Differential diagnosis and surgical management in chondrosarcoma of the jugular foramen / 中华耳鼻咽喉头颈外科杂志

Objective: To explore the diagnosis, surgical management and outcome of jugular foramen chondrosarcoma (CSA). Methods: Fifteen patients with jugular foramen CSA hospitalized in the Department of Otorhinolaryngology Head and Neck Surgery of Chinese PLA General Hospital from December 2002 to February 2020 were retrospectively collected,of whom 2 were male and 13 were female, aging from 22 to 61 years old. The clinical symptoms and signs, imaging features, differential diagnosis, surgical approaches, function of facial nerve and cranial nerves IX to XII, and surgical outcomes were analyzed. Results: Patients with jugular foramen CSA mainly presented with facial paralysis, hearing loss, hoarseness, cough, tinnitus and local mass. Computed tomography (CT) and magnetic resonance (MR) could provide important information for diagnosis. CT showed irregular destruction on bone margin of the jugular foramen. MR demonstrated iso or hypointense on T1WI, hyperintense on T2WI and heterogeneous contrast-enhancement. Surgical approaches were chosen upon the sizes and scopes of the tumors. Inferior temporal fossa A approach was adopted in 12 cases, inferior temporal fossa B approach in 2 cases and mastoid combined parotid approach in 1 case. Five patients with facial nerve involved received great auricular nerve graft. The House Brackmann (H-B) grading scale was used to evaluate the facial nerve function. Preoperative facial nerve function ranked grade Ⅴ in 4 cases and grade Ⅵ in 1 case. Postoperative facial nerve function improved to grade Ⅲ in 2 cases and grade Ⅵ in 3 cases. Five patients presented with cranial nerves Ⅸ and Ⅹ palsies. Hoarseness and cough of 2 cases improved after operation, while the other 3 cases did not. All the patients were diagnosed CSA by histopathology and immunohistochemistry, with immunohistochemical staining showing vimentin and S-100 positive, but cytokeratin negative in tumor cells. All patients survived during 28 to 234 months' follow-up. Two patients suffered from tumor recurrence 7 years after surgery and received revision surgery. No complications such as cerebrospinal fluid leakage and intracranial infection occurred after operation. Conclusions: Jugular foramen CSA lacks characteristic symptoms or signs. Imaging is helpful to differential diagnosis. Surgery is the primary treatment of jugular foramen CSA. Patients with facial paralysis should receive surgery in time as to restore the facial nerve. Long-term follow-up is necessary after surgery in case of recurrence.

Proliferation, Differentiation and Immunoregulatory Capacities of Brown and White Adipose-Derived Stem Cells from Young and Aged Mice

Background and Objectives@#Adipose tissue is a source of mesenchymal stem cells, which have the potential to differentiate into various types of cells. Adipose-derived stem cells (ADSCs) are now recognized as an accessible, abundant, and reliable stem cells suitable for tissue engineering and regenerative medicine applications. However, few literatures gave a comprehensive report on the capacities of ADSCs harvested from different sites. Especially, the capacities of ADSCs from aged mice remained unclear. In this study, we investigated several main capacities of brown adipose derived stem cells (B-ADSCs) and white adipose derived stem cells (W-ADSCs) from both young and aged mice. @*Methods@#and Results: When isolated from young mice, B-ADSCs showed a stronger proliferation rate and higher osteogenic, adipogenic and myocardial differentiation ability than W-ADSCs. Carboxy fluorescein diacetate succinimidyl ester (CFSE) labeling test suggested no significant difference in immunosuppression capacity between B-ADSCs and W-ADSCs. Similarly, no difference between these two were found in several immune related molecules, such as programmed death-ligand 1 (PD-L1), intercellular cell adhesion molecule (ICAM-1), vascular cell adhesion molecule (VCAM-1), inducible nitric oxide synthase (iNOS), tumour necrosis factor-α (TNF-α), interleukin 10 (IL10), and suppressor of cytokine signaling 1 (socs1). When isolated from aged mice, B-ADSCs also showed a stronger proliferation rate and higher osteogenic, adipogenic and myocardial differentiation ability than W-ADSCs; however, it demonstrated an attenuated immunosuppression capacity compared to W-ADSCs. @*Conclusions@#In summary, our data showed that ADSCs’ characteristics were tissue source dependent and changed with age. It provided evidence for choosing the right tissue-specific ADSCs for clinical application and fundamental research.

Hookworm Infection: A Neglected Cause of Overt Obscure Gastrointestinal Bleeding

Hookworm infections are widely prevalent in tropical and subtropical areas, especially in low income regions. In the body, hookworms parasitize the proximal small intestine, leading to chronic intestinal hemorrhage and iron deficiency anemia. Occasionally, hookworms can cause overt gastrointestinal bleeding, but this is often ignored in heavily burdened individuals from endemic infectious areas. A total of 424 patients with overt obscure gastrointestinal bleeding were diagnosed by numerous blood tests or stool examinations as well as esophagogastroduodenoscopy, colonoscopy, capsule endoscopy or double-balloon enteroscopy. All of the patients lived in hookworm endemic areas and were not screened for hookworm infection using sensitive tests before the final diagnosis. The patients recovered after albendazole treatment, blood transfusion, and iron replacement, and none of the patients experienced recurrent bleeding in the follow-up. All the 31 patients were diagnosed with hookworm infections without other concomitant bleeding lesions, a rate of 7.3% (31/424). Seventeen out of 227 patients were diagnosed with hookworm infections in the capsule endoscopy (CE), and 14 out of 197 patients were diagnosed with hookworm infections in the double balloon enteroscopy (DBE). Hookworm infections can cause overt gastrointestinal bleeding and should be screened in patients with overt obscure gastrointestinal bleeding (OGIB) in endemic infectious areas with sensitive methods. Specifically, the examination of stool specimens is clinically warranted for most patients, and the proper examination for stool eggs relies on staff's communication.

CD64 Expression Is Increased in Patients with Severe Acute Pancreatitis: Clinical Significance

BACKGROUND/AIMS: Upregulated CD64 expression on neutrophils is the most useful marker for acute bacterial infections and systemic inflammation. However, it is unknown whether CD64 is involved in the pathogenesis of acute pancreatitis (AP). This study was designed to determine whether CD64 is implicated in severe acute pancreatitis (SAP), and thus, is a suitable marker for SAP. METHODS: SAP was induced in rats with an intraperitoneal injection of L-arginine. CD64 expression in the rat pancreas was determined by quantitative real-time polymerase chain reaction (qRT-PCR) and immunohistochemistry. Additionally, the CD64 mRNA expression in peripheral blood leukocytes from 21 patients with mild acute pancreatitis (MAP) and 10 patients with SAP was investigated at the time of admission and during remission by qRT-PCR. RESULTS: CD64 mRNA and protein expression in the pancreas was significantly higher in rats with SAP, compared to the controls. The CD64 expression was higher in the patients with SAP than in the patients with MAP. During remission, CD64 mRNA decreased in both the MAP and SAP patients. The area under the curve of CD64 expression for the detection of SAP was superior to both the Ranson and the Acute Physiology and Chronic Health Evaluation II scores. CONCLUSIONS: The CD64 level was significantly increased in correlation with the disease severity in SAP and may act as a useful marker for predicting the development of SAP.

Huai Qi Huang ameliorates proteinuria and hematuria in mild IgA nephropathy patients: a prospective randomized controlled study.

BACKGROUND/PURPOSE: Huai Qi Huang (HQH) is a compound Chinese herbal medicine that contains Trametes robiniophila murr, wolfberry fruit, and Polygonatum. In the present study, we investigated the effects of HQH on patients with mild immunoglobulin A nephropathy (IgAN) through a prospective randomized controlled study. METHODS: Forty-five adults diagnosed with IgAN according to renal pathology, who had hematuria or/and proteinuria (≤ 2 g/day), were randomly assigned to receive HQH or no treatment for 12 weeks. Twenty-four hour urinary protein excretion and hematuria were measured at Weeks 0, 4, 8, and 12. The rate of complete remission of proteinuria and hematuria was evaluated. Any adverse events induced by HQH were also observed during the treatment period. RESULTS: Twenty-four hour urinary protein excretion was significantly reduced by HQH treatment compared with that in the control group at Weeks 8 and 12. A much higher rate of complete remission of proteinuria was observed in the HQH group than in control group at Week 12. HQH administration also obviously reduced the extent of hematuria compared with that in the control group at Week 12. HQH treatment dramatically increased the rate of complete remission of hematuria compared with that in control group at Weeks 8 and 12. No obvious adverse events caused by HQH were observed. CONCLUSION: HQH could be a new conservative therapy for IgAN patients who cannot tolerate steroids and immunosuppressive agents. The relapse rate after discontinuing treatment still needs further investigation.

Math1 gene therapy for kanamycin and furosemide-induced deaf guinea pigs / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To observe the morphology and function changes of cochlear hair cells before and after math1 gene injection into the cochlea of deaf guinea pigs which were induced by kanamycin and furosemide. To explore the feasibility of Math1 gene for medicine-induced deafness therapy.</p><p><b>METHODS</b>Kanamycin (500 mg/kg) and furosemide (50 mg/kg) were given to the healthy adult guinea pigs intramuscularly and intravenously to establish the deafness model. The guinea pigs whose auditory brainstem response (ABR) threshold > 95 dB SPL were randomly divided into five groups. Blank control group (without any treatment, n = 3), operation control group (right ear scala tympani operation, n = 3), artificial perilymph group (right ear scala tympani injection artificial perilymph, n = 3), virus vector group [right ear scala tympani injection adenovirus which carrying enhanced green fluorescent protein (EGFP) gene (Ad. EGFP) , n = 4], Math1 gene therapy group [right ear scala tympani injection adenovirus which carrying Math1 and EGFP gene (Ad. Math1-EGFP), n = 6]. Each animal received ABR test before and after injection. The cochlear tissue was observed by scanning electronic microscopy.</p><p><b>RESULTS</b>The ABR thresholds of tone burst( 4, 8, 16, 20 kHz ) were not statistically significant in different groups (P > 0.05). The number of hair cells increased in some of severe deaf guinea pigs after the injection of Ad. Math1-EGFP gene. However, there was no obvious difference with morphology and numbers of cochlea hair cells in other groups.</p><p><b>CONCLUSIONS</b>The injection of Math1 gene to cochlea can regenerate or repair the hair cells of medicine-induced deaf guinea pigs, but there was no improvement on the hearing loss.</p>

Endolymphatic sac tumor with von Hippel-Lindau disease: report of two cases with testing of von Hippel-Lindau gene / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>Endolymphatic sac tumors (ELSTs) are rare in the general population with much higher prevalence in von Hippel-Lindau(VHL) disease. The purpose of this study is to present two cases of endolymphatic sac tumor with VHL disease with analysis of VHL gene and to explore their association with VHL disease using molecular analysis.</p><p><b>METHODS</b>Clinical data of these two patients from different VHL families were studied. DNAs extracted from peripheral bloods were amplified by the polymerase chain reaction using oligonucleotide primers corresponding to the VHL gene, then compared the mutations with the Human Gene Mutation Database.</p><p><b>RESULTS</b>In case 1, 6 family members were enrolled in the study. Among them, three had been identified to have a germline missense point mutation at codon 194 of the VHL gene exon 1 (p.S65W). The little sister of the patient (case 1) underwent vitrectomy for retinal hemangioblastoma 5 years ago in another hospital. The mother of the patient (case 1) was further diagnosed to have a cerebellar hemangioblastoma and renal carcinoma in the following physical examination. Case 2 with her parents were also tested. Codon 499 of the VHL gene exon 3 (p.R167W) were detected in case 2 and her mother, but the mother refused further examination.</p><p><b>CONCLUSIONS</b>The genetic diagnosis plays an important role in early detection of symptomatic patients and suspected patients. Clinical screening for members of the VHL families, and close follow-up of carriers allow an early detection of tumors and the metastasis, which is the most common cause of death of these patients.</p>

Histological changes of peripheral vestibular organs in the inner ears of Smad4 conditional knockout mice / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the histological changes in the vestibular endorgans of Smad4 gene conditional knockout mice and to explore the influence of the Smad4 gene on vestibular development.</p><p><b>METHODS</b>Histological changes of periphery vestibular organs in inner ear of Smad4 conditional knockout mice were investigated by frozen sections, immunofluorescence, confocal microscopy, scanning electron microscopy and transmission electron microscopy.</p><p><b>RESULTS</b>There was no Smad4 expression in the inner ear cartilage capsule of Smad4-/- mice. In Smad4+/- mice, Smad4 expression in the same cartilage capsule was positive, and it was strong positive in Smad4+/+ mice. Smad4 expression in vestibular sense epithelium, crista ampullaris and macula, was positive. And no difference was found among these three genotypes. Studying at scanning electron microscopy and transmission electron microscopy levels and anti-filament immunofluorescence showed that no pathological changes were observed in all the three genotype mice.</p><p><b>CONCLUSION</b>Although the Smad4 gene was knockout effectively in the auricular cartilage capsule of Smad4 conditional knockout mice,the histological changes of Smad4 conditional knockout mice in vestibulum auris internal were slightly.</p>

Study on discrepant protein expression in rat auditory cortex under impulse noise exposure / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>Impulse noise was adopted in adult rats to built acute deafferent animal model. Differential proteomics techniques were applied to detect the changes of protein expression in the auditory cortex before and after the noise exposure.</p><p><b>METHODS</b>Thirty adult SD rats were divided into three groups: normal group, rats with acute noise exposure and rats 28 days recovery after noise exposure (n=10/group). All animals were exposed to impulse noise at 156 dB for 50 pulses with a rise-time of 100 µs and duration of around 0.25 ms. ABR was used to evaluate the auditory function. The two-dimensional gel electrophoresis (2-DE) and matrix-assisted laser desorption ionization time-of-flight mass spectrometer (MALDI-TOF-MS) were used to identified the differential protein expression.</p><p><b>RESULTS</b>Compared with the normal group, ABR thresholds were found significantly increased at 2, 4, 8, 16, 32 kHz (P<0.05) in the acute and recovery groups. There was a 40-60 dBSPL ABR threshold shift at all tested frequencies immediately after impulse noise exposure. There was a partial recovery of ABR thresholds at 7 day to 28 days after impulse noise exposure. In addition, it seemed that the thresholds were rather stable and no further ABR threshold recovery was observed from 14 day to 28 days after the impulse noise exposure. Using differential proteomic techniques, 36 spots containing 27 proteins were revealed and identified in auditory cortex. Those proteins are related to cytoskeleton, neurotransmission, energy supply, mitochondrial function and synaptic remolding.</p><p><b>CONCLUSIONS</b>Impulse noise may influence the function of microtubule transport and cell metabolism, there after affect the neurotransmission of auditory neurons. The compensatory changes such as pre- and postsynaptic or such related functional changes may also happen in auditory cortex after the deafferentation treatment.</p>

Surgical management and prognosis of iatrogenic peripheral facial nerve injury following middle ear surgery / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To discuss the causes, sites, management strategies and curative effects of accidental facial nerve paralysis in the middle ear surgery.</p><p><b>METHODS</b>Forty two cases with peripheral facial nerve paralysis following middle ear surgery who underwent surgical exploration and reanimation were analyzed. Facial nerve decompression, primary end-to-end anastomosis, interpositional nerve grafts with the great auricular nerve and nerve substitution of facial-hypoglossal anastomosis were applied to restoration of the facial nerve function. The facial nerve function was graded according to House-Brackmann (HB) Grade.</p><p><b>RESULTS</b>The most common operation complicating iatrogenic facial nerve injury was mastoidectomy, and the common sites of the injured facial nerve were the tympanic segment and pyramid segment. The facial nerve exploration showed facial nerve edema in nine cases (21.4%), injury of the facial nerve sheath was observed in 10 cases (23.8%), partial nerve fibers transection was found in four cases (9.5%), total nerve fibers transection was detected in 17 cases (40.5%) and two cases (4.8%) with facial nerve anatomical integrity. Facial nerve re-animation methods include facial nerve decompression in 24 cases (57.1%), end-to-end anastomosis in two cases (4.8%), end-to-end anastomosis after nerve transfer in two cases (4.8%), interpositional nerve grafts with the great auricular nerve in 10 cases (23.8%) and facial-hypoglossal nerve anastomosis in four cases (9.5%). The facial nerve function was graded according to House-Brackmann Grade before and after surgery. Twenty eight patients were followed up more than one year. For the 17 cases who received facial nerve decompression, four cases recovered to House-Brackmann Grade I, 11 cases recovered to House-Brackmann Grade II, two cases recovered to House-Brackmann Grade III. For the five cases who underwent the great auricular nerve grafting, three cases recovered to House-Brackmann Grade II, two cases recovered to House-Brackmann Grade III. For the four cases who received facial-hypoglossal nerve anastomosis recovered to House-Brackmann Grade III. For the two cases who underwent the end-to-end anastomosis recovered to House-Brackmann Grade II.</p><p><b>CONCLUSIONS</b>The tympanic segment and pyramid segment are more vulnerable to be injured during mastoid surgery. The injured facial nerve should be explored and repaired. The methods include facial nerve decompression, end-to-end anastomosis, end-to-end anastomosis after nerve transfer, interpositional nerve grafts with the great auricular nerve and facial-hypoglossal nerve anastomosis.</p>

Preliminary clinical research of cochlear implantation in elderly and pre-elderly patients with profound hearing loss / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the safety and efficacy of cochlear implantation among elderly patients with severe to profound hearing loss.</p><p><b>METHODS</b>Eight pre-elderly and elderly patients with an medium age of 58 years who suffered from bilateral severe to profound sensorineural hearing loss received cochlear implantation between November 2008 and November 2009. The patients' tolerance to implant surgery and the occurrence of complications were observed. Three months after switch-on, aided threshold and speech performance were measured.</p><p><b>RESULTS</b>The surgery was uneventful in all cases with normal intraoperative neural response telemetry elicited. Three months after switch-on, average aided threshold across speech frequencies was 35 - 50 dB HL measured in sound field with warble tone. The results of speech audiometry showed large variation between individuals. Some patients achieved good performance in monosyllable recognition test, disyllables threshold test and sentences recognition test under both bubble noise and quiet conditions.</p><p><b>CONCLUSIONS</b>Pre-elderly and elderly patients can endure a state of general anesthesia for cochlear surgery without complications. Cochlear implant can provide reconstruction of speech recognition capabilities for elderly patients suffering from severe to profound hearing loss. Cochlear implantation can improve the quality of life of elderly patients with hearing loss.</p>

Analysis of improper pattern of Mandarin monosyllable recognition test among the patients with auditory neuropathy / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To analyze the improper pattern in mandarin monosyllable recognition test among the patients with Auditory Neuropathy (AN) in order to work out the common characteristics in speech recognition which might be suitable for diagnosis of AN.</p><p><b>METHODS</b>Sixteen AN patients (32 ears) were studied and 22 patients (32 ears) with sensorineural hearing loss (SNHL) were set for control. In accordance with audiogram pattern, all subjects were then divided into the up-type hearing (15 ears) and non up-type hearing (17 ears) groups. All 64 ears were tested in high intensity by mandarin monosyllable test material which we have developed before. Monosyllable performance scores from testing ears and improper patterns were recorded respectively. Eight improper patterns were then defined as follows: consonant only, vowel only, tone only, consonant and vowel, consonant and tone, vowel and tone, all phonemes and no response.</p><p><b>RESULTS</b>The score of patients with AN was lower than those patients with SNHL in monosyllable recognition test (P < 0.001). No significant difference was found between subgroup of up-type hearing loss and SNHL group in percentage correct scores of monosyllables, consonants, vowels, and tones statistically (P > 0.05), but significant lower score was found in subgroup of non up-type hearing loss compared with SNHL group in these 4 percentage scores concerned (P < 0.001). Chi square test presented a significant difference in improper pattern proportion between AN and SNHL groups (P < 0.001), which could be related to more proportional tone recognition in the former's incorrect items. Improper pattern proportions between two AN subgroups presented a significant difference statistically (P < 0.001), which could be related to a larger proportional recognition of tones and vowels in subgroup of up-type hearing loss compared with subgroup of non up-type hearing loss.</p><p><b>CONCLUSIONS</b>A poor performance might be a major clinical feature identified AN from SNHL in mandarin tone recognition. There are significant differences between AN patients with up-type hearing loss and patients with non up-type hearing loss in performance of monosyllable recognition and improper pattern proportion of tones and vowels. A psychophysical testing may be a key potential in diagnosis of AN in further clinical application.</p>

Clinical analysis of adenoid cystic carcinoma of external auditory canal / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore methods of treatment for adenoid cystic carcinoma of external auditory canal, and discuss the correlating factors that effect prognosis.</p><p><b>METHODS</b>A retrospective analysis of 19 cases of adenoid cystic carcinoma of external auditory canal treated from 1988 to 2004 was carried out. Based on University of Pittsburgh TNM staging system of external auditory canal carcinoma, 19 cases were classified into groups as 5 cases in T1, 2 in T2, 6 in T3, and 6 in T4. Local resection was performed in cases in stage T1 and T2, while radical mastoidectomy or temporal bone resection was performed in stage T3 and T4. Radiotherapy was applied after operation. Relapsed cases with isolated metastasis were treated by surgery. Multiple metastasis were treated with radiotherapy.</p><p><b>RESULTS</b>The follow-up time is from 6 months to 19 years, and the median is 44 months. There're 8 cases with more than 5 years' follow-up. Twelve patients relapsed and 7 had metastasis but 4 died. The cases with positive incisal edge after first operation relapsed even treated with radiotherapy. In recurrent cases, 9 cases received more than 2 operations, 8 more than 3, and 4 received 4 operations.</p><p><b>CONCLUSIONS</b>The adenoid cystic carcinoma of external auditory canal grows insidiously, and relapses frequently. But the patients can live long with neoplasm implanted. A wide surgical excision combined with post operative radiotherapy was proposed, and negative incision edge should be confirmed. Recurrent cases can be treated with several operations to elongate survival. Multiple relapses will cause metastasis more frequently. Metastasis is the main reason to cause death.</p>

The effects of GABAergic neurotransmitters and GABAA receptors on the auditory afferent pathway in the brainstem analyzed by optical recording / 中国应用生理学杂志

<p><b>AIM</b>To explore the influence of GABAergic neurotransmitters and GABAA receptors on the auditory afferent impulses recorded in the brainstem evoked by electro-stimulation.</p><p><b>METHODS</b>Brainstem slices were prepared using ddy/ddy mice of postnatal 0-5th days. The brainstem slices were stained with a voltage-sensitive dye(NK3041). The cut end of the vestibulocochlear nerve (nVIIIth) connected with slices was stimulated by a tungsten electrode, a 16 x 16 pixels silicon photodiode array apparatus was used to record the optical mapping from auditory brainstem slices. The data were analyzed by ARGUS-50/PDA software.</p><p><b>RESULTS</b>The spatial-temporal patterns of the excitatory propagation from the vestibulocochlear nerve (nVIIIth) to cochlear nucleus and vestibular nucleus were displayed with multiple-sites optical recording. The optical signal coming from one pixel consisted of a fast spike-like response and a following slow response. Inhibitory neurotransmitter GABA decreased the fast spike-like response and following slow response of evoked optical signals, while an antagonist BMI against GABAA receptors increased the both responses.</p><p><b>CONCLUSION</b>A 16 x 16 pixel silicon photodiode array apparatus can be used to record multiple-sites optical mapping evoked by electro-stimulation to the cut end of the vestibulocochlear nerve. The every optical signal consists of both presynaptic and postsynaptic elements. Inhibitory neurotransmitter GABA and an antagonist BMI of GABAA receptors can modulate the excitatory propagation of evoked optical signals.</p>

Technique of hearing preservation during acoustic neuroma surgery / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the possibility of hearing protection in acoustic neurinoma (AN) resection and to evaluate the effect of dynamic auditory monitoring and the effect of oto-endoscope for hearing protection.</p><p><b>METHODS</b>From July 2003 to July 2007, there were a total of 138 cases of AN received surgical treatment Continuous hearing monitoring was conducted in 18 cases with residual hearing. In these 18 cases, there were 6 males and 12 females, with 12 cases in left side and 6 cases in right. Fifteen cases were solitary AN, 3 cases were diagnosed as neurofibromatosis II. Maximal diameters of the tumor varied between 12 and 33 millimeters with an average of 19.9 millimeters. All cases were operated on by retrosigmoid approach with routine facial nerve monitoring. Ten cases were assisted by oto-endoscope. Eighteen cases were performed accompanying continuous auditory brainstem response (ABR) and electro-cochleogram (EcochG). The patients were given routine hearing function test 7 to 10 days after operation, and reexamined 6 months to 1 year. The duration of follow-up ranged 6 months to 2. 5 years. Hearing data of the last time was thought as the judging result. Preoperative and postoperative hearing standard refer to (AAO-HNS) classifying.</p><p><b>RESULTS</b>In all 18 cases, tumors were resected completely in 16 cases, but sub-totally removed in 2 cases which were II neurofibromatosis. There was no mortality and no severe complication in this series. All the 18 cases had no facial paralysis before operation, and during operation facial nerves in 18 cases were kept anatomic integrity. According to House-Brackmann grade system, for 18 AN patients 7 days after operation only 50.0% (9/18) were kept at grade I to II , but 88.9% (16/18) were kept at grade I to II 6 months after operation. Out of 18 cases, hearing function were preserved in 11 cases (61.1%, 11/18). After operation, there were 4 cases at hearing grade A, 4 cases at hearing grade B, 2 cases at hearing grade C and 1 cases at hearing grade D. In all 18 cases, there were 5 cases with tumor diameter more than 20 millimeters, in which only 2 cases of them preserved hearing function (2/5). However, 9 cases preserved their hearing function in the other 13 cases whose tumors diameter less than 20 millimeters (69.2%, 9/13). In 10 cases assisted by oto-endoscope, 8 cases obtained hearing protection (80.0%, 8/10) and 2 cases lost hearing. During operative monitoring, when drilling posterior lip of internal auditory canal (IAC), dragging and electric coagulating nearby IAC, especially clamping labyrinthine artery, removing tumor in IAC or electric coagulating arachnoid blood vessel on the top of tumor tissue, the ABR waves were affected greatly.</p><p><b>CONCLUSIONS</b>For the AN patient with preoperative residual hearing, it was necessary to protect hearing by combining continuous auditory monitoring with oto-endoscope technique. Based on these efforts the patient could preserve applicable hearing after operation. Whether or not arachnoidal on the top of AN remain and the conditions about blood supplying were the main factors that affect postoperative hearing. Moreover trauma of labyrinthine artery was the key to postoperative hearing loss.</p>

Investigation and management of wound on head and neck from the disaster area in Wenchuan earthquake / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate and analyze the wounded's state of ear, nose, throat, neck and head injury in Wenchuan earthquake.</p><p><b>METHODS</b>The 206 wounded cases, who was treated in No. 452 Hospital of People's Liberation Army, were investigated specially with emphasis on injury cause, severity and treatment.</p><p><b>RESULTS</b>The injured 165 cases among the 206 were in hospital, while the cases who related to the injury of ear, nose and throat were 37 cases (22.4%). Among the inpatients, the trauma of otorhinolaryngology and head and neck included: ear injuries totally 13 cases (including hemotympanum 2 cases), extraneous matter 4 cases, haemorrhagic 4 cases, nasalis and the fracture of nasal bone and nasal sinuses 7 cases (including cerebrospinal rhinorrhea 1 case), zygomatic abscess 1 case, fracture of mandible 4 cases, lip injuries 2 cases and hoarse 2 cases. The inpatients were wounded mostly because of falling and stepping. All the inpatients recovered well after properly management by ENT doctors.</p><p><b>CONCLUSIONS</b>Maxillofacial injury of the wounded those were medical evacuation in the earthquake area, was ignored more readily comparing to the injury of other spots, so specialist should examine early and treat properly the people as soon as possible.</p>

Relevance between clinical behavior and bionomical findings of acoustic neuromas / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the relationship between labeling index (LI) Ki-67, proliferating cell nuclear antigen (PCNA) and transforming growth factor-beta1 (TGF-beta1) with the clinical behavior of acoustic neuroma.</p><p><b>METHODS</b>Expression of Ki-67, PCNA and TGF-beta1 was detected by immunohistochemistry in 53 specimens of acoustic neuromas. The relationship among tumor proliferation, histological representation, size of tumor, clinical proliferation index of tumor and tumor proliferation activity were analyzed.</p><p><b>RESULTS</b>In all 53 cases, the positive rate of Ki-67 was 77.4% (41/53) but the positive rate of PCNA was 84.9% (45/53). There was significant difference between the proliferate index, clinic growth rate and course of disease (t = 2.14, t = 2.70; P < 0.05). The positive rate of TGF-beta1 was 83.0% (44/53). The correlation of TGF-beta1 with LI (Ki-67) was significant difference (r = 0.36, P < 0.05). Cystic degeneration often occurred in large-size tumor (Z = 4.44, P < 0.05). There was no significant relationship between the expression of LI (Ki-67), LI (PCNA) and TGF-beta1 and the course of disease as well as between the cystic degeneration and the non-cystic degeneration. Although clinic growth rate of cystic degeneration was bigger than that of non-cystic degeneration, there was not statistically significant.</p><p><b>CONCLUSIONS</b>Ki-67 and PCNA are reflected proliferation activities of tumor cells in acoustic neuromas. Cell proliferation-labeling index LI (PCNA) was related with clinical growth rates. TGF-beta1 might participate in the biological behavior of acoustic neuroma. Cystic degeneration was one of special pattern of acoustic neuroma, however, tumor enlargement might due to the volume of the cystic but unrelated to fast proliferation of parenchyma cell.</p>

Long-term results of endolymphatic sac drainage for Meniere disease / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the efficacy of endolymphatic sac drainage for Meniere disease.</p><p><b>METHODS</b>The efficacy of endolymphatic sac drainage for Meniere disease was retrospectively summed up in 26 patients in General Hospital of Chinese People's Liberation Army from March 1987 to September 2004. Of 26 patients, there were eighteen patients followed up more than two years after surgery.</p><p><b>RESULTS</b>According to Chinese Meniere disease's diagnosis and curative effect standard evaluation criteria published in 1996, for vertigo symptom of these 18 patients, there were 9 cases (50%) with grade A (completely controlled), 8 cases (44.4%) with grade B (fundamentally controlled) and one case (5.6%) with grade D (not controlled). The vertigo fully controlled rate was only 50%, but the vertigo completely or fundamentally controlled rate reached 94.4%. Tinnitus of the patients after operation disappeared in 2 cases (11.1%), reduced in 9 case (50%) and unchanged in 7 cases (38.9%). Hearing post operation was improved in 6 cases (33.3%), unchanged obviously in 4 cases (22.2%) and decreased in 8 cases (44.5%).</p><p><b>CONCLUSIONS</b>Endolymphatic sac drainage was an effective and safe management as well as with less complication for intractable Meniere's disease patients with residual hearing before operation.</p>

Transseptal endoscopic excision of nasal dermoid sinus cyst / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>Surgery is the curative treatment for nasal dermoid cysts. Many different surgical incisions have been advocated. All approaches described have the advantage of either improved accessibility or improved patients'cosmetic satisfaction, but none is optimal. We designed a new transseptal endoscopic approach for the treatment of nasal dermoid sinus cyst and reported the result of a special case.</p><p><b>METHODS</b>The diagnostic studies, the operative technique, and the result of 18 month follow-up were presented.</p><p><b>RESULTS</b>The patient, a 16 years old girl, remains free of disease 18 months after surgical treatment, most importantly without facial scar.</p><p><b>CONCLUSIONS</b>Transseptal endoscopic approach is an alternative surgical technique for selected nasal dermoid cysts. So far as we know, the operative method presented in the current report is the first surgical approach reported in the world literature.</p>

Preliminary study of intraoperative auditory monitoring techniques in acoustic neuroma surgery / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the value of intraoperative auditory monitoring techniques in acoustic neuroma surgery.</p><p><b>METHODS</b>Ten cases with acoustic neuroma were resected with retrosigmoid approach. Continuous hearing monitoring of auditory brainstem responses (ABR) and transtympanic electrocochleography (ECochG) was performed during operation.</p><p><b>RESULTS</b>Before surgery, 3 patients had class A hearing, 4 had class B hearing, and 3 had class C hearing. With ABR monitoring, 5 patients had waves I , III and V, 5 had only waves I preoperation. After anesthesia,only 2 cases had waves I, III and V, 6 had wave I (Compound action potential, CAP N1 is equivalent to wave I of ABR) and 2 had no waves. The hearing was preserved in 2 cases, which had class A hearing post operation with tumor size <2 cm. With continuous hearing monitoring, the waves of I , III and V could be evoked in one case. In another case, the waves of I, III could be evoked after the tumor resection with the disappearance of wave V. The hearing was not preserved in 8 cases. The 6 out of 8 cases showed up CAP (waves I ) waveform. The CAP amplitudes decreased significantly in 4 cases and even dropped to zero while dissecting the tumor at the lateral end of the internal auditory canal (IAC) or clamping the internal auditory artery (IAA) during operation. After surgery, the CAP amplitudes were recovered to 50%-60% of normal level or normal. In one case, although the cochlear nerve was cut down, the CAP could still be recorded after the tumor resection. However, the CAP amplitudes was dropped to zero while pressurized and pulled cochlea nerve of brainstem lateral and the wave disappeared post-operation in another cases. The waves had not been recorded in two cases after anesthesia. One of them showed low amplitude of CAP wave when the tumor partially removed. The others had no wave all the time.</p><p><b>CONCLUSIONS</b>In combination with ABR monitoring, ECochG proved to be a useful supplementary tool for hearing preservation in acoustic neurinoma surgery. Drilling of the IAC and tumor removal at the lateral end of the IAC were the most critical steps for achieving hearing preservation. The surgeon's experience are the most significant factors influencing the hearing outcome after removal of acoustic neuroma.</p>