Speech restoration following total laryngo-pharyngectomy with free jejunal repair.

Nine patients who have undergone total laryngo-pharyngectomy with free jejunal reconstruction between 1984 and 1993, have had Blom-Singer valves inserted. All patients had little or no voice prior to valve insertion, compared with a good but gravelly voice after valve insertion. Tracheo-oesophageal puncture and valve insertion provides a safe and reliable means of restoring voice after laryngo-pharyngectomy with free jejunal repair.

Videofluoroscopy in motor neurone disease prior to cricopharyngeal myotomy.

Cricopharyngeal myotomy is a recognised treatment for the dysphagia in motor neurone disease, although the results are sometimes disappointing. In this study, 27 patients with motor neurone disease causing significant dysphagia have been investigated by the technique of videofluoroscopy, in order to determine the nature of their swallowing disability; those patients found suitable have been offered cricopharyngeal myotomy. Of the 27 patients, only seven were found to have cricopharyngeal dysfunction as the predominant disability and, of these, six underwent myotomy, resulting in relief of dysphagia in five, three of whom returned to a near normal diet. Previous studies showed poor overall benefit from cricopharyngeal myotomy. Videofluoroscopy allows accurate patient selection, and a much improved outcome in the selected group.

Stimulation by 17 alpha-hydroxyprogesterone of glycoprotein and glycosaminoglycan synthesis in human placenta in vitro.

The incorporation of 14C-glucosamine into glycoproteins (GP) and glycosaminoglycans (GAG), of 3H-leucine into protein, and the hexuronic acid (HA) content of polymerized GAG was determined in incubated placental tissue. In placentae of earlier gestational age (GA), incorporation of 14C-glucosamine was 2.6 times greater than other at 38-39 weeks GA. 19 of 26 placentae at 38-39 weeks GA responded by one or more parameters when incubated with 0.5-3 microM 17 alpha-OH-progesterone (17OHP). Those which did not respond were all of earlier GA; the placental content of GAG decreased in these from 31.1 +/- 1.8 nmol HA/mg protein to 16.4 +/- 1.5 nmol in placentae of GA 38-39 weeks. In the latter, 17OHP increased GAG by 42.5% to 24.4 +/- 2.5 nmol HA/mg protein in a 2-hour incubation. Progesterone, oestriol, cortisol and testosterone were without effect. It is concluded that synthesis of placental GAG decreases toward the end of gestation, but can be increased by 17OHP specifically. This indicates that 17OHP is a biologically active steroid and might have a role in maintaining placental function.

An effect of corticosteroids on thymocytes not mediated by macromolecule synthesis.

Rat thymocytes were incubated for 2 min at 37 degrees C and the cells then broken by osmotic shock in 1.5 mM MgCl2 and the nuclei harvested. Treatment with 50 nM dexamethasone for 2 min resulted in about one third of nuclei showing abnormalities in appearance, in shape and density. This was not prevented by prior incubation for 10 min with actinomycin D and cycloheximide, but was when nuclei were isolated in the presence of anions larger than F- and Cl-, including I-, Br-, SO = 4 and citrate identical to. Subsequent addition of Cl- ion, however, resulted in development of abnormalities in steroid-treated nuclei. It is concluded that the steroid induces a mechanism resulting in influx of chloride ion leading to nuclear edema, which is not mediated by processes involving synthesis of macromolecules.