OBJECTIVE To describe the clinical features of the parapharyngeal space tumors and assess the postoperative complications and outcomes in our hospital.METHODS The clinical data of 135 cases with parapharyngeal space tumor treated from Jan.1995 to Dec.2005 in our hospital were retrospectively studied.RESULTS It included 24 heterogeneous histologies in this group.Neurogenic tumors(72.6 %) were the most common tumors,next were salivary gland tumors(15.6 %),and others 11.8 % tumors were miscellaneous tumors.There were 121(89.6 %) patients with benign lesions and 14(10.4 %) with malignant tumors.Transcervical approach was the most commonly applied route.Only 4 cases recurred in 113 operated benign patients.At end of the follow-up,of 14 patients with malignant tumors,4(28.6 %) were alive with no evidence of disease,5(35.7 %) were alive with disease,5(35.7 %) died of the diseases.CONCLUSION Primary parapharyngeal space neoplasms are rare and the majority of these tumors are benign.Surgery is the mainstay of treatment for parapharyngeal space tumors.Most benign cases with a low rate of complication and recurrence after operation,but malignant neoplasms have a poor prognosis.

Objective To assess the effect of the balloon valvuloplasty for congenital valvular aortic stenosis (AS) in children.Methods A total of 27 (mean age 6.09 years) children with AS accepted the treatment of percutaneous balloon aortic valvuloplasty (PBAV). The ratios of balloon/valve were 0.95 ± 0.08 for 19 cases of typical AS and 1.00 ± 0.11 for 8 cases of hypoplastic AS. The patients were evaluated by the gradients across aotic valves in pre- and post-PBAV and by echocardiogram during the follow-up period.Results Fifteen of 19 (78.9％)cases of typical AS had a batter outcome and the gradient of the remaining 4 cases (26.7％) had increased after follow-up (△P ＞ 50 mm Hg) . Four of 8 (50.0％) cases of hypoplastic AS had satisfactory responses and the gradient of the remaining 3 cases (75.0％) rose. There was no moderate to severe aortic insufficiency (Al).Conclusion The balloon aortic valvuloplasty provides safe and significant hemodynamic and clinical improvement in pediatric patients. The outcome of PBAV for typical AS is better than for hypoplastic AS.

Objective To evaluate the efficiency of percutaneous balloon angioplasty of coarctation ot the aorta in children and discuss its risk factors that can lead to poor long-term results. Mehods From September 1987 to August 1999, 24 patients underwent 27 balloon angioplasty procedures for native or recurrent coarctation of the aorta at our institution. There were 19 patients with discrete (membranous) coarctation, 4 patients with long-segment and aortic arch hypoplasia, and 1 patient with postoperative recurrence. The balloon diameter was chosen not to exceed the diameter of the aorta proximal to the stenotic site ( 11.06 + 2.80 mm vs 11.78 + 3.18 mm), with the chosen diameter two to four times that of the stenotic segment (2.57 + 0.68 times). The patients have been followed up for half to twelve years (mean 6.2 + 2.8 years). Satisfactory result was defined as a reduction in the pressure gradient across the site of coarctation to ≤20 mm Hg.Results The systolic pressure gradient across the coarctation site decreased from 48.17 + 14.68 mm Hg to 14.96 + 13.12 mm Hg ( P ＜ 0.01 ) and the diameter of the coarctation site increased from 4.66 + 2.43 mm to 8.80 + 3.32 mm ( P ＜ 0.01 ). Immediate satisfactory results were obtained in 19 patients (79％). Of the 5 patients with unsatisfactory results, 4 had aortic arch hypoplasia and 1 had membranous coarctation. Of the 19 patients with satisfactory results, 18 patients had membranous coarctation and 1 patient had recurrent postoperative coarctation. No aneurysm and other complications had occurred in any patients at the follow-ups.Conclusion Percutaneous balloon angioplasty is an effective treatment altemative to surgery in most patients with recurrent postoperative or native membranous coarctation of the aorta. It should not be recommended for the coarctation of aortic arch hypoplasia.

Objective To investigate the clinical efficacy of laparoscopic spleen-preserving distal pancreatectomy (Kimura method and Warshaw method) for benign lesions of pancreatic body and tail.Methods The retrospective cohort study was conducted.The clinicopathological data of 39 patients with benign lesions of pancreatic body and tail who underwent laparoscopic spleen-preserving distal pancreatectomy in the Second Affiliated Hospital of Nanchang University between March 2008 and January 2018 were collected.Of 39 patients,28 undergoing Kimura method (splenic artery and vein-preserving distal pancreatectomy) were allocated into the Kimura group,and 11 undergoing Warshaw method (cutting splenic vessels and preserving short gastric vessels)due to serious adhesion between pancreatic body and tail and splenic hilum were allocated into the Warshaw group.Observation indicators:(1) operation situations;(2) postoperative situations;(3) follow-up situations.Followup using outpatient examination and telephone interview was performed to detect blood glucose level and tumor recurrence of patients up to March 2018.Measurement data with normal distribution were represented as (x)±s and comparison between groups was analyzed using the t test.Measurement data with skewed distribution were described as M (range) and comparison between groups was done using nonparametric rank-sum test.Comparisons of count data were analyzed using chi-square test or Fisher exact probability.Results (1) Operation situations:39 patients received laparoscopic spleen-preserving distal pancreatectomy,operation time and volume of intraoperative blood loss of 39 patients were respectively (194 ±58)minutes and 100 mL (range,30-800 mL).The operation time and volume of intraoperative blood loss were respectively (197±56)minutes,100 mL (range,30-800 mL) in the Kimura group and (186±63)minutes,150 mL (range,30-450 mL) in the Warshaw group,with no statistically significant difference between groups (t =0.494,Z =-0.597,P＞ 0.05).(2) Postoperative situations:time to anal exsufflation and duration of hospital stay were respectively (2.6±0.8)days,(9.2±7.3)days in 39 patients and (2.4±0.6)days,(7.5±4.2)days in the Kimura group and (2.8±1.3)days,(13.5±11.1)days in the Warshaw group,with no statistically significant difference between groups (t=-0.720,-1.736,P＞0.05).Seven patients had postoperative complications.The incidence of complication was 2/28 in the Kimura group,1 patient with pancreatic leakage at 5 days postoperatively was cured by 15-day B ultrasound guided catheter drainage,and 1 who was diagnosed as pulmonary infection by chest CT examination at 5 days postoperatively was discharged from hospital after 8-day anti-infection and sputum-inductive treatments.The incidence of complication was 5/11 in the Warshaw group,3 patients with sustained fever at 5 and 7 days postoperatively who were diagnosed as grade 1 splenic infarction by epigastric enhanced CT examination were improved and discharged from hospital by antibiotic and low molecular weight heparin treatments,and then epigastric enhanced CT re-examination at 3 months postoperatively showed recovery of splenic perfusion;1 with pancreatic leakage at 7 days postoperatively was cured by 18-day conservative treatment;1 who was diagnosed as delayed gastric emptying by upper gastrointestinal contrast at 16 days postoperatively was improved and then discharged from hospital by 15-day placement of intestinal feeding tube and nutrition support therapy.There were statistically significant differences in the incidences of overall complication and splenic infarction between groups (x2 =5.485,4.878,P＜0.05) and no statistically significant difference in the incidence of other complications between groups (P＞0.05).(3) Follow-up situations:39 patients were followed up for 12 months (range,2-64 months).During the follow-up,six patients had normal blood glucose level,and all patients had good quality of life,without recurrence.Conclusions Laparoscopic spleen-preserving distal pancreatectomy for the benign lesions of pancreatic body and tail is satisfactory in short-and long-term curative effects.The incidences of complication and splenic infarction of Kimura method are lower than that of Warshaw method.

Objective To evaluate the effect of different kind of intravenous immunoglobulin (IVIG) therapy in treating Kawasaki disease (KD) and preventing cardiac consequences (coronary artery lesion, CAL). Methods A questionnaire form and guideline for KD diagnosis were sent to 50 hospitals providing pediatric medical care in Shanghai. The data from a total of 1 682 KD patients were collected. It included 1 064 males and 618 females from 1998 through 2008 in Shanghai. The average age of the KD patients was (2.57±2.33) years old (0.1-18.8 years).The patients had been divided into 6 groups for different IVIG therapy, which included 1 g/kg once, 2 g/kg once, 0.4-0.5 g/kg five times, 1 g/kg twice, 2 g/kg twice and others. SAS 6.12 software was used for statistical analysis. Results In all KD patients, the patients treated with IV1G in 5th-10th day of illness has the least cardiac complication and CAL incidence and the group with IVIG therapy of 1 g/kg twice also has the least cardiac complication and CAL incidence. Conclusions The best doses of IVIG in treating KD is 1 g/kg twice and the IVIG therapy should be used in 5th-10th day of KD illness.