Alterations of posterior pharyngeal wall movement during swallowing in postoperative tongue cancer patients: assessment with a videofluoroscopic swallowing study.

This study aimed to determine the association between the progressive contraction of the posterior pharyngeal wall and dysphagia in postoperative patients with tongue cancer. A videofluoroscopic swallowing study (VFSS) was performed in 34 patients after tongue cancer surgery. Images were analyzed using a two-dimensional video measurement software. Cases in which the processes on the posterior pharyngeal wall moved downward from the 2nd to 4th vertebral regions were defined as "normal type", other cases were defined as "abnormal type". Twenty-four patients showed normal movement of the posterior pharyngeal wall, whereas 10 patients showed the abnormal type. The results showed that there was a significant difference in dysphagia scores between the postoperative swallowing type and swallowing dysfunction score. This implies that dysphagia is related to the movement of the posterior pharyngeal wall after tongue cancer surgery. Furthermore, the extent of resection and stage were significantly different between the normal and abnormal groups in the posterior pharyngeal wall movement. There was also a significant difference between the two groups in terms of the following: whether the tongue base was included in the excision range (p < 0.01), whether neck dissection was performed (p < 0.01), or whether reconstruction was not performed (p < 0.01). VFSS results showed that posterior pharyngeal wall movement was altered after surgery in patients with tongue cancer who had severe dysphagia.

A preliminary deep learning study on automatic segmentation of contrast-enhanced bolus in videofluorography of swallowing.

Although videofluorography (VFG) is an effective tool for evaluating swallowing functions, its accurate evaluation requires considerable time and effort. This study aimed to create a deep learning model for automated bolus segmentation on VFG images of patients with healthy swallowing and dysphagia using the artificial intelligence deep learning segmentation method, and to assess the performance of the method. VFG images of 72 swallowing of 12 patients were continuously converted into 15 static images per second. In total, 3910 images were arbitrarily assigned to the training, validation, test 1, and test 2 datasets. In the training and validation datasets, images of colored bolus areas were prepared, along with original images. Using a U-Net neural network, a trained model was created after 500 epochs of training. The test datasets were applied to the trained model, and the performances of automatic segmentation (Jaccard index, Sørensen-Dice coefficient, and sensitivity) were calculated. All performance values for the segmentation of the test 1 and 2 datasets were high, exceeding 0.9. Using an artificial intelligence deep learning segmentation method, we automatically segmented the bolus areas on VFG images; our method exhibited high performance. This model also allowed assessment of aspiration and laryngeal invasion.

Clinical study regarding the anatomical structures of the right atrial isthmus using intra-cardiac echocardiography: implication for catheter ablation of common atrial flutter.

BACKGROUND: The construction of complete bi-directional block in the isthmus (ITH) between the tricuspid annulus and inferior vena cava by radiofrequency energy (RF) applications is sometimes hampered due to anatomical problems such as a thick isthmus or aneurysmal pouch in patients with common atrial flutter (AFL). METHODS AND RESULTS: Fifteen patients were referred for RF ablation of AFL. The anatomical thickness of the right atrial ITH, diameter of the right atrium and thickness of the right atrial free wall were determined using intracardiac echocardiography (ICE), along with the endocardial electrogram recordings at the ITH. RF was applied at the ITH to create a transmural incision to treat the AFL. A significant parallel relationship between the maximum amplitude of the atrial electrogram and the thickness of the ITH, was observed. When the maximum amplitude of the atrial electrogram at the ITH exceeded 1.5 mV, the thickness at the ITH was approximately larger than 5 mm. CONCLUSIONS: Using ICE, the precise measurement of the anatomical structures in the heart, including the ITH, was feasible. From the amplitude of the atrial electrogram, a deduction of the thickness at the ITH was possible, which is indispensable information for the appropriate selection of the RF devices.

Computed tomographic features of bilateral coronoid process hyperplasia with special emphasis on patients without interference between the process and the zygomatic bone.

OBJECTIVE: To reveal computed tomography (CT) features of patients with coronoid process hyperplasia without interference between the process and the zygomatic bone. STUDY DESIGN: A case-control study was designed. Thirteen cases without interference (2 male and 11 female, 28-56 years old) and 65 controls were sampled from a patient database. Differences in CT features were analyzed between the 2 groups regarding the following 7 points of 5 regions: configuration of the coronoid process, vertical level of the coronoid process, the distance between the bilateral zygomatic arches, thickness of the temporal muscle, anteroposterior width of the temporal muscle, thickness of the temporal muscle tendon, and thickness of the masseter muscle. Cluster analysis was applied to differentiate between individuals. RESULTS: All cases had bilateral hyperplastic change of the coronoid process. Differences were found between the cases and controls in 6 of 7 CT features with the exception of temporal muscle thickness. All incidences of significant difference showed larger values in the cases. All cases were clustered into the same group and were differentiated from the controls. CONCLUSION: CT features appeared to be effective for diagnosis of this condition, and these patients should be put into the same category under the diagnosis of coronoid process hyperplasia.

Color Doppler sonography of the facial artery in the anterior face.

OBJECTIVES: The purpose of this study was to clarify the Doppler sonographic features of the facial artery in the anterior face in healthy volunteers and to investigate those of related hemangiomas. STUDY DESIGN: Forty-six volunteers and 3 patients with hemangiomas were examined with Doppler sonography. The detection rates of the facial artery in the anterior face were determined. The features of the main trunk, superior and inferior labial branches, and the branches in the buccinator area were investigated together with the flow diameter, flow velocities, and resistive and pulsatility indexes. RESULTS: The detection rates of the main trunk and superior and inferior branches were 100%, whereas that of the branches in the buccinator area was 92.4%. There were no significant differences in the measured values for all indexes between the right and left sides. However, there were significant correlations between right and left sides in the flow diameter and minimum velocity of the main trunk and in the flow diameter and pulsatility index of the superior labial branch. The Doppler sonographic features of the hemangioma were characterized as a hypoechoic area with internal and surrounding blood flows. CONCLUSIONS: Doppler sonography can clearly depict the facial artery and its branches in the anterior face, and this method appears to be useful in the follow-up examination of hemangiomas in this area.

MRI features of mandibular osteomyelitis: practical criteria based on an association with conventional radiography features and clinical classification.

OBJECTIVES: The aims of this study were (1) to assess the diagnostic power of magnetic resonance imaging (MRI) for mandibular osteomyelitis through comparison with conventional techniques and (2) to establish practical MRI diagnostic criteria in relation to treatment and clinical outcome. STUDY DESIGN: In 55 subjects, clinically suspected as mandibular osteomyelitis, signal intensities (SI) were evaluated on T1-weighted/short T1 inversion recovery (STIR) images. RESULTS: Forty-seven subjects were definitively diagnosed as having osteomyelitis by pathology studies or clinical course. For the acute or subacute stage, positively associated appearances were low SI on T1-weighted image and extensive high or focal high SI on the STIR image. For chronic stage, appearances of low SI on both T1-weighted and STIR images should be added to those for the acute or subacute stage. These findings support the at-present accepted imaging diagnostic criteria based on bony changes for detection of osteomyelitis. CONCLUSION: This study confirms that T1-weighted/STIR images are useful for the detection of mandibular osteomyelitis.

Bifid mandibular canal in Japanese.

The location and configuration of mandibular canal variations are important in surgical procedures involving the mandible, such as extraction of an impacted third molar, dental implant treatment, and sagittal split ramus osteotomy. We report 3 Japanese patients with bifid mandibular canals using panoramic radiograph and multi-slice helical computed tomography (CT) images. In 2 of the 5 sides, the bifid mandibular canal was suggested on panoramic radiograph. The bifid mandibular canal had a short and narrow upper canal toward the distal area of the second molar in 4 sides, and a short and narrow lower canal toward the distal area of second molar in 1 side, as revealed on reconstructed CT images. Since the location and configuration of mandibular canal variations are important in surgical procedures involving the mandible, they should be carefully observed using reconstructed CT images.

Radiofrequency catheter ablation of various kinds of arrhythmias guided by virtual electrograms using a noncontact, computerized mapping system.

Three-dimensional visualization of cardiac activation has become important for providing further insights into the pathophysiological mechanisms of arrhythmias and to increase the efficacy of catheter ablation. The noncontact mapping system enables a single-beat analysis of the reconstructed geometry of the cardiac chamber. In 8 patients with various kinds of arrhythmias (3 with atrial flutter, 2 with right ventricular outflow tract ventricular tachycardia, 1 with idiopathic left ventricular tachycardia, 1 with atrioventricular nodal reentrant tachycardia and 1 with concealed Wolff-Perkinson-White syndrome), non-contact mapping using an EnSite 3000 system was performed for the guidance of catheter ablation. The optimal sites for successful ablation were detected and all of these arrhythmias were successfully eliminated with the radiofrequency energy applications without any adverse effects. The computerized EnSite 3000 mapping system described here computes accurate isopotential maps that are a useful guide for catheter ablation.