[Analysis and comparison of the clinical features and prognosis between extra - gastrointestinal stromal tumors and duodenal gastrointestinal stromal tumors]

Objective: To investigate the differences of clinicopathological features, diagnosis, treatment and prognosis between patients with extra-gastrointestinal stromal tumors (EGIST) and duodenal gastrointestinal stromal tumors (DGIST). Methods: A retrospective case - control study was performed. Case inclusion criteria: (1) tumor confirmed by histology and pathology; (2) primary tumor locating in the extra - gastrointestinal tract or duodenum; (3) without other synchronous tumors; (4) complete clinical and pathological data. Clinical data of 20 EGIST patients and 32 DGIST patients from March 2011 to September 2016 at Department of Gastrointestinal Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine were retrospectively collected and analyzed. The observational parameters included clinicopathological characteristics, treatment and prognosis conditions. Continuous data of abnormal distribution were expressed as median (range) and compared using the Mann-Whitney U-test. Survival curves were drawn by the Kaplan-Meier method and compared with the Log-rank test. Results: Of the 20 EGIST patients, 8 were males and 12 were females with age of 61.0 (30.0 to 86.0) years and of the 32 DGIST patients, 12 were males and 20 were females with age of 55.5 (27.0 to 70.0) years. Compared with DGIST patients, EGIST patients were older (U=188.000, P=0.012], had larger tumor size [10.0 (3.0 to 29.0) cm vs. 4.0 (1.5 to 10.0) cm, U=98.500, P<0.001] and higher ratio of high risk classification [85.0% (17/20) vs. 12.5% (4/32), χ(2)=26.870, P<0.001]. Among the 20 EGIST patients, 5 were diagnosed with distal metastasis and received imatinib (400 mg/d), and the other 15 patients underwent radical resection who were included in survival analysis. All the 32 DGIST patients underwent radical resection. The median follow-up of whole group was 43 (14 to 76) months. The 3-year recurrence/metastasis-free survival rate of 15 cases undergoing radical resection in the EGIST group was 85.6%, which was lower than that of the DGIST group (88.6%), and the difference was not statistically significant (P=0.745). There was no significant difference in the 3-year overall survival rate between the EGIST group (92.9%) and the DGIST group (100%) (P=0.271). Conclusions: As compared to DGIST, EGIST mostly occurs in those with older age, larger tumor size and higher risk grade. The prognosis of EGIST patients after radical resection is similar to that of DGIST patients.

[Correlation between laryngopharyngeal reflux and otitis media with effusion in adults patients]

Objective:Using the pepsin A concentration to investigate the relationship among gastroesophageal Reflux/laryngopharyngeal reflux and otitis media with effusion in adults patients.Method: Adults with OME underwent myringotomy with tube placement or eardrum puncturing suction were collected in the study group and the patients with coclear implatation were collected as control group. A standard sandwich Enzyme-linked Immunosorbent Assay (ELISA) method was applied to measure pepsin A concentration in the middle ear fluid.RSI and GERD-Q were used for the patients in study group.Result: Pepsin A concentration was (23.72±26.64; 2.00-84.47 ng/ml) in study group.The positive rates of pepsin A in the patients and samples were 21.69%(18/83) and 17.27%(19/110) respectively.In the control group, no pepsin A was detected in 26 samples. In the study group, 5 (6.02%) were diagnozid with GERD and 19 out of 83 patients (22.89%,19/83) were diagnosed with LPRD.LPRD, 8 out of 18 patients (44.44%) in the pepsin A positive group, was much higher than that in the pepsin A negative group (16.92%)(P<0.01).Conclusion: Laryngopharyngeal reflux was an important pathogeny of OME in adults patients, although those patients maybe have no any symptoms of GERD. The fat maybe be one of a indirect risk factor of OME in adults.

[Crouzon syndrome coupled with OSAHS and congenital heart disease: a case report]

A case of Crouzon syndrome coupled with OSAHS and congenital heart disease in our hospital was reported. The patient who was a 2 years and 7 months old boy, was admitted in our hospital for repetitive sore throat, snoring with mouth breathing during sleep for more than 2 years and been found with some typical defect of Crouzon syndrome during physical examination. Half a year ago the boy underwent ventricular septal defect closure surgery. PSG shows severe apnea hypopnea and low ventilation existed. Under general anesthesia, the patient accepted bilateral tonsillectomy and adenoidectomy but dyspnea occurred after post-operative extubation till 2 days later the boy can breathe by himself. The follow-up at 6 months and 1 year revealed that the patient did not have snoring or mouth breathing during sleep. For this kind of case, we should assess detailed pre-operation and observe carefully post-operation so as to reduce the perioperative period risks.

[The long-term benefits of cochlear implantation for children and their families]

Objective:To study the auditory language ability of children with artificial cochlea after entering normal schools as well as the school life conditions and to evaluate the long-term comprehensive benefits of surgery on children along with their families. Method:The questionnaire was designed referring to the categories of auditory performance (CAP), the speech intelligibility rating (SIR), and family burden scale of diseases (FBS), with the questions involving four aspects of the general conditions, the auditory language ability, the school life conditions and the family conditions. Altogether 50 families were participated. Children who had applied artificial cochlea for at least two years and studied in normal schools were selected as the studying objects. The follow-up questionnaire was conducted on the parents. The differences were compared in the auditory language ability and the school life conditions, grouped by gender, age at surgery, parents' educational level, residence, service time of artificial cochlea and parent-child time in general. Meanwhile, the differences of 15 family conditions were compared before and after surgery. Result:The variable factors were of no obvious statistical significance in the comparison among groups of the auditory language ability (P>0.05); In the comparison of the school life conditions, there were significant differences in the number of making friends when grouped by parent-child time (P<0.05), there wes no statistical significance in the comparison among groups of the remaining various factors (P>0.05); In the comparison of family conditions before and after surgery, the rest of the indexes were of significant differences (P<0.05), there was no significant differences in the economic burden and social time of parents (P>0.05). Family conditions improved evidently after surgery. Conclusiont:Under the circumstances of different variable factors, after 2 years of rehabilitation, children are able to acquire better auditory language ability, and adjust themselves to the school life, finishing their studies, still there is a deficiency in the aspect of organizational competence in comparison to age-matched children. In addition, with children's recovery and attending schools, parents' mental stress is significantly reduced, family life returns to normal, and family atmosphere becomes harmonious. Not only can the artificial cochlea help rid children of disability, but also it can be of obvious benefits to their families.

[The significance of prophylactic migraine therapy in controlling familial Meniere's disease, a preliminary study]

Objective:To investigate the effect of prophylactic migraine therapy in controlling vertigo episode of Meniere's disease. Method:We prospectively collected 16 cases of familial Meniere' disease diagnosed in our vertigo outpatient. The patients were divide into without migraine group (WOM) and with migraine group (WM). Give WM group a prophylactic therapy for migraine and compare within groups about the follow-up results of vertigo episodes. Result:WOM group had better results in controlling vertigo, then the controlling effect equaled after we added a prophylactic therapy for migraine. Conclusion:Combined with prophylactic migraine therapy may have better effect in accompanying migraine patients when controlling familial Meniere's disease.