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Hard working liver firmness measured simply by digital effect quantification predicts the occurrence of posthepatectomy refractory ascites in people using hepatocellular carcinoma.
A 74-year-old woman suffered from asphyxia due to a huge thyroid mass compressing cervical trachea. The patient developed dyspnea, orthopnea, shortness of breath. SpO2 was about 90% under high flow oxygen inhalation. Protuberant mass was seen in the anterior midline of neck. The palpation was hard, the boundary was not clear, and the trachea couldn't be touched. Neck CT showed a huge mass in the thyroid and severe tracheal compression. And electronic laryngoscopy showed paralysis in bilateral vocal cord, which were fixed in the paramedian position. With the further development of the disease, the patient appeared asphyxia and was in critical condition. After multidisciplinary consultation, considering the high risk of direct intubation, ECMO was used to assist and performed "total thyroidectomy + tracheostomy" under general anesthesia. The patient got successful treatment finally.Noonan syndrome is a multisystem disease with widespread heterogeneity regarding the genetic and clinical characteristics, which can be accompanied by distinctive facial dysmorphism, congenital heart defects, short stature, cryptorchidism, lymphatic malformations, bleeding disorders and skeletal malformations. Some patients have hearing impairment. Noonan syndrome is a rare cause of sensorineural hearing loss. The study describes a Noonan syndrome patient with profound bilateral hearing loss. He received a cochlear implantation successfully. The patient had clinical characteristics of Noonan syndrome, and the diagnosis was confirmed by the detection of pathogenic variants in PTPN11 by whole exome sequencing. According to the authors' knowledge, this is the first report regarding cochlear implantation in a Noonan syndrome patient in China.ObjectiveTo investigate the application and efficacy of pedicled middle turbinate mucosal flap in transnasal endoscopic repair of cerebrospinal fluid rhinorrhea. Methods15 patients with cerebrospinal fluid rhinorrhea were retrospectively analyzed，including 13 patients with simple cerebrospinal fluid rhinorrhea （86.7%） and 2 patients with cerebrospinal fluid rhinorrhea with meningoencephalocele （13.3%）. According to the location of the fistula, the pedicled middle turbinate mucosal flap under nasal endoscopy was used to repair cerebrospinal fluid rhinorrhea, in which 5 cases （33.3%） had leakage at the top of the sieve and 8 cases （53.3%） had leakage at the sieve plate. Two cases had leakage at the lateral racess of sphenoid sinus. ResultsAll cases of cerebrospinal fluid rhinorrhea were repaired successful and the mucosa epithelialized well in the operative area. There was no recurrence of cerebrospinal fluid rhinorrhea or other complications during the follow-up period of 4-24 months （average 13 months）. ConclusionThe pedicled middle turbinate mucosal flap has a high success rate for repairing cerebrospinal fluid rhinorrhea, and the nasal cavity damage is small, which is worthy of clinical promotion.ObjectiveTo evaluate the short-term efficacy of nasal nitric oxide（nNO） on specific allergen subcutaneous immunotherapy in children with allergic rhinitis. MethodsThe data of 87 children with allergic rhinitis treated in the otolaryngology clinic of Guangzhou Women and Children's Medical Center from January 2018 to January 2019（case group） and 80 healthy children who received physical examination in the hospital during the same time period（control group） were retrospectively analyzed. The case group was treated with specific allergen subcutaneous immunotherapy. Compare the nNO and symptom score changes of the control group and the case group at different time points. Describe the treatment effect of children in the case group after 1 years of treatment. Analyze the changes of nNO and TNSS（nNO, TNSS） in the case group of patients with different treatment effects during treatment, and calculate the evaluation value of nNOand TNSSon the treatment effect of children. ResultsThe nNO and TNSS in the case group ment in children.ObjectiveTo investigate the staging of vestibular organ damage in Meniere's disease, based on the vestibular function examination battery. MethodsThirty-nine patients, clinically diagnosed as unilateral Meniere's disease, underwent audiologic test and vestibular function examination battery, including ocular vestibular evoked myogenic potential（oVEMP）, cervical vestibular evoke myogenic potential（cVEMP）, and caloric tests. Based on the results of the vestibular function examination battery, the vestibular function was divided into 4 stages. StageⅠ oVEMP, cVEMP, and caloric tests were normal; stage Ⅱ any one test of the three examinations was abnormal; stage Ⅲ two of the three examinations were abnormal; Stage Ⅳ All the three examinations were abnormal. ResultsAccording to the vestibular function staging strategy in this study, patients in stage Ⅰ, Ⅱ, Ⅲ, Ⅳ were 7.7%（3/39）, 30.8%（12/39）, 33.3%（13/39）, 28.2%（11/39） respectively in the 39 Meniere's disease patients. However, according to the current clinical staging strategy of Meniere's disease, patients of stage1, 2, 3, 4 were 20.5%（8/39）, 43.6%（17/39）, 28.2%（11/39）, and 7.7%（3/39） respectively. 37.5%（3/8） patients in stage 1 and 64.7%（11/17） patients in stage 2 had two or more abnormal vestibular organs. While all the patients in stage 4 had abnormal semicircular canals, utricle, and saccule. The stage of vestibular function was correlated with the distribution of current clinical staging strategy of Meniere's disease（P less then 0.05）. ConclusionThe combination of oVEMP, cVEMP and caloric tests can divide the vestibular function into four stages, which can be used as a supplement to the traditional vestibular evaluation and clinical staging based on audiology in Meniere's disease.ObjectiveBy observing the nystagmus forms at different positions during Epley reduction in patients with posterior semicircular canal benign parochial positional vertigo（PC-BPPV）, to compare the effects of the first reduction, and to further summarize the possible causes of reduction failure and the prognosis of patients with different nystagmus forms. MethodsA retrospective analysis of 191 PC-BPPV patients diagnosed with PC-BPPV showed that 95 cases had positive nystagmus during the reduction process（group A）, 69 cases had no nystagmus （group B）, and 27 cases had reverse nystagmus （group C）. All the patients were diagnosed by G-Force BPPV and were treated through simulative Epley CRP. The form of nystagmus and the effect of the first reduction were compared. ResultsThe first reduction effect of group A was better than that of group C（P0.05）. ConclusionThe form of nystagmus in the reduction process of PC-BPPV has a certain guiding significance for the evaluation of the first reduction effect and the successful reduction. The reverse nystagmus during the reduction process indicates a poor reduction effect.ObjectiveTo introduce the clinical features and clinical imaging grading methods of cervical internal carotid artery（ICA） malformation. MethodsThe clinical data of 6 cases with cervical ICA malformation admitted to the department of Otolaryngology, Head and Neck Surgery, the First Affiliated Hospital of Chengdu Medical College from April 2018 to February 2021 were retrospectively analyzed and graded according to the clinical imaging grading method. ResultsAll 6 patients were confirmed by enhanced CT or CT angiography. The minimum distance from deformity ICA to pharyngeal mucosa was 0 - 2.0 mm, while the median distance was 1.3 mm. According to the clinical imaging grading standards, the four cases with oropharyngeal ICA were grade Ⅳ, which is considered extremely high risk of ICA injury. G6PDi-1 ic50 The two cases with hypopharyngeal ICA were grade Ⅲ, which is considered high risk of ICA injury. ConclusionICA malformation is not a rare condition, and can be definitively diagnosed by enhanced CT and CT angiography. The clinical imaging grading can be used to assess the risk of damaged ICA malformation, which has great clinical significance. Otolaryngologists and anesthesiologists should pay attention to this malformation to prevent ICA damage in the operation which could lead to fatal hemorrhage.ObjectiveTo explore and analyze the effect and indication of hormone replacement therapy（HRT） in perimenopausal women with chronic tinnitus. MethodsThe perimenopausal women with chronic tinnitus were divided into mild group and moderate to severe group according to Kupperman score of menopause, and then were divided into treatment group and untreated group according to whether they received MHT treatment or not. The serum 5-HT level, tinnitus handicap inventory （THI） and Pittsburgh sleep quality index （PSQI） were compared before and after treatment. ResultsIn moderate to severe perimenopausal tinnitus, the serum 5-HT level, THI and PSQI in the treatment group were statistically different before and after treatment（P less then 0.05）, and no significant difference was found in the untreated group. In mild perimenopausal tinnitus, there was no significant difference in 5-HT levels, THI and PSQI between the treated group and the untreated group before and after treatment. The 5-HT levels were correlated with THI. The lower the 5-HT level was, the more severe tinnitus was. ConclusionHRT is helpful in the treatment of perimenopausal chronic tinnitus, especially in moderate to severe perimenopausal patients, and is recommended for clinical use.ObjectiveTo explore the diagnostic efficacy of ultrasound-guided fine needle aspiration cytology（US-FNAC） for thyroid nodules ≥1 cm, and the effect of Hashimoto's thyroiditis（HT） on it. MethodsThe clinical data of 1027 cases of thyroid nodules ≥ 1 cm were retrospectively analyzed. Two-dimensional ultrasound, US-FNAC and BRAFV600E gene testing were performed. The postoperative pathological results were used as the criterion. The two dimensional ultrasound examination, clinical characteristics, follow-up results, and BRAFV600E were used to diagnosis for unoperated patients. The diagnostic efficiency of US-FNAC in HT（+） group and HT（-） group was compared, and the factors affecting the diagnostic efficiency were analyzed. ResultsOf the 1027 nodules, the cytological results were nondiagnostic/unsatisfactory in 73 nodules（7.1%）, benign in 282（27.5%）, atypia of undetermined significance/follicular lesion of undetermined significance in 230（22.4%）, follicular neoplasm/suspicious for a follicular neoplasm in 20（1.9% effective method for the diagnosis of thyroid nodules and it has high sensitivity and specificity in ≥ 1 cm nodules. However, the combination of HT reduces the diagnostic accuracy and HT is a risk factor for increased false negative rate.ObjectiveTo investigate interrelationships in parameters between caloric test and video head impulse test（vHIT） in the common peripheral vertigo diseases and healthy people, and to conduct correlation and difference analysis between the results in two tests, so as to evaluate the clinical diagnosis value of peripheral vertigo. MethodsThe caloric test and vHIT were fulfilled in 68 patients with vertigo and 17 healthy volunteers. The diagnosis was done according to history inquiring, otology and audiology examination and vestibular tests. The vestibulo-ocular reflex（VOR） gain and gain asymmetry（GA） of a vHIT as well as unilateral weakness（UW） and the sum of the slow-phase velocities（SPVs） of warm and cold irrigation of the same side were compared. A cutoff value of VOR gain of a vHIT was also calculated using a receiver-operating characteristic curve. ResultsIn all ears（n=170）, there was significant correlation in ipsilateral SPVs and VOR gain（r=0.568, P less then 0.0001）; In all ears（n=34） of 17 healthy volunteers, there was no correlation in ipsilateral SPVs and VOR gain（r=-0.
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