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1.
Scand J Gastroenterol ; 59(3): 378-383, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38031937

RESUMO

BACKGROUND: The proliferative zone of colonic adenomas is confined to the upper third of the crypt or is scattered along its entire axis. In contrast, there are unusual adenomas with proliferative zones confined to the lower two-thirds of the crypt. We investigated the frequency and endoscopic features of adenomas with lower proliferative zones. METHODS: We retrospectively reviewed consecutive patients who underwent colonoscopies between September 2022 and March 2023 at the Toyoshima Endoscopy Clinic. Colorectal polyps were endoscopically assessed using the Japan Narrow-Band Imaging Expert Team (JNET) classification. All resected polyps were histologically examined, and the proliferative zone locations were assessed in the adenomas. RESULTS: The frequency of adenomas with a lower proliferative zone was 1.8% (44/2420) in adenomas. Among these adenomas, JNET type 1 incidence was 43.2% (19/44), which was significantly higher than that in adenomas with a normal proliferative zone. Adenomas with a lower proliferative zone were diminutive (mean size: 2.5 mm) and prone to develop in the proximal colon. CONCLUSION: Colonic adenomas with proliferative zones confined to the lower two-thirds of the crypt often appear as diminutive, hyperplastic polyps.


Assuntos
Adenoma , Neoplasias do Colo , Pólipos do Colo , Neoplasias Colorretais , Humanos , Pólipos do Colo/patologia , Estudos Retrospectivos , Neoplasias do Colo/patologia , Adenoma/patologia , Colonoscopia , Neoplasias Colorretais/patologia , Hiperplasia
2.
Digestion ; 103(6): 411-420, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36075194

RESUMO

INTRODUCTION: Helicobacter pylori eradication is expected to significantly change the prevalence of Barrett's esophagus (BE). However, few reports on this relationship exist. We analyzed the risk factors of BE using the current consensus on length of BE considering H. pylori infection status. METHODS: We analyzed 10,122 individuals (5,962 men; mean age = 52.9 ± 9.9 years) who had undergone esophagogastroduodenoscopy as part of a medical checkup. Correlations among factors including H. pylori infectious status, endoscopic findings, and BE ≥1 cm were analyzed. RESULTS: Prevalence of BE, long-segment BE, and esophageal adenocarcinoma was 22.5%, 0.014%, and 0%, respectively. Logistic regression analysis showed that the risk factors for BE were hiatal hernia (odds ratio [OR]: 2.89 [2.59-3.24]), female sex (OR: 0.52 [0.46-0.59]), social drinking (OR:0.77 [0.68-0.87]), H. pylori eradication therapy (OR: 1.34 [1.19-1.51]), proton pump inhibitor (PPI) use (OR: 1.52 [1.18-1.96]), bile reflux (OR: 1.18 [1.04-1.33]), age ≥50 years (OR: 1.13 [1.02-1.26]), and nonsteroidal anti-inflammatory drug (NSAID) use (OR: 1.29 [1.02-1.62]). Although reflux esophagitis (RE) was more common in H. pylori-negative patients (17.2%) than in those after H. pylori eradication therapy (11.8%, p < 0.00001), the latter was correlated with BE, disputing RE as a strong risk factor for BE. Therefore, we conducted a subgroup analysis; most of the risk factors except for PPI use (p = 0.75), H2-receptor antagonist use (p = 0.078), and atrophic gastritis absence (p = 0.72) were positively correlated with BE after H. pylori eradication therapy compared with H. pylori-negative status. CONCLUSIONS: H. pylori eradication, bile reflux, PPI use, and NSAID use were risk factors for BE along with hiatal hernia, male sex, and older age.


Assuntos
Esôfago de Barrett , Refluxo Biliar , Esofagite Péptica , Infecções por Helicobacter , Helicobacter pylori , Hérnia Hiatal , Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Esôfago de Barrett/diagnóstico , Esôfago de Barrett/epidemiologia , Estudos Transversais , Hérnia Hiatal/epidemiologia , Refluxo Biliar/complicações , Refluxo Biliar/tratamento farmacológico , Japão/epidemiologia , Infecções por Helicobacter/complicações , Infecções por Helicobacter/tratamento farmacológico , Infecções por Helicobacter/epidemiologia , Esofagite Péptica/tratamento farmacológico , Inibidores da Bomba de Prótons/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Fatores de Risco
3.
Eur Arch Otorhinolaryngol ; 276(11): 3159-3164, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31485732

RESUMO

PURPOSE: Ultra-high-resolution computed tomography (UHRCT) is an emerging imaging technology that is able to achieve simultaneous 160 slices with super-thin 0.25 mm thickness. The purpose of this study was to assess the feasibility of UHRCT to visualize laryngeal structure and kinetics. METHODS: Three normal volunteers and three patients with unilateral vocal fold paralysis (UVFP) were incorporated in this case series. First, images were taken under five conditions in normal volunteers. Five tasks consisted of (1) air inspiration through the nose (IN), (2) breath holding (BH), (3) sustained vowel /i:/ phonation (IP), (4) humming phonation (HP), and (5) forced glottic closure during exhalation (FC). Three-dimensional CT images of arytenoid and cricoid cartilages, as well as virtual laryngoscopic images, were reconstructed using UHRCT data. Reconstructed images were compared among five conditions to assess the best tasks to picture laryngeal kinetics. Second, pre- and post-phonosurgical images were examined in UVFP patients to evaluate potential role of UHRCT to assess laryngeal pathology in hoarse patients. RESULTS: Among the five conditions, IN and IP conditions were considered suitable to visualize laryngeal structure at rest and during phonation, respectively. Kinetic abnormalities including asymmetric motion of arytenoid cartilages were elucidated in UVFP patients, and virtual endoscopy visualized the clinically invisible posterior three-dimensional glottic chinks. Furthermore, UHRCT was useful to understand changes in laryngeal structure achieved by phonosurgery. CONCLUSIONS: UHRCT is an emerging imaging technology that can be used for minimally invasive visualization and assessment of laryngeal structure and kinetics. Future studies to assess more number of patients with laryngeal dysfunction are warranted.


Assuntos
Processamento de Imagem Assistida por Computador/métodos , Imageamento Tridimensional/métodos , Laringe , Tomografia Computadorizada Multidetectores/métodos , Paralisia das Pregas Vocais , Adulto , Cartilagem Aritenoide/diagnóstico por imagem , Feminino , Humanos , Cinética , Laringoplastia/métodos , Laringoscopia/métodos , Laringe/diagnóstico por imagem , Laringe/fisiopatologia , Masculino , Pessoa de Meia-Idade , Fonação/fisiologia , Reprodutibilidade dos Testes , Paralisia das Pregas Vocais/diagnóstico , Paralisia das Pregas Vocais/fisiopatologia , Paralisia das Pregas Vocais/cirurgia
5.
Endosc Int Open ; 12(3): E448-E455, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38550765

RESUMO

Background and study aims This study aimed to evaluate the relationship between sessile serrated lesion (SSL) size and the comorbidity rate of SSL with dysplasia (SSLD) and cancer in SSL (SSL-cancer). Patients and methods This retrospective, single-center analysis identified SSL cases that underwent endoscopic resection between January 2015 and December 2022. The prevalence of SSL, SSLD, and SSL-cancer and their annual trends were assessed. The tumor diameter was stratified as 0 to 5 mm, 6 to 9 mm, 10 to 19 mm, and ≥ 20 mm in size. Furthermore, the frequency of SSL-D/SSL-cancer was determined in each group. Results The prevalence of SSL was 2.9% (1328/45799). This prevalence was 1.8% (112/6192) in 2015 and 4.2% (230/5500) in 2022, indicating an increasing trend over time. A total of 1825 lesions were assessed: 1751 (96.0%), 55 (3.0%), 14 (0.8%), and 5 (0.3%) of lesions were SSL, SSL with low-grade dysplasia, SSL with high-grade dysplasia and SSL-cancer, respectively. Stratifying the SSLs by size: 0 to 5 mm, 5 to 9 mm, 10 to 19 mm, and ≥ 20 mm, SSLD and SSL-cancer rates were 2.3% (10/429), 2.4% (16/674), 5.3% (31/584), and 11.8% (16/136), respectively. SSLD and SSL-cancer were observed in 2.4% (26/1103) of small SSLs < 10 mm. Conclusions In cases of SSL, the rate of SSLD and SSL-cancer increased as the lesion diameter increased. A certain rate of SSLD and SSL-cancer was observed even in small SSLs less than 5mm.

6.
Clin Endosc ; 2024 Mar 22.
Artigo em Inglês | MEDLINE | ID: mdl-38514988

RESUMO

With increasing global life expectancy, the significance of geriatric assessment parameters has increased. Sarcopenia is a crucial assessment parameter and is defined as the age-related loss of muscle mass and strength. Sarcopenia is widely acknowledged as a risk factor for postoperative complications in diverse advanced malignancies and has a detrimental effect on the long-term prognosis. While most studies have primarily concentrated on the correlation between sarcopenia and advanced cancer, more recent investigations have focused on the relationship between sarcopenia and early-stage cancer. Endoscopic submucosal dissection (ESD), which is less invasive than surgical intervention, is extensively employed in the management of early-stage cancer, although it is associated with complications such as bleeding and perforation. In recent years, several reports have revealed the adverse consequences of sarcopenia in patients with early-stage cancer undergoing ESD. This literature review briefly summarizes the recent studies on the association between sarcopenia and ESD.

7.
World J Gastrointest Endosc ; 15(12): 690-698, 2023 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-38187913

RESUMO

BACKGROUND: Accurate diagnosis and early resection of colorectal polyps are important to prevent the occurrence of colorectal cancer. However, technical factors and morphological factors of polyps itself can lead to missed diagnoses. Image-enhanced endoscopy and chromoendoscopy (CE) have been developed to facilitate an accurate diagnosis. There have been no reports on visibility using a combination of texture and color enhancement imaging (TXI) and CE for colorectal tumors. AIM: To investigate the visibility of margins and surfaces with the combination of TXI and CE for colorectal lesions. METHODS: This retrospective study included patients who underwent lower gastrointestinal endoscopy at the Toyoshima Endoscopy Clinic. We extracted polyps that were resected and diagnosed as adenomas or serrated polyps (hyperplastic polyps and sessile serrated lesions) from our endoscopic database. An expert endoscopist performed the lower gastrointestinal endoscopies and observed the lesion using white light imaging (WLI), TXI, CE, and TXI + CE modalities. Indigo carmine dye was used for CE. Three expert endoscopists rated the visibility of the margin and surface patterns in four ranks, from 1 to 4. The primary outcomes were the average visibility scores for the margin and surface patterns based on the WLI, TXI, CE, and TXI + CE observations. Visibility scores between the four modalities were compared by the Kruskal-Wallis and Dunn tests. RESULTS: A total of 48 patients with 81 polyps were assessed. The histological subtypes included 50 tubular adenomas, 16 hyperplastic polyps, and 15 sessile serrated lesions. The visibility scores for the margins based on WLI, TXI, CE, and TXI + CE were 2.44 ± 0.93, 2.90 ± 0.93, 3.37 ± 0.74, and 3.75 ± 0.49, respectively. The visibility scores for the surface based on WLI, TXI, CE, and TXI + CE were 2.25 ± 0.80, 2.84 ± 0.84, 3.12 ± 0.72, and 3.51 ± 0.60, respectively. The visibility scores for the detection and surface on TXI were significantly lower than that on CE but higher than that on WLI (P < 0.001). The visibility scores for the margin and surface on TXI + CE were significantly higher than those on CE (P < 0.001). In the sub-analysis of adenomas, the visibility for the margin and surface on TXI + CE was significantly better than that on WLI, TXI, and CE (P < 0.001). In the sub-analysis of serrated polyps, the visibility for the margin and surface on TXI + CE was also significantly better than that on WLI, TXI, and CE (P < 0.001). CONCLUSION: TXI + CE enhanced the visibility of the margin and surface compared to WLI, TXI, and CE for colorectal lesions.

8.
Diagnostics (Basel) ; 13(7)2023 Mar 28.
Artigo em Inglês | MEDLINE | ID: mdl-37046502

RESUMO

The ABC method is a classification method used for stratifying the risk of gastric cancer. However, whether the ABC method should be performed only once or multiple times throughout an individual's lifetime remains unclear. Therefore, this study aimed to analyze whether performing ABC screening twice in a lifetime is useful. We retrospectively analyzed the data of individuals who participated in health checkups in 2010 and 2015. We collected data on patient characteristics, pepsinogen levels, anti-Helicobacter pylori antibody titers, and the presence of gastric cancer. Overall, 7129 participants without a history of H. pylori eradication were included in this study. The participants' average age in 2010 was 48.4 ± 8.3 years, and 58.1% were male. In addition, 11 and 20 cases of new H. pylori infection (0.15%) and spontaneous eradication (0.28%), respectively, were recorded. No significant difference was found in the incidence of gastric cancer between participants who underwent the ABC method once and those who underwent it twice (Group A: 0.16% vs. 0.16%; Group B: 0.47% vs. 0.39%; and Group C + D: 1.97% vs. 1.82%). Therefore, performing the ABC method twice, 5 years apart, does not significantly improve gastric cancer risk stratification.

9.
Anat Sci Int ; 97(4): 347-357, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35113344

RESUMO

Tissue-hardening effect and health-hazard issue of formaldehyde (FA) have long been a great disadvantage of this conventional fixative in anatomical research. We recently developed a FA-free embalming method for cadavers which utilizes N-vinyl-2-pyrrolidone (NVP) and enables assessment of motion kinetics by maintaining the softness of embalmed tissue. By assessing the feasibility of NVP-embalmed tissue to mimic vocalization, this study aimed to prove the potential of embalmed cadavers, which have previously been used only for the understanding of anatomical morphology, for the assessment of precise motion physiology in the human body. Ten cadavers embalmed in NVP (n = 6) and FA (n = 4) were incorporated in this study. Excised larynges underwent experimental phonation to mimic vocalization with fast and pliable vibration of vocal folds. High-speed digital imaging was utilized for the assessment of vocal fold vibration. Furthermore, acoustic analysis of the voiced sound, and reproducibility examination were also performed. Regular vocal fold vibrations successfully produced voiced sounds during experimental phonation using NVP-embalmed larynges. The vibratory frequency, vibration amplitude, and stretch rate of the vocal folds were comparable to those of living humans. Six months after the first experiment, the vocal parameters were reproduced, to suggest the long-term preservation potential of our NVP-embalming technique. On the other hand, neither voiced sound nor vocal fold vibration were observed in FA-embalmed larynges. This novel embalming technique could pioneer the next era to utilize embalmed cadavers for the examination of motion physiology in the human body.


Assuntos
Laringe , Prega Vocal , Cadáver , Embalsamamento , Humanos , Pirrolidinonas , Reprodutibilidade dos Testes , Vibração , Prega Vocal/fisiologia
10.
Curr Oncol ; 29(7): 4678-4688, 2022 07 04.
Artigo em Inglês | MEDLINE | ID: mdl-35877231

RESUMO

Although the mortality rates of gastric cancer (GC) are gradually declining, gastric cancer is still the fourth leading cause of cancer-related death worldwide. This may be due to the high rate of patients who are diagnosed with GC at advanced stages. However, in countries such as Japan with endoscopic screening systems, more than half of GCs are discovered at an early stage, enabling endoscopic resection (ER). Especially after the introduction of endoscopic submucosal dissection (ESD) in Japan around 2000, a high en bloc resection rate allowing pathological assessment of margin and depth has become possible. While ER is a diagnostic method of treatment and may not always be curative, it is widely accepted as standard treatment because it is less invasive than surgery and can provide an accurate diagnosis for deciding whether additional surgery is necessary. The curability of ER is currently assessed by the completeness of primary tumor removal and the possibility of lymph node metastasis. This review introduces methods, indications, and curability criteria for ER of EGC. Despite recent advances, several problems remain unsolved. This review will also outline the latest evidence concerning future issues.


Assuntos
Ressecção Endoscópica de Mucosa , Neoplasias Gástricas , Detecção Precoce de Câncer , Mucosa Gástrica/patologia , Mucosa Gástrica/cirurgia , Gastroscopia , Humanos , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgia
11.
Laryngoscope Investig Otolaryngol ; 6(2): 252-260, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33869757

RESUMO

OBJECTIVES: Recent technology manufactured a nasopharyngeal videoscope with pistol-shaped grip (PG). This study aimed to assess the ergonomic feasibility of this novel device in daily ENT practice. METHODS: To assess the ergonomic impact of grip shape on ENT physicians, conventional grip videoscope (CG) and PG were utilized in this study. Surface electromyography (sEMG) was recorded to assess the muscle activity in the upper limb during endoscopy on a training model. Bilateral sEMG recordings were performed including thenar muscle, pronator teres muscle, brachioradialis muscle, and biceps brachii muscle. Mean value of the mean sEMG amplitude throughout the task in triplicated examinations (mMA) with each electrode, total values of four mMAs in both of the grip-side and the insertion tube-side limb muscles, and total value of all eight mMAs were calculated, and compared between CG and PG. Subgroup analyses were also performed in the experienced ENT physicians and the residents. RESULTS: PG provided significantly lower mMA values in thenar muscle and brachioradialis muscle of the grip-side limb compared with CG. Total value of four mMAs in PG was significantly lower compared with that in CG in the grip-side limb, and total value of all eight mMAs in PG was significantly lower compared with that in CG. Furthermore, total value of four mMAs in PG was significantly lower compared with that in CG in the grip-side limb, in both of the subgroups. CONCLUSION: This is the first study to support the idea that the newly designed pistol-grip endoscope may have an ergonomic advantage over conventional endoscope for otolaryngologists in daily practice. LEVEL OF EVIDENCE: 4.

12.
J Neurophysiol ; 104(5): 2487-99, 2010 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-20810689

RESUMO

In this study, we examined the neuronal correlates of frog collision avoidance behavior. Single unit recordings in the optic tectum showed that 11 neurons gave selective responses to objects approaching on a direct collision course. The collision-sensitive neurons exhibited extremely tight tuning for collision bound trajectories with mean half-width at half height values of 0.8 and 0.9° (n = 4) for horizontal and vertical deviations, respectively. The response of frog collision-sensitive neurons can be fitted by a function that simply multiplies the size dependence of its response, e(-αθ(t)), by the image's instantaneous angular velocity θ'(t). Using fitting analysis, we showed that the peak firing rate always occurred after the approaching object had reached a constant visual angle of 24.2 ± 2.6° (mean ± SD; n = 8), regardless of the approaching velocity. Moreover, a linear relationship was demonstrated between parameters l/v (l: object's half-size, v: approach velocity) and time-to-collision (time difference between peak neuronal activity and the predicted collision) in the 11 collision-sensitive neurons. In addition, linear regression analysis was used to show that peak firing rate always occurred after the object had reached a constant angular size of 21.1° on the retina. The angular thresholds revealed by both theoretical analyses were comparable and showed a good agreement with that revealed by our previous behavioral experiments. This strongly suggests that the collision-sensitive neurons of the frog comprise a threshold detector, which triggers collision avoidance behavior.


Assuntos
Comportamento Animal/fisiologia , Neurônios/fisiologia , Colículos Superiores/fisiologia , Animais , Eletrofisiologia , Feminino , Modelos Lineares , Masculino , Percepção de Movimento/fisiologia , Rana catesbeiana , Vias Visuais/fisiologia
13.
Auris Nasus Larynx ; 34(2): 249-51, 2007 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-16905284

RESUMO

Laryngeal carcinoma presenting as a cervical abscess is rare, so that its diagnosis is not easy. We described a case of laryngeal squamous cell carcinoma presenting as a prelaryngeal large abscess. Markedly swollen false vocal fold inhibited fiberscopic examination of the vocal folds. CT scan indicated destruction of the thyroid cartilage. Although biopsies from the abscess did not reveal malignancy, laryngeal squamous cell carcinoma was confirmed by laryngomicrosurgery with laryngeal vestibulectomy. The patient was treated by total laryngectomy with neck dissection followed by radiotherapy. The abscess was thought to be formed not by direct extension and necrosis of the tumor, but by the leakage of air and mucus through the fistula on the destroyed thyroid cartilage. Precise observation and biopsy under directscopic vestibulectomy played an important role in diagnosis of malignancy inherent in severe inflammatory tissues.


Assuntos
Abscesso/etiologia , Carcinoma de Células Escamosas/diagnóstico , Doenças da Laringe/etiologia , Neoplasias Laríngeas/diagnóstico , Infecções Estreptocócicas/etiologia , Streptococcus milleri (Grupo) , Abscesso/cirurgia , Carcinoma de Células Escamosas/radioterapia , Carcinoma de Células Escamosas/cirurgia , Terapia Combinada , Diagnóstico Diferencial , Humanos , Doenças da Laringe/cirurgia , Neoplasias Laríngeas/radioterapia , Neoplasias Laríngeas/cirurgia , Laringectomia , Laringoscopia , Masculino , Microcirurgia , Pessoa de Meia-Idade , Esvaziamento Cervical , Radioterapia Adjuvante , Reoperação , Infecções Estreptocócicas/cirurgia , Tomografia Computadorizada por Raios X
14.
J Exp Zool A Ecol Integr Physiol ; 327(10): 600-610, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-29532620

RESUMO

Toads on the ground control landing behavior by a simple strategy in which they extend their elbows at roughly the same time after take-off and continue extending them at the same velocity until they land. However, this simple strategy does not work well in much more complicated arboreal habitat. We analyzed properties of jumping and timing of forelimb extension of the tree frog, Hyla japonica, to demonstrate how the arboreal species land safely. The results showed that distance, duration, and velocity of jump were not affected by explicit optic flow information, whereas the all three parameters decreased significantly in the blindfolded animals. This suggests that the frogs do not use optic flow information during flight but need visual information to plan a jump to reach the destination appropriately. Many animals generate prelanding behavior when time-to-contact reaches a threshold value. However, the results showed that a significant positive correlation was found between jump duration and time-to-contact both in normal and blindfolded animals. The slopes and the intercepts of the linear regression lines were about 0.8 and about 50 msec, respectively, in both cases. These suggest that, without any visual inputs, the animal can make the decision for prelanding forelimb extension at 20% of jump duration and start extending the forelimb after a motor delay of about 50 msec as in the normal condition. This strategy enables the tree frog to always maintain 80% of the jump duration to prepare for landing in their complex habitat.


Assuntos
Anuros/fisiologia , Membro Anterior/fisiologia , Locomoção , Animais , Fenômenos Biomecânicos
15.
JA Clin Rep ; 2(1): 10, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-29497665

RESUMO

Unanticipated difficult airway is a challenging problem for anesthesiologists. Oropharyngeal stenosis (OPS) is a rare complication of upper airway surgery which may cause difficult airway. We present a patient whose postsurgical OPS was revealed during the induction of general anesthesia, and necessitated reschedule of surgery and tracheotomy. We also discuss the etiology and risk factors of postsurgical OPS.

16.
Br J Ophthalmol ; 86(2): 140-3, 2002 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-11815335

RESUMO

AIMS: To describe the results of a study of the incidence of conjunctival ulceration and its pathology as a manifestation of Behçet's syndrome. METHODS: The authors reviewed retrospectively medical charts of 152 patients with Behçet's syndrome seen at the uveitis service of Okayama University Hospital from January 1995 to December 1999. Criteria used to diagnose Behçet's syndrome in this study required the presence of oral aphthous ulceration plus any two of three other manifestations-genital ulceration, eye lesions such as iridocyclitis and uveoretinitis, or skin lesions such as erythema nodosum. The presence of conjunctival ulceration was determined in patients with Behçet's syndrome through standardised ophthalmological examinations. A biopsy of the conjunctival ulceration was performed in one patient. The incidence of conjunctival ulceration in patients with Behçet's syndrome was calculated and the clinical and pathological features of this ulceration were examined. RESULTS: Four of 152 patients (2.6%) developed conjunctival ulceration in concordance with exacerbation of their systemic symptoms. Histopathological examinations of a conjunctival biopsy specimen in one patient revealed intraepithelial and perivascular infiltration with neutrophils and lymphocytes, consistent with Behçet's syndrome. The conjunctival ulcerations of the study patients showed good response to topical corticosteroids or topical steroids plus oral colchicine. CONCLUSIONS: Conjunctival ulceration should be noted as an uncommon but possible manifestation of Behçet's syndrome. Accordingly, routine examination of the conjunctiva is recommended in patients with Behçet's syndrome, and Behçet's syndrome should be included in a list of differential diagnoses for patients with conjunctival ulcerations.


Assuntos
Síndrome de Behçet/patologia , Doenças da Túnica Conjuntiva/patologia , Úlcera/patologia , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
17.
Laryngoscope ; 114(4): 726-32, 2004 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-15064631

RESUMO

OBJECTIVES/HYPOTHESIS: The authors have designed a rat laryngeal paralysis model to study gene transfer strategies using a muscle-specific expression system to enhance local delivery of human insulin-like growth factor-1 (hIGF-1). In preliminary studies, a nonviral vector containing the alpha-actin promoter and human hIGF-1 sequence produced both neurotrophic and myotrophic effects 1 month after single injection of plasmid formulation into paralyzed rat thyroarytenoid muscle in vivo. Based on these findings, it is hypothesized that the effects of hIGF-1 will enhance the results of laryngeal muscle innervation procedures. The timing of gene delivery relative to nerve repair is likely to be important, to optimize the results. STUDY DESIGN: Prospective analysis. METHODS: The effects of nonviral gene transfer for the delivery of hIGF-1 were evaluated in rats treated immediately following recurrent laryngeal nerve transection and repair and in rats receiving a delayed treatment schedule, 30 days after nerve transection and repair. Gene transfer efficiency was determined using polymerase chain reaction and reverse transcriptase-polymerase chain reaction techniques. Muscle fiber diameter, motor endplate length, and percentage of motor endplates with nerve contact were examined to assess hIGF-1 trophic effects. RESULTS: Compared with reinnervated untreated control samples, both early and delayed hIGF-1 transfer resulted in significant increase in muscle fiber diameter. Motor endplate length was significantly decreased and nerve/motor endplate contact was significantly increased following delayed gene transfer, but not after early treatment. CONCLUSION: We infer from results of the study that delayed hIGF-1 gene transfer delivered by a single intramuscular injection will enhance the process of muscle reinnervation. The clinical relevance of these findings supports the future application of gene therapy using nonviral vectors for management of laryngeal paralysis and other peripheral nerve injuries.


Assuntos
Terapia Genética/métodos , Proteínas de Ligação a Fator de Crescimento Semelhante a Insulina/genética , Músculos Laríngeos/inervação , Proteínas da Gravidez/genética , Paralisia das Pregas Vocais/patologia , Paralisia das Pregas Vocais/terapia , Animais , Técnicas de Transferência de Genes , Proteína 1 de Ligação a Fator de Crescimento Semelhante à Insulina , Fibras Musculares Esqueléticas/patologia , RNA Mensageiro/genética , Ratos , Reação em Cadeia da Polimerase Via Transcriptase Reversa
18.
Laryngoscope ; 114(2): 368-71, 2004 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-14755220

RESUMO

OBJECTIVES/HYPOTHESIS: To determine whether the myotrophic activity of human insulin-like growth factor (hIGF)-1 promotes restoration of normal myosin heavy chain (MHC) composition after nerve injury, MHC composition was analyzed after hIGF-1 gene transfer in denervated rat laryngeal muscle. STUDY DESIGN: Animal model to study effects of gene transfer on laryngeal paralysis. METHODS: In anesthetized rats, the left recurrent and superior laryngeal nerves are cut and suture ligated. A midline thyrotomy is performed, and the thyroarytenoid muscle is injected with a polyvinyl-based formulation containing a muscle specific expression system and hIGF-1 DNA (treatment group) or saline (control group). After 30 days, animals were killed, and the thyroarytenoid muscle was removed and processed for sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE). Densitometric measurements were obtained to determine composition of MHCs. RESULTS: As previously described, MHC composition in denervated laryngeal muscle was characterized by a decrease in type IIB and IIL and up-regulation of IIA/IIX. Compared with controls, hIGF-1 treated animals demonstrated a significant increase in expression of type IIB and IIL and a significant decrease in expression of type IIA/X. CONCLUSIONS: These findings suggest that the myotrophic effect of hIGF-1 gene transfer results in normalization of MHC composition in denervated muscle, with suppression of type IIA/X MHC and promotion of type IIL expression.


Assuntos
Técnicas de Transferência de Genes , Músculos Laríngeos/metabolismo , Cadeias Pesadas de Miosina/análise , Animais , Eletroforese em Gel de Poliacrilamida , Terapia Genética/métodos , Fator de Crescimento Insulin-Like I/genética , Músculos Laríngeos/inervação , Denervação Muscular , Ratos , Ratos Sprague-Dawley , Paralisia das Pregas Vocais/terapia
19.
Otolaryngol Head Neck Surg ; 130(2): 217-22, 2004 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-14990919

RESUMO

OBJECTIVE: This study examines the differential expression of myosin heavy chain (MyHC) components in human laryngeal muscle groups. STUDY DESIGN: A battery of monospecific monoclonal antibodies in Western blots was used to determine expression of IIX, extraocular-specific (EOM), and IIB MyHCs for the thyroarytenoid (TA), vocalis (VOC), lateral cricoarytenoid (LCA), cricothyroid (CT), and posterior cricoarytenoid (PCA) muscles obtained from fresh cadaver specimens. RESULTS: Fast IIX MyHC was only expressed in the TA, VOC, and LCA muscles. Fast IIA and slow MyHCs were expressed in all laryngeal muscles including the CT and PCA. The CT with mixed phonatory and respiratory function and the PCA with respiratory function did not express IIX MyHC. The 2 MyHC isoforms associated with the highest speeds of contraction in rat laryngeal muscle, namely, the EOM MyHC and IIB MyHC, were not detected in human laryngeal muscles. Novel MyHC bands were not detected in SDS-PAGE gels or Western blots using a broad specificity MyHC antibody. CONCLUSION: The profile of MyHC expression in human laryngeal muscles differs from that observed in human extraocular and masticator muscles, and other mammalian species. Our data demonstrate that IIX MyHC expression is associated primarily with muscles affecting glottic closure and is absent in CT and PCA. SIGNIFICANCE: A higher percentage of IIX MyHC is expected to impart a high speed of shortening to the TA and LCA muscles. The absence of IIX MyHC in muscles with respiratory (PCA) and mixed respiratory/phonatory function (CT) further supports the inference that the physiologic difference between laryngeal muscles is reflected in the molecular composition of contractile protein.


Assuntos
Cartilagens Laríngeas/metabolismo , Músculos Laríngeos/metabolismo , Cadeias Pesadas de Miosina/metabolismo , Idoso , Anticorpos Monoclonais , Western Blotting , Densitometria , Eletroforese em Gel de Poliacrilamida , Humanos , Pessoa de Meia-Idade , Isoformas de Proteínas/metabolismo
20.
J Colloid Interface Sci ; 263(1): 1-3, 2003 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-12804877

RESUMO

Solubilization of fullerene into water was studied by the use of fluoroalkyl end-capped acryloylmorpholine oligomers, N,N-dimethylacrylamide oligomers, and acrylic acid oligomers. In these fluorinated oligomers, fluoroalkyl end-capped acryloylmorpholine oligomers were more effective in solubilizing fullerene into water. Interestingly, the aqueous solutions of fullerene were applicable to fluorescence analyses.


Assuntos
Fulerenos/química , Espectrometria de Fluorescência/métodos , Acrilamidas/química , Modelos Químicos , Fatores de Tempo , Raios Ultravioleta , Água/química
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