Long-term results of surgical treatment of dysphagia secondary to cervical diffuse idiopathic skeletal hyperostosis

Background contextLarge, prominent osteophytes along the anterior aspect of the cervical spine have been reported as a cause of dysphagia. Improvement of swallowing after surgical resection has been reported in a few case reports with short-term follow-up. The current report describes outcomes of a series of five patients with surgical treatment for this rare disorder, with a long-term follow-up.PurposeTo study the clinical and radiographic outcomes of a case series of patients surgically treated for dysphagia secondary to cervical diffuse idiopathic skeletal hyperostosis (DISH).Study designRetrospective review of a case series.Patient sampleFive cases from a University Hospital.Outcome measuresClinical and imagenological follow-up.MethodsThe records of five patients with dysphagia who had undergone anterior surgical resection of prominent osteophytes secondary to DISH were reviewed. Extrinsic esophageal compression secondary to anterior cervical osteophytes was radiographically confirmed via preoperative barium esophagogram swallowing study. All patients underwent anterior cervical osteophytes resection without fusion. Postoperatively, patients were followed-up clinically and radiographically with routine lateral cervical radiographs.ResultsPreoperative esophagogram showed that the esophageal obstruction was present at one level in three cases and two levels in two cases. The C3–C4 level was involved in three cases, C4–C5 in three cases, and C5–C6 in one case. There were no postoperative complications, including recurrent laryngeal nerve palsy, wound infection, or hematomas. All patients had resolution of dyphagia soon after surgery (within 2 weeks). Postoperative radiographs demonstrated complete removal of osteophytes. At final follow-up, ranging from 1 to 9 years (average 59.8 months, median 53 months), no patients reported recurrence of dysphagia. Final radiographic examination demonstrated minimal regrowth of the osteophytes.ConclusionsAlthough rarely indicated, surgical resection of anterior cervical osteophytes from DISH causing dyphagia produces good clinical and radiographical outcomes. After thorough evaluation to rule out other intrinsic or extrinsic causes of swallowing difficulty, surgical treatment of this uncommon condition might be considered.     

社区卫生服务信息系统功能建模研究

理顺功能关系、理清业务流程是构建社区卫生服务信息系统的前提和基础,功能建模是理顺功能关系的一个重要手段。在研究现有的各种功能分析方法的基础上,本文以IDEF0模型方法为基础,提出了社区卫生服务信息系统功能建模方法。通过建立功能、数据和约束之间的内在联系,为系统的功能设计和数据分析提供了基础。     

丙帕锗的制备及分析

目的 探索合成条件，制备体内活性和稳定性好的高聚物丙帕锗．并分析其结构确定目的物的正确性。方法 以GeO2为起始原料，磷酸二氢钠为还原剂,制备3-氧锗丙烯酸低分子量聚合物和高分子量3-氧锗丙烯酸(丙帕锗)，并进行元素、红外光谱、核磁共振和X-射线的分析。结果 高分子量聚合物生成，在320℃以下不分解，终产率为72．9％。结论 所采用的方法可行，合成的产品结构正确。     

NEWLY DEVELOPED ULTRASOUND ENDOSCOPE WITH AN ELECTRONIC RADIAL ARRAY TRANSDUCER

A prototype electronic radial scan ultrasound endoscope has been developed by Olympus (Tokyo, Japan) for endoscopic ultrasound (EUS) study. The ultrasound view‐angle of this model is 360° vertical to the scope. Though the diameter of the scanner and the shaft of the scope is bigger than those of the present mechanical radial scan model, clinical manipulation of the new scope is the same as that of the present model. Image quality of the ultrasound picture demonstrated by the electronic radial model was as clear as those provided by the mechanical radial scan model. Ultrasound penetration was better and satisfactory because of less echoic reduction compared to the mechanical radial model. The newly developed electronic radial model can be evaluated as an ultrasound endoscope for the next generation. The advantage of this system is to facilitate the clinical use of color Doppler function and tissue harmonic imaging, and this system can be operated by the same monitor unit as a convex model of ultrasound endoscope.     

Differing time courses between Δlactate and mitochondrial respiration during coronary occlusion and after reperfusion in canine hearts

Summary The present study was designed to clarify whether or not a difference between arterial and venous lactate (0422055h6rl568/xxlarge916.gif" alt="Delta" align="BASELINE" BORDER="0">lactate) levels is useful for evaluation of mitochondrial function in ischemia-reperfused myocardium. In the first experiment, 12 dogs were divided into 2 groups: 10-min occlusion of the left anterior descending coronary artery (LAD) followed by 10-min reperfusion, or 30-min occlusion followed by 40-min reperfusion, were performed. The lactate levels in the femoral artery and the great cardiac vein were measured enzymatically. 0422055h6rl568/xxlarge916.gif" alt="Delta" align="BASELINE" BORDER="0">Lactate was reversed immediately after occlusion. Ten min and 20 min were required for the recovery of 0422055h6rl568/xxlarge916.gif" alt="Delta" align="BASELINE" BORDER="0">lactate in the 10-min-occlusion with 10-min-reperfusion, and 30-min-occlusion with 40-min-reperfusion groups, respectively. In the second experiment, 36 dogs were divided into 6 groups: 10-min occlusion of LAD; 10-min occlusion with 10-min reperfusion; 30-min occlusion; and 30-min occlusion with 10-, 20-, or 40-min reperfusion were performed. Mitochondria from normal and occluded or reperfused areas were prepared, and the respiratory function of the mitochondria was measured polarographically. No significant decreases in the mitochondrial function were observed in the 10-min-occlusion, and 10-min-occlusion with 10-min-reperfusion groups. On the other hand, respiratory function of mitochondria was impaired by 30-min occlusion and was not improved by 10- or 20-min reperfusion. Significant recovery in the mitochondrial function was observed after 40-min reperfusion. That is, differing recovery time courses between 0422055h6rl568/xxlarge916.gif" alt="Delta" align="BASELINE" BORDER="0">lactate and the mitochondrial function were observed.     

Antiserotonergic inhibition of calcitonin-induced increase of β-endorphin,ACTH, and cortisol secretion

Summary In a previous study we observed that calcitonin increases 05j170173261525/xxlarge946.gif" alt="beta" align="MIDDLE" BORDER="0">-endorphin, ACTH, and cortisol secretion. We assumed that calcitonin might have a modulatory role on the pituitary function. The present study was initiated to clarify whether this effect is due to a direct pituitary stimulation or to an indirect stimulation through CRF (corticotropin releasing factor).Fourteen healthy subjects, aged 30013;60 years were investigated. All the subjects received 100IU Salmon calcitonin Sandoz i.v. at 8a.m. (time 0). Plasma 05j170173261525/xxlarge946.gif" alt="beta" align="MIDDLE" BORDER="0">-endorphin, ACTH and cortisol were estimated every 30min from 013; 30 to 120 min by specific radioimmunoassay. The same parameters were estimated a second time, at the same intervals, when cyproheptadine 8 mg (7 subjects) and 40 mg propranolol (7 subjects) were given per os at 013; 30 min and calcitonin i.v. at time 0. 05j170173261525/xxlarge946.gif" alt="beta" align="MIDDLE" BORDER="0">-endorphin, ACTH and cortisol levels (Mean ±SEM) rose significantly after calcitonin (peak value at 30013;90 min) from 5.2 ±0.7 to 15.1±2.6 pmol/l; from 43.0±2.7 to 70.7±4.1 pg/ml and from 10.6±1.5 to 19.6 ±2.1 05j170173261525/xxlarge956.gif" alt="mgr" align="MIDDLE" BORDER="0">g/100 ml respectively (p< 0.0001 by analysis of variance and covariance and repeated measures). Propranolol 40 mg (per os) administered at time 013; 30 did not alter the response of 05j170173261525/xxlarge946.gif" alt="beta" align="MIDDLE" BORDER="0">-endorphin, ACTH and cortisol to calcitonin (infused at time 0).Cyproheptadine, the antiserotonergic substance that inhibits the synthesis and release of CRF completely inhibited the stimulatory effect of calcitonin.We conclude that probably calcitonin has a modulatory role on the hypothalamo-pituitary adrenal axis and that it acts at the hypothalamic level probably by stimulating CRF secretion.     

Comparison of the size of neuronal and non-neuronal histamine pools in the brain of different rat strains

Summary The size of the neuronal and non-neuronal histamine pools in the brain of three different strains of rats was measured by assuming that the 072557712553u57/xxlarge945.gif" alt="agr" align="BASELINE" BORDER="0">-fluoromethylhistidine-induced maximal decrement of histamine represents the size of the neuronal pool. Although the total histamine levels in the brain showed a considerable interstrain variation, no significant interstrain difference was observed in the neuronal histamine level. These results suggest that the size of the neuronal histamine pool in the brain is relatively stable, whereas the size of the non-neuronal histamine pool is variable.     

Monoamine oxidase-B inhibition: a comparison of in vivo and ex vivo measures of reversible effects

Summary A behavioural test involving potentiation of the effects of an acute injection of 02rh6v77j5/xxlarge946.gif" alt="beta" align="MIDDLE" BORDER="0">-phenylethylamine (10 mg kg^013;1 i.p.) was used to assess the time-course of type-B MAO inhibition after administration of (013;)deprenyl (5 mg kg^013;1 i.p.) and of MD 240928 (20 mg kg^013;1 i.p.) respectively. Potentiation of the effects of 02rh6v77j5/xxlarge946.gif" alt="beta" align="MIDDLE" BORDER="0">-phenylethylamine was observed 1 h after injection of (013;)deprenyl or MD 240928. This effect was still evident 120 h after administration of (013;)deprenyl but not 24 h after administration of MD 240928. Comparisons of ex vivo estimates of MAO activity yielded a corresponding time-course for the recovery of this enzyme. The extent of MAO inhibition required for potentiation of the effects of 02rh6v77j5/xxlarge946.gif" alt="beta" align="MIDDLE" BORDER="0">-phenylethylamine was inferred from a comparison of the behavioural test results and the ex vivo MAO activity observed after (013;)deprenyl administration. These comparisons indicate a significant underestimation of MD 240928-induced MAO inhibition using ex vivo measures. This underestimation is interpreted as evidence fordilution effects in the ex vivo assay of MAO inhibition. The potentiation of effects of 02rh6v77j5/xxlarge946.gif" alt="beta" align="MIDDLE" BORDER="0">-phenylethylamine under the present conditions is proposed as a useful and simple test for effects of reversible type-B MAO inhibitors.     

Prospect for enzyme therapy in glycogenosis II variants: a study on cultured muscle cells

Summary Impairment of skeletal muscle function is the common feature of distinct clinical forms of glycogenosis type II. In the present study, muscle cultures from different patients were used to investigate the cause of clinical heterogeneity and the feasibility of enzyme replacement therapy. The activity of acid 0864817np01rk54/xxlarge945.gif" alt="agr" align="BASELINE" BORDER="0">-glucosidase appears to be the primary factor in determining the extent of lysosomal glycogen storage in muscle, and thereby the clinical severity of the disease. Neutral 0864817np01rk54/xxlarge945.gif" alt="agr" align="BASELINE" BORDER="0">-glucosidases do not seem influencial. Correction of the enzymatic defect was achieved in skeletal muscle cultures from patients by administration of a 0864817np01rk54/xxlarge8220.gif" alt="ldquo" align="MIDDLE" BORDER="0">high-uptake0864817np01rk54/xxlarge8221.gif" alt="rdquo" align="MIDDLE" BORDER="0"> form of acid 0864817np01rk54/xxlarge945.gif" alt="agr" align="BASELINE" BORDER="0">-glucosidase, purified from human urine. The enzyme reaches the lysosomes, including the glycogen storage vacuoles, and the lysosomal glycogen content is reduced to control level. In normal muscle cells 20% of the total cellular glycogen pool is segregated in lysosomal compartments. This percentage is higher than in fibroblasts, which may partly explain why muscles are more prone to store glycogen. The relevance of this study for enzyme therapy is discussed.