Adult ; Female ; Humans ; Male ; Middle Aged ; Pharyngeal Neoplasms ; Young Adult

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.

OBJECTIVETo evaluate the missing diagnosis of neck metastases by routine detecting method (palpation combined with one pathological slide) in laryngeal carcinomas.

METHODSSixty-six specimens of neck dissections were collected and observed by routine method, transparent method, and continuous sliding method.

RESULTSTotally, 1153 lymph nodes were detected by palpation method and another 1204 lymph nodes were detected by transparent method. The lymph nodes detected by transparent method account for 51.1% of the total, and among them 10 metastases were found, which account for 15.6% (10/64) of metastatic lymph nodes. For those with no metastasis detected by routine method, 50 microm interval continuous sliding method was performed, and 14 tiny metastases were found, which account for 21.9% (14/64) of metastatic lymph nodes. Detecting by routine method, most lymph nodes (95%) were in tumor growth and tumor suffusion stage. The missing diagnosis rate of routine method was 37.5% (24/64).

CONCLUSIONSWhen routine method was used to detect lymph nodes in neck specimens, missing diagnosis should be considered to select best therapy. Through transparent method small lymph nodes could be found and it is a valuable method to observe pathological changes of small nodes. Continuous sliding method could find micrometastasis precisely, but the work burden is heavy and it is difficult to be widely used.

Carcinoma, Squamous Cell ; secondary ; surgery ; Diagnostic Errors ; Female ; Humans ; Laryngeal Neoplasms ; pathology ; surgery ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; Male ; Neck Dissection ; Neoplasm Staging ; Specimen Handling ; methods

OBJECTIVE: To study the related factors of contralateral lymph node metastasis in pyriform sinus carcinoma. METHOD: Fifty-three patients with pyriform sinus carcinoma underwent simultaneous neck dissection from Oct. 1993 to Oct. 1999 were collected. Transparent lymph node selection and continuous slicing method were used on the postoperative specimens to observe the status of cervical lymph node metastasis. The relationship between contralateral lymph node metastasis and clinico-pathological factors, ipsilateral neck metastatic status were analyzed by the follow-up data. RESULT: Cervical lymph node metastatic rate was 79.2% in 53 patients with pyriform sinus carcinoma. Contralateral cervical lymph node metastatic rate was 35.8%. Contralateral neck metastasis was closely related with clinical N stage, cell differentiation, fused metastasis and extracapsular spread of ipsilateral neck. CONCLUSION Contralateral neck dissection should be undertaken in patients with N2,3, moderate and low cell differentiation, or fused fused metastasis and extracapsular spread of ipsilateral neck.
Adult ; Aged ; Aged, 80 and over ; Carcinoma, Squamous Cell ; pathology ; surgery ; Female ; Humans ; Hypopharyngeal Neoplasms ; pathology ; surgery ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; Male ; Middle Aged ; Neck ; pathology ; Neck Dissection ; Neoplasm Staging ; Retrospective Studies

OBJECTIVETo evaluate the impact of extracapsular lymph node spread (ECS) in the ipsilateral neck on the contralateral neck metastasis and prognosis of laryngeal cancer.

METHODSThe data of 184 laryngeal cancer patients who underwent laryngectomy and simultaneous radical or modified radical neck lymph node dissection between Jan. 1994 and Dec. 1997 were retrospectively analyzed. Of these 184 patients, 144 underwent unilateral neck lymph node dissection and 40 bilateral; 159 had supraglottic lesion and 25 transglottic. All had squamous cell carcinoma. The clinical T stage was T1 in 3, T2 63, T3 77, T4 41; N stage: NO in 123, N1 38, N2a 5, N2b 11, N2c 7. Transparent lymph node detection and continuous sectioning method were applied to all dissected neck lymph nodes. Statistical analysis was carried out using SPSS software package ( version 11.5). Survival curves were calculated through the Kaplan-Meier model. Impact of extracapsular lymph node spread in the ipsilateral neck on prognosis was assessed using the Log rank test.

RESULTSOf these 184 patients, neck lymph node metastasis was pathologically proven in 80, 26 had ECS in the ipsilateral neck with a ECS rate of 32.5% (26/80). The ECS incidence was positively correlated with advanced pathological N stage and metastatic lymph nodes (P < 0.01). The incidence of the contralateral neck metastasis and ipsilateral neck recurrence with ECS were higher than those without ECS, which was 46.2% versus 24.1%, and 34.6% versus 7.4%, respectively (P < 0.05). The 3- and 5-year survival rates of patients with ECS were significantly lower than those of patients without ECS, which was 53.9% versus 70.4%, and 23.1% versus 57.4%, respectively (P = 0.0125).

CONCLUSIONExtracapsular lymph node spread is found to be an important prognostic factor in the laryngeal cancer. Bilateral neck dissection may be mandatory due to patients with ECS have a higher incidence of contralateral neck metastasis. The capsule of metastatic lymph nodes should be pathologically checked and reported in order to determine the extra-capsular spread status.

Adult ; Aged ; Carcinoma, Squamous Cell ; secondary ; surgery ; Female ; Follow-Up Studies ; Head and Neck Neoplasms ; secondary ; surgery ; Humans ; Kaplan-Meier Estimate ; Laryngeal Neoplasms ; pathology ; surgery ; Laryngectomy ; methods ; Lung Neoplasms ; secondary ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; Male ; Middle Aged ; Neck Dissection ; methods ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Prognosis ; Retrospective Studies

OBJECTIVETo study the prognostic factors of 1018 patients with laryngeal cancer treated surgically.

METHODSAll patients were treated surgically for laryngeal cancer from 1984 to 1996. A total of 16 clinical factors was studied by univariate analysis and Cox multivariate model.

RESULTSThe follow-up rate was 93.5% over 5 years. The overall cumulative survival rate was 79.1% at 3 years, 70.2% at 5 years. The 5-year survival rate of T1N0 is the highest, followed by T1N+, T2N0, T3N0, T4N0, T2N+, T4N+, and T3N+. In univariate analysis, the survival was related to patient age, mobility of vocal cords, preoperative T status, preoperative N status, preoperative UICC stage, postoperative T status, postoperative N status, postoperative UICC stage, topographic location of the tumor and tumor size. In Cox multivariate modal, only postoperative N status, mobility of vocal cords and tumor size were independent prognostic factors.

CONCLUSIONIndependent prognostic factors for patients with laryngeal cancer after curative resection are postoperative N stage, mobility of vocal cords as well as tumor size. Postoperative follow-up and salvage surgery in time should be attached with importance to improve the survival of patients with laryngeal cancer.

Adult ; Aged ; Aged, 80 and over ; Female ; Follow-Up Studies ; Humans ; Laryngeal Neoplasms ; mortality ; pathology ; surgery ; Laryngectomy ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; Male ; Middle Aged ; Multivariate Analysis ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Prognosis ; Proportional Hazards Models ; Salvage Therapy ; Survival Rate ; Vocal Cords ; physiopathology

OBJECTIVETo evaluate the impact of extracapsular spread (ECS) in ipsilateral neck metastasis on prognosis and its related factors in laryngeal cancer.

METHODSThe study included 184 patients who underwent laryngectomy and simultaneous radical or modified radical neck dissection between January 1994 and December 1997 for laryngeal cancer. All of them had a complete 5-year follow-up. We used transparent lymph node detection and continuous slicing method on all neck dissection specimens. Kaplan-Meier model was used for survival analysis and the log-rank test was used to assess significance.

RESULTSWe found pathological neck metastases in 80 patients. Among them, 26 cases (32.5%) had ECS in ipsilateral neck. ECS incidence increased with advanced pathological N (pN) stages (pN1 3.7%, pN2a 25.0%, pN2b 50.0%, and pN2c 55.6%; P = 0.001). ECS incidence also increased with number of positive nodes (1 positive node 8.6%, 2 positive nodes 33.3%, 3 and more positive nodes 66.7%; P < 0.001). Incidences of contralateral neck metastases and ipsilateral neck recurrence in patients with ECS were higher than those in patients without ECS (46.2% vs. 24.1%, P = 0.046; 34.6% vs. 7.4%, P = 0.002). The 5-year survival rate of patients with ECS was significantly lower than that of patients without ECS (23.1% vs. 57.4%, P = 0.013).

CONCLUSIONECS is an important prognostic factor in laryngeal cancer. Patients with ECS have a higher incidence of contralateral neck metastasis, so bilateral neck dissection should be selected.

Adult ; Aged ; Female ; Humans ; Laryngeal Neoplasms ; pathology ; surgery ; Lymphatic Metastasis ; pathology ; Male ; Middle Aged ; Neck ; Neck Dissection ; Prognosis ; Survival Analysis

BACKGROUNDHigh peritoneal transport status was previously thought to be a poor prognostic factor in peritoneal dialysis (PD) patients. However, its effect on diabetic nephropathy PD patients is unclear in consideration of the adverse impact of diabetes itself. The purpose of this study was to investigate the influence of peritoneal transport characteristics on nutritional status and clinical outcome in diabetic nephropathy patients on PD.

METHODSOne hundred and two diabetic nephropathy patients on PD were enrolled in this observational cohort study. According to the initial peritoneal equilibration test result, patients were divided into two groups: Higher transport group (HT, including high and high average transport) and lower transport group (LT, including low and low-average transport). Demographic characteristics, biochemical data, dialysis adequacy, and nutritional status were evaluated. Clinical outcomes were compared. Risk factors for death-censored technique failure and mortality were analyzed.

RESULTSCompared with LT group (n = 37), serum albumin was significantly lower and the incidence of malnutrition by subjective global assessment was significantly higher in HT group (n = 65) (P < 0.05). Kaplan-Meier analyses showed that death-censored technique failure and mortality were significantly increased in HT group compared with that in LT group. On multivariate Cox analyses, higher peritoneal transport status and lower residual renal function (RRF) were independent predictors of death-censored technique failure when adjusted for serum albumin and total weekly urea clearance (Kt/V). Independent predictors of mortality were advanced age, anemia, hypoalbuminemia, and lower RRF, but not higher peritoneal transport status.

CONCLUSIONSHigher peritoneal transport status has an adverse influence on nutrition for diabetic nephropathy patients on PD. Higher peritoneal transport status is a significant independent risk factor for death-censored technique failure, but not for mortality in diabetic nephropathy patients on PD.

Aged ; Aged, 80 and over ; Biological Transport ; Cohort Studies ; Diabetic Nephropathies ; metabolism ; therapy ; Female ; Humans ; Kidney ; metabolism ; pathology ; Male ; Middle Aged ; Nutritional Status ; Peritoneal Dialysis

BACKGROUND: Distal radius fractures are often accompanied by the ulna styloid process fractures, and the treatment of the ulna styloid process fracture is disputed in clinic. Manipulative reduction and splint fixation is a common method to treat such diseases. The mechanism of intervention on ulnar styloid process is difficult to obtain in the corpse mechanics experiments. In recent years, the finite element analysis method has been widely used in the field of orthopedics, which has opened up a way for the study of orthopedic disease. OBJECTIVE: To explore the biomechanical mechanism of splint intervention on ulnar styloid fracture by finite element analysis, and to provide the basis for clinical treatment choice. METHODS: A three-dimensional finite element model of normal wrist joint was established based on the forearm and wrist CT images of a healthy volunteer. The validity of the model was verified by comparing with the experimental data in the literature. On this basis, four wrist joint finite element models with and without splint fixation for ulnar styloid type I and type II fractures were established. Under axial compression, lateral extension, pronation and supination working conditions, the changes of the relative displacement of the distal radioulnar joint and the ulnar styloid fracture broken end were analyzed. RESULTS AND CONCLUSION: (1) A three-dimensional finite element model of normal wrist joint was established and validated, and the other four models were established based on this model. (2) In pronation and supination conditions, the relative displacement values of the ulnar and radial joints in the ulnar styloid type I and II fracture models were greater than those in the normal wrist joint model, and the displacement was smaller in the type I fracture model than in the type II fracture model; the displacement was significantly reduced after the intervention on the two fracture models by the splint. (3) In the lateral tension, pronation and supination conditions, the displacement values of the ulnar styloid fracture end in the ulnar styloid type I fracture model were smaller than in the type II fracture model, and the displacement values were significantly reduced after the intervention by the splint. Under the remaining conditions, the change of the above values was not obvious. (4) In conclusion, the stability of distal radioulnar joint became worse after ulnar styloid fracture, and the stability of distal radioulnar joint after type I fracture was less than that after type II fracture. As an elastic fixation method, splint can increase the stability of the wrist ulnar column during the treatment.

Objective To observe the circadian rhythm of blood pressure and investigate the impact of Norvasc and Tanatril administrated at different time points based on the theory of time therapeutics in hypertensive patients. Methods The 24-hour ambulatory blood pressure was monitored in 130 inpatients and outpatients with grade 3 or 2 hypertension from May 2008 to November 2009. A total of 34 dipper hypertensive patients were grouped into dipper blood pressure group and 5 mg/d of Norvasc and Tanatril were taken by them at 6:00 AM. A total of 96 nondipper hypertensive patients were further divided into three subgroups after adjustment for age and gender: 5 mg/d of Norvasc and Tanatril were taken by group I (n = 30) at 6:00 AM; 5 mg/d of Tanatril at 6:00 AM and 5 mg/d of Norvasc at 18:00 PM by group Ⅱ (n = 32); 5 mg/d of Norvasc at 6:00 AM and 5 mg/d of Tanatrilat 18:00 PM by group Ⅲ(n=34).The 24-hour ambulatory blood pressure monitoring was performed again after four weeks treatment and 24-hour mean systolic blood pressure(24 hSBP),24-hour mean diastolic blood pressure(24 hDBP),daytime and nighttime mean systolic blood pressure(dSBP,nSBP)and daytime and nighttime mean diastolic blood pressure(dDBP,nDBP),were analyzed.Results The 24 hSBP,24 hDBP and dSBP,and dDBP were reduced from(154.3±5.6),(95.4±3.1),(158.7±6.5),(99.6±3.7)mmHg to(137.2±3.9),(82.5±2.7),(139.7±3.8),(85.2±3.5)mmHg,respectively,in dipper blood pressure group(t=2.124,2.356,2.278,2.449,all P<0.05).The 24 hSBP and 24 hDBP of the three groups in nondipper blood pressure were decreased from(154.4±6.1),(156.7±6.7),(156.6±5.2),(95.8±2.8),(94.9±3.8),(95.7±3.2)mmHg to (139.6±4.1),(134.5±4.6),(133.4±3.5),(83.5±4.2),(80.8±5.6),(81.6±4.7)mmHg,respectively(t=2.038,2.040,2.135,2.142,2.213,2.216,all P<0.05).dSBP and dDBP were decreased from(158.6±3.50),(158.4±5.6),(159.5±4.),(98.4±3.7),(99.6±3.7),(83.9±5.2)mmHg to(138.9±5.4),(136.7±4.1),(137.4±6.4),(85.8±5.3),(83.6±5.1),(83.9±5.2)mmHg,respectively(t=2.021,2.252,2.261,2.217,2.167,2.076,all P<0.05).nSBP and nDBP were decreased from(146.7±6.9),(149.8±3.9),(150.2±4.1),(93.7±4.2),(95.7±4.3),(93.4±3.3)mmHg to(133.7±4.6),(129.8±5.7),(127.6±2.8),(87.8±2.9),(78.5±6.4),(77.8±4.8)mmHg,respectively(t=1.798,2.032,2.014,1.864,2.157,2.166,all P<0.05).There were significant differences in nSBP and nDBP among all groups after treatment(F=2.32,2.17,all P<0.05),and the effect of the drugs was better in groug Ⅱ and Ⅲ than in group Ⅰ(q=3.17,4.03,3.32,4.19,all P<0.05),but there were no significant differences between group Ⅱ and Ⅲ(P>0.05).Conclusions Blood pressure can be controlled effectively by taking two antihypertensive medictions in the morning in hypertensive dipper patient but the blood pressure of nondipper hypertensive patients were able to be controlled more efficiently by taking the two antihypertensive medictions separately in the morning and at the evening compared with that taking the two drugs together in the morning.