The effect of 5Hz high-frequency rTMS over contralesional pharyngeal motor cortex in post-stroke oropharyngeal dysphagia: a randomized controlled study.

BACKGROUND: We sought to find the therapeutic effect of 5Hz high-frequency repetitive transcranial magnetic stimulation (rTMS) over the unaffected pharyngeal motor cortex in post-stroke dysphagic patients. METHODS: Eighteen patients with unilateral hemispheric stroke oropharyngeal dysphagia that lasted more than 1 month were randomly divided into two groups. They all performed videofluoroscopic swallowing study (VFSS) before rTMS intervention. The experimental group (EG) received 5Hz rTMS over contra-lesional pharyngeal motor cortex for 10 min per day for 2 weeks. The control group (CG) received sham stimulation under the same condition. Videofluoroscopic swallowing study were performed again just after treatment cessation and 2 weeks afterward. The evaluation was performed using videofluoroscopic dysphagia scale (VDS) and penetration-aspiration scale (PAS). KEY RESULTS: Mean baseline VDS and PAS of EG was 33.6 ± 12.1 and 3.41 ± 2.32 respectively and the scores were reduced to 25.3 ± 9.8 and 1.93 ± 1.52 just after 2 weeks intervention (P < 0.05). This effect lasted for up to 2 weeks after treatment. However, there was no change in the CG. Baseline prevalence of aspiration, pharyngeal residue, delayed triggering of pharyngeal swallowing and abnormal pharyngeal transit time (PTT) in EG was 66.7%, 66.7%, 33.3%, and 44.4%, respectively. After rTMS, the prevalence of aspiration and pharyngeal residue was reduced to 33.3% and 33.3%, respectively. However, the prevalence of delayed triggering and abnormal PTT was not changed. CONCLUSIONS & INFERENCES: A 5Hz high-frequency rTMS on contra-lesional pharyngeal motor cortex might be beneficial for post-stroke dysphagic patients. This intervention can be used as a new treatment method in post-stroke patients with dysphagia.

Exercise using tongue-holding swallow does not improve swallowing function in normal subjects.

We evaluated the effects of repetitive tongue-holding swallow (THS) as an exercise for improving swallowing function. Twenty healthy subjects were randomly divided into two groups. One group [THS group (THSG)] performed the tongue-holding manoeuvre every 5s for 20min. The other group (normal swallow group) swallowed without tongue-holding for the same length of time as a control. Twenty sessions of training were performed for 4weeks. All participants also had a videofluoroscopic swallowing study for analysing the biomechanical parameters of swallowing (hyolaryngeal movement, posterior pharyngeal wall movement and the pharyngeal constriction ratio). After 4weeks of training, none of the biomechanical parameters changed in either group. Exercise using THS did not affect swallowing function in normal subjects.

Heterogeneity of stage IIIA endometrial carcinomas: implications for adjuvant therapy.

The purpose of this study was to evaluate overall survival (OS) and determine prognostic subclassifications for stage IIIA endometrial cancer. Stage IIIA endometrial cancer patients treated at M.D. Anderson Cancer Center from 1989 to 2002 were reviewed. Clinical information was obtained from the medical record. Cox regression analyses were performed to evaluate the association of pathologic criteria and OS. Patients were divided into four groups based on this analysis: E1, endometrioid/pelvic cytology only; E2, endometrioid/adnexa +/- serosal spread; NE1, nonendometrioid/pelvic cytology only; and NE2, nonendometrioid/adenexa +/- serosal spread. Forty-nine patients were identified. By multivariate analysis, histology and extent of disease were the only factors associated with OS. Five-year OS in the four subgroups based on histology and extent of disease were: E1, 79%, E2, 65%, NE1, 64%, and NE2, 13%. Histologic subtype and extent of pelvic disease are the only prognostic factors associated with OS. Patients with endometrioid tumors and extent of pelvic disease limited to positive cytology had a favorable outcome, with or without adjuvant therapy. Future prospective clinical trials should consider subclassifying patients with stage IIIA disease to better evaluate the role of adjuvant therapy.

A gelatin matrix-thrombin tissue sealant (FloSeal) application in the management of groin breakdown after inguinal lymphadenectomy for vulvar cancer.

The rate of groin breakdown after radical wide vulvar excision and inguinal lymphadenectomy for vulvar cancer remains significant despite conservative surgical approaches. An 86-year-old Latin American woman underwent wide radical excision and bilateral inguinal lymphadenectomy for vulvar cancer. The postoperative course was complicated by bilateral groin wound separation and high output lymphorrhea. The patient responded to the application of a gelatin matrix-thrombin tissue sealant (FloSeal) to the bases of each groin with resolution in lymphorrhea and formation of granulation tissue. The application of a gelatin matrix-thrombin tissue sealant (FloSeal) may be a viable treatment in the management of groin breakdown in selected patients when conventional therapy produces suboptimal results.

Catheter ablation of ventricular tachycardia in patients with right ventricular dysplasia: Identification of target sites by entrainment mapping techniques.

OBJECTIVE: To identify target sites for radiofrequency ablation of ventricular tachycardia (VT) by entrainment mapping techniques in patients with arrhythmogenic right ventricular dysplasia. METHODS: Entrainment mapping and radiofrequency ablation of eight VTs was performed in seven patients. Radiofrequency ablation was applied at 31 reentry circuits sites that were classified based on findings during entrainment. RESULTS: By entrainment criteria the 31 sites were classified as: exit sites (n = 12), proximal sites (n = 6), and outer loop sites (n = 13). Radiofrequency current application terminated VT at 7 of 31 sites: 2 of 12 exit sites (17%), 4 of 6 proximal sites (67%), and 1 of 13 outer loop sites (8%). CONCLUSION: Radiofrequency ablation terminated VTs most often at sites proximal to the exit as opposed to outer loop sites and exit sites (P = 0.05). The critical isthmus for ablation of VT in right ventricular dysplasia often may be distant to the exit.