Congenital subglottic hemangioma: frequency of symmetric subglottic narrowing on frontal radiographs of the neck.

OBJECTIVE. This study was undertaken to determine how often symmetric subglottic airway narrowing is present in cases of infantile subglottic stenosis and to determine if the radiographic finding has any association with the anatomic location of the hemangioma. MATERIALS AND METHODS. All cases (n = 12) of endoscopically proved subglottic hemangioma from 1976 to 1991 were collected from the records at Children's Hospital of Michigan. In 10 cases, high-kilovoltage magnification studies or frontal radiographs of the neck were available for review by two observers who classified the subglottic narrowing as either symmetric or asymmetric. The radiographic findings in these 10 cases were then compared with the location and extent of the lesion as described endoscopically. RESULTS. In 50% of cases (n = 5), narrowing of the subglottic airway was symmetric. In four of these the hemangioma was either situated on the posterior wall or was circumferential, and in the remaining one an associated marked fibrotic reaction to a lateral wall lesion was present. All other lesions were on the lateral wall, and asymmetric subglottic airway narrowing was consistently shown on radiographs. CONCLUSION. Our results show that subglottic hemangioma often manifests as a symmetric subglottic airway narrowing and that the anatomic location of the hemangioma appears to be associated with the appearance on radiographs.     

黏附分子E-cadherin、CD44和Tenascin在喉复发癌组织芯片中的表达和意义

目的　研究E cadherin、CD4 4和Tenascin黏附分子的表达与喉癌复发的关系 ,以对预后进行评估。方法　回顾分析 195 8～1999年喉癌手术病例 5 74例 ,术后随访 3年 ,确诊术后复发 5 6例 ;正常喉对照标本 39例。标本制成组织芯片 ,采用免疫组化SABC法 ,对芯片标本进行染色。结果　E cadherin、CD4 4和Tenascin在喉癌组织中有表达 ,其阳性率各有不同。E cadherin蛋白的表达在喉癌复发组明显降低 ,与未复发组比较差异显著 (P <0 0 0 1) ,与喉癌复发呈负相关。而CD4 4、Tenascin蛋白的表达在喉癌复发组明显升高 ,与未复发组比较差异显著(P <0 0 0 1) ,与喉癌复发呈正相关。E cadherin、CD4 4和Tenascin黏附蛋白在喉癌组织的表达与正常组织比较差异有统计学意义 (P <0 0 0 1)。结论　黏附分子E cadherin、CD4 4和Tenascin的表达可作为喉癌预后估计的指标。     

Cyclin D1、PCNA、Ki-67细胞周期相关蛋白在喉复发癌组织芯片中的表达和意义

目的研究Cyclin D1、PCNA、Ki-67细胞周期相关蛋白的表达与喉癌复发的关系,并评价其对预后评估的作用.方法回顾分析1958～1999年喉癌手术病例574例,术后随访3年,确诊术后复发56例;正常喉对照标本39例.标本制成组织芯片,采用免疫组化SABC法,对芯片标本进行染色.结果 Cyclin D1、PCNA、Ki-67在喉癌组织及正常喉组织中均有表达,且在喉癌组织的表达强于正常喉组织(P<0.01),在喉癌复发组强于未复发组(P<0.01),与喉癌复发呈正相关.结论 Cyclin D1、PCNA、Ki-67细胞周期相关蛋白的表达可作为估计喉癌预后的指标.     

VEGF、Cath-D在喉复发癌组织芯片中的表达和意义

目的　研究VEGF、Cath D蛋白的表达与喉癌复发的关系 ,对预后进行估计。方法　回顾性分析 195 8～1999年喉癌手术病例 5 74例 ,术后随访 3年 ,确诊术后复发 5 6例 ;正常喉对照标本 39例。标本制成组织芯片 ,采用免疫组化SABC法对芯片标本进行染色。结果　VEGF、Cath D在喉癌组织中有表达 ,其阳性率不同。VEGF、Cath D蛋白的表达在喉癌复发组明显增强 ,与未复发组的表达差异有统计学意义 (P <0 0 0 1) ,与喉癌复发呈正相关。VEGF、Cath D蛋白在喉癌组织的表达与正常组织的表达比较差异有统计学意义 (P <0 0 0 1)。结论　VEGF、Cath D蛋白的表达可作为估计喉癌预后的指标     

Videofluoroscopic studies of swallowing dysfunction and the relative risk of pneumonia

OBJECTIVE: The purpose of our investigation was to determine the relationship between the degree of swallowing dysfunction observed on barium studies and the likelihood of developing pneumonia in a large series of patients. MATERIALS AND METHODS: The findings on videofluoroscopic swallowing studies in 381 patients were used to classify these patients into one of five groups: those with normal swallowing; those with abnormal swallowing but no laryngeal penetration or tracheobronchial aspiration; those with laryngeal penetration; those with tracheobronchial aspiration; and those with silent tracheobronchial aspiration. Clinical data were also reviewed to determine how many patients had developed pneumonia during the 6 months before or after the barium studies. The data were then analyzed to determine whether the risk of developing pneumonia increased significantly with each level of swallowing dysfunction seen on barium studies. RESULTS: No significant difference was found in the frequency of pneumonia in patients with abnormal swallowing but no laryngeal penetration or tracheobronchial aspiration compared with patients with normal swallowing on barium studies (p = 0.85). In contrast, patients with laryngeal penetration, tracheobronchial aspiration, or silent tracheobronchial aspiration were approximately four times (p = 0.008), 10 times (p < 0.0001), and 13 times (p < 0.0001), respectively, more likely to develop pneumonia than those with normal swallowing. CONCLUSION: Our findings indicate that the likelihood of developing pneumonia is directly related to the degree of swallowing dysfunction seen on videofluoroscopic studies. Patients with no laryngeal penetration-regardless of whether they had normal or abnormal swallowing-have the lowest risk of developing pneumonia. Patients with laryngeal penetration, tracheobronchial aspiration, or silent tracheobronchial aspiration are, in increasing order of magnitude, significantly more likely to develop pneumonia than patients with normal swallowing.     

CT扫描在喉及下咽癌术后评价中的应用价值

目的探讨CT扫描在评价喉及下咽癌术后状况中的应用价值。材料与方法回顾性分析了45例（术后1～120月共作了69次CT扫描）经喉镜、活检或手术病理证实的喉及下咽癌术后正常和异常的CT表现。结果10例患者呈喉及下咽癌术后正常改变,8例水肿或瘢痕形成,2例术后滞溜囊肿。25例有术后肿瘤复发或/和转移,包括局部肿瘤复发18例、颈部淋巴结转移13例及远处转移2例。结论CT扫描能很好地显示喉及下咽癌术后的正常和异常改变,判断有无肿瘤复发及其侵犯范围,为临床治疗提供重要的帮助。     

Colonic interposition: radiographic evaluation

This report reviews the clinical and radiographic features of 40 patients who underwent visceral esophageal substitution with colon for benign or malignant lesions of the esophagus. The incidence and radiographic identification of complications are discussed. All patients were routinely examined with barium esophagrams on postoperative day 10. If an anastomotic leak was suspected clinically before this time, studies were performed using water-soluble iodinated contrast material. Follow-up barium esophagrams were obtained 1-96 months after operation (average, 60 months) in 24 patients. Eight patients (21%) demonstrated asymptomatic "jejunization" of the colonic mucosa with no attributable clinical manifestations; this finding resolved in 1-3 months, without sequelae, and has not been reported before. The spectrum of ischemic changes in the colonic segment included mucosal edema, spasm, ulceration, loss of haustration, and frank necrosis. Radiographically detectable early postoperative complications included anastomotic leak in six (three pharyngocolic, three cervical esophagocolic) and aspiration of barium into the tracheobronchial tree due to incoordinated swallowing in eight. Late postoperative complications included anastomotic narrowing (12) malfunctioning of the colon due to impaired emptying (five), recurrent aspiration pneumonia (three), small bowel obstruction (three), transhiatal herniation of small bowel through the diaphragmatic hiatus (one), and reflux into the retained bypassed esophagus (one).     

Gastric interposition following transhiatal esophagectomy: CT evaluation

Transhiatal esophagectomy without thoracotomy (THE) but with gastric interposition results in less morbidity and mortality than standard transpleural esophagectomy with thoracotomy. Barium examination has been the primary radiographic study following THE for detecting postoperative complications. We reviewed computed tomography (CT) scans of 21 patients who had undergone THE and correlated CT appearance with clinical status and with findings of the barium studies. Local mediastinal recurrent neoplasm was detected by CT in seven patients; barium study within 2 weeks of the CT scan failed to detect tumor recurrence in three of these patients. A mediastinal abscess well delineated by CT was percutaneously drained under CT guidance. Water-soluble contrast medium/barium study is preferable for the evaluation of certain postoperative complications such as anastomotic leak. However, CT is the modality of choice for detecting locally recurrent neoplasm and distant metastases following THE and may also be helpful in patients with postoperative mediastinal abscess. Normal mediastinal CT anatomy after esophagectomy is reviewed in order to warn against pitfalls in scan interpretation.     

CT evaluation after esophagogastrectomy

The computed tomographic (CT) scans and barium esophagrams of 25 patients who had undergone esophagogastrectomy were reviewed to assess the utility of CT in the postoperative evaluation of these patients. CT provided information not provided by esophagography in 13 cases; in nine of these 13 cases, the CT scan was instrumental in directing patient management. One anastomotic leak not detected by esophagography was demonstrated by CT. In two patients, esophagography demonstrated mucosal recurrence at the esophagogastric anastomosis which was not shown by CT. Data indicate that CT is a useful method for detecting postoperative complications and extramucosal recurrent disease in this group of patients. Knowledge of the expected postesophagogastrectomy CT appearance is essential for the proper interpretation of postoperative scans.     

Pharyngeal swallowing in patients with paresis of the recurrent nerve

Pharyngolaryngeal function during swallowing was investigated cineradiographically in 22 patients with paresis of the recurrent nerve. Nineteen of these patients (86%) had defective closure of the laryngeal vestibule: 10 patients had defective apposition of the corniculate cartilages, (paresis of the oblique cricoarytenoid muscle), 9 patients had defective apposition of the arytenoid cartilages, (paresis of the interarytenoid muscle), 13 patients had defective movement of the epiglottis (paresis of, i.a. the thyrohyoid muscle), 1 patient had defective closure of the subepiglottic portion of the vestibule (paresis of the thyroepiglottic muscle), 2 patients had defective closure of the supraglottic portion of the vestibule (paresis of the superior ventricular segment of the thyroarytenoid muscle). Five patients with immobility of the epiglottis also had paresis of the pharyngeal constrictor musculature indicating paresis of the superior laryngeal nerve. Our investigation has shown that patients with paresis of the recurrent nerve who present with dysphagia with or without aspiration should be examined cineradiographically for pharyngolaryngeal function during swallowing.     

CT of the abdomen after the Whipple procedure: value in depicting postoperative anatomy, surgical complications, and tumor recurrence

We performed a retrospective study of CT scans in 29 patients who had undergone the Whipple procedure (radical pancreaticoduodenectomy) to study the CT appearance of the postsurgical anatomy and assess the use of CT in the evaluation of early postoperative complications and recurrent tumor. In the postoperative period, the scans from 15 patients revealed seven transient fluid collections; four deep abscesses, three of which were successfully drained under CT guidance; three superficial abscesses; and five cases of ascites. In 19 patients, CT scans were obtained up to 4 years after surgery to search for recurrent tumor. The most frequent site of recurrence was the liver. CT correctly identified liver metastases in six of seven patients and was falsely positive in one. Recurrence also was found twice in retroperitoneal lymph nodes; one time each in the mesenteric root, spleen, and lung base; and twice causing afferent loop blockage. Surgical proof of recurrence was obtained in eight cases. Our experience suggests that an understanding of the normal postoperative anatomy following the Whipple procedure is essential in evaluating postoperative CT scans. Scans obtained for detection of tumor recurrence should be optimized for imaging the liver because this was the most frequent site of recurrence.     

Elliptical cricoid cartilage: a unique type of congenital subglottic stenosis

An elliptically shaped cricoid cartilage, a specific type of congenital subglottic stenosis, is described, and the laryngoscopic and radiographic findings in three cases are discussed. An "hourglass" deformity of the subglottic laryngeal airway on an anteroposterior airway radiograph is suggestive of this diagnosis.     

喉及下咽癌的MRI评价(兼与CT比较)

目的：探讨MRI对喉及下咽癌术前分期及术后评价中的临床应用价值。方法：26例喉及下咽癌患者(原发性肿瘤23例、术后复发3例)进行MRI扫描，分析其MRI表现，将结果与手术病理及CT扫描作比较。结果：MRI能较好地显示肿瘤的部位、大小及其侵犯范围。MRI对术前肿瘤分期及诊断颈部淋巴结转移的准确性为91％。高于CT扫描的87％及83％。结论：MRI扫描喉及下咽癌术前分期及术后评价有较大的帮助。     

CT prior to second-look operation in ovarian cancer

Second-look surgery is used in restaging patients with ovarian cancer to define sites of recurrence, plan therapy, and perform tumor debulking. We evaluated the role of CT in detecting residual or recurrent tumor in 55 patients in whom 64 abdominopelvic CT scans were obtained. Forty-eight patients underwent a second-look operation, and eight of these patients had an additional third-look operation. CT correctly identified 17 (85%) of 20 cases with residual or recurrent pelvic disease and three (75%) of four cases with bulky abdominal disease. CT failed to detect tumor in any of the five cases with minimal abdominopelvic disease and was able to detect carcinomatosis in only two (8%) of 24 cases. In four cases, CT detected pelvic disease not identified on clinical pelvic examination. On the 56 scans in 48 patients with surgical proof (280 surgical findings), CT had a sensitivity of 40% (22/55) and a specificity of 99% (224/225). In seven additional patients, second-look laparotomy was canceled because of CT findings of extensive, unresectable tumor. We conclude that CT provided valuable information regarding residual or recurrent tumor prior to second- and third-look surgery. In selective cases, CT findings obviated unnecessary surgery. However, the CT's lack of sensitivity in identifying minimal abdominopelvic disease and carcinomatosis precludes its use as a substitute for second-look surgery.     

The normal pediatric larynx on CT and MR.

PURPOSETo determine the MR and CT appearance of the normal pediatric larynx.METHODSFifteen CT scans and 15 MR examinations of children with normal larynges and airways were reviewed retrospectively. Characteristics that were noted included the level of the hyoid bone, calcification and signal intensity within separate laryngeal components, amount of paraglottic fat, anteroposterior airway diameters, and airway contours. Two cadaveric larynges were imaged by CT and MR and were then sectioned at corresponding levels and section thicknesses.RESULTSThe larynx is higher in children than in adults, with the hyoid bone found at the C2-3 level in the youngest children (newborn to 2 years). The subglottic airway was narrowest in the youngest children. The hyoid bone was the only laryngeal structure ossified in any of the children. A thin line of high density was seen in the expected location of the thyroid cartilage in some children. The featureless circumferential soft tissue seen around the airway represented the uncalcified laryngeal cartilaginous structures. This was confirmed on gross sectioning of cadaveric larynges. The supraglottic airway contour was triangular or oval, the glottis was shaped like a teardrop, and the subglottic contour was oval. Contours were confirmed on histologic examination of necropsy specimens.CONCLUSIONSThis preliminary study suggests that the pediatric larynx differs from the adult larynx with respect to size, position, consistency, and shape, and these differences are reflected on CT and MR studies.     

Computed tomography of the injured larynx.

Computed tomography (CT) permitted a much more detailed appraisal of laryngeal dysfunction in patients with blunt laryngeal trauma (8 cases) and iatrogenic injury caused by radiation therapy (7 cases), surgery (2 cases), or intubation (1 case). In thyroid cartilage fractures, the fragments may be widely displaced. The cricoid ring breaks in two places, frequently involving the signet. CT facilitates diagnosis of the mechanism of injury based on the site and extent of fractures. The patterns of distortion and fibrosis of the laryngeal cartilage following radiation therapy may be manifested as encroachment on the airway, easily mistaken for recurrent tumor or localized edema. Minor distortion probably escapes detection on clinical examination. The authors consider CT the examination of choice in laryngeal injury.     

Digital cineradiography of the pharynx and the oesophagus after total or partial laryngectomy

PURPOSE: The aim of the present study is to report our experience using digital cineradiography to assess morphological and functional disorders of the pharynx in patients with prior partial or total laryngectomy. MATERIALS AND METHODS: From March 2000 to October 2002, 21 patients (18 males and 3 females) with prior total laryngectomy (12 patients), total laryngopharyngectomy (2 patients) and partial laryngectomy (7 patients) were examined. A digital cineradiography with 12 frames/second acquisition was performed in all patients. In four patients the procedure was interrupted for massive barium aspiration, without cough (silent aspiration). In 17 patients standing in the left posterior oblique position and prone in the right posterior oblique position the oesophagus and oesophagogastric junction were also examined. The water siphon test was performed at the end of the procedure. Small boluses (10 ml) of liquid (60% w/v) and high-density (250% w/v) barium, barium paste (110% w/v), and solid meal (obtained spreading a dry biscuit with barium paste) were used. RESULTS: All patients with prior total laryngectomy and total laryngopharyngectomy showed morphological and functional disorders of the neopharynx: parapharyngeal diverticulum (2 cases), submandibular pouch (6 cases), fistulas (2 cases), lumen narrowing and post-surgical stenoses (2 cases), tumour recurrence (1 case), prominent cricopharynx (5 cases) and rhinopharyngeal reflux (4 cases). All patients with prior partial laryngectomy (7 cases) presented silent aspiration. Eleven patients had an oesophageal motility disorder, which was very serious in three of them with decrease in oesophageal clearing and barium retention in the oesophagus. Oesophagogastric junction evaluation showed hiatus hernia in six cases, two of them with associated gastro-oesophageal reflux. CONCLUSIONS: Digital cineradiography appears able to identify the organic and functional postoperative complications of patient treated with partial or total laryngectomy. A special swallowing study can suggest to the speech therapist the best compensatory mechanism for improving patient swallowing and therefore quality of life.     

Radiation therapy for stage I and II laryngeal cancer using 10 MV X-rays or cobalt-60 gamma-rays.

From 1970 to 1985, 117 patients with stage I and stage II carcinoma of the larynx (98 with glottic, 15 with supraglottic, and 4 with subglottic cancer) received radiation therapy. The patients were treated with (1) a 60Co machine equipped with 45-degree wedge filters, at a total dose of 6,000-7,000 cGy, 300 cGy per fraction, 3 days a week in the period from 1970-1974; (2) 10 MeV linear accelerator X-rays from 1975-1980, and (3) 10 MeV linear accelerator X-rays and/or the 60Co machine in the period from 1981-1985, at a total dose of 6,000-7,000 cGy, 5 days a week by parallel opposing portals without wedge filters. The 5-year local control rates by radiotherapy alone were 66%, 78%, and 83%, respectively, in the three periods, and the 5-year survival rates were 77%, 97%, and 96% following salvage surgery for recurrent disease. In the 1970-1974 period, four patients developed severe laryngeal edema, and two patients had total laryngectomy without local residual tumor. In the 1975-1985 period, 16 patients had local recurrence in five years, and in five of them the tumor exhibited verrucous-like histopathological findings. In the 1975-1980 period, local recurrence was considered to result from underdosing of lesions with 10 MV X-ray beams and split-course irradiation. In the last five years of the period, the 5-year local control rate for stage I and II carcinoma of the glottis, excluding verrucous-like carcinoma, reached 90% with 10 MV X-rays combined with 60Co gamma-rays.     

Postoperative follow-up of juvenile nasopharyngeal angiofibromas: assessment by CT scan and MR imaging

The purpose of this study was to assess the radiological findings after surgical removal of juvenile nasopharyngeal angiofibromas (JNA). The postoperative CT and MRI scans of ten patients were reviewed. The cured group included six patients. The non-controlled group included six patients with eight recurrences. Two patients belonged to both groups as they were also followed and cured after surgery for relapse. Four recurrences were asymptomatic and diagnosed by imaging. The imaging patterns were matched to the patients clinical status and endoscopic findings. In the cured group, non-enhanced residual soft tissue masses were seen in all cases. In the non-controlled group, recurrence was always demonstrated on early postoperative CT or MR as a dramatically enhanced mass. The recurrence was located in the lateral or superior aspect of the nasopharynx (n = 3), deep to the fossa of Rosenmuller (n = 4) or out of the nasopharynx (n = 1). In two cases a remaining enhanced mass disappeared spontaneously on iterated examinations. Because of numerous asymptomatic relapses, a radiological workup is recommended four months after surgery, even in patients with normal endoscopy, to rule out posterolateral or extranasopharyngeal recurrences. Spontaneous evolution of residual masses must be appreciated on iterated imaging examinations. Received 18 February 1997; Revision received 14 July 1997; Accepted 22 September 1997     

持续声门下吸引对预防呼吸机相关性肺炎的研究

目的：观察持续声门下吸引预防机械通气（MV）发生呼吸机相关性肺炎的临床价值。方法：将ICU 72例气管插管行机械通气的患者随机分为观察组36例、对照组36例,对照组采用常规气道护理,观察组在此基础上行持续声门下吸引,收集口咽部、声门下、下呼吸道分泌物进行细菌学检查。结果：机械通气5 d内观察组呼吸机相关肺炎发生率明显低于对照组;观察组声门下分泌物培养革兰阳性致病菌数明显少于对照组。结论：持续声门下吸引可减少和延迟呼吸机相关性肺炎的发生。