[Show abstract][Hide abstract] ABSTRACT: To investigate the surgical outcomes of different uvulopalatopharyngoplasty (UPPP).
All subjects underwent overnight polysomnography and were evaluated using the Epworth sleepiness scale (ESS), the Quebec sleep questionnaire and the snoring scale at the baseline and 3 and 12 months following operation. The primary endpoint was the overall effective rate representing the sum of the surgical success rate and effective rate.
The overall effective rate at 12 months post surgery was 55.6% for simple UPPP, 95.8% for UPPP+GA, and 92.3% for UPPP+TBA. The surgical success rate at 3 and 12 months postoperation for UPPP+GA or UPPP+TBA was significantly higher than simple UPPP (P<0.05). Marked improvement was observed in all patients in the snoring scale score and the ESS score 3 and 12 months following surgery compared to the baseline (P<0.05 in all).
UPPP, UPPP+GA, and UPPP+TBA are all effective in improving the surgical outcome of obstructive sleep apnea hypopnea syndrome (OSAHS) patients with multilevel obstruction. UPPP+TBA appears to be the most effective in treating OSAHS patients.
[Show abstract][Hide abstract] ABSTRACT: Objective:
We retrospectively analyzed the surgical outcome and safety of the Montgomery T-tube for laryngotracheal stenosis.
The patients with laryngotracheal stenosis who had undergone T-tube placement between 1996 and 2010 were reviewed. The severity of the stenosis was evaluated using the Cotton-Myer staging method. The primary endpoint was the rate of successful extubation and the secondary endpoint was safety.
546 patients were eligible. T-tubes were successfully extubated in 342 patients 6-24 months following intubation. The initial extubation success rate was 62.3%. Laryngotracheal restenosis following extubation occurred in 192 patients, necessitating T-tube placement for a second time. The success rate for the second attempt was 58.9%. The overall success rate was 83.3%. Hemoptysis was reported in 8 patients, postoperative infection in 6 patients, wound dehiscence in 3 patients, laryngeal obstruction in 13 patients, aspiration in 12 patients, and postoperative tracheoesophageal fistula in 2 patients.
This large clinical series demonstrated the safety and effectiveness of the T-tube for grade 1 and 2 stenosis with stenosed segments of <6 cm. For those being >6 cm, tracheal end-to-end anastomosis is not appropriate and long-term placement of a T-tube is recommended. Our findings provide useful guidance for preoperatively selecting patients with laryngotracheal stenosis of various causes and differing severity.
[Show abstract][Hide abstract] ABSTRACT: Objective:
To investigate changes in the upper airway and its surrounding soft tissue and to characterize the extent and severity of upper airway obstruction in 136 obstructive sleep apnea/hypopnea syndrome (OSAHS) patients who were awake.
OSAHS patients and healthy controls were evaluated by fiber-optic nasolaryngoscopy and MRI. The cross-sectional area and pharyngeal wall thickness of the retropalatal, retroglossal and epiglottic region were determined.
Ninety-five percent of the mild OSAHS subjects had single-plane obstruction (vs. severe OSAHS, p < 0.05), 5.0% of the mild OSAHS subjects had two-plane obstruction (p < 0.05) and none of them had three-plane obstruction (p < 0.05). The cross-sectional area of the retropalatal, retroglossal and epiglottic region progressively declined as the severity of OSAHS increased (severe OSAHS vs. controls, p < 0.05). The lateral pharyngeal wall was significantly thicker in OSAHS subjects than in healthy controls (p < 0.05). The cross-sectional area of the soft palate in moderate and severe OSAHS subjects was markedly larger than that of the healthy controls (p < 0.05) and positively correlated with the apnea/hypopnea index (p < 0.05).
Moderate and severe OSAHS patients exhibit multi-plane obstruction of the upper airway, particularly in the retropalatal and retroglossal region. The severity of OSAHS negatively correlates with the thickness, length and cross-sectional area size of the soft palate.
[Show abstract][Hide abstract] ABSTRACT: Objective:
To investigate changes in S3 sleep and the apnea hypopnea index (AHI), SpO2 desaturation and CT90, and to determine changes in the degree of airway collapse and in the cross-sectional area of the retropalatal and lingual region in obstructive sleep apnea hypopnea syndrome patients.
All subjects underwent overnight polysomnography and were evaluated using Müller's test and magnetic resonance imaging at baseline, 3, and 12 months following surgery.
The mean S3 scores in patients receiving uvulopalatopharyngoplasty combined with genioglossus advancement (UPPP-GA) or UPPP combined with tongue base advancement using the Repose™ system (UPPP-TBA) noticeably increased. Marked improvement was seen in the mean AHI, LSO2, and CT90 scores 3 and 12 months following surgery compared to baseline. Airway collapsed by 25-50% in the greatest proportion undergoing surgery at the tongue base.
UPPP-GA and UPPP-TBA more effectively improve S3 sleep, and mean AHI, LSO2, and CT90 scores. In addition, they effectively alleviate airway obstruction by improving the cross-sectional area of these regions.
[Show abstract][Hide abstract] ABSTRACT: The aim of this study is to explore the relationship between structural/MHC changes in upper airway palatopharyngeal muscle morphology and obstructive sleep apnea/hypopnea syndrome. Palatopharyngeal muscle specimens were taken from 51 patients with obstructive sleep apnea hypopnea syndrome (OSAHS) who underwent uvulopalatopharyngoplasty (UPPP) resection. Patients were divided into light, medium and severe in terms of the severity of their OSAHS. There were 17 patients in each severity group. Palatopharyngeal muscle specimens were also taken from 17 patients suffering from chronic tonsillitis for comparison as the control group. All specimens were stained using Masson and observed for structural changes, especially in muscle fiber morphology, density and arrangement, as well as intermuscular connective tissues, under light microscopy. All specimens were also analyzed for MHC-I, MHC-IIa and MHC-IIb phenotype and protein expression differences using mRNA quantitative reverse transcription polymerase chain reaction (RT-PCR) and immunofluorescence staining. The results from each group were then statistically analyzed using semi-quantitative analysis. Light microscopy with Masson staining revealed that in the control group, the muscle fibers are closely connected and arranged neatly. In specimens from patients suffering from OSAHS, the palatopharyngeal muscle fibers are larger with obvious hypertrophy and there was an increase in elastic fibers. The mucosal lamina propria was thickened, and the density of muscle fibers was reduced. Muscle fibers are not neatly arranged and degeneration was observed. The amount of muscular pathology and fibrosis corresponds to the severity of disease in the patients. In patients with severe OSAHS, the proportion of collagen to muscle fibers was increased significantly. Immunofluorescence results reveal that there were significantly more fast muscle fibers and less slow muscle fibers in the study group than the control group. mRNA quantitative reverse transcription polymerase chain reaction (RT-PCR) revealed similar results, i.e., the proportion of MHC-II palatopharyngeal muscle fibers is higher in the study group than the control group, and increases with the severity of OSAHS. Pathological change occurs in both the collagen and muscle of OSAHS patients and corresponds to the degree of severity of OSAHS. Pathological change in palatopharyngeal muscle tissues is therefore, likely to be related to the occurrence and development of OSAHS. The increase in the proportion of the MHC-1I type fibers in OSAHS patients is likely to have an effect on the amount of airway support conferred by the muscle. This is likely the reason behind the lack of clinical improvement in some patients with severe OSAHS despite surgical treatment.
Archives of Oto-Rhino-Laryngology 04/2013; 271(1). DOI:10.1007/s00405-013-2361-z · 1.55 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVES/HYPOTHESIS: We investigated the clinical efficacy of free nerve grafts in bridging gaps between the recurrent laryngeal nerve (RLN) and ansa cervicalis in patients with unilateral RLN injury. STUDY DESIGN: We retrospectively reviewed the charts of 14 patients who underwent relevant free nerve grafting and assessed the clinical outcomes of this procedure. METHODS: Between January 2000 and January 2010, 14 patients with unilateral vocal fold paralysis were enrolled in this study. In all patients, the RLN was resected and free nerve grafts were applied to bridge the gap between the distal stump of the RLN and the anterior root of ansa cervicalis during surgery. Videostroboscopy, acoustic analysis, perceptual evaluation, maximum phonation time (MPT), and laryngeal electromyography (EMG) were performed both preoperatively and postoperatively to assess the clinical outcomes. RESULTS: Videostroboscopic findings showed that glottic closure, vocal fold edge, vocal fold position, phase symmetry, and phase regularity were significantly improved postoperatively (P<0.05), and no paradoxical movements of vocal cords were observed. Perceptual evaluation showed that overall grade, roughness, breathiness, asthenia, and strain were also significantly decreased postoperatively (P<0.05). The acoustic parameters jitter (local) and shimmer (local) and the mean noise-to-harmonics ratio were significantly lower than the corresponding preoperative values (P<0.05). The postoperative MPT values were also significantly longer than the preoperative values. Laryngeal EMG revealed significant improvement in voluntary motor unit recruitment during phonation postoperatively (P<0.05). CONCLUSIONS: Free nerve grafting is an effective procedure in bridging the gap between the RLN and ansa cervicalis in patients with unilateral RLN injury, as well as a safe procedure without obvious morbidity. A satisfactory vocal outcome can be obtained.
Journal of voice: official journal of the Voice Foundation 03/2013; 27(3). DOI:10.1016/j.jvoice.2013.01.009 · 0.94 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: MMP1 is an important member of the MMP endopeptidase family that plays a critical role in the development of head and neck cancer (HNC). Several studies have investigated the association between the MMP1 -1607 1G>2G polymorphism and risk of HNC, but their results have been inconsistent. Here, we conducted a meta-analysis to further explore the role of the MMP1 -1607 1G>2G polymorphism in HNC development.
We identified all eligible studies in the electronic databases of PubMed, ISI Web of Knowledge, MEDLINE, Embase, and Google Scholar (from January 2000 to June 2012). A meta-analysis was performed to evaluate the association between the MMP1 -1607 1G>2G polymorphism and risk of HNC by calculating odds ratios (OR) and 95% confidence interval (CIs).
Twelve studies were included in this meta-analysis. In overall comparison, significant associations were found using the recessive and allelic contrast models (OR, 1.38; 95% CI, 1.07-1.79 and OR, 1.27; 95% CI, 1.05-1.53, respectively), but no association was detected using the dominant model. In the stratified analyses by several variables, significant associations were observed using the recessive, dominant, and allelic contrast models in the Asian population (OR, 1.64; 95% CI, 1.29-2.08; OR, 1.39; 95% CI, 1.06-1.82; and OR, 1.41; 95% CI, 1.21-1.65, respectively), European population (OR, 0.58; 95% CI, 0.40-0.84; OR, 0.64; 95% CI, 0.44-0.92; and OR, 0.68; 95% CI, 0.54-0.85, respectively), and population-based subgroup (OR, 1.24; 95% CI,1.05-1.47; OR,1.48; 95% CI,1.04-2.12; and OR, 1.22; 95% CI, 1.07-1.38, respectively). Furthermore, significant associations were detected in oral cavity cancer and nasopharyngeal cancer under the recessive model.
Our results suggest that the MMP1 -1607 1G>2G polymorphism is associated with risk of HNC and that it plays different roles in Asian and European populations. Further studies with large sample size are needed to validate our findings.
PLoS ONE 02/2013; 8(2):e56294. DOI:10.1371/journal.pone.0056294 · 3.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To investigate the clinical features and prognostic factors of advanced hepatocellular carcinoma (HCC) patients presenting with lung metastasis at initial diagnosis.
Between 2001 and 2010, we recruited 76 consecutive HCC patients initially presenting with lung metastasis, without co-existing metastasis from other sites. These patients were divided into three groups: untreated group (n = 22), single treatment group (n = 19), and combined treatment group (n = 35).
Metastasis of bilateral lung lobes was common and noted in 35 patients (46.1%), and most of patients (59/76, 77.6%) presented with multiple lung metastatic nodules. Nineteen patients (25.0%) received single-method treatment, including hepatectomy in 4, transcatheter arterial chemoembolization in 6, radiotherapy in 5, and oral sorafenib in 4. Thirty-five patients (46.1%) received combined treatment modalities. The overall median survival of the all patients was 8.7 ± 0.6 mo; 4.1 ± 0.3, 6.3 ± 2.5 and 18.6 ± 3.9 mo, respectively in the untreated group, single treatment group and combined treatment group, respectively, with a significant difference (log-rank test, P < 0.001). Multivariate analysis revealed that Child-Pugh score, the absence or presence of portal vein tumor thrombus, and treatment modality were three independent prognostic factors affecting survival of patients with advanced HCC and concomitant lung metastasis.
Combined treatment modalities tend to result in a better survival as compared with the conservative treatment or single treatment modality for HCC patients initially presenting with lung metastasis.
World Journal of Gastroenterology 05/2012; 18(20):2533-9. DOI:10.3748/wjg.v18.i20.2533 · 2.37 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The BCLC staging classification has been widely endorsed to predict the prognosis of patients with HCC. However, its validity as a means of therapeutic instructions needs to be challenged. This study aimed to evaluate perioperative and long-term outcomes of surgical resection in patients with advanced hepatocellular carcinoma (HCC) according to the Barcelona Clinic Liver Cancer (BCLC) staging.
This study used a prospectively maintained database consisting of a consecutive series of 511 Chinese patients with advanced HCC who underwent surgical resection in a hepatobiliary surgical center from 2001 to 2007. Mortality, morbidity, long-term overall survival (OS) and disease-free survival (DFS) were evaluated.
Hospital mortality was 2.3%, and overall morbidity was 31.3%. After a median follow-up period of 27.8 months (range, 0-112 months), the 1-, 3- and 5-year OS rate was 69.9, 41.2 and 30.5%, and the 1-, 3- and 5-year DFS rate was 48.2, 30.3 and 24.0%, respectively. The 1-, 3- and 5-year OS and DFS rates were significantly poorer in patients with vascular invasion and/or extrahepatic spread than those in patients without (both P < 0.001), and also poorer in patients with biliary invasion than those in patients without (both P < 0.05).
Surgical resection could be considered in part of patients with advanced HCC (BCLC stage C), with low mortality, acceptable morbidity and favorable survival benefits. These results imply that BCLC recommendations for treatment schedules of advanced HCC need to be re-evaluated.
Journal of Cancer Research and Clinical Oncology 03/2012; 138(7):1121-9. DOI:10.1007/s00432-012-1188-0 · 3.08 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To assess the benefits and limits of surgery for primary hepatic lymphoma (PHL), and probability of survival after postoperative chemotherapy.
A retrospective analysis was undertaken to determine the results of surgical treatment of PHL over the past 8 years. Only nine patients underwent such treatment. The detailed data of diagnosis, treatment, and prognosis were carefully studied.
All patients were mistaken as having α-fetoprotein-negative hepatic cancer before pathological diagnosis. The mean delay time between initial symptoms and final diagnosis was 26.8 d (range: 14-47 d). Hepatitis B virus infection was noted in 33.3% of these patients. Most of the lesions were found to be restricted to a solitary hepatic mass. The surgical procedure performed was left hepatectomy in five cases, including left lateral segmentectomy in three. Right hepatectomy was performed in three cases and combined procedures in one. One patient died on the eighth day after surgery, secondary to hepatic insufficiency. The cumulative 6-mo, 1-year, and 2-year survival rates after hepatic surgery were, respectively, 85.7%, 71.4%, and 47.6%. One patient survived for > 5 years after surgery without any signs of recurrence until latest follow-up, who received routine postoperative chemotherapy every month for 2 years and then regular follow-up. By univariate analysis, postoperative chemotherapy was a significant prognostic factor that influenced survival (P = 0.006).
PHL is a rare entity that is often misdiagnosed, and has a potential association with chronic hepatitis B infection. The prognosis is variable, with good response to early surgery combined with postoperative chemotherapy in strictly selected patients.
World Journal of Gastroenterology 12/2010; 16(47):6016-9. DOI:10.3748/wjg.v16.i47.6016 · 2.37 Impact Factor