Extracapsular spread in the clinically negative neck (N0): implications and outcome

The myotomal muscle of Synbranchus marmoratus was investigated using histochemical and immunohistochemical reactions. This musculature is composed of a superficial red compartment, uniformly distributed around the trunk circumferentially and also in the lateral line. The red compartment fibers are small in diameter and have an oxidative metabolism, a high rate of glycogen and a negative reaction to alkaline and acid myofibrillar ATPase (mATPase). The white muscle forms the bulk of the muscle mass. Its fibers are large in diameter and have a glycolytic metabolism, a negative reaction to glycogen, a strong reaction to alkaline mATPase and a negative reaction to acid mATPase. Between these two compartments there is an intermediate layer of fibers presenting a mosaic metabolism pattern with a high rate of glycogen. These fibers stained moderately for alkaline and acid m-ATPase. Several clusters of red muscles were observed inside the white muscle. Each cluster is composed of three fiber types, with a predominance of red and intermediate fibers. Reactivity to anti-MHC BA-D5 was positive only in the intermediate fibers. Reactivity to anti-MHC SC-71 was negative in all fiber types.     

The extent of neck disease after regional failure during observation of the N0 neck

A female infant with 21 trisomy syndrome associated with congenital chylothorax was reported. She was born at a gestational age of 34 weeks by Cesarean section because of fetal hydrothorax and hydrops fetus, confirmed by ultrasonography at 32 weeks. Emergent resuscitation and immediate thoracentesis were performed soon after birth. After beginning breast feeding, the serous pleural fluid became opalescent and a diagnosis of congenital chylothorax was made. Feeding was changed to medium-chain triglyceride (MCT) feeding and the production of pleural effusion disappeared after thoracentesis was performed several times. Accumulating evidence suggested that MCT feeding and intermittent thoracentesis under echo guide were effective. Some reports on patients, including this one, suggest that there may be more patients with 21 trisomy associated with congenital hydrothorax. Therefore, congenital hydrothorax might be listed as a complication of 21 trisomy.     

Management of the neck in nasopharyngeal carcinoma (NPC)

Management of cervical nodal metastasis from nasopharyngeal carcinoma (NPC) begins with a thorough assessment of the patient to determine extent of the disease process at the primary site, regionally and systematically. Detailed knowledge of the anatomy of the head and neck will facilitate an accurate diagnosis and subsequent staging of each individual patient. The use of the appropriate diagnostic tools such as imaging, fine-needle aspiration studies, and serology direct the clinician to the appropriate management scheme. This article attempts to cull information from various clinicians who treat the majority of NPC patients, and to raise the issue of the need for more innovative approaches.     

Ability of temperature-sensitive mutants of the recombinant influenza S/N (H2N1) virus to induce immunity to parental (H0N1 and H2N2) viruses

The behavior in mice of two thermosensitive (ts) mutants (denoted ts217 and ts700) of the recombinant influenza virus S/N (H2N1) was studied. The parental thermoresistant (tr) virus and both of the mutants were capable of inducing protection against pneumotropic A/Singapore (H2N2) and A/WS (H0N1) challenge viruses. Immunity against the Singapore virus, with which the S/N virus shared the hemagglutinin, developed earlier than against the WS virus, with which the S/N virus shared the neuraminidase. The tr and ts217 viruses were immunologically more active than the ts700 virus. The first two viruses grew markedly better in mouse lungs than did the latter. In the course of ts217 virus replication in vivo, revertants capable of growing at 39 degrees C appeared readily. On the other hand, the ts700 virus proved to be genetically stable. These data seem to provide evidence of a linkage between the stability of the ts phenotype, reproductive capacity in mouse lungs, and immunogenicity in the viruses examined.     

Wedge resection versus lobectomy for stage I (T1 N0 M0) non-small-cell lung cancer

BACKGROUND: The role of nonanatomic wedge resection in the management of stage I (T1 N0 M0) non-small-cell lung cancer continues to be debated against the present gold standard of care--anatomic lobectomy. METHODS: We analyzed the results of 219 consecutive patients with pathologic stage I (T1 N0 M0) non-small-cell lung cancer who underwent open wedge resection (n = 42), video-assisted wedge resection (n = 60), and lobectomy (n = 117) to assess morbidity, recurrence, and survival differences between these approaches. RESULTS: There were no differences among the three groups with regard to histologic tumor type. Analysis demonstrated the wedge resection groups to be significantly older and to have reduced pulmonary function despite a higher incidence of treatment for chronic obstructive pulmonary disease when compared with patients having lobectomy. The mean hospital stay was significantly less in the wedge resection groups. There were no operative deaths among patients having wedge resection; however, a 3% operative mortality occurred among patients having lobectomy (p = 0.20). Kaplan-Meier survival curves were nearly identical at 1 year (open wedge resection, 94%; video-assisted wedge resection, 95%; lobectomy, 91%). At 5 years survival was 58% for patients having open wedge resection, 65% for those having video-assisted wedge resection, and 70% for those having lobectomy. Log rank testing demonstrated significant differences between the survival curves during the 5-year period of study (p = 0.02). This difference was a result of a significantly greater non-cancer-related death rate by 5 years among patients having wedge resection (38% vs 18% for those having lobectomy; p = 0.014). CONCLUSION: Wedge resection, done by open thoracotomy or video-assisted techniques, appears to be a viable "compromise" surgical treatment of stage I (T1 N0 M0) non-small-cell lung cancer for patients with cardiopulmonary physiologic impairment. Because of the increased risk for local recurrence, anatomic lobectomy remains the surgical treatment of choice for patients with stage I non-small-cell lung cancer who have adequate physiologic reserve.     

纳米粒子的开发应用研究

纳米粒子在若干重要学科上的初步开发应用研究成果，揭示了纳米粒子的奇特性能，由此预示纳米粒子将成为今后不久世界开发研究的热点之一。     

Management of the neck in thyroid cancer

The incidence of nodal metastasis in differentiated thyroid cancer ranges between 40% to 75%. Elective neck dissection is generally not advised in patients with differentiated thyroid cancer; however, if clinically apparent nodal disease is noted in the tracheoesophageal groove during surgery, central compartment clearance is advised. If clinically apparent nodal disease is present in the lateral compartment of the neck, modified neck dissection preserving the sternomastoid, accessory nerve, and jugular vein is advised. The "berry picking procedure" is generally not recommended because of the higher incidence of regional recurrence. Due consideration should be given for parathyroidal transplantation if the blood supply to the parathyroids is damaged during central compartment clearance. The incidence of lymph node metastasis is highest in young patients, however, lymph node metastasis has no bearing on long-term survival. There seems to be a higher incidence of regional recurrence in elderly individuals. If patients present with bulky nodal disease, consideration may be given for postoperative radioactive iodine dosimetry and ablation if necessary. Differentiated thyroid cancer represents a unique disease in the human body, where lymph node metastasis has no prognostic implication. Aggressive surgical clearance is advised in patients with medullary thyroid cancer in the central compartment and the jugular chain lymph nodes.     

Kikuchi's disease of the neck (histiocytic necrotizing lymphadenitis)

Histocytic necrotizing lymphadenitis (HNL), also known as Kikuchi's disease is a benign self limiting disease of unknown origin. It effects cervical lymph nodes, predominantly in young females. It is well described in the pathology literature, but little is written about this in the ENT literature, as few clinicians are probably aware of this condition. Five cases of cervical Kikuchi's disease are presented with a brief review of the literature.     

合金元素对Co3Ti力学性能的影响

Ｃｏ３Ｔｉ是ＬＴ２型长程有序金属间化合物,具有优良的高温性能,可望成为新型的高温结构材料,但由于存在着固有脆性,使其应用推广受到限制。对此本文较系统地研究了几中不同聚代行为的合金元素Ｃｏ３Ｔｉ从低温到高温力学性能的影响,并对其韧化规律进行发初步的探讨。     

铁基胎体玻璃打孔器的研究

研究了不同的铜含量对玻璃打孔器铁基胎体组织争性能的影响，通过显微镜观察了打孔器在凌用后金刚石的脱落情况，结果表明，当铜含量为16％～18％时，铁基胎体对金刚石的把持力优于银含量为14％和20％时，并支现了铁和镍在金刚石表面的明显富集，证明形成了碳化物，改善了胎体对金刚石的润湿性。     

Management of malignant melanoma of the head and neck

A total of 91 patients with melanoma of the head and neck treated between 1973 and 1991 were studied prospectively with regard to prognostic features, treatment and outcome. Other than Breslow thickness, the only important prognostic feature was the less aggressive nature of lentigo maligna melanoma. A policy of selective excision margins, 1 cm for impalpable and 2 cm for palpable lesions, was found to be safe, although preliminary biopsy should be used if there is diagnostic uncertainty or where the expected extent of surgery entails a mutilating procedure. Local recurrence rates were not affected by the method of wound closure, which should be determined by the best functional and cosmetic outcome. These results support the trend against prophylactic neck dissection. Such dissection, when indicated for lesions of the face, pinna, anterior scalp and parotid area, should routinely include superficial parotidectomy. Uncontrolled symptomatic loco-regional recurrence is an uncommon complication that may occur despite radical primary surgery. The role of preoperative radiotherapy for high-risk melanoma in this situation warrants investigation.