Clinical and Cellular Evidence of Glycyrrhiza glabra and Platycodon grandiflorus for Vocal Fold Nodules Complementary Treatment.

Vocal fold nodules (VFNs) are the most frequent cause of hoarseness. The management comprised medical, surgical and physical therapy but the effectiveness is not always satisfactory. In this study, we try to figure out an alternative treatment from our clinical experience summary. We retrospectively reviewed VFNs patients who received traditional Chinese medicine (TCM) treatments from July 2018 to August 2020 and traced their Chinese Voice Handicap Index-10 (VHI-C10) and multidimensional voice program (MDVP) analysis results. For further evaluation, we conducted an inflammatory response of porcine vocal fold epithelial (PVFE) cells with 50 ng/mL TNF-alpha. The inflamed PVFE cells were separately cultured in the aqueous extract of Glycyrrhiza glabra (G. glabra) and Platycodon grandifloras (P. grandifloras). In these VFNs patients (n = 22), the average VHI-C10 score decreased from 17.6 to 6.6 (p < 0.001). MDVP analysis revealed improvements in jitter, shimmer, noise-harmonic ratio, and GRBAS scoring system. Of the TCM prescription patterns, G. glabra and P. grandiflorus were used most frequently. In the MTT assay of PVFE cells, no adverse effects of our extracts were observed at doses of 1-200 µg/mL. Western blot analysis revealed downregulation of p65 and mitogen activated protein kinase pathway proteins. The results from both the clinical and in vitro aspects of this study revealed that the herbs G. glabra and P. grandiflorus may offer beneficial outcomes as alternative treatments for VFNs after precise diagnosis.

A case of vocal polyps improved with herbal medicine: A case report.

Vocal polyps are benign vocal cord lesions, which mainly manifest as a hoarse voice. Laryngeal microsurgery is the most common treatment. However, because of anxiety regarding invasive treatment, it is necessary to have a non-invasive treatment option. A 43 year old female patient who is a teacher visited a Korean medical hospital for persistent hoarseness with a vocal polyp. After taking herbal medicine for hoarseness (Kyung-Hee-cheong-um-whan) and pharyngitis (cheong-in-li-gyok-tang and cheong-in-ryu-que-whan) for almost 10 weeks, the vocal polyp was reduced and symptoms improved. Herbal prescription for pharyngitis and hoarseness can be applied to vocal polyps as non-invasive treatment.

Outcomes of Gallbladder Polyps and Their Association With Gallbladder Cancer in a 20-Year Cohort.

Importance: Gallbladder polyps (GP) are found in more than 4% of adult abdominal ultrasonographs. Their growth pattern and association with gallbladder cancer (GBC) are poorly defined. Objective: To determine the growth pattern of GPs and their association with GBC. Design, Setting, and Participants: This cohort study included 622 227 adult members (ie, aged 18 years or older) of Kaiser Permanente Northern California, an integrated health care delivery system, enrolled between January 1, 1995, and December 31, 2014. The GBC cohort comprised a total of 365 adults with GBC and prior ultrasonography, and the GP cohort comprised 35 970 adults with GPs present on ultrasonography. Data analysis was performed from March 2016 to November 2019. Exposures: Gallbladder polyps (quantitative size, <6 mm, 6 to <10 mm, and ≥10 mm or qualitative size [ie, tiny, small, moderate, and large]). Main Outcomes and Measures: For the GBC cohort, proportion of patients with GBC with polyps identified on preceding ultrasonograph. For the GP cohort, rates of GBC among those with polyps according to size and rate of GP growth of at least 2 mm over time. Results: The GBC cohort comprised 365 individuals (267 [73.1%] women; 173 [47.4%] white patients; median [interquartile range] age, 71 [61-79] years). After excluding 14 patients who did not have evaluation of polyp size, the final GP cohort comprised 35 856 adults, with 18 645 (52.0%) women, a median (interquartile range) age 50 (40-60) years, and 15 573 (43.3%) white patients. Gallbladder polyps were found in 22 patients (6.0%) in the GBC cohort and in 35 870 of 622 227 adults (5.8%) who underwent abdominal ultrasonography. Of these, 19 (0.053%) were diagnosed with GBC, similar to those without GP (316 of 586 357 [0.054%]). The unadjusted GBC rate per 100 000 person-years was 11.3 (95% CI, 6.2-16.3) overall and increased with polyp size, from 1.3 (95% CI, 0-4.0) with initial size of less than 6 mm (n = 17 531) to 128.2 (95% CI, 39.4-217.0) with initial size of 10 mm or larger (n = 2055). In those observed for at least 1 year, the rate was 3.6 (95% CI, 0.7-6.5) per 100 000 person-years. In 6359 patients with evaluable follow-up, unadjusted cumulative probabilities of polyp growth of at least 2 mm at 10 years were 66.2% (95% CI, 62.3%-70.0%) in polyps initially less than 6 mm and 52.9% (95% CI, 47.1%-59.0%) in polyps initially 6 mm to less than 10 mm. Conclusions and Relevance: In this study, GBC rates were low and similar among patients with and without GPs. Growth of 2 mm or more appeared to be part of GP natural history. The results call into question the strategy of proactively following GP to detect GBC.

Histological examination of the gallbladder following routine cholecystectomy? A selective analysis is justified.

BACKGROUND: It was hitherto common practice to analyse each removed gallbladder for the presence of gall bladder cancer (GBC) although this approach may be questioned. The aim of this study was to determine whether a policy of selective histopathological analysis (Sel-HPA) is oncologically safe and cost effective. METHODS: This retrospective study was conducted in a single Dutch teaching hospital. Immediately following cholecystectomy, the surgeon decided on the basis of inspection and palpation whether histological examination was indicated. The Dutch Comprehensive Cancer Organisation (IKNL) registry was used to identify the number of GBC during this time period. RESULTS: Of 2271 patients who underwent a cholecystectomy in our institution between January 2012 and December 2017, 1083 (47.7%) were deemed indicated for histopathological analysis. Sixteen pathological gallbladders (1.5%) were identified in that period (intestinal metaplasia, n = 3; low grade dysplasia n = 7; carcinoma n = 6). During follow-up, no patient was found to have GBC recurrence in the population whose gallbladder was not sent for pathology (52.3%, n = 1188, median 49 months of follow up). The percentage of gallbladders that were analysed decreased over the six years of observation from 83% to 38%. Our policy of Sel-HP saved over €65 000. CONCLUSIONS: A policy of selective histopathology after cholecystectomy is oncologically safe and reduces costs.

Celecoxib use and circulating oxylipins in a colon polyp prevention trial.

Drugs that inhibit cyclooxygenase (COX)-2 and the metabolism of arachidonic acid (ARA) to prostaglandin E2 are potent anti-inflammatory agents used widely in the treatment of joint and muscle pain. Despite their benefits, daily use of these drugs has been associated with hypertension, cardiovascular and gastrointestinal toxicities. It is now recognized that ARA is metabolized to a number of bioactive oxygenated lipids (oxylipins) by cyclooxygenase (COX), lipoxygenase (LOX), and cytochrome P450 (CYP450) enzymes. Currently, the contribution of individual variability in ARA metabolism in response to the COX-2 inhibitors and potential adverse effects remains poorly understood. Using patient samples from the randomized, placebo-controlled phase III selenium/celecoxib (Sel/Cel) trial for the prevention of colorectal adenomatous polyps, we analyzed plasma concentrations of 74 oxylipins in a subset of participants who received celecoxib (n = 90) or placebo (n = 95). We assessed the effect of celecoxib (with and without low dose aspirin) on circulating oxylipins and systolic blood pressure (SBP). Individual CYP450- and LOX- but not COX-derived metabolites were higher with celecoxib than placebo (P<0.05) and differences were greater among non-aspirin users. LOX derived 5- and 8-HETE were elevated with celecoxib and positively associated with systolic blood pressure (P = 0.011 and P = 0.019 respectively). 20-HETE, a prohypertensive androgen-sensitive CYP450 metabolite was higher with celecoxib absent aspirin and was positively associated with SBP in men (P = 0.040) but not women. Independent of celecoxib or aspirin, LOX derived metabolites from ARA were strongly associated with SBP including 5- and 8-HETE. These findings support oxylipins, particularly the ARA LOX-derived, in blood pressure control and indicate that pharmacologic inhibition of COX-2 has effects on LOX and CYP450 ARA metabolism that contribute to hypertension in some patients.

[Jinsangsanjie capsule for treating vocal fold polyps and vocal nodules].

OBJECTIVE: To investigate therapeutic effects of Jinsangsanjie capsule on vocal fold polyps and vocal nodules. METHOD: Seventy-five patients with vocal fold polyps and vocal nodules were treated by taking Jinsangsanjie capsule orally. After the therapeutic course, they were all followed up for 1 month. RESULT: The effective rate of vocal nodule group was 93.8%, the effective rate of vocal fold polyp group was 89.7%, the effective rate of vocal nodule with acute congestion group was 100%, the effective rate of vocal fold polyp with acute congestion group was 100%, and the effective rate of hypertrophy of vocal cords with chronic congestion group was 66.7%. CONCLUSION: Jinsangsanjie capsule has definite efficacy for treatment of vocal fold polyps and vocal nodules and deserved to be recommended.

[Uterine abnormalities in non menopausal women who received tamoxifen for breast cancer adjuvant therapy]. / Anomalies utérines chez la femme non ménopausée sous tamoxifène en traitement adjuvant du cancer du sein.

OBJECTIVE: To elaborate a strategy of endometrial follow-up for premenopausal women treated with Tamoxifen as adjuvant hormonal treatment of breast cancer. PATIENTS AND METHODS: Retrospective study of 152 premenopausal patients treated with Tamoxifen in Nantes Comprehensive Cancer Center for a breast cancer from January 2003 to December 2005. Vaginal sonography was used in the follow-up of 70 of them. RESULTS: Endometrial hypertrophy was found in 26 patients. Sonohysterography and hysteroscopy allowed to find 11 polyps and three hyperplasias in the 19 women who were investigated. In our study, endometrial pathology was found in 20% of premenopausal women treated with Tamoxifen (polyps or hyperplasia). Uterine bleeding was found in half patient of this group. DISCUSSION AND CONCLUSION: Vaginal sonography monitoring could be proposed to premenopausal women treated with Tamoxifen among whom endometrial pathology is usual.

Hyperplastic polyps of the gastric antrum in patients with gastrointestinal blood loss.

The significance of hyperplastic polyps of the gastric antrum in anemic patients with suspected gastrointestinal bleeding has not been determined. The aim of this study is to evaluate the prevalence and prognosis of such polyps in this patient group. Clinical records of patients referred to our endoscopy lab from November 1999 to February 2003 for the evaluation of iron deficiency anemia or suspected gastrointestinal bleeding were reviewed. There were 987 patients. Fourteen patients (1.4%) had hyperplastic polyps in the gastric antrum. Five of the patients reported melena, but the rest were asymptomatic. Multiple antral polyps were present in seven cases. The largest polyp measured 5.0 cm. Helicobacter pylori infection was present in one patient. All patients were anemic and nine had documented iron deficiency. No follow-up information was available in four patients. Hyperplastic polyps of the gastric antrum are a rare but significant cause of gastrointestinal blood loss in older patients. Removal of the polyps using endoscopic or surgical methods may be required for resolution of the blood loss along with iron supplementation. Gastroenterologists should be aware that hyperplastic polyps of the gastric antrum might result in gastrointestinal blood loss and iron deficiency anemia.

[The "intra-cordal polyp": a clinical alternative to recognize?]. / Le polype "intra-cordal" : une variante clinique à reconnaitre?

UNLABELLED: The vocal cord polyp is an inflammatory false tumour of the larynx. It is characterized mainly by the specific existence of fibrinous exsudats organized in loose network or mounds, surrounded by newly formed vascular slits. The epithelium covering the polyp is usually more or less impaired. CLINICAL CASES: The authors report two adult patients among whom the initial presentation in video-stroboscopy was that of an intracordal lesion of a cystic type, however; with unusual characteristics (purplish color, angiomatous aspect). The surgery consisted of a cordotomy, the surface epithelium appearing normal. After dissection, the two lesions seemed to be presenting the typical aspect of fibrinoïd mound of a polyp, observation confirmed by the anatomo-pathological study. In these cases, the resection was finally carried out with no mucous loss. CONCLUSION: The particular etiopathogeny of these lesions is been discussed. The treatment, medical and of rehabilitation could achieve a partial recovery. In the event of surgery, an access to the lesion through a cordotomy and not directly by removal with microcissors is advised.

Selenium, copper, and zinc concentrations in intestinal cancer tissue and in colon and rectum polyps.

The prospective randomized trial was used to determine Se, Zn, and Cu concentrations in intestinal cancer tissue and colorectal polyp. We also determined the relationship among the trace element levels in cancer tissue, the localization of neoplasms, and the stage of their development. The concentrations of these trace elements were examined in cancer tissue of the colorectum in 67 patients and in the colon and rectum polyps in 42 patients using the total-reflection X-ray fluorescence (TRXRF) method. The mean concentration of Se in colorectal cancer was 0.86 microg/g tissue and was statistically higher than in the case of polyps (0.57 microg/g). The mean concentration of Zn in colorectal cancer was higher than in the polyp (14.8 microg/g and 9.84 microg/g, respectively). The determined average concentration of Cu in colorectal cancer was 3.87 microg/g tissue and was a little lower than the level of this metal in the polyp (3.94 microg/g). There was no difference in the levels of these trace elements depending on the location of the neoplasm and the stage of its development. Also, there was no difference between the concentrations of these trace elements in the cancer tissue of malignant and benign tumors after taking into consideration the sex and age of patients. During the examination, we determined significantly higher concentrations of only selenium and zinc in the cancer tissue and not in the polyp. The level of copper was lower in a malignant tumor than in a benign one.

Tiflitis aguda: a propósito de un caso / Acute typhlitis: a case report

Se presenta un caso clínico de un paciente varón de 51 años que ingresó en nuestro hospital por presentar rectorragia. En el enema opaco se apreció una imagen de defecto de repleción en el ciego y en la colonoscopia una masa cecal necrosada que posteriormente expulsó con la defecación, siendo el resultado histopatológico de necrosis. Se decidió realizar una laparotomía exploradora encontrando como hallazgos significativos la inflamación de todo el ciego y del apéndice, así como la escara de implantación del pólipo expulsado y una masa submucosa paraapendicular, por lo cual se continuó la intervención con una hemicolectomía derecha. El diagnóstico de anatomía patológica fue de tiflitis aguda, una rara enfermedad cecal de la cual comentaremos algunos aspectos (AU)

[Ambulatory hysteroscopy in evaluation of postmenopausal bleeding]. / Die ambulante Hysteroskopie in der Abklärung der postmenopausalen Blutung.

INTRODUCTION: Diagnostic hysteroscopy is the most precise procedure to evaluate diseases involving the uterine cavity. There is, however, only limited data concerning the use of hysteroscopy carried out as an outpatient procedure in patients with postmenopausal bleeding. MATERIALS AND METHODS: In this study we report on 360 postmenopausal patients with erratic bleeding, who were referred to our outpatient hysteroscopy clinic. 185 women had frank postmenopausal bleeding (PMB) and another 175 had abnormal uterine bleeding while taking hormone replacement therapy (AUB). The mean age was 57.9 years (range: 42-86). All hysteroscopies were performed using a standard 5-mm hysteroscope with a 30 degrees fore-oblique lens; the uterine cavity was generally distended with normal saline. RESULTS: Outpatient hysteroscopy was performed successfully in 339 patients (94.2%). In 166 cases (46.1%) cervical dilatation was necessary, and 138 required (38.3%) intracervical anaesthesia. Intrauterine pathology was diagnosed in 49.6% of cases, with endometrial polyps (20.9%) and fibroids (15.9%) being the most common abnormalities. While there was no difference in the incidence of intrauterine lesions between patients with AUB and those with PMB, endometrial carcinoma was more common in the latter group (PMB: n = 11 vs. AUB: n = 1; p < 0.002). CONCLUSION: Due to its high accuracy and patient acceptance, outpatient diagnostic hysteroscopy should become a first line investigation in postmenopausal patients with bleeding disorders.

[Study on relationship between nail-fold microcirculation and histopathology of patients with vocal cord polyp and blood stasis syndrome].

Nail-fold microcirculation of 50 vocal cord polyp patients was observed and compared with hoarseness patients without vocal cord polyp. The results showed that peripheral microcirculation was disturbed in the vocal cord polyp patients. Histopathologic observation of 200 vocal cord polyp patients was made. It was found that principal pathologic change concentrated on the lamina propria mucosae of vocal cord and the most prominent manifestation was disturbance of topical microcirculation of Reinke's layer. In microcirculation aspect, the relationship between polyp of vocal cord and the Blood Stasis Syndrome was confirmed, and pathogenic mechanism of vocal cord polyp was discussed.

Inflammatory endotracheal polyp resolved after antibiotic treatment.

We describe a rare case of asymptomatic inflammatory endotracheal polyp resolved by antibiotic treatment. Histological examination of biopsy specimens showed an inflammatory polyp consisting of fibrovascular stroma and sparse lymphocyte infiltration. The size of the polyp was unchanged during 3 months without any treatment and its etiology was unclear. Although a bacterial organism was never proven, the polyp decreased remarkably under treatment with an oral antibiotic (ciprofloxacin) and did not recur for 6 months. Antibiotic treatment may be of value for inflammatory tracheobronchial polyps in cases of unclear etiology.

Gastric glandular cysts--investigations into their genesis and relationship to colorectal epithelial tumors.

One thousand five hundred cases presenting with glandular cysts of the gastric mucosa (Elster's polyps) (64.2 per cent women, 38.8 men) were investigated. The average age of 57.1 +/- 14.5 years militates against the possibility of these polyps being Hamartomas. In 41 out of 100 cases submitted to follow-up gastroscopies, these Elster's polyps were either reduced in number and sitze, or else had newly formed in previously unremarkable mucosa--which is further argument against the hamartoma hypothesis and in favour of a functional-secretory genesis. The results of 596 cases submitted to examinations of colorectal epithelial tumours (24.8 per cent in the overall group, and 35.6 per cent in those patients submitted to examination of the entire colon by means of colonoscopy and/or colon contrast enema). In 21 patients with adenomatosis coli (including 11 patients with Gardner's syndrome), in addition to Elster's polyps, a higher incidence of adenomas in the upper gastrointestinal tract was also observed (57.1%), in 5 cases taking the form of initial tubular adenomas in the apex of Elster's polyps. After surgical treatment, some of the patients (28.6%) revealed a reduction in the number of polyps in the stomach. On the basis to these results, a thorough diagnostic work-up of the colon in patients with Elster's polyps is recommended.(ABSTRACT TRUNCATED AT 250 WORDS)

Rapid promotion and progression of fibrovascular polyps by inflammation and/or hyperplasia in hamster check pouch: implications for carcinogenesis assay.

Tumor initiation by topical application of 7,12-dimethylbenz[a]anthracene (DMBA) in dimethyl sulfoxide (DMSO) followed by topical application of retinyl acetate (RA), ethylphenylpropiolate, or acetic acid in DMSO at inflammatory and hyperplasiogenic dose regimens caused the rapid promotion of fibrovascular polyps with dysplastic epithelium in hamster cheek pouch. Such lesions did not occur in control animals initiated with DMBA followed by application of DMSO only, where inflammation was also minimal. At the dose regimen employed, RA caused obvious cytotoxicity and tissue destruction. With EPP and AA, there was no histological evidence of tissue destruction. At dose regimens resulting in minimal inflammation and no apparent cytotoxicity, RA promoted almost no polyps, but a higher yield of other tumor types. Thus, inflammation and/or hyperplasia apparently exerted a strong polyp-promoting and progressive influence. This and other differences between the tumorigenic responses of hamster-pouch mucosa and mouse skin suggest that the former supplement the latter in carcinogenic risk assessment.

Which colonic polyps should be excised endoscopically?

A review of 464 consecutive polypoid lesions of the colon reveals that virtually all pedunculated polyps and over 80% of 218 sessile polyps were removed colonoscopically. Although size or location of the lesions occasionally precludes colonoscopic excision, the endoscopic appearance of a sessile polyp is the most important factor in deciding upon the method of excision. In gneeral, smooth, soft, nonulcerated sessile lesions of all sizes were excised endoscopically, while approximately half of the larger (2-6 cm) firm, irregular-surfaced, benign sessile lesions, and all ulcerated or malignant sessile lesions required laparotomy for proper management. All polypoid lesions should be viewed endoscopically before deciding the method of excision, regardless of their size, location, or general appearnce by barium enema. Experience with endoscopic morphology and snare electrocautery technics was most important, since more than 85% of all polypoid lesions in this consecutive series were removed endoscopically.