The long-term impact of expansion sphincter pharyngoplasty treatment on blood pressure control and health-related quality of life in patients with obstructive sleep apnea and hypertension.

PURPOSE: To assess how expansion sphincter pharyngoplasty (ESP) impacts blood pressure (BP) and health-related quality of life (HRQOL) in hypertensive patients with obstructive sleep apnea (OSA). METHODS: Patients were separated into two groups based upon whether or not they adhered to antihypertensive drug regimens. Patients underwent 24-h ambulatory BP monitoring before and at 6 months post-ESP, while clinical BP measurements and HRQOL questionnaires (SF-36) were conducted over the course of 24 months post-surgery. RESULTS: We enrolled 62 patients, with 25 and 37 in the medicated and non-medicated groups, respectively. Mean 24-h BP differed significantly, with systolic and diastolic BP (SBP and DBP) decreases of 5.3 mmHg and 2.5 mmHg, respectively (P <0.01). Mean 24-h SBP and DBP decreases in the medicated group were 10.2 mmHg and 4.6 mmHg, respectively (P < 0.001), with significant decreases during the daytime of 8.6 mmHg, 3.0 mmHg, and nighttime of 12.3 mmHg, 7.7 mmHg (P <0.001). In the non-medicated treatment group, 24-h SBP and DBP decreases were 1.9 mmHg and 1.1 mmHg (P < 0.005) with significant decreases in mean nighttime BP values of 3.2 mmHg and 1.9 mmHg (P < 0.001). While pre- and postoperative SF-36 results differed significantly, no differences were observed between the two groups. CONCLUSION: ESP decreases BP and improves HRQOL in OSA patients with hypertension, particularly in combination with antihypertensive drugs.

[Quantitative Analysis for Levocetirizine Hydrochloride Tablets Based on NIR Spectroscopy].

The aim of this study was to develop a quantitative analytical method to measure the effective components in the left cetirizine hydrochloride tablets using near infrared spectroscopy combining with a partial least square (PLS) analysis model. The method was internal cross-validated to determine the best wavelength range, spectral preprocessing methods and the optimal number of principal components. The concentration of validation set samples was predictable by PLS model. The RMSECV value was 0.276, and the R(2) value was 0.974. Our study suggests that this model can be used for rapid quantitative analysis of left cetirizine hydrochloride tablets from different manufacturers.

Narrow-Band Imaging in Head and Neck Carcinomas: A Systematic Review and Meta-Analysis.

OBJECTIVE: The purpose of this study was to assess the diagnostic performance of narrow-band imaging (NBI) in monitoring patients with head and neck carcinomas posttreatment and to compare it with that of white light endoscopy (WLE). DATA SOURCES: PubMed, Embase, Web of Science (WOS), Cochrane Library, China Biology Medicine disc (CBM disc), China National Knowledge Internet (CNKI), Wanfang Data, China Science and Technology Journal Database (CSTJ), Chinese Clinical Trial Register. REVIEW METHODS: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), literature published before July 2024 was searched. Patients who underwent surgery, radiotherapy (RT), or chemo-RT for head and neck carcinomas with posttreatment follow-up using NBI were analyzed. The main outcomes were sensitivity, specificity, and diagnostic odds ratio (DOR) for NBI and WLE in posttreatment follow-up. RESULTS: The sensitivity, specificity, and DOR for NBI and WLE in posttreatment follow-up for head and neck carcinomas were 95% (95% confidence interval [CI]: 88%-98%), 96% (95% CI: 92%-98%), 433 (95% CI: 120-1560) and 72% (95% CI: 49%-87%), 72% (95% CI: 4%-99%), 7 (95% CI: 0-191). Additionally, the area under the curve (AUC) values for NBI and WLE were 0.99 (95% CI: 0.97-0.99) and 0.75 (95% CI: 0.71-0.79), respectively. The number of lesions and patients, treatment modality, follow-up time, disease, and endoscopic system might be sources of heterogeneity. CONCLUSION: Compared to WLE, NBI demonstrated superior diagnostic performance in follow-up patients with head and neck carcinoma posttreatment. NBI offers technical support and a clinical foundation for early detection of head and neck carcinoma recurrence. LEVEL OF EVIDENCE: NA Laryngoscope, 2024.

Comparison of learning curves and related postoperative indicators between endoscopic and robotic thyroidectomy: a systematic review and meta-analysis.

BACKGROUD: Endoscopic thyroidectomy (ET) and robotic thyroidectomy (RT) yield similar perioperative outcomes. This study investigated how the learning curve (LC) affects perioperative outcomes between ET and RT, identifying factors that influence the LC. MATERIALS AND METHODS: Two researchers individually searched PubMed, EMBASE, Web of Science, and Cochrane Library for relevant studies published until February 2024. The Newcastle-Ottawa Scale assessed study quality. Random effects model was used to compute the odds ratio and weighted mean difference (WMD). Poisson regression comparison of the number of surgeries (NLC) was required for ET and RT to reach the stable stage of the LC. Heterogeneity was measured using Cochran's Q. Publication bias was tested using funnel plots, and sensitivity analysis assessed findings robustness. Subgroup analysis was done by operation type and patient characteristics. RESULTS: This meta-analysis involved 33 studies. The drainage volume of ET was higher than that of RT (WMD=-17.56 [30.22, -4.49]). After reaching the NLC, the operation time of ET and RT was shortened (ET: WMD=28.15[18.04, 38.26]; RT: WMD=38.53[29.20, 47.86]). Other perioperative outcomes also improved to varying degrees. Notably, RT showed more refined central lymph node resection(5.67 vs. 4.71), less intraoperative bleeding (16.56 mL vs. 42.30 mL), and incidence of transient recurrent laryngeal nerve injury(24.59 vs. 26.77). The NLC of RT was smaller than that of ET(Incidence-rate ratios [IRR]=0.64[0.57, 0.72]). CUSUM analysis (ET: IRR=0.84[0.72, 0.99]; RT: IRR=0.55[0.44, 0.69]) or a smaller number of respondents (ET: IRR=0.26[0.15, 0.46]; RT: IRR=0.51[0.41, 0.63]) was associated with smaller NLC. In RT, transoral approach (IRR=2.73[1.96, 4.50]; IRR=2.48[1.61, 3.84]) and retroauricular approach (RAA) (IRR=2.13[1.26, 3.60]; IRR=1.78[1.04, 3.05]) had smaller NLC compared to bilateral axillo-breast and transaxillary approach (TAA). In ET, the NLC of RAA was smaller than that of TAA (IRR=1.61[1.04, 2.51]), breast approach(IRR=1.67[1.06, 2.64]), and subclavian approach(IRR=1.80[1.03, 3.14]). CONCLUSIONS: Rich surgical experience can improve surgical results of ET and RT. After reaching the NLC, the perioperative outcomes of RT are better than those of ET. Study subjects, surgical approaches, and analysis methods can affect NLC.

Incidence and prognosis of olfactory and gustatory dysfunctions related to SARS-CoV-2 Omicron strain infection in China: A national multicenter survey of 35,566 individuals.

Objective: This cross-sectional study aimed to determine the epidemiology of olfactory and gustatory dysfunctions related to COVID-19 in China. Methods: This study was conducted by 45 tertiary Grade-A hospitals in China. Online and offline questionnaire data were obtained from patients infected with COVID-19 between December 28, 2022, and February 21, 2023. The collected information included basic demographics, medical history, smoking and drinking history, vaccination history, changes in olfactory and gustatory functions before and after infection, and other postinfection symptoms, as well as the duration and improvement status of olfactory and gustatory disorders. Results: Complete questionnaires were obtained from 35,566 subjects. The overall incidence of olfactory and taste dysfunction was 67.75%. Being female or being a cigarette smoker increased the likelihood of developing olfactory and taste dysfunction. Having received four doses of the vaccine or having good oral health or being a alcohol drinker decreased the risk of such dysfunction. Before infection, the average olfactory and taste VAS scores were 8.41 and 8.51, respectively; after infection, they decreased to 3.69 and 4.29 and recovered to 5.83 and 6.55 by the time of the survey. The median duration of dysosmia and dysgeusia was 15 and 12 days, respectively, with 0.5% of patients having symptoms lasting for more than 28 days. The overall self-reported improvement rate was 59.16%. Recovery was higher in males, never smokers, those who received two or three vaccine doses, and those that had never experienced dental health issues, or chronic accompanying symptoms. Conclusions: The incidence of dysosmia and dysgeusia following infection with the SARS-CoV-2 virus is high in China. Incidence and prognosis are influenced by several factors, including sex, SARS-CoV-2 vaccination, history of head-facial trauma, nasal and oral health status, smoking and drinking history, and the persistence of accompanying symptoms.

USP9X expression is functionally related to laryngeal cancer.

An increasing number of studies have shown that USP9X is closely related to cancer. However, its role in carcinogenesis and progression of laryngeal cancer has not yet been investigated. In this study, we found that USP9X was upregulated in laryngeal cancer tissues. The expression of USP9X was significantly correlated with degree of laryngeal cancer differentiation and lymphatic metastasis. USP9X knockdown led to a decrease in the ability of proliferation, migration, and invasion of FaDu cells. The proportion of FaDu apoptotic cells increased by interfering with the endogenous expression of USP9X. We speculated that inhibiting USP9X might induce apoptosis in FaDu cells by downregulating Mcl-1 and upregulating Bax protein expression. Our findings for the first time suggest the expression level and trend of USP9X in laryngeal cancer tissue and USP9X may plays an important role in promoting the occurrence and progression of laryngeal cancer. USP9X may be a potential target for intervention in treatment of laryngeal cancer.

Global, regional, and national prevalence of hearing loss from 1990 to 2019: A trend and health inequality analyses based on the Global Burden of Disease Study 2019.

As a severe public health issue, hearing loss has caused an increasingly disease burden, especially in the elderly population. Hearing loss may inevitably induce asymmetric hearing, which makes it difficult for elderly individuals to locate sound sources, therefore resulting in increased postural instability and falling risk. To emphasize the public health emergence of hearing loss, we investigated the temporal trend of prevalence of hearing loss over the last 30 years and further predicted its changes in the next 20 years, decomposed the trend according to demographic factors and epidemiological changes, and quantified the cross-country healthy inequalities, using the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. In 2019, there were more than 140 million cases of hearing loss worldwide, a 93.89% increase from 70 million cases in 1990. The age-standardized rate (ASR) also increased with an estimated annual percentage change of 0.08% per year. Population growth and aging are the major drivers contributing to the changes, accounting for 60.83% and 35.35%. Of note, the contribution of aging varies showing a gradual increasing trend with sociodemographic index (SDI) elevating. Also notable, there were significant health inequalities across 204 countries and territories, with slope index of inequality rising over time. Projection of the global burden of hearing loss from 2020 to 2040 indicated progressive increases in both case number and ASR. These reflect the heavy disease burden of hearing loss that needed more targeted and efficient strategies in its prevention and management.

Effectiveness of the recurrent laryngeal nerve monitoring during endoscopic thyroid surgery: systematic review and meta-analysis.

BACKGROUND: Thyroid disease is a common endocrine disorder, and thyroid surgeries and postoperative complications have increased recently. This study aimed to explore the effectiveness of intraoperative nerve monitoring (IONM) in endoscopic thyroid surgery using subgroup analysis and determine confounding factors. MATERIALS AND METHODS: Two researchers individually searched for relevant studies published till November 2022 in the PubMed, Embase, Web of Science and Cochrane Library databases. Eventually, eight studies met the inclusion criteria. Heterogeneity was assessed using the Cochran's Q test, and a funnel plot was implemented to evaluate publication bias. The odds ratio or risk difference were calculated using fixed-effects models. The weighted mean difference of continuous variables was calculated. Subgroup analysis was performed according to the disease type. RESULTS: Eight eligible papers included 915 patients and 1242 exposed nerves. The frequencies of transient, permanent and total recurrent laryngeal nerve (RLN) palsy were 2.64, 0.19 and 2.83%, respectively, in the IONM group and 6.15, 0.75 and 6.90%, respectively, in the conventional exposure group. In addition, analysis of the secondary outcome indicators for the average total length of surgery, localisation time of the RLN, recognition rate of the superior laryngeal nerve and length of incision revealed that IONM reduced the localisation time of the RLN and increased the identification rate of the superior laryngeal nerve. Subgroup analysis showed that IONM significantly reduced the incidence of RLN palsy in patients with malignancies. CONCLUSIONS: The use of IONM significantly reduced the incidence of transient RLN palsy during endoscopic thyroid surgery, but it did not significantly reduce the incidence of permanent RLN palsy. However, the reduction in the total RLN palsy was statistically significant. In addition, IONM can effectively reduce the location time of the RLN and increase the recognition rate of the superior laryngeal nerve. Therefore, the application of IONM for malignant tumours is recommended.

The complete mitochondrial DNA sequence of Yimeng wool rabbit.

Yimeng wool rabbit is a national breed of geographical indication in China. The complete mitochondrial genome sequence of Yimeng wool rabbit was first determined in this study (Accession number MN296708). The mitogenome (16,740 bp) consists of 22 tRNA genes, 2 ribosomal RNA genes, 13 protein-coding genes, and 1 control region (D-loop region). The complete mitochondrial genome sequence of the Yimeng wool rabbit enriches data resource for further study in genetic mechanism and classification.

A clinical study of microcirculatory disturbance in Chinese patients with sudden deafness.

CONCLUSION: Cochlear microcirculation disturbance is closely associated with sudden deafness. OBJECTIVES: To investigate the relationship between cochlear microcirculation and sudden deafness. SUBJECTS AND METHODS: Clinical laboratory parameters (clinical chemistry, hemorheology, hematology, and hemostasis determinations) were studied in 86 patients with sudden deafness and 30 healthy control subjects. RESULTS: The levels of total cholesterol (TCH), triglyceride (TG), and lipoprotein A were significantly higher in patients with sudden deafness than in control subjects. Plasma viscosity, ratio viscosity of whole blood, reduced viscosity of whole blood, high and low shear relative viscosity of whole blood, index of red blood cells transmutation, and fibrinogen level in the plasma of patients with sudden sensorineural hearing loss (SSNHL) were also significantly elevated in comparison with those in control subjects. White-collar workers with psychological and behavioral abnormalities tend to suffer from sudden deafness.

Artemin promotes proliferation and metastasis in human laryngeal squamous cell carcinoma.

Laryngeal squamous cell carcinoma (LSCC) is the main type of human laryngeal cancer which is one of the most common malignant head and neck tumors and the outcomes of LSCC patients are always poor. The intrinsic molecular mechanisms in initiation, development, growth and metastasis of LSCC remain unclear. Further researches are necessary and urgent. In this article, we examined artemin (ARTN) promoted both cell proliferation and metastasis of human LSCC cells Hep-2 by siRNA mediated ARTN knocking down using MTT assay, cell migration assay and cell invasion assay. Moreover, we examined the expression level of ARTN in LSCC tissues was much higher than that in benign laryngeal polyp tissues. In addition, ARTN was identified as a direct target of miR-223 and miR-223 suppressed the expression of ARTN in LSCC cells. Supplement to our former study, we demonstrated ARTN was oncogenic both in vitro and in clinical tissues. As a result, ARTN could be used as a potential therapeutic target for human LSCC.

The positive clinical therapeutically effects of Escin on advanced thyroid cancer.

The incidences of thyroid cancer keep rising worldwide over the past few decades. Although most thyroid cancers are indolent and highly curable, the treatment for advanced thyroid cancer remains challengeable in clinical practice. We performed two separate cohorts to evaluate the safety and efficiency of Escin in patients with advanced thyroid cancer . In cohort 1, 120 patients were divided into four groups equally and were administrated with placebo or different dosages of Escin. The pharmacokinetics of Escin and the side effects were evaluated. In cohort 2, 120 patients were treated with Escin. Several biomarkers related to the progression of thyroid cancer were evaluated. Kaplan-Meier (KM) analyses were performed to evaluate progression-free survival (PFS) and overall survival (OS). The serum Escin concentrations were stable during the treatment. Escin (0.6 mg/kg/day for 9 days, intravenous injection) was tolerable for patients with thyroid cancer . Escin significantly reduced the serum levels of TSH, TgAb, Tg, and calcitonin and prolonged the PFS and OS for patients with advanced thyroid cancer. This study showed Escin is efficient and well tolerated in patients with advanced thyroid cancer. Future studies are needed to investigate the mechanism of Escin on thyroid cancer and the proper dosage of Escin clinically.

[Differential expression of the epithelial membrane protein 1 of laryngeal carcinoma].

OBJECTIVE: In order to explore pathogenic mechanism of laryngeal carcinoma, the involved genes were identified in larynx carcinogenesis by comparing the gene expression profile in matched primary normal epithelial cells and primary laryngeal carcinoma cells from the same patients. METHODS: A cDNA microarray analysis consisting of 11,431 human genes revealed significant changes in the expression of 35 genes, with 8 genes being up-regulated and 27 being down-regulated. The epithelial membrane protein-1 (EMP-1) is one of the down-regulated genes. EMP-1 expression in various kinds of laryngeal carcinoma was determined by semi-quantitative reverse transcriptase polymerase chain reaction (qRT-PCR). RESULTS: The EMP-1 mRNA levels in all laryngeal carcinoma cells was significantly lower than that in the matched primary normal epithelial cells (P < 0.05) and were not correlated to the stage and differentiation of laryngeal carcinoma (P > 0.05). CONCLUSIONS: The EMP-1 expression was correlated to larynx carcinogenesis and may be helpful to elucidate the pathogenic mechanism in laryngeal carcinoma.

[Comparison of the efficacy of 2 types of mandibular advancement device in severe obstructive sleep apnea hypopnea syndrome].

PURPOSE: To evaluate the efficacy of 2 mandibular advancement devices in 6-week treatment of patient with severe obstructive sleep apnea hypopnea syndrome (OSAHS) who refused to CPAP or CPAP therapy. METHODS: A randomized cross-over study was designed and conducted. Twenty-two male patients with severe OSAHS were included for treatment. Rod type and controllable type mandibular advancement devices (MADs) were used respectively in 6 weeks with 2-week interval, while the whole experimental duration was 14 weeks. The differences of the indexes of the polysomnography (PSG) were analyzed, which were gained before the intervention and 6 weeks after use of 2 types of MADs. Questionnaires with Epworth sleep and SCL-90 symptoms self evaluation scales were proceeded. Meanwhile, the parameters such as the stability of the MAD, the adverse reaction and the subjective symptom relief were assessed. The result was statistically analyzed by SPSS19.0 software package. RESULTS: Compared with the apnea hypopnea index (AHI) before the intervention (48.16±13.99 times/hr), both the AHI of the rod type (19.16±2.74 times/hr) and the controllable type (18.93±2.57 times/hr) were reduced by 50%. The remaining parameters showed that both types of MADs had a significant effect on mandibular advancement. There was significant different decrease in each index of the SCL-90 (P<0.01), while significant differences were found in somatization, interpersonal sensitivity and anxiety compared with those before intervention(P<0.05). At the same time, there were significant differences in the indexes of stability and results occlusive comfort between the rod type and the controllable MADs (P<0.05). CONCLUSIONS: The objective results and the patients' physical and mental health are improved obviously by using the 2 types of MADs. Controllable MADs have more advantages in compliance; however, further research should be conducted for long-time outcome.

Extracranial and intracranial complications of otitis media: 22-year clinical experience and analysis.

CONCLUSION: The morbidity of the complications has had a decreased tendency in recent decades, but the category of the complications was rather diverse. There are still many serious complications that require our attention. Surgery is still the most important treatment option. OBJECTIVE: To investigate otogenic extracranial and intracranial complications in patients with acute and chronic otitis media. METHODS: A retrospective study investigated 285 patients with extracranial and intracranial complications among the 2346 inpatients with acute or chronic otitis media with or without cholesteatoma admitted to the Department of Otolaryngology, AnHui Medical University Hospital between 1987 and 2008. RESULTS: In the 285 patients with cranial complications, 253 had a single complication, 29 had two complications, and 3 had more than two complications. Intracranial complications included meningitis (16 cases), brain abscess (42 cases), sigmoid sinus involvement (29 cases), extradural abscess (8 cases), subdural abscess (1 case), and hydrocephalus (2 cases). Extracranial complications included labyrinthitis (90 cases), mastoid abscess (79 cases), facial paralysis (47 cases), Bezold abscess (5 cases), and apicitis pyramidalis (1 case). In all, 267 patients were cured or improved without recurrence. Five patients died from complications, of whom four died of cerebral hernia and one died of multiple abscesses.

[Diagnosis and treatments for recurrent malignant tumors involving the carotid artery].

OBJECTIVE: To study the diagnosis and treatment of the malignant tumor involving carotid artery. METHODS: A total of 23 cases of recurrent malignant tumors involving the carotid artery were included in this study. For the primary cancers, 8 of 23 cases were laryngeal carcinomas, 10 hypopharyngeal carcinomas, 2 thyroid carcinomas, 1 tonsil carcinoma, 1 parotid gland carcinoma, and 1 hypopharyngeal sarcoma with the invasion of cervical esophagus. Detailed evaluation on each case was performed before treatment. The relations of recurrent tumors with neck blood vessels were determined with enhanced CT/CTA. Of 23 cases with recurrent malignant tumors involving the carotid artery, 16 cases received surgery and 7 cases received the palliative treatment without operation. RESULTS: Seven patients with palliative treatments died of hemorrhage from the invaded neck blood vessels, systemic failure or pulmonary metastasis in six months. Of 16 cases with surgery, recurrent tumors were completely excised in 14 cases and there were residual tumor tissues on artery walls in 2 cases. Within 16 surgical cases, 2 cases died of neck hemorrhoea after one week because of infection, 2 cases died of lung metastasis 8 months later, 3 cases died of neck local recurrence 1 year later, 2 cases died of lung metastasis after 2 years, 1 case died of neck local recurrence 2 years later and 1 case died of a heart attack 2 years later. The rest 5 cases were alive. CONCLUSIONS: Enhancement CT/CTA can used in the evaluation for recurrent malignant tumors involving the carotid artery. Surgical treatments can be applied to some selected patients, which can improve the quality of life and survival time of the patients.

[Swallowing and laryngeal function preserving in surgical treatment of the head and neck tumors involving the tongue root].

OBJECTIVE: To investigate the surgical technique which could preserve the swallowing and laryngeal function effectively in the malignant head and neck tumors involving the tongue root. METHODS: From January 2003 to December 2008, 31 cases of malignant head and neck tumors involving the tongue base had been treated in this hospital were retrospectively analyzed. There were 27 males and 4 females in which 9 cases of primary malignant tumor were from the base of tongue; 3 cases were from the tonsil, 11 cases were from supraglottic laryngeal carcinoma and 8 cases were from hypopharyngeal carcinoma. Preserved the lingual artery of the reserved side and the normal tissue of the root of tongue according to the clinical anatomy of lingual artery during the operation. If preoperative CT had indicated that bilateral lingual arteries were involved, total glossectomy should have been done. The epiglottis, vocal cords and the ventricular band of larynx was preserved as much as possible for the mechanisms of laryngeal function. RESULTS: In this group, residual tongue necrosis did not occurred. One case with total glossectomy didn't remove the trachea cannula. Five had total laryngectomy. The other 25 cases decannulated from 14th days to 90th days postoperatively. The time of oral feeding was started from 10th days to 31st days postoperatively. Two cases with hypopharyngeal carcinoma developed fistula, which were cured by dressing change. Two with root of tongue cancer and 1 with tonsil cancer had postoperative infection and healed in 2 weeks. The median follow-up time was 36 months, and the Kaplan-Meier 3-years and 5-years survival rates were 79.5% and 69.6% respectively. CONCLUSIONS: In the surgical treatments of the malignant head and neck tumors involving the base of tongue, the excisions and reconstructions of the primary tumor and the involved tongue base according to the clinical anatomy of lingual artery and the protection mechanisms of laryngeal function during the operation was one of the most effective technique to preserve the swallowing and laryngeal function.

[Application of lateral cervical incision in the removal of the cervical esophageal foreign body].

OBJECTIVE: To study the indication and clinical application of lateral neck incision for the removal of cervical esophageal foreign bodies. METHODS: From January 1999 to January 2009, 2189 cases esophageal foreign bodies were treated. The clinical data of 137 cases (6.25%) with lateral neck incision were retrospectively analyzed. In these 137 cases, 114 cases were over 16-years-old (adult group), while 23 cases were under 16-years-old (children group). In adult group, 67 cases (58.8%) had esophageal perforation (esophageal perforation with neck abscess 29 cases, esophageal perforation without neck abscess 38 cases); 47 cases did not have esophageal perforation (impacted foreign body without neck abscess 40 cases, foreign body with esophageal abscess 7 cases). In children group, 19 cases (82.6%) had esophageal perforation including 15 cases with neck abscess; 4 cases without esophageal perforation, 3 cases had esophageal abscess and one case without abscess but of huge foreign body. RESULTS: All 137 patients with foreign body were cured through lateral neck incision. Nineteen cases (13.9%) had hoarseness and recovered in 3 months. Five adult patients had post-operative cicatricial stricture of the esophagus, but it was mild and completely recovered by the treatment of dilatation in 3 to 11 months. Nine adult patients with esophageal perforation were cured by secondary suture, the remaining esophageal perforation cases were healed by first intention. One case with common carotid artery impairement by the foreign body was successfully treated by carotid artery ligation without hemiplegia, aphasia and other sequelae. Two cases had cardiopulmonary arrest, 2 cases had febrile convulsions and 1 case had acute respiratory failure, 5 cases had septic shock, all these patients were effectively controlled and cured. Seven of the 9 cases with tracheotomy had the tracheal tube removed during hospitalization; 1 of the two obese patients had the extubation 3 months after the discharge and the other one still had the tube. All esophageal perforation cases in children group had primary healing by perforation apposition suture. Four of the 5 children had successful tracheotomy decannulation, one child had extubation by 2 months through continuously reduced tracheal tube model. CONCLUSION: Penetrating esophageal foreign body and neck abscess were indication of the lateral neck incision, and positive prevention and cure the complications of lateral neck incision could achieve good curative effect.

[Experience of successful remedy of hemorrhage after treatment of head and neck neoplasms].

OBJECTIVE: To discuss the effective emergency treatment to patients with different malignant tumors of head and neck after treatment. METHODS: Eighteen hemorrhage patients which have been successfully rescued with different malignant head and neck neoplasias after operation and (or) radiotherapy were analyzed retrospectively. Emergency treatment was used in 1 patient with nasopharyngeal cancer (NPC) suffering from massive epistaxis and suffocation after radiotherapy. The digital subtraction angiography (DSA) was used in 6 patients suffering from rupture of internal maxillary artery after irradiation for NPC. Two cases suffering from ulcer bleeding from deep par of pars nasalis pharyngis underwent repair of galea aponeurotic after elotomy. Hemostasis by finger pressing and per-cutsem ligation of carotid were used in 9 patients who suffered from rupture of carotid artery, then underwent normal treatment in operating room. RESULTS: Ligation of carotid artery was used in one patient with NPC after radiotherapy suffering from bleeding from arteria carotis interna of skull base. DSA was used in 6 patients with hemorrhage of nasopharynx who was confirmed rupture of internal maxillary artery by CT and DSA. Two cases suffering from ulcer bleeding from deep par of pars nasalis pharyngis underwent repair of galea aponeurotic; pectoralis major myocutaneous flap and infra-trapezius were used in 7 patients with laryngocarcinoma, carcinoma of infra-pharynx, thyroid carcinoma and lymphadenoma of cervical part, 6 cases of them were successful while 1 patient's pectoralis major myocutaneous flap partly necrosis. One patient with thyroid carcinoma who can not be repaired after many operations and radiotherapies. One patient with lymphoma of cervical part also can not be repaired because bad body condition. All cases have no hemiplegic paralysis after first aid. One cases with NPC suffering from massive epistaxis that after ligation of carotid artery suffered from partly cerebral infarction and died of pulmonary infection 6 months postoperatively; 2 cases of nasopharyngeal carcinoma died of recurrence 11 months postoperatively; other cases died of recurrence (7 cases), metastasis and/or multi organic failure of the whole body (8 cases) from 12 to 36 months. CONCLUSION: Different treatments were used in different cases, The DSA and per cutsem Ligation of artery after hemostasis by finger pressing were the modus operandi for NPC patients with intractable epistaxis after radiotherapy and patient suffered from rupture of carotid artery respectively.

[Selective neck dissection for node-positive necks (N1, N2) in patients with head and neck squamous cell carcinoma].

OBJECTIVE: To evaluate therapeutic effect in a consecutive series of patients with node-positive of N1 and N2 head and neck squamous cell carcinoma (HNSCC) who underwent selective neck dissection as part of their treatment in a single institution. METHODS: Retrospectively analyzed 36 patients with node positive head and neck squamous cell carcinoma, which had undergone 40 selective neck dissection (SND) and 16 radical neck dissections (RND) and the therapeutic effects of the SND in HNSCC patients with node positive. Kaplan-Meier method was used to estimate the survival analysis among the different levels, and log-rank method for comparison of the different distribution of the several influential factors of the survival; the fisher's exact test was used to test the difference of the neck recurrence between the groups that with or without lymph node extracapsular spread. Cox proportional hazard model was applied to screen the potentially significant prognostic factors. RESULTS: The 3 and 5 years survival rate of this group were 76.8% and 54.3% retrospectively. The 3 and 5 years' survival rate were both 100% in the N1 + N2a group, while 59.4% and 32.0% in the N2b + N2c group correspondingly. With log-rank test between the two groups above, significant statistical difference was revealed (P = 0.003) in the 5 years' survival rates. To the groups that with or without extracapsular spread (ECS), the recurrence rate were 36.4% and 3.4% respectively and significant statistical difference existed (P = 0.015). In the groups that with or without ECS, the 3 years' survival rate were 45.5% and 81.8% , and 5 years' survival rate were 39.7% and 65.5% respectively, also the significant statistical difference (P = 0.0148 and P = 0.0423 respectively) had presented. CONCLUSIONS: SND is appropriate for treatment of N1 neck of the patient with HNSCC; However, SND should be taken very cautious to the N2 neck and node-positive neck with extracapsular spread, MRND or RND might be a better choice to prevent the recurrence in the neck.