Subjective and objective evaluation of swallowing in lateral decubitus positions examined in healthy volunteers.

BACKGROUND: Dysphagia can result from shock, trauma, aging, head and neck neoplasms, and some cerebrovascular diseases or neuromotor degenerative disorders. Swallowing rehabilitation therapy combined with postural control of the neck, head, and body can be effective for patients with dysphagia. Though the lateral decubitus posture has been a favorable option for swallowing rehabilitation therapy, available clinical data pertaining to it are scarce. METHODS: Twenty-seven healthy volunteers were enrolled in this study. The subjects underwent a repetitive saliva swallowing test, food swallowing test, and water swallowing test. The trials were performed in four different positions: upright sitting position, lateral decubitus position with the head raised to 60°, lateral decubitus position with the head raised to 30°, and complete lateral decubitus position. After each trial, the subjects were asked to declare the swallowing difficulty utilizing a visual analogue scale. Swallowing time and swallowing sound level were recorded simultaneously, as objective evaluation in each trial. We analyzed the visual analogue scale scores, swallowing time, and swallowing sound levels for all the four positions. RESULTS: The results of the visual analogue scale of the water swallowing test in the sitting position were significantly lower than those of the complete lateral decubitus position (p < 0.01). However, statistical significance was not detected in swallowing time or the swallowing sound level among the four different positions. Although subjective discomfort in swallowing was identified, difficulty of swallowing was not objectively evident in the trials, irrespective of the position. CONCLUSIONS: A complete lateral decubitus position can be an effective and safe position in swallowing.

Pathogenic mechanisms of intestinal pneumatosis and portal venous gas: should patients with these conditions be operated immediately?

We aimed to histologically observe portal venous gas (PVG)-causing intestinal pneumatosis (IP) and evaluate pathogenic mechanisms and therapeutic strategies, including decisions on whether emergency surgery should be performed. Autopsy was performed in two cases of nonocclusive mesenteric ischemia (NOMI). We directly histologically observed the pathogenic mechanisms of IP caused by gas-producing bacteria and IP considered to be caused by mechanical damage to the intestinal mucosa. IP can be classified hypothetically into the following types according to pathogenesis: (1) infection, (2) rupture (damage) of the intestinal mucosa + increased intestinal intraluminal pressure, and (3) mixed type. In cases of IP caused by gas-producing bacteria or IP associated with intestinal wall damage extending beyond the mucosa to the deep muscular layer, emergency surgery should be considered. However, it is highly possible that patients who test negative for infection with gas-producing bacteria whose intestinal wall damage remains only in the mucosa can be conservatively treated.

[Remarkable tumor response to cisplatin plus gemcitabine therapy in a patient with recurrent gallbladder cancer - a case report].

We report a case of recurrent gallbladder cancer in which the patient's tumor showed a remarkable response to gemcitabine( GEM)plus cisplatin(CDDP)therapy. In January 2007, the patient underwent curative resection for gallbladder cancer (T2N1M0, Stage III), and tegafur/uracil was administered for a year as adjuvant chemotherapy. In September 2009, elevated serum CA19-9 levels were observed, and para-aortic lymph node swelling was seen on CT scans. In addition to the indications reported by Valle et al, CDDP plus GEM therapy was initiated. After the first 2 courses of therapy, the para-aortic lymph nodes markedly decreased in size, and the serum CA19-9 levels normalized. Grade 4 neutropenia and grade 3 thrombocytopenia were observed after 3 courses of therapy. We decreased the drug doses because toxicities were observed. We hesitated to discontinue therapy because the indications for discontinuing chemotherapy while the patient showed a good response were not known. Finally, we discontinued therapy after 28 courses because recovery from the resultant toxicities became difficult in spite of decreasing the drug doses(CDDP 25 mg/body, GEM 600 mg/body), and because a good response to therapy was confirmed by CT. The patient is alive and has been disease-free for more than 2 years.

Gastric leiomyosarcoma manifesting peculiar findings: radiological-pathological correlation.

Reported herein is a gastric leiomyosarcoma, which, nowadays, is extremely rare. Attention was focused not only on pathological findings but also on the histological basis of magnetic resonance imaging (MRI) findings. The patient was a 29-year-old Japanese woman. Preoperative T2-weighted MRI showed a large high-intensity gastric tumor with isointense streaks. The tumor was a broad-based large polypoid lesion and histologically consisted of fascicles of spindled cells having eosinophilic cytoplasm and cigar-shaped nuclei. Immunoreactivity for several smooth muscle markers including desmin on tumor cells, low amplification of both c-kit and PDGFRA cDNA on polymerase chain reaction, and absence of c-kit gene mutation in exons 9 and 11 strongly suggested that the tumor was not a gastrointestinal stromal tumor but a true leiomyosarcoma. In vitro MRI of the fresh tumor was obtained to explain the radiological findings on a morphological basis. In vitro MRI clearly depicted the very high-intensity areas separated by radially extended isointense lines. This radiological finding corresponded best to the most characteristic histological feature, that is, linearly extended fascicles of the tumor cells often with myxedematous change separated by radially elongated thin fibrovascular stroma: in other words, spouting appearance.