Improvement of dysphagia following cricopharyngeal myotomy in a group of elderly patients. Histochemical and biochemical assessment of the cricopharyngeal muscle.

Cricopharyngeal myotomy is not effective in all cases of dysphagia. However, it should be the specific treatment in cases of dysphagia caused by a primary cricopharyngeal muscle dysfunction. Of a group of 10 patients with swallowing disorders in the absence of any defined cause, 7 (mean age, 81.6 years) were improved by a myotomy and 3 were not. The cricopharyngeal muscle was studied histologically and biochemically and compared to muscle obtained from nondysphagic subjects. In the muscle of the 7 improved patients, homogeneous histologic abnormalities were demonstrated: connective tissue infiltration, inflammatory cell infiltration, and degenerative changes of the muscle fibers. Conversely, muscles of the nonimproved patients and of the controls did not present the same degree of histologic lesions.

Histological assessment of gestational age in human embryos and fetuses.

A light microscopic study performed on 760 human fetuses allows us to define several stages in their visceral development and to relate these to gestational age. The histological examination of most viscera, such as the central nervous system, is useless when the tissue preservation is poor. Nevertheless, three organs may still be studied in macerated fetuses: the lungs (where different glandular, canalar, and alveolar stages of development are evident), the kidneys (where the respective numbers of rows of primitive glomeruli and of generations of mature glomeruli vary after week 22), and the adrenal glands (where neuroblastic nests are normally found between weeks 7 and 26 of gestation). It is important to compare the degree of histological maturation with the clinical, macroscopic, and radiologic data in order to define the profile of maturation proper to each human fetus.