Visualisation of the vomerovaginal canal during endonasal transpterygoid approaches and CT imaging diagnosis.

The vomerovaginal canal (VVC) and palatovaginal canal (PVC) are two canals that open forward to the posterior wall of the pterygopalatine fossa (PPF). Although the anatomy and computed tomography (CT) appearances of the PVC have been well studied, the VVC has been rarely reported, especially in endoscopic examinations. Some studies have even failed to distinguish the PVC from the VVC on CT images. The purpose of this study was to demonstrate the anatomy of the VVC on endoscopy and reveal its differences from the PVC, and to analyse the relative positions of the VVC, PVC, and pterygoid canal on CT images. Ten dry skull bases were studied to observe the structures involved in the formation of the VVC. Dissection of four cadaveric heads was performed to demonstrate the anatomy of the VVC on endoscopy. Coronal CT image analysis in 70 patients was conducted to evaluate the distances and relative positions between the VVC, PVC, and pterygoid canal. The PVC and VVC were also compared on axial CT images. The osteological study showed the top wall of the VVC was the antero-inferior wall of the sphenoid sinus. The VVC may be a helpful landmark in endoscopic endonasal transpterygoid approaches. Steps and discrimination in the dissections of the VVC and PVC were described. The interval between the PVC and VVC could be observed on both coronal and axial CT images. The coronal CT images of patients showed differences in the positions and distances among the three canals at both the anterior and posterior apertures of the PVC. The VVC can be easily mistaken for the PVC if its existence is not suspected. The anatomical morphologies and trajectories of the VVC and PVC differed on both nasal endoscopy and CT. The existence of the VVC should be considered during surgery and CT diagnosis within this area.

Combined transoral and endoscopic approach for cervical spine tumor resection.

This study aimed to explore the feasibility and clinical effectiveness of a combined transoral and endoscopic approach for the removal of benign cervical spine tumors.First, we obtained detailed anatomical measurements of the atlantoaxial joint from 20 fresh cadaveric specimens and performed simulated surgeries with the combined transoral and endoscopic approach on 10 cadaveric specimens. Then, we applied the combined approach for the resection of benign cervical spine tumors in 8 patients at our hospital from October 2013 to October 2015. All patients underwent enhanced axial, coronal, and sagittal computed tomography (CT) examination before and after surgery. Preoperative 3-dimensional (3D) reconstruction and printing models were used in 5 cases.On the basis of CT measurements of fresh cadaveric atlantoaxial anatomy and practical experiences from simulated surgeries on the cadaveric specimens with latex perfusion, cervical tumors were completely removed from 8 patients without complications. The average surgery time was 73 minutes, and the average intraoperative bleeding volume was 34 mL. The average hospital stay was 6.5 days. The average NRS score of patients was 2.25 points at 3 days postoperation. At the 12-month postoperative follow-up, the atlantoaxial vertebral bone had been largely repaired, and no recurrence was observed by cervical CT examination.The combined transoral and endoscopic approach could be used safely and effectively to excise cervical spine tumors with substantial advantages, including direct surgical access, relatively simple operation, short operative time, quick postoperative recovery, a reliable curative effect, and few complications.

[Analysis of the causes of immediate bleeding after pediatric adenoidectomy].

OBJECTIVE: To evaluate the incidence of postoperative hemorrhage in children undergoing adenoidectomy, and to discuss its possible causes. METHODS: Included in this study were children who underwent adenoid and/or tonsil surgery at Shenzhen Children's Hospital between January 2004 and November 2009. The change of hemoglobin (Hb) and hematocrit (Hct) were retrospectively analysed. The blood loss was estimated by the change of Hct. RESULTS: There were 2078 cases that accomplished the inclusion criteria in the period of study. Ten children bled 0.5 - 4.0 hours after surgery, without superfluous hemorrhage during the operation and post-tonsillectomy. This represented an incidence of 0.48%of immediate postoperative haemorrhage among the 2078 procedures analyzed. Statistical differences were found between boys (0.21%) and girls (1.10%, χ² = 5.597, P < 0.05). The change of Hb and Hct was positively correlated (r = 0.95, P < 0.01), the blood loss was positively correlated with the bleeding time (r = 0.66, P < 0.05). The causes of postoperative hemorrhage were coagulation system deficits, chronic nasopharyngitis, deficient hemostasis and immoderate ravage. To control the postoperative hemorrhage, 2 postnasal packing under topical anaesthesia and 8 electrocautery under general anaesthesia were applied. CONCLUSIONS: Poor operative technique and deficient hemostasis are the major causes of primary hemorrhage. Prompt operation to control the postoperative bleeding should be done 2 hours after bleeding under general anesthesia in order to avoid severe complications.

Clinical research of intraoperative image-guidance in endoscopic nasocular operation.

AIM: To evaluate the availability and our experience of intraoperative image-guidance in endoscopic nasocular operation. METHODS: Seven cases of endoscopic nasal surgery with intraoperative image-guidance were retropectively reviewed, including 3 cases of optic nerve injury; 3 cases of foreign object of optic behind the eyeball; 1 case of retrobulbar tumor (angeioma). RESULTS: The preoperative preparatory time would take 15 minutes, including coordination, head holder localization, conventional instrument registration. In our cases, the localization accuracy between 3-D image landmarks of navigation system and actual anatomical landmarks was less than 1.3mm. The optic nerve and other anatomical points could be orientated accurately in intraoperative procedures. No complication occurred. CONCLUSION: Nasal endoscope combined with image-guidance systems provides accurate anatomical localization of anterior skull base with enlarged operation field. It is possible for surgeons to observe important anatomical structures during endoscopic surgery. It could increase the effectiveness and decrease surgical complications, especially in complicated cases.

Identification of epidermal growth factor receptor (EGFR) exon 20 single nucleotide polymorphism in Chinese squamous cell carcinoma of head and neck (SCCHN).

CONCLUSION: The 78th single nucleotide polymorphism (SNP) in exon 20 of epidermal growth factor receptor (EGFR) might be a predictor of the clinical course of squamous cell carcinoma of the head and neck (SCCHN), and genetic predisposition could influence the progression of SCCHN in Chinese subjects. OBJECTIVE: To analyze the clinical significance of EGFR SNP in Chinese SCCHN patients. MATERIALS AND METHODS: Direct sequencing of exons 18-21 was used to analyze somatic mutations of EGFR. Reverse transcriptase polymerase chain reaction (RT-PCR) was used to evaluate the expression level of EGFR. The chi-square test and Kaplan-Meier method were the main statistical methods used to analyze the correlation of the investigated variables and prognostic significance. RESULTS: In analyzing exons 18-21 of EGFR in 96 patients with SCCHN, only one SNP was found in the 78th site of exon 20 and it mostly existed in specimens coming from the hypopharynx. Further statistical analysis showed that among the clinical or histopathologic parameters, the 78th SNP had a close relationship with earlier stage and more localized primary carcinoma, while at present the analysis did not support the proposition that the SNP was an independent prognostic factor.

[Expression of growth hormone receptor in hepatocellular carcinoma and its significance].

BACKGROUND & OBJECTIVE: Recombinant human growth hormone (rhGH) has been proved effective in clinic, such as promoting protein synthesis and decreasing the mortality. But there are still many arguments on whether it can be used in hepatocellular carcinoma (HCC) patients. rhGH cannot work except that it combines to its own receptor growth hormone receptor (GHR). The current study was designed to explore the expression of GHR in HCC tissues and to investigate the viability of rhGH for HCC treatment. METHODS: Radioreceptor assays were used to determine growth hormone receptor (GHR) in 40 HCC tissues; 6 normal liver tissues were used as control. Receptor binding capacity(RT) and affinity constant(Kd) of GHR were calculated by Scatchard's method; the relationship between RT of GHR in cancer and clinicopathologic factors were also analyzed. RESULTS: The growth hormone- specific singular binding site, namely GHR, was detected respectively in 35 HCC cases and control tissues. The RT and Kd of GHR were 18.5416+/-4.1686 fmol/mg protein and 0.6319+/-0.1978 nmol/L in tumor tissues, 39.5467+/-3.4770 fmol/mg protein and 0.6167+/-0.1007 nmol/L in control tissues, respectively. Compared with the normal liver tissue, RT of GHR in tumor was lower (P< 0.05) but Kd did not show any difference(P >0.05). The RT of the GHR was negatively relevant to the tumor size and disease stage, but was not associated with differentiation of tumor, ages of the patients or whether the patient suffered from cirrhosis at the same time. GHR was undetectable in 5 cases. CONCLUSION: This study showed that most of the HCC tissues express low levels of GHR. Before their functions are well understood, rhGH should be very carefully used in HCC patients.