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Journal of Stroke and Cerebrovascular... Feb 2014Laterality of bolus passage in the pharynx is often seen in patients with medullary infarction. We evaluated the dominant side of bolus passage in the pharynx and...
Laterality of bolus passage in the pharynx is often seen in patients with medullary infarction. We evaluated the dominant side of bolus passage in the pharynx and investigated the factors that cause the passage to dominantly occur on the affected side. Forty-one patients (35 men and 6 women, 64 ± 9 years) with unilateral medullary infarction participated in this study. Bolus passage of 4 mL of thick liquid was evaluated in 3 regions (oropharyngeal, thyropharyngeal, and cricopharyngeal) and classified into 4 patterns (dominantly on the unaffected side [UAS], on both sides without clear laterality [BS], dominantly on the affected side [AS], and nonpassage of the bolus [NP]) by videofluoroscopic examination of swallowing. The bolus passages were as follows: UAS, BS, and AS occurred in 2, 32, and 7 patients in the oropharyngeal region; UAS, BS, and AS occurred in 5, 20, and 16 patients in the thyropharyngeal region; and UAS, BS, AS, and NP occurred in 11, 9, 10, and 11 patients in the cricopharyngeal region, respectively. In the thyropharyngeal region, the proportion of patients in whom the swallowing reflex occurred when the bolus was in the oropharynx and the proportion of patients with unilateral pharyngeal constrictor paralysis were greater in patients whose bolus passage was AS than in patients whose passage was BS. This suggests that the bolus predominantly passed through the affected side of the thyropharyngeal portion because of the asymmetry of pharyngeal contraction during swallowing in the early period after onset.
Topics: Adult; Aged; Brain Stem Infarctions; Deglutition; Deglutition Disorders; Female; Fluoroscopy; Functional Laterality; Humans; Magnetic Resonance Imaging; Male; Medulla Oblongata; Middle Aged; Pharynx; Reflex; Time Factors; Tomography, X-Ray Computed; Video Recording
PubMed: 23540256
DOI: 10.1016/j.jstrokecerebrovasdis.2013.02.019 -
Pathology Annual 1975The main histopathologic features of infectious mononucleosis are described. In the lymph nodes, the principal change is the appearance of numerous large pyroninophilic... (Review)
Review
The main histopathologic features of infectious mononucleosis are described. In the lymph nodes, the principal change is the appearance of numerous large pyroninophilic cells (immunoblasts), initially expanding the paracortical zone but later extending throughout the node. Similar, large lymphoid cells appear as infiltrates in many other organs and tissues. Cells morphologically similar to Sternberg-Reed cells may be found in the lymph nodes of patients with infectious mononucleosis and other conditions apart from Hodgkin's disease. The diagnostic importance of considering not only the Sternberg-Reed cells but their milieu is stressed. A possible relationship between infectious mononucleosis and lymphoreticular malignancy is suggested by a number of observations, but a definite etiologic link is yet to be established.
Topics: Bone Marrow; Bone Marrow Cells; Child; Herpesvirus 4, Human; Histiocytes; Hodgkin Disease; Humans; Infectious Mononucleosis; Liver; Lymph Nodes; Necrosis; Nervous System; Palatine Tonsil; Spleen
PubMed: 170576
DOI: No ID Found -
Chinese Journal of Cancer Oct 2013Postradiation nasopharyngeal necrosis is an important late effect of radiotherapy that affects prognosis in patients with nasopharyngeal carcinoma. In the present study,...
Postradiation nasopharyngeal necrosis is an important late effect of radiotherapy that affects prognosis in patients with nasopharyngeal carcinoma. In the present study, we reviewed the clinical and imaging features of 67 patients with pathologically diagnosed postradiation nasopharyngeal necrosis who were treated at Sun Yat-sen University Cancer Center between June 2006 and January 2010. Their clinical manifestations, endoscopic findings, and imaging features were analyzed. Early nasopharyngeal necrosis was limited to a local site in the nasopharyngeal region, and the tissue defect was not obvious, whereas deep parapharyngeal ulcer or signs of osteoradionecrosis in the basilar region was observed in serious cases. Those with osteoradionecrosis and/or exposed carotid artery had a high mortality. In conclusion, Postradiation nasopharyngeal necrosis has characteristic magnetic resonance imaging appearances, which associate well with clinical findings, but pathologic examination is essential to make the diagnosis.
Topics: Adult; Aged; Carcinoma; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Nasopharyngeal Carcinoma; Nasopharyngeal Neoplasms; Nasopharynx; Necrosis; Osteoradionecrosis; Radiation Injuries; Radiotherapy, Intensity-Modulated
PubMed: 23816556
DOI: 10.5732/cjc.012.10252 -
Dysphagia 2001Hypertrophy of the cricopharyngeal muscle is a serious clinical condition that can cause severe dysphagic symptoms, including prolonged deglutition and postdeglutitive... (Review)
Review
Hypertrophy of the cricopharyngeal muscle is a serious clinical condition that can cause severe dysphagic symptoms, including prolonged deglutition and postdeglutitive aspiration. Although the therapeutical concepts are well established, the pathogenic mechanism of cricopharyngeal hypertrophy remains unclear. We present a patient with a ten-year history of progressive dysphagia. The neurological and MRI findings were normal. However, videocineradiography showed severe hypertrophy of the cricopharyngeal muscle. This condition was first treated by injections of botulinum toxin, which did not alleviate the symptoms. Next, myotomy and muscle biopsy were performed. Histological evaluation disclosed lymphoplasmacellular florid myositis, single-fiber atrophy, and muscle fiber necrosis with phagocytosis. There were no signs of inclusion body myositis or oculopharyngeal muscular dystrophy. Our finding of severe cricopharyngeal muscle hypertrophy associated with myositis has been published previously (n = 34). The study presented here shows cricopharyngeal dysphagia associated with various systemic diseases, including motor neuron disease, general granulomatous disease, dermatomyositis, or inclusion body myositis. Isolated changes of the cricopharyngeal muscle were described in 65% of the cases.
Topics: Aged; Deglutition Disorders; Female; Humans; Hypertrophy; Myositis; Pharyngeal Muscles
PubMed: 11720399
DOI: 10.1007/s00455-001-0082-8 -
Journal of Clinical Anesthesia 1994Uvular necrosis as a potential source of infection is a poorly detected complication that should be considered as part of the differential diagnosis of postoperative...
Uvular necrosis as a potential source of infection is a poorly detected complication that should be considered as part of the differential diagnosis of postoperative sore throat. We report a unique case of uvular necrosis following endotracheal intubation. The patient complained of a severe sore throat and foreign body sensation 48 hours following surgery.
Topics: Adolescent; Diagnosis, Differential; Foreign Bodies; Humans; Intubation, Intratracheal; Male; Necrosis; Pharyngitis; Pharynx; Uvula
PubMed: 8204233
DOI: 10.1016/0952-8180(94)90012-4 -
Sleep & Breathing = Schlaf & Atmung Jun 2021Raftlin is a large, major lipid raft protein of cell membranes. Raftlin levels have not been previously examined in patients with obstructive sleep apnea (OSA). Our...
BACKGROUND
Raftlin is a large, major lipid raft protein of cell membranes. Raftlin levels have not been previously examined in patients with obstructive sleep apnea (OSA). Our study aimed to evaluate the changes in raftlin, interleukin-6 (IL-6), interleukin-8 (IL-8), and tumor necrosis factor alpha (TNFα) values from the preoperative state to the third month postoperatively in patients undergoing expansion sphincter pharyngoplasty for OSA.
METHODS
Of 60 patients, 10 patients had mild OSA (AHI 5-14), 10 moderate (AHI 15-29), 10 severe (AHI ≥ 30), and 30 with AHI < 5 formed a control group. Preoperatively and at 3 months post-operatively, IL-6, IL-8, TNFα, and raftlin values were measured.
RESULTS
Preoperatively, mean raftlin levels were 914.4 ± 62.7 pg/mL for controls, 910.0 ± 42.5 pg/mL in mild, 1000.5 ± 63.3 pg/mL in moderate, and 1386.3 ± 101.4 pg/mL in severe groups, with moderate and severe groups significantly elevated compared to controls (p < 0.001). Preoperatively to 3 months post-operatively, raftlin levels decreased significantly in each OSA group (p < 0.05). Levels of IL-6, IL-8 and TNFα followed similar patterns at baseline and after surgical intervention.
CONCLUSIONS
Raftlin levels at the third postoperative month decreased significantly compared with preoperative levels in parallel with other markers of inflammation.
Topics: Adult; Female; Humans; Interleukin-6; Interleukin-8; Male; Membrane Proteins; Middle Aged; Patient Acuity; Pharynx; Postoperative Period; Preoperative Period; Sleep Apnea, Obstructive; Treatment Outcome; Tumor Necrosis Factor-alpha
PubMed: 32776303
DOI: 10.1007/s11325-020-02161-7 -
Hematology/oncology Clinics of North... Oct 2005Persons with sickle cell disease (SCD) are more likely to undergo surgery than are the general population during their lifetime. For example, cholecystectomy as a... (Review)
Review
Persons with sickle cell disease (SCD) are more likely to undergo surgery than are the general population during their lifetime. For example, cholecystectomy as a consequence of gallstones is more frequent in persons with SCD, as is hip arthroplasty in younger people as a result of avascular necrosis of the femoral head. Because surgery exposes patients to many of the factors that are known to precipitate red blood cell sickling, persons with SCD undergoing surgery require meticulous clinical care to prevent perioperative sickle cell-related complications. Even with meticulous care, approximately 25% to 30% of patients will have a postoperative complication. This article provides readers with information about the role of surgery in SCD and the measures that should be taken to ensure patients are well cared for in the perioperative period.
Topics: Anemia, Sickle Cell; Arthroplasty, Replacement, Hip; Cholecystectomy; Cholelithiasis; Femur Head Necrosis; Humans; Hyperplasia; Palatine Tonsil; Preoperative Care; Splenectomy; Splenic Diseases; Tonsillectomy
PubMed: 16214650
DOI: 10.1016/j.hoc.2005.07.004 -
Necrosis of the intranasal structures and soft palate as a result of heroin snorting: a case series.Substance Abuse 2013The link between nasal inhalation of cocaine and nasal and palatal necrosis is well documented. In contrast, few data are available concerning nasal mucosa necrosis...
BACKGROUND
The link between nasal inhalation of cocaine and nasal and palatal necrosis is well documented. In contrast, few data are available concerning nasal mucosa necrosis related to heroin snorting. The authors report here the retrospective analysis of 24 cases of orofacial lesions in patients with nasal heroin usage, collected between 2006 and 2012.
CASES
The cases concern 17 males and 7 females (median age 29.5 (range: 24-42)) with chronic consumption of intranasal heroin (from 2 months to more than 10 years). Six patients had a history of cocaine abuse. The median daily amount of heroin consumption was 5 g (range: 0.5-10). The complications were nasal perforation (11 cases), nasal ulceration or erythema (5 cases), nasal septum necrosis (5 cases), pharyngeal ulceration (3 cases), and palate damages (5 cases). The most common clinical signs and symptoms were nasal pain, purulent sputum, dysphagia, and rhinitis. Maintenance therapy with methadone (19 cases) or buprenorphine (3 cases) was initiated. In 8 cases, the injury improved.
DISCUSSION
The potential of heroin to induce destructive orofacial lesions should be considered when nasal damages are observed in patients with drug abuse. A multidisciplinary approach seems to be the most effective means of managing such patients.
Topics: Administration, Intranasal; Adult; Buprenorphine; Female; Heroin; Heroin Dependence; Humans; Male; Methadone; Necrosis; Nose; Opiate Substitution Treatment; Palate, Soft; Pharynx
PubMed: 24159913
DOI: 10.1080/08897077.2013.781565 -
Sleep Medicine Jun 2010Obstructive sleep apnea (OSA) is common after stroke and associated with poor stroke outcomes. Whether OSA after acute stroke is caused by anatomic, physiologic, or both...
BACKGROUND
Obstructive sleep apnea (OSA) is common after stroke and associated with poor stroke outcomes. Whether OSA after acute stroke is caused by anatomic, physiologic, or both etiologies has not been studied. We therefore used brain magnetic resonance imaging (MRI) scans to assess oropharyngeal anatomy in stroke patients with and without OSA.
METHODS
Patients within 7 days of ischemic stroke underwent nocturnal polysomnography. Sagittal T1-weighted MRI performed for clinical purposes was used to measure retropalatal distance, soft palatal length, soft palatal thickness, retroglossal space, and tongue length. Nasopharyngeal area and high retropharyngeal area were measured from axial T2-weighted images, and lateral pharyngeal wall thickness from coronal T1-weighted images.
RESULTS
Among 27 subjects, 18 (67%) had OSA (apnea/hypopnea index (AHI)5). Demographics, vascular risk factors, and stroke severity were similar in the two groups. Median retropalatal distance was shorter in subjects with OSA (Wilcoxon rank-sum test, p=0.03). Shorter retropalatal distance was associated with higher AHI (linear regression, p=0.04). None of the other morphological characteristics differed.
CONCLUSIONS
Anatomic difference between awake acute stroke patients with and without OSA shows that the sleep disorder cannot be attributed solely to sleep, sleeping position, or changes in neuromuscular control that are specific to the sleep state.
Topics: Aged; Airway Resistance; Cerebral Infarction; Female; Humans; Image Processing, Computer-Assisted; Magnetic Resonance Imaging; Male; Middle Aged; Nasopharynx; Organ Size; Oxygen; Pharynx; Polysomnography; ROC Curve; Reference Values; Sleep Apnea, Obstructive; Wakefulness
PubMed: 20466584
DOI: 10.1016/j.sleep.2010.01.008 -
European Annals of Otorhinolaryngology,... Dec 2017
Topics: Aged; Anti-Bacterial Agents; Biopsy; Chronic Disease; Diagnosis, Differential; Female; Humans; Laryngoscopy; Levofloxacin; Nasopharyngitis; Nasopharynx; Necrosis; Pigmentation; Treatment Outcome; Ulcer
PubMed: 28673656
DOI: 10.1016/j.anorl.2016.11.013