2012 Vol. 3, No. 2

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Original Contributions
Abstract:
  Objective  To investigate the initial efficacy of transoral coblation microsurgery (TCM) for head and neck tumors.  Methods  A total of 93 patients treated with TCM at Peking Union Medical College Hospital from May 2008 to October 2011 were retrospectively reviewed. Among them, 43 patients were with stage T1-T2 laryngeal cancers, 14 with laryngeal benign tumors, 10 with oro-hypopharyngeal cancers, 4 with benign tumors in the oro-hypopharynx, 13 with vallecular cysts, and 9 with benign tumors in the parapharyngeal space. Eleven patients had recurrent primary tumors following endoscopic or open-neck resections. Three patients had neck dissections, and 18 patients with stage T2 laryngeal cancers or oro-hypopharyngeal cancers received adjuvant radiotherapy.  Results  Total resection was achieved endoscopically in all the patients. Among 53 cases with malignant neoplasms, 51 cases underwent one-stage resection, and 2 cases underwent subsequent extended local resection according to the pathological results from the one-stage resection. As for the 40 cases with benign tumors, one-stage resection was achieved in all cases. The complications included postoperative hemorrhage in 3 cases, subcutaneous emphysema in 2 cases, dehiscence of the pharyngeal wounds in 4 cases, and laryngeal web or granulation in 10 cases. Patients with laryngeal cancers were followed up 2-40 months (median, 14.5 months), and 2 patients suffered local recurrence. Patients with pharyngeal malignant neoplasms were followed up 6-40 months (median, 19 months), 1 patient was lost and the others were disease-free. Patients with benign tumor in larynx, pharynx, and the parapharyngeal space were followed up 2-37 months (median, 17 months), and 3 patients with laryngeal papilloma suffered local recurrence.  Conclusion  TCM is a safe and effective treatment alternative for selected early malignant neoplasms at stage T1-T2 or benign tumors of head and neck.
Abstract:
  Objective  To study the development of auditory nerves and postsynaptic glutamate receptors (GlutR2/R3) between inner hair cells and auditory nerve fibers of mouse cochlea.  Methods  The development and distribution of auditory nerves and postsynaptic glutamate receptors (GlutR2/R3) between inner hair cells and auditory nerve fibers of mouse cochlea were observed by immunohistochemical techniques in the embryos and newborns of mice with C57BL/6J and 129S6 mixed genetic background.  Results  At 9.5-day embryo (E9.5) of mouse inner ear, high signals of NeuroD were detected on otic epithelia, vestibulocochlear ganglia, and facial ganglia. Innervation connections between vestibulocochlear ganglia and otic epithelia and between vestibulocochlear ganglia and neural tubes were observed at stage as early as E12.5. At E13.5, highly expressed signals of L1 and Tuj1 were detected in spiral ganglia and nerve fibers in cochlea, which suggested that efferent fibers further developed after the division of inner ear into cochlear and vestibular parts. At E16.5, nerve fibers connecting the spiral ganglia and hair cells were clearly visible. L1 and Tuj1 were highly expressed and rich clusters of nerve fibers were visible around the inner hair cells. However, GlutR2/R3 signals were not detected until E18.5 between inner hair cells and auditory nerve fibers and became stronger at P1. Postsynaptic GlutR2/R3 signals were focused around the bottom of inner hair cells.  Conclusions  The auditory nerves appear to establish fiber connections with the sensory epithelium and central nervous system as early as the period of embryo development. The establishment of nerve fiber domination is earlier than the maturation of inner hair cells. The synapse connection between the inner hair cells and auditory nerves gradually develops at the later stages of gestation and after birth.
Abstract:
  Objective  To explore the impact of allergic rhinitis (AR) on olfactory function and observe the effectiveness of betamethasone in treating mice with olfactory dysfunction.  Methods  Mouse AR models were established by intraperitoneal injection and intranasal application of ovalubumin. The olfactory function of the mice was evaluated by buried food test (BFT). The expression of olfactory marker protein (OMP) in the olfactory mucosa was tested by immunohistochamistry. The expression of OMP in the olfactory mucosa was observed 7 and 14 days after intraperitoneal application of betamethasone.  Results  The incidence of olfactory dysfunction in AR mice was 74.55%. The olfactory epithelium became thinner in AR mice than in control group. The down-regulation of OMP in olfactory epithelium was observed in AR mice compared with control group. The number of OMP-positive cells was 66.38±1.517 in control group and 59.50±0.558 in group without olfactory dysfunction (P > 0.05). The number of OMP-positive cells was 39.77±2.012 in group with olfactory dysfunction, which was significantly different compared with control group and the group with olfactory dysfunction (P < 0.05). The number of OMP-positive cells was 62.04±1.227 in betamethasone group 1, which was significantly higher than that in the non-medication group (47.34±1.809) (P < 0.05); meanwhile, it showed no significant difference between betamethasone group 1 and the control group (P > 0.05). The number of OMP-positive cells was 63.82±1.254 in betamethasone group 2, and the expression of OMP in betamethasone group 2 was similar to that in betamethasone group 1.  Conclusions  AR-associated olfactory dysfunction is not only due to the blockage of nasal cavity but also the change in mucosa by inflammation. Systemic application of betamethasone is an effective method in treating AR-associated olfactory dysfunction.
Abstract:
  Objective  To explore the assessment of pre-esophageal dysphagia.  Methods  The data of 16 patients with pre-esophageal dysphagia who were treated in our department from January 2001 to October 2011 were retrospectively analyzed.  Results  Of these 16 patients, 9 showed abnormal results during repetitive saliva swallowing test and 8 showed grade Ⅲ or higher abnormalities during Kubota drinking test, 11 patients had abnormal videofluoroscopic swallowing examination results including pooling, residuals, reflex, spillage, penetration, aspiration, and cricopharyngeal disorder. Fibroptic endoscopic evaluation of swallowing showed abnormalities including vocal paralysis, saliva retention, stenosis, and aspiration in 11 patients.  Conclusions  Repetitive saliva swallowing test and Kubota drinking test can be applied for screening purpose and as bedside test. Vediofluoroscopic swallowing examination and flexible endoscopic evaluation of swallowing can be used as more accurate assessments.
Abstract:
  Objective  To summarize the effect in the surgical treatment of pediatric otitis media with effusion (OME).  Methods  The clinical data of 36 pediatric cases of OME who were hospitalized in our department from January 2009 to September 2011 were retrospectively analyzed. Patients were divided into 3 groups:ventilation tube placement, adenoidectomy, and ventilation tube placement + adenoidectomy.  Results  The conditions were improved in all 36 patients (63 ears), among which 44 ears were completely cured and 19 improved. Patients were treated with different surgical procedures including ventilation tube placement, adenoidectomy, and ventilation tube placement + adenoidectomy, and the outcomes showed no significant difference.  Conclusions  Ventilation tube placement is the preferred surgical treatment for OME. Adenoidectomy and adenoidectomy + ventilation tube placement also show good effectiveness. Surgical treatment for pediatric OME should be individualized.
Abstract:
  Objective  To determine the clinical and pathological characteristics as well as outcome of sarcoma of the larynx.  Methods  A retrospective review of 13 patients with laryngeal sarcoma treated in Peking Union Medical College Hospital from January 1990 to December 2008 was taken to identify clinical characteristics, pathological characteristics, and therapeutic modalities. Kaplan-Meier survivals were compared according to T-stage and histological G-grade.  Results  Sarcoma of the larynx showed a male predominance in all cases (9/13) and presented 7 pathological types:maglignant fibrous histiocytoma, leiomyosarcoma, rhabdomyosarcoma, synovial sarcoma, chondrosarcoma, neurofibrosarcoma, carcinosarcoma. Twelve cases underwent tumor resection, including partial laryngectomy, total laryngectomy, and endoscopic resection. Among them, 7 cases underwent postoperative radiological therapy and/or chemical therapy. Another case only received radiological therapy. The average follow up time of all cases was 29.3 months and five-year survival rate was 38.0%. Local recurrence occurred in 5 cases and distant metastasis in 1 case. Survival rate was significantly different according to T-stage and histological G-grade (log-rank, P < 0.05).  Conclusions  Sarcomas of the larynx show poor prognosis. The factors influencing survival rate include T-stage and G-grade.
Abstract:
  Objective  To evaluate the key surgical points for treatment of jugular foramen tumors.  Methods  Twelve patients with jugular foramen tumors treated surgically from February 2008 to December 2010 in Peking Union Medical College Hospital were reviewed retrospectively. All patients underwent CT or MRI. Their tumors were removed using microsurgical techniques and they were followed up for 14-45 months.  Results  Among 12 patients with jugular foramen tumors, 11 underwent complete surgical resection of the tumor, 1 underwent near-total resection of the tumor and postoperatively treated by gamma knife. One-stage facial nerve reconstruction was carried out in 4 cases, including 2 cases of auricular nerve grafting and 2 cases of facial-hypoglossal nerve anastomosis. The pathological results of 12 cases showed that 8 were paraganglioma, 1 hypoglossal nerve sheath tumor, 1 meningioma, 1 chondrosteoma, and 1 middle ear cholesterol granuloma. Five cases achieved improved symptoms postoperatively, 5 cases had no improvement in symptoms, and 2 cases had worsened symptoms with severe dysphagia and hoarseness, mainly for Ⅻ, Ⅹ cranial nerve permanent palsy. One of the cases with worsened symptoms underwent cricopharyngeal myotomy and typeⅠthyroplasty 5 months after operation, and the other underwent esophageal sphincter resection and typeⅠthyroplasty 7 months after operation. Both achieved significantly improved postoperative condition.  Conclusions  The anatomical environment of the region of jugular foramen tumors is complex, and we should choose the appropriate surgical approach based on patients' different situations and image data for individualized treatment. To completely remove the tumor and retain or reconstruct the major blood vessels and nerve function is the key point for surgical management.
Abstract:
  Objective  To evaluate the feasibility of DNA microarray as a rapid genetic diagnosis technique in nonsyndromic hearing loss.  Methods  Totally 133 patients with profound nonsyndromic sensorineural hearing loss admitted to the Department of Otorhinolaryngology of Peking Union Medical College Hospital were enrolled in this study. Their peripheral blood samples were taken and tested using Hearing Loss Array Kit (gene chip). Nine hot mutation sites including GJB2 (35 del G, 176 del 16, 235 del C, 299 del AT), GJB3 (538C > T), SLC26A4 (IVS7-2A > G, 2168A > G), and mitochondrial 12S rRNA (1494C > T, 1555A > G) were detected. Accuracy of the detection results was tested by DNA sequence analysis with PCR.  Results  The positive rate of GJB2, GJB3, SLC26A4, and mitochondrial 12S rRNA gene were 20.3%, 0, 21.8%, and 1.5%, respectively, and the overall positive rate in this cohort was 43.6%. DNA sequence analysis showed 100% coincidence with DNA microarray results.  Conclusions  The Hearing Loss Array Kit has a high positive detection rate. It is characterized by being rapid high-flux sensitive, high specific, and easy to judgment, which make it possible and promising in future screening and diagnosis in patients with sensorineural hearing loss.
Abstract:
  Objective  To investigate the prevalence of mitochondrial DNA (mtDNA) 1555A > G and 1494C > T mutations in patients with profound nonsyndromic hearing loss.  Methods  We enrolled 208 patients with profound nonsyndromic sensorineural hearing loss in this study, including 108 patients from the Special Education School of Jiamusi of Heilongjiang Province and 100 outpatients from Peking Union Medical College Hospital. DNA microarray and restriction enzyme assays were used to detect the mtDNA mutations of 1555A > G and 1494C > T, and accuracy of the detection results was tested by DNA sequence analysis.  Results  The detection rates of mtDNA 1555A > G and mtDNA 1494C > T mutations were 4.81% (10/208) and 0 (0/208), respectively.  Conclusion  MtDNA 1555A > G mutation has a high detection rate among patients with profound nonsyndromic hearing loss, whereas mtDNA 1494C > T mutation is rare in Chinese populations with hearing loss.
Abstract:
  Objective  To assess the efficacy and safety of transperineal ultrasound guided template saturation prostate biopsy.  Methods  In a prospective study, a total of 2066 patients (26-92 years old, mean:70.2 years) who met the inclusion criteria underwent transperineal ultrasound guided saturation prostate biopsy using an 11-region template. The inclusion criteria included:a prostate specific antigen (PSA) level of 4.0 ng/ml or greater and abnormal prostate gland findings on digital rectal examination, ultrasound, CT, and/or MRI. Of these 2066 patients, the median PSA level was 11.7 ng/ml (range:0.2-5000 ng/ml) and the median prostate volume was 45.0 ml (range:7-450 ml).  Results  Prostate cancer was detected in 812 of 2066 patients (39.3%). The prostate cancer detection rates in groups with PSA 0-4.0, 4.1-10.0, 10.1-20.0, 20.1-50.0, 50.1-100.0, and > 100.1 ng/ml groups were 24.1% (28/116), 18.9% (140/739), 30.4% (192/631), 56.3% (148/263), 84.5% (130/142), and 99.4% (174/175), respectively. Among all these 2066 patients, 785 (38.0%) had mild and transient (1 to 7 days) hematuria, 42 (2.1%) had urinary retention, and 1 (0.05%) had septic shock postoperatively. No patient died during the procedure.  Conclusion  Transperineal ultrasound guided template saturation prostate biopsy is a safe and accurate procedure and can be useful for the precise TNM staging and the treatment decision-making.
Abstract:
  Objective  To investigate the clinical features and prognosis of paraneoplastic syndromes (PNS) in patients with renal carcinoma.  Methods  The clinical data and follow-up results of 464 patients with surgically and pathologically confirmed renal cell carcinoma (RCC) were retrospectively reviewed.  Results  Of these RCC cases, PNS was identified in 156 patients (33.6%) and manifested as anemia (26.3%, 41/156), hypertension (24.4%, 38/156), fever (21.8%, 34/156), polycythemia (19.2%, 30/156), Stauffer's syndrome (17.3%, 27/156), fatigue, weight loss, and anorexia (15.4%, 24/156), high erythrocyte sedimentation rate (12.8%, 20/156), leukocytosis (8.3%, 13/156), hypercalcemia (5.1%, 8/156). The average diameter of tumors was 5.5 cm in these 156 patients and was 4.7 cm in the remaining patients (P < 0.01).  Conclusion  The incidence of RCC is about 33.6% in patients with renal carcinoma, and the morbidity may be associated with the tumor stages.
Abstract:
  Objective  To compare the results of the IOL-Master and contact ultrasonic axial scan (US Ascan) for anterior chamber depth (ACD) and axial length (AL) measurements.  Methods  A total of 161 eyes of 92 cases were enrolled in this study. ACD and AL estimation were measured with IOL-Master and contact US A-scan, and the corneal curvature was measured by IOL-Master and computer refractometery.  Results  The ACD measured by IOL-Master and contact US A-scan was (2.94±0.19) mm and (2.77±0.13) mm, respectively, which showed significant difference (P < 0.001); however, these two methods showed no significant correlation (r=0.012, P>0.05). The AL measured by IOL-Master and contact US A-scan was (24.10±2.36) mm and (23.91±2.13) mm, which was significantly different between these two measurement methods (P < 0.01), and the two measurement methods showed significant correlation (r=0.983, P < 0.001). The corneal curvature measured by IOL-Master and computer refractor keratometer was (44.38±1.66) D and (44.12±1.62) D, respectively, which showed significant difference (P < 0.001).  Conclusions  Both IOL-Master and contact US A-scan can be used for the measurement of anterior segment parameters. Based on optical prin-ciples, IOL-Master can reliably measure ACD and AL, and thus provides a new option for clinical biological measurements.
Abstract:
  Objective  To explore the characteristics of patients with endometriosis and ovarian cancer.  Methods  We retrospectively analyzed the clinical characteristics of 33 patients with endometriosis and ovarian cancer treated in Peking Union Medical College Hospital from January 1997 to April 2009.  Results  The average age of 33 patients with endometriosis and ovarian cancer was 45.3 years. Most patients had ovarian clear cell cancers. Twenty-four patients were at stage Ⅰ when they were diagnosed as ovarian cancer. Five patients combined with endometrial lesions. Nineteen cases had the endometriotic lesion in ovarian, while 14 cases outside of ovary. The average five-year survival rate was 60% and the average tumor-free survival time was 41.9 months.  Conclusions  Patients with both ovarian cancer and endometriosis are younger than those without endometriosis. The pathological types of ovarian cancer are usually epithelial cancers, especially clear cell cancer, sometimes combined with endometrial cancer. Endometriosis might be an indicator of better prognosis for patients with ovarian cancer.
Abstract:
  Objective  To compare the image quality and radiation exposure of prospective electrocardiogram (ECG) -triggered sequential and retrospective spiral acquisition coronary CT angiography by dual-source CT.  Methods  Seventy patients with suspected or known coronary artery disease were randomly divided into two groups (n=35). Group A underwent prospective ECG-triggered sequential scan and group B underwent retrospective ECG-triggered spiral scan. The image quality and radiation exposure of both modes were evaluated.  Results  There was no significant difference in gender, age, or body mass index between the two groups (P > 0.05). The rates of diagnostic coronary segments for group A and group B were 99.62% and 99.62%, respectively (χ2=0.000, P=1.000). The average image quality score was 1.13±0.36 in group A and 1.04±0.24 in group B, with significant difference between the two groups (Z=-5.073, P=0.000). The mean radiation dose of group A was significantly lower than that of group B[(3.47±1.00) mSv vs. (14.28±1.81) mSv, P=0.032].  Conclusion  The prospective ECG-triggered sequential scan coronary CT angiography technique significantly reduces radiation dose without impairing the rates of diagnostic coronary segments when compared with the retrospective ECG-triggered spiral data acquisition in patients with a low and stable heart rate (≤ 70 bpm).
Abstract:
  Objective  To investigate the pathogen distribution of positive blood culture in Peking Union Medical College Hospital from January 2008 to December 2010.  Methods  BacT/Alert 3D 480 and BD Bactec 9120 automatic blood culture instruments were used for blood culture. Microorganism identification methods including Vitek 2 compact and Pheonix 100 microbial identification system, API series kit, and Chromagar chromogenic medium were used to identify the pathogens.  Results  The number of positive blood culture from outpatients and inpatients of Peking Union Medical College Hospital in 2008, 2009, and 2010 was 928, 942, and 913, respectively. The most common bacteria was coagulase-negative Staphylococci (27.0%, 27.7%, 26.0%), the second was Escherichia coli (13.3%, 14.4%, 17.1%), followed by Staphylococcus aureus (6.8%, 6.3%, 5.0%), Klebsiella pneumonia (4.8%, 4.1%, 6.1%), Acinetobacter baumannii (4.7%, 5.8%, 5.6%), Pseudomonas aeruginosa (3.0%, 4.0%, 3.4%), Enterococcus faecium (5.0%, 4.8%, 3.0%), and Enterococcus faecalis (2.5%, 3.4%, 3.0%). The most common fungi from blood culture in the three years were Candida albican (1.0%, 1.6%, 2.1%) and Candida parapsilosis (1.1%, 0.7%, 1.3%).  Conclusion  We should pay more attention to the isolation and identification of fastidious bacteria, less common bacteria, and fungi.
Abstract:
  Objective  To investigate the incidence and tendency of thyroid carcinoma in adults during health check-up.  Methods  Sonogrphic assessment of thyroid was performed in 10 903 adults from January 2009 to June 2011 and surgical operations were performed for the suspected malignant tumors. The incidence of thyroid carcinoma was calculated.  Results  Of 54 highly suspected malignant tumors under ultrasound, 40 were pathologically confirmed to be thyroid carcinoma, yielding an incidence of thyroid carcinoma of 0.37% among these health chech-up receivers (0.23% in male and 0.53% in female).  Conclusion  The incidence of thyroid carcinoma has remarkably increased, especially in females. Preventive efforts should be taken to address this trend.
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