Exploration on total parathyroidectomy for secondary hyperparathyroidism / 中华耳鼻咽喉头颈外科杂志

To evaluate the clinical significance of dissection parathyroidectomy for secondary hyperparathyroidism (SHPT) in patients with renal disease on maintenance dialysis. We retrospectively reviewed 195 patients with SHPT treated in the Department of Otolaryngology & Head and Neck Surgery of Beijing Civil Aviation General Hospital between September 2009 and September 2017, including 92 males and 103 females, aged from 23 to 77 years old. There were 167 patients by operated firstly and 28 patients by operated secondly for persistent or recurrent SHPT after operation. All patients received dissection parathyroidectomy with parathyroid autograft in the sternocleidomastoid. The easement of symptoms, the levels of serum intact parathyroid hormone (iPTH), serum-ionized calcium, phosphorus, and hemoglobin were compared before and after operation. Data were analyzed by SPSS 22.0 software. Confirmed by postoperative pathology, a total of 804 hyperplastic parathyroid glands were removed in 195 patients with SHPT. Among them, 765 parathyroid glands were clearly identified and located with naked eye. The anatomic distribution of the glands showed 577 (75.4%) in the tracheoesophageal groove. The incidence of ectopic parathyroid glands was 24.6% (188/765). Other 39 (4.9%) hyperplastic parathyroid glands from 22(11.3%) patients, which were not identified and located with naked eye during operation, were pathologically detected in the dissected tissue specimens. Among 195 patients, 28(14.4%) showed supernumerary parathyroid glands. No serious complications occurred after operation. Within 6 months after the operation, the bone pain and skin itch symptoms were completely relieved and, also, the symptoms of muscle weakness, restless leg, anemia and poor sleep quality were significantly alleviated. Following-up at 6 months after surgery showed the serum levels of iPTH [(70.31±60.12) pg/ml], calium [(2.13±0.22) mmol/L], and phosphorus [(1.17±0.27) mmol/L] decreased significantly respectively compared with the preoperative serum levels of iPTH [(1 501.02±167.26) pg/ml], calium [(2.40±0.32) mmol/L], and phosphorus[(2.27±0.50)mmol/L], all with statistically significant differences (0.01); the levels of hemoglobin [(120.32±10.63) g/L] and hematocrit [(39.20±3.21)%] were higher than the preoperative levels of hemoglobin[(104.11±15.17) g/L] and hematocrit [(31.25±5.12)%], both with statistically significant differences ( valve was 12.22,18,37,respectively, all 0.05). Dissection parathyroidectomy is a beneficial and safe surgical procedure for patients with medically refractory SHPT.

Re-operation treatment in uremic patients complicated with persistent secondary hyperparathyroidism after parathyroidectomy with autotransplantation / 临床耳鼻咽喉头颈外科杂志

To analyze the clinical profile and therapeutic effect of re-operation treatment in uremic patients complicated with persistent secondary hyperparathyroidism(SHPT)after parathyroidectomy with autotransplantation.Twelve persistent SHPT patients who were treated with reoperation of paramyroidectomy(PTX)were enrolled in this study during the period from Jan 2014 to Jul 2017 in our hospital.We evaluated the location of the remaining parathyroid glands by ultrasonography,dual-phase 99 Tcm-sestamibi scintigraphy,CT and MR imaging of the neck before the operation.We resected the parathyroid gland tissue in situ,and the ectopic parathyroid glands hiding in thymus,mediastinal,tracheal esophageal groove,thyroid gland and other locations in the neck.During the surgery,nanocarbon imaging was used to help identify the parathyroid gland and parathyroid hormone assay(IOPTH)was measured at the end of the surgery.We observed the changes of clinical symptoms after the surgery and collected blood parameters including serum intact aramyroidhomone(i-PTH),calcium(Ca),phosphoms(P),calcium and phosphorus product before and after surgery.Complications and failure were also analyzed.All the 12 patients underwented successful operation.The postoperative pathological results were hyperplastic parathyroid glands tissue.22 parathyroid glands were resected,among which 14 were located at the neck in situ,8 were ectopic,i.e.,located at thymus in 4 cases,superior mediastinum in 2 cases and thyroid parenchyma in 2 cases.The clinical symptoms were significantly improved including osteoarthritis,skin itching and limb weakness.The levels of serum iPTH,calcium,phosphorus and calcium and phosphorus product were significantly lower than those before operation(<0.05).Ten patients presented hypocalcemia after surgery and the level of calcium returned to normal after supplement of calcium.Temporary injury of laryngeal nerve was found in4 cases,but there was no patient with transient bucking,dyspnea or death.No recurrence was found during 1 year follow-up.It was very important to locate the residual parathyroid gland accurately with a variety of imaging methods in uremic patients complicated with persistent or recurrent SHPT when they needed re-operation.Surgeons should explorate ectopic parathyroid gland according to the concept of the superior mediastinum dissection and the central compartment neck dissection.Meanwhile,the use of nanocarbon assisted parathyroid gland negative imaging and rapid IOPTH can significantly improve the success rate of surgery and reduce surgical complications.

Primary investigation of central auditory function in patients with temporal lobe epilepsy / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the function of central auditory, Speech-perception-in-noise test (SPIN test) was used to assess that whether temporal lobe epilepsy patients have central auditory processing disorders.</p><p><b>METHODS</b>Four audiological test were performed in 9 patients with temporal lobe epilepsy and 19 age-matched normal hearing persons as controls, which include pure tone audiometry, acoustic immittance measurement, ABR (auditory brainstem response) and SPIN test. All the temporal lobe epilepsy patients were performed by CT or MRI and diagnosed by the neurologists prior to the test. The testing materials of speech and noise in SPIN test was recorded in independent tracks and the S/N was identified by -25 dB by pre-experiment. In the test, every words were read twice and both the results were recorded.</p><p><b>RESULTS</b>In the ABR test, only wave V latency showed longer values in the left ear, other waves like I, III and inter-peak intervals had'nt shown significant statistical differences in both ears of temporal lobe epilepsy patients. However, in the SPIN test, there's no significant statistical differences in both left and right ears of the controls by the first-time hearing (P = 0.107), and the differences showed by the second-time hearing (P = 0.048); but in the comparison of both ears in temporal lobe epilepsy patients, both time of hearing showed no significant statistical differences with P = 0.174 and P = 0.163. In additional, the SPIN recognition score of the temporal lobe epilepsy patients, whether in the fist or second time hearing, whether in the monaural or binaural models, presented significant statistical differences compared to the controls (P = 0.000).</p><p><b>CONCLUSIONS</b>There was no statistically significant difference in pure tone audiometry and ABR test for all the groups. But the speech recognition score obtained from SPIN test of tempol lobe epilepsy patients is lower than the normal persons, which has statistically significant difference. (P < 0.001) Then we can come to the conclusion that Temporal lobe epilepsy patients had central auditory dysfunctions and SPIN test is a sensitive way to assess this abnormal.</p>

Application of flow cytometry in diagnosis of T-cell rich diffuse large B-cell lymphoma / 中华病理学杂志

<p><b>OBJECTIVE</b>To investigate the application of flow cytometry in diagnosis of T-cell rich diffuse large B-cell lymphoma.</p><p><b>METHODS</b>Histopathologic features, immunohistochemical findings and flow cytometry results of three cases of T-cell rich diffuse large B-cell lymphoma were reviewed retrospectively.</p><p><b>RESULTS</b>In CD45-side scatter (SSC) dot plot of the first patient, two different CD45-positive lymphoid cell populations were identified. The bright population consisted of both T and B cells, with a T-cell predominance. The dim population consisted mainly of B cells which showed lambda light chain restriction. In the second patient, CD45-positive cells were subdivided into two groups according to CD45-SSC dot plot. The small population consisted of both T and B cells, with a T-cell predominance. The large population consisted mainly of B cells which showed kappa light chain restriction. In the third patient, CD19-positive cells were subdivided into two groups according to the expression of CD20 in CD19-CD20 dot plot. The CD20-positive population expressed both kappa and lambda light chains, while the CD20-negative population demonstrated kappa light chain restriction.</p><p><b>CONCLUSIONS</b>Neoplastic B cells can be distinguished from reactive lymphoid cells in T-cell rich diffuse large B-cell lymphoma by flow cytometry, according to a number of parameters which include intensity of antigen expression, loss of antigens, expression of non-B-cell lineage antigens, patterns of forward scatter (FSC) and/or SSC, and expression of immature B-cell antigens.</p>

Treatment and prognosis of tracheal invasion by papillary thyroid carcinoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the treatment and prognosis on patients with tracheal invasion by papillary thyroid carcinoma (PTC).</p><p><b>METHODS</b>Forty-five patients treated for PTC with tracheal invasion between 1980 and 1995 were retrospectively analyzed. The different kinds of surgical modalities were performed according to the extent and degree of tracheal invasion by PTC. Neck dissect was performed in 39 patients. External beam radiotherapy was used postoperatively in patients with gross residual tumor or microscopic residual tumor in pathologic margins after resection. Survival was evaluated using the Kaplan-Meier method.</p><p><b>RESULTS</b>(1) Twenty-eight patients with limited tracheal invasion were treated with shave excision, the 5- and 10-year survival rates were 85.0% and 62.6%, respectively. After a shave excision, the differences of 5- and 10-year survival rates between irradiated and nonirradiated patients were not statistically significant (P > 0.05). (2) Ten patients were radical excision for intraluminal involvement extending through the tracheal cartilage, including circumferential sleeve resection (4 cases), tracheal window resection (5 cases) and total laryngectomy (1 case), the survival rate was 80.0% for five years and 58.3% for ten years. After a radical excision, the differences of 5- and 10-year survival rates between irradiated and nonirradiated patients were not statistically significant (P > 0.05). (3) For 7 patients performing the palliative operation, the 5-and 10-year survival rates were 42.9% and 28.6%, respectively. For 4 patients received postoperative radiotherapy, the 5-and 10-year survival rates were 50.0% and 50.0%, respectively. Three patients didn't received postoperative radiotherapy, the 5-year survival rate was 33.3%, no patient survived for ten years. In these patients of incomplete resection, the differences of 5-and 10-year survival rates between irradiated and nonirradiated patients were not statistically significant (P > 0.05).</p><p><b>CONCLUSIONS</b>PTC with limited involvement of the trachea could be treated successfully by shaving tumor off the tracheal cartilage. Intraluminal involvement extending through the tracheal cartilage could be resected radically in patients with PTC. Postoperative radiotherapy could improve the survival of the patients with PTC with tracheal invasion who have been performed incomplete resection.</p>

Specialization in thyroid surgery / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the results of surgically treated patients with benign thyroid disorders from Department of Otolaryngology- Head and Neck Surgery.</p><p><b>METHODS</b>The clinical data of 496 patients operated for benign thyroid disorders were retrospectively analyzed in this department from January 2001 to April 2004. The incidence of complications, particularly postoperative permanent recurrent laryngeal nerve palsy and hypocalcemia, duration of surgery, incision length on the neck, hospitalization days and postoperative recurrence were evaluated.</p><p><b>RESULTS</b>Unilateral total thyroidectomy with contralateral partial lobectomy was performed in 314 cases, unilateral total thyroidectomy with isthmectomy in 76, bilateral subtotal thyroidectomy with the remnant left at the upper pole in 29, isthmectomy in 3, total thyroidectomy in 46. The operations on 28 patients with substernal goiter have been successfully performed via cervical collar incision. Of these patients, the incidences of unilateral recurrent laryngeal nerve paralysis and temporary postoperative hypocalcemia were 0.2% (1/496) and 1.8% (9/496), respectively. There were no bilateral vocal cord paralyses and permanent hypocalcaemia. Postoperative hemorrhage requiring reoperation occurred in 3 cases (0.6%). No patients had incision infection. The mean duration of surgery was 66 min. The mean incision length on the neck was 5.2 cm. The incidence of postoperative recurrence was 0.2% (1/496). The mean hospitalization day was 6.3 d.</p><p><b>CONCLUSIONS</b>Otolaryngologists who had received stringent training of head and neck surgery seem to have the advantage to avoid injury of recurrent nerve in the thyroid surgery.</p>

Detailed deletion mapping of loss of heterozygosity on 9p13-23 in laryngeal squamous cell carcinoma by microsatellite analysis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>This study was designed to investigate the hot spots of microsatellite loss of heterozygosity (LOH) on 9p13-23 in laryngeal squamous cell carcinoma and to find out the correlation between the incidence of microsatellite LOH and the clinicopathological parameters.</p><p><b>METHODS</b>Tumor tissues were obtained from paraffin embedded sections with microdissection. Genomic DNA was extracted from tumor tissues and peripheral blood lymphocytes with the phenol-chloroform. Polymerase chain reaction (PCR) amplification and denaturing gel electrophoresis were carried out in a set of 42 squamous cell carcinoma (SCC) of larynx and corresponding peripheral blood lymphocytes using 13 highly polymorphic microsatellite markers on 9p13-23. The correlation was analyzed between microsatellite LOH at the high frequency on 9p13-23 and clinicopathological parameters in the patients with squamous cell carcinoma of larynx.</p><p><b>RESULTS</b>Of the 42 laryngeal cancers, 41 (97.6%) showed LOH in at least one of the microsatellite markers tested on 9p13-23. The most frequently deleted marker was D9S162 in 17 of the 19 (89.5%) informative samples. The marker D9S171, which is located on 9p21, had LOH detected in 12 of the 15 informative cases (80.0%). LOH at the D9S1748 marker (closest to the p16 gene locus) was detected in 18 of the 36 informative cases (50.0%). Allelic deletion mapping revealed two minimal regions of LOH encompassing markers D9S161-D9S171 on 9p21 and IFNA-D9S162 on 9p22-23. Multiple LOH (> or = 4) on 9p21-23 was found more frequently in the patients under 60 years, with supraglottic SCC or cervical lymph node metastasis than those over 60 years, with glottic SCC or without cervical lymph node metastasis (P < 0.01 or 0.01, 0.05, respectively). On the contrary, there was no correlation between T stages or pathologic classification and the frequency of LOH on 9p21-23 in 42 SCC of Larynx.</p><p><b>CONCLUSIONS</b>These findings imply the presence of at least two putative tumor suppressor genes on 9p13-23 in laryngeal SCC. Multiple genetic alterations are probably implicated in supraglottic SCC with cervical lymph node metastasis in younger patients.</p>

Application of flow cytometry in the differential diagnosis of lymphoma/leukemia with aberrant antigen expression / 中华病理学杂志

<p><b>OBJECTIVE</b>To investigate the application of flow cytometry in the differential diagnosis of lymphoma/leukemia with aberrant antigen expression.</p><p><b>METHODS</b>The results of flow cytometry of 30 lymphoma/leukemia cases with aberrant antigen expression, of which 3 cases being lymphomas, 8 B-cell leukemia, 1 T-cell leukemia, 17 acute non-lymphoid leukemia and 1 acute non-lymphoid leukemia involving lymph nodes were analyzed. Immunohistochemistry (EnVision) for CD79a, CD3 and MPO was performed on all cases.</p><p><b>RESULTS</b>Eleven cases of B-cell lymphoma/leukemia were cytoplasmic CD79a (cCD79a)-positive, cytoplasmic CD3 (cCD3epsilon) and cytoplasmic MPO (cMPO)-negative. Five of these cases were positive for CD5 and 2 for CD5, 1 or 2 for myeloid marker(s). The T-cell leukemia cases were cCD3epsilon-positive, cCD79a and cMPO-negative, they also co-expressed CD13 and CD33. The mantle cell lymphoma cases were positive for CD3, CD13 and CD33. Of the 8 B-cell leukemia cases, 4 were positive for CD5, 3 for CD13 and 1 for CD13 and CD33. The 18 acute non-lymphoid leukemia cases (including 1 acute non-lymphoid leukemia case involving lymph nodes) were cMPO-positive and cCD79a and cCD3epsilon-negative. Eight of the 18 expressed T-cell markers (including 1 case of acute non-lymphoid leukemia involving lymph nodes), 8 expressed B-cell markers, 2 expressed both T and B-cell markers.</p><p><b>CONCLUSIONS</b>Flow cytometry can demonstrate aberrant antigen expression in lymphoma/leukemia cells and is helpful in delineating their cell origin. The technique is thus useful in the differential diagnosis of lymphoma/leukemia.</p>