[Clinical characteristics of myasthenia gravis with dysphonia as the initial symptom].

OBJECTIVE: To identify clinical features and diagnostic tests that would alert the otolaryngologist to consider myasthenia gravis (MG) in the differential diagnosis of dysphonia, we reviewed the clinical characteristics of MG whose initial symptom is dysphonia. METHODS: 31 patients who presented with dysphonia as their initial and primary complaint are reported, their symptoms and signs are observed and analyzed. RESULTS: Patients with dysphonia as their initial symptom of MG may complain of vocal fatigue, difficulty sustaining or projecting their voices, breathy voice or intermittent hoarseness. These symptoms are characterized by fluctuating weakness and abnormal fatigability. Flexible fibroendoscopic examination revealed that patients had incomplete adduction of the vocal folds, fatigue of the tensors of the vocal fold, incomplete glottic closure, vocal cord paralysis, saliva pooling over the bilateral or unilateral pyriform sinus. Neostigmine test revealed dramatic improvement in all patients. Serum levels of anti-Ach-R antibodies were tested in 19 cases, only 5 cases were abnormality. All patients had improved after treatment CONCLUSIONS: Voice changes can be the first sign of early MG. Based on fluctuating weakness or weak voice at the end of the day, a positive neostigmine test, significantly higher circulating antibody to acetylcholine receptor, a diagnosis of MG could definitively be made.

[A study of the relationship between the expression of connexin43, E-cadherin and biological behaviors of human laryngeal cancer].

OBJECTIVE: To investigate expression of connexin43 (Cx43) and E-cadherin (E-cad) and its relationship with the biological behavior in Laryngeal carcinomas. METHODS: Immunohistochemistry staining (PicTure two steps method) was used to detect connexin 43 and E-cadherin expression in 60 paraffin-embedded laryngeal carcinomas and 10 normal epithelia around tumors. All the patients were followed up more than five years. RESULTS: Cx43 and E-cad were expressed by normal epithelia with typical membranous staining 10 normal epithelia strongly expressed Cx43 and E-cad. The reduction rate of Cx43 expression in laryngeal carcinomas was 30.0%. The significant relationship was observed between low Cx43 expression and differentiation, lymph node metastasis and recurrence (chi2 = 15.09, 6.41, 3.86, P < 0.01, 0.05, 0.05), but there was no significance between low Cx43 expression and prognosis (chi2 = 2.65, P > 0.05). 41.7% laryngeal carcinoma showed reduced or no expression of E-cad. Tumor cell dedifferentiation correlated with reduced expression for E-cad (chi2 = 15.07, P < 0.01). Absent or low E-cad expression was observed more frequently in patients with local recurrence and lymph node metastasis and with less than 5-year survival period (chi2 = 5.35, 6.65, 5.14; P < 0.05, 0.01, 0.05). There was a positive relationship between the expression of Cx43 and E-cad in same sample (r = 0.63, P < 0.0001). CONCLUSIONS: Laryngeal cancer presented inactivation of Cx43 gene and E-cad gene and down regulation of Cx43 and E-cad proteins. The level of Cx43 and E-cad may be a sensitive predictor of differentiation, invasion, lymph node metastasis and recurrence. E-cad is also a prognostic factor for patients with laryngeal cancer.

[Relationship between levels of intercellular adhesion molecule-1, interleukin-6 and airway hyperresponsiveness in patients with allergic rhinitis].

OBJECTIVE: To investigate the relation between levels of intercellular adhesion molecule-1, interleukin-6 and airway hyperresponsiveness in patients with allergic rhinitis. METHODS: Fifty-four patients with allergic rhinitis (AR) and 20 controls were included in the study. The levels of intercellular adhesion molecule-1 (ICAM-1) and interleukin-6 (IL-6) in nasal lavage fluid, gathered 1 hour after specific allergen nasal provocation test (SANPT), were detected by sandwich enzyme-linked immunosorbent assay (ELISA) technique. The pulmonary function (FEV1) and nonspecific bronchial provocation test were measured in 54 patients with AR, 36 patients with AR and bronchial asthma (BA) and 20 controls. At the same time, the correlation between levels of ICAM-1 and IL-6 in nasal lavage fluid and pulmonary function (FEV1) was studied. RESULTS: The levels of ICAM-1 and IL-6 in nasal lavage fluid from patients with AR were (272.75 +/- 32.25) pg/ml and (52.11 +/- 16.54) pg/ml, significantly higher than those the controls, which were (158.82 +/- 33.88) pg/ml and (25.64 +/- 10.14) pg/ml (P < 0.01). The pulmonary function (FEV1) in patients with AR and BA was (78.82 +/- 7.41)%. It was obviously lower than that in patients with AR [(83.90 +/- 4.87)%], much lower than that in normal controls [(90.25 +/- 4.69)%]. The difference among them was significant. In patients with AR, the positive percentage of bronchial provocation test was 64.81%, in patients with AR and BA, it was 83.33% in normal controls, it was 0. The differences among them had very significant meaning. The levels of ICAM-1 and IL-6 in nasal provocation fluid had closely negative correlation with pulmonary function (FEV1), r = -0.7071, -0.6248, P < 0.01. CONCLUSIONS: The close correlation was observed in upper and lower airway for allergic inflammation. The pulmonary function of patients with AR was lower, and 64. 8% of them had airway hyperresponsiveness, so that they had the potent possibility to have bronchial asthma.