Hysteroscopic management of a "hernia-like" uterine myoma within the uterine cavity.

OBJECTIVE: To introduce a case of a uterus "hernia-like" myoma within the uterine cavity that was successfully treated with hysteroscopy. DESIGN: Step-by-step explanation of the case and surgical procedure using a video and slides. The Medical Ethics Committee of Women and Children's Hospital of Chongqing Medical University approved the study and decided for this video to be exempt from formal approval, and informed consent was obtained from the patient. SETTING: Hospital. PATIENT(S): A 37-year-old woman, gravida 1, para 1, with a history of secondary infertility for 2 years and heavy menstrual bleeding for 7 months, which eventually resulted in anemia, was diagnosed with a type 1 (International Federation of Gynecology and Obstetrics leiomyoma subclassification system) myoma approximately 4 cm in diameter using ultrasonography. Her hemoglobin level was 8.6 g/dL (11.5-15.0 g/dL), red blood cell count was 3.6 ×10-12/L (3.8-5.1 ×10-12/L), and hematocrit was 26.7% (35%-45%). INTERVENTION(S): Hysteroscopic myomectomy with bipolar resectoscope and transabdominal ultrasound guidance was used to resect the hernia-like myoma. Blunt dissection combined with oxytocin (20 U I.V.) and uterine dilation pressure reduction was used to induce the hernial content (myoma) protrusion into the uterine cavity. MAIN OUTCOME MEASURE(S): The hernia-like myoma was completely resected by hysteroscopy, and all symptoms disappeared. RESULT(S): The hernia-like myoma was successfully and completely resected by hysteroscopy. The operative time was 37 minutes. No surgical-related or anesthesia-related complications occurred. During the follow-up period, the patient had regular menstrual cycles without hypermenorrhea, and her anemia had improved. The 5-month follow-up ultrasound examination and hysteroscopy revealed that the uterine cavity had recovered well. The patient conceived 7 months after the procedure and delivered at term (39 weeks 1 day) via cesarean section. CONCLUSION(S): A hernia-like myoma covered with endometrium is a degenerative myoma that herniates into the myometrium and forms a hernia sac-like defect. Hysteroscopy is an effective and feasible method for treating hernia-like myoma.

GLTP Is a Potential Prognostic Biomarker and Correlates with Immunotherapy Efficacy in Cervical Cancer.

Cervical cancer (CC) is the fourth most commonly diagnosed cancer in women worldwide. The prognosis of CC patients remains poor. The objective of our study was to explore the potential of glycolipid transfer protein (GLTP) in predicting the prognosis of CC and patients' response to immunotherapy. The expression of GLTP was determined using TCGA and GEO datasets. The prognostic value of GLTP in CC patients was analyzed using Kaplan-Meier analysis and multivariate analysis. The relationships between BTBD10 and immunological checkpoints, immune checkpoint genes, and ferroptosis-related genes were analyzed to explore the impact of GLTP on CC immunotherapy. According to the dysregulated expressions of BTBD10, the IC50 distribution of various targeted medicines was studied. In this study, we found that GLTP expression was distinctly upregulated in CC specimens. However, Kaplan-Meier assays showed that CC patients with low GLTP expressions tended to exhibit a shorter overall survival. Importantly, multivariate assays revealed that GLTP expression was an independent prognostic factor for CC patients. Moreover, we observed that GLTP expression was related to CD4+ T cells, macrophages, and dendritic cells (DCs). Meanwhile, GLTP expressions were associated with those of immune checkpoints, ferroptosis-related genes, and m6A-related genes. The IC50 of Cisplatin, Docetaxel, and Paclitaxel was lower in the high-GLTP-expressing group. Taken together, GLTP was expected to be a prognostic and immunotherapeutic marker for CC.

A new treatment of an intravesical eroded mesh after TVM: 3 mm trocar-assisted cystoscopic approach.

INTRODUCTION AND HYPOTHESIS: To present a novel technique to remove intravesical eroded mesh through a 3-mm trocar-assisted cystoscopy. METHODS: First, a 3-mm trocar was inserted into the bladder under ultrasound guidance after the bladder had been infused with 600 ml normal saline. Second, we inserted the forceps through the trocar into the bladder and pulled the mesh through the 3-mm trocar. Last, cystoscopic scissors were used to remove the eroded mesh completely. RESULTS: The patient was managed adequately in the inpatient department. The urethral catheter was left in situ for 3 days, and the patient was discharged within 5 days. CONCLUSION: Surgery under 3-mm trocar-assisted cystoscopy offers the advantage of lower risk of morbidity and complications compared to other surgical techniques. It is an effective and feasible procedure for treatment of synthetic mesh erosion into the bladder after TVM surgery.

The impact of the COVID-19 pandemic on the mental health of young people: A comparison between China and the United Kingdom.

PURPOSE: As COVID-19 spreads globally and affects people's health, there are concerns that the pandemic and control policies may have psychological effects on young people (age from 17 to 35 years). This psychological impact might vary in different countries, and thus we compared the prevalence of self-reported psychological distress, loneliness and posttraumatic stress symptoms (PTSS) among young people in the United Kingdom (UK) and China at the beginning of the COVID-19 pandemic. METHODS: Data of this study came from two sources. One source was the first wave of COVID-19 study in Understanding Society, a special wave of the UK household longitudinal study, which provided the high-quality, national-wide representative panel data. The sample comprised 1054 young people. The other source was an online survey on the mental health of 1003 young people from Shanghai, a highly developed area in China. The questionnaire included questions on the prevalence of common mental disorders (cut-off score ≥ 4), loneliness and potential PTSS (cut-off ≥ 33). Univariable analyses were conducted to test the differences in the self-reported prevalence of psychological distress and loneliness between the two groups. Multivariable logistic regression analyses were run to explore the predictors of psychological distress and loneliness among all the young people from England and Shanghai. RESULTS: Among the samples with self-reported psychological distress, the UK sample accounted for 34.4% (n=1054) and the Chinese sample accounted for 14.1% (n=1003). The difference between the two groups was statistically significant (p < 0.001). Additionally, 57.1% of people in the UK and 46.7% in China reported that they sometimes or often felt lonely, of which the difference is statistically significant (p < 0.001). Regression analysis of the entire samples showed that nationality, gender, psychotherapy and loneliness were significant predictors of 12-item General Health Questionnaire scores, while the variables of age and living alone were not. Significant predictors of self-reported loneliness were the nationality, gender, age, living alone and psychotherapy. In China, 123 (12.3%) young people, 49 men (11.3%) and 74 women (13.0%), met the criteria of PTSS symptoms (cut-off scores ≥ 33). These scores were only collected in China. CONCLUSION: This evidence suggests that mental health and loneliness reported by young people were lower in China than that in the UK during the studied period. More research is needed to understand these differences. If the differential negative psychological impacts are confirmed, country-specific measures of prevention and intervention should be adopted to improve the mental health of young people under the ongoing impact of the pandemic.

Proteomic analysis of early-stage incompatible and compatible interactions between grapevine and P. viticola.

Wild grapevines can show strong resistance to the downy mildew pathogen P. viticola, but the associated mechanisms are poorly described, especially at early stages of infection. Here, we performed comparative proteomic analyses of grapevine leaves from the resistant genotype V. davidii "LiuBa-8" (LB) and susceptible V. vinifera "Pinot Noir" (PN) 12 h after inoculation with P. viticola. By employing the iTRAQ technique, a total of 444 and 349 differentially expressed proteins (DEPs) were identified in LB and PN, respectively. The majority of these DEPs were related to photosynthesis, respiration, cell wall modification, protein metabolism, stress, and redox homeostasis. Compared with PN, LB showed fewer downregulated proteins associated with photosynthesis and more upregulated proteins associated with metabolism. At least a subset of PR proteins (PR10.2 and PR10.3) was upregulated upon inoculation in both genotypes, whereas HSP (HSP70.2 and HSP90.6) and cell wall-related XTH and BXL1 proteins were specifically upregulated in LB and PN, respectively. In the incompatible interaction, ROS signaling was evident by the accumulation of H2O2, and multiple APX and GST proteins were upregulated. These DEPs may play crucial roles in the grapevine response to downy mildew. Our results provide new insights into molecular events associated with downy mildew resistance in grapevine, which may be exploited to develop novel protection strategies against this disease.

[Surgical treatment of carotid body tumor: a report of 36 cases].

OBJECTIVE: To study surgical methods and techniques to reduce complications in carotid body tumors (CBT). METHODS: A total of 36 patients with CBT treated by the same surgeon between 2004 and 2012 was reviewed. Clinical presentation, imaging, surgery techniques, postoperative complications and outcomes as well as follow-up evaluations were analyzed. RESULTS: Of 36 patients, 13 males and 23 females, with a median age of 42 years (range 9-61 years). Nineteen patients had a CBT on the left side, 14 on the right side and 3 on both sides. All patients (36 patients with 38 tumors) received surgical treatment. Twenty nine tumors were excised completely. Kudo clamp was used in 6 cases with solid firm tumors and potentially high risks of intracranial complications, with common carotid artery compression exercise before tumor excision. Blood loss in operation were less than 80 ml(n = 17), 100-550 ml(n = 18), 800 ml (n = 1), 1000 ml(n = 1) and 1500 ml(n = 1) respectively. There were more blood loss in cases used embolization (median of 200 ml) than in those without embolization (median of 60 ml) . Post-operative local nerve impairment occurred in 10 patients (26.3%) including persistence of preexisting deficits (n = 8) and newly developed deficits (n = 2). Twenty-seven patients were followed up for 10 month to 6 years with a mean period of 24 months and 9 patients lost of follow-up. One patient with malignant CBT survived with tumor and other 26 patients were alive with no recurrence. CONCLUSIONS: Surgery is the first choice of treatment for CBT. Soft CBT often can be excised completely with preservation of the internal carotid artery (ICA), whereas solid firm CBT encasing the ICA should be evaluated with DSA preoperatively to determine the presence of communicating branches of cerebral vessels, due to the high risk of major vessel compromise. Two-stage operation is often required, in which the ICA is gradually closed following ligation of the external carotid to establish collateral circulation, followed by excision of the tumor and IAC, so that serious intracranial complications can be avoided.

[Trend analysis on the mortality of cardiovascular diseases from 2004 to 2010 in China].

OBJECTIVE: To explore the trend and characteristics of cardiovascular disease mortality in China. METHODS: Mortality data from the National disease surveillance system from 2004 to 2010 was used. Underreporting was adjusted and trends were analyzed on the rates of crude mortality, standardized mortality and causes of death fraction among cardiovascular diseases. RESULTS: The total mortality of cardiovascular diseases increased from 240.03 to 268.92 per one hundred thousand during 2004 to 2010, with an average annual increase of 5.50 per one hundred thousand, with the annual increase of 2.17% . Data from all causes of death, ischemic heart disease, hypertensive heart disease, cerebrovascular disease, and other heart disease showed an upward trend, with the annual rise of 5.05%, 2.08%, 1.02% and 2.66% respectively while rheumatic heart disease showed a downward trend, with the declining rate of 7.02% per annum. After eliminating the effect of aging, the trend remained the same but the slope was decreasing. The proportion of national cardiovascular mortality on total deaths increased annually by 37.46% to 40.73% from 2004 to 2010. The proportion of cerebrovascular disease remained unchanging but the proportion of ischemic heart disease showed a significant increase. The proportion of rheumatic heart disease declined while the proportion of other cardiovascular disease mortality showing a slight change. CONCLUSION: In recent years, the cardiovascular mortality had significantly increased, which was mainly due to the increase of ischemic heart disease mortality.

Outline of the report on cardiovascular disease in China, 2010.

Major and profound changes have taken place in China over the past 30 years. Rapid socioeconomic progress has exerted a great impact on lifestyle, ranging from food, clothing, working and living conditions, and means of transportation to leisure activities and entertainment. At the same time, new health problems have emerged, and health services are facing new challenges. Presently, cardiovascular diseases (CVD) are among the top health problems of the Chinese people, and pose a serious challenge to all engaged in the prevention and control of these diseases. An epidemic of CVD in China is emerging as a result of lifestyle changes, urbanization and longevity. Both national policy decision-making and medical practice urgently need an authoritative report which comprehensively reflects the trends in the epidemic of CVD and current preventive measures. Since 2005, guided by the Bureau of Disease Prevention of the Ministry of Health of the People's Republic of China and the National Center for Cardiovascular Diseases of China, nationwide experts in the fields of epidemiology, clinical medicine and health economics in the realms of CVD, cerebrovascular disease, diabetes and chronic kidney disease, completed the Report on Cardiovascular Diseases in China every year. The report aims to provide a timely review of the trend of the epidemic and to assess the progress of prevention and control of CVD. In addition, as the report is authoritative, representative and readable, it will become an information platform in the CVD field and an important reference book for government, academic institutes, medical organizations and clinical physicians. This publication is expected to play a positive role in the prevention and control of CVD in China. We present an abstract from the Report on Cardiovascular Diseases in China (2010), including trends in CVD, morbidity and mortality of major CVDs, up-to-date assessment of risk factors, as well as health resources for CVD, and a profile of medical expenditure, with the aim of providing evidence for decision-making in CVD prevention and control programs in China, and of delivering the most authoritative information on CVD prevention and control for all citizens.

[Diagnosis and treatment of the primary parapharyngeal space tumors].

OBJECTIVE: To study the clinical characteristics, diagnosis and surgical managements of the parapharyngeal space tumors. METHODS: A retrospective study of 40 patients with primary parapharyngeal space tumors treated from January 2006 to December 2008 in Chinese PLA General Hospital was performed. Among the 40 patients, there were male 22 patients, female 18 (45%), age ranged from 1 - 77, median 42 years old. CT scan combined with MRI was helpful to diagnose the parapharyngeal space tumor and make surgical plan. The surgical approaches include: trans-oral in 1 patient, trans-cervical approach in 22, transcervical-parotid approach in 8, vertical ramus osteotomy approach in 1, transcervical-partial bone resection in the angle of mandible in 4, transparotid approach in 2, and transcervical in combination with post auricle craniotomy approach in 2. RESULTS: All 40 patients had undergone surgical treatment. Postoperative histopathology showed benign in 28 patients and malignant in 12 patients. The tumors originating from salivary glands were in 15 patients, neurogenic tumors in 12 patients and tumors originating from other tissues were in 13 patients.Among 28 patients with benign tumors, 23 had been cured with one operation, without recurrence during following-up of 13 - 47 months, with a median of 39 months. Among 12 patients with malignant tumors, 6 patients alive (with following-up of 24 - 50 months and a median of 36 months), 3 patients died in half year after operation and 3 patients lost. The post-operative complication included Cerebrospinal fluid leak in one patient, operative field infection in 2 patients, and vagus nerve injury in 3 patients. CONCLUSIONS: Surgery is the first choice for parapharyngeal space tumors. Transcervical approach alone can apply to most tumors and a broader approach is indicated for malignant or large benign tumors. The prognosis is good for the benign lesions, but poor for the malignant tumors.

[Relationship between SLP-2 expression and prognosis in laryngeal squamous cell carcinoma and mammary invasive carcinoma].

OBJECTIVE: To study the expression of stomatin like protein-2 (SLP-2) at mRNA and protein levels in two kinds of malignant epithelial tumors, including laryngeal squamous cell carcinoma (LSCC) and invasive breast cancer, and to study the relations of SLP-2 expression and clinicopathologic parameters with the prognosis. METHODS: RT-PCR and Western blot were used to detect the expression of SLP-2 mRNA and protein in LSCC and their normal counterparts (46 and 10 pair, respectively). Immunohistochemistry was carried on tissue array constructed from LSCC (104 cases) and breast cancer (263 cases), respectively. The association between SLP-2 expression and clinicopathologic parameters was analyzed. RESULTS: LSCC showed a higher expression of SLP-2 than that of their normal counterparts (negative expression) at mRNA (83%, 38/46) and protein (7/10) level. Immunohistochemical analysis of LSCC showed that compared with negative expression in normal laryngeal epithelium (0/20), a higher SLP-2 expression was detected in LSCC (36/104, P=0.000) and associated with the advanced clinical stage (P<0.01) and lymph node metastasis (P=0.003). Immunohistochemical study of invasive breast cancer demonstrated that compared with negative expression in normal breast tissue (0/10), more than one half of the cases showed a high SLP-2 expression (52.5%, 138/263, P=0.000) in breast cancer, which correlated with the tumor size (P=0.020), lymph node metastasis (P<0.01), advanced clinical stage (P<0.01), distant metastasis (P=0.002) and HER2/neu protein expression (P=0.037). Survival analysis showed a shorter overall survival probability in patients with a high SLP-2 expression. It was considered that lymph node metastasis, positive HER2/neu expression, and high-level SLP-2 expression may act as the independent prognostic factors for those tumors. CONCLUSIONS: A high expression level of SLP-2 may be associating with the development of invasion and metastasis in LSCC and breast cancer, and SLP-2 is also considered working as an independent factor indicating a poor prognosis clinically in breast cancer.

[Rescue of postoperative carotid blowout in head and neck neoplasms].

OBJECTIVE: To investigate the prevention and rescuing measures of postoperative fatal bleeding induced by carotid blowout in head and neck tumors. METHODS: Seven cases with postoperative carotid bleeding treated from October 2003 to August 2009 were reviewed retrospectively. Of the patients, 6 were with common carotid blowout and one with internal carotid artery blowout. All patients underwent pre- or post-operative radiotherapy for primary head and neck tumours and 3 patients had neck defect repair with deltopectoral skin flap, frontal flap or free radial arm flap respectively. After carotid blowout bleeding, the patients were treated in time with X ray transcatheter intervention including transcatheter arterial embolization (TAE) and self-expanding covered stent implantation, followed by repairing the carotid region with appropriate myocutaneous flaps. RESULTS: Of 7 patients with carotid blowout, 5 patients were successfully rescued with X ray transcatheter intervention, of them 2 with self-expanding covered stent implantation and 2 with TAE respectively, and other 2 patients died due to rapid bleeding. Of the successfully rescued patients, 2 patients were with the repair of carotid area by pectoralis major myocutaneous flap, one by submental flap and one by local flap, but another one not with flap repair. Follow-up showed the 3 patients rescued with self-expanding covered stent implantation were survival for 6, 12, and 20 months, respectively, and the 2 patients rescued with TAE died of repeated carotid blowout in 2 and 13 months later, respectively. CONCLUSIONS: The planned and timely X ray transcatheter intervention is an effective method to treat carotid blowout bleeding in the patients underwent head and neck tumour surgeries. Compared with TAE, self-expanding covered stent implantation may be more reliable for restoring the blood supply of head and neck region, with less complications. One-stage repair of carotid region with myocutaneous flap is of great importance to protect the carotid and to promote the wound healing.

[Effects of amlodipine plus telmisartan or amlodipine plus amiloride regimen on blood pressure control in hypertensive patients: preliminary report of Chinese Hypertension Intervention Efficacy (CHIEF) trial].

OBJECTIVE: To evaluate the effects of amlodipine-based antihypertensive combination regimen on blood pressure control and impact on cardiovascular events. METHODS: From Oct. 2007 to Oct. 2008, a total of 13 542 hypertensive patients from 180 centers in China were included in this multi-centre randomized, controlled, blind-endpoint assessment clinical trial. Inclusion criteria were: essential hypertension, 50 - 79 years of age with at least one cardiovascular risk factor and signed consent forms. Patients were randomly assigned to receive low-dose amlodipine + diuretics (group A) or low-dose amlodipine + telmisartan (group T). The primary endpoints are composite of non-fatal stroke/myocardial infarction and cardiovascular death. All patients will be followed-up for 4 years. RESULTS: The characteristics of patients between the two groups were similar: mean age (61.5 +/- 7.7) Yrs with 19% history of cerebrovascular diseases, 12% coronary diseases, 18% diabetes, 42% dyslipidemia, mean initial blood pressure 157/93 mm Hg. After 8-week treatment, mean blood pressure in group A and B were reduced to (133.0 +/- 11.0)/(81.0 +/- 7.6) mm Hg, (132.9 +/- 11.6)/(80.6 +/- 7.9) mm Hg respectively. Blood pressure control rates reached 72.1% and 72.6% in group A and T, respectively. CONCLUSION: Amlodipine-based antihypertensive combination regimens achieved satisfactory blood pressure control rate in patients with essential hypertension in this patient cohort.

Prognostic significance of stomatin-like protein 2 overexpression in laryngeal squamous cell carcinoma: clinical, histologic, and immunohistochemistry analyses with tissue microarray.

Stomatin-like protein 2 (SLP-2) is a novel cancer-related gene whose product promotes cell growth, tumorigenicity, and adhesion in human esophageal squamous cell carcinoma. The purpose of this study was to investigate whether SLP-2 is overexpressed in human laryngeal squamous cell carcinoma (LSCC) and, if so, the significance of its overexpression in relation to clinical parameters. By analyzing 124 cases of LSCC with a tissue microarray, we concluded that SLP-2 is overexpressed in LSCC as compared with the adjacent normal laryngeal epithelium (P = .000) and furthermore that SLP-2 expression correlates with clinical stage. Overexpression can be regarded as a significant prognostic factor, with higher expression being found in lymph node metastasis.

[Result analysis of perioperative radiotherapy and laryngeal preservation in hypopharyngeal and pyriform sinus squamous cell carcinoma].

OBJECTIVE: To evaluate perioperative radiotherapy and laryngeal preservation clinical result of hypopharyngeal pyriform sinus squamous cell carcinoma. METHODS: A retrospective review was undertaken of 134 pyriform sinus squamous cell carcinoma cases who were treated at this institute in Department of Head and Neck Surgery from September 1985 to July 2001. One hundred patients received preoperative radiotherapy and surgery (R + S). Thirty-four patients received surgery and postoperative radiotherapy (S + R). The median follow-up interval was 38.1 months. RESULTS: (R + S) and (S + R) group 3-year and 5-year survival according to Kaplan-Meier were 54.8%, 50.1%; 51.1%, 45.9% respectively, and had no significant differences (all P > .05). The laryngeal function preservation of T1, T2, T3, T4 in (R +S) and (S + R) were 4/5, 3/3; 66.7% (32/48), 6/6; 32.4% (12/37), 0 (0/16); 0 (0/10), 0/9 respectively. T3 stage in (R + S) was good and significant different than in (S + R) (P < 0.05) and laryngeal preservation didn't increase hazard of survival and local recurrence. The two group Pathology( + ,P + ) in specimen margin were 7.0% (7/100); 20.6% (7/34) and had significant difference (P <0. 05). P + in specimen margin and clinical N stage are obvious interrelated in prognosis(P < 0. 05). CONCLUSIONS: Combined therapy (R + S) and (S + R) are equal in treat result. T3 (only paraglottic space is invaded) stage of (R + S) could increase preserved laryngeal ratio if condition is permitted and didn't add hazard. P + in specimen margin could be receded in (R + S) and profit to prognosis and function. Clinical N stage is obvious hazard and is an emphasis in combined therapy.

[Surgical therapy of subglottic carcinoma].

OBJECTIVE: To analyze the clinical characteristics, surgical procedures and correlated prognostic factors of the cases with subglottic carcinoma; to seek for the optimal surgical treatment for the patients suffering from subglottic carcinoma. METHODS: Twenty-four cases with subglottic carcinoma were retrospectively reviewed, the disease-free survival rates of the patients at 3 years were analyzed according to the different T N phases and the surgical modalities. RESULTS: The free-disease survival rate at 3 years was 50.0% (12/24) for 24 cases with subglottic carcinoma. The survival rates of 19 cases with total laryngectomy was 47.4% (9/19), and the survival rates in T2, T3, T4 phases were respectively 1/1, 6/11, 2/7. The survival rates of 5 cases with partial laryngectomy was 3/5, the survival rates in T2, T3 phases were respectively 3/4, 0/1, and the surgical margins were verified to be positive in 2 of 5 cases being performed partial laryngectomy. The metastasis rate of lymph nodes was 33.3% (8/24). The survival rates of patients with N0, N1, N2 disease were respectively 10/16, 1/4, 1/4. The positive lymph nodes were verified in the neck regions of II-VI and superior mediastinum. CONCLUSIONS: Prognoses of the cases with subglottic carcinoma were poor, early treatment could result in good effect. Until now total laryngectomy still the mainly treatment of subglottic carcinoma. Only the patients with earlier subglottic carcinoma are amenable to partial laryngectomy and should be given postoperative irradiation. Lymph node metastasis was a very important prognostic factor. Paratracheal lymph nodes are the sentinel nodes for subglottic carcinoma, and it is reasonable to probe the nodes. Once verifying positive lymph node, the typical neck dissection involving I-VI regions and superior mediastinum should be performed.

[Evaluation of sentinel lymph node in squamous cell carcinoma of the head and neck].

OBJECTIVE: To assess the feasibility of sentinel lymph node (SLN) radiolocalization in stage in head and neck squamous cell carcinoma and to gain insight as to whether the sentinel lymph node could be prognostic of regional micrometastatic disease. METHODS: A prospective trial was made on the application sentinel lymph node radiolocalization in 10 patients with NO squamous cell carcinoma of the head and neck region. For each patient a peritumoral submucosal injection of filtered technetium 99m prepared with dextran colloid (99mTc-DX) was performed immediately. After 30 minutes, focal areas of accumulation corresponding to sentinel lymph nodes (SLN) were marked on the skin surface. The SLN was localized by lymphoscintigraphy and intraoperatively through the intact skin by a hand-held gamma-probe. SLN was defined as the count of lymph node could be detected 4 times more than that of background. Complete neck dissections were performed, and SLNs were identified for later histological evaluation and comparison to the remaining lymphadenectomy specimen. RESULTS: SLN radiolocalization accurately identified one or more SLNs in the ten cases. 3 of 10 cases revealed occult metastatic disease. Therefore the negative metastasis rate was 30% (3/10). The positive rate of SLN and nonsentinel lymph node (NSLN) were 22.7% (5/22) and 0.4% (1/247) respectively. Serial sectioning (SS) and immunohistochemical (IHC) on SLNs would reduce the false-negative rate of sentinel lymph node biopsy (SLNB). There was no instance in which SLN was negative for micrometastatic disease while being positive in a nonsentinel lymph node. CONCLUSIONS: SLN evaluation in NO neck in squamous cell carcinoma of the head and neck is accurately feasible and seems to adequately predict the presence of occult metastasis. Although SLN radiolocalization in head and neck squamous cell carcinoma may potentially reduce the time, cost, and morbidity of regional lymph node management, more experience with technique is required before its role can be determined.