Mu-Kuan Chen

Minimally Invasive Endoscopic Nasopharyngectomy in the Treatment of Recurrent T1-2a Nasopharyngeal Carcinoma

Objective: To study the efficacy of endoscopic nasopharyngectomy in salvaging recurrent T1 to 2a nasopharyngeal carcinoma (NPC).

Deep neck infections in diabetic patients

PURPOSEnDeep neck infections may be lethal if life-threatening complications occur, especially in immunocompromised hosts such as diabetic patients. This study was undertaken to better define the clinical features and prognosis of deep neck infections in the diabetic patients with special emphasis on the use of empirical antibiotics and the role and timing of surgical management.nnnPATIENTS AND METHODSnA retrospective analysis of 105 consecutive patients treated at a single institution during a 9-year period was conducted. Of these, 30 patients also presented with diabetes mellitus.nnnRESULTSnCompared with the nondiabetic patients, the unique features of deep neck infections in diabetic patients were as follows: (1) older age, (2) tendency of unclear infection source, (3) tendency to involve multiple spaces, (4) required more aggressive surgical intervention, (5) prolonged hospitalization, and (6) higher complication rate. The differences were statistically significant (P< .05). There were no significant differences in the complete blood count/ differential count positive findings and fever between the 2 groups (P> .05). Bacterial cultures showed that Klebsilla pneumoniae was the most common causative pathogen in diabetic patients.nnnCONCLUSIONSnIn deep neck infection patients with diabetes mellitus, the clinical course is more severe and there is a poorer prognosis. Thus, in treating them, we should keep close observation, appropriately control the diabetes, detect the life-threatening complications early, perform aggressive surgical treatment if fluctuation or complication occurs, and take into account the preponderance of K pneumoniae when administering the empirical antibiotics.

MINIMALLY INVASIVE ENDOSCOPIC RESECTION OF THE SUBMANDIBULAR GLAND: A NEW APPROACH

This study evaluates the benefits of a new approach, endoscopic resection of the submandibular gland through the hyoid midline level skin incision by use of an ultrasonically activated scalpel.

Patient satisfaction and treatment outcome of fungus ball rhinosinusitis treated by functional endoscopic sinus surgery

Fungal rhinosinusitis is an important clinical problem with diverse manifestations. Although many literatures had found low recurrence rate after surgical treatment of fungus ball rhinosinusitis, patient satisfaction and treatment outcomes (symptom-free and symptom improvement rate, etc.) for fungus ball sinusitis are not yet well established. The purpose of this study is to estimate the patient satisfaction and treatment outcome in patients with fungus ball rhinosinusitis undergoing functional endoscopic sinus surgery (FESS). Medical records of consecutive patients with diagnosed fungus ball rhinosinusitis treated by FESS between 1995 and 2005 were reviewed retrospectively. The post-operative improvement in individual symptom was assessed by chart review and telephone visiting. Ninety consecutive patients (21 men and 69 women) were eligible for the study. Six patients (7%) presented bilateral fungus ball rhinosinusitis. Multiple paranasal sinus fungus ball involvements were found in 48 patients (53%). Complete resolution of complaints with respect to nasal discharge, postnasal drip, cough with sputum, nasal bleeding, fetid odor of nose, olfactory dysfunction, nasal obstruction, headache, and facial pain or pressure were described in 74 patients (82%). The overall patient satisfaction rate was 96%. The estimated recurrence rate of fungus ball rhinosinusitis treated with FESS was 3%, with a mean follow-up of 81xa0months. Treatment protocol of fungus ball rhinosinusitis with FESS and without postoperative antifungal drugs is efficient because of very low recurrence rate, high patient satisfaction, and very high symptom-free rate. Furthermore, the obvious difference of symptom-free rate between fungus ball rhinosinusitis and chronic rhinosinusitis highlights the need of further studies to discover the pathophysiology of fungal sinusitis.

Prognostic impact of bcl‐2 expression on advanced nasopharyngeal carcinoma

Our aim was to evaluate the prognostic impact of bcl‐2 expression on patients with advanced nasopharyngeal carcinoma (NPC).

Expression of p53 protein and primary tumour volume in patients with nasopharyngeal carcinoma

OBJECTIVEnTo investigate the relationship of p53 protein expression and primary tumour volume in patients with nasopharyngeal carcinoma.nnnDESIGNnRetrospective study.nnnSETTINGnTertiary care centre.nnnMETHODnForty-two newly diagnosed patients participated in the study.nnnMAIN OUTCOME MEASURESnThe relationship between p53 status, TNM stage, and computed tomography-derived primary tumour volume.nnnRESULTSnIn patients with high p53 stains, the tumour volume was larger (p = .03). p53 was found to be independent of clinical stage (p = .84).nnnCONCLUSIONnThere is a positive correlation between primary tumour volume and p53 status.

Primary tumor volume measured by FDG PET and CT in nasopharyngeal carcinoma.

Background: The prognostic value of CT-derived primary tumor volume in patients with nasopharyngeal carcinoma (NPC) has been demonstrated in our previous serial studies. The purpose of the present study is to compare the primary tumor volume measured by FDG PET and traditional CT in NPC, and to ascertain their prognostic value. Materials and Methods: From 2007 to 2008, 32 patients with newly diagnosed NPC were prospectively studied. All patients underwent a CT scan, followed by a FDG PET/CT scan. CT-derived primary tumor volume (VolumeCT) was measured using the summation-of-area technique. PET-volume was measured using 3 methods: delineating the contour of tumor with the threshold of standardized uptake value (SUV) ≧2.5 (Volume2.5), ≧40% of maximal SUV (Volume40%), and ≧50% of maximal SUV (Volume50%). The primary tumor volumes derived from the 4 methods, VolumeCT, Volume2.5, Volume40%, and Volume50%, were compared. Univariate Cox regression was used to identify the above parameters as prognosticators. Results: The volumes derived from the VolumeCT, Volume2.5, Volume40%, and Volume50% methods were 16.48 ± 12.46 cm3, 25.87 ± 16.96 cm3, 13.66 ± 6.90 cm3, and 8.25 ± 4.52 cm3, respectively. There was decent correlation between VolumeCT and Volume2.5 (r = 0.64, P = 0.0001), and Volume2.5 was systemically larger than VolumeCT. No significant difference was noted between VolumeCT and Volume40% (P = 0.24), but the correlation was poor (r = 0.15, P = 0.39). For VolumeCT and Volume50%, the difference was significant (P = 0.0006) and the correlation was poor (r = 0.23, P = 0.20). Larger tumor volumes presented as VolumeCT, Volume2.5, and Volume50% were associated with shorter overall survival. Conclusion: PET-derived primary tumor volumes are substantially different from CT-derived tumor volumes, only decent correlation is noted between VolumeCT and Volume2.5. Volume2.5 and Volume50% seem to be reasonable alternatives for VolumeCT in predicting the patient outcomes.

Primary tumour volume: important predictor of outcome for T3- and T4-staged nasopharyngeal carcinoma.

OBJECTIVEnTo investigate the relationship between primary tumour volumes and treatment outcomes within T3- and T4-staged nasopharyngeal carcinoma.nnnDESIGNnRetrospective study.nnnSETTINGnTertiary care centre.nnnMETHODSnForty newly diagnosed T3-staged patients and 36 newly diagnosed T4-staged patients participated in the study.nnnMAIN OUTCOME MEASURESnComputed tomography-derived primary tumour volume was obtained from the summation of areas technique. The probabilities of achieving tumour control and patient survival were estimated using the product-limit method of Kaplan and Meier. The log rank test was used to examine significance.nnnRESULTSnIn T3-staged nasopharyngeal carcinoma, the median primary tumour volume was 29.6 mL, with a range from 8.0 to 131.8 mL. After segregating the primary tumour volume into two subgroups (< 30 mL, > 30 mL), large primary tumour volume was associated with a significantly poorer disease-specific survival (p = .0001). In T4-staged cases, the median primary tumour volume was 54.07 mL, with a range from 6.7 to 223.1 mL. After segregating the primary tumour volume into two subgroups (< 60 mL, > 60 mL), larger primary tumour volume was associated with a significantly poorer disease-specific survival (p = .0022).nnnCONCLUSIONnWithin the same T3- and T4-staged nasopharyngeal carcinoma, the primary tumour volume represented an important prognostic factor. To improve the treatment outcome of T3- and T4-staged nasopharyngeal carcinoma with large primary tumour volumes, more aggressive treatment is needed.

Symptoms treatment for allergic rhinitis using diode laser: results after 6-year follow-up

Allergic rhinitis is a very common chronic disease. The purpose of this study was to measure the outcome of treating allergic rhinitis with diode laser, over a long-term follow-up of 6xa0years. Forty-two consecutive patients with newly diagnosed allergic rhinitis that was refractive to conservative medical therapies were enrolled in the study. Treatment was with a diode laser (wavelength 805xa0nm, laser parameter 12xa0W, in ‘contact’ mode) under local anesthesia between September 1999 and May 2000. A quality of life questionnaire was used after a follow-up period of 6xa0years to assess the outcome of diode laser surgery. All 42 patients suffered from either perennial or persistent-type allergic rhinitis. Twenty-five out of 42 patients (60%) replied to the questionnaire 6xa0years after laser surgery. The mean operation time was 1xa0min 28xa0s for each patient. No complications were observed (e.g., major bleeding), and no nasal packing was necessary. Statistical analysis revealed significant improvements in symptom score, medication score and total score 6xa0years after laser surgery. A total of 60% of the patients described improvements in symptom scores, and 68% of the patients described improvements in total score 6xa0years after laser treatment. It was evident that the effectiveness of laser surgery persisted through the 6xa0years of follow-up. Long-term follow-up after 6xa0years confirmed that diode laser surgery for allergic rhinitis is a useful procedure that has a long-lasting effect and can be performed in an outpatient surgery under local anesthesia. Minimal discomfort, long-term effectiveness and short operation time are other reasons why this treatment should be selected for patients with allergic rhinitis that is refractive to conservative management.

Outcome survey of therapy with diode laser in patients with allergic rhinitis.

OBJECTIVEnTo measure the outcome of treatment of allergic rhinitis with a diode laser in the contact mode.nnnDESIGNnProspective study.nnnSETTINGnTertiary care centre.nnnMETHODnForty-two newly diagnosed patients participated in the study.nnnMAIN OUTCOME MEASURESnAfter a follow-up of 1 year, we measured the result of treatment by an allergy outcome survey questionnaire in the 3 months, 6 months, and 1 year following the operation.nnnRESULTSnTwenty-seven of 42 patients (64.3%) who replied filled out the questionnaire completely. The mean operation time took 1 minute, 28 seconds per patient, no nasal packing was necessary, and no complications were observed. Statistical analysis revealed significant improvement in the symptom score 1 year after laser surgery. The outcome of laser surgery declines with time.nnnCONCLUSIONnShort-term results revealed that diode laser treatment of allergic rhinitis is a useful procedure that can be performed as outpatient surgery under local anesthesia. The short operation time and less discomfort provide other reasons for choosing this treatment for allergic rhinitis.