[Development of head and neck neoplasm surgery in China].
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Head and Neck Neoplasms↗
Biomedical subjects
G Tu
Publications and source records attributed to G Tu.
[Squamous cell carcinoma of temporal bone: an analysis of long-term treatment results in 33 patients].
OBJECTIVE: To evaluate the long-term results in patients with squamous cell carcinoma of the temporal bone and treated by of mastoidectomy combined with perioperative radiation therapy. METHODS: Thirty-three patients with squamous cell carcinoma invading the temporal bone were reviewed retrospectively. According to the tumor extent, the patients were staged into three subgroups, 3 with lesions confined to the auditory canal(Group I), 17 with involvement of the middle ear or mastoid(Group II) and 13 with more extensive disease(Group III). Two patients were treated by surgery, 11 by irradiation and the remaining 20 by the combined surgery and perioperative radiotherapy. The surgical procedures included sleeve resection for group I patients, mastoidectomy for all other patients except one who had subtotal temporal bone resection. The radiation doses were in the range of 3,500 to 10,000 cGy, with an average dose of 6,560 cGy. RESULTS: The 5-year survival rate for the whole series was 51.7% by the life table analysis. The estimated 5-year survival rates for 3 subgroups were 100%, 68.8%, and 19.6%, respectively (P = 0.012). Radiation alone had a 28.7% survival rate and combined therapy 59.6% (P = 0.80). For patients treated with planned combined therapy, the actual 5-year survival rates were 72.7% (8/11) for Group II and 12.5% (1/8) for Group III (P = 0.02). Twelve patients died of local recurrence (10 cases), cervical metastases(1 case) and liver metastases (1 case) with 67.0% (8/12) succumbed to their diseases within two years. Complications included osteonecrosis (n = 1), osteitis (n = 3), radiation dermatitis (n = 2), facial palsy (n = 2), and delayed healing (n = 2). CONCLUSION: The 5-year survival rates in patients with mastoidectomy with removal of gross tumor, combined with planned perioperative irradiation therapy, are similar or higher than those from literature. This protocol can be used in patients with squamous cell carcinoma confined to the middle ear or the mastoid.
Adult↗
[The extended indications of near-total laryngectomy].
OBJECTIVE: To evaluate near-total laryngectomy in treatment of laryngeal cancers. METHODS: Fifty-seven near-total laryngectomies were reviewed, among them 40 were T3 or T4 laryngeal cancers due to tumor invasion to the base of tongue or subglottic region. RESULTS: In these patients, there were 11 cases of T3 pyriform sinus cancers, 5 cervical esophageal cancers, 1 case with adenoid cystic carcinoma involving the base of the tongue and oropharynx. Speech function had been preserved in 93% of cases with normal swallowing. Three year survival rates were 67.5% in laryngeal cancer and 50% in hypopharyngeal cancer. Local recurrence rate was only 3.5%. CONCLUSION: The authors believed that near-total laryngectomy is safe and beneficial to the patients with the above types of cancers. The quality of life may improve if speech function is preserved.
Aged↗
[Visceral voice training for laryngectomy after hypopharyngectomy and visceral transplant].
OBJECTIVE: To establish a way to visceral voice after stomach or colon transplantation for patients with hypopharyngeal or cervical esophageal cancer. METHODS: Esophageal voice training was used and modified according to the compliance of the patients. Twenty laryngectomies with replacement of the hypopharynx and esophagus by stomach(13 cases), colon(6 cases) and jejunum (1 case) were trained for voice rehabilitation at the Department of Head and Neck Surgery. RESULTS: The patients with an artificial esophagus from vicera were easy to gain an influx of certain volume of gas into their artificial esophagus (stomach or colon) and to learn to speak. But on the whole the quality of voice was not so satisfactory. In this series nineteen out of 20 patients (95%) could express their idea by speech after a training course of three weeks. CONCLUSION: The literature has emphasized role of cricopharyngeus muscle in the training of esophageal voice. Owing to the fact that this series of patients who had had their cricopharyngeus removed, could easily get their voice rehabilitated, it seems this muscle played no major role in the voice rehabilitation.
Aged↗
[Preoperative radiation plus surgery vs. operation alone for laryngeal carcinoma].
OBJECTIVE: To study the validity of preoperative radiation in improving the survival rate of laryngocarcinoma. METHODS: A prospective randomized clinical trial was conducted with preoperative radiation plus surgery (RS) as one group and surgery alone (SA) as the other group. The ages of the patients were less than 75 years, and the operative types were decided after clinical examination. The patients were divided into SA or RS group by random. Doses of preoperative irradiation was 40 Gy. Three hundred and seventy patients with laryngocarcinoma were treated, 215 in the SA group; 155 in the RS group. All patients were followed up over three years. RESULTS: In SA group, 3 years survival rate was 83.3%, 5-year survival rate 82.6%, 10-year survival rate 80.3%. In RS group, 3-year survival rate was 78.9%, 5-year survival rate 76.4%, 10-year survival rate 68.6%. There is no statistically significant difference in survival rates between the groups (P = 0.1); but, the 10-year survival rate in SA group was better than that in RS group for the stage III and IV supraglottic carcinomas, the former was 73.6% and the latter 63.5% (P = 0.003). The 10-year survival rate for the patients with T3 and T4 supraglottic carcinomas who underwent total laryngectomy in SA group was better than that in RS group. The former was 68% and the latter 50% (P = 0.0001). CONCLUSION: Preoperative radiotherapy with 40 Gy didn't increase the survival rate of laryngeal carcinoma. The 10-year survival of stages III and IV supraglottic carcinoma in combined treatment group was lower than that in the surgery alone group.
Adult↗
[A new saikosaponin from Bupleurum chinense DC].
Bupleurum chinense DC. is a well-known and very important traditional Chinese drug. It is often used to treat common cold with fever, alternating chill and fever, feeling of fullness and oppression in the chest. A new saikosaponin was isolated from Bupleurum chinense DC. and its structure was identified as 3-O-[beta-D-glucopyranosyl (1-->3)-beta-D-fucopyranosyl]-3 beta, 16 alpha, 23, 28-tetrahydroxy-olean-11, 13 (18)-dien-30-oic acid 30-O-[xylityl(1-->1)]-beta-D-glucopyranosyl-6-ester on the basis of chemical and spectral evidence. In addition, three known saikosaponins were isolated and characterized as saikosaponin 1, 2"-O-acetyl-saikosaponin b2 and 2"-O-acetyl-saikosaponin a. All the compounds were isolated from Bupleurum chinense DC. for the first time.
Bupleurum↗
Molecular analysis of the POU3F4 gene in patients with clinical and radiographic evidence of X-linked mixed deafness with perilymphatic gusher.
The molecular defect in some patients with X-linked mixed deafness with perilymphatic gusher at stapes surgery (DFN3) was recently attributed to mutations in the POU3F4 gene. In this manuscript we describe the molecular analysis of the POU3F4 gene in 5 patients with clinical and radiographic evidence of DFN3. Novel mutations were found in 2 of the 5 patients analyzed, while 3 had an entirely normal protein coding sequence. The fact that 3 of the 5 patients with clinical histories and radiographic abnormalities characteristic of X-linked mixed deafness with perilymphatic gusher displayed normal POU3F4 gene sequences supports the possibility that not all patients with the characteristic phenotype have involvement of the POU3F4 gene.
Base Sequence↗
[Therapy of head and neck neoplasms: surgery, surgery ... and others?].
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Combined Modality Therapy↗
[Surgery of substernal thyroid goiter].
A retrospective study on 87 substernal thyroid nodules operated between 1965 and 1994 was made. Among them 73.6% were goiters, 14.9% adenoma and 11.5% malignancy. Resection via cervical collar incision was performed in 70% of all cases, sternotomy in 16% and thoracotomy in 14%. A cervical collar incision was adequate in 91% of 43 cases after 1985, only one goiter was completed by sternotomy. Morbidity rate of complications was 41.4%, while the rate of recurrent laryngeal nerve paralysis was 20.7%. Surgery via cervical collar incision for all retrosternal thyroid nodules was advised and sternotomy or thoracotomy are suggested.
Adenocarcinoma, Follicular↗
[Clinical uses should be emphasized in current research of head and neck neoplasms].
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Head and Neck Neoplasms↗
NMR determination of the structure of Julibroside J1.
Julibroside J1 is a new triterpenoid saponin which contains one triterpene, two monoterpenes and nine sugar residues. The structure has been determined almost exclusively by high-resolution NMR methods. The 1H and 13C NMR spectra of Julibroside J1 C5D5N have been assigned by homonuclear and heteronuclear correlation experiments, such as COSY, CH-COSY, TOCSY, HMBC, HMQC-COSY, HMQC-TOCSY and NOESY. Anomeric configurations were obtained by combined use of 1JCH and 3JH1,H2 and NOESY data. The particular sugar residues were identified by utilizing 3JHH values obtained from TOCSY cross-peaks, NOE difference spectra, and several 1D-TOCSY spectra, and three-bond intra-ring cross-peaks from a HMBC spectrum. Linkage assignments were made using the HMBC spectrum, and supplemented by NOE data from the NOESY spectrum. The structure of Julibroside J1 was characterized as 3-O-[beta-D-xylopyranosyl-(1-->2)-alpha-L-arabinopyranosyl-(1-->6) -beta-D- glucopyranosyl]-21-O-((6S)-2-trans-2-hydroxymethyl-6-methyl-6-O-[4-O-((6 S)- 2-trans-2,6-dimethyl-6-O-(6-deoxy-beta-D-glucopyranosyl)-2,7-octadien oyl)-6- deoxy-beta-D-glucopyranosyl]-2,7-octadienoyl)-acacic acid 28-O-(beta-D-glucopyranosyl-(1-->3)-[alpha-L-arabinofuranosyl-(1-->4)]- alpha-L-rhamnopyranosyl-(1-->2))-beta-D-glucopyranosyl ester.
Carbohydrate Conformation↗
[The use of hyoid osteomuscular flap in extended partial laryngectomy].
The surgical defect after conventional partial laryngectomy practically needs no special technique to repair. On conservation surgery for late (T3 and T4) cases a large part of the larynx is to be resected so that the margin of surgical clearance is ample and, at the same time, an appropriate method of reconstruction is mandatory to restore the essential functions of the larynx. For this purpose we developed a technique of osteomuscular flap to repair the defect left behind after a three-fourths laryngectomy (for supraglottic case) or an extended vertical partial laryngectomy (for glottic case). In both cases the arytenoid cartilage or the cricoarytenoid joint was resected to ensure the safety margin of resection. The mylohyoid muscle was severed at the upper border of the body of the hyoid bone. A small piece of the hyoid bone (about 5 mm) and its attached strap muscles were used. The muscles were made a 90 degree bent toward the laryngeal cavity. The hyoid bone was used to substitute the removed arytenoid and the muscles to bridge over the laryngeal lumen. The postericoid mucosa was advanced to cover the transplanted hyoid bone. Then the cut edge of the thyroid cartilage was lifted up and sutured with the base of the tongue to close the wound. 108 cases were treated within a period of 12 years (1979-1990). The three year survival rates for stage II and stage IV of supraglottic type (66 cases) were 78.6% and 66.7% respectively, and for stage II of glottic type (42 cases), 79.3%. The decannulation rate was 75%-85%, and 80% of the patients enjoyed a socially acceptable voice. All cases resumed normal mouth-food-taking.
Adult↗
[Development of tertiary disciplines in otorhinolaryngology].
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Otolaryngology↗
[Treatment and results of N1 supraglottic laryngeal carcinoma].
One hundred and eleven cases of supraglottic squamous cell cancer (T1-4N1) were retrospectively analysed. The result showed that: 1. the 3 years survival rate was 72% (80/111); 2, the rate of contralateral neck node metastasis after ipsilateral RND was 17.9%, and the cases of T3-4 with positive histologic findings of neck dissection samples had a higher rate contralateral neck node metastasis (38.6%); 3, the contralateral neck node metastasis rate (26.1%) in the group with surgery alone was significantly higher than that (7.1%) in the group with preoperative radiation (P < 0.05). The authors draw the conclusion that contralateral neck node metastasis is a high risk factor for recurrence of N1 supraglottic laryngeal cancer and that preoperative radiation may be be useful in controlling subclinical metastasis.
Adult↗
Cationic liposome-mediated intravenous gene delivery.
Systemic gene transfer provides new opportunities for the analysis of gene function and gene regulation in vivo, as well as for human gene therapy. We used the chloramphenicol acetyltransferase reporter gene to examine several parameters important for the development of efficient, cationic liposome-mediated, intravenous (IV) gene transfer in mice. We then demonstrated that this approach can produce high level expression of biologically important genes. Specifically, we assessed the relationship of expression vector design to the level of systemic gene expression produced, and compared transfection levels produced by intravenously injecting DNA alone versus DNA-liposome complexes. We found that both the position of the heterologous intron, and the promoter element used in the expression plasmid, significantly affected the level of systemic gene expression produced. Although intravenous injection of plasmid DNA alone transfected every tissue analyzed, liposome-mediated delivery was much more efficient. We also established that repeated i.v. injection of DNA-liposome complexes produced high level systemic transfection. The second injection of DNA-liposome complexes produced levels of gene expression at least as high as those following a single i.v. injection. Thus, unlike some viral vectors, a neutralizing host-immune response does not limit re-expression, following reinjection of DNA-liposome complexes. Finally, we showed that the expression vectors which produced the highest levels of chloramphenicol acetyltransferase reporter gene expression could also produce high level expression of two colony stimulating factor genes in mice. Specifically, i.v. injection of liposomes complexed to expression vectors into which we had inserted either the murine granulocyte-macrophage-colony stimulating factor cDNA or the human granulocyte-CSF cDNA, produced circulating levels of the corresponding colony stimulating factor gene product comparable to levels which have been shown previously to be both biologically and therapeutically significant.
Animals↗
Laryngeal reconstruction and survival after function-sparing laryngectomy for selected T3 and T4 lesions.
Most patients lost their vocal ability after ablative surgery for the laryngeal cancer. Total laryngectomy has a history of over 100 years, hence many surgeons are accustomed to the en bloc organ resection and the loss of ability for communication after surgery. The recent advance of surgery introduces the concept and technique of radical cure and functional preservation of the cancer-afflicted-organ at the same setting. For lesions of late T categories (T3, T4), the maintenance of normal function after wide resection to ensure radicality demands a special technique to repair the crippled larynx. For this purpose a local osteomuscular flap was designed to reconstruct a functioning larynx. The surgical manoeuvre was described and the result proved to be successful. The outcome of 138 patients with T3 and T4 laryngeal carcinomas following conservation laryngectomy was analyzed. The five-year survival rate was 69% for supraglottic type and 75% for glottic type. The quality of life was much improved.
Adult↗
[A preliminary study of surgical therapy and combined therapy for cervical esophageal carcinoma].
52 patients with carcinoma of cervical esophagus were treated surgically. Their 3- and 5-year survival rate of was 38.5% and 35.1% respectively. The 3- and 5-year survival rate for surgery alone was 15.4% (2/13) and 9.1% (1/11). The 3- and 5-year survival rate for combined therapy (pre- or postoperative radiation and surgery) was 48.1% (13/27) and 52.9% (9/17). The 3- and 5-year survival rate for surgical salvage after failure of radical radiotherapy was 41.7% (5/12) and 33.3% (3/9). Our data suggest that the result of combined therapy is much better than the result of surgery or radiotherapy. The invation of recurrent nerve, hypopharynx, trachea, larynx and thyroid gland by tumor is contracindicated to surgery.
Adult↗
[The management of cervical esophageal cancer by head and neck surgeons].
Fifty-five cases of cervical esophageal cancer treated at the Department of Head and Neck Surgery, Cancer Hospital, are reported. The three and five year survival rates were 38.2% and 35%, respectively. There are advantages for head and neck surgeons over thoracic surgeons to deal with such cases. The low recurrence rate (7.3%) of this series was a result of high resection and anastomosis at the level of the hypopharynx and hence the better safety margin of tumor clearance. The lymph node metastasis of the neck and the involvement of other neck organs were no longer contraindications of surgery as observed by thoracic surgeons. However, the head and neck surgeons have difficulties in dissecting the mediastinal lymph nodes and in preparing the abdominal viscera while the stomach or colon is to be used to restore the continuity of the upper alimentary tract. Authors concluded that since the cervical esophageal cancer is a disease in the neck, it is reasonable to be managed mainly by head and neck surgeons and otolaryngologists under the support of thoracic and abdominal surgeons and radiotherapists.
Adult↗