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Although the involvement of insulin-like signaling in cancer has been well documented in various types of cancers, the association between the genetic variants in the insulin-like signaling and the development of hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) remains unclear. In this study, a total of 498 individuals including 173 HBV related cirrhosis patients, 171 HBV-related HCC patients, and 154 healthy controls were enrolled. Sixteen single nucleotide polymorphisms (SNPs) in IGF1, IGF2, IGF1R and IGF2R have been genotyped by employing SNaPshot assays. We found A/A genotype at rs3743251 of IGF1R was negatively associated with HBV related HCC [odds ratio (OR) = 0.38, 95% confidence interval (CI) = 0.20-0.72, P = 0.037]; A/G genotype decreased the risk of portal vein thrombosis (OR = 0.38, 95%CI = 0.18-0.82, P = 0.01). These results indicate that rs3743251 polymorphism in IGF1R is associated with the susceptibility of HBV-related HCC., (© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objective: To investigate the clinical characteristics and management of thyroid carcinoma with the upper mediastinal and axillary metastasis., Methods: Six cases of thyroid carcinomas with metastases to mediastinum and axillary, in addition to the neck, undergoing surgeries from 2006 to 2011 were reviewed. Five cases was papillary carcinoma and one was follicular carcinoma. Of six patients, five underwent surgical treatment at least one time previously and one of them received a radiotherapy with total dose of 60 Gy. (131)I treatment and thyroxine were used postoperatively in all cases., Results: The numbers of metastatic nodes in the axillary were 2/7, 3/12, 2/6, 1/5, 3/7 and 3/10 respectively, while the numbers in the upper mediastinum ranged from 2 to 6, with a 4.3 average, a metastatic lymph node in the retropharyngeal space was also found in one patient. Horner's sign occurred in three cases, temporary hypocalcemia in two cases and chylous fistula in one case. No injury to the recurrent laryngeal nerve or to important vessels. Neck or lower mediastinum recurrence and new lung metastasis occurred in three cases separately. No recurrence in the upper mediastinum or axillary area was found with the follow-up of 23-77 months. One died of heart disease 4 years after operation., Conclusion: The surgical treatment of node metastases in the upper mediastinum and axillary from the well-differentiated thyroid cancer is safe and has a promising outcome.

Ordered W18O49 nanowire thin films were fabricated by Langmuir-Blodgett (LB) technique in the presence of poly(vinyl pyrrolidone) coating. The well-organized monolayer of W18O49 nanowires with periodic structures can be readily used as electrochromic sensors, showing reversibly switched electrochromic properties between the negative and positive voltage. Moreover, the electrochromism properties of the W18O49 nanowire films exhibit significant relationship with their thickness. The coloration/bleaching time was around 2 s for the W18O49 nanowire monolayer, which is much faster than the traditional tungsten oxide nanostructures. Moreover, the nanowire devices display excellent stability when color switching continues, which may provide a versatile and promising platform for electrochromism device, smart windows, and other applications.

Background: Many epidemiological studies have found a positive association between periodontal disease (PD) and the risk of preeclampsia, but the magnitude of this association varies and independent studies have reported conflicting findings. We performed a meta-analysis to ascertain the relationship between PD and preeclampsia., Methods: The PubMed database was searched up to January 12, 2013, for relevant observational studies on an association between PD and the risk of preeclampsia. Data were extracted and analyzed independently by two authors. The meta-analysis was performed using comprehensive meta-analysis software., Results: Thirteen observational case-control studies and two cohort studies, involving 1089 preeclampsia patients, were identified. Based on a random-effects meta-analysis, a significant association between PD and preeclampsia was identified (odds ratio = 2.79, 95% confidence interval CI, 2.01-3.01, P<0.0001)., Conclusions: Although the causality remains unclear, the association between PD and preeclampsia may reflect the induction of PD by the preeclamptic state, or it may be part of an overall exaggerated inflammatory response to pregnancy. Larger randomized controlled trials with preeclampsia as the primary outcome and pathophysiological studies are required to explore causality and to dissect the biological mechanisms involved.

Purpose: To explore the relationship of serum concentrations of osteopontin(OPN), TNF-α and TGF-β1 in Sjoigren's syndrome patients., Methods: Forty Sjoigren's syndrome (SS) patients were determined by pathological examination, which included 15 primary SS and 25 secondary SS. Serum level of OPN, TNF-alpha and TGF-beta 1 were examined by enzyme linked immunosorbent assay (ELISA). Multiple correlation analysis was performed using SPSS13.0 software package., Results: Serum OPN, TNF-alpha levels increased in SS compared with healthy subjects (P<0.05).Serum TGF-beta 1 level in secondary SS significantly increased than primary SS (P<0.05). On the contrary, serum TGF-beta1 level had no significant change compared with the controls. OPN was correlated with TGF-beta 1., Conclusions: OPN and TNF-alpha may be used as adjunctive diagnostic parameter. TGF-beta 1 can be used as an index in differential diagnosis of primary and secondary SS. OPN and TGF-beta 1 have different effects and interactions between them, demonstrating mutuality, diversity and integrity of the cytokine network.

Objective: Acute rejection resulting from alloimmune responses is a major risk factor affecting patient survival following liver transplantation. Since interleukin (IL)-6 can mediate acute rejection, the association between IL-6 gene single nucleotide polymorphisms (SNPs) and incidence of acute rejection in liver transplant recipients was investigated., Methods: Patients who received liver transplant between January 2005 and December 2010 were typed for IL6-572C/G (rs1800796) polymorphisms using the snapshot technique. Association between genotype and acute rejection was analysed using the SNP Statistics website: http://bioinfo.iconcologia.net/snpstats/start.htm. Allelic and genotypic distributions for rs1800796 were compared among 335 patients with or without acute rejection within the first 6 months following liver transplant., Results: Incidence of acute rejection was 11.94%. A heterozygous CG genotype for IL6-572C/G was associated with a lower acute rejection rate compared with homozygous CC or GG genotypes., Conclusion: IL6-572 CG genotype may be related to protection from acute rejection following liver transplant in Han Chinese patients.

Background: Recurrence of hepatocellular carcinoma (HCC) after liver transplantation (LT) remains one of the most common causes of poor long-term survival. However, the host genetic factors affecting increased risk of tumor recurrence after transplantation have not been thoroughly elucidated. The present study was designed to investigate the association of cytokine gene polymorphisms with the risk of tumor recurrence in LT patients for HCC., Methods: Eleven single-nucleotide polymorphisms within the promoter regions of 7 cytokine genes, i.e., the IL-1 family (IL-1alpha and IL-1beta), IL-6, IL-8, IL-10, TNF-alpha, and TGF-beta1, were genotyped in 93 HCC patients treated with LT using DNA sequencing. The association between these polymorphisms and the risk of tumor recurrence was evaluated while controlling confounding clinical variables., Results: The genotype frequency of IL-10 -1082 A/G in patients with and without recurrence of HCC was AA 83.3%, GA 16.7% and AA 97.6%, GA 2.4%, respectively. The association between IL-10 -1082 GA and recurrence was significant (P=0.033). No other single-nucleotide polymorphism in the cytokine gene was found to be associated with recurrence. Kaplan-Meier survival curves showed that the homozygous AA patients had a significantly longer mean recurrence-free survival than heterozygous GA patients (23.5 vs 5.7 months, P=0.001). However, multivariate analysis failed to reveal that the GA genotype of IL-10 -1082 A/G was an independent indicator of recurrence., Conclusions: This study suggests the lack of association of selected cytokine gene polymorphisms with HCC recurrence after LT in the Han Chinese population. The finding does not exclude the idea that other cytokine polymorphisms could act as candidate biomarkers of disease prognosis.

Hepatic artery pseudoaneurysm is a rare complication following liver transplantation but can lead to life threatening hemorrhage if not treated effectively and in a timely manner. We describe a hepatic artery pseudoaneurysm that occurred after liver transplantation in a 53-year-old woman. The pseudoaneurysm was initially treated by implantation of a balloon-expandable covered stent-graft, but an endoleak was observed 6 days later. The endoleak was successfully resolved by further balloon angioplasty, which expanded the cylindrical stent to a conical stent, matching the anatomy of the anastomotic hepatic artery. Follow-up ultrasound examinations demonstrated patent hepatic arteries, with no evidence of pseudoaneurysm. Balloon-expandable covered stent-graft may be utilized to treat hepatic artery pseudoaneurysm following liver transplantation, due to the remodeling ability of stent-grafts, enabling them to fit the diseased vessels., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Background/aims: To report our experiences with percutaneous transhepatic biliary drainage to treat non-anastomotic biliary strictures following orthotopic liver transplantation in an effort to evaluate the efficacy and safety of this procedure., Methodology: From January 2002 to December 2011, forty-two consecutive patients (37 male and 5 female; aged 17-67 years, mean age 45.8 years) underwent percutaneous trans hepaticbiliary drainage for non-anastomotic biliary strictures.Twenty-six of them underwent percutaneous trans hepatic biliary drainage through right bile duct, 15 under-went bilateral (right bile duct and left bile duct) percutaneous transhepatic biliary drainage with 12 patients through left bile duct in the second procedure, the remaining one underwent percutaneous transhepatic biliary drainage through the left bile duct alone., Results: Percutaneous transhepatic biliary drainage was successfully completed in all 42 patients, 23 of whom gained treatment success after first procedure. The other 19 patients underwent percutaneous transhepatic biliary drainage for the second time and 15 of them were successfully treated, the total success rate was 90.5% (38 in 42 cases). Procedure related complications were observed in 4 patients including cholangitis, sepsis, bleeding and acute pancreatitis., Conclusions: Percutaneous transhepatic biliary drainage ap-pears to be an effective and safe treatment with high technical success rate and few major complications for non-anastomotic biliary strictures following orthotopic liver transplantation.

Objective: To study the clinical features of hyperparathyroidism due to parathyroid tumors, and evaluate the efficiency of surgical management., Methods: Twenty-two patients with hyperparathyroidism resulted from parathyroid tumors were reviewed. The age ranged from 32 to 79 years, 9 males and 13 females. Recurrent laryngeal nerve was routinely exposed, and procedures were performed in normal tissue in initial surgery. Additional selective neck dissection of levels II, III, IV, and VI was taken in the cases with recurrent cancer. Local flaps were used to repair the esophageal defects after resecting tumors. The recurrent laryngeal nerves of 4 cases had to be sacrificed because they were embedded in the tumor tissues despite the nerves had normal function before operation. Prophylactic tracheostomy was performed in 5 cases., Results: Eight cases were identified pathologically as parathyroid carcinoma, of them four with neck metastasis, and 14 cases as parathyroid adenoma after surgery. Their PTH dropped to normal level within two hours after surgery and hypercalcemia disappeared in two days postoperatively. The PTH and serum calcium were in normal range during the follow-up of 12 to 40 months. Recurrence occurred again in two cases in 6 and 8 months after the removal of the recurrent tumor tissues respectively. Esophageal fistula, chylous fistula and dehiscence of sternotomy developed in three cases separately. The tracheostomy was removed in four cases two weeks after operation and in one case six weeks after operation. One patient with parathyroid adenoma died of hypocalcemia about two weeks after operation and another one with recurrent parathyroid carcinoma also died of hypercalcemia 52 months after revised surgery., Conclusion: Extended resection of tumor and intraoperative PTH assay were strongly suggested for the managements of both benign and malignant parathyroid tumors.

Aim: To determine the agreement and diagnostic accuracy of three-dimensional gadolinium-enhanced magnetic resonance venography (3D-Gd-MRV) in central venous steno-occlusive disease (CVSD) in haemodialysis patients., Materials and Methods: Fourteen consecutive haemodialysis patients underwent interventional procedures to evaluate or treat CVSD. 3D-Gd-MRV was performed before the procedures and the results were compared with digital subtraction angiography (DSA)., Results: DSA showed >50% stenosis in all 14 patients, 13 of whom were diagnosed correctly using 3D-Gd-MRV. Moderate stenosis was missed at 3D-Gd-MRV in one case whereby the indwelling dialysis central venous catheter may have caused an artefact on the images and hindered the accuracy of the result. The sensitivity of 3D-Gd-MRV in revealing stenosis was 93% (13/14). No complications caused by contrast agent toxicity occurred in any patient., Conclusion: 3D-Gd-MRV employing a non-breath-hold technique is highly sensitive in the diagnosis of CVSD and may be an alternative technique to DSA for the visualization of central veins., (Copyright © 2011 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.)

Objective: To evaluate the factors contributed to the recurrence of parathyroid carcinoma with the invasion of the upper aerodigestive tract and the outcomes of reoperation., Methods: Six cases reviewed, in which the age ranged from 32 to 79 years old. The initial diagnoses and surgical procedures, the sites and surgical treatment of the recurrent disease, and the chemical markers, such as parathyroid hormone (PTH) and serum calcium, were retrospectively studied. The preoperative PTH levels ranged from 860 to 2830 ng/L. In 4 patients the recurrence diseases were founded in the tracheoesophageal groove, of them one with invasion of the larynx only and one with invasion of the larynx and pharynx in addition to the trachea and esophagus involvement. Selective neck dissection for level II, III, IV and VI was taken in all cases in addition to the removal of the local recurrent diseases. Recurrent laryngeal nerves were so badly embedded in tumor tissue that they were intentionally resected in 4 patients although they were functionally normal before operation. Prophylactic tracheostomy was carried out in 5 cases., Results: PTH level dropped more than 70% of that prior the operation at 10 min after the removal of the tumor-bearing tissues and to normal range within the first 2 hours postoperatively, and hypocalcemia disappeared in 2 days postoperatively. All cases experienced significant improvement in symptoms and signs in the first three days postoperatively. PTH and serum calcium levels were within normal range in 4 cases during the follow-up of 11 to 40 months, while hyperparathyroidism was encountered 8 and 11 months postoperatively in other 2 cases, respectively. Esophageal fistula, chylous fistula and dehiscence of sternotomy developed in 3 cases separately. Of 5 patients with tracheostomy, the tracheostomy tubes were removed two weeks in 4 cases and six weeks in the other one after operation., Conclusions: Recurrent parathyroid carcinoma even with invasion of the upper aerodigestive tract still has promising surgical outcomes. Both the precise localization of the recurrent diseases and the intraoperative PTH assay are importance to the successful treatment of these diseases.

Objective: To investigate the clinical value of combination of human epididymis protein 4 (HE4), CA125 and the Risk of Ovarian Malignancy Algorithm (ROMA) in diagnosis of ovarian carcinoma., Methods: To detect the serum concentration of HE4 using ELISA and CA125 using ECL in patients of ovarian carcinoma group (n = 119), borderline ovarian tumor group (n = 36), benign ovarian neoplasm group (n = 96) and female healthy control group (n = 53). The ROMA based on the serum level of CA125, HE4 and a woman's menopausal status was used to calculate the predicted probability (PP) and diagnostic results of ovarian cancers., Results: The receiver operating characteristic (ROC) analysis showed the cut-off value was 67.3 pmol/L (the AUC was 0.906, the sensitivity was 80.7% and specificity was 94.6%). The serum levels of HE4 and CA125 in the ovarian carcinoma group were significantly higher than that in the borderline ovarian tumor group, benign ovarian neoplasm group and female healthy control group (P < 0.01). The serum levels of CA125 and HE4 showed statistically no significant difference between the borderline ovarian tumor group and benign ovarian neoplasm group (P > 0.05). The levels of HE4 and CA125 were reduced significantly in ovarian patients after surgery therapy (P < 0.01). The sensitivity and specificity of HE4 + CA125 combination was 92.7% and 72.5%. The ROMA that can classify patients into high and low risk groups was established as 9.3% in premenopausal and 27.3% in postmenopausal women., Conclusions: HE4 is a helpful biomarker for ovarian carcinoma diagnosis. Biomarker combination of HE4 and CA125, and applying of the ROMA are helpful to improve the accuracy in diagnosis of ovarian cancers.

Approximately 20-40% of hepatocellular carcinoma (HCC) patients who undergo liver transplantation (LT) experience HCC recurrence within 5 years of the operation. Current predictors cannot sufficiently differentiate patients at risk for biochemical recurrence. The aim of the present study was to investigate the methylation status and expression levels of cell adhesion molecule 1 (CADM1) in HCC; to elucidate its regulation mechanisms; and finally, to evaluate the potential predictive value for tumor recurrence. Aberrant hypermethylation of CADM1 was frequently found in HCC cell lines with decreased CADM1 mRNA by bisulfite sequencing PCR. Re-expression of CADM1 was induced by treatment with demethylating agents. The promoter region of CADM1 was identified and the basal promoter activity was located in the -226 to -146 region relative to the transcriptional start site (TSS). Site-directed mutagenesis revealed that the consensus Sp1 binding site located in the basal promoter region was important for mediating CADM1 promoter activity. Furthermore, aberrant hypermethylation of CADM1 was detected in 34 of 82 (41.5%) of HCC tissues. The recurrence rate of the patients with CADM1 methylation was higher compared to that without CADM1 methylation (70.6% versus 33.3%; P=0.001). Multivariate analysis revealed that CADM1 methylation status (HR = 2.788; 95% CI, 1.043-5.063; P=0.010) was an independent prognostic factor for disease-free survival (DFS) of HCC patients treated with LT. In conclusion, CADM1 methylation may be used as a potential predictive biomarker for tumor recurrence of HCC after LT.

Aim: To review percutaneous transhepatic portal venoplasty and stenting (PTPVS) for portal vein anastomotic stenosis (PVAS) after liver transplantation (LT)., Methods: From April 2004 to June 2008, 16 of 18 consecutive patients (11 male and 5 female; aged 17-66 years, mean age 40.4 years) underwent PTPVS for PVAS. PVAS occurred 2-10 mo after LT (mean 5.0 mo). Three asymptomatic patients were detected on routine screening color Doppler ultrasonography (CDUS). Fifteen patients who also had typical clinical signs of portal hypertension (PHT) were identified by contrast-enhanced computerized tomography (CT) or magnetic resonance imaging. All procedures were performed under local anesthesia. If there was a PVAS < 75%, the portal pressure was measured. Portal venoplasty was performed with an undersized balloon and slowly inflated. All stents were deployed immediately following the predilation. Follow-ups, including clinical course, stenosis recurrence and stent patency which were evaluated by CDUS and CT, were performed., Results: Technical success was achieved in all patients. No procedure-related complications occurred. Liver function was normalized gradually and the symptoms of PHT also improved following PTPVS. In 2 of 3 asymptomatic patients, portal venoplasty and stenting were not performed because of pressure gradients < 5 mmHg. They were observed with periodic CDUS or CT. PTPVS was performed in 16 patients. In 2 patients, the mean pressure gradients decreased from 15.5 mmHg to 3.0 mmHg. In the remaining 14 patients, a pressure gradient was not obtained because of > 75% stenosis and typical clinical signs of PHT. In a 51-year-old woman, who suffered from massive ascites and severe bilateral lower limb edema after secondary LT, PVAS complicated hepatic vein stenosis and inferior vena cava (IVC) stenosis. Before PTPVS, a self-expandable and a balloon-expandable metallic stent were deployed in the IVC and right hepatic vein respectively. The ascites and edema resolved gradually after treatment. The portosystemic collateral vessels resulting from PHT were visualized in 14 patients. Gastroesophageal varices became invisible on poststenting portography in 9 patients. In a 28-year-old man with hepatic encephalopathy, a pre-existing meso-caval shunt was detected due to visualization of IVC on portography. After stenting, contrast agents flowed mainly into IVC via the shunt and little flowed into the portal vein. A covered stent was deployed into the superior mesenteric vein to occlude the shunt. Portal hepatopetal flow was restored and the IVC became invisible. The patient recovered from hepatic encephalopathy. A balloon-expandable Palmaz stent was deployed into hepatic artery for anastomotic stenosis before PTPVS. Percutaneous transhepatic internal-external biliary drainage was performed in 2 patients with obstructive jaundice. Portal venous patency was maintained for 3.3-56.6 mo (mean 33.0 mo) and all patients remained asymptomatic., Conclusion: With technical refinements, early detection and prompt treatment of complications, and advances in immunotherapy, excellent results can be achieved in LT.

Early diagnosis of oral squamous cell carcinoma (OSCC) and precursor lesions is an attractive strategy to decrease patient morbidity and mortality, but presently there are no satisfied diagnostic approaches. This study proposed a metabonomics-based diagnostic approach for OSCC and its precancerous lesions, including oral lichen planus (OLP) and oral leukoplakia (OLK). Saliva samples were collected from patients and healthy donors, and HPLC/MS analysis was performed to acquire metabolic profiles. Diagnostic model was then constructed with hierarchical principal component analysis (HPCA) and discriminate analysis algorithms. The results indicate that metabolic profiling can properly describe the pathologic characteristics of OSCC, OLP and OLK. HPCA combined with kernel fisher discriminant analysis achieved 100% accuracy in diagnosis of test samples, which is superior to direct principal component analysis and other modeling algorithms. The metabonomic approach based on the integral investigation of oral metabolites enables the detection of OSCC and precancerous lesions on noninvasive saliva samples. The proposed approach is noninvasive, efficient and low-cost, and it can be developed as a promising method for population-based screening of cancers and precancers in the oral cavity.

Objective: To study the surgical management of tumors in the conjunctive area among the neck, thorax and axilla and its efficacy., Methods: From Oct. 1999 to March 2006, eleven cases with benign tumors in the area between the neck, thorax and axilla were collected and analysed. Among them, five neurilemmoma, three neurofibroma, two chondroma and one meningioma, respectively. CT scans showed that the neck, thorax and axilla were affected simultaneously more or less. In this group, direct invasion to the vertebra was found in 4 cases, and spinal compression in one patient. After the disarticulation and displacement of the clavicle, the tumor was removed with the structures of importance in the neck, thorax and axilla under direct views. A bypass was constructed between the axillary vein and the medial end of the subclavian vein., Results: All these tumors were completely removed, injury of vertebral artery was encounter in two cases, and immediate repair was successfully carried out. No other serious complications were found in this group. During the follow-up period from 3 months to 3 years and 5 months, local recurrence was found in no patient., Conclusions: Benign tumors in the area between neck, thorax and axilla could be successfully dissected and removed with displacement of the medial portion of the clavicle.

Objective: To evaluate the indications, surgical techniques and complications of cochlear implantation in patients with otitis media-related diseases., Methods: Retrospective study of the data collected from patients receiving cochlear implantation. Totally 866 cases of cochlear implantation were performed in Peking Union Medical College Hospital from May 1995 to February 2006. Among which, 41 patients with otitis media-related diseases were grouped into 5 types: chronic secretory otitis media (13 cases), silent (subclinical) otitis media (18 cases), dry eardrum perforation (1 case), bilateral cholesteatoma of middle ear (2 cases) and middle ear granuloma (7 cases). Seven cases were accompanied with deformities of middle ear and (or) inner ear. Pedicled aponeurosis of occipitofrontalis muscle was transplanted to cover and protect the inserted electrodes and facial nerve in a patient with bilateral cholesteatoma after radical mastoidectomy., Results: All the 41 patients with otitis media-related diseases were successfully implanted in one stage or staged operations and followed up uneventfully for 5 months to 6 years and 11 months. All implant devices had worked normally and all patients had performed well., Conclusions: Patients with chronic secretory otitis media, silent (subclinical) otitis media, middle ear granuloma or dry ear-drum perforation could be operated in one stage or staged procedures safely and effectively. Patients with bilateral cholesteatoma could be implanted after radical removal of related lesions. Pedicled aponeurosis of occipitofrontalis muscle could be transplanted in cases of mastoid bowl to cover and protect the inserted electrodes and the exposed facial nerve and with easy access to observe the mastoid cavity. Active suppurative otitis media was contraindicated for cochlear implantation. Long-term following-up was essential for better evaluation of the outcomes of cochlear implantation in patients with otitis media-related diseases.

Objective: To review the characteristics of Madelung's disease which is rare and unfamiliar to clinicians and to find the method of diagnosis and treatment., Methods: Detailed clinical data of 7 patients with Madelung's disease were reviewed and analyzed. And related literatures were discussed together., Results: All of 7 patients have excessive subcutaneous fat deposit predominantly around neck. One patients had the complication of central and peripheral neuropathy, One patients had the complication of glucose intolerance, One patients had the complication of chronic hepatopathy and hyperuricaemia. These 3 patients were associated with sleep apnea syndrome simultaneously. Another one patient was accompanied by autonomic nervous system disease only. Total neck lipectomy and abstinence from alcohol were performed on 5 patients. No recurrence was seen during a follow-up of 6 months to 5 years. One patient received partial lipectomy twice and relapsed again. All pathological results were nonencapsulated fat. One patient refused treatment. Six men patients were alcohol abusers., Conclusions: Madelung's disease is characterized by massive accumulation of nonencapsulated subcutaneous fat mainly located symmetrically in the neck. Chronic alcoholism may be a major risk factor. It may be associated with some internal diseases. Total neck lipectomy to improve figuration and relieve pressure and abstinence from alcohol may be the main effective therapy.

Portal vein stenosis after liver transplantation is a relatively uncommon vascular complication that may result in graft loss if not promptly treated. The purpose of this study was to evaluate the midterm result of the use of intravascular stents for portal vein stenosis after liver transplantation. From April 2004 to September 2005, percutaneous transhepatic balloon dilation with stent deployment was performed in nine cases. Varices were embolized with stainless steel coils in two cases. No procedure-related complication occurred. Portal venous patency was maintained in all nine patients from 6 to 19 months (mean 10 months). In conclusion, an intravascular stent is an effective treatment for the portal vein stenosis after liver transplantation with excellent midterm patency.

Objective: To evaluate the symptoms and surgical management results of metastatic disease in the retropharyngeal space., Methods: Six patients with malignant tumors were collected, in which enlarged lymph nodes presented both in neck and retropharyngeal space. They consisted of two supraglottic carcinoma (T3N2MO), one thyroid carcinoma (TXN2MO), one nasal melanoma (TXN2MO), one oropharyngeal carcinoma (T2N2M0) and one hypopharyngeal carcinoma (T3N2MO). The enlarged nodes in the retropharyngeal space were measured with CT and (or) MRI, which ranged from 1.5-2.5 cm in diameter. Based on the control of the primary and neck disease, the mass in the retropharyngeal space was dissected and sent for pathologic exam separately., Results: Metastasis in the retropharyngeal space was pathologically proved in all of them, along with the involved internal jugular lymph nodes of 3/15, 3/17, 4/19, 5/19, 6/20, and 6/23, respectively. No serious complications occurred, such as fistula and central nerve damage. The patient with hypopharyngeal carcinoma died of lung metastasis 2 years after operation. The one suffering nasal malignant melanoma was out of follow-up in the 14th months. The patient with oropharyngeal carcinoma locally relapsed in the 18th months and died at the 24th months postoperatively. The rest was alive with tumor free within the follow-up period from 2 to 4 years., Conclusions: CT or Mifi are the mainstay of diagnosis of the metastatic disease in the retropharyngeal space and can he surgically controlled with safety.

Objective: To investigate causes and treatment of complications of tracheoesophageal puncture for Blom-Singer voice restoration after total laryngectomy., Methods: From 1986 to 2004, one hundred and fifty one cases with Blom-Singer technique after total laryngectomy for voice restoration were retrospectively analyzed., Results: All cases were followed up from 6 months to 15 years. Among 151 cases, 138 cases got successful phonation and the total success rate of voice restoration was 91.4%. Of the 151 cases, 15 cases occurred complications. The rate of complications was 9.9%. The common complications included fistula granulations, infection, and leakage. Twelve cases got successful treatment accordingly, and the other 3 cases failed in phonation., Conclusions: The procedure of tracheoesophageal puncture for voice restoration is relatively simple and has low complications. this method had high phonation success and good phonation quality, which is one of the best way to make laryngectomee to speak.

Objective: To evaluate the application of Ni-Ti shape memory alloy stent for treating tracheal stricture, including its indications and complications., Methods: Forty-three patients clinical data were analyzed, among them, 15 suffered from tumor; 7 trauma; 4 granulation; 1 Wegener's granuloma, 2 rhinoscleroma, 1 without clear diagnosis; 7 were relapsing polychondritis; 1 were respiratory amyloidosis; 4 were tracheobronchial tuberculosis, 5 were tracheobronchomalacia. The stricture degree: Level I: 15 patients, Level II:24 patients, Level III:4 patients. The location of stricture in 5 patients extended to the subglottis area. All patients had tracheal stricture and accepted the treatment with Ni-Ti shape memory alloy stent., Results: Forty-two patients breathed freely after the operation, 1 patient died after surgery. The tracheostoma in 18 patients was closed 34 days after operation. Among the remaining 8 patients with tracheostoma:3 patients left hospital with tracheal cannula; 1 patient died,2 patients were found stent shifted and no evident breath improving; 2 patients were found granulation and had secondary operation with laser., Conclusion: Ni-Ti shape memory alloy stent can expand the tracheal stricture quickly and thus improve the breath effectively, which is minimally invasive and simple. It can be used as a method in the treatment of tracheal stricture.

Objective: To study the surgical management of metastatic disease in the conjunctive area between the neck and thorax and its efficacy., Methods: Fourteen cases with metastatic node disease in the area between neck and thorax were collected and analysed. Eleven tumors were from the thyroid cancer, and the other three were from the hypopharyngeal cancer, esophagual cancer and malignant pheochromocytoma, respectively. The clavicle was displaced or resected, and the upper half of the manubrium might also be resected when necessary. The recurrent laryngeal nerve and phrenic nerve were exposed and protected. The metastatic disease was completely removed with the internal jugular and/or the brachiocephalic vein resected or spared, depending on the disease condition., Results: In 10 cases with metastases from the thyroid, no local recurrence was found within the follow-up period from 2 to 5 years. In contrast, no patient with metastatic disease from hypopharyngeal or esophageal cancer survived more than 11 months. No serious complications were found in this group., Conclusions: The surgical treatment of node metastases in the conjunctive area between neck and thorax from the well-developed thyroid cancer has promising effect and is comparatively safe.