Efficacy of Surgical Therapy for Carotid Body Tumors

Objective To evaluate the efficacy of surgical therapy for carotid body tumors. Methods A retrospective analysis was conducted, covering the diagnosis, surgical procedure, postoperative complications, and prognosis of 120 cases of carotid body tumors in Peking Union Medical College Hospital from 1949 to May, 2011. Results Surgical excision was successfully performed in 111 cases with 117 tumors. In all those cases, 50 underwent simple tumor resection, 42 underwent resection of tumors and ligation of the external carotid arteries, 7 underwent co-resection of tumors and common carotid arteries, internal carotid arteries, as well as external arteries without vascular reconstruction, and the other 12 cases experienced tumor resection and vascular reconstruction as internal carotid arteries were involved. After operation, 3 cases developed cerebral infarction, 30 cases showed cranial nerve palsy, including 15 cases of hypoglossal nerve damage, 10 cases of vagus paralysis, and 5 cases of Horner's syndrome. Conclusion It is essential to make a proper surgical strategy, which can reduce postoperative com- plications.

ANALYSIS OF EFFECT AND COMPLICATION ON SURGICAL TREATMENT OF CAROTID BODY TUMORS IN 46 CASES

Objective.To describe the effects of surgical treatment a nd complications in46patients with carotid body tumor.Method.Retrospe ctive study on surgical treatment and complications was carried out in46case s of CBT which were surgically treated with different kind of procedures.Resul t.All procedures performed successfully except that the CBT was not excised in 4cases.No operative mortality was observed.There were2postoperative hemiple gia,4hypoglossal nerve impairment ,2glossopharyngeal nerve impairment ,1va gus nerve impairment ,and1accessory nerve impairment.One patient presented p ostoperative cranial nerve impairment in glossopharyngeal,vagus and hypoglossa l nerves.Two patients developed local recurrence during the long-term follow-up.Conclusion.Complete surgical excision was possible in each patient if th e diagnosis had been cor-rectly made through selective preoperative angiography ,vessel ultrasound Doppler and other examinations.Reasonable surgical procedur e and Matas training were necessary to the successful surgical treatment and t hus decrease the complicative incidence rate of carotid chemodectomas.

Anaesthetic Management and Challenges for Carotid Body Tumour Excision in a Young Nigerian: A Case Report and Review of Literature

Background: Carotid body tumours (CBTs) are rare tumours that arise from chemoreceptor cells at the bifurcation of carotid artery. Excision of CBT poses several anesthetic challenges and may be complicated with marked intraoperative hemodynamic instability and turbulent postoperative recovery. Attention to details and a meticulous anesthetic plan are essential for successful anesthetic management. Aim: To present anaesthetic management and challenges for carotid body tumour excision in a young Nigerian. Case Presentation: A 26-year-old man presented with left sided slow growing neck tumour. The tumour was completely excised with no anaesthetic or surgical complication. Histology and immunohistochemistry of the excised tumour confirmed paraganglioma. He was discharged fifteenth post-operative day. Conclusion: General anesthesia is the preferred technique. The basic elements of anesthetic management are protection of hemodynamic stability and maintenance of cerebral perfusion pressure (CPP).

DSA Diagnosis of Carotid Body Tumor

Objective: To make a further understanding of the DSA features of the carotid body tumor (CBT) and to explore the clinical value of DSA diagnosis and interventional treatment for CBT. Methods: Twelve cases of CBT with DSA data were analyzed retrospectively. The DSA appearances in all of the patients were observed dynamically in a double blind manner by two experienced radiologists together and a consensus interpretation formed. Results: DSA could establish definitive diagnosis in all cases. The DSA features of the CBT were: the increase of bifurcation angles of internal and external carotid arteries in all cases; the CBT supplied by external carotid arteries in most cases and the significant increase of tumor vessels in bifurcation; invasion of internal or external carotid arteries in 6 cases. The tumor staining disappeared mostly after the supplying arteris were embolized in 2 cases, and the bleeding during the operation reduced significantly. Conclusion: The DSA is useful in the diagnosis of the CBT and for therapeutic planning. The pre-operation embolization of the CBT contributes to reduce the bleeding during operation.

Experimental Study on Heterograft of Glomus Cells of Carotid Body for Hemiparkinsonian Rats

Summary: To observe the effects of heterograft of glomus cells of carotid body on hemiparkinsonian rat models, rats with unilateral 6-hydroxydopamine (6-OHDA)-induced lesions of the right dopaminergic neurons of substantia nigra received intrastriatal glomus cells heterograft. Apomorphine-induced rotation was monitored for 30 min at various time points after grafting. The striata were cut and examined for dopamine content by HPLC and for immunohistochemical staining of tyrosine hydroxylase positive neurons (TH +) at the end of the experiments. The results showed that apomorphine-induced rotational behavior was significantly reduced for 12 weeks and the dopamine contents were significantly elevated after grafting (P<0.01), and TH + cells survived better. The present study demonstrates that intrastriatal heterograft of glomus cells within carotid body in rats with 6-OHDA-elicited lesions could reduce apomorphine-induced rotational behavior and elevate the dopamine contents and numbers of TH + cell surviving within striatum, and can serve as a new and effective alternative for Parkinson disease.

Large carotid body tumor successfully resected in hybrid operating theatre: A case report

BACKGROUND Surgical treatment for large carotid body tumor (CBT),particularly the Shamblin III type,is challenging and rarely reported.CASE SUMMARY In July 2014,a 63-year-old woman presented to our hospital with a large CBT (130 mm × 60 mm × 70 mm).The lesion was hypervascular,spanned from the first to the seventh cervical vertebra,and adhered to the right common carotid artery (CCA),internal carotid artery (ICA) and external carotid artery (ECA).The resection was carried out in a hybrid operating theatre.First,we used Onyx gel to embolize the feeding artery.An ICA balloon was used to prevent gel entry into the ICA.After shrinkage and hardening of the CBT,we quickly resected the CBT as well as a part of the ECA that adhered to the CBT.A vascular shunt was inserted between CCA and ICA,and the part where the ICA was cut off from the CCA was directly sutured.A follow-up at four years later showed no neurological damage.CONCLUSION For large hypervascular CBT,embolization of the feeding artery prior to resection is helpful.The hybrid operating theatre is the ideal platform to carry out such operations.

Diagnosis of carotid body tumor by digital subtraction angiography

Objective: To make a further understanding of the features of the carotid body tumor (CBT) by digital subtraction angiography (DSA) so as to explore the clinical value of DSA diagnosis and interventional therapy for CBT. Methods: DSA data from 12 cases of CBT were analyzed retrospectively. A consensus interpretation of the DSA appearances in all of the patients was reached after dynamic observation by 2 experienced radiologists in a double blind manner. Results: Definite diagnosis in all cases could be made by DSA. The DSA features of the CBT included bigger bifurcation angles of the internal and external carotid arteries, displacement of internal and external carotid arteries, CBT supplied by external carotid arteries in most cases and the significant increase of tumor blood vessels in bifurcation. Invasion of internal or external carotid arteries was found in 6 cases. Smaller stained area of the tumor and significantly reduced intraoperative bleeding were found after embolization of the supplying arteria in 2 cases. Conclusion: DSA is the effective method for the diagnosis and preoperative assessment of CBT. Preoperative embolization of CBT may contribute to the reduced intraoperative bleeding.

Postoperative secondary aggravation of obstructive sleep apneahypopnea syndrome and hypoxemia with bilateral carotid body tumor:A case report

BACKGROUND Carotid body tumor(CBT)is a chemoreceptor tumor located in the carotid body,accounting for approximately 0.22%of head and neck tumors.Surgery is the main treatment method for the disease.CASE SUMMARY We reviewed the diagnosis and treatment of one patient who had postoperative secondary aggravation of obstructive sleep apnea–hypopnea syndrome(OSAHS)and hypoxia after surgical resection of bilateral CBTs.This patient was admitted,and relevant laboratory and imaging examinations,and polysomnography(PSG)were performed.After the definitive diagnosis,continuous positive airway pressure(CPAP)treatment was given,which achieved good efficacy.CONCLUSION This case suggested that aggravation of OSAHS and hypoxemia is possibly caused by the postoperative complications after bilateral CBTs,and diagnosis by PSG and CPAP treatment are helpful for this patient.

Eight cases of carotid body tumor diagnosed by Bmode ultrasonic imaging

This paper reports that 8 patients with carotid body tumors were diag-nosed by B-mode ultrasonic imaging.Among them,only 3 were originally clinicallydiagnosed as having the disease.The features of carotid body tumors in the 8cases,seen by B-mode ultrasonogram,are described.It is considered thatultrasonography of carotid body tumors is specific,trauma-free,accurate andsimple,and it may be an important method in identifying and diagnosing the dis-ease.

Respiratory neuroplasticity following carotid body denervation Central and peripheral adaptations

Historically, the role of the carotid bodies in ventilatory control has been understated, but the current view suggests that the carotid bodies （1） provide a tonic, facilitory input to the respiratory network, （2） serve as the major site of peripheral 02 chemoreception and minor contributor to CO2/H＋ chemoreception, and （3） are required for ventilatory adaptation to high altitude. Each of these roles has been demonstrated in studies of ventilation in mammals after carotid body denervation. Following carotid body denervation, many of the compromised ventilatory ＂functions＂ show a time-dependent recovery plasticity that varies in the degree of recovery and time required for recovery. Respiratory plasticity following carotid body denervation is also dependent on species, with contributions from peripheral and central sites/mechanisms driving the respiratory plasticity. The purpose of this review is to provide a summary of the data pointing to peripheral and central mechanisms of plasticity following carotid body denervation. We speculate that after carotid body denervation there are altered excitatory and/or inhibitory neuromodulator mechanisms that contribute to the initial respiratory depression and the subsequent respiratory plasticity, and further suggest that the continued exploration of central effects of carotid body denervation might provide useful information regarding the capacity of the respiratory network for plasticity following neurologic injury in humans.

Dynamic Expression of bFGF and TGFβ2 in Glomus Cell Grafts of Carotid Body in Rat Model of Parkinson Disease

To investigate the changes in the expression of basic fibroblast growth factor (bFGF) and transforming growth factor beta 2 (TGFβ2) in glomus cell grafts of carotid body in the rat model of 6 hydroxydopamine induced Parkinson disease, immunohistochemical staining of bFGF and TGFβ2 in the sections of striate body was done on the 2nd, 4th and 12th week after transplantation. The results showed that on the 2nd week after transplantation, bFGF annd TGFβ2 were not detectable in the glumous cell grafts. On the 4th week after graft, bFGF and TGFβ2 immunoreactivity was increased within the grafts and at the graft host interface but was restricted only to astrocytes. In the striatum surrounding the graft, bFGF was expressed persistently, while TGFβ2 showed transient expression. It was suggested that the transient expression of TGFβ2 was likely due more to the trauma imposed by the graft procedure than to an intrinsic. The deficiency in astrocytic bFGF early after graft may be responsible for the poor survival of grafted glomus cells of carotid body.

Carotid Body Tumours: A Review

The carotid body is a small structure weighing 12 mg located in the adventitia of carotid artery bifurcation acting as a chemoreceptor. Carotid body tumour (CBT);formerly known as chemodectoma is a rare, highly vascular, mostly benign tumour arising from the paraganglia of carotid body;hence, the name (carotid paraganglioma). The high vascularity and proximity to cranial nerves and major vessels make this tumour a surgical challenge. Abundant literature has been written about CBT in the last century with a continuous debate regarding its etiology, natural history, biological behavior, proper technique of excision, and the morbidity and mortality associated with its resection. The purpose of this review article is to simplify understanding the basic and clinical aspects of this challenging neoplasm.

Immunohistochemical Localization of Some Neurotrophic Factors and Their Receptors in the Rat Carotid Body

The carotid body (CB) is a small neural crest-derived organ that registers oxygen and glucose levels in blood and regulates ventilation. The most abundant cell type in the CB glomeruli is glomus or type I cells, which is enveloped by processes of sustentacular or type II cells. Growth and neurotrophic factors have been established as signaling molecules played an important role in the development of the CB. To gain insight whether these signaling molecules are present in the adult rat CB, we examined the expression and cellular localization of some neurotrophic factors and their corresponding receptors in this organ by immunohistochemistry. The results showed the presence of nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), glial cell line-derived neurotrophic factor (GDNF) as well as p75NTR, tyrosine kinase A receptor (TrkA), tyrosine kinase B receptor (TrkB) and GDNF family receptor alpha1 (GFRα1) in the adult CB. At the light-microscopical level, the immunoreactivity for NGF and both its low-affinity (p75) and high-affinity (TrkA) receptors was detected in the majority of glomus cells and also in a subset of sustentacular cells. BDNF and its receptors, p75 and TrkB, were observed in the glomus cells, too. Remarkably, the immunohistochemical analysis revealed that the neuron-like glomus cells, but not the glial-like sustentacular cells, expressed GDNF and GFRα1. Taken together with prior results, it can be inferred that neurotrophins may be involved in the CB cell differentiation and survival in adulthood, and may exert a potent glomic protective action as well. It is also presumable that GDNF production by glomus cells plays a pivotal role in permitting long-term viability of CB grafts, which permits their potential applicability in cell therapy as a promising tool in neurodegenerative disorders.

Carotid Body Tumour: The Second Case Series from Baghdad, Iraq

Background: Carotid body tumour (CBT) is a rare neoplasm, yet it is the commonest head and neck paraganglioma. In Iraq, relevant literature is sparse. Herein, we present our second case series. Methodology: Patients with CBTs that were operated upon in the Department of Thoracic and Vascular Surgery, Baghdad Medical City from 2010 to 2014 were enrolled. History and examination were followed by a workup of duplex ultrasonography, CT scan, magnetic resonance imaging, CT or conventional carotid angiography. Surgical exploration via a standard anterolateral cervical incision and subadventitial dissection was used to resect the tumours with preservation of carotid arteries. Intra-luminal carotid shunts and vein grafts were prepared to be used if necessary. Results: There were 5 males and 2 females aging 17 - 46 with a mean of 32.9 ± 9.8 year. All patients had slowly growing painless pulsatile swelling below mandiblular angle for long durations (1 - 25 years) and a positive Fontaine’s sign. All tumours were benign, unilateral (right n = 4, left n = 3) and ranging in size from 3 × 3 cm to 6.4 × 3.2 cm. Beside US neck exam, carotid angiography was done in 5 patients. According to Shamblin classification, 4 were class II, 2 class I and 1 class III. All tumours were successfully resected with preservation of ICA. However, the ECA was safely ligated twice due to severe involvement. Tongue deviation occurred once (14.3%) but no patient died and none had stroke or recurrence. Conclusions: Our results of surgery for CBT compare very well with the international standards.

颈动脉内膜剥脱术后体重指数与早期预后的关系

目的针对肥胖与颈动脉内膜剥脱术(CEA)不良结局相关性的现有结果不一致,本研究旨在探讨体重指数升高与颈动脉内膜剥脱术后30 d并发症的相关性。方法这项队列研究包括2012-2022年邯郸市第一医院和邢台市人民医院收治的398例CEA患者。其中体重指数正常者(18.5-24.9 kg/m^(2))138例,超重者(25.0-29.9 kg/m^(2))188例,肥胖者(≥30 kg/m^(2))72例。采用Logistic回归分析评估超重和肥胖与CEA早期结局的相关性。结果CEA围手术期(30 d)内所有患者术后发生心肌梗死1例(0.25%)、卒中和短暂性脑缺血发作(TIA)12例(3.0%),术后死亡2例(0.5%)。在其他并发症中,出血10例(2.5%),呼吸道术后并发症2例(0.5%),泌尿系并发症2例(0.5%),心脏并发症3例(0.75%),颅神经损伤4例(1.0%),13例(3.3%)患者需再次手术。围手术期(30 d)的结果在各组之间没有显著差异。与正常体重的患者相比,超重患者的出血频率显著减少(P<0.05)。结论超重和肥胖与死亡率增加、TIA、卒中、心肌梗死或轻微并发症以及CEA后再次手术无明显相关性。而出血却相反,与正常体重的患者相比,超重患者CEA后术区出血的发生率明显减少。

体检人群中超重和肥胖对基底动脉、颈内动脉和椎动脉功能的影响

目的探讨健康体检人群中,体质量指数(BMI)与颅内动脉(基底动脉、颈内动脉和椎动脉)功能的相关性。方法回顾性选取2023年6至8月健康体检者共1169例。收集一般资料、实验室指标以及经颅多普勒数据。依据BMI分为3组:正常组(<24 kg/m^(2))546例、超重组(24~<28 kg/m^(2))484例和肥胖组(≥28 kg/m^(2))139例。比较3组临床特征、实验室指标、颅内动脉血流速度情况。分析BMI与颅内动脉血流速度的相关性,利用多元线性回归及限制性立方条分析BMI与颅内动脉血流速度的关系,并确定颅内动脉血流速度减慢风险增加的临界值。结果与正常组相比,肥胖组和超重组颅内动脉收缩期血流速度、舒张期血流速度和平均血流速度均较低(P<0.05)。多元线性回归分析显示,BMI与颅内动脉收缩期血流速度、舒张期血流速度及平均血流速度呈负相关(P<0.01),与血管搏动指数、阻力指数无相关性(P>0.05)。限制性立方条结果显示,基底动脉和双侧椎动脉血流速度与BMI之间呈线性相关(P>0.05),双侧颈内动脉血流速度与BMI之间呈非线性相关(P<0.05)。结论健康体检人群中BMI与颅内动脉血流速度呈负相关,当BMI超过特定值(24.18~24.26 kg/m^(2))时,颅内动脉血流速度减慢的风险增加。

黄河玛尔挡水电站库区Qd04倾倒体稳定性评价及涌浪分析

玛尔挡水电站库区发育的Qd04倾倒体距离上游抽水蓄能电站下水库进水口较近,考虑到该倾倒体潜在失稳体积较大,宏观稳定性较差,水库蓄水后可能沿软弱面或折断面发生失稳,准确评价其稳定性及涌浪风险至关重要。为了准确评价该倾倒体稳定性,分析涌浪情况,采用M-P(Morgenstern-Price)法进行稳定性分析,并采用常用的3种滑速计算方法与3种涌浪计算方法9种组合进行涌浪计算,使用数值模拟法对涌浪值进行验证。结果表明:结合新滩滑坡实测的涌浪数据,得出使用经验公式法时采用能量守恒法计算滑速和潘家铮法计算涌浪高度的组合计算成果更贴近实测值,即在死水位、正常蓄水位时倾倒体整体失稳产生涌浪至上游抽蓄电站的涌浪高度分别为11.3、11.5 m。研究成果可为玛尔挡水电站库区相关工程的风险预测提供借鉴。

兼顾调节特性和经济成本的调压室体型优化策略

过渡过程动态特性和调压室建设成本是调压室体型设计中需要关注的两个主要方面。如何选取调压室体型参数使两者均达到最优对水电站建设和运行具有重要意义。针对这一问题,基于第三代非支配排序遗传算法(NSGA-Ⅲ)和优劣解距离评价方法(TOPSIS),提出了一种兼顾大小波动调节特性和工程投资最优的调压室体型优化策略。首先,基于特征线法,建立水力发电系统精细化模型。其次,以调压室断面直径、阻抗孔直径和安装位置为决策变量,分别建立以大波动动态特性(机组最大水头+机组转速最大上升率)与调压室体积为目标的大波动优化模型和以转速超调量与ITAE为目标的小波动优化模型,并引入NSGA-Ⅲ算法,得到调压室在两种优化模型下的Pareto解集。最后,基于TOPSIS评价方法,以上述4个优化目标为决策层,对Pareto解集进一步评价,得到兼顾大小波动调节特性和经济性最优的调压室体型。结果表明,与得分最低的方案相比,最优方案在牺牲较小调压室经济性的前提下,能够有效改善大小波动综合调节特性,实现平衡调压室建设成本和大小波动综合调节特性的目标。研究结果对水电站调压室结构设计具有重要指导意义。

司美格鲁肽联合常规方案治疗2型糖尿病并颈动脉粥样硬化临床研究

目的探讨司美格鲁肽联合常规方案治疗2型糖尿病(T2DM)并颈动脉粥样硬化的临床疗效。方法选取医院2021年10月至2022年8月收治的T2DM并颈动脉粥样硬化患者68例,随机分为对照组和观察组,各34例。两组患者均予常规治疗方案(口服降糖药及阿托伐他汀钙片),观察组患者加予司美格鲁肽注射液皮下注射。两组均连续治疗6个月。结果治疗后,观察组患者的体质量,体质量指数,血糖指标[空腹血糖、餐后2 h血糖、糖化血红蛋白]水平,血脂指标[总胆固醇、甘油三酯、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)]水平,颈动脉内膜中层厚度及斑块切面最大面积(S_(max))均显著改善(P<0.05),且除LDL-C和HDL-C水平及S_(max)与对照组相当(P>0.05)外,其余指标改善程度均显著优于对照组(P<0.05)。观察组与对照组的不良反应发生率相当(14.71%比20.59%,P>0.05)。结论司美格鲁肽联合常规方案治疗T2DM并颈动脉粥样硬化,能有效控制患者的体质量(指数)及血糖、血脂水平,并对颈动脉斑块有一定改善作用。

肥胖型高血压患者颈动脉体化学感受器敏感性与血压控制的相关性研究

目的探讨肥胖型高血压患者颈动脉体化学感受器敏感性(CBRS)与血压控制的相关性。方法选取2022年1月至2023年12月收治的202例肥胖型高血压患者作为观察组,另选取同期肥胖血压正常患者101例作为对照组,同期健康志愿者101例作为正常组。比较3组CBRS、体质量指数(BMI)、血压。观察组均按指南给予相关治疗3个月,根据血压控制情况分为控制良好亚组(n=148)与控制不良亚组(n=54),对比两亚组临床特征、CBRS,分析CBRS与BMI、收缩压、舒张压的相关性,评价CBRS、BMI、收缩压、舒张压对血压控制的预测价值及CBRS对血压控制的影响。结果观察组CBRS低于对照组、正常组,对照组CBRS低于正常组(P<0.05);观察组及对照组BMI高于正常组,观察组收缩压、舒张压高于对照组及正常组(P<0.05);控制不良亚组BMI、收缩压、舒张压高于控制良好亚组,CBRS低于控制良好亚组(P<0.05,P<0.01);CBRS与BMI、收缩压、舒张压呈负相关(r=-0.672、-0.710、-0.695,P<0.05)。CBRS、BMI、收缩压、舒张压联合预测血压控制的曲线下面积大于各指标单独预测(P<0.05)。以最佳截断值为界将CBRS分为低值与高值,CBRS低值的肥胖型高血压患者血压控制不良风险是CBRS高值的肥胖型高血压患者7.143倍。结论肥胖型高血压患者CBRS与BMI、收缩压、舒张压及血压控制不良风险密切相关,可作为预测血压控制情况的重要指标。