Case report: Quadruple primary malignant neoplasms including esophageal, ureteral, and lung in an elderly male.

Multiple primary malignant neoplasms (MPMNs) are defined as multiple tumors with different pathogenic origins. MPMNs are rare, but the morbidity rate is on the rise. With the development of anti-tumor treatments, such as targeted therapy and immunotherapy, the overall survival of cancer patients has been significantly prolonged, leading to an increased number of patients with MPMNs. A crucial aspect of MPMNs management is deciding how to schedule further treatments according to individual tumor risk. This process involves a multidisciplinary physician team to ensure favorable outcomes. Herein we report a 60-year-old male who developed four different malignancies, including esophageal squamous cell carcinoma, upper urinary tract urothelial carcinoma, mediastinal small cell lung cancer, and left lung squamous cell carcinoma over 20 years and received appropriate treatment of each cancer with long survival.

[Application of combined intracapsular and extracapsular hypothermic plasma tonsillectomy in reducing intraoperative and postoperative hemorrhage in children with OSA].

Objective:The aim of this study is to explore the application and advantages of combined intrathecal and extrathecal hypothermic plasma tonsillectomy in reducing intraoperative and postoperative hemorrhage in OSA children. Method:We retrospectively reviewed 726 cases who were diagnosed as OSA. All patients were divided into two groups according to the surgical method: 320 cases by total tonsillectomy and 406 cases by combined extracapsular and intracapsular tonsillectomy. The intro operative bleeding volume, post operative haemorrhage data as time, location and degree in the two groups were compared. Result:There was no statistical difference in the intro operative bleeding volume in the two groups [（9.3±4.6） mL]vs [（7.6±3.5） mL], t=12.687, P=0.235. Two patients who underwent combined extracapsular and intracapsular tonsillectomy presented with post operative haemorrhage, the total post operative haemorrhage rate was significantly decreased that in the total tonsillectomy group（14 cases）（χ²=10.779, P=0.001）. The 2 patients in combined extracapsular and intracapsular tonsillectomy group were secondary haemorrhage, with location in the upper pole and medium, grade A haemorrhage; while in the 14 cases in in the total tonsillectomy group, there were 2 cases presented with primary haemorrhage and 12 cases with secondary haemorrhage; with regard to location of haemorrhage, 1 in the upper pole, 2 in the medium, 11 in the lower pole; 5 cases presented with grade A haemorrhage, 8 with grade B haemorrhage and 1 with grade C haemorrhage. The haemorrhage rate at 7 days after surgery （χ²=5.697, P=0.017）, at the lower pole（χ²=11.961, P=0.001） and grade B（χ²=8.097, P=0.004） were all significantly decreases in the combined extracapsular and intracapsular tonsillectomy group. Conclusion:Plasma tonsillectomy combined with intrathecal and extrathecal hypothermic tonsillectomy is a safe and effective method, which has obvious advantages in reducing the postoperative hemorrhage, especially the secondary hemorrhage of Subtonsillar Pole.

Local therapy combined with chemotherapy versus chemotherapy for postoperative oligometastatic non-small-cell lung cancer.

Aim: To compare the efficacy and toxicity of local therapy plus chemotherapy versus chemotherapy in non-small-cell lung cancer (NSCLC) patients with oligometastases after surgery. Patients & methods: A total of 152 patients with oligometastases after surgery were enrolled. Data of patient survival, treatment response and toxicities were compared between the groups receiving local ablative therapy plus chemotherapy and chemotherapy alone. Results: Compared with chemotherapy, the combination treatment conferred better progression-free survival, objective response rate and disease control rate (10 vs 7 months; 66.7 vs 31.9%; 94.3 vs 80.9%, respectively), but with more grade ≥3 adverse events. Besides, the overall survival was not significantly different (19 vs 20 months). Conclusion: The addition of local therapy to chemotherapy improved progression-free survival, objective response rate and disease control rate, but not overall survival in postoperative oligometastatic non-small-cell lung cancer.

Local ablative therapy with or without chemotherapy for non-small-cell lung cancer patients with postoperative oligometastases.

BACKGROUND: The optimal treatment strategy for patients with non-small-cell lung cancer (NSCLC) with postoperative oligometastases is poorly defined. This two-institution analysis sought to retrospectively compare the efficacy and toxicity of local ablative treatment plus chemotherapy vs local treatment alone in patients with NSCLC who developed oligometastases after surgery. PATIENTS AND METHODS: Among patients who underwent surgery for stage I-III NSCLC, 163 patients with oligometastases were enrolled between 2005 and 2016 in this study. All patients had ≤5 metachronous metastases with a disease-free interval (DFI) of ≥6 months after surgery. Patients with a second primary cancer, local recurrence, or driver mutations were excluded. Overall survival (OS), progression-free survival (PFS), objective response rate (ORR), failure patterns, and treatment-related toxicities were compared between groups receiving local ablative treatment plus chemotherapy and local treatment alone. RESULTS: A total of 105 patients who underwent local ablative therapy combined with chemotherapy and 58 patients who received local ablative therapy alone were included in this study. The median follow-up was 19 (range, 1.5-107) months. The combination therapy group had a higher ORR than the local therapy alone group (66.7% vs 46.5%, P=0.012), while the median PFS was 10 vs 7 months (P=0.006) and the median OS was 19 vs 18.5 months (P=0.498), respectively. By multivariate analysis, combination therapy and DFI ≥24 months were associated with superior PFS. Age was the only independent prognostic factor for OS (P<0.001). The incidences of grade ≥3 adverse events were higher in the combination treatment group. CONCLUSION: Local ablative therapy plus chemotherapy conferred higher ORR and prolonged PFS but did not improve OS in NSCLC patients with postoperative oligometastases. Further prospective and randomized trials are urgently needed to validate these findings.

[Cervical esophagostomy improves the life quality of patients with dysphagia induced by radiotherapy for nasopharyngeal carcinoma].

OBJECTIVE: To evaluate the effect of cervical esophagostomy for the treatment of patients with dysphagia induced by radiotherapy, in order to improve the therapeutic effects. METHODS: A retrospective study was performed on 53 nasopharyngeal carcinoma (NPC) patients with dysphagia, who received cervical esophagostomy. The nutritional status of these patients was measured at five given time before and after operation. The occurrence of pneumonia and reflux esophagitis before and after operation was recorded, and the quality of life based on SF-36 quality of life (QOL) scale was studied. RESULTS: After operation, the nutritional status of these patients improved substantially, including the weight, levels of hemoglobin, total protein, albumin and transferring (P<0.05). The pneumonia-infection decreased from 60.38% (32/53) before operation to 15.22% (7/46) after operation (χ(2)=21.04, P<0.01). The incidences of reflux esophagitis decreased from 26.42% (14/53)without operation to 6.52% (3/46) after operation (χ(2)=5.00, P<0.01). Meanwhile, the status of physical health, mental health as well as physical function and social function of these patients were improved significantly at 1 month, 6 months, 1 year and 2 years after operation (P<0.05). CONCLUSION: Cervical esophagostomy can improve the life quality of patients with dysphagia induced by radiotherapy for nasopharyngeal carcinoma.

[Treatment for benign thyroid nodules with hoarseness as primary symptom].

OBJECTIVE: To investigate the effect of operation on Benign thyroid nodules with hoarseness as primary symptom. METHOD: Twelve patients were underwent the operation of subtotal thyroidectomy and exposing of recurrent laryngeal nerve. We evaluating the effect by fibrolaryngoscope and voice acoustic analysis before and after operation. RESULT: All the 12 patients underwent surgery successfully. The hoarseness improved obviously and vocal cords were reactivate. Jitter, shimmer and dysphonia severity index showed significant difference pre and one month after surgery. CONCLUSION: Benign thyroid nodules could also cause vocal cord paralysis and hoarseness, the effect can be satisfying by subtotal thyroidectomy and exposing of recurrent laryngeal nerve if it can be early diagnosed.

[Clinical reseach of early laryngocarcinoma treatment by carbon dioxide laser microsurgery].

OBJECTIVE: To define the oncologic efficacy of transoral endoscopic CO2 laser surgery in early glottic carci noma. METHOD: A retrospective study of 112 patients with laryngocarcinoma treated. Surgical treatment included endoscopic CO2 laser cordectomies according to the classification of the European Laryngological Society. After the patients were given the general anesthesia and oral intubation, the tumors in the study group were resected along the margin of the tumor under larynscope, and the safety margin was reserved as 3-5 mm. All the patients were followed-up for 12-62 months. RESULT: Eight relapses were detected in 112 cases of glottic laryngeal carcinoma after CO2 laser surgery. The local recurernce rate was 7.14% (8/112),of the rate for T1a, T1b and T2 were 0.89%, 0.89% and 5.04% respectively, with significant differences among groups (chi2 = 5.306, P < 0.01) . The rate of local recurrence rate of anterior commissure involvement was 7.14% and that was 7.14% when this site was not compromised by the tumor, which has no statistically significant differences (chi2 = 0.000, P > 0.01). CONCLUSION: According to our reaserch, endoscopic CO2 laser sur gery is an effective treatment for early laryngocarcinoma.

Modified endoscope-assisted partial-superficial parotidectomy through a retroauricular incision.

OBJECTIVES: The aim of this study was to evaluate the feasibility of an endoscope-assisted partial parotidectomy through a modified retroauricular incision. PATIENTS AND METHODS: Thirty patients with benign parotid superficial lobe tumors with a diameter of 2.4 ± 0.5 cm, located in the anterior portion of the inferior auricular lobule, underwent an endoscope-assisted partial-superficial parotidectomy. A retrograde approach through a small skin incision was used. An additional 30 patients who underwent conventional surgeries were used as controls. The operation time, operative bleeding volume and subjective satisfaction with the incision scar were compared between the groups. RESULTS: All operations were successfully performed. The endoscopic surgery duration (74.8 ± 15.7 min), bleeding volume (12.7 ± 3.9 ml) and incision length (4.8 ± 0.4 cm) differed between the groups (p = 0.001). The mean patient satisfaction score was 8.6 ± 1.2 in the endoscope-assisted surgery group and 5.4 ± 1.3 in the control group (p = 0.001). There were no tumor recurrences during the 9-36 months of follow-up. CONCLUSION: Endoscope-assisted partial-superficial parotidectomy via a modified retroauricular incision is a feasible method for the treatment of benign parotid superficial lobe tumors located in the anterior portion of the inferior auricular lobule. The main advantage of this procedure was that the small operative scars improved the cosmetic results.

Endoscope-assisted second branchial cleft cyst resection via an incision along skin line on lateral neck.

The aim of the study is to report the feasibility of endoscope-assisted second branchial cleft cyst resection via a small incision along the skin line on the lateral neck. In total, 41 patients from the Department of Otolaryngology, Foshan Hospital of Yat-sen University were randomly assigned to conventional (20 patients) or endoscope-assisted (21 patients) second branchial cleft cyst resection. The patient clinical characteristics, operation time, operative bleeding volume, postoperative complications, and subjective satisfaction with the incision scar (measured using a visual analog scale) were compared between the groups. All 41 s branchial cleft cyst resections were successfully performed, and the wounds healed uneventfully. The bleeding volume (6.3 ± 2.5 ml) and incision length (2.7 ± 0.3 cm) differed between the groups (P < 0.00). The mean patient satisfaction score was 8.0 ± 0.8 in the endoscope-assisted surgery group and 6.4 ± 0.9 in the control group (P < 0.00). All of the patients in the endoscope-assisted surgery group were satisfied with their cosmetic results. No marginal nerve palsy occurred. No complications such as bleeding, salivary fistula, or paresis of the marginal mandibular branch occurred. All of the patients were disease free through a follow-up period of 6-24 months (median: 14 months). Endoscope-assisted second branchial cleft cyst resection via a small incision along the dermatoglyph on the lateral neck is a feasible technique. This procedure may serve as an alternative approach, allowing a minimally invasive incision and better cosmetic results.

[Cervical chronic radiation ulceration reconstruction with flap after radiotherapy for nasopharyngeal carcinoma].

OBJECTIVE: To evaluate the application of flaps or musculocutaneous flaps in repairing cervical postradiation ulcer (cpu) at nasopharyngeal carcinoma. METHOD: Deltopectoral flaps and pectoralis major flaps were applied to repair cervical radiation ulceration with different size and depth in 19 cases. RESULT: Twelve cases repaired with deltopectoral flaps and 7 cases repaired with pectoralis major flaps, impaired wound healing happened at distal end of one deltopectoral flap, and the wound was healing hy second intention after debridement and dressing change. All the other deltopectoral flaps and pectoralis major flaps stayed alive. Flaps stayed alive without the recurrence of ulcer after the long-term follow-up for one to ten years. CONCLUSION: The effectiveness of cervical radiation ulceration reconstruction by deltopectoral flaps and pectoralis major flaps was proved. The reconstruction could prevent the recurrence of ulcer. Refer to the poor prognosis of chronic radiation ulceration with expectant treatment, precautions do count.

[Effect of water conservancy schistosomiasis control projects in rivers and estuaries connecting with the Yangtze River on Oncomelania snail control].

OBJECTIVE: To evaluate the effect of the water conservancy schistosomiasis control projects in rivers and estuaries connecting with the Yangtze River on Oncomelania snail control. METHODS: Three water conservancy schistosomiasis control projects of Laobianmin River, Panjia River and Bianmin River were chosen for the objects of the study. The concrete slope protection and the overflow dam, the concrete slope protection and the check sluice, and the simple concrete slope protection were built respectively in above mentioned three rivers. The changes of the area with snails and density of snails were investigated before and after the interventions, and the results were compared among the three projects. RESULTS: In the condition of the routine snail control with the molluscicide, the snails were eliminated in the main riverway of the Laobianmin River, but the snails still existed in the target protected area (tributaries of the river and irrigation areas); the snails were eliminated in the Panjia River and its irrigation areas; in the Bianmin River, the areas with snails dropped by 89.22% in the main river and still remained in the tributaries and irrigation areas after the project implementation. CONCLUSIONS: The sluice and overflow dam more contribute to control and eliminate snails in the project areas and the target protected areas in the rivers and estuaries connecting with the Yangtze River. The priority of consideration should be given to the water level control and prevention of snail spreading in the water level instability rivers connecting with the Yangtze River.

[Salvage surgical approach for patients with post-radiation local recurrent nasopharyngeal carcinoma].

OBJECTIVE: To evaluate salvage surgical approaches and efficacy for post-radiation local recurrent nasopharyngeal carcinoma (NPC). METHODS: Thirteen patients with post-radiation local recurrent NPC underwent salvage surgical treatment by routes as transpalatal approach, nasal medial swing approach, maxillary swing approach and infratemporal fossa approach. All cases were followed up for 2 to 5 years. Analysis was done on the indications and efficacy of these 4 different approaching routes. RESULTS: No immediate operative complications occurred for all these 13 cases. Four patients with T1 and T2a operated via transpalatal approach and nasal medial swing approach survived more than 3 years. Five patients with T2b and T3 operated via maxillary swing approach. Among them, two patients died at second and 24th month after operation, one survived with tumor and died at 13rd month after operation, two were alive free of tumor for 2 and 4 years after operation. Four patients with T4 operated via infratemporal fossa approach. Among them, three died in 1 year, one was alive free of tumor for 2 years. CONCLUSIONS: Surgical approaches were decided by a comprehensive consideration of recurrent tumor site and invasive range to achieve the best operative site exposure with minimal traumatic damage.

[Modified type I thyroplasty for treating unilateral vocal cord paralysis].

OBJECTIVE: To explore a new surgical approach for treating unilateral vocal cord paralysis. METHODS: Five cases of unilateral vocal cord paralysis due to various causes were treated with modified type I thyroplasty. Laryngostroboscopy and electroglottography were performed before and after the operations. RESULTS: The vocal cords were shifted very close to the median line in all the 5 cases postoperatively as shown by laryngostroboscopy and electroglottography. Complete closure of the glottis was achieved. The patients had almost normal results of electroglottography, and the vocal sound nearly recovered normal or was significantly improved. CONCLUSION: Modified type I thyroplasty is effective, safe and easy in treating unilateral vocal cord paralysis.

[Laryngeal function preservation and voice reconstruction in surgical treatment of hypopharyngeal and cervical esophageal carcinoma].

OBJECTIVE: To evaluate surgical treatment methods for preserving laryngeal function and voice reconstruction for patients with hypopharyngeal and cervical esophageal carcinoma. METHOD: 16 patients with hypopharyngeal and cervical esophageal carcinoma were treated with preserving larynx in 8 cases, partial laryngectomy with laryngeal reconstruction in 3, voice reconstruction by blom-singer technique without laryngeal function preservation in 5. The types of hypopharyngeal and cervical esophageal reconstruction included gastric transpostion, pectoralis major myocutaneous flap, free forearm flap, delto-pectoral skin flap, sternocleidomastoid myocutaneous flap, platysma myocutaneous flap and laryngeal-tracheal flap following carcinoma resection. RESULT: Deglutition restored in all patients except one who died of heat-break in 14th day after the operation. 13 patients rehabilitated speech, total laryngeal function restoration in 6 cases, partial laryngeal function restoration in 2 cases. The overall following-up was from 2 to 5 years. For the 5 cases with blom-singer voice reconstruction, all of them restored speech function. CONCLUSION: To improve life quality, laryngeal function preservation and voice reconstruction should be done for patients with hypopharyngeal and cervical esophageal carcinoma. Surgery methods should be carefully selected according to tumor's site, staging, patient's general condition and age.

[EGG used in laryngeal diseases].

OBJECTIVE: To analyze the EGG of laryngeal diseases and to evaluate the significance of Electroglottgrapihc waveform in the diagnosis of laryngeal diseases. METHOD: The computer multimedia program of Dr. Speech science for Windows was used to obtain the EGG parameters in 120 cases of vocal polyp, 42 cases of vocal nodule, 21 cases of vocal cord paralysis, 42 cases of laryngeal cancer and 38 cases of Reinke's edema. The ECG parameters were analyzed. RESULT: The special abnormal changes in the waves of EGG were related to the formation (type, position and size ) of laryngeal disease. CONCLUSION: The changes of Electroglottgraphic waveform perform a quantitative and objective index to the diagnosis of the laryngeal disease.