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Objective: This study aimed to improve the safety supervision of cadmium in milk samples. Methods: A liquid-liquid microextraction method based on hydrophobic deep eutectic solvent （DES） was developed for the determination of cadmium in milk samples by graphite furnace atomic absorption spectrometry. The types of deep eutectic solvents were selected for high extraction efficiencies and it was found that DES composed of thymol and lactic acid at the molar ratio of 1∶1 provided higher extraction efficiency. In addition, several important experimental conditions including the volume of DES, sample pH value, the pretreatment methods of samples were optimized. Results: Under the optimized conditions, Cd had good linearity in the range of 0~3.0 ng/mL, and the correlation coefficient was 0.998. The detection limit was 0.02 μg/kg. The recoveries ranged from 94.7% to 113.0% with relative standard deviations （RSD） of 0.38%~7.00%. Conclusion: With the advantages of simplicity, rapidness, exactness and low detection limit, this method could be used for the detection of cadmium in milk samples.

Conclusion: These findings indicate that in hypopharyngeal squamous cell carcinoma (HSCC), hypermethylation and down-regulation of death-associated protein kinase-1 (DAPk1) are common events, which are associated with a poor prognosis. Objectives: This study aimed to investigate the methylation and expression of DAPk1, a tumor suppressor gene, in HSCC, and explore its clinical significance. Methods: The tumor and adjacent non-tumor tissues were collected from 53 patients with HSCC. The methylation status of DAPk1 was detected by methylation-specific polymerase chain reaction (MSP), and expression of DAPk1 was determined with real-time reverse transcriptase polymerase chain reaction (RT-PCR), immunohistochemistry, and Western blot at mRNA or protein levels. Correlations between the findings and patients' clinicopathological parameters were further evaluated. Results: The methylation ratio of DAPk1 in tumor tissues (60.38%) was significantly higher than that in the adjacent non-tumor tissues (26.42%) ( p = 0.001), while DAPk1 expression in the tumors was down-regulated markedly (real-time RT-PCR, p = 0.002; immunohistochemistry, p = 0.006; Western blot, p < 0.001). DAPk1 methylation was negatively correlated with its mRNA expression ( p = 0.002, r = -0.521). Both hypermethylation and down-regulation of DAPk1 were closely related to lymph node metastasis ( p = 0.001 and 0.001, respectively), advanced TNM stage ( p = 0.009 and 0.019, respectively), and low survival rates ( p = 0.031 and 0.045, respectively). [ABSTRACT FROM AUTHOR]

Background: This study aimed to assess the relationship between dyslipidemia (DL) risk and health-related physical fitness (HPF) and evaluated the prognostic value of HPF for risk of DL. Methods: A total of 776 university staff members were recruited, of which 407 were females, and 369 males. Blood samples and HPF tests were collected from all participants after 12 h fasting. Results: The prevalence of DL was 41.77% and 51.49% in female and male university staff members, respectively, and there was no significant difference between genders (χ2 = 2.687, p = 0.101). According to the logistic regression analysis, age, male sex, GLU, hypertension, BMI, BF, WHtR, and LAP were significant risk factors for DL (p < 0.05), VCI and, SAR were significant protective factors for DL (p < 0.05), and SMI, GS, and VG were not significantly associated with the risk of DL. The area under the receiver-operating characteristic (ROC) curve (AUC) analysis indicated that, LAP (AUC: 0.730, 95CI%: 0.697–0.762), WHtR (AUC: 0.626, 95CI%: 0.590–0.660), and BMI (AUC: 0.599, 95CI%: 0.563–0.634) are valid predictors of DL, and LAP and WHtR perform better than BMI (Z = 8.074, p < 0.001) in predicting DL in male and female university staff members. Conclusion: The risk of DL is significantly related to body composition, cardiorespiratory fitness, and flexibility. LAP and WHtR perform better than BMI in predicting risk of DL in male and female university staff members. [ABSTRACT FROM AUTHOR]

Conclusion: The tumor's grade, rather than the tumor's location, was related to the opportunity of preserving laryngeal functions in patients with pyriform sinus cancer. The survival rate decreased significantly with the increase of tumor grade or node grade. Preservation of laryngeal functions is a safe and promising method without compromising the survival rate of patients with pyriform sinus cancer. Objective: Surgical resection of pyriform sinus carcinoma has a profound influence on the preservation of laryngeal functions. The purpose of this study was to assess the safety and efficacy of the surgical treatment of pyriform sinus carcinoma in the preservation of laryngeal functions without compromising the survival rate. Methods: Two hundred and thirty patients with pyriform sinus cancer had been operated from March 1978 to December 2002. Of them, 158 cases had been operated with the preservation of laryngeal functions and 72 cases had been undergone total laryngectomy. In addition, 216 cases had received adjuvant postoperative radiotherapy. All cases were followed up for 6--12 months (mean 51 ±± 26) after surgery. The survival rate was calculated on the basis of Kaplan-Meier analysis, and the factors that influenced the survival rate of patients with and without preservation of laryngeal functions were analyzed with the log-rank test. Results: Laryngeal functions were preserved completely (speech, respiration, and deglutition) in 70.9% (112/158) cases, and partially (speech and deglutition) in 29.1% (46/158) cases. The 3- and 5-year survival rates were 75.4% and 59.0%, respectively, for the group with laryngeal function preservation, and 58.6% and 41.5%, respectively, for the group without preservation. There was no statistically significant difference in the survival rate between the two groups within the follow-up period ( p > 0.05). Increase in the tumor grade resulted in a proportional decrease of patients with preservation of laryngeal function ( p < 0.05). Increase in the tumor grade ( p < 0.05) or node grade ( p < 0.05) also led to significant decrease in the survival rate. The location of the primary lesions (the lateral wall or medial wall of the pyriform sinus) showed no significant influence on either the opportunity for preserving laryngeal functions ( p > 0.05) or survival rate of patients ( p > 0.05). [ABSTRACT FROM AUTHOR]

Background:Beclin-1, a key regulator of autophagy. Microtubule-associated protein 1 light chain 3 (LC3), is involved in autophagsome formation during autophagy. The autophagic genes beclin-1 and LC3 paly an important role in the development and progression of tumor. This study was designed to investigate the expression of beclin-1 and LC3 and to clarify their clinical significance in hypopharyngeal squamous cell carcinoma (HSCC). Methods:Eighty-two surgical hypopharyngeal squamous cell carcinoma specimens and fifty-four adjacent non-cancerous mucosal epithelial tissues were obtained. Beclin-1 and LC3-II expression was examined by immunohistochemistry, real-time RT-PCR and Western blotting assays. Correlations with patient clinical characteristics and overall survival were evaluated. Results:Beclin-1 was positively expressed in 42.7% (35/82) of HSCC specimens (adjacent non-cancerous tissues, 79.6%, 43/54; P<0.0001). Furthermore, 41.5% (34/82) of HSCC specimens exhibited high LC3 immunoreactivity (adjacent non-cancerous tissues, 74.1%, 40/54; P=0.0002). Beclin-1 and LC3-II mRNA transcript levels were significantly lower in HSCCs than in paired non-cancerous tissues (P<0.0001, P=0.0001, respectively). Similarly, western blotting assays showed that beclin-1 and LC3-II were markedly decreased in HSCCs (P=0.02, P=0.004, respectively). A positive correlation was observed between the mRNA transcript levels of beclin-1 and LC3-II in HSCCs (r=0.51, P<0.0001; 95%CI: 0.273 to 0.689). Beclin-1 and LC3 expression were significantly correlated with T categories, differentiation and lymph node metastasis. Negative beclin-1 immuoreactivity and low LC3 expression were associated with poorer overall survival in HSCC patients (P<0.0001, P=0.0145, respectively). Multivariate analysis revealed that beclin-1 was an independent prognositic factor for overall survival. Conclusion:Beclin-1 and LC3-II are downregulated in HSCCs and their aberrant expression correlates with poor prognosis of HSCCs. [ABSTRACT FROM AUTHOR]

Objective: To explore the surgical methods for advanced laryngeal cancer and long term effects of laryngectomy., Methods: Two hundred and thirty-eight cases of laryngeal cancer at different stages, including 103 cases with supraglottic cancer, 118 cases with glottic cancer, 3 cases with subglottic cancer, and 14 cases with recurrent cancer, underwent different kinds of operation from 2000 to 2010. The TNM classifications were as follows: T3 168 cases, T4 70 cases. Stage III 145 cases, Stage IV 93 cases. N0 134 cases,N1 64 cases,N2 38 cases, and N3 2 cases. The effects of operation, especially with the preservation of laryngeal function, was analyzed. The disease-free survival rate was calculated by Kaplan-Meier methods., Results: Partial laryngectomy was performed on 142 of the 238 cases (59.7%). Total laryngectomy was performed on 96 cases. In 142 patients who received partial laryngectomy with preservation of laryngeal function, the trachea cannula was extracted in 90 patients, with the decannulation rate as 63.4%. The nasal feeding tube was removed and peroral feeding was recovered in all patients. The patients undergoing partial laryngectomy succeeded in phonation. The 3 years and 5 years disease-free survival rates in all patients were 81.4% and 59.5%. The 3 years and 5 years disease-free survival rate of partial laryngectomy were 82.9% and 64.3%. The 3 years and 5 years disease-free survival rates in total laryngectomy were 79.2% and 52.4%. There was no significantly different between the two groups (χ(2) = 2.478, P = 0.115)., Conclusion: For the advanced laryngeal cancer, it is possible to preserve the laryngeal function without compromising the remote survival rate by detailed pre-operational estimation, properly selected operation and skilled surgical practice.

Objective: To present the surgical technique and clinical effect of transnasal endoscopic repair of cerebrospinal fluid (CSF) rhinorrhea., Methods: From 1996 to 2010, 54 patients with CSF rhinorrhea were treated with intranasal endoscopic surgery, including 25 patients with traumatic CSF rhinorrhea, 17 patients with spontaneous CSF rhinorrhea, and 12 patients with iatrogenic CSF rhinorrhea. The temporalis muscle, temporalis fascial, middle turbinate mucosa, nasal septum mucosa, inferior turbinate mucosa, fascia lata, leg muscle, abdominal fat, uncinate process mucosa and sinus mucosa were used to repair the fistulae., Results: Forty-nine patients were successfully treated after the first operation, 1 after the second attempt, 1 after the third attempt, and 1 was successfully treated at the second operation in other hospital, 1 stopped therapy after an unsuccessful repairing. One patient recurred within one and a half years after operation and stopped therapy. Seven patients developed complications after the operation (high fever in 4, high fever and transient mild coma in 1, epilepsy in 1, pneumocephalus in 1) and were cured afterwards., Conclusions: Transnasal endoscopic surgery is safe, effective and microinvasive treatment for patients with CSF rhinorrhea, it is the first choice for repairing of CSF rhinorrhea for its high successful rate. Accurate leakage site identification, selection of suitable approach and repairing method are critical to the success of operation.

Purpose: Several research groups have investigated the influence of the human 8-oxoguanine DNA glycosylase 1 (hOGG1) Ser326Cys polymorphism on head and neck cancer (HNC) susceptibility. However, the results remain inconclusive and controversial. We therefore conducted the present meta-analysis., Methods: Relevant studies were identified through a search of PubMed databases until July 2011 and selected on the basis of established inclusion criteria for publications., Results: A total of 8 case-control studies on the association of hOGG1 Ser326Cys polymorphism with HNC risk were included in the present meta-analysis. Overall significant associations were observed (G allele vs. C allele: OR=1.49, 95%CI=1.08-2.05, P<0.01 for heterogeneity; GG vs.CC: OR=2.30, 95%CI=1.05-5.05, P<0.01 for heterogeneity; CG vs. CC: OR=1.40, 95%CI=1.03-1.90, P<0.01 for heterogeneity; dominant model (GG+CG vs. CC): OR=1.52, 95%CI=1.06-2.16, P<0.01 for heterogeneity; recessive model (GG vs. CG+CC): OR=2.04, 95%CI=1.05-3.96, P=0.01 for heterogeneity) after excluding the studies that were not in agreement with HWE. On performance of a subgroup meta-analysis by ethnicity, significant associations were found (G allele vs. C allele: OR=1.40, 95%CI=1.001-1.95, P<0.01 for heterogeneity; GG vs.CC: OR=2.30, 95%CI=1.05-5.05, P<0.01 for heterogeneity; recessive model (GG vs. CG+CC): OR=2.04, 95%CI=1.05-3.96, P=0.01 for heterogeneity) in Caucasian populations after excluding one study not in agreement with HWE., Conclusions: Our results suggested that the G allele might be associated with an increased risk of HNC in Caucasian populations.

Purpose: The purpose of this study was to examine the expression of mir-21 and phosphatase and tensin homologue (PTEN) in laryngeal squamous cell carcinomas (LSCCs) and hypopharyngeal squamous cell carcinomas (HSCCs), and assess correlations between the two as well as with clinical characteristics of patients., Methods: The expression of mir-21 in tumor and adjacent non-tumor tissues was investigated by real-time RT-PCR. Immunohistochemistry (IHC) was carried out to analyze PTEN protein levels., Results: Mir-21 was up-regulated in LSCCs and HSCCs compared to adjacent non-tumor tissues (P < 0.05), and the up-regulated expression of mir-21 was associated with clinical stage (P = 0.001), T classification (P = 0.007), pathologic differentiation (P = 0.025), and lymph node positivity (P = 0.002). In contrast, PTEN IHC staining was notably weaker in tumor tissues than in matched non-tumor tissues (P < 0.05), and the down-regulated expression of PTEN was correlated with tumor staging (P = 0.025), the extent of tumor (P = 0.017), and lymph node positivity (P = 0.040). Furthermore, the level of mir-21 was reversely correlated with PTEN expression (P = 0.006)., Conclusion: mir-21 and PTEN might play important roles in the progression of LSCC and HSCC, the two fcators demonstrating a negative correlation.

Objective: To develop a high-performance liquid chromatographic method for the determination of isoguanosine in Semen Crotonis Tiglii., Methods: The determination was done by using reverse-phase high-performance liquid chromatography with a Hedera ODS-2 column (4.6 mm x 250 mm, 5 microm). Elution was employed with the mobile phase of acetonitrile-methanol-water (1:4:95) at flow rate of 1.0 mL/min. The detection wavelength was set at 292 nm and the column temperature was 25 degrees centigrade. Injection volume was 10 microL., Results: The linear range of isoguanosine was from 0.161 to 0.967 mg. The correlation coefficient of the calibration curves was 0.999 8. The average recovery rate was 98.78% with relative standard deviation of 0.02%., Conclusion: The results show that the method is simple, accurate, and repeatable, and it is suitable for quality control of Semen Crotonis Tiglii.

Objective: To review the experience of different surgical construction methods and comprehensive treatments for hypopharyngeal cancer., Methods: Three hundred and fifty-two cases (According to UICC 2002 criteria, stage I, 3; II, 31; III, 134; IV, 184) with hypopharyngeal cancer were retrospectively reviewed from 1999 to 2005 in the Department of Otorhinolaryngology of Qilu Hospital of Shandong University, including 321 males and 31 females. The median age was 58 years old, ranged from 26 to 82 years old. All the tumors originated from the pyriform sinus (272), posterior pharyngeal wall (61), postcricoid area (19). There were no distant metastasis. Two hundred and fourty-one cases were surgically treated with laryngeal functions preserved and 111 cases without laryngeal functions preserved. All the patients received modified neck dissection, including both unilateral (247 patients) and bilateral (105 patients). Pharyngoesophageal defect reconstruction methods in cases with laryngeal functions preserved were: direct suture in 137, pectoralis major musculocutaneous flap in 62, split graft in 2, pectoralis major musculocutaneous flap combined with the split graft in 5, stomach pulling-up in 12, colon interposition in 23 patients. While in cases without laryngeal functions preserved the methods includes: direct suture in 54, laryngotracheal flap in 54 patients, pectoralis major musculocutaneous flap in 7, laryngotracheal flap combined with pectoralis major musculocutaneous flap in 8, stomach pulling-up in 22, colon interposition in 3 patients. All patients received radiotherapy postoperatively (dose 55 - 75 Gy)., Results: The overall 3 and 5 year survival rates were 65.1% (229/352) and 53.6% (142/265), respectively. For stage I, the 5 year survival rate was 3/3, stage II, 80.6%(25/31), stage III, 65.0% (67/103), stage IV, 36.7% (47/128). The 3 and 5 year survival rates in functionally preserved group were 68.0% (164/241) and 59.7% (114/191), respectively, while in non-functionally preserved group were 58.6% (65/111) and 37.8% (28/74), respectively. The cervical lymph node metastasis was found in 239 sides. Pathologic findings showed that well, moderately and lower differentiated squamous cell carcinomas were 84, 163, 105 cases, respectively. Laryngeal functions (voice, respiration and deglutition) were completely restored in 169 patients and partially restored (voice and deglutition) in 72 patients., Conclusions: Combined surgery and radiotherapy are the best choice for hypopharyngeal cancer. The continuity of the pharyngoesophagus is restored and the laryngeal function is preserved as far as possible. The preservation of laryngeal function and the laryngeal and pharyngeal reconstruction are based on the premise that the tumor was excised completely.

Objective: Canine model established for tracheal defect reconstruction, to investigate the outcome of tracheal reconstruction with combination of polypropylene and flap., Methods: About 3.5 to 4 centimeter cervical trachea was resected and replaced with artificial trachea made from monofilament knitted polypropylene and surgical flap. Covered stent was implanted postoperatively. Survival period and quality of life were recorded, bronchofibroscopy, X-ray films and HE sections were performed., Results: Six dogs survived well and another two died. The causes of death were respiratory failure in 1 and infection in another. Stenosis of anastomosis in 1 was recorded during survival period. The dogs started drinking and eating on the second postoperative day, no dyspnea was found. The animals were sacrificed at 2, 4, 8 weeks and 6 months after surgery. Soft tissue growth was found in polypropylene net 2 weeks after surgery and more at 4 weeks. The polypropylene net was covered completely with soft tissue at 8 weeks and 6 months postoperatively, the hardness and sustentation degree were enhanced following the growth and fibrosis of soft tissue. The squamous epithelium and columnar epithelium were observed healing well by HE staining method., Conclusions: One-stage operative artificial trachea made from monofilament knitted polypropylene which has good histocompatibility and surgical flap is the closer artificial trachea to native trachea. It has a promising prospect in clinical use.

Objective: To explore the methods of surgical treatment and preservation of laryngeal function in senile patients with advanced laryngeal carcinoma., Methods: A retrospective data review of 87 advanced laryngeal carcinoma patients aged over 65 years was carried out. Of these 87 patients treated by different modes of surgery, 48 had supraglottic cancer, 35 glottic cancer and 4 subglottic cancer. The surgery modes consisted of major partial laryngectomy in 36 patients, subtotal partial laryngectomy with laryngoplasty in 21 and total laryngectomy in 30. All patients received postoperative radiotherapy to a dose of 50-60 Gy. Kaplan-Meier method was used to analyze the survival., Results: The overall 3- and 5-year survival rate was 73.2% and 67.4%, respectively. The ultimate rate of larynx preservation was 65.5%. Of 57 patients with partial laryngectomy, 46 were decannulated with a decannulation rate of 80.7%. Yet, in all patients, the nasal feeding tube was removed and food intake per os was resumed. All patients who underwent partial laryngectomy regained their phonation function., Conclusion: It is safe and effective to treat and preserve laryngeal function surgically in the senile patients with advanced laryngeal carcinoma. The key points to achieve this are selection of proper patient, renovation of surgical procedure and improvement of surgical skill.

Objective: To analyse the diagnostic and therapeutic aspects of carotid body tumor (CBT)., Methods: Seven patients with CBT had been hospitalized between 2003 and 2006. The clinical data was analyzed retrospectively. The preoperative evaluation included angiography in 7 patients. Most of them had an asymptomatic cervical lateral mass. Only one patient had the hoarseness and buckling and was given radiation therapy alone. Six of seven patients with carotid body tumour underwent surgery. Simple tumor excision was accomplished in 4. Carotid artery resection with the tumor was required in 2 patients and in the both, interposition of a 7 mm polytetrafluoroethylene graft was performed . During the resection, temporary carotid shunt was required in the two patients., Results: All tumors by surgery were identified as carotid paragangliomas without evidence of malignancy. There was no mortality and no hemiplegia. After surgery, temporary cranial nerve dysfunction was noted in one case. In the follow-up period of 2 months to 2 years, no recurrent disease occurred. The patient's tumor who accepted radiotherapy was in the stable stage under the half year follow up, and the follow up would be further continued., Conclusions: With non-invasive investigation and arteriography it was possible to obtain an early and precise diagnosis. The surgical management was the major treatment of these tumors. The pattern of operation should be chosen according to the relation of tumor and carotid. The decision to perform simple tumor excision or additional arterial resection was based on diagnostic preoperative and after the arterial resection the polytetrafluoroethylene graft would be used for carotid reconstruction.

Background & Objective: The prolongation of life expectancy results in an increasing number of aged patients with hypopharyngeal carcinoma who have poor surgical tolerance because of degenerative organ functions. This study was to explore the surgical methods and preservation of laryngeal function for aged patients with hypopharyngeal carcinoma., Methods: Clinical data of 84 patients with hypopharyngeal carcinoma who aged above 60 years, treated from 1996 to 2001, were retrospectively reviewed. Of the 84 cases, 68 were originated from pyriform sinus, 5 from postcricoid area, 11 from posterior pharyngeal wall; 57 patients received partial laryngectomy with laryngeal function preservation, 27 received total laryngectomy. Kaplan-Meier method and log-rank test were used to evaluate the survival rates., Results: The overall 3- and 5-year survival rates were 60.7% and 53.3%, respectively. The 3- and 5-year survival rates of laryngeal function preservation group was not significantly different from those of total laryngectomy group (63.2% vs. 55.6%, P = 0.37; 56.7% vs. 46.3%, P > 0.05). In laryngeal function preservation group, 39 (68.4%) had all functions preserved (voice, respiration, and deglutition), and 18 (31.6%) partially preserved (voice and deglutition)., Conclusion: It is safe and effective to treat aged hypopharyngeal carcinoma patients with surgery, and is possible to preserve laryngeal function in T3-4 stage aged patients who have no involvement of contralateral larynx, no invasion to esophagus, and no deglutition difficulty.

Objective: To review the experience of different surgical construction methods for hypopharyngeal cancer with cervical esophageal invasion., Methods: From 1989 to 2000,forty-eight patients with advanced hypopharyngeal cancer and cervical esophageal invasion were retrospectively reviewed, including 38 males and 10 females. The median age was 54. 3 years old, ranged from 26 to 71 years old. According to UICC 1997 criteria, all the tumors were T4 stage and originated from the pyriform sinus (33), posterior pharyngeal wall (14), postcricoid area (1), there were 28 patients in cN0, 15 in cN1, 5 in cN2 and no distant metastasis. Precise preoperative evaluation was performed with computed tomography scan, barium swallow perspective and biopsy. All the patients received modified neck dissection, including both unilateral (38 patients) and bilateral (10 patients). Pharyngoesophageal defect reconstruction methods were: laryngotracheal flap in 11 patients, pectoralis major musculocutaneous flap in 13, laryngotracheal flap combined with pectoralis major musculocutaneous flap in 6, pectoralis major musculocutaneous flap combined with the split graft in 10, stomach pulling-up in 3, colon interposition in 5 patients. Total laryngectomy was carried out in 8 patients. All patients received radiotherapy postoperatively (dose 55 - 75 Gy)., Results: The cervical lymph node metastasis was found in 20 patients. Pathologic findings showed that well, moderately and lower differentiated squamous cell carcinomas were 18, 24, 6 cases, respectively. The overall 3 and 5 year survival rates were 52.1% (25/48) and 27.3% (12/44), respectively. The 3 and 5 year survival rates in functionally preserved group were 65.2% (15/23) and 33.3% (7/21), while in non functionally preserved group were 40.0% (10/25) and 21.7% (5/23), respectively. Fifteen patients laryngeal functions (voice, respiration and deglutition) were completely restored and 8 patients partially restored (voice and deglutition). The decannulation rate was 65% (15/23). The complication included pharyngeal fistulas in 10 cases and splitting of chest wall in 1 cases., Conclusions: Combined therapy was the best choice for hypopharyngeal cancer with cervical esophageal invasion. The laryngeal function is preserved as far as possible. The continuity of the pharyngoesophagus was restored by pectoralis major musculocutaneous flap, laryngotracheal flap, or combined with the split graft. Stomach transposition or colon interposition was used while the defect of the esophagus was greater.

Objective: To explore the surgical techniques in surgical treatment of postcricoid carcinoma., Methods: Twenty-one cases with postcricoid carcinoma were treated surgically. The TNM stage were as follows: T3NOM0 5 cases, T3N1M0 1 case, T3N2M0 2 cases, T4NOM0 7 cases, T4N1M0 4 cases, T4N2M0 1 case, T4N3M0 1 case. The laryngeal and pharyngeal functions were rebuilt by the remaining tissue when the lesions entirely removed. Ten cases were surgically treated with laryngeal functions preserved and 11 cases with total laryngectomy. Eight cases were received unilateral neck dissection, and 3 cases were received bilateral neck dissection. All the cases received postoperative radiotherapy., Results: The follow-up interval varied from 60 to 276 months with average interval 96 months. Four cases died of cervical metastasis,3 died of local recurrence, 1 died of cardiopulmonary failure, 2 died of unknown reasons. The overall 3 and 5 year survival rates were 61.9% (13/21) and 52.4% (11/21), respectively. Among 10 cases having laryngeal functions partially restored (voice and deglutition), the postoperative complications included 5 cases of pharyngeal fistula, 3 hypopharyngeal stenosis and 1 severe aspiration., Conclusions: The preservative surgery is feasible for the selected cases with postcricoid carcinoma. The laryngeal function can be partially restored with lesions entirely removed. The patients can gain satisfied survival rate and quality of life.

Objective: To investigate the surgical approaches for sinonasal tumors with intracranial extension., Methods: Seventeen patients with intracranial invasion tumors were treated surgically by maxillectomy combined with frontal or infratemporal approaches in 11 cases, including squamous cell carcinoma 8 cases, papillocarcinoma 2 cases and meningioma 1 case. Nasofrontal bone translocation in 1 case which was a meningioma case, craniofacial approaches in 5 cases, including squamous cell carcinoma 4 cases and esthesioneuroblastoma 1 csae., Results: One of two meningioma cases with cavernous sinus invasion was incompletely resected, another case was resected en bloc. In malignant group, ten cases were treated by nasomaxillectomy combined with frontal or infratemporal approaches. One patient died 1 year after operation, 7 cases survived for over 3 years, and 5 for over 5 years. Five cases were treated by craniofacial approach, among them, one patient died 6 months after operation, 4 cases survived for over 3 years, and 2 for over 5 years. All patients healed smoothly., Conclusions: Maxillary nasopyramid translocation combined with frontocranial or infratemporal approach is available for en bloc removal of sinonasal tumors with intracranial extension. The nasofrontal bone translocation is available for removal of tumors with limited intracranial extension and well developed frontal sinus. Cranioanterolateral facial approach is suitable for nasocranial tumors with facial bone involvement.

Objective: To explore the feasibility and the related surgical techniques of laryngeal function preservation in surgical treatment of pyriform sinus cancer., Methods: Two hundred and thirty cases (stage I, 6; stage II, 10; stage III, 91; stage IV, 123) with pyriform sinus cancer were treated surgically from 1978 to 1996 in the Department of Otorhinolaryngology of Qilu Hospital of Shandong University. The methods of removing tumor and repairing surgical defects were depended on the extension of lesions. The laryngeal and pharyngeal functions were rebuilt by normal tissue preserved with lesions entirely removed. One hundred and fifty-eight cases were surgically treated with laryngeal functions preserved and 72 cases total laryngectomy. The most of the cases received postoperative radiotherapy., Results: The overall 3 and 5 year survival rates were 67.4% (155/230) and 48.3% (111/230) respectively. For stage I, the survival rate was 5/6; stage 11, 70.0% (7/10); stage III, 57.1% (52/91) and stage IV, 38.2% (47/123); the 3 and 5 year survival rates in functionally preserved group were 67.7% (107/158) and 50.0% (79/158), while in none functional group were 66.7% (48/72) and 43.1% (31/72), respectively. 75.3% (119/158) patients have laryngeal functions (voice,respiration and deglutition) completely restored and 24.7% (39/ 158) partially restored(voice and deglutition)., Conclusions: The preservative surgery is feasible for the selected pyriform sinus cancer cases. Choosing and following optimum surgical methods is a prerequisite for improving the quality of life of the cases.

Background & Objective: Chylous fistula, a severe complication after operation on neck, has close correlation with definite anatomical position and variation. Its treatment remains controversial. This study was to evaluate the validity of high negative pressure drainage for chylous fistula after neck dissection., Methods: A treatment of high negative pressure (-30 to -50 kPa) drainage, fasting, and reasonable venous nutrition was applied to 8 patients with postoperative chylous fistula., Results: Of the 8 patients, 7 recovered smoothly without severe complication, and pectoralis major muscle flap was adopted to cure the failed one., Conclusion: A treatment of high negative pressure drainage and reasonable diet is effective and safe for chylous fistula at early stage.

Background & Objective: The surgical treatment of laryngeal cancer, especially for the supraglottic cancer, usually involve the management of tongue-base, which is important in the rebuilding laryngeal function. There was no simple and effective method to repair tongue-base previously, which was removed for the greater part when invaded by advanced laryngeal cancer. As a result, many cases could not regain the satisfactory laryngeal function. And only several published reports focused on the efficacy of rebuilding laryngeal function by means of tongue-base flap. In order to develop a simple and reliable method to rebuild the laryngeal function, the management of tongue base in surgical treatment of laryngeal cancer was explored., Methods: After the laryngeal carcinoma or the involved tongue-base was removed, according to the extent of surgical defect, sternohyoid myofascial flap was used to reconstruct the tongue-base, or the tongue-base was selected to rebuild the laryngeal function when greater part of it was preserved., Results: Out of the 32 cases with partial laryngectomy, 26 cases were decannulated with a decannulation rate of 81.3%, all the cases regained speaking functions except 4 cases undergone total laryngectomy. All the cases resumed normal diet, none presented complication of accidental aspiration. The 3-year and 5-year survival rates were 81.3% and 65.6%, respectively., Conclusion: Reconstructing or pulling down the tongue-base is highly effective in rebuilding satisfactory laryngeal function, which is easily and simply performed with less damage and complications, appropriate for surgical treatment of laryngeal cancer.