Objective To evaluate accuracy of preoperative tumor grade and intracperative gross examination of myometrial invasion in patients with clinical stage Ⅰ endometriod adenocarcinoma for lymphadenectomy. Methods Clinic-pathological data were retrospectively collected from 687 patients with clinical stage Ⅰ endometriod adenocarcinoma who underwent operation in Women's Hospital, Zhejiang University School of Medicine from January 1999 to December 2008. According to postoperative histology diagnosis, accuracy of preoperative tumor grade by curettage and depth of myometrial invasion by intraoperative gross examination was evaluated, and clinic-pathological factors associated with accuracy were analyzed. Results Sensitivity, specificity, accuracy, false negative rate, false positive rate, and positive and negative predictive value for the prediction of needing for intraoperative lymphadenectomy in patients with clinical stage Ⅰ endometriod adenocarcinoma were 70. 4% ,80. 2% ,77.6% ,12.0%, 43.0%, 57.0% and 88.0%, respectively. Analysis of mutil-factors shown that patient age, tumor size, lymph node metastasis and extrauterine spread lesions were independent factors affected the accuracy of prediction(P ＜ 0. 05 ). Conclusion Prediction of needing for lymphadenectomy by preoperative tumor grade and intraoperative gross examination of myometrial invasion is reliable in clinical stage Ⅰ endometriod adenocarcinoma patients, while there is a highly false negative rate in prediction of not needing for lymphadenectomy, while other prognostic factors such as patient age, tumor size, lymph node metastasis and extrauterine spread lesion should be together considered.

OBJECTIVE To study the frequencyof extracapsular spread (ECS) in neck metastasis and its impact on prognosis in supraglottic carcinoma. METHODS A total of 177 patients with radical or modified neck dissection between Jan. 1994 and Dec. 1997 for supraglottic carcinoma were summarized. Transparent lymph node detection and a series of sectioning method were applied on all neck dissection specimens. The SPSS software package (version 11.5) was used to make statistical analysis. Survival curves were calculated with the Kaplan-Meier model. Impact of extracapsular spread on prognosis was assessed for significance with the Log-Rank test. RESULTS Eighty one patients were pathologically positive in neck specimens and the neck metastatic rate was 45.8 %. ECS was found in 32 cases and the ECS frequency was 39.5 % (32/81). The ECS was related with pathological N stage and the number of positive nodes. Patients with ECS had a higher possibility of regional recurrence and contralateral metastasis. The 5-year survival rates of patients with neck metastasis ECS- and patients with ECS+ were 61.9 % and 22.2 % respectively. The differences had statistically significance. CONCLUSION ECS in neck metastasis affects the prognosis in patients with supraglottic carcinoma. If bilateral neck dissection was not selected simultaneously, close follow-up on contralateral neck should be selected in patients with ECS because of a higher incidence of contralateral neck metastasis.

Clinical practice was an important part in the medical education.To improve the clinical education quality of obstetrics and gynecology,several methods were chosen to settle the problems such as setting up and perfecting the management mechanism,strengthening the construction of teachers and the cultivation of students’overall quality.

Objective: To study the clinic and pathological features of leukoplakia of the larynx, and reduce canceration rate. Method: Seventy-four postoperative patients of leukoplakia of the larynx were followed up for four years by telephone or clinic service. Result: None of eighteen cases of pure leukoplakia was recurrence. Fifty-six ca-ses were leukoplakia with epithelial dysplasia histologically. Seven out of fifty-six postoperative cases occurred hoarseness; three out of fifty-six postoperative cases recured, and accepted twice or more operations successively; three out of fifty-six postoperative cases occurred canceration. Conclusion:Operation is the main means for the treatment of leukoplakia of the larynx, and the effect is comparatively well. The patients with histological epitheli-al dysplasia should be pay great attention because of their higher canceration rate, and enlarged operation ranges appropriately with the patient consent could effectually prevent recurrence or canceration during the early lesions. Close observation is important for these patients.

OBJECTIVETo assess the feasibility of University of Washington Quality of Life (UW-QOL) questionnaire in laryngeal cancer patients treated by total or partial laryngectomy and their prognostic factors in China.

METHODSWith UW-QOL questionnaire, a survey was conducted in patients treated by partial (81, Group A) or total (37, Group B) laryngectomy for laryngeal cancer.

RESULTSThe composite QOL scores of group A (692.34 +/- 127.94) were higher than those of group B (636.35 +/- 139.97), with a difference statistically significant (P < 0.05). Group A (74.32 +/- 23.82; 80.86 +/- 20.26) was better than group B (40.27 +/- 25.76; 69.59 +/- 27.09) in speech and appearance (P < 0.001; P < 0.05); but group B (92.57 +/- 13.00) was superior to group A (83.02 +/- 20.47) in pain (P < 0.01). Six factors including stage, operative, modality, complication, postoperative radiotherapy or chemotherapy, with whom to live, chronic disease before or after operation were related to postlaryngectomy QOL.

CONCLUSIONPartial laryngectomy is superior to total laryngectomy in speech, appearance and overall QOL. UW-QOL questionnaire is suitable for QOL research in laryngeal cancer in China.

Aged ; Aged, 80 and over ; Feasibility Studies ; Female ; Follow-Up Studies ; Humans ; Laryngeal Neoplasms ; psychology ; surgery ; Laryngectomy ; Male ; Middle Aged ; Quality of Life ; Surveys and Questionnaires

OBJECTIVE: To study the relationship between different types of lymph node metastasis and contralateral neck metastasis and their impacts on prognosis. METHOD: Two hundred and forty-eight patients with supraglottic carcinomas and complete follow-up were analyzed retrospectively. Transparent lymph node detection and continuous sectioning methods were applied on postoperative neck specimens. RESULT: Cervical lymph node metastases were found in 115 patients and the lymph node metastatic rate was 46.4%. There were three types of lymph node metastases, 39 cases with single type, 34 with multiple type, 42 with fusion type. Contralateral metastatic rates were 5.1%, 44.1% and 61.9% in single, multiple and fusion type respectively. Contralateral metastasis was also related with tumor extension across midline and clinical N stages. The 3- and 5-year survival rates were 79.5% and 74.4% in single type, 61.8% and 41.2% in multiple type, 61.9% and 35.7% in fusion type. CONCLUSION Bilateral neck dissections should be undertaken in multiple and fusion types of lymph node metastasis. The lymph node metastatic type should be an important criteria to judge prognosis.
Adult ; Aged ; Carcinoma, Squamous Cell ; diagnosis ; pathology ; Female ; Humans ; Laryngeal Neoplasms ; diagnosis ; pathology ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; pathology ; Male ; Middle Aged ; Neck ; Neoplasm Staging ; Prognosis ; Retrospective Studies

OBJECTIVE: To study the expression and prognostic significance of cyclooxygenase-2 (Cox-2) in supraglottic laryngeal squamous cell carcinomas (SGLSCC) and identify the relationship between Cox-2 and angiogenesis and the roles of Cox-2 in SGLSCC as a biological marker. METHOD: Eighty-eight primary SGLSCC patients received surgical treatment were studied by immunohistochemical staining, and reverse transcription-polymerase chain reaction (RT-PCR) technique. RESULT: The percentage of Cox-2-positive cells was 94.3% (83/88) in SGLSCC whereas there was no immunostaining in the all cells of normal mucosa of paracarcinoma. Cox-2 expression was higher in well-differentiated tumors compared with poorly-differentiated SGLSCC. The relative concentration of Cox-2 mRNA was 141.871 +/- 20.5435 in SGLSCC and 17.031 +/- 2.2597 in normal paracarcinoma mucosa (P < 0.01). It was significantly higher in SGLSCC than in normal paracarcinoma mucosa. In SGLSCC, only pathological grading and the percentage of Cox-2-positive cells had significant correlation (P < 0.01). And not only the percentage of Cox-2-positive cells but also Cox-2 intensity had significant correlation with microvessel density (MVD) (P < 0.01). Kaplan-Meier survival analysis showed there had significant relationship between Cox-2 intensity and cumulative survival rate of SGLSCC patients (P < 0.05). But the percentage of Cox-2-positive cells was different (P > 0.05). Cox's regression analysis indicated that Cox-2 intensity were significantly independent prognostic factors (P < 0.01). CONCLUSION Cox-2 expression maybe relate to the carcinogenesis and progress in tumors especially in well-differentiated ones; The changes of Cox-2 expression are synchronous with MVD. Cox-2 intensity is a significantly independent prognostic factor. So Cox-2 may be an effective target of prevention, therapy and prognostic evaluation for laryngeal carcinoma and other head and neck squamous cell carcinomas (HNSCC).
Adult ; Aged ; Aged, 80 and over ; Carcinoma, Squamous Cell ; diagnosis ; metabolism ; pathology ; Cyclooxygenase 2 ; metabolism ; Female ; Humans ; Laryngeal Mucosa ; metabolism ; pathology ; Laryngeal Neoplasms ; diagnosis ; metabolism ; pathology ; Male ; Middle Aged ; Neoplasm Staging ; Prognosis

OBJECTIVE: To study the clinic and pathological features of leukoplakia of the larynx, and reduce canceration rate. METHOD: Seventy-four postoperative patients of leukoplakia of the larynx were followed up for four years by telephone or clinic service. RESULT: None of eighteen cases of pure leukoplakia was recurrence. Fifty-six cases were leukoplakia with epithelial dysplasia histologically. Seven out of fifty-six postoperative cases occurred hoarseness; three out of fifty-six postoperative cases recurred, and accepted twice or more operations successively; three out of fifty-six postoperative cases occurred canceration. CONCLUSION Operation is the main means for the treatment of leukoplakia of the larynx, and the effect is comparatively well. The patients with histological epithelial dysplasia should be pay great attention because of their higher canceration rate, and enlarged operation ranges appropriately with the patient consent could effectually prevent recurrence or canceration during the early lesions. Close observation is important for these patients.
Adult ; Aged ; Aged, 80 and over ; Carcinoma in Situ ; pathology ; surgery ; Female ; Humans ; Laryngeal Diseases ; pathology ; surgery ; Larynx ; pathology ; Leukoplakia ; pathology ; surgery ; Male ; Middle Aged

OBJECTIVETo explore the hematopoietic and immunologic reconstitution and transplantation-related complications of HLA one locus mismatched unrelated umbilical cord blood transplantation for the treatment of hematological malignancies.

METHODSTwo children with acute lymphoblastic leukemia received HLA-mismatched unrelated umbilical cord blood transplantation. The conditioning regimens were BU-CTX (case 1) and BU-CTX plus BCNU (case 2). GVHD prophylaxis regimen consisted of cyclosporine (CsA) and mycophenolate mofetil (MMF). The patients received 14.6 x 10(7) nucleated cells/kg with 7.24 x 10(5) CD(34)(+) cells/kg and 16.24 x 10(7) nucleated cells/kg with 21.11 x 10(5) CD(34)(+) cells/kg, respectively.

RESULTSThe two recipients, ANC > 0.5 x 10(9)/L occurred at day 27 and day 17, BPC > 50 x 10(9)/L at day 53 and day 46, the peripheral blood counts normalization at day 60 and day 52, the immune function normalization at day 134 and day 122 and the DNA fingerprinting showing engraftment at day 19 and day 17, respectively. The donor-recipient pair of case 1 was male to female, and the chromosome karyotype of recipients bone marrow and peripheral blood cells showed 100%, 46, XY cells at day 49. Grade II acute graft versus host disease (aGVHD) occurred at day 26 (case 1) and day 21 (case 2). The two recipients have survived for 353 days and 256 days.

CONCLUSIONThe hematopoietic and immunologic reconstitution in umbilical cord blood transplantation were earlier and more durable. The transplantation-related complications were less and aGVHD were milder.

Child, Preschool ; Cyclosporine ; therapeutic use ; DNA Fingerprinting ; DNA, Neoplasm ; genetics ; Female ; Fetal Blood ; cytology ; immunology ; Graft Survival ; drug effects ; immunology ; Graft vs Host Disease ; immunology ; prevention & control ; HLA Antigens ; immunology ; Hematopoietic Stem Cell Transplantation ; Histocompatibility Testing ; Humans ; Immunosuppressive Agents ; therapeutic use ; Infant ; Male ; Mycophenolic Acid ; analogs & derivatives ; therapeutic use ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; genetics ; immunology ; therapy ; Transplantation Conditioning

Objective To evaluate the effect of pretransplant iron overload on the clinical efficacy of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in patients with severe aplastic anemia (SAA). Methods Clinical data of 80 SAA recipients who underwent allo-HSCT for the first time were retrospectively analyzed. According to the incidence of iron overload, all recipients were divided into the iron overload group (n=20) and non-iron overload group (n=60). The engraftment rate, incidence of postoperative complications and clinical prognosis of the recipients afterallo-HSCT were statistically compared between two groups. The influencing factors of 2-year overall survival (OS) and 180 d transplantation related mortality (TRM) were analyzed by Cox proportional hazards regression model. Results The engraftment rate of neutrophils in the non-iron overload group was 98% (59/60), significantly higher than 75% (15/20) in the iron overload group (P < 0.05). The engraftment rate of platelet in the non-iron overload group was 90% (54/60), significantly higher than 65% (13/20) in the iron overload group (P < 0.05). The incidence rate of bloodstream infection in the non-iron overload group was 23% (14/60), remarkably lower than 40% (8/20) in the iron overload group (P < 0.05). The 180 d TRM of the recipients in the non-iron overload group was 17%, significantly lower than 45% in the iron overload group (P < 0.05). The 1- and 2-year OS of the recipients in the non-iron overload group were 82% and 80%, significantly higher than 50% and 44% in the iron overload group (both P < 0.05). Iron overload or not was an independent risk factor of the OS and TRM of the recipients (both P < 0.05). Conclusions Iron overload can affect the OS and TRM of SAA patients after allo-HSCT.