95.5% (64/67), and by Kaplan-Meier method, it was 98.0%. The treatment of microcarcinoma are multiple. There is no relapse or metastases in 60 cases of papillary thyroid microcarcinoma. The 5-year survival was 100.0%, 1 cases occurred recurrent laryngeal nerve paralysis in thyroid cancer. No hypocalcemia or hemorrhage. Eight case relapsed in 156 cases of thyroid carcinoma,3 cases died. CONCLUSION: The correct surgical management for the patients with thyroid tumor should benefit for the prognosis and reduce the complications and the recurrence of the operation.