Nd-YAG激光腔内照射治疗鼻、鼻窦、咽喉血管瘤46例

应用Nd-YAG激光腔内照射治疗鼻、鼻窦、咽喉血管瘤46例,经过1～4年的随访,治愈率91.3％,显效率10.9％。同时论述静脉畸形血管瘤的临床表现及诊断。并对Nd-YAG激光治疗血管瘤的主要方法和优越性等进行讨论。     

Giant dermoid cyst of the neck can mimic a cystic hygroma: using MRI to differentiate cystic neck lesions

OBJECTIVE: To describe differential features of giant cervical dermoid cysts and other cystic lesions of the head and neck. METHODS: Case report including magnetic resonance imaging, surgical excision, pathologic examination and correlation. RESULTS: We report the case of a 15-year-old boy who presented for evaluation of a slowly enlarging doughy submental mass. Ultrasound showed some features consistent with a cystic hygroma and both sclerotherapy and surgical excision were discussed with the family. However, an unusual solid component on magnetic resonance imaging (MRI) mitigated toward surgical excision. At surgery, the cystic mass was excised and measured 9.5 cm x 5.5 cm x 4.0cm. Histology showed a giant dermoid cyst similar to those seen in the ovary. The solid component was a smooth spherical collection of inspissated sebum. CONCLUSIONS: The unique MRI characteristics of giant dermoid cysts can help to separate these rare lesions from more common cystic hygromas. Fine needle aspiration should be considered for questionable lesions before treatment with OK 432 or similar agents.     

Management of chylous fistula after neck dissection using negative-pressure wound therapy: A preliminary report

Chylous fistula is a distressing complication resulting from thoracic duct injury during neck dissections. We have successfully managed chylous fistula using negative-pressure wound therapy (NPWT) in a case where all conservative treatments failed. A 60-year-old man with tongue cancer underwent subtotal glossectomy and bilateral neck dissections. On postoperative day 4, a chylous fistula with large drainage developed in the right neck. Conservative treatments were not effective, therefore, NPWT was started from postoperative day 9. The drainage volume then began to decrease, and the chylous fistula was closed 6 days after starting NPWT. In our case, the effects of wound shrinkage and fluid removal by NPWT were considered to contribute to early closure. Although preliminary, NPWT can be an important treatment choice for the management of a chylous fistula after neck dissections.     

头颈部鳞癌患者同步放化疗和(或)分子靶向治疗继发口腔黏膜炎的防治

目的 探讨接受同步放化疗和(或)分子靶向药物治疗的中晚期头颈部鳞癌患者口腔黏膜炎的防治.方法 回顾性分析2007年11月至2010年11月期间接受同步放化疗和(或)分子靶向药物治疗的179例中晚期头颈部鳞癌患者口腔黏膜炎发生情况及治疗效果.男155例,女24例.临床分期:Ⅲ期124例,Ⅳ期55例.口腔黏膜炎发生情况:Ⅰ级49例,Ⅱ级50例,Ⅲ级67例,Ⅳ级13例.接受同步放化疗的同时采取预防口腔黏膜炎的方法,对发生黏膜炎的患者采用常规治疗结合喹诺酮类抗生素的方法进行治疗.结果 99例Ⅰ、Ⅱ级和4例Ⅲ级口腔黏膜炎患者经常规治疗达到有效控制,即口腔黏膜炎性反应范围减少,疼痛明显减轻,可进食.76例Ⅲ、Ⅳ级口腔黏膜炎患者通过常规治疗结合喹诺酮类抗生素,得到有效控制.无一例患者出现放疗中断及抗生素药物相关的毒副作用.结论 对接受同步放化疗和(或)分子靶向药物治疗的中晚期头颈部鳞癌患者发生的口腔黏膜炎,轻度患者采用常规治疗有效,中重度患者采用抗生素治疗有效.

Abstract：

Objective To investigate the prevalence and treatment of oral mucositis caused by concurrent chemoradiotherapy and/or molecular targeted therapy in the patients with advanced squamous cell carcinoma of the head and neck. Methods A retrospective study of the incidence and treatment of oral mucositis was performed in 179 patients (155 male and 24 female; 124 patients at stage Ⅲ and 55 patients at stage Ⅳ) receiving concurrent chemotherapy and (or) molecular targeted therapy between November 2007 and November 2010. Grade Ⅰ , Ⅱ , Ⅲ and Ⅳ oral mucositis occurred respectively in 49, 50, 67 and 13 patients. All the patients received oral mucositis prophylaxis. After the occurrence of oral mucositis, conventional treatment of mucositis combined with quinolone antibiotics were applied. Results Of the patients, 99 patients with grade Ⅰ or Ⅱ and 4 patients with grade Ⅲ oral mucositis were effectively managed by conventional treatment; 76 patients with grade Ⅲ or Ⅳ oral mucositis were also significantly controled by conventional treatment plus antibiotics. After the treatments, all patients with oral mucositis were under control, with the decrease in the grade of oral mucositis, the reduction of oral pain and the improvement in ability to eat None of them had radiation treatment breaks. Conclusions Combined modality therapy can effectively control chemoradiation-induced oral mucositis in patients with head and neck squamous cell carcinoma, grade Ⅰ and Ⅱ oral mucositis were cured by conventional treatment and quinolone antibiotics play a key role in the treatmeats for grade Ⅲ and Ⅳ oral mucositis.     

Frequency difference limens of C57BL/6 and DBA/2 mice: relationship to auditory neuronal response properties and hearing impairment

Frequency difference limens (DLs) were measured in DBA/2 and C57BL/6 mice using an avoidance conditioning procedure and were viewed in relation to previously obtained neurophysiological data. DRA mice had significantly smaller DLs at 12 and 16 kHz, despite progressive sensorineural hearing loss and disrupted tonotopic organization characteristic of this strain. C57 mice had smaller DLs at 8 kHz. Several inferior colliculus (IC) neuronal response properties, that may be related to DL performance, differ between strains. Compared to C57s, a large proportion of DBA neurons respond to 12 and 16 kHz, many more best frequencies (BF, the frequency for which a neuron is most sensitive) fall between 10 and 20 kHz, response ranges are narrow, and neural intensity functions are steep. For C57 mice, a large proportion of neurons respond to 8 kHz, and more neurons have BFs between 5 and 10 kHz.     

Automated detection of auditory response: applying sequential detection strategies with constant significance level to magnitude-squared coherence

Objective: The detection of the auditory steady-state responses is usually performed by an appropriate objective response detector applied to stimulus-related epochs of the raw electroencephalogram (EEG). In order to improve the detection time, sequential detection strategies are usually used. These multiple tests strategies increase the probability of mistakenly detecting a response. The aim of this study was to develop strategies to determine the critical values for the sequential detection strategies based on constant significance level tests.

Design: Extensive Monte Carlo simulations were used to test these strategies for the magnitude-squared coherence (MSC) detector. The performances of these strategies were compared with previous works found in the literature.

Study sample: All strategies were applied to synthetic and real EEG datasets.

Results: The strategies ensure the desired significance level at the end of the sequential detection strategy. The simulated results are in accordance with the real data results.

Conclusions: For the MSC detector, where the critical value depends on the number of epochs, the proposed sequential detection strategies obtain better performance regarding test time and detection rate, but worse overall detection rate compared to applying a test only once.     

Primary B cell lymphoma of the sphenoid sinus: CT and MRI characteristics with correlation to perfusion and spectroscopic imaging features

Primary non-Hodgkin lymphoma (NHL) of the paranasal sinuses is a rare neoplasm that cannot be easily diagnosed and differentiated as its clinical, histological, and imaging features are similar to those of other inflammatory and tumorous diseases in their early stages. We evaluated the morphological and functional imaging characteristics of primary NHL of the sphenoid sinus using CT and MR imaging. Morphological CT and MR imaging as well as perfusion CT imaging and proton MR spectroscopy (PRESS technique, TE = 135) was performed in three patients with the histological diagnosis of highly malignant primary B cell lymphoma of the sphenoid sinus. In all patients an inhomogeneous contrast agent enhancement as well as bony erosion of the sphenoid sinus was identified in CT and MR sections. In one patient an infiltration of the adjacent dura was present. The mean blood flow of the lymphomas was 135 ml/min per 100 g tissue, the mean blood volume was 8.06 ml/min, while the mean transit time and the mean permeability surface area product values were 5.11 s and 26.53 ml/min per 100 g, respectively. The mean choline to creatine ratio in the proton MR spectroscopy was 5.7. Cross-sectional imaging findings are not sufficient to establish the diagnosis of a primary NHL in the sphenoid sinus. Physiologic imaging offers valuable information that may be characteristic of the tumor. Future studies may lead to a safe differentiation of the lymphomas from other pathologic entities based on the combination of morphological and functional imaging.     

Utility of response assessment PET-CT to predict residual disease in neck nodes: A comparison with the Histopathology

ObjectiveTo assess the ability of Positron Emission Tomography-Computed Tomography (PET-CT) scans to detect residual disease in neck nodes with the Histopathology (HPR) as the gold standard. To obtain a Standardized Uptake Value max cutoff in these patients to predict residual disease in neck.MethodsHead and neck squamous cell carcinoma patients who underwent Salvage neck dissection with or without primary site surgery post Concurrent Chemo-Radiotherapy (CCRT) during the period January 2008–December 2017 were included. All patients had response assessment PET-CT scan at 10–14 weeks. Agreement analysis was performed between PET-CT and HPR, fine needle aspiration cytology and HPR. Positive predictive value, Negative predictive value of PET-CT to detect residual neck nodal disease in comparison to HPR was analyzed. A Receiver Operating Characteristic (ROC) curve was plotted between the SUV max values and the HPR. A SUV max cutoff value was obtained from the ROC curve.ResultsA total of 75 patients were included. Thirty-one underwent salvage neck dissection along with surgery for primary disease and 45 underwent salvage neck dissection alone. PET-CT showed good agreement with the HPR to detect residual disease in neck nodes (Kappa = 0.604). PET-CT had a PPV and NPV of 87.5% and 79.15% respectively as compared against the HPR. A SUV max cutoff of 4.62 had a specificity of 92.3% and sensitivity of 73.5% to detect residual disease in neck nodes on the HPR.ConclusionPET-CT surveillance is an accepted treatment strategy. A neck node with SUV max of 4.62 and above is most likely to harbor residual nodal disease.Level of evidence: Level 2b     

Expression of Bcl-2 family proteins in advanced laryngeal squamous cell carcinoma: correlation with response to chemotherapy and organ preservation

OBJECTIVES/HYPOTHESIS: Induction chemotherapy and definitive radiation therapy in advanced laryngeal cancer has been shown to achieve survival rates that are similar to total laryngectomy and postoperative radiation therapy. In patients with advanced laryngeal cancer, quality of life can be significantly enhanced by treatment regimens that preserve the larynx. However, which patients will respond best to organ preservation protocols remains unknown. The Bcl-2 family proteins are involved in control of apoptosis and, potentially, tumor response to chemotherapy. STUDY DESIGN: Retrospective analysis of immunohistochemical tumor characteristics and clinical outcome. METHODS: To determine whether Bcl-2 family proteins were predictive of successful organ preservation, immunohistochemical analysis of tissue specimens from 47 patients with advanced laryngeal cancer from the U.S. Department of Veterans Affairs Cooperative Study Program (VA CSP-268) were evaluated for the expression of Bcl-2, Bcl-X(L), and Bax protein expression. Tumor response was classified as either complete or partial/nonresponse after induction chemotherapy. Protein expression was correlated with tumor response, organ preservation, and overall patient survival. RESULTS: The Bcl-2 protein was expressed at high levels in only 15% of specimens, but five of seven tumors with high Bcl-2 showed complete response (P = .10). The majority of tumors expressed high levels of Bcl-X(L) (74%). Reduced expression of Bcl-X(L) was associated with a complete response (P = .143) and with larynx preservation (P = .06). Most patients (81%) had increased levels of Bax expression. Reduced expression of Bax was associated with a complete response rate (P = .074), but there was no correlation between Bax expression and larynx preservation. CONCLUSIONS: The findings indicate that laryngeal cancer cells typically produce high levels of only one of the apoptosis protective proteins, Bcl-2 or Bcl-X(L). Prospective studies of larger numbers of patients are under way to determine whether Bcl-X(L) expression will be a useful marker predicting larynx preservation.     

Adenocarcinoma of the paranasal sinuses and nasal cavity with lung metastasis showing complete response to combination chemotherapy with docetaxel,cisplatin and 5-fluorouracil (TPF): A case report

Malignant tumors in the paranasal sinuses and nasal cavity are mostly squamous cell carcinomas, with comparatively few adenocarcinomas. Adenocarcinoma developing in paranasal sinuses and nasal cavity generally has a low response to radiotherapy and low chemotherapeutic sensitivity, making surgery the most reliable treatment. However, advanced adenocarcinoma is often difficult to treat due to anatomical complexity, and the outcome may not be satisfactory. We report the case of a 62-year-old man who presented with nasal congestion and epistaxis. We were unable to observe an oncogenic lesion in the nasal cavity directly, but the tumor gave inhomogeneous low intensity signals on T1-weighted images and an isointense signal on T2-weighted images in MRI. Adenocarcinoma was diagnosed by open biopsy. Six courses of chemotherapy by super-selective intra-arterial infusion of cisplatin with concurrent intensity-modulated radiation therapy of 70 Gy were performed at another hospital. However, the tumor enlarged and developed distant metastasis to the lung after this therapy. Therefore, TPF chemotherapy (docetaxel, cisplatin and 5-fluorouracil) was performed 5 times, after which the tumor gradually reduced in size. The patient is alive after a follow-up period of 43 months, indicating that TPF chemotherapy may be useful for adenocarcinoma of the paranasal sinuses and nasal cavity.     

Factors contributing to hearing impairment in patients with cleft lip/palate in Malaysia: A prospective study of 346 ears

ObjectiveTo determine the factors contributing towards hearing impairment in patients with cleft lip/palate.MethodA prospective analysis was conducted on 173 patients (346 ears) with cleft lip and palate (CL/P) who presented to the combined cleft clinic at University Malaya Medical Centre (UMMC) over 12 months. The patients' hearing status was determined using otoacoustic emission (OAE), pure tone audiometry (PTA) and auditory brainstem response (ABR). These results were analysed against several parameters, which included age, gender, race, types of cleft pathology, impact and timing of repair surgery.ResultsThe patients' age ranged from 1–26 years old. They comprised 30% with unilateral cleft lip and palate (UCLP), 28% with bilateral cleft lip and palate (BCLP), 28% with isolated cleft palate (ICP) and 14% with isolated cleft lip (ICL). Majority of the patients (68.2%) had normal otoscopic findings. Out of the 346 ears, 241 ears (70%) ears had passed the hearing tests. There was no significant relationship between patients' gender and ethnicity with their hearing status. The types of cleft pathology significantly influenced the outcome of PTA and ABR screening results (p < 0.001). There was no significant difference between the repaired and unrepaired cleft groups and the outcome of hearing tests. However, hearing improvement occurred when palatal repair was performed at the age of <1year old (OR = 2.37, CI 1.2 = 4.6, p = 0.01).ConclusionMajority of the cleft patients had normal hearing (70%). Hearing threshold varied significantly between the different types of cleft pathology. Surgery conferred no significant impact on the hearing outcome unless surgery was performed at the age of <1 year old.     

Presbycusis: a human temporal bone study of individuals with flat audiometric patterns of hearing loss using a new method to quantify stria vascularis volume

OBJECTIVE: The purpose of this study was to determine the prevalence of stria vascularis atrophy in individuals with presbycusis and flat audiometric patterns of hearing loss. Individuals with presbycusis have historically been categorized by the shape of their audiograms, and flat audiometric thresholds have been reported to be associated with atrophy of the stria vascularis. Stria vascularis volume was not measured in these studies. STUDY DESIGN: Retrospective case review. METHODS: Archival human temporal bones from individuals with presbycusis were selected on the basis of strict audiometric criteria for flat audiometric thresholds. Six temporal bones that met these criteria were identified and compared with 10 temporal bones in individuals with normal hearing. A unique quantitative method was developed to measure the stria vascularis volume in these temporal bones. The hair cell and spiral ganglion cell populations also were quantitatively evaluated. RESULTS: Only one of the six individuals with presbycusis and flat audiometric thresholds had significant atrophy of the stria vascularis. This individual with stria vascularis atrophy also had reduced inner hair cell, outer hair cell, and ganglion cell populations. Three of the individuals with presbycusis had spiral ganglion cell loss, three individuals had inner hair cell loss, and all six individuals had outer hair cell loss. CONCLUSIONS: The results of this investigation suggest that individuals with presbycusis and flat audiometric patterns of hearing loss infrequently have stria vascularis atrophy. Outer hair cell loss alone or in combination with inner hair cell or ganglion cell loss may be the cause of flat audiometric thresholds in individuals with presbycusis.     

The effect of leukocyte interleukin injection (Multikine) treatment on the peritumoral and intratumoral subpopulation of mononuclear cells and on tumor epithelia: a possible new approach to augmenting sensitivity to radiation therapy and chemotherapy in oral cancer--a multicenter phase I/II clinical Trial

OBJECTIVES/HYPOTHESIS: The main objective of this study was to investigate the effect of the administration of a novel immunoadjuvant, leukocyte interleukin injection, as part of an immuno-augmenting treatment regimen on the peritumoral and intratumoral subpopulations of the tumor infiltrating mononuclear cells and on the epithelial and stromal components, when administered to patients with advanced primary oral squamous cell carcinoma classified as T2-3N0-2M0, as compared with disease-matched control patients (not treated with leukocyte interleukin injection). STUDY DESIGN: Multicenter Phase I/II clinical trial. Fifty-four patients from four clinical centers were included in the dose-escalating study (27 in each group [leukocyte interleukin injection-treated and control groups]). Cumulative leukocyte inter-leukin injection doses were 2400, 4800, and 8000 IU (as interleukin-2 equivalent). METHODS: Paraffin-embedded tumor samples obtained at surgical resection of the residual tumor (between days 21 and 28 after treatment initiation) were used. Histological analysis, necrosis evaluation, and American Joint Committee on Cancer grading were performed from H&E-stained sections. Immunohistochemical analysis was performed on three different tumor regions (surface, zone 1; center, zone 2; and tumor-stroma interface, zone 3). Trichrome staining was used to evaluate connective tissue, and morphometric measurements were made using ImagePro analysis software. Cell cycling was determined by the use of Ki-67 marker. RESULTS: Leukocyte interleukin injection treatment induced a shift from stromal infiltrating T cells toward intraepithelial T cells and posted a significant (P <.05) increase in intraepithelial CD3-positive T cells independent of the leukocyte interleukin injection dose, whereas the increase in CD25 (interleukin-2 receptor alpha [IL-2Ralpha])-positive lymphoid cells was significant only at the lowest leukocyte interleukin injection dose (P <.05). Furthermore, both low- and medium-dose leukocyte interleukin injection treatment induced a significant (P <.05) increase in the number of cycling tumor cells, as compared with control values. CONCLUSION: The results could be highly beneficial for patients with oral squamous cell carcinoma. First, leukocyte interleukin injection treatment induces T-cell migration into cancer nests and, second, noncycling cancer cells may enter cell cycling on administration of leukocyte interleukin injection. This latter effect may modulate the susceptibility of cancer cells to radiation therapy and chemotherapy. The findings may indicate a need to re-evaluate the way in which follow-up treatment (with radiation therapy and chemotherapy) of patients with head and neck cancer is currently approached.