[Changes of cardiac structure and function in pregnant women with different types of hypertensive disorders in pregnancy and their influencing factors].

Objective: To analyze the changes in cardiac structure and function in women with different types of hypertensive disorders in pregnancy (HDP) and explore their influencing factors. Methods: A total of 1 967 pregnant women diagnosed with HDP who delivered at Peking University Third Hospital from January 1, 2014 to April 15, 2022 were included in the study. They were categorized into four groups based on specific HDP diagnoses: gestational hypertension (506 cases, 25.7%), pre-eclampsia (589 cases, 29.9%), pregnancy complicated with chronic hypertension (332 cases, 16.9%) and chronic hypertension with pre-eclampsia (540 cases, 27.5%). Differences in cardiac structure and function among four groups were retrospectively analyzed. Cardiac structure indicators included left atrial diameter (LAD), left atrial area (LAA), right atrial area (RAA), left ventricular end-diastolic diameter (LVEDD), interventricular septal thickness (IVST), left ventricular posterior wall thickness (LVPWT), systolic function indicators included left ventricular ejection fraction (LVEF), lateral systolic mitral annular velocity (Sm), diastolic function indicators included peak early diastolic mitral in flow velocity (E)/peak late diastolic mitral in flow velocity (A), and E/peak early diastolic myocardial velocity of the lateral mitral annulus early diastolic velocity (Em). Influencing factors on cardiac structure and function were analyzed using generalized linear regression. Influencing factors were assessed by generalized linear regression. Results: (1) General clinical data: the differences in age, gestational week at delivery, blood pressure, proportion of diabetes, and length of hospital stay were statistically significant among four different HDP types (all P<0.05). (2) Compared with pregnant women with pregnancy complicated with chronic hypertension, pre-eclampsia, and gestational hypertension, those with chronic hypertension with pre-eclampsia had larger LAD, LAA, RAA and LVEDD (all P<0.001), thicker IVST and LVPWT (all P<0.001), and reduced left ventricular diastolic function (E/A, lateral Em, E/Em) and systolic function (lateral Sm; all P<0.001). Pregnant women with gestational hypertension had the least changes in cardiac structure and function. Compared with pregnant women with pre-eclampsia, those with pregnancy complicated with chronic hypertension had smaller RAA (P<0.001) and lower E/A (P<0.001), with no significant difference in other indicators (all P>0.05). (3) Chronic hypertension with pre-eclampsia, pregnancy complicated with chronic hypertension, and pre-eclampsia were associated with larger LAD, LAA, and LVEDD, and lower lateral Em (all P<0.05). Conclusions: Different types of HDP are associated with distinct changes in cardiac structure and function. Chronic hypertension with pre-eclampsia demonstrates the most pronounced alterations, followed by pre-eclampsia and pregnancy complicated with chronic hypertension, and gestational hypertension showed the least changes.

[Summary of experience with patterning cropped and shaped mesh repair for perineal hernia after abdominoperineal excision in rectal cancer].

Objective: To examine the patterning cropped and shaped mesh repair for perineal hernia after abdominoperineal excision (APE) in rectal cancer. Methods: The clinical data of 8 patients with perineal hernia after APE who accepted surgical treatment in the Department of Hepatopancreatobiliary and Hernia Surgery, the First Affiliated Hospital of Fujian Medical University from March 2017 to December 2022 were retrospectively reviewed. There were 3 males and 5 females, aged (67.6±7.2) years (range: 56 to 76 years). Eight patients developed a perineal mass at (11.3±2.9) months (range: 5 to 13 months) after APE. After surgical separation of adhesion and exposing the pelvic floor defect, a 15 cm×20 cm anti-adhesion mesh was fashioned as a three-dimensional pocket shape to fit the pelvic defect, then fixed to the promontory or sacrum and sutured to the pelvic sidewalls and the anterior peritoneum, while two side slender slings were tailored in front of the mesh and fixed on the pectineal ligament. Results: The repair of their perineal hernias went well, with an operating time of (240.6±48.8) minutes (range: 155 to 300 minutes). Five patients underwent laparotomy, 3 patients tried laparoscopic surgery first and then transferred to laparotomy combined with the perineal approach. Intraoperative bowel injury was observed in 3 patients. All patients did not have an intestinal fistula, bleeding occurred. No reoperation was performed and their preoperative symptoms improved significantly. The postoperative hospital stay was (13.5±2.9) days (range: 7 to 17 days) and two patients had postoperative ileus, which improved after conservative treatment. Two patients had a postoperative perineal hernia sac effusion, one of them underwent placement of a tube to puncture the hernia sac effusion due to infection, and continued irrigation and drainage. The postoperative follow-up was (34.8±14.0) months (range: 13 to 48 months), and 1 patient developed recurrence in the seventh postoperative month, no further surgery was performed. Conclusions: Surgical repair of the perineal hernia after APE can be preferred transabdominal approach, routine application of laparoscopy is not recommended, combined abdominoperineal approach can be considered if necessary. The perineal hernia after APE can be repaired safely and effectively using the described technique of patterning cropped and shaped mesh repair.

Imatinib-induced ophthalmological side-effects in GIST patients are associated with the variations of EGFR, SLC22A1, SLC22A5 and ABCB1.

Imatinib-induced ophthalmological side-effects, including conjunctiva hemorrhage and periorbital oedema, although very common and still remain relatively little understood. The present study investigated the effects of genetic polymorphisms of drug targets and membrane transporters on these side effects. We found that the minor allele of EGFR rs10258429 and SLC22A1 rs683369 were significant risk determinants of conjunctival hemorrhage with OR of 7.061 (95%CI=1.791-27.837, P=0.005 for EGFR rs10258429 CT+TT vs CC), and 4.809 (95%CI=1.267-18.431, P=0.021 for SLC22A1 rs683369 GG+CG vs CC). The minor allele of SLC22A5 rs274558 and ABCB1 rs2235040 were protective factors to periorbital oedema with OR of 0.313 (95%CI=0.149-0.656, P=0.002 for SLC22A5 rs274558 AA+AG vs GG), and 0.253 (95%CI=0.079-0.805, P=0.020 for ABCB1 rs2235040 CT vs CC). These results indicated that variants in EGFR, SLC22A1, SLC22A5 and ABCB1 influenced the incidence of Imatinib-induced ophthalmological toxicities, and polymorphism analyses in associated genes might be beneficial to optimize Imatinib treatment.

[The roles of holothurian glycosaminoglycan combined with cisplatin on proliferation and chemotherapeutic response in A549 human lung adenocarcinoma cell].

Objective: To investigate the effects and mechanism of Holothurian Glycosaminoglycan (hGAG) alone in combination with cisplatin (DDP) on apoptosis of pulmonary adenocarcinoma cell A549. Methods: A549 cells were separately treated with blank, hGAG, DDP and hGAG combined with DDP (hGAG + DDP). The cell morphology in 4 groups was observed using light microscope. CCK8 assay was used to determine the cell viability. Flow cytometry by Hoechst 33258 and AnnexinV-FITC/PI staining was applied to detect cell apoptosis. Western blot was then used to detect the protein expression of Bax, Bcl-2, survivin and caspase-3. Results: After treatment for 24 h, the inhibitory rates of A549 cells in control, hGAG, DDP and hGAG + DDP groups were 0, (19.74±5.39)%, (42.01±2.57)% and (53.89±4.58)%, respectively. Moreover, after treatment for 48 h and 72 h, the inhibitory rates in each group were 0, (23.17±4.78)% and (29.17±4.21 )%, (54.00±7.64)% and (59.35±7.31)%, as well as (77.58±4.26)% and (79.94±4.58)%, respectively. The cell viability was significantly lower in drug treatment groups compared with those in control group at the same time point (P<0.05). Hochest 33258 staining showed that no obvious apoptotic cells were detected in the control group, while apoptotic cells were visible in hGAG, cisplatin and combination groups. Flow cytometry showed that cell apoptotic rates were (2.38±0.59)%, (12.59±4.22)%, (16.36±3.63)% and (44.60±5.45)% in the control, hGAG, DDP and hGAG + DDP groups, respectively. The cell apoptosis was significantly lower in drug treatment groups compared with those in control group at the same time point (P<0.05). Furthermore, western blot results showed that the expression of Bax and caspase-3 protein was increased (P<0.05), whereas Bcl-2 and survivin was decreased (P<0.05) in the hGAG+ DDP group compared with cisplatin alone (P<0.05). Conclusions: HGAG can inhibit the proliferation and promote the apoptosis of human lung adenocarcinoma A549 cells. Meanwhile, it can strengthen the chemosensitivity of A549 cells to DDP via up-regulation of Bax, caspase-3 and down-regulation of Bcl-2 and survivin.

Correlation between the NPPB gene promoter c.-1298 G/T polymorphism site and pulse pressure in the Chinese Han population.

The aim of this study was to investigate the correlation between the natriuretic peptide precursor B (NPPB) gene single nucleotide polymorphism (SNP) c.-1298 G/T and pulse pressure (PP) of the Chinese Han population and the association between genotype and clinical indicators of hypertension. Peripheral blood was collected from 180 unrelated patients with hypertension and 540 healthy volunteers (control group), and DNA was extracted to amplify the 5'-flanking region and 2 exons of the NPPB gene by polymerase chain reaction; the fragment was sequenced after purification. The clinical data of all subjects were recorded, the distribution of the NPPB gene c.-1298 G/T polymorphism was determined, and differences in clinical indicators between the two groups were evaluated. The mean arterial pressure PP, and creatinine levels were significantly higher in the hypertension group than in the control group (P<0.05), but no other clinical indicators differed between the groups. There were no significant differences in genotype frequency and distribution of the NPPB gene c.-1298 G/T polymorphism between the hypertension group and the control group (P>0.05); in the control group, the mean PP of individuals with the SNP c.-1298 GG genotype was greater than that of individuals with the GT+TT genotype (P<0.05). In conclusion, there was no significant correlation between the NPPB gene c.-1298 G/T polymorphism and the incidence of essential hypertension in the Han population; however, the PP of the SNP c.-1298 GG genotype was greater than that of the GT+TT genotype in the control group.

[Characteristics of commercial homosexual behaviors and factors associated with unprotected anal intercourse in men who have sex with men in Fuzhou].

Objective: To understand the commercial homosexual behavior characteristics of men who have sex with men (MSM) and the factors associated with unprotected anal intercourse (UAI) in this population, and provide reference for the development of intervention strategy in MSM. Methods: Men who were aged ≥16 years and had anal sex with men in the past 6 months were recruited through internet in Fuzhou from January to December 2023 for a cross-sectional study with a sample size of 283. Multivariate logistic regression model was used to analyze the factors associated with the incidence of UAI in the past 6 months in MSM. The SPSS 25.0 software was used for statistical analysis. Results: In 4 484 MSM, the proportion of those with commercial homosexual behaviors was 9.59% (430/4 484), the average age was (27.00±9.07) years. In the MSM with commercial homosexual behaviors, 70.00% (301/430) had anal sex in the past one week, and 43.02% (185/430) had anal sex with more than 10 partners in the past 6 months. The proportion of MSM with UAI was 75.58% (325/430) in the past 6 months. The results of multivariate analysis showed showed that in MSM with commercial homosexual behaviors in the past 6 months, compared with those who were students, age >18 years at the first sexual intercourse, had not anal sex in the past one week, and anal sex with less than 10 partners in the past 6 months, the risk for UAI was higher in those who were not students (aOR=1.99,95%CI:1.18-3.36), those who were aged ≤18 years at first sexual intercourse sex (aOR=2.04,95%CI:1.26-3.29), those who had anal sex in the past one week (aOR=2.04,95%CI:1.25-3.33), and those who had anal sex with more than 10 partners in the past 6 months (aOR=1.97,95%CI:1.16-3.35). Conclusions: The risk for UAI was high in MSM with commercial homosexual behaviors in Fuzhou, so it is necessary to improve the awareness of safe sex and promote sex with regular partners and condom use, and preventing drug abuse in MSM.

[Application of closed negative pressure irrigation and suction device in the treatment of high perianal abscess].

Objective: To explore the efficacy of closed negative pressure irrigation and suction device (Patent number: Z200780013509.8) in the treatment of high perianal abscess. Methods: From January 2015 to December 2016, ≥18-year-old patients with primary high perianal abscess who were treated at our department were prospectively enrolled. Exclusion criteria: (1) recurrent perianal abscess; (2) complicated with anal fistula formation; (3) preoperative, intraoperative or postoperative physical therapy, and curettage treatment, negative pressure irrigation; (4) Crohn's disease-related perianal abscess; (5) with immunosuppressive status, such as transplant recipients; (6) co-existence of malignant tumors, such as leukemia; (7) with diabetes; (8) those who could not receive long-term follow-up and were not suitable to participate in this study. According to the random number table method, the patients were randomly divided into negative pressure irrigation and suction group and routine drainage group. All patients were clearly diagnosed and the location and size of the perianal abscess were marked before surgery. These two groups were treated as follows: (1) Negative pressure irrigation and suction group: the skin was incised at a diameter of 1-2 cm at the site where the abscess fluctuated most obviously. After the abscess was removed, a closed negative pressure irrigation and suction device was installed and the pressure of -200 to -100 mmHg (1 mmHg=0.133 kPa) was maintained to keep the abscess cavity collapsed. Generally, the irrigation was stopped 5 days later or when the drainage was clear. The closed vacuum suction was maintained for 2 additional days, before the wound was sutured. (2) Conventional drainage group: conventional incision and drainage was carried out. The skin was cut at a diameter of 8 to 10 cm at the site of abscess with most obvious fluctuation. After the abscess was removed, normal saline gauze was used for dressing. Dressing was changed regularly until the wound healed. The efficacy, operative time, intraoperative bleeding, incision length, frequency of dressing change, pain index (visual analogue score, VAS score), postoperative healing time, complications, recurrence rate of perianal abscess, anal fistula formation rate were observed. The t test and χ2 test were used for comparison between the 2 groups. Results: There were both 40 patients in the negative pressure irrigation and suction group and the conventional drainage group. There were 28 males and 12 females in negative pressure irrigation and suction group with a mean age of (38.3±12.0) years and mean disease course of (6.6±2.1) days. The abscess in pelvic-rectal space accounted for 50.0% (20/40) and the mean diameter of abscess was (8.0±3.7) cm. There were 26 males and 14 females in the conventional drainage group with a mean age of (37.1±11.8) years and mean disease course of (6.4±2.5) days. The abscess in pelvic-rectal space accounted for 55.0% (22/40) and the diameter of abscess was (8.2±3.5) cm. The differences in baseline data between two groups were not statistically significant (all P>0.05). Both groups successfully completed the operation. There was no significant difference in operative time between two groups (P>0.05). As compared to conventional drainage group, intraoperative blood loss in negative pressure irrigation and suction group was less [(12.1±5.5) ml vs. (18.3±4.4) ml, t=5.606, P<0.001], incision length was shorter [(2.3±0.8) cm vs. (7.6±1.7) cm, t=17.741, P<0.001], postoperative VAS pain scores at 1-, 3-, 7-, and 14-day after operation were lower [3.7±1.4 vs. 7.6±1.8, t=10.816, P<0.001; 3.0±1.3 vs. 6.8±1.6, t=11.657, P<0.001; 2.7±0.9 vs. 5.1±1.1, t=10.679, P<0.001; 1.2±0.3 vs. 1.6±0.4, t=5.060, P=0.019], the dressing change within 7 days after operation was less (3.5±1.2 vs. 12.6±2.7, t=19.478, P<0.001), postoperative healing time was shorter [(10.4±3.0) d vs. (13.5±3.8) d, t=4.049, P<0.001] and postoperative complication rate was lower [17.5% (7/40) vs. 2.5% (1/40), χ2=5.000, P=0.025]. During follow-up of 12 to 36 (24±5) months, the recurrence rate of perianal abscess within 1 year after operation and anal fistula formation rate in negative pressure irrigation and suction group were lower than those in conventional drainage group [5.0% (2/40) vs. 20.0% (8/40), χ2=4.114, P=0.042 and 2.5% (1/40) vs. 17.5% (7/40), χ2=5.000, P=0.025, respectirely]. The one-time cure rate of negative pressure irrigation and suction group and conventional drainage group was 92.5% (37/40) and 62.5%(25/40), respectirely (χ2=10.323, P=0.001). Conclusions: The application of the negative pressure irrigation and suction device in the treatment of high perianal abscess can improve the efficiency of one-time cure, reduce postoperative pain, accelerate healing time, decrease the morbidity of postoperative complication and the rates of abscess recurrence and anal fistula formation, indicating an improvement of the treatment.

Detection of let-7a microRNA by real-time PCR in colorectal cancer: a single-centre experience from China.

Colorectal cancer, a heterogeneous disease arising from a complex series of molecular changes, is one of the world's leading causes of cancer deaths. MicroRNAs (miRNAs), an extensive class of small non-coding RNAs, have been implicated in cancer development and progression. One of the first miRNAs to be identified was let-7 miRNA, which has recently been found to be expressed at reduced levels in human lung cancer cells. We used a rapid stem-loop reverse transcription polymerase chain reaction method to quantify human let-7a miRNA expression in samples of human colorectal cancer. This method was able to detect let-7a miRNA in as little as 0.05 ng of total RNA from colorectal mucosa and its specificity was high (100%). Our results showed that the expression of let-7a miRNA was considerably reduced in two of eight patients. To our knowledge, this is the first study of Chinese patients to show reduced expression of endogenous let-7 miRNA in colorectal cancer.

Distribution of type A and type B EBV in normal individuals and patients with head and neck carcinomas in Taiwan.

The subtypes of Epstein-Barr virus (EBV) according to the EBNA 2 gene were investigated in Taiwan by the polymerase chain reaction (PCR) and by Southern blot hybridization. The materials included 53 nasopharyngeal carcinoma (NPC) biopsies, 49 other head and neck cancers and 32 throat washings of normal individuals. EBV DNA was found in all NPC biopsies, 27 of 49 other head and neck carcinomas and 81% of normal individuals. Type A EBV was the predominant type of EBV in both normal individuals and patients with head and neck carcinomas in Taiwan. Type B EBV or coexistence of the A and B types comprised a small number of samples in this study.

Polymorphic reticulosis: a malignant lymphoma of B-cell lineage.

Whether the pathogenesis of polymorphic reticulosis is from T cells, B cells, or histiocytes has been controversial. In this study, the Southern blot hybridization technique was used to analyze immunoglobulin and T-cell receptor beta-chain genes and to perform the conventional surface marker analysis in two patients with polymorphic reticulosis. The immunophenotype demonstrated the presence of predominantly mature, activated T-lymphocytes, minimal B-cells, and no natural killer cells or monocytes/granulocytes. The mature T-cell phenotype could be due to either inflammatory infiltrates or neoplastic cells of peripheral T-cell type, because the two coexist in polymorphic reticulosis tumors. The value of surface marker examination is limited in the analysis of PMR tumors. However, genetic analysis revealed that only Ig genes were rearranged, with no rearrangement of the TCR beta gene. Rearrangement of immunoglobulin genes occurs in B-lineage lymphoid neoplasms and is thought to be a criterion for diagnosis of lymphoid neoplasms. Based on genetic analysis and clinicopathologic information, this study concluded that polymorphic reticulosis is a malignant lymphoma of B-cell lineage.

Nasopharyngeal carcinoma with bone marrow metastasis.

Five of 23 patients with recurrent nasopharyngeal carcinoma (NPC) were diagnosed to have bone marrow metastasis. They all had advanced local-regional disease, and were treated with neoadjuvant chemotherapy and definitive radiotherapy after the initial diagnosis. Bone marrow metastasis developed 4-24 months later. The clinical features were anemia (5 of 5), leukopenia (3 of 5), thrombocytopenia (4 of 5), sepsis (3 of 5), tenderness of the sternum (3 of 5), and fever (4 of 5). Patients frequently had elevation of serum lactic dehydrogenase (LDH), alkaline phosphatase (ALK-P), and IgG and IgA antibody titers to Epstein-Barr viral capsid antigen when bone marrow involvement was diagnosed. However, clinical manifestations and laboratory tests were not specific. It is important that three patients had normal bone scans. All five patients had a rapid downhill course; four patients died within 23 days, and the fifth 3 months after the diagnosis of bone marrow metastasis. We concluded that bone marrow was a common metastatic site in NPC patients. Bone marrow metastasis adversely affected patients' survival and required a high index of suspicion for diagnosis. We suggested that bone marrow biopsy should be considered as a routine staging procedure in NPC patients and indicated especially when patients presented with abnormal blood counts, sepsis, bone pain, or tenderness of the sternum. It may be positive in the face of a normal bone scan.

[Changes in calcium and water content of stunned myocardium and effects of hyperosmotic mannitol in rat heart].

In this study we investigated changes in myocardial electrolytes and water contents following 20 min of global ischemia and 40 min reperfusion in isolated rat hearts perfused by Langendorff procedure. After ischemia and reperfusion, calcium and water contents in myocardium increased by 42% (P less than 0.01) and 7.6% (P less than 0.05) respectively as compared with nonischemic myocardium, but sodium, potassium and magnesium in myocardial tissue did not change significantly (P greater than 0.05). When hyperosmotic mannitol (12%) was infused at the beginning of reperfusion and persisted for 25 min, postischemic left ventricular function was improved significantly. At 40 min of reperfusion, heart rate-left ventricular pressure product, an index of ventricular function, recovered to 85% of preischemia, and only 66.3% recovery was seen in postischemic heart without mannitol (P less than 0.01). In addition, hyperosmotic mannitol caused marked decreases in myocardial calcium, water and other cations, suggesting that nonspecific sarcolemmal permeability changes induced by ischemia/reperfusion probably is one of entry routes of calcium into the cell. We conclude that calcium overload with mild myocardial edema is involved in myocardial stunning and hyperosmotic mannitol can improve the function of stunned myocardium in isolated rat heart, which is, at least partially, due to the reduction of myocardial calcium overload and swelling.

[New techniques of cultivating Ganoderma lucidum (W. Curt.:Fr)Karst.,Rev. with woodlog].

Imitating wild cultivation of Ganoderma lucidum with short-woodlog is a method of cultivating artificial G. lucidum developed in recent years. The method can be applied to large scale production. This paper shows that section-inoculating and impregnating with steamed shortwoodlog indoors and soil-cover cultivating under large shed are important in the cultivation.

Impact of a novel mutation in the 5'-flanking region of natriuretic peptide precursor B gene on the antihypertensive effects of sodium nitroprusside in patients with hypertension.

Our aim was to identify the possible mutations of the natriuretic peptide precursor B (NPPB) gene in a family with hereditary hypertension, and determine whether the mutations are associated with the antihypertensive effect of sodium nitroprusside. The subjects included one family with hereditary hypertension, 36 cases of sporadic hypertension and 120 healthy controls. The 5'-flanking sequence of NPPB was amplified with PCR, and the presence of mutations was analyzed by direct sequencing. Patients with hypertension were treated with sodium nitroprusside and blood pressure data and serum B-type natriuretic peptide (BNP) levels were measured. A novel complex mutation in 5'-flanking sequence of the NPPB gene was detected in three patients (II 2, III 2, and III 5) of the hypertension family, which included c.-1195_ -1176 insert 5'-CCTTCTTTCTTTCTTTCTTT-3', c.-1208 T>A, c.-1214 T>C, and c.-1216 T>A. Patients with this mutation were less sensitive to sodium nitroprusside treatment. Sporadic hypertension patients (without NPPB gene mutation) and patients with the c.-1181 T>A point mutation were sensitive to sodium nitroprusside treatment. BNP levels of patients with the complex mutation were significantly lower than that of sporadic hypertension patients and c.-1181 T>A mutation patients before and during the early stage of sodium nitroprusside treatment. The complex mutation of the NPPB gene might be an etiological factor of hereditary malignant hypertension, and it is associated with low sensitivity to the antihypertensive effect of sodium nitroprusside.

Bilateral superficial cervical plexus block reduces postoperative nausea and vomiting and early postoperative pain after thyroidectomy.

OBJECTIVE: To compare the incidence of postoperative nausea and vomiting (PONV) and postoperative pain in thyroidectomy patients undergoing general anaesthesia, with or without bilateral superficial cervical plexus block (BSCPB). METHODS: In this prospective, randomized, double-blind study, adult patients scheduled for thyroid surgery under general anaesthesia were randomized to receive BSCPB with 20 ml 0.5% ropivacaine (ropivacaine group) or placebo (20 ml saline; saline group) before surgery. The incidence of PONV and postoperative pain, and the need for rescue antiemetics were assessed at 0-24 h postoperatively. RESULTS: Data from 135 patients were evaluated and the incidence of PONV, the need for rescue antiemetics and the number of patients needing additional perioperative pain relief in the postanaesthetic care unit were significantly lower in the ropivacaine group compared with the saline group. Early postoperative (0-8 h) visual analogue scale pain scores were significantly lower in the ropivacaine group compared with the saline group. CONCLUSIONS: BSCPB with 0.5% ropivacaine administered before surgery can significantly reduce the incidence of PONV and early postoperative pain and also reduce perioperative opioid requirements in thyroidectomy patients undergoing general anaesthesia.

Nasopharyngeal angiofibroma.

BACKGROUND: Nasopharyngeal angiofibromas are uncommon neoplasms, which are histologically benign but locally invasive and destructive. They mostly affect the nose and nasopharynx, but may extend to the adjacent structures. The first choice of treatment is surgery. This paper presents our experience in the management of nasopharyngeal angiofibroma. METHODS: We retrospectively reviewed 13 patients of nasopharyngeal angiofibroma attending the Department of Otorhinolaryngology at Taipei Veterans General Hospital (VGH-TPE) from 1979 to 1999. Two patients recurred after surgery at other hospitals and were excluded from this study. Eleven patients underwent the primary surgery and were included for statistical analysis. The relationship between preoperative embolization and intraoperative effective blood loss (EBL) was also discussed. RESULTS: The incidence was about 1 per 5,000 otorhinolaryngology admissions. The ratio of female to male was 1 to 10. The median age of symptom onset was 18 years. There were 7, 3 and 1 patients in IA, IB and IIA stages of Sessions' classification. Seven patients underwent preoperative embolization. One patient was treated with stilbestrol preoperatively. Of the surgical procedures, transpalatal approach was the most often performed (8/11). Postoperative radiotherapy (1,000 cGy) was administered to 1 patient due to the suspected residual tumor. The average intraoperative EBL was 731.8 ml. Patients with preoperative embolization had an average EBL of 814.3 ml and those without embolization had an average EBL of 587.5 ml. The difference of EBL between the patients with and without preoperative embolization was not statistically significant. The average follow-up duration was 118.4 months and no tumor recurred. CONCLUSIONS: Surgery is the main therapeutic option for nasopharyngeal angiofibroma. We suggest preoperative embolization. Radiotherapy is an adjuvant treatment and reserved for the patients with advanced stage or recurrent tumors.

[The clinical application of distally based neurocutaneous flaps by anastomosis of superficial veins].

OBJECTIVE: To investigate the clinical results of the distally based neurocutaneous flap by anastomosis of superficial veins. METHODS: From June 1996, 19 cases with composite skin defects of the distal part of limb were repaired by the transposition of distally based neurocutaneous flaps, including traumatic defect in 10 cases, chronic ulcer in 3 cases, scar contracture in 6 cases. The distally based sural neurocutaneous flaps were used in 9 cases, the reverse-flow saphenous neurocutaneous island flaps were used in 2 cases, and the retrograde neurocutaneous island flaps of the forearm were used in 8 cases. The flap area ranged from 15 x 24 cm to 4 x 6 cm, the pedicle of the flap ranged from 6 cm to 15 cm in length. The superficial vein of the flap were anastomosed with the subcutaneous superficial vein of the recipient site to improve the venous drainage. RESULTS: The composite flap survived completely in 17 cases. One cases with retrograde-flow forearm neurocutaneous flap and another case with reversed sural neurocutaneous flap were partially survived because of thrombosis in anastomosed veins postoperatively. Sixteen cases were followed-up for 6 to 24 months, the color and texture of the flap were excellent, the protective sensation were recovered, the configuration and function were satisfactory. CONCLUSION: Anastomosis of superficial veins of the composite flaps with the subcutaneous superficial veins of the recipient site can significantly improve the venous drainage, enlarge the survival area of the flap and the reparable area.

Inverted papilloma.

BACKGROUND: Inverted papilloma, a benign sinonasal lesion, constitutes 0.5% to 4% of all nasal tumors. Its local aggressiveness, high recurrence rate, association with malignancy or malignant transformation, and tendency toward multicentricity lead most physicians to advocate radical surgery. Nonetheless, conservative surgery is effective for selected patients with limited disease. This study was done to reassess the efficacy of both radical and conservative surgery. METHODS: The records of all patients with the diagnosis of inverted papilloma treated at the Taipei Veterans General Hospital between January 1986 and October 1998 were collected. A minimal follow-up period of 12 months was required for inclusion in the study. Clinical manifestations, radiologic findings, methods of treatment, pathology reports and recurrence rates were all retrospectively reviewed. RESULTS: Sixty patients with an average age at diagnosis of 58 years were studied. The follow-up period ranged from 12 to 195 months, with a mean of 43 months. The most common presenting symptom was unilateral nasal obstruction. The duration of symptoms ranged from one month to 30 years, with a mean of 36 months. The lateral wall and middle meatus were the most commonly involved sites. Bone erosion and intracranial or intraorbital extension were observed in some patients. Medial maxillectomy was the most common surgical treatment, followed by functional endoscopic sinus surgery and the Caldwell-Luc operation. The overall recurrence rate was 23%, with an average interval from initial treatment to recurrence of 42 months (range, 2-93 months). The recurrence rates for the two groups undergoing medial maxillectomy and conservative surgery were 16% and 27%, respectively. CONCLUSIONS: Early diagnosis relies on high suspicion and biopsy. The treatment modality is related to the location and extent of the disease, which is assessed by preoperative imaging studies. Any tumor with extensive involvement of the sinuses or inaccessibility to the endoscope should be treated with traditional medial maxillectomy for best control. The endoscopic technique is good for preoperative biopsy and follow-up.

Predicting the probability of malignancy of the neck mass with logistic regression model: a statistical analysis of excisional biopsy of neck masses.

One hundred and fifty-six patients with neck lesions were selected into this retrospective study between January, 1989 and December, 1990. All the patients visited OPD with the chief complaint of neck mass without other apparent symptoms and signs after initial work-up. They can be divided into 5 types according to the pathological reports: type a) metastatic lesion, type b) malignant lymphoma, type c) TB lymphadenitis, type d) miscellaneous benign lesion, and type e) inadequate specimen. They represent 24.4%, 12.8%, 9.6%, 52.6%, and 0.6% of the patients respectively. Type a) and type b) were classified as group of malignancy and the other three types were group of benignancy. Chi-square test and t-test were then used to evaluate the significant level of difference in each semiological factor between both groups. Several parameters were found to reach significant level, including tumor fixation, age of the patients, tenderness, location and size of the tumor, and history of cancer. Stepwise logistic regression was utilized to obtain a regression equation to predict the probability of malignancy in OPD patients with neck masses. The accuracy rate of prediction is 83.3%, if the cutpoint value is 0.5. A clinician can therefore avoid untimely excisional biopsy and delay in treatment planning.

[Function endoscopic sinus surgery in children].

Sinusitis is commonly seen in children. There is evidence that both acute and chronic sinusitis in children is a dynamic, multifactorial disease. Generally most patients will be cured by medical treatment. Surgery is indicated when medical treatment fails. Functional endoscopic sinus surgery (FESS), the procedure of ostiomeatal reconstruction, had become a popular surgical treatment for sinus diseases in the world. We collected 22 children with chronic sinusitis who received FESS between June, 1990 and September, 1991. The children's age ranged from 6 to 16 years. Postoperative follow-up was from 3 to 18 months. All patients tolerated the procedure well, and there were no major complications. Synechia between the middle turbinate and lateral nasal wall occurred in 47% children. Fair results were obtained in 86% patients. Well-trained functional endoscopic sinus surgery is a safe procedure and benefits in treatment of pediatric sinusitis.