A review of the management and prognosis of thyroid carcinoma with tracheal invasion.

The objective of the study was to explore the surgical approaches, treatment significance and prognosis of thyroid carcinoma with tracheal invasion. We retrospectively reviewed 48 patients with tracheal invasion by papillary thyroid carcinoma, follicular thyroid carcinoma and medullary thyroid carcinoma by means of clinical data ranging from 1993 to 2011. The patients were classified into three groups in terms of the depth and extent of tracheal invasion by the tumors, i.e., group A of 18 patients with localized tracheal invasion; group B of 21 patients with intraluminal tracheal invasion, and group C of nine patients with extensive invasion of the trachea, larynx, esophagus and/or mediastinum. Of these patients, 18 received radical tumorectomy and segmental resection of the outer layer of the tracheal wall; 21 had radical tumorectomy, circumferential sleeve trachea resection or segmental tracheal resection plus tracheal repair, and the remaining nine patients underwent radical tumorectomy, segmental trachea resection and esophagolaryngectomy. 46 patients took I(131) oral solution and/or had external radiotherapy postoperatively. A survival analysis was done using Kaplan-Meier Estimator for cumulative survival probability together with Log-Rank test, and Cox Regression Model was used for multivariate analysis. (1) In group A of 18 patients, 10 took I(131)oral solution and 7 received radiotherapy after surgery. The overall 5 and 10-year survival rates were 88.93 and 77.78 %, respectively; (2) In group B of 21 patients, 15 took I(131) oral solution and 7 received radiotherapy after surgery. The overall 5 and 10-year survival rates were 90.47 and 61.87 %, respectively; (3) In group C of 9 patients, 7 received radiotherapy after surgery. The overall 5 and 10-year survival rates were 77.78 and 22.22 %, respectively. Whether they received postsurgical I(131) treatment or radiotherapy, there was a statistical difference between the 5-year survival rates and the 10-year survival rates in all of these three groups (P value in each group is <0.05). In the treatment of thyroid carcinoma with tracheal invasion, radical tumorectomy plus tracheal repair, segmental tracheal resection or circumferential sleeve trachea resection could lengthen the survival time. Radical tumorectomy could enhance the probability of survival of patients with thyroid carcinoma that had extensively invaded the larynx, esophagus and/or mediastinum. Postsurgical I(131) treatment and radiotherapy enhanced the probability of survival.

Clinical manifestation and management of primary malignant tumors of the cervical trachea.

To explore clinical manifestation and therapies of primary malignant tumors of the cervical trachea, we retrospectively reviewed 31 patients with primary cervical tracheal malignant tumors diagnosed in the last 15 years by means of clinical manifestation, fiberoptic endoscopy, CT scanning and histopathological examinations. All of them were hospitalized and treated at the Second Xiangya Hospital, Central South University. Of them, 4 underwent emergent tracheotomy under local anesthesia, 9 were inserted with a laryngeal mask airway, 18 underwent tumorectomy under general anesthesia with endotracheal intubation, and of them 11 had tracheotomy during surgery. Of those 31 patients, tracheal malignant tumors in 9 cases were resected via laryngeal and retrograde tracheal incisions under endoscope; the tumors in 13 cases were excised via sleeve trachea resection and end-to-end anastomosis; those in 8 were removed by tracheofissure, and the tumor in 1 case was not excised surgically. Among the 30 resected patients, 20 patients received both radiotherapy and chemotherapy; 6 received radiotherapy only, and 4 did not receive any adjuvant therapies. During follow-up between 2 and 11 years, among 31 patients, there was no recurrence in 24 cases. Among the 7 deceased patients, 1 displayed multiple tracheal chondrosarcoma, 4 displayed adenoid cystic carcinoma, and 2 displayed squamous cell carcinoma. Emergency lower tracheotomy is necessary only when patients with tracheal, malignant tumors are in a critical condition. Sleeve trachea resection is the optimal therapy for tracheal malignant tumors. However, in the treatment of tracheal malignant tumors adjacent to the larynx or the involved trachea is over 6 cm in length, other surgeries shall be performed. Postoperative adjuvant radiotherapy and chemotherapy can achieve the same therapeutic effect as sleeve trachea resection.

Effect of cold stress on photosynthetic physiological characteristics and molecular mechanism analysis in cold-resistant cotton (ZM36) seedlings.

Low temperature and cold damage seriously hinder the growth, development, and morphogenesis of cotton seedlings. However, the response mechanism of cotton seedlings under cold stress still lacks research. In this study, transcriptome sequencing, gas exchange parameters, and rapid chlorophyll fluorescence parameters were analyzed in leaves of cold-tolerant upland cotton variety "ZM36" under different temperature stress [25°C (T25, CK), 15°C (T15), 10°C (T10), and 4°C (T4)]. The results showed that the net photosynthetic rate (Pn), stomatal conductance (Gs), transpiration rate (Tr), PSII potential maximum photochemical efficiency (Fv/Fm), and performance index (PIabs) of cotton leaves significantly decreased, and the intercellular CO2 concentration (Ci) and Fo/Fm significantly increased under cold stress. The transcriptome sequencing analysis showed that a total of 13,183 DEGs were involved in the response of cotton seedlings at each temperature point (T25, T15, T10, and T4), mainly involving five metabolic pathways-the phosphatidylinositol signaling system, photosynthesis, photosynthesis antenna protein, carbon fixation in photosynthetic organisms, and carotenoid synthesis. The 1,119 transcription factors were discovered among all the DEGs. These transcription factors involve 59 families, of which 15.8% of genes in the NAC family are upregulated. Through network regulatory analysis, the five candidate genes GhUVR8 (GH_A05G3668), GhPLATZ (GH_A09G2161), GhFAD4-1 (GH_A01G0758), GhNFYA1 (GH_A02G1336), and GhFAD4-2 (GH_D01G0766) were identified in response to cold stress. Furthermore, suppressing the expression level of GhPLATZ by virus-induced gene silencing led to the reduction of low temperature resistance, implying GhPLATZ as a positive regulator of low temperature tolerance. The findings of the study revealed a piece of the complex response mechanism of the cold-tolerant variety "ZM36" to different cold stresses and excavated key candidate genes for low temperature response, which provided support for accelerating the selection and breeding of cotton varieties with low temperature tolerance.

International Recommendations on Postoperative Management for Potentially Resectable Locally Recurrent Nasopharyngeal Carcinoma.

Locally recurrent nasopharyngeal carcinoma (NPC) presents substantial challenges in clinical management. Although postoperative re-irradiation (re-RT) has been acknowledged as a potential treatment option, standardized guidelines and consensus regarding the use of re-RT in this context are lacking. This article provides a comprehensive review and summary of international recommendations on postoperative management for potentially resectable locally recurrent NPC, with a special focus on postoperative re-RT. A thorough search was conducted to identify relevant studies on postoperative re-RT for locally recurrent NPC. Controversial issues, including resectability criteria, margin assessment, indications for postoperative re-RT, and the optimal dose and method of re-RT, were addressed through a Delphi consensus process. The consensus recommendations emphasize the need for a clearer and broader definition of resectability, highlighting the importance of achieving clear surgical margins, preferably through an en bloc approach with frozen section margin assessment. Furthermore, these guidelines suggest considering re-RT for patients with positive or close margins. Optimal postoperative re-RT doses typically range around 60 Gy, and hyperfractionation has shown promise in reducing toxicity. These guidelines aim to assist clinicians in making evidence-based decisions and improving patient outcomes in the management of potentially resectable locally recurrent NPC. By addressing key areas of controversy and providing recommendations on resectability, margin assessment, and re-RT parameters, these guidelines serve as a valuable resource for clinical experts involved in the treatment of locally recurrent NPC.

Function analysis of GhWRKY53 regulating cotton resistance to verticillium wilt by JA and SA signaling pathways.

WRKY transcription factors (TFs) play an important role in regulating the mechanism of plant self-defense. However, the function of most WRKY TFs in upland cotton (Gossypium hirsutum) is still unknown. Hence, studying the molecular mechanism of WRKY TFs in the resistance of cotton to Verticillium dahliae is of great significance to enhancing cotton disease resistance and improving its fiber quality. In this study, Bioinformatics has been used to characterize the cotton WRKY53 gene family. we analyzed the GhWRKY53 expression patterns in different resistant upland cotton cultivars treated with salicylic acid (SA) and methyl jasmonate (MeJA). Additionally, GhWRKY53 was silenced using a virus-induced gene silencing (VIGS) to determine the contribution of GhWRKY53 to V. dahliae resistance in cotton. The result showed that GhWRKY53 mediated SA and MeJA signal transduction pathways. After VIGS of the GhWRKY53, the ability of cotton to resist V. dahliae decreased, indicating that the GhWRKY53 could be involved in the disease resistance mechanism of cotton. Studies on the levels of SA and jasmonic acid (JA) and their related pathway genes demonstrated that the silencing of GhWRKY53 inhibited the SA pathway and activated the JA pathway, thereby reducing the resistance of plants to V. dahliae. In conclusion, GhWRKY53 could change the tolerance of upland cotton to V. dahliae by regulating the expression of SA and JA pathway-related genes. However, the interaction mechanism between JA and SA signaling pathways in cotton in response to V. dahliae requires further study.

Study of clinical treatment of esophageal foreign body-induced esophageal perforation with lethal complications.

Esophageal foreign body-induced esophageal perforation is a lethal complication and its treatment very complex. We had reviewed 1,428 patients with esophageal foreign body, who were hospitalized and treated over the past 25 years. A classification summary was made of 121 patients (of these 1,428 cases) who presented with esophageal foreign body-induced perforation and complicated cervical abscess, mediastinitis, and mediastinal abscess. This summary considered foreign body types, location and lodging duration, complications, and surgical approaches. Among these 121 patients, esophageal foreign bodies in 81 patients were successfully extracted via esophagoscope or fiber optic esophagoscope. Cervical esophageal foreign bodies in 22 patients were extracted by esophagoscope and lateral cervical incision (n = 6) and simple lateral cervical incision (n = 16). Thoracotomy was performed to remove thoracic esophageal foreign bodies in 18 patients with 10 successes and 8 failures. Of the 121 patients, 67 patients with cervical abscess were cured by means of lateral cervical abscess incision and drainage, esophageal stent placement, and esophageal perforation repair with pedicle myolemma or pedicle muscular periosteum flap. 54 patients with mediastinitis and/or abscess were all cured, except one mortality, by means of mediastinotomy and drainage or/and closed-chest drainage, simple esophageal repair, esophageal repair with pedicle myolemma or pedicle muscular periosteum flap and stent placement for esophageal perforation, and esophageal exclusion plus two-stage gastric-pharyngeal anastomosis. In the treatment of esophageal foreign body-induced severe complications, various therapies should be applied simultaneously. Lateral cervical incision should be made immediately to remove the foreign bodies if the foreign body extraction under esophagoscope proves to be a failure after repeated attempts, or esophageal perforation develops during the procedure, or should cervical abscess develop. Mediastinotomy and drainage or/and closed-chest drainage should be carried out as early as possible when mediastinitis and/or mediastinal abscess develops after esophageal foreign body ingestion.

Systematical Characterization of the Cotton Di19 Gene Family and the Role of GhDi19-3 and GhDi19-4 as Two Negative Regulators in Response to Salt Stress.

Drought-induced 19 (Di19) protein is a Cys2/His2 (C2H2) type zinc-finger protein, which plays a crucial role in plant development and in response to abiotic stress. This study systematically investigated the characteristics of the GhDi19 gene family, including the member number, gene structure, chromosomal distribution, promoter cis-elements, and expression profiles. Transcriptomic analysis indicated that some GhDi19s were up-regulated under heat and salt stress. Particularly, two nuclear localized proteins, GhDi19-3 and GhDi19-4, were identified as being in potential salt stress responsive roles. GhDi19-3 and GhDi19-4 decreased sensitivity under salt stress through virus-induced gene silencing (VIGS), and showed significantly lower levels of H2O2, malondialdehyde (MDA), and peroxidase (POD) as well as significantly increased superoxide dismutase (SOD) activity. This suggested that their abilities were improved to effectively reduce the reactive oxygen species (ROS) damage. Furthermore, certain calcium signaling and abscisic acid (ABA)-responsive gene expression levels showed up- and down-regulation changes in target gene-silenced plants, suggesting that GhDi19-3 and GhDi19-4 were involved in calcium signaling and ABA signaling pathways in response to salt stress. In conclusion, GhDi19-3 and GhDi19-4, two negative transcription factors, were found to be responsive to salt stress through calcium signaling and ABA signaling pathways.

Comparative transcriptome analysis of melon (Cucumis melo L.) reveals candidate genes and pathways involved in powdery mildew resistance.

Powdery mildew is a major disease in melon, primarily caused by Podosphaera xanthii (Px). Some melon varieties were resistant to powdery mildew, while others were susceptible. However, the candidate genes associated with resistance and the mechanism of resistance/susceptibility to powdery mildew in melon remain unclear. In this study, disease-resistant melon cultivar TG-1 and disease-susceptible melon cultivar TG-5 were selected for comparative transcriptome analysis. The results suggested that the numbers of differentially expressed genes (DEGs) in TG-5 was always more than that in TG-1 at each of the four time points after Px infection, indicating that their responses to Px infection may be different and that the active response of TG-5 to Px infection may be earlier than that of TG-1. Transcription factors (TFs) analysis among the DEGs revealed that the bHLH, ERF, and MYB families in TG-1 may play a vital role in the interaction between melon and powdery mildew pathogens. GO enrichment analysis of these DEGs in TG-5 showed that the SBP, HSF, and ERF gene families may play important roles in the early stage of melon development after Px infection. Finally, we speculated on the regulatory pathways of melon powdery mildew and found PTI and ABA signaling genes may be associated with the response to Px infection in melon.

Study on the treatment of traumatic orbital apex syndrome by nasal endoscopic surgery.

Orbital apex syndrome (OAS) is a complex disease caused by a variety of pathological factors, and trauma is one of the main factors/causes. Clinical data of 17 cases of traumatic OAS treated by nasal endoscopic surgery in our department from January 2002 to April 2009 were gathered and reviewed. Among them, the six patients presented with OAS after injury to the lateral wall of orbital apex. Seven other patients exhibited OAS after injury to the medial wall of orbital apex, two displayed OAS after zygomatic trauma, while OAS manifested in the other two patients with craniocerebral trauma 3 days after they had decompressive craniotomy--of them, one was blind in both eyes. In the 17 cases, 6 patients were without light sensation, 1 was blind in both eyes; the sight-chart index of eight patients was 0.1, that of three other patients was 0.1-0.2. Fifteen patients displayed eyeball movement disturbance (disorder) and cornea sensory disturbance (disorder), two were with the eyeball abducent disturbance. After the nasal endoscopic surgeries for OAS performed on the 17, the sight of the most patients was restored in varying degrees. The sight of nine patients was between 0.2 and 0.3, that of two patients was between 0.1 and 0.2, that of the other two patients was 0.1, and that of four patients remained unchanged. The eyeball movement and the cornea esthesia in 15 patients recovered from the surgeries, one patient recovered with good eyeball adducent movement and the cornea esthesia but with eyeball abducent disturbance, the other patient did not make a recovery from the eyeball immobility, cornea anesthesia and ptosis. A follow-up lasting 2 months to 2 years suggested that the 16 patients had stable recovery from the surgeries. Satisfactory results could be achieved in the treatment of traumatic OAS by nasal endoscopic surgery. From objective assessment of the therapeutic effects of traumatic OAS, it can be concluded that if a patient is diagnosed with fractures of the optic canal and the superior and medial walls of orbital apex, nasal endoscopic decompression of superior and medial walls of orbital apex and optic canal via the approach to the sphenoid and ethmoid sinuses is the most ideal operative therapy.

miR-204 suppresses cochlear spiral ganglion neuron survival in vitro by targeting TMPRSS3.

Sensorineural hearing loss (SNHL) is the most common cause of hearing impairment. One of the essential steps to prevent progressive hearing loss is to protect spiral ganglion neurons (SGNs) from ongoing degeneration. MicroRNAs and TMPRSS3 (transmembrane protease, serine 3) have been reported to be involved in development of SGNs and genesis of SNHL. The aim of this study was to investigate the role of miR-204 and TMPRSS3 in SGNs. Effect of miR-204 on cell viability of SGNs was first examined using MTT (3-[4,5-dimethylthiazol-2-yl]-2,5 diphenyl tetrazolium bromide) assay. Expression of TMPRSS3 in SGNs with or without addition of miR-204 was assessed by real-time PCR and western blot further. A luciferase reporter activity assay was conducted to confirm target association between miR-204 and 3'-UTR of TMPRSS3. Finally, role of TMPRSS3 on cell viability of SGNs was evaluated by transfection of TMPRSS3 siRNA. Cell viability of SGNs was suppressed by miR-204 in a concentration-dependent manner. Overexpression of miR-204 reduced expression of TMPRSS3 in SGNs at both mRNA and protein levels. Binding to the 3'-UTR of TMPRSS3 by miR-204 was identified by luciferase assay. Knockdown of TMPRSS3 by siRNA significantly inhibits cell viability of SGNs. miR-204 could be a potential therapeutic target in sensorineural hearing loss.

[Treatment of esophageal perforation complicated with lethal massive hemorrhage induced by foreign body].

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.

[Management and prognosis of differentiated thyroid carcinoma with tracheal invasion].

OBJECTIVE: To evaluate treatment modalities and prognosis differentiated thyroid carcinoma (DTC) with tracheal invasion. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

[One case report of carotid body tumor resected with hemorrhage and artery repair].

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.

Exploration of endonasal endoscopic repair of pediatric cerebrospinal fluid rhinorrhea.

OBJECTIVES: To summarize the clinical manifestations of pediatric cerebrospinal fluid rhinorrhea (CSFR), discuss the localization of CSFR, and the surgical approaches, the graft material selection and the prognoses of endoscopic repair of CSFR. METHODS: The case data, surgical techniques and graft materials of endonasal endoscopic approach of 43 patients with CSFR who have been treated at the Second Xiangya Hospital, Central South University in the last 13 years were retrospectively analyzed. Among them, leaks in 34 cases were from the roof of the ethmoid sinuses. Other sites included frontal sinus (1), sphenoid sinus (6), and the conjunction of ethmoid and frontal sinuses (2). 37 patients were with unilateral CSF leaks, 6 were with bilateral CSF leaks. The dimensions of the defects ranged between 8 and 22mm. For 25 cases, the procedure was as follows: first, the wound surrounding the perimeter of the defect was freshened and the leaks were plugged by myoplasm and overlaid with iliac fascia, and followed by the use of fibrin glue and nasal packing; for 5 cases, the procedure was as follows: at first, the wound was curetted and the leaks were intracranially plugged by autologous cartilage and muscle, overlaid with iliac fascia, followed by the use of fibrin glue and nasal packing; for 6 cases, the leaks were overlaid with iliac fascia only, and then fibrin and packing were used. For the rest of 7 cases, the frontal and sphenoid sinuses were filled with muscle. RESULTS: Of the total 43 cases, 31 had successful closure of the leaks by endonasal endoscopic repair on first attempt; 8 had successful closure of the leaks on second attempt, 3 was cured on third attempt; while, leaks in 2 patients failed to close after three attempts. Therefore, they underwent combined intracranial and transnasal endoscopic repair, one patient was cured and another one died postoperatively because of recurrent intracranial infection. At 12 month to 24 month follow-up 42 children remained leak free. CONCLUSION: Endoscopic repair of CSF leaks is the optimum approach to the treatment of pediatric CSFR, featuring minor trauma, high successful rate, fewer complications and advantage of being able to carry out a revision surgery or more if needed. For children who have a large CSF leak in size and have failed to be treated successfully via endonasal endoscopic repair, combined intracranial and endoscopic repair could be performed to close the leak.

Endoscopic optic nerve decompression for traumatic optic neuropathy in children.

OBJECTIVES: To discuss the necessity of nasal endoscopic surgery for pediatric traumatic optic neuropathy and its therapeutic effect. METHODS: We retrospectively reviewed the cases of 41 children (involving 43 eyes) with traumatic optic neuropathies who were treated in our department by endoscopic optic nerve decompression and postoperative corticosteroid in large doses from Feb. 2000 to Apr. 2010. A 6-month follow-up study was performed for each patient in order to observe the postoperative eyesight recovery and analyze the therapeutic effect. RESULTS: The eyesight of 11 patients out of 41 patients reached 0.2-0.3 postoperatively, the eyesight of 16 patients recovered from counting fingers to 0.1 after the surgery, the eyesight of 6 patients ranged from light sensation to seeing the hand movement, the eyesight of 7 children did not recover from the operation. The prognosis in the children who underwent the decompression 7 days post-traumatically was much worse than other children. CONCLUSIONS: The age of the patients was not the main element influencing the decision-making process for the operation. The main elements affecting the prognosis were the degree of injury and the time interval between the trauma and the time when patients underwent the surgery. The operation opportunity and plan are very important to a successful operation.

[Clinical diagnosis and treatment of nasal sinus mucoceles with visual loss].

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].

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 study on the treatment of juvenile recurrent laryngeal papilloma].

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.

Treatment of 38 cases of foreign body aspiration in children causing life-threatening complications.

OBJECTIVES: The objectives of this study were to discuss the clinical magnifications and therapies of tracheobronchial foreign body aspiration (FBA) in children causing life-threatening complications. METHOD: We retrospectively reviewed 38 cases of FBA with serious complications in children out of 749 cases of FBA in children that had been admitted to and treated in the Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China, from June 1990 to December 2007. The complications included pneumothorax (14 cases); pneumomediastinum (6 cases); pulmonary abscess (7 cases); massive hemorrhage, tracheoesophageal fistula and exudative pleurisy, in 3 cases, respectively; and heart failure (2 cases). Each child's symptoms, including duration, physical findings, chest radiographs, including CT, and the nature of the foreign body causing the complications due to FBA were recorded. RESULTS: Among the 38 cases of FBA, the FBs in 36 cases were removed by bronchoscopy, and in 2 cases the FBs were removed via thoracotomy. Except for 1 case that resulted in death, the other 37 children were completely cured and discharged to home from the hospital. CONCLUSIONS: For children with FBA who experience severe and life-threatening complications from FBA, our recommendation is that emergency measures should be available during FBs removal. With correct judgment and management of the complications of FBA, the mortality rate can be reduced.

[Study on clinical manifestations and treatment of primary cervical tracheal malignant tumor of children].

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.