[Long-term follow-up of C(1)-C(2) pedicle screw fixation for pediatric atlantoaxial dislocation]

Objective: To investigate the clinical curative effect of C(1)-C(2) pedicle screw fixation for pediatric atlantoaxial dislocation after a long-term follow-up. Methods: From March 2005 to April 2011, a total of 12 male and 9 female patients were included, with age from 3 to 9 years old (mean, 6.1 years old). Among them, 14 cases (67%) had typeⅠinstability atlantoaxial dislocation, 7 cases (33%) had type Ⅱ reducible atlantoaxial dislocation. All 21 pediatric patients with atlantoaxial dislocation underwent posterior pedicle screw fixations. Frankel Grade was used to evaluate function before and after treatment. Furthermore, the information of C(1)-C(2) bony fusion, cervical spine alignment, angle of sagittal curvature, and instability of the subaxial spine were collected from all patients preoperatively, immediately postoperatively and during follow-up period. Results: All 21 patients had regular follow-up with an average duration of 96.4 months (range, 65 to 127 months). All children had good bony fusion within 6 months after treatment. There were 9 patients with lordotic alignment and 12 patients with straight alignment before surgery. After surgery, there were 12 patients with lordotic alignment and 9 patients with straight alignment. At the time of the last follow-up, 17 patients had lordotic alignment and 4 patients had straight alignment. No difference was found between pre- and post-operation (P=0.354). The same result was found between post-operation and last follow-up (P=0.095). Neither kyphotic nor swan-neck deformity was found in any of the 21 patients. The mean angle of sagittal curvature decreased from 31.7°±4.3°preoperatively to 15.5°±2.5°postoperatively (P<0.001). The mean angle of sagittal curvature increased from 15.5°±2.5°postoperatively to 19.1°±2.7°at the final follow-up (P=0.343). No spinal deformities or subaxial instabilities were found. Of the four patients with preoperative neurological defects, Frankel Grade was significantly improved at 3 months follow-up compared with pretreatment values. None of the patients experienced worsening neurological symptoms or injury to the vertebral artery. Conclusion: The results demonstrate that C(1)-C(2) pedicle screw fixation could achieve satisfactory clinical effects for the management of pediatric atlantoaxial dislocation with long-term follow-up.

Renal metastases as the initial presentation of papillary thyroid carcinoma: A case report and literature review

Distant metastasis of thyroid carcinoma is rare, and it occurs particularly rarely in renal regions, which represent ~3% of all thyroid distant metastases, with fewer than 30 single case study reports existing in the literature. The present study (and subsequent literature review) of papillary thyroid carcinoma (PTC) reports the case of a 53-year-old male patient who presented with a left renal mass and who had no previous history of thyroid disease. Following renal and thyroid surgery, postoperative pathology confirmed the case to be a follicular variant of PTC, accompanied by renal metastasis. The patient exhibited brain metastasis during a later follow-up. In conclusion, thyroid metastases to the renal site are extremely rare events, particularly for men who present initially with renal neoplasms, which may easily be misdiagnosed as renal cell carcinoma. PTC tends to have a good prognosis; however, when it is accompanied by distant metastasis, the prognosis becomes less favorable.

[The application of free anterolateral thigh flap with a reporter skin paddle in the reconstruction of circumferential hypopharyngeal defects]

OBJECTIVE

To study the short-term results and technological improvement of free anterolateral thigh (ALT) flaps in the reconstruction of circumferential hypopharyngeal defects.

METHODS

The free ALT flap with a reporter skin paddle was used in 22 cases with circumferential hypopharyngeal defects. The short-term results of reconstructive surgeries and key points, advantages and complications of this technique were summarized.

RESULTS

The length of circumferential hypopharyngeal defects ranged from 7 to 9 cm. ALT flap with an area of (8-9) cm × (11-18) cm was harvested. A reporter skin island with the skin area of (2.0-3.0) cm × (2.5-4.0) cm was designed. 91% (20/22) of ALT flaps survived. Two cases with flap necrosis underwent second reconstruction with a pedicled pectoralis major flap. All the patients had patent anastomotic lumen. Good postoperative subjective swallowing evaluation was obtained in 59% (13/22) of patients; 41% (9/22) of patients had acceptable swallowing results. Three patients (14%) presented with postoperative pharyngocutaneous fistula. One case recovered spontaneously in short-term and other two cases received the second reconstructive surgery.

CONCLUSIONS

The application of free ALT flap with a reporter skin paddle in the reconstruction of circumferential hypopharyngeal defect is technologically easy and reliable, with satisfying swallowing function and limited trauma.

Preoperative Serum Thyrotropin to Thyroglobulin Ratio Is Effective for Thyroid Nodule Evaluation in Euthyroid Patients

OBJECTIVE

This study was designed to assess the efficiency of the serum thyrotropin to thyroglobulin ratio for thyroid nodule evaluation in euthyroid patients.

STUDY DESIGN

Cross-sectional study.

SETTING

Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China.

SUBJECTS AND METHODS

Retrospective analysis was performed for 400 previously untreated cases presenting with thyroid nodules. Thyroid function was tested with commercially available radioimmunoassays. The receiver operating characteristic curves were constructed to determine cutoff values. The efficacy of the thyrotropin:thyroglobulin ratio and thyroid-stimulating hormone for thyroid nodule evaluation was evaluated in terms of sensitivity, specificity, positive predictive value, positive likelihood ratio, negative likelihood ratio, and odds ratio.

RESULTS

In receiver operating characteristic curve analysis, the area under the curve was 0.746 for the thyrotropin:thyroglobulin ratio and 0.659 for thyroid-stimulating hormone. With a cutoff point value of 24.97 IU/g for the thyrotropin:thyroglobulin ratio, the sensitivity, specificity, positive predictive value, positive likelihood ratio, and negative likelihood ratio were 78.9%, 60.8%, 75.5%, 2.01, and 0.35, respectively. The odds ratio for the thyrotropin:thyroglobulin ratio indicating malignancy was 5.80. With a cutoff point value of 1.525 µIU/mL for thyroid-stimulating hormone, the sensitivity, specificity, positive predictive value, positive likelihood ratio, and negative likelihood ratio were 74.0%, 53.2%, 70.8%, 1.58, and 0.49, respectively. The odds ratio indicating malignancy for thyroid-stimulating hormone was 3.23.

CONCLUSION

Increasing preoperative serum thyrotropin:thyroglobulin ratio is a risk factor for thyroid carcinoma, and the correlation of the thyrotropin:thyroglobulin ratio to malignancy is higher than that for serum thyroid-stimulating hormone.

[Clinical application of carbon nanoparticles in surgery for papillary thyroid carcinoma in young patients]

OBJECTIVE

To investigate the number of dissected lymph nodes and the incidence of injury to parathyroid glands during surgery for papillary thyroid carcinoma (DTC) in young patients.

METHODS

This study collected clinicopathological data of 51 young patients with PTC. Of the 51 patients, 18 patients were classified into carbon nanoparticles group (CNP group) and 33 patients into traditional surgical group (TS group). The number of dissected lymph nodes and the incidence of injury to parathyroid glands were analyzed using Wilcoxon rank sum test and chi-square test.

RESULTS

There were 16 males and 35 females, with a male/female ratio of 1: 2.19. The age ranged from 14 to 29 (25 ± 3.9) years. There was no statistically significant difference in age, gender, T-classification, TNM stage and surgical procedures between two groups (P > 0.05). The total number of dissected lymph nodes in CNP group was higher than that in TS group (Z = -2.258, P < 0.05) . However, significant difference in the total number of metastatic lymph nodes between the two groups was not found (Z = -0.396, P > 0.05). In level VI, the detected lymph node number of group CNP was higher than that of TS group (Z = -2.461, P < 0.05) but there was no significant difference in the detected number of metastatic lymph nodes (Z = -1.396, P > 0.05) . The rates of injury to parathyroid gland were 5.5% in CNP group and 18.2% in TS group, respectively (χ(2) = 1.568, P > 0.05).

CONCLUSION

Carbon nanoparticles could be an effective lymph nodes tracer applying to PTC operation in young patients.

[Fine-needle aspiration with measurement of parathyroid hormone levels in thyroidectomy]

OBJECTIVE

Hypoparathyroidism is one of the most serious complications of thyroidectomy. It is important to identify the parathyroid glands during thyroidectomy. In order to find an economic, simple and less traumatic way to identify the parathyroid glands and testify its feasibility, fine-needle aspiration of suspected parathyroid tissue was used to measure the parathyroid hormone (PTH) levels during the surgical procedure.

METHODS

From Nov. 2011 to Apr. 2012, 50 patients were recruited for thyroid surgery in the Sun Yat-sen University Cancer Centre. During surgery, fine-needle aspiration of suspected tissues, including parathyroid gland, thyroid gland, muscle, fat tissue, and lymph node, was performed, the PTH levels were measured. In addition, the tissues above-mentioned were taken to pathological examination. Statistical processing was adopted to determine the sensitivity and specificity of intraoperative fine-needle aspiration with measurement of PTH level in finding the pathology of the parathyroid gland.

RESULTS

There were 237 tissues from 50 patients in total, and 45 of them were certified as the parathyroid glands by pathology. Intra-operative PTH (ioPTH) of the tissues in forty-four cases were higher than 600 ng/L, ioPTH of the tissues in one case was lower than 600 ng/L, and it was 160 ng/L. The highest ioPTH in other cases was 537.7 ng/L. The sensitivity was 97.8%. The specificity was 100%. The difference between the sensitivity and the specificity of two groups was not statistically significant, and P > 0.05. The level of PTH of parathyroid gland were much higher than other tissues, and P < 0.001.

CONCLUSIONS

The level of ioPTH of parathyroid gland were far higher than thyroid, muscle, fat, lymph node. It is an economic, fast and less traumatic way to identify the parathyroid gland by using the fine-needle aspiration of the parathyroid tissue with measurement of PTH levels. The sensitivity and the specificity are high. It can be used in the thyroidectomy to identify the parathyroid glands.

[Laryngeal reconstruction by complex hyoid bone flap after frontal partial laryngectomy]

OBJECTIVE

The aim of this study was to describe a new technique of combined hyoid bone and thyrohyoid membrane flap in laryngeal reconstruction after tumor resection, and to evaluate outcome.

METHODS

Six patients requiring an frontal partial laryngectomy for cancer were enrolled between September 2008 and August 2012.

RESULTS

Nasogastric feeding was initiated within 24 hours. The mean times to swallow batter, ability to drink water and removal of the nasogastric tube were 2.6, 5.5 and 6.3 days. All patients had good respiratory function. There were no deaths, and no reports of postoperative dyspnea or dysphagia. The vocal quality was satisfactory, slightly deeper and raspy, and the volume was weak when calling. The final follow-up assessment was in August 2012, and the overall mean follow-up period was 29.5months, range 14 to 47 months. Case two subsequently underwent total laryngectomy for recurrence in the paraglottic space, but there was no evidence of further tumor recurrence at the final assessment.

CONCLUSIONS

The combined muscle-pedicle hyoid bone and thyrohyoid membrane flap is a reliable graft for one-stage repair of laryngotracheal defects, providing effective repair of the mucosa and cartilage support. Vocal quality, swallowing function and ventilation after the procedure were favorable.

[Use of a linear stapler device in total laryngectomy]

OBJECTIVE

To evaluate the value of using a linear stapler device for the closure of the pharynx during total laryngectomy.

METHODS

Sixteen total laryngectomies were performed between August 2010 and December 2011, during the operation, the TA 60 linear stapler was used for pharyngeal closure. Among these patients, two patients had the history of pre-operative radiotherapy, four patients recurred after radiotherapy, ten patients were treated for the first time. 100 ml methylene blue was injected into the newly closed laryngopharyngeal cavity through the nasopharyngeal breather pipe for checking up whether it was watertight or not.

RESULTS

Among the sixteen patients, methylene blue leakage from the mucosal joint of the gular cavity closed by the stapler were not found in fifteen patients, it was only found in one patient. The transudatory places were sutured with absorbable Vicryl sutures. This patient healed well without pharyngocutaneous fistula. Negative surgical margins were achieved in all patients. No patient needed to be transferred to open surgery. Using a linear stapler device in total laryngectomy, 45 minutes could be saved as compaired to manual suture. One patient developed a light pharyngocutaneous fistula. The incidence of pharyngocutaneous fistula was 6.25% (1/16).

CONCLUSIONS

This stapled closed technique for pharyngoplasty is efficient, eliminates the risk of wound contamination, saves operation time and decreases the incidence of pharyngocutaneous fistula. This technique can be recommended as alternative for repairing the pharynx in patients undergoing total laryngectomy.

Circulating microRNA profiles as potential biomarkers for diagnosis of papillary thyroid carcinoma

CONTEXT

There are no known effective and reliable biomarkers to distinguish benign thyroid nodules from papillary thyroid carcinomas (PTC). Previous studies have indicated that serum microRNA (miRNA) profiles may be diagnostic and/or prognostic markers for numerous other cancers.

OBJECTIVE

We studied circulating miRNA profiles in patients with PTC or benign nodules and healthy controls to identify serum miRNA that may be useful as markers for PTC.

DESIGN, SETTING, AND PARTICIPANTS

Genome-wide serum miRNA expression profiles were determined using Solexa sequencing followed by extensive quantitative RT-PCR validation in 245 subjects (106 patients with PTC, 95 patients with benign nodules, and 44 healthy controls). A panel of miRNA was used to assess the expression of specific miRNA in the sera and thyroid tissues of patients with PTC or benign nodules.

RESULTS

The expression of serum let-7e, miR-151-5p, and miR-222 was significantly increased in PTC cases relative to benign cases and healthy controls. Receiver operating characteristic curve analyses indicated that use of these three miRNA had a high diagnostic sensitivity and specificity for PTC. Serum let-7e, miR-151-5p, and miR-222 levels were found to be well correlated with certain clinicopathological variables, such as nodal status, tumor size, multifocal lesion status, and Tumor-Node-Metastasis stage. Expression of serum miR-151-5p and miR-222 in a subset of PTC patients decreased significantly after tumor excision. Increased expression of miR-151-5p and miR-222 was also found in the tissue of PTC patients.

CONCLUSIONS

Our study demonstrates that serum miRNA profiles may be used as novel and minimally invasive diagnostic markers for PTC.

[Prognostic factors of early tongue squamous cell carcinoma and neck treatment]

OBJECTIVE

To analyse the prognostic factors and the neck treatment strategy of early tongue squamous cell carcinoma (SCC).

METHODS

Total of 152 cases of early tongue SCC underwent surgery between January 1994 December 2003 were reviewed. The patients, according to their neck managements, were divided into two groups, or wait-whach group (n = 32) and neck dissection group (n = 120), and the neck dissection group was subdivided into supraomohyoid neck dissection (SND) group and comprehensive neck dissection(CND) group (including radical neck dissection and modified radical neck dissection).

RESULTS

All patients were followed up over 5 years or until death and the 5-year follow-up rate was 94.7%. The regional recurrence rates of wait-whach group and neck dissection group were 34.4% and 14.2% respectively (χ(2) = 6.865, P < 0.01) and 5-year overall survival rates of the two groups were 68% and 79% respectively (χ(2) = 1.699, P > 0.05). There were no significant difference in the regional recurrence rate or 5-year survival rate between SND group and CND group (P > 0.05). The patients with pathologically node positive had a low 5-year survival rate compared to those with node negative. The patients with regional recurrence had a significant low 5-year survival rate compared to patients without regional recurrence (P < 0.01).

CONCLUSIONS

Occult lymph node metastasis and regional recurrence were important prognostic factors for early tongue cancer. Supraomohyoid neck dissection can not improve the 5-year survival rate, but significantly reduce the rate of neck recurrence. The results suggest that the selective neck dissection for ipsilateral level I-III should be applied to the patients with early tongue carcinoma which does not cross the midline.

[Clinical analysis of myoepithelial carcinoma of head and neck]

OBJECTIVE

To evaluate clinical feature, diagnosis, treatment and prognosis of myoepithelial carcinoma (MC) in the head and neck.

METHODS

Clinical data of 11 patients which were confirmed by pathology and immunohistochemistry in Cancer Center, Sun Yat-sen University from Jan. 1992 to Dec. 2006, were reviewed. There were 5 cases in parotid gland, 1 in hard palate, 1 in maxillary sinus, 1 in pharyngeal recess, 1 in bucca cavioris, 1 in scalp, and 1 in gingiva. Male female ratio is 4 to 7. The median age at diagnosis was 37 years (range: 14 - 60 years).

RESULTS

All cases were operated, 4 underwent surgery alone, 2 underwent surgery plus adjuvant radiotherapy, 2 received surgery plus adjuvant chemotherapy, 3 underwent surgery plus adjuvant chemoradiation. After operation, 8 cases occurred local recurrence and 4 cases occurred distance and lymph nodes metastasis. There was spindle cell type in 5 cases, clear cell type, plasmacytoid cell type in 2 cases, epithelioid cell type, mixed type in 1 case. The median follow-up time was 40 months. AS to the last follow-up time, 8 patients died.

CONCLUSIONS

The characteristics of the tumor were rapidly enlarging, invading the surrounding regions, high rates of lymph node metastasis, high rates of distance metastasis. It was easily recurrence if the surgical excision was not radically for MC, and the prognosis was poorly. MC was a sort of malignant tumor. Radical operation must be advocated initially. Chemotherapy and radiotherapy may be effective after operation.

A retrospective cohort study of nasopharyngeal adenocarcinoma: a rare histological type of nasopharyngeal cancer

OBJECTIVES

The purpose of this study was to investigate the clinical manifestations, Epstein-Barr virus (EBV) serology, and treatment outcome of patients with nasopharyngeal adenocarcinoma (NPAC).

DESIGN

A retrospective study of clinical data from consecutive patients with NPAC identified between 1964 and 2000.

SETTING

A tertiary cancer center in China.

PARTICIPANTS

Forty-eight patients diagnosed with NPAC.

MAIN OUTCOME MEASURES

Crosstabs and chi-square test were conducted to study the association of positive VCA-IgA levels among different pathological types of NPAC, and also to compare the proportions of local control rates in patients treated with different modalities. The survival rate was calculated using the Kaplan-Meier method, and the Log Rank test was used to compare the survival rates considering different factors. To balance the distribution bias, a multivariate COX model survival analysis was also performed.

RESULTS

Of the 48 NPAC patients identified, 45% presented with cervical metastasis. Pathologically, 58% of NPAC cases were common type and 42% were salivary gland type. The positive rate for the EBV antibody VCA-IgA in all patients was 53% and only 24% in the salivary gland type of NPAC. The overall local control rate and the 5-year disease-free survival rates were 87% and 65% respectively. Patients treated with surgery plus radiotherapy (RT) had a significantly higher 5-year disease-free survival rate than patients receiving RT alone (89%versus 75% respectively) (P = 0.039). Multivariate analysis confirmed that treatment modality was the significant factor influencing patient survival (P = 0.027) and the pathological type was not a factor predicting survival.

CONCLUSIONS

Nasopharyngeal adenocarcinoma is a distinct entity in all types of nasopharyngeal carcinoma and EBV serology has limited value in its diagnosis. The combination of surgery and RT should be considered for treatment of early lesions of NPAC.

[Clinical study on 88 cases of adenoid cystic carcinoma in nasal cavity and paranasal sinuses]

OBJECTIVE

To study the clinical characters, diagnosis, management and prognosis of patients with adenoid cystic carcinoma in nasal cavity and paranasal sinuses.

METHODS

The data were analyzed retrospectively for 88 patients with adenoid cystic carcinoma in nasal cavity and paranasal sinuses, to evaluate the clinical characters, diagnostic and therapeutical aspects and the contribution of every factor influencing the survival. Survival analysis was performed by Kaplan-Meier method, comparison among/between groups was performed using Log-rank test, and multivariate analysis was carried out using Cox proportional hazard model.

RESULTS

There were 56 patients in stage III and IV. Most of them received surgical operation combined with radiotherapy. The 5-year, 10-year and 15-year survival rates were 0.640, 0.341 and 0.190 respectively. While there were only 0.833, 0.221 and 0.323, 0.145 in stage III and stage IV lesions respectively. The 5-year and 10-year survival rates of 0.761, 0.415 were obtained in patients who received surgery combined with radiotherapy, 0.750, 0.367 and 0.286, 0.143 respectively in those treated by surgery and by radiotherapy alone.

CONCLUSIONS

Advanced adenoid cystic carcinoma should be treated by combined surgical operation and radiotherapy. Stage and treatment approach are the independent factors affecting the prognoses of patients with adenoid cystic carcinoma in nasal cavity and paranasal sinuses.

[Clinicopathological features and prognosis of nasopharyngeal adenocarcinoma]

OBJECTIVE

To investigate the clinical manifestations, EB virus serology and treatment outcome of nasopharyngeal adenocarcinoma (NPAC).

METHODS

Clinical records of NPAC patients between 1964 and 2000 in Cancer Center of Sun Yat-sen University were retrospectively reviewed.

RESULTS

Among 48 patients with NPAC, 45.2% (7 cases of N1, 8 cases of N2 and 4 cases of N3) of them presented with cervical metastasis. Pathologically, common type and salivary gland type of NPAC accounted for 58.3% (28 cases) and 41.7% (20 cases) respectively. The positive rate of the EB virus antibody VCA-IgA was 56.7% in the whole group and only 23.7% in the salivary gland type of NPAC. The overall local control rate and the 5-year disease free survival rate by Kaplan-Meier method were 87.0% (40/46) and 65.2% respectively. Baseline data analysis showed that age, gender, N stage and M stage were not the significant factors, never the less the T stage was not balanced between the two groups (surgery plus radiotherapy vs radiotherapy alone, chi2 = 4.801, P = 0.045). The patients treated by surgery plus radiotherapy had significantly higher 5-year disease free survival rate than by radiotherapy alone (88.9% vs 74.7%, Log Rank test: chi2 = 4.272, P = 0.039). Cox's multivariate analysis showed treatment modality and N stage were the significant factors influencing survival (RR were 15.276 and 6.529, P < 0.05).

CONCLUSIONS

NPAC is a distinct entity in all types of nasopharyngeal carcinoma. EB virus serology has limited value in its diagnosis. Surgery plus radiotherapy could be another choice of treatment for early lesions of NPAC.