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    16 June 2010 Volume 24 Issue 3
      
    Articles
    Detection of micrometastasis in cervical lymph nodes from laryngeal or laryngopharyngeal carcinoma and preliminary research on the clinical significance of micrometastasis
    Qian Xiaoyun1, Zhang Yifen2, Yu Chenjie1, Ding Xiaoqiong1, Qin Yang1, Qin Xiaoming1, Gao Xia1
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2010, 24(3):  9-14. 
    Abstract ( 1324 )   PDF (1222KB) ( 1243 )   Save
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    Objective  To Compare the positive detection rates of hematoxylin and eosin stain with immunohistochemical stain by semi-consecutive sectioning of  histopathologically negative cervical lymph nodes from laryngeal or laryngopharyngeal squamous cell carcinoma.The  relationship between micrometastasis and clinicopathological factors,  micrometastasis and early recurrences was studied primitively. Methods  Totally, 326 negative cervical lymph nodes (CLNs) from 13 patients (15 sides), with laryngeal or laryngopharyngeal squamous cell carcinoma, were included in this study. Two methods( H&E stain and EnVison′s two-step IHC technique with monoclonal antibody CK (AE1/ AE3)) combined with semi--consecutive sectioning(per-50μm) were applied to detect the micrometestasis . The positive detection rates of H&E and IHC were compared by Chisquare test . The clinicopathological factors, consisted of sex, age, pT stage, clinical typing, grade of differentiation,depth of primary tumor invasion, were studied and all the cases were followed-up for 11~56 months(median time 31.4 months). Further, the relationship between micrometastasis and clinicopathological factors, micrometastasis and early recurrences were analyzed with Chisquare test.  Results  1. All the paraffin specimens of 75 cases were semi-consecutively sectioned into two sets of 750 slices for H&E stain and IHC stain. In the IHC group, 40(5.33%)slices were found positive in 7 (2.14 %) lymph nodes which came from 5(38.46 %) patients Howerver, only 24(3.20%)positive slices were found in 3 lymph nodes of 2 patients in the H&E group.The positive detection rates of these two groups were statistically significant(Ρ<0.05). 2. There was no statistically significance between micrometastasis and the clinicopathological factors (Ρ>0.05) except for the age (Ρ=0.032). There was no statistically significance between micrometastasis and early recurrences. Conclusion  1. Even the experienced pathologists may miss the micrometastasis in cervical lymph nodes from laryngeal or laryngopharyngeal carcinoma if only by H&E stain,though  semi-serial or serial section was applied in those cases.While the IHC technique can obviously increace the positive detection rates. 2.The possible relationship between micrometastasis and clinicopathological factors, micrometastasis and recurrences should be verified with more samples and long-term follow-up.

    Expression and implication of focal adhesion kinase and MMP9 in squamous cell carcinoma of larynx
    GAO Shang, LI Dawei, DONG Pin, WANG Guo, SHEN Bin
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2010, 24(3):  15-18. 
    Abstract ( 1361 )   PDF (772KB) ( 1149 )   Save
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    Objective  To investigate the expressions and implications of focal adhesion kinase(FAK), matrix metalloproteinase(MMP9) in human squamous cell carcinoma of larynx. Methods  SP immunohistochemical technique was used to detect the expressions of FAK, MMP9 in 57 human squamous cell carcinoma of larynx and 10 paracarcinoma. Results  Positive expressions of FAK, MMP9 were found in 66.7% and 63.2% of laryngeal squamous cell carcinoma, which were significantly higher than those in paracarcinoma (10.0% and 20.0% respectively. P<0.05).The positive expression of FAK correlated with the clinical stage and lymph node metastasis(P<0.05), but not with patient′s gender, age, tumor location, tumor size or the degree of differentiation. So did  MMP9. Furthermore, the positive expression of FAK correlated significantly with the expression of MMP9(P<0.01). ConclusionIn   squamous cell carcinoma of larynx, FAK, MMP9 is overexpressed. Moreover,  the correlation between the expression of MMP9 and that of  FAK implies both play important roles in enhancing the metastasis and invasion of squamous cell carcinoma of larynx.

    Treatment of earlystage glottic cancer with CO2 laser
    WANG Junguo, SHEN Xiaohui, QIAN Xiaoyun, DAI Yanhong, CHEN Feng, GAO Xia
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2010, 24(3):  19-21. 
    Abstract ( 2552 )   PDF (331KB) ( 1911 )   Save
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    Objective  To investigate the impact of transoral endoscopic CO2 laser microsurgery (TLM) for the treatment of T1 and T2 glottic cancer.  Methods  Twenty-six patients with early-stage glottic cancer (T1a=12、T1b=2 and T2=12) treated with TLM were enrolled in this study. The outcome and the complications of the surgery were analyzed. Results  No complication happened during the follow-up between 5 to 15 months. All the patients achieved satisfying post-operative voice. Recurrences were identified in 3 patients (11.5%). Two were treated by CO2 laser microsurgery again, while the other one was treated by total laryngectomy. Conclusions   TLM is a good technique to treat the early-stage glottic cancer because of its minimal invasion, few complications and good voice preservation.

    Juvenile adenoidectomy and secretory otitis
    JU Hongshuang, MA Mingzhong, WU Haiying, YI Jiliang
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2010, 24(3):  27. 
    Abstract ( 1610 )   PDF (318KB) ( 1383 )   Save
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    Objective  To evaluate the relationships between the adenoidectomy and secretory otitis media in children.  Methods  A total of 206 children who underwent the surgical treatment of adenoidal hypertrophy were enrolled for retrospective analysis. The functional diagrams of tympanum were evaluated before and after adenoidectomy.  Results  The majority cases who suffered from secretory otitis media had be treated  effectively, with 103 ears cured and 19 ears improved. Recurrence or no significant improvement occured in 14 ears, 12 cases suffered from recurred chronic otitis media for more than 2 years.  Conclusion  Recovery of secretory otitis media in children is closely related with the severity and duration of adenoidal hypertrophy. Adenoidectomy is effective to the recovery of eustachian tube′s function.

    Clinical analysis of  particular congenital preauricular fistula of 3 cases
    HONG Yanli, LI Zhaosheng, FANG Mingda
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2010, 24(3):  29-31. 
    Abstract ( 1466 )   PDF (331KB) ( 1537 )   Save
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    Objective  To improve the diagnosis and treatment of particular congenital preauricular fistula. Methods  A retrospective analysis was made on the clinical data of 3 cases. Results   One case, combined with cholesteatoma of middle ear, was resected  surgically at the same time; one case of hidden orificium fistulae was completely removed;One case in which the fistula arose from the foot of the helix to the deep external auditory canal and the surface of mastoid process, was completely removed by dual-incision operation. Conclusion  Preoperative CT scanning of temporal bone is required for congenital preauricular fistula accompanied with hearing loss. Recurrence depends on whether the fistula, infected auricular cartilage, granulation and scar tissue are thoroughly removed during the operation.

    Detection of EOS in nasal section of the early stage in patients with allergic rhinitis treated with sublingual specific immunotherapy
    MENG Qinghua, XIE Jinghua, SU Fang, WANG Lei
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2010, 24(3):  36-39. 
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    Objective  To explore the relationship in early stage between EOS in the nasal section and clinic syndromes in patients with allergic rhinitis treated with sublingual specific immunotherapy. Methods  43 patients with allergic rhinitis treated with sublingual specific immunotherapy were enrolled in this study. EOS account in the nasal sections was carried out before the treatment and 2,4 and 8 weeks after the treatment. Result  After 4 and 8 weeks, expression of EOS in the nasal section in all cases and in cases with alleviation of clinic syndromes was statistically decreased(P<0.05). Conclusion  The local immune status of nasal mucosa has been changed after 4 week sublingual immunotherapy in patients with allergic rhinitis.

    Endoscopic replacement in nasal bone fracture and nasal septum fracture
    SUN Haimin, WANG Yan, YANG Zhun, XUE Weiguo
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2010, 24(3):  40-41. 
    Abstract ( 1971 )   PDF (295KB) ( 1487 )   Save
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    Objective  To explore the feasibility and necessity of endoscopic replacement in nasal bone fracture and nasal septum fracture and to explore matters need attention. Method  32 patients received the surgery. Results  30 patients received once surgery and 2 two times. All got satisfied results without complications. Conclusion  Endoscopic replacement in nasal bone fracture and nasal septum fracture is feasible.

    Modified septectory under nasal endoscopy
    ZHENG Haizhou, ZHANG Jiangyun
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2010, 24(3):  42-43. 
    Abstract ( 1434 )   PDF (293KB) ( 1201 )   Save
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    Objective  To explore the method and effect of modified septectory by nasal endoscopy.  Methods  56 cases of septal deviation were performed modified septectory.A mucosal incision was made in front of the left septal wall under nasal endscopy, then the left mucoperichondrium was diverged. Junction between the septal cartilage and the bone was diverged, and the samLl cartilage batten was dissected. The deviation part of the bone was removed and of the cartilage was corrected by scoring or removing the small batten. Result  Followed up for 6 months, the clinical symptoms of the 56 cases disappeared, and no obvious complications were found.  Conclusion  Modified septectory by nasal endoscopy has a good effect and less injury in treatment of nasal septal deviation.

    Sub-mucoperiosteous partial resection in combination with fractured-bone removemont for choronic hypertrophioc rhinitis
    GUO Tao, SUN Jingwu, HU Yanming, WANG Yinfeng
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2010, 24(3):  44-46. 
    Abstract ( 2000 )   PDF (435KB) ( 1441 )   Save
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    Objective  To evaluate the effect of sub-mucoperiosteous partial resection(SPR) in combination with fractured-bone removement in treatment of chronic hypertrophioc rhinitis (CHR) by nasal endoscopy. Methods  Seventy-two patients with CHR received SPR plus fractured-bone removement. Position of the nosepiece,  condition of rhinocleisis and wound were recorded after the surgery. Results  62 patients were followed up post-operatively for 6 months, of who 52 patients were healed and 10 patients had improvements. Effect rate of 48 patients followed up  postoperatively for 1 year was 94%. There was no intraoperative complication. All the patients showed no severe synechia,  persistent crusting,  drying flu at nasal mucosa, or inferior turbinate mucosa atrophy. Conclusion  The transnasal endoscopic SPR in combinatin with fractured-bone removement is good for CHR with hyperplasia of the inferior turbinate bone, and it avoid the inferior turbinate mucosa damage, restore the function of cilia as well.

    Adenoidectomy under endoscopy through the nose in 78 cases
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2010, 24(3):  47-49. 
    Abstract ( 993 )   PDF (380KB) ( 973 )   Save
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    Objective  To assess the technical points and therapeutic effects of adenoidectomy via a transnasal endoscopic approach. Methods  A total of 78 children aging from 2 to 13 years were diagnosed as having adenoidal hypertrophy, of which 71 cases were complainted with snoring, breath holding and mouth breathing, 5 had nasal congestion and runny nose and 2 had hearing loss in long-term. All the children received adenoidectomy directed by an endoscopic approach via transoral under general anesthesia. Results  The average time in surgery was 28 minutes, the average bleeding during surgery was 10 ml, but there were no primary and secondary bleeding or tubal damage. During a one-year follow-up, there was significant improvement in all the symptoms and no nasal adhesion and recurrence happened. Conclusion  Adenoidectomy directed by an endoscopic approach via transoral in combination with integrated power systems would be effective to get a clear operative field, accurate removement and complete hemostasis.

    Nasal endoscopy in difficult microlaryngeal surgery
    LI Chuangwei, LIN Xinsheng, WANG Shuangle
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2010, 24(3):  50. 
    Abstract ( 1603 )   PDF (425KB) ( 866 )   Save
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    Objective  To investigate the clinical value of nasal endoscopy in micro-laryngeal surgery and to compare the excellence and disadvantage between nasal endoscopy and microscopy in micro-laryngeal surgery.  Method  From January 2004 to December 2009, 28 patients with laryngeal diseases were treated by nasal endoscopy and self-retaining laryngoscopy. Result  All lesions were removed by the first surgery and no intraoperative complications occurred. Conclusion  The methods is simple,safe,and easy to manipulate in treating benign laryngeal diseases.

    A case study of relapsing polychondritis with the involvement of respiratory tract
    LIU Jingbo, HUANG Jianmin, LIU Jianzhi
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2010, 24(3):  54-56. 
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    Objective  To investigate the clinical characteristics of relapsing polychondritis(RP) with the involvement of respiratory tract. Methods  The clinical features, tests and treatment of RP with airway involvement in 3 patients were retrospectively reviewed. Results  Three RP cases of typical symptoms were confirmed by biopsy. CT scan with 3D reconstruction and bronchoscopy revealed the range and severity of the lesion. After initial medications, such as corticosteroids and immunosuppressive drugs, the symptoms in all cases alleviated significantly for a while but tended to recur and deteriorate later. During the follow-up, one recurrent case adopted laryngotracheal reconstruction in which pedicled surgical flaps was applied and a long-term stable condition persisted. Meanwhile, 2 cases died in the second and fifth year respectively after the diagnosis. Conclusion  RP with airway involvement is a rare disease affecting multiple systems in the body. The diagnosis is made on the clinical features, imaging studies and pathological examination. Early treatment with corticosteroids and immunosuppressive agents might achieve a relatively satisfying result at the beginning. However, in the later stage, invasive approaches, including tracheotomy, laryngotracheal reconstruction, should be applied for a better prognosis.

    Hemorrhage after tracheotomy in 14 cases
    XIAO Erbin
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2010, 24(3):  57-58. 
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    Objective  To analyze the causes of incision hemorrhage after tracheotomy and to propose the treatment. Methods  14 cases had incision hemorrhage after tracheotomy. Some cases were treated by local packing with Vaseline gauzes when no blood entered trachea and all the bleedings  were contained. 2 days later, Vaseline gauzes were removed without rehemorrhage. For the patients in whom packing was not effective, we probed the incisions to ligate or cauterize the hemorrhagic spots. Then, we sutured the skin incisions to monitor the progress. Results  After tracheotomy, the causes and time points of hemorrhage varied, most cases had a fat and short neck.  Lots of hemorrhage was due to the injures to thyroid gland.  Conclusions  The causes and time points of hemorrhage are various.Serious consequences may occur. Therefore, we should treat it timingly and actively.

    Four surgical treatments of pterygium on 168 eyes
    WANG Yuxia, XIAO Ying, SUN Hongyi, GAO Xue, LIU Jing, CHEN Guoling, YANG Lixia
    JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY). 2010, 24(3):  64-66. 
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    Objectiv  eTo compare the therapeutic effects of simple pterygium excision,  pterygium excision combined with mitomycin C, limbus corneae stem cell transplantation, or amniotic membrane transportation on pterygium.  Methods  168 eyes of 158 patients were divided into four groups, i.e.  groups A,B, C and D, in terms of  applied treatments.41 eyes (group A),42 eyes (group B), 44 eyes (group C)  and 41 eyes ( group D) were treated with simple pterygium excision, pterygium excision combined with mitomycin C, limbus corneae stem cell transplantation, or  amniotic membrane transportation,  respectively.The patients were followed up from 6 months to one year.Results  The recurrence rates of pterygium in groups A,B, C and D were 17.1%,9.5%, 4.5% and 4.9%,respectively.The difference between group A and the other three groups(B,C and D)was statistically significant (P<0.05),whereas there was no statistical significance between group B & C ,group  B & D and group C & D. Group C had fewer complications than the other three groups. Conclusion  Pterygium excision combined with limbus corneae stem cell transplantation is the preferable methods while it demonstrates better costeffectiveness, lowere recurrence rate, shorter corneal epithelial healing time and fewer complications.