Association between dysphagia and tongue strength in patients with amyotrophic lateral sclerosis

IntroductionAmyotrophic lateral sclerosis is the most common motor neuron disease in adults despite it being rare. It is a neurodegenerative disease in which dysphagia is a common and debilitating symptom. Dysphagia can be assessed by complementary exams, such as fiberoptic endoscopic evaluation of swallowing and the tongue strength test, as this is one of the main muscles involved in swallowing.ObjectiveTo compare the results of tongue strength and endurance measured by the Iowa oral performance instrument with the findings of the fiberoptic endoscopic evaluation of swallowing examination in patients affected by amyotrophic lateral sclerosis.MethodsCross-sectional study, carried out in a tertiary hospital specialized in treatment and rehabilitation. Twenty-five patients diagnosed with amyotrophic lateral sclerosis underwent dysphagia questionnaires, fiberoptic endoscopic evaluation of swallowing examination and tongue strength and resistance test with the Iowa oral performance instrument to assess the presence of dysphagia.ResultsForty-eight percent of the sample had dysphagia at the fiberoptic endoscopic evaluation of swallowing and 76% had an altered tongue strength test. Ninety percent of patients with dysphagia had an average tongue pressure lower than 34.2 KPa. The tongue strength test showed sensitivity of 91.67% and specificity of 38.46% and accuracy of 64%. There was a statistically significant relationship between tongue strength and dysphagia and between tongue resistance and dysphagia.ConclusionTongue strength tests, such as the Iowa oral performance instrument, proved to be effective in assessing dysphagia. This result should encourage further research to facilitate the early diagnosis of dysphagia.     

Videomanofluorometric study in amyotrophic lateral sclerosis

OBJECTIVE: To elucidate the time-course changes of swallowing function in amyotrophic lateral sclerosis (ALS) by videomanofluorometry. STUDY DESIGN: Videomanofluorometry was conducted on 21 patients with ALS, who were divided into five groups according to type of disease and according to the length of time following the appearance of bulbar symptoms. METHODS: Videomanofluorometry, which is videofluoroscopic and manometric study conducted simultaneously, was performed on patients in the five groups, and swallowing function in each group was evaluated. Some of the patients were followed up by videomanofluorometry performed several times, and their swallowing function changes over time were investigated. RESULTS: A decrease of swallowing pressure first appeared in the oropharynx, then the hypopharynx became involved. Oropharyngeal swallowing pressure had already decreased to approximately 50 mm Hg within 6 months after the appearance of bulbar symptoms; however, hypopharyngeal swallowing pressure was relatively maintained until 1 year after the onset of bulbar symptoms. Most of the patients with ALS maintained normal upper esophageal sphincter relaxation, but upper esophageal sphincter spasm was seen in some patients with ALS. Aspiration was seen in eight cases, five of which showed upper esophageal sphincter spasm. CONCLUSIONS: Patients with ALS gradually face the danger of aspiration as decreases of oropharyngeal and hypopharyngeal swallowing pressure progress. Upper esophageal sphincter spasm occurs in some patients with ALS, and it is an important cause of aspiration. Both videofluoroscopic and manometric evaluation are necessary to assess these conditions, and they are quite useful for follow-up of swallowing function in patients with ALS.     

The patulous eustachian tube complicated with amyotrophic lateral sclerosis: a video clip demonstration

We report a 60-year-old case diagnosed as the amyotrophic lateral sclerosis with patulous eustachian tube (ET). To our knowledge, this is the first case report of the amyotrophic lateral sclerosis complicating patulous ET in the literature, demonstrating the movement of the tympanic membrane, the pharyngeal orifice of the ET and abnormal movement of the uvula because of paralysis of the soft palate on video.     

Evaluation of swallowing pressure in a patient with amyotrophic lateral sclerosis before and after cricopharyngeal myotomy using high-resolution manometry system

Background

This study aimed to evaluate the pharyngeal pressure of a patient with, amyotrophic lateral sclerosis (ALS) before and after cricopharyngeal myotomy by high-resolution manometry (HRM) system.

Methods

A 60-year-old man with ALS underwent cricopharyngeal myotomy for his intractable, aspiration. The swallowing pressure along the velopharynx and upper esophagus was measured using, the HRM 1 month before and 3 months after the surgery.

Results

Before cricopharyngeal myotomy, the maximum values of the resting UES pressure, the dry swallowing, pressures in the velopharyngeal muscle zone and in the UES zone were 89, 95, and 171 mmHg, respectively. After surgery, the maximum values of both the resting pressure and dry swallowing, pressure in the UES zone remarkably decreased to 21 and 75 mmHg, respectively.

Conclusions

This is the first report showing the effect of cricopharyngeal myotomy by demonstrating, the difference in the swallowing pressure along the velopharynx and upper esophagus before and after, the surgery in an ALS patient using this HRM system.     

Fiberoptic endoscopy evaluation of swallowing in patients with amyotrophic lateral sclerosis

Amyotrophic lateral sclerosis (ALS) is a progressive degenerative motor neuron disease that adversely affects the muscles responsible for swallowing.ObjectiveTo assess the oral preparatory, oral transit and pharyngeal phases of swallowing in ALS patients through endoscopic evaluation.MethodThis cross-sectional historical cohort study included ALS patients submitted to endoscopic examination. Eleven patients (six males and five females; mean age of 61.7 years) were enrolled in the study from january to december of 2011.ResultsAll patients had alterations in phases of the swallowing process, but only 72.7% complained of dysphagia. The oral preparatory phase was altered in 63.6% of the subjects; the oral transit and pharyngeal phases were altered in all studied individuals, regardless of food consistency. Laryngeal penetration or tracheal aspiration were seen in 90.9% of the patients during the pharyngeal phase while they were swallowing fluids.ConclusionEven in the absence of complaints, dysphagia is a frequent comorbidity in ALS patients. The oral transit and pharyngeal phases were the most frequently affected. Laryngeal penetration or tracheal aspiration occurred more frequently during the pharyngeal phase while patients were swallowing fluids.     

下咽癌共病食管癌的高危因素及预后分析

目的 探讨下咽癌共病同时性食管癌的高危因素及预后。 方法 2011年1月至2014年3月诊治的200例下咽癌患者作为研究对象,回顾性分析患者的一般资料、肿瘤信息和随访情况。先对可能影响下咽癌共病同时性食管癌的危险因素进行单因素分析,组间比较采用卡方检验,进一步将有统计学差异的因素纳入Logistic回归分析。生存率的分析采用Kaplan-Meier法。 结果 单因素分析发现,年龄(<55岁)、男性、重度吸烟史、重度饮酒史和肿瘤侵犯部位≥3个是下咽癌患者共病同时性食管癌的高危因素(P<0.05)。多因素分析结果显示,年龄(<55岁)、重度吸烟史、重度饮酒史和肿瘤侵犯部位≥3个是下咽癌患者共病同时性食管癌的独立危险因素(P<0.05)。200例下咽癌患者中位生存时间仅为37.5个月,5年生存率仅为36.7%。56例下咽癌共病同时性食管癌患者中位生存时间为24.8个月,低于下咽癌不伴同时性食管癌患者(P<0.05)。早期食管癌(0+Ⅰ期)患者的中位生存时间为29.2个月,明显高于进展期食管癌(Ⅱ+Ⅲ期)的15.8个月,差异有统计学意义(P<0.05)。 结论 下咽癌共病同时性食管癌患者的生存时间较低。年龄(<55岁)、重度吸烟史、重度饮酒史和肿瘤侵犯部位≥3个是下咽癌患者共病同时性食管癌的独立危险因素,临床上应该针对这些高危因素进行早期干预。     

下咽癌侵犯颈段食管的治疗

目的 探讨下咽癌侵犯颈段食管的最佳治疗方案和处理经验。 方法 通过回顾性分析71例累及颈段食管的下咽癌患者临床资料,总结几种安全有效的治疗方式。71例均行颈淋巴结清扫术,切除患侧甲状腺37例,保留喉功能28例,全喉切除气管造瘘31例,喉气管代下咽食管12例。消化道重建方法有胸大肌肌皮瓣22例、喉气管瓣修复12例、裂层皮片或生物修复膜+胸大肌肌皮瓣6例,全食管切除后胃或结肠代食管31例。术后接受局部放疗(55~70 GY)65例。 结果 术后病理均为鳞状细胞癌,其中高、中、低分化分别为21例、18例、32例。淋巴结转移率45.2%,切除甲状腺37例中病理查见肿瘤14例,占比37.8%,甲状腺受侵犯占总病例19.7%。喉功能保留占39.4%,保留喉功能的患者中拔管率67.8%,术后咽瘘12例,刀口感染2例,吻合口狭窄1例。kaplan-meier生存率统计所有病例总的3年和5年无瘤生存率为43.7%和23.9%,其中喉功能保留组分别为50%和28.6%,喉功能不保留组分别为39.5%和20.9%。两组比较差异无统计学意义(χ²=1.244,P=0.265)。 结论 下咽癌侵犯颈段食管的治疗以手术+放疗的综合治疗为主,胸大肌肌皮瓣、喉气管瓣、全食管切除胃或结肠代食管的手术方式安全有效,部分患者采用合适的手术方式可以保留喉功能。     

352例下咽癌综合治疗分析

,高、中、低分化分别为84例、163例、105例;淋巴转移为239侧.结论 下咽癌以综合治疗为主,在安全彻底切除肿瘤的前提下,保留喉的正常部分,重建恢复喉全部或部分功能,可提高患者生活质量和术后生存率.     

Quality of life after treatment for advanced laryngeal and hypopharyngeal cancer

OBJECTIVES: To compare health-related quality of life measures after treatment for advanced (stages III and IV) laryngeal and hypopharyngeal cancers. STUDY DESIGN: Retrospective chart review and patient response to Health Status Questionnaire-12 (HSQ-12). METHODS: Our study included 54 patients identified from the Tumor Registry of the University of Louisville Brown Cancer Center who were diagnosed and treated between 1995 and 2000. Demographics, tumor data, and treatment information were obtained from the Tumor Registry database. Questionnaires were mailed to all patients and included telephone follow-up. Comparative data and responses were analyzed for the 24 patients who responded to the survey. RESULTS: Fifteen patients were treated with chemotherapy and radiation therapy (CRT). Six patients underwent surgery with postoperative radiation therapy (SRT). The remaining three patients were treated with radiation therapy but were not used in this analysis. The average follow-up was 35 months after treatment. The CRT and SRT groups were statistically similar regarding age, sex, duration of follow-up, tumor grade, and tumor stage. Laryngeal primary tumors were more common in the SRT group than in the CRT group (P =.005). Eight domains were assessed by the HSQ-12: physical functioning, role-physical, bodily pain, health perception, energy/fatigue, social functioning, role-mental, and mental health. No statistical differences were found between the CRT and SRT groups, except for role limitations attributable to physical health (P =.007). CONCLUSIONS: These results indicate that only one of eight domains differs significantly between treatment groups when using the HSQ-12. Two-year survival end-point analysis of global health assessment may represent a simplified and meaningful way to compare treatment modalities in patients with advanced-stage head and neck cancer.     

Laminin-5 immunohistochemical mapping for analysis of local extension in hypopharyngeal cancer: A preliminary report

Objective

Laminin-5 γ2 chain (LNγ2) plays an important role in cancer differentiation and migration. Using a novel immunohistochemical mapping technique to investigate whole mucosal strips of total laryngopharyngectomy specimens using iodine, H–E, and LNγ2 stainings, we investigated the locoregional behavior of hypopharyngeal cancer.

Methods

Surgical specimens from two patients with pyriform sinus cancer were investigated. Three percent iodine was applied to the tumor-bearing laryngopharynx during surgery and photographed. Stainabilities of H–E and LNγ2 on pathologic sections from all mucosal strips were scored and coordinated with the laryngopharyngeal photograph to illustrate the immunohistochemical map.

Results

In both patients, the main tumor of invasive squamous cell carcinoma was circumferentially surrounded by a superficial lesion characterized by high grade intraepithelial neoplasia that remained unstained by iodine. On LNγ2 immunohistochemical mapping, the main tumor was demonstrated by Score 2 staining and the superficial lesion by a stronger Score 3 staining.

Conclusions

The finding of neoplastic cells at the periphery demonstrating a higher potential than the cancer cells at the tumor center is suggestive of impending progression from neoplasia to carcinoma. The current preliminary report suggested morphological evidence of intraepithelial infiltration and lateral invasion in hypopharyngeal cancer.     

Rational choice of induction chemotherapy-based larynx preservation for hypopharyngeal cancer

Abstract

Backgroud: Induction chemotherapy, as a larynx preservation treatment, has been available for over 20 years. We conducted a retrospective study to evaluate the efficacy of this protocol with taxene, cisplatin and 5-fluorouracil in Chinese patients with hypopharyngeal cancer that chose preservation strategy.

Material and methods: 170 patients with locally advanced hypopharyngeal cancer were assigned to receive induction chemotherapy. 107 patients (63%) with complete response or partial response received larynx preservation treatment and 63 non-responders (37%) received radical surgery.

Results: Median survival time was 30 months (range: 3–59 months). 63 patients (37%) had local-regional failure and 15 (9%) had distant metastasis. Three-year LFS was 27.8% (95% CI: 23.6–32.0%). The estimated three-year overall survival rate was 44.5% (95% CI: 39.5–49.5%). There was no significant difference in the three-year survival rate between responders (44.8%) and non-responders (43.9%) (p?=?.237), however patients with a partial response had a significant decrease in survival (32.2%) (p?<?.001).

Conclusions: In patients with hypopharyngeal cancer, ICT with TPF regimen followed by RT, as a larynx preservation treatment, may be suitable for complete responders, but not partial responders.     

下咽癌中差异表达的蛋白激酶及其抑制剂的生物信息学筛选

目的 筛选下咽癌中差异表达的激酶基因及其选择性抑制剂,为下咽癌的分子靶向治疗提供新的参考。 方法 利用GEO数据库和SAM软件筛选下咽癌中差异表达的激酶基因,体外培养人下咽癌FaDu细胞系。为验证GEO数据库中芯片结果的准确性,利用实时定量聚合酶链反应(Real-time PCR)检测差异表达激酶在FaDu细胞中的表达量,通过KEGG数据库获得激酶调控的通路,利用激酶抑制剂数据库和文献挖掘筛选获得在下咽癌FaDu细胞系中差异表达激酶的选择性抑制剂。 结果 (1)在GEO数据库的下咽癌基因组表达谱中,共筛选出3个高表达的激酶基因,分别为PKC-β、CDK6和CDC42(差异倍数≥2.0且P<0.05);(2)Real-time PCR结果显示在人下咽癌FaDu细胞中这3个上调激酶基因也出现高表达(P<0.05),证明全基因组的结果准确;(3)KEGG通路分析的结果显示3个高表达激酶调控复杂的通路网络;(4)激酶抑制剂的筛选结果显示共有5个激酶抑制剂调控PKC-β, 4个激酶抑制剂调控CDK6,3个激酶抑制剂调控CDC42。文献挖掘的结果显示在这12个激酶抑制剂中,有4个在癌症方面的研究较少,文献<10篇。 结论 下咽癌中共有3个激酶PKC-β、CDK6和CDC42发生高表达,并发挥促癌作用。它们的激酶抑制剂可能有潜在的抗癌作用,为下咽癌的分子治疗提供新的切入点。     

下咽癌累及颈段食管的处理

目的总结下咽癌累及颈段食管的处理经验。方法回顾性分析1989年—2000年48例累及颈段食管的下咽癌患者的手术治疗情况，其中男38例，女10例；年龄26～71岁，平均54．3岁。梨状窝癌33例，下咽后壁区癌14例，环后癌1例，均无远处转移。根据UICC1997年TNM分期标准均为T4M0期，其中cN0 28例，cNl 15例，cN2 5例。喉全切除术8例，喉部分切除残喉气管瓣修复下咽17例，23例保留了喉功能。所有病例均行改良性颈清扫术，其中单侧清扫38例，双侧清扫10例。患侧甲状腺叶切除42例。下咽食管缺损的修复方法分别为：喉气管瓣修复11例，胸大肌肌皮瓣13例，喉气管瓣＋胸大肌肌皮瓣6例，裂层皮片＋胸大肌肌皮瓣10例，胃上提咽胃吻合3例，结肠上徙5例。术后均接受放射治疗，剂量为55—75Gy。结果手术证实颈部淋巴结转移20例病理诊断；高分化鳞状细胞癌18例，中分化鳞状细胞癌24例，低分化鳞状细胞癌6例。术后并发症包括胸部刀口裂开1例，咽瘘10例。直接法计算生存率，失访2例以死亡计。全组患者3、5年生存率分别为52．1％（25／48）和27．3％（12／44）。保留喉功能组3、5年生存率分别为65．2％（15／23）和33．3％（7／21），不保留喉功能组3、5年生存率分别为40．0％（10／25）和21．7％（5／23）。23例保留了喉功能，15例患者拔除了气管套管，恢复了全部喉功能（发音、呼吸、吞咽保护），8例患者恢复了部分喉功能（发音、吞咽保护），拔管率为65．2％（15／23）。结论下咽癌累及颈段食管的处理以手术＋放疗的综合治疗为主，需行患侧颈清扫术，应尽量保留喉功能，无法保留喉功能时可以采用喉气管瓣或联合裂层皮片、胸大肌肌皮瓣修复下咽颈段食管缺损，颈段食管缺损较大时则采用胃或结肠代替。     

Value of computed tomography-based tumor volume as a predictor of outcomes in hypopharyngeal cancer after treatment with definitive radiotherapy

OBJECTIVES: To investigate the value of pretreatment computed tomography (CT) volumetric analysis for the prediction of treatment outcome in patients with hypopharyngeal cancer (HPC) treated by definitive radiotherapy (RT). METHODS: From January 2000 through February 2004, 63 patients with HPC were enrolled for a retrospective analysis. The pyriform sinus was the principle site of involvement in 62 cases. All patients received with 1.8 Gy daily to a total dose of 68.4 to 73.8 Gy (median, 70.2 Gy). Contrast-enhanced CT images were transferred to a planning system. Tumor volume measurement was derived from summation of the primary and metastatic nodal tumor. RESULTS: With a median follow-up of 38 (range, 24-68) months, the 5 year local relapse-free survival (LRFS) was 83% for patients with T1 to T2 disease, 46% for those with T3 disease, and 40% for those with T4 disease (P = .01). The 5 year LRFS was 75% for those with tumors less than 40 mL and 26% when volumes were 40 mL of larger (P = .0001). For patients with T3 to T4 disease, the 5 year LRFS was 70% for those with tumors less than 40 mL and 24% when volumes were 40 mL or larger (P = .0005). Multivariate analyses of local relapse-free survival revealed two prognostic factors: tumor volume more than 40 mL and the involvement of the larynx. CONCLUSIONS: CT-based tumor volumes are a strong predictor of outcomes for HPC treated using definitive RT. A selected group of patients, mainly those with tumor volumes less than 40 mL, should be considered for laryngeal preservation.     

352例下咽癌综合治疗分析

,高、中、低分化分别为84例、163例、105例;淋巴转移为239侧.结论 下咽癌以综合治疗为主,在安全彻底切除肿瘤的前提下,保留喉的正常部分,重建恢复喉全部或部分功能,可提高患者生活质量和术后生存率.     

胸大肌肌皮瓣在侵犯下咽晚期头颈鳞癌手术切除术后缺损修复中的应用

目的 探讨不同情况下应用胸大肌肌皮瓣(PMF)修复下咽颈食管区域重要和复合缺损的方法和可行性。 方法 采用PMF单独或联合其他修复方法,结合对修复方法的改良,采用不同方式修复晚期和复发性下咽癌和喉癌侵犯下咽颈食管区域手术切除术后下咽颈食管巨大和复合性缺损59例,缺损类型包括下咽颈食管部分缺损、下咽颈食管环周缺损以及下咽颈食管缺损合并颈前软组织巨大复合缺损。 结果 完成单纯PMF覆盖法26例,椎前筋膜游离植皮加PMF覆盖4例,PMF覆盖加颈前表面游离植皮2例,PMF覆盖下咽加胸三角皮瓣(DPF)修复颈前缺损2例,单纯PMF皮管16例,PMF皮管加肩胸皮瓣表面覆盖4例,胃上提加PMF覆盖3例,双岛瓦合PMF 2例。术后20例出现了不同程度并发症,除1例院内死亡外,其余均经妥善处理治愈,恢复吞咽功能。 结论 PMF适合各种情况的下咽颈食管缺损修复,特别是在颈部同时伴有巨大软组织复合缺损时,这种方法更具优越性。     

结肠上徙代食管在下咽、食管疾病中的治疗体会

目的 :探讨在保留喉功能的基础上结肠上徙代食管治疗晚期下咽癌、颈段食管癌及严重食管狭窄的可行性及疗效。方法 :1989～ 1996年共进行结肠上徙代食管手术 2 5例 ,晚期下咽癌 9例 ,其中 T3期 7例 ( N0 1例 ,N1 4例 ,N2 2例 ) ,T4 N1 M0 2例 ( U ICC1997) ;颈段食管癌 13例 ,其中 T1 N0 M0 2例 ,T2 期 11例 ( N0 4例 ,N1 7例 ) ;严重食管狭窄 3例 (狭窄长度 3～ 5 cm)。术后肿瘤患者给予放疗。结果 :2 5例患者 3、5年生存率分别为5 4 .5 % ( 12 / 2 2 )和 4 2 .9% ( 6/ 14 ) ,其中晚期下咽癌、颈段食管癌 3年生存率分别为 4 4 .4 % ( 4 / 9)和 61.5 % ( 8/ 13 )。结论 :结肠上徙代食管符合生理功能 ,只要手术适应证选择合适 ,术中精细操作 ,可以减少并发症 ,提高患者的生存质量。     

下咽癌178例临床病理特征及预后分析

目的 探讨下咽癌的临床病理特征及影响下咽癌治疗预后的因素.方法 回顾分析2000年1月至2006年12月浙江省肿瘤医院收治的178例下咽癌患者的临床病历资料.生存率采用Kaplan-Meier方法(KM法)统计.结果 KM法统计178例患者下咽癌预期生存时间中位数为42.8个月(1～127个月),3年和5年生存率分别为47％和35％,各期5年生存率分别为Ⅰ+Ⅱ期76.2％,Ⅲ期46.7％,Ⅳ期29.6％.14.0％ (25/178)患者合并第二原发肿瘤,其中同时多原发癌18例,异时多原发癌7例.影响下咽癌患者生存的因素分别为T分级(x2=27.994,P＜0.01)、N分级(x2 =31.663,P＜0.01)、临床分期(x2=22.267,P＜0.01)、功能状态评分(x2=48.856,P＜0.01)、吸烟指数(x2=8.085,P＜0.01)和治疗方法(x2=105.528,P＜0.01).Cox多因素分析证实吸烟指数、肿瘤分期和治疗方法是影响预后的独立危险因素.保留喉功能的治疗手段所占的比例在逐年上升,由2000年的38.5％提高至2006年的60.0％.结论 手术联合放疗是治疗下咽癌的重要手段.肿瘤分期和治疗方法可作为评价下咽癌预后的重要指标.