Application research on RBH perceptual evaluation of voice disorders / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the reliability of RBH perceptual evaluation system, and the correlation between its perceptual and acoustic parameters inorder to providing the evidence for clinic practice.</p><p><b>METHODS</b>The voice samples were collected from 100 patients with variable dysphonia and 15 normal people. According to the R, B, H parameters of the RBH system,voice samples were rated on 4-point scale from 0 to 3. The interrater agreement and intrarater reliability were tested. The differences of the acoustic parameters between adjacent ranks in the perceptual parameters were investigated. The correlation between perceptual parameters and acoustic parameters were also studied.</p><p><b>RESULTS</b>The interrater agreement and intrarater reliability were good. Intrarater reliability was varying from 0.428 to 0.608 using Kappa coefficient; intraclass correlation coefficients for interrater agreement were 0.741-0.797 and 0.689-0.762 in the twice perceptual assessments. The differences of the acoustic parameters between adjacent ranks in the perceptual parameters (R, B, H) were significant (P < 0.05). The perceptual parameters (R, B, H) were significantly correlated with the acoustic parameters (Jitter, Shimmer, HNR, MPT and DSI, with r varying from 0.360 to 0.551 or from -0.472 to -0.620, P < 0.01).</p><p><b>CONCLUSION</b>The reliability of RBH perceptual evaluation system is good; its 4-point scale is acceptable; the perceptual parameters are correlated with the acoustic parameters; the RBH system has broad prospects in clinic practice.</p>

Surgical management and reconstruction of petrous internal carotid artery involved in malignant tumors of lateral skull base / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the feasibility of reconstruction of internal carotid artery after ablation of malignant tumors in lateral skull base.</p><p><b>METHODS</b>Four male patients with malignant tumors in lateral skull base involved internal carotid artery underwent surgical treatment during Jan 2006 to Jan 2009 were retrospectively analyzed. MRI, CT and DSA were performed in all patients and showed that petrous internal carotid arteries (PICAs) were invaded, with luminal narrow. After radical dissection of tumors and the invaded PICAs, saphenous veins were used to reconstruct the PICAs. All cases were applied with postoperative concomitant radiochemotherapy. Three cases underwent total resection of temporal bone and one case underwent sub-total resection of temporal bone. Retrusion of facial nerve was performed in one case and reconstruction of facial nerve in three cases; Resection of sigmoid sinus and jugular foramen was performed in three cases. Resection and repair of meninges were performed in three cases. Free abdominal rectus and latissimus dorsi muscle myocutaneous flaps were used to repair the defect of lateral skull base and the flaps were well survived.</p><p><b>RESULTS</b>No significant neurovascular complications occurred in the patients. Postoperative DSA showed that the reconstructed PICAs were in well conditions. Follow up showed two patients survived tumor-free for five years, one patient had recurrence three years after operation and survived with tumor, and one patient died of recurrence one year after operation.</p><p><b>CONCLUSIONS</b>Reconstruction of PICA by saphenous vein offered the possibility of radical resection of malignant tumors in lateral skull base involved PICAs.</p>

Role of different ligation of the inferior mesenteric artery in sigmoid colon or rectal cancer surgery: a meta-analysis / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the effect of different ligation of the inferior mesenteric artery in sigmoid colon or rectal cancer surgery on 5-year overall survival rate and operative mortality.</p><p><b>METHODS</b>The results of several literatures from different countries on high or low ligation of the inferior mesenteric artery and prognosis were analyzed using meta-analysis.</p><p><b>RESULTS</b>Seven studies were included. The 5-year overall survival rate was compared between low and high ligation. The odd ratio (OR) for 5-year survival was 0.87 (95% CI=0.76-0.98, P=0.02), and the OR for perioperative mortality was 1.28 (95% CI=0.94-1.75, P=0.19).</p><p><b>CONCLUSIONS</b>High ligation of the inferior mesenteric artery may improve 5-year overall survival rate. Perioperative mortality may not be influenced by the level of ligation.</p>

Sternum-hyoid muscle transposition and arytenoid adduction for unilateral vocal cord paralysis / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the therapeutic effect of sternum-hyoid muscle transposition and arytenoid adduction for unilateral vocal cord paralysis (UVCP).</p><p><b>METHODS</b>Included in this study were 19 patients with UVCP lasted for 12 months to 15 years. The surgical technique was as follows. The thyroid cartilage was engaged with a skin hook and gently rotated anteriorly. The lateral-inferior corner of the thyroid cartilage was exposed and the muscular process of the arytenoid was identified. Then, the thyroid lamina on the involved side was parasagittally separated 5 mm off the midline. The inner perichondrium was carefully freed from the overlying thyroid cartilage. The lamina was retracted laterally, and a 3-0 prolene suture was placed through the muscular process and tied to the cricoid cartilage at the origin of the lateral cricoarytenoid muscle. A bipedicled strap muscle flap was then transposed into the space between the lamina and the inner perichondrium. Pre- and postoperative voice evaluations measured mean fundamental frequency, jitter, shimmer, harmonic ratio and maximal phonation time, as well as assessments of voice quality.</p><p><b>RESULTS</b>Vocal improvement was obtained in 100% (19 of 19) of patients. Immediately after the operation, the ingression could be observed in vocal cord membrane and vocal process, vocal cord volume was amplified. There was a significant difference (P < 0.05) in all parameters (fundamental frequency, jitter, shimmer, harmonic ratio and maximal phonation time) between pre- and postoperative voice evaluations measured mean. There was no significant difference (P > 0.05) in voice evaluations measured mean between 2 months and 12 months after operation in all patients. No major complications were noted in any patient.</p><p><b>CONCLUSION</b>Sternum-hyoid muscle transposition and arytenoid adduction for unilateral vocal cord paralysis is simple and convenient, no immune rejection, and the long-term result is stable.</p>

Correlation between myogenin and transforming growth factor-beta1 expression in long-term human denervated posterior cricoarytenoid muscles / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the protein expression of myogenin, a mark of muscle regeneration, and TGF-beta1, an important factor of myelofibrosis, in long-term denervated posterior cricoarytenoid muscles (PCAMs) in order to find the appropriate time point of reinnervation in long-term denervated PCAMs.</p><p><b>METHODS</b>Thirty-eight patients with vocal paralysis were divided into four groups, the 0.5-year denervation group, the 1-year denervation group, the 2-year denervation group and the over 3-year denervation group. Twelve normal adults served as a control group. The change in expression of related factors such as myogenin and TGF-beta1 were observed using immunofluorescence stain and Western blot.</p><p><b>RESULTS</b>Immunostaining with antibody against myogenin showed no staining in innervated, however, by 0.5-year of muscle denervation, there was a significant accumulation of myogenin protein in myonuclei. There was a peak in expression of myogenin in 1-year denervated muscles. After 2 years of denervation, expression of myogenin protein in myonuclei was decreased, but after 3 years of denervation, no expression of myogenin protein in myonuclei was found. TGF-beta1 showed no staining in innervated, however, by 0.5-year and 1-year of muscle denervation there was a significant accumulation of TGF-beta1 protein in endochylema of myofiber, After 2 years of denervation, expression of TGF-beta1 protein in endochylema of myofiber was decreased, but after 3 years of denervation, no expression of TGF-beta1 protein in endochylema could be found. In Western blot, the change in protein expression of myogenin was observed 7.12-fold (F = 332.205, P < 0.001) increase from 0.5-year denervated muscles to innervated muscles, 15.58-fold (P < 0.001) increase from 1-year denervated muscles to innervated muscles, 6.50-fold (P < 0.001) increase from 2-years denervated muscles to innervated muscles (P < 0.001). After 3 years, the protein expression of myogenin decreased, 1.12-fold to innervated muscles. The change in protein expression of TGF-beta1 was observed 4.80-fold (F = 106.192, P < 0.001) increase from 0.5-year denervated muscles to innervated muscles, 10.59-fold (P < 0.001) increase from 1-year denervated muscles to innervated muscles, 6.01-fold (P < 0.001) increase from 2-years denervated muscles to innervated muscles(P < 0.001). After 3 years, the protein expression of TGF-beta1 decreased 1.20-fold to innervated muscles. There was significant positive correlation between expression of myogenin and TGF-beta1 in long-term denervated PCAMs.</p><p><b>CONCLUSIONS</b>The change in expression of myogenin and TGF-beta1 indicated that there was a good muscles regeneration and a high amplitude of myelofibrosis within 2 years.</p>

Combination of genioglossus advancement by non-trephine technic with uvulopalatopharyngoplasty for treatment of obstructive sleep apnea-hypopnea syndrome / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy and reliability of genioglossus advancement and hyoid suspension with non-trephine technic (GAHM) and uvulopalatopharyngoplasty (UPPP) for surgical obstructive sleep apnea-hypopnea syndrome treatment.</p><p><b>METHODS</b>Twenty-six patients (4 female and 22 male) were classified as moderate and severe cases in terms of apnea hypopnea index (AHI) and Friedman classification in the present study. All cases patients underwent genioglossus advancement and hyoid suspension with non-trephine technic Uvulopalatopharyngoplasty UPPP. Pre- and postoperative polysomnography and Epworth sleepiness scale were performed to assess the therapeutic outcomes.</p><p><b>RESULTS</b>The whole operation time ranged from 120-180 minutes. The average amount of bleeding in genioglossus advancement was about 50-100 ml. There were no severe complications during and after the operation. All the cases were followed up to one year. After surgery, AHI was decreased in both group cases, (42.9 +/- 6.6 vs 16.2 +/- 5.7) in the severe group, and 21.3 +/- 4.4 vs 11.3 +/- 5.2 (x(-) +/- s) in the moderate group. With success defined as AHI decreased by more than 50 per cent after surgery, the total success rate in moderate and severe group was 83.3% and 91.7%, respectively (P < 0.01). Furthermore, the success rate of the moderate group was higher than those of the severe group (P < 0.01).</p><p><b>CONCLUSION</b>GAHM combined with UPPP may be beneficial for the moderate and severe OSAHS patients with oropharyngeal and hypopharyngeal obstruction.</p>

Display of different injuries of recurrent laryngeal nerve in laryngeal electromyography / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To study the display of different types injuries of recurrent laryngeal nerve (RLN) in laryngeal electromyography (LEMG).</p><p><b>METHODS</b>LEMGs of one hundred and forty-seven patients (147 sides) with traumatic unilateral vocal cord paralysis (UVCP) were studied. After LEMGs, the RLNs exploration operations were performed. The condition of RLNs injury and laryngeal muscles was observed and recorded during the operation.</p><p><b>RESULTS</b>The severe injuries of RLNs were found during operation. The types of injuries were listed as ligation (58 cases), adhesion (28 cases) and cut (61 cases). The waveform morphology of LEMG was recorded less in the patients with the RLNs cut than that in the patients with the RLN ligation or adhesion, respectively. 75.4% RLNs cut showed spontaneous waveform while 96.4% RLNs adhesion and 94.8% RLNs ligation. When the RLN was cut off, single pattern was showed oftener. When the RLN was adhered or ligated, mixed pattern was showed oftener. 92.9% RLN adhesion showed misdirect-regeneration-potentials while 70.7% RLN ligation and 24.6% RLN cut. There were significant difference between two types, but the compound muscular active potential (CMAP) amplitude wasn't significantly different. Evoked amplitude could be recorded in 91.4% patients with ligation and its amplitude was (23.6 +/- 8.1)%, in 85.7% patients with adhesion and its amplitude (16.3 +/- 5.2)%, in 29.5% patients with cut and its amplitude (2.6 +/- 4.2)%.</p><p><b>CONCLUSIONS</b>The display of different injuries of RLN in LEMG presents significant difference. If RLN was cut off, the CMAP might be recorded in most cases. The clinical injury of RLN often is followed by sub-clinic reinnervation.</p>