Presentation of oropharyngeal dysphagia and rehabilitative intervention following esophagectomy: a systematic review.

No study has systematically reviewed the evidence on presentation of oropharyngeal dysphagia and swallowing rehabilitation following esophagectomy. The purposes of this systematic review are to 1) qualitatively synthesize the current findings on oropharyngeal swallowing abnormalities identified by instrumental swallowing evaluations, 2) describe the reported health-related outcomes in relation to swallowing abnormality following esophagectomy, and 3) examine the efficacy of reported rehabilitative interventions for oropharyngeal dysphagia in patients who underwent esophagectomy. Publications were searched using five electronic databases. No language or publication date restrictions were imposed. Two authors performed a blind review for published or unpublished studies that reported swallowing biomechanics and dysphagic symptoms using instrumental evaluation of swallowing, specifically the videofluoroscopic swallowing study and fiberoptic endoscopic evaluation of swallowing, and/or health-related outcomes in relation to swallowing abnormalities, and/or therapeutic interventions for oropharyngeal dysphagia following esophagectomy. Twelve studies out of 2,193 studies including 458 patients met the inclusion criteria. Reported abnormal swallowing biomechanics included vocal fold immobility, delayed onset of swallowing, reduced hyolaryngeal elevation, and reduced opening of the upper esophageal sphincter. Aspiration (0-81%) and pharyngeal residue (22-100%) were prevalent. Those abnormal swallowing biomechanics and swallowing symptoms were commonly reported following both transhiatal and transthoracic esophagectomy. Pneumonia presented in 5-25% of the study patients. One quasi-experimental study examined the effectiveness of swallowing exercises for postoperative oropharyngeal dysphagia; three case series reported a benefit of the chin-tuck maneuver in reducing aspiration and residue. This review revealed distinct swallowing impairments and increased pneumonia risks following esophagectomy. This review also found that evidence on the efficacy of therapeutic interventions was limited. Future studies are warranted to develop effective rehabilitative interventions for postesophagectomy patients with oropharyngeal dysphagia.

[Immunohistochemical study of thymidine phosphorylase in uterine cervical intraepithelial neoplasia].

Studies have shown that thymidine phosphorylase (TdRPase) activity in various tumors is higher than that in normal tissues. We studied the immunohistochemical localization of TdRPase in uterine cervical intraepithelial neoplasia (CIN) using monoclonal antibody against TdRPase. Sixty-nine patients were studied: CIN 1, 14; CIN 2, 15; CIN 3 (severe dysplasia), 23; CIN 3 (carcinoma in situ), 17. Immunoreactivity for TdRPase was found in 29% of CIN 1, 40% of CIN 2, 70% of CIN 3 (severe dysplasia), and 88% of CIN 3 (carcinoma in situ), showing increasing incidence with the progression of tumor grade. Furthermore, in higher grade tumor, more immunoreactive cells were found with increased intensity of immunoreaction. Both nucleus and cytoplasm of atypical cells showed immunoreactivity in most TdRPase positive cases, while either nucleus or cytoplasm was positive in a few cases. The stromal tissues were negative for the antibody except 3 cases of CIN 3 (carcinoma in situ) in which the stromal tissues adjacent to the tumor was positive. Our data suggest that immunoreactivity of TdRPase in CIN may correlate with the grade of CIN.

[Cytological and immunocytochemical study of prostatic carcinoma cell in voided urine. Usefulness of prostate-specific antigen in cytology specimen].

The presence of prostatic carcinoma cells in voided urine was seldom noticed and these cells might be hardly distinguished from transitional cell carcinoma cells of the urinary tracts on the Papanicolaou-stained slides. We investigated the cytological findings and the localizations of prostate-specific antigen (PSA) in 7 cases of prostatic carcinomas (4 adenocarcinomas, 2 squamous cell carcinomas, and 1 undifferentiated carcinoma) which showed tumor cells in voided urine. The cytological findings of each histological types were as follows: adenocarcinoma cells were observed in small clusters of round or columnar cells with eccentric nuclei and prominent nucleoli with occasion, squamous cell carcinoma cells were characteristically well-differentiated keratinizing ones varying in shape and in staining reaction, and undifferentiated carcinoma cells were polyhedral and large ones with dense cytoplasm. After destaining of the Papanicolaou-stained slides, the positivity for PSA was demonstrated by immunocytochemical stain with PSA antiserum in cytoplasms of the tumor cells of 6 cases except for 1 undifferentiated carcinoma. We recognized that immunocytochemical detection of PSA was a useful mean in cytological detection for prostatic carcinomas in voided urine.

[Clinicopathological study on microscopic urinalysis as screening for malignant cells].

Study on detection of malignant cells in urinary sediments using supravital staining was described. We examined 96,554 specimens of urinary sediments for 2 years from January 1985 to December 1986. The results of microscopic urinalysis were compared with the cytological and histological diagnoses. Atypical cells were found in 138 patients, and 47 (34.1%) cancers were diagnosed histologically among them. These included 33 bladder cancer, 1 ureter cancer, 1 renal pelvic cancer, 2 prostate cancers, 1 rectal cancer, and 9 uterine cancers. Seven patients of them had not been under suspicion of malignancy yet before atypical cells were detected. Therefore microscopic urinalysis caused the triggers of cancer diagnoses. For bladder cancers, the positive rates in microscopic urinalysis were 43.4%, and those in urinary cytology were 52.4%. The positivity revealed higher in high-grade cancers than in low-grade. As compared with the results between microscopic urinalysis and urinary cytology in identical patients, the rate of correspondence between them was 89.5%. In 61.2% of positive and suspicious urinary cytology, atypical cells were not found. Atypical cells were seen in negative urinary cytology of 26 cases, and 5 cases of cancers were diagnosed histologically. These suggested that microscopic urinalysis as a screening for malignant cells was useful to detect urinary tract malignancy combining with urinary cytology.