Impact on swallowing functions of arytenoid adduction in patients with unilateral vocal fold paralysis.

OBJECTIVE: Although the pathophysiology of swallowing dysfunction in patients with unilateral vocal fold paralysis (UVFP) remains uncertain, glottal insufficiency is known to be a possible major cause, and other factors due to vagus nerve or recurrent laryngeal nerve damage may contribute to dysphagia or aspiration. This study aimed to evaluate the effect of arytenoid adduction (AA) surgery on the swallowing functions of UVFP patients and to investigate the important role of glottic closure during swallowing. METHODS: We prospectively analyzed the data of thirteen patients with UVFP who underwent AA in combination with medialization laryngoplasty (ML) for improving voice quality. The subjects received a series of examinations for not only voice function but also swallowing function and cough strength both preoperatively and approximately 6 months after surgery. The evaluations of voice function included the Voice Handicap Index and aerodynamic measures; the evaluations of swallowing function included the Eating Assessment Tool-10, liquid aspiration, a videofluorographic examination of swallowing study, and high-resolution manometry; and the evaluation of cough strength included the measurement of cough peak flow. All measurements before and after surgery were statistically compared and examined. RESULTS: Considerable improvements in voice measures were observed after the procedure, as sufficient glottic closure was achieved during phonation and swallowing. In terms of swallowing evaluation, there were significant differences in the subjective assessment methods after the operation. Additionally, our intervention improved two cases of aspiration according to abnormal findings on the videofluorographic examination of swallowing. There was a significant difference in cough peak flow, with all participants having better values after surgery. High-resolution manometry revealed no significant differences between pre- and postsurgery in any parameters at the level of the mesopharynx or upper esophageal sphincter. CONCLUSION: The findings of our study suggest an important effect on the dysphagia of UVFP patients who undergo AA combined with ML. In addition, we revealed improvements in swallowing by strengthening incomplete glottic closure; thus, we consider that sufficient glottic closure must play an important role in swallowing function in patients with UVFP.

Clinical Usefulness of Endoscopy, Barium Fluoroscopy, and Chest Computed Tomography for the Correct Diagnosis of Achalasia.

Objective The definite diagnosis of esophageal achalasia is established using manometry, which is performed in patients with suspected achalasia based on the findings of screening examinations, such as upper gastrointestinal endoscopy, chest computed tomography (CT), or a barium swallow test. However, the exact values of test characteristics in these supportive diagnostic examinations remain unclear. Methods We estimated the sensitivity and specificity of characteristic findings in the supportive diagnostic examinations for achalasia by comparing the data of a large number of achalasia patients and others with digestive symptoms. Patients Achalasia patients (n=119) and non-achalasia patients with suspected achalasia and repeated feelings of chest discomfort (n=37) who were treated in a single university hospital. Results Characteristic findings on chest CT (i.e., dilated esophagus, air-fluid level formation) and barium swallow tests were observed in more than 80% of achalasia patients but in less than 10% of non-achalasia patients. In contrast, conventional characteristic findings of upper gastrointestinal endoscopy (i.e., intra-esophageal food debris, feeling of resistance at the esophagogastric junction) were seen in only 40-70% of achalasia patients. In particular, the feeling of resistance at the esophagogastric junction was observed by the examiner in only 30-50% of patients. Conclusion Intra-esophageal food debris or resistance at the esophagogastric junction on upper gastrointestinal endoscopy will be positive in only about half of patients with achalasia. Other supportive diagnostic examinations, such as chest CT or barium fluoroscopy, should therefore be included in order to avoid overlooking the disease.

Identification of Two Phenanthrene Derivatives from Australasian Allied Species in Genus Dendrobium.

Genus Dendrobium (Orchidaceae) contains numerous species. Phylogenetic analyses based on morphological characteristics and DNA sequences indicated that this genus is divided into two major groups: Asian and Australasian clades. On the other hand, little is known about the phytochemical differences and similarities among the species in each clade. In this study, we selected 18 Dendrobium species (11 from the Asian clade and 7 from the Australasian clade) and constructed HPLC profiles, arrays composed of relative intensity of the chromatographic peaks. Next, orthogonal partial least square discriminant analysis (OPLS-DA) was applied to the profile matrix to classify Dendrobium species into the Asian and Australasian clades in order to identify the peaks that significantly contribute to the class separation. In the end, two phenanthrenes, 4,9-dimethoxyphenanthrene-2,5-diol 1 and 1,5-dimethoxyphenanthrene-2,7-diol 2, which contributed to the class separation, were isolated from the HPLC peaks. The existence of 2 was limited to the genetically related Australasian species.

Pharmacological and psychosomatic treatments for an elderly patient with severe nausea and vomiting in reaction to postoperative stress.

Here we present a case of successful treatment employing a mixed approach including pharmacological and psychosomatic treatments for a 72-year-old woman who experienced severe nausea and vomiting in reaction to postoperative stress from gastric cancer surgery. This case demonstrates that appropriate provision of psychosomatic treatments, including a psychotherapeutic session and autogenic training, enhances the efficacy of pharmacotherapy.

The features of adolescent irritable bowel syndrome in Japan.

OBJECTIVE AND BACKGROUND: The onset of IBS is in adolescence in many cases. However, the features of adolescent IBS were generally lacking. The objective of this research was to know the features of adolescent IBS in Japan. METHODOLOGY: In 2004 and 2009, we randomly selected Junior high school students in Miyagi prefecture, Japan, according to population of each area. Eight hundred thirty-three boys and 888 girls (age: 15 years old) in 2004 and 256 boys and 335 girls (age: 14 years old) in 2009 participated in this study. They fulfilled self-reported questionnaires those include Rome-II Modular Questionnaire, Self-reported IBS Questionnaire, Generalized Self-Efficacy Scale, Short Form-36 ver.2, other questions on their lives and Toronto Alexithymia Scale-20. RESULTS: The prevalence of adolescent IBS was 14.6% in 2004 and 19% in 2009. Compare with students without abdominal symptoms, IBS showed lower health-related QOL and self-efficacy and complained more sleep disturbance, traumatic episodes and perceived stress in both researches. IBS girls were worse in both physical and psychological aspects. They also have alexithymic tendency and it influenced on severity of IBS symptoms. CONCLUSIONS: Adolescent IBS had almost the same prevalence as adult IBS, however the rate of IBS subtypes was different. They also had psychological problems in addition to physical conditions even though most of them were non-consulters. Improvement of self-efficacy and alxithymia may help to prevent and treat IBS.

Formation mechanisms of melanoidins and fluorescent pyridinium compounds as advanced glycation end products.

The formation mechanisms of melanoidins as advanced glycation end products (AGEs) have not been resolved. Blue and red pigments generated in the D-xylose-glycine reaction system are postulated to be intermediate oligomers in the generation of melanoidins. A novel blue pigment, designated blue-M5, was identified as a similar structure to blue-M1 except for the side chain of two dihydroxypropyl groups. Blue pigments were also generated in the D-glucose-glycine and D-xylose-beta-alanine reaction systems as well as in the D-xylose-glycine reaction system. Blue pigments by the Maillard reaction might be formed by the decarboxylation of two molecules of pyrrolopyrrole-2-carbaldehydes (PPA). PPA, composed of a side chain of a dihydroxypropyl group, was identified as a precursor of blue pigments. In fact, blue-M5 was generated by the incubation of PPA alone. Blue pigments, which involved pyrrolopyrrole structures, were readily changed to brown polymers. Glyceraldehyde-derived pyridinium (GLAP) compound, a glyceraldehyde-derived fluorescent AGE, and lysyl-pyrropyridine, a 3-deoxyglucosone-derived fluorescent AGE, were detected at higher levels in the plasma proteins and the tail tendon collagen of streptozotocin-induced diabetic rats compared to normal rats. GLAP and lysyl-pyrropyridine, therefore, might be related to the progression of diabetic complications.