Role of Laryngeal Movement and Effect of Aging on Swallowing Pressure in the Pharynx and Upper Esophageal Sphincter

Objectives Describe contribution of laryngeal movement to pressure changes at the upper esophageal sphincter (UES) and the effect of aging on the swallowing function. Study Design Manofluorography on 56 nondysphagic adults divided into three age groups: the 21‐ to 31‐year‐old group (n = 32), the 61‐ to 74‐year‐old group (n = 12) and the 75‐ to 89‐year‐old group (n = 12). Analyses of the bolus transit time, the amplitudes and durations of pharyngeal pressures, the timing of a pressure fall at the UES and the laryngeal movements. Methods Intraluminal strain‐gauge sensors recorded pressure changes in the oropharynx, hypopharynx and the UES. Motion pictures of the videotapes were fed into a personal computer, and movements of the hyoid bone were measured in both the horizontal and vertical directions as an indication of laryngeal movement. Results In 26‐ and 70‐year‐old men with calcification of the thyroid cartilage, it was determined that the larynx and hyoid bone moved in consonance until the end of the rapid hyoid movements in both the superior and anterior directions. In the 21‐ to 31‐year‐old group, the magnitude of the pressure fall at the UES was maximal before or almost at the same time as the bolus arrival, in preparation for smooth passage of the bolus from the pharynx to the esophagus. The rapid superior movements of the hyoid bone started significantly early as compared with its anterior movements (P = .0001). The rapid anterior movements of the hyoid bone started simultaneously with the pressure fall at the UES. In the elderly, all segmental transit times were significantly increased. The timing of the pressure fall at the UES was significantly delayed and the UES pressure reached its minimum value after arrival of the bolus at the UES. The minimum pressure at the UES increased to a significantly positive value. The rapid anterior movements of the hyoid were significantly delayed, suggesting that this delay causes the delay in the pressure fall at the UES. Conclusions The rapid superior and anterior movements of the hyoid bone are considered to start at the same time as those of the larynx. In the young group, it is suggested that superior laryngeal movement protects the lower airway prior to the anterior laryngeal movement, causing the pressure fall at the UES to enable the passage of a bolus into the UES. In the elderly, smooth passage of the bolus from the pharynx to the esophagus is hindered and the system that prevents aspiration is rendered inefficient by changes in the swallowing pressures and laryngeal movements with aging.     

胸导管结扎预防食管癌术后乳糜胸的临床研究

目的　寻找减少或消除食管癌切除术后乳糜胸发生率的有效方法。方法　随机选取 45例 (A组 )食管癌患者 ,在食管癌切除加胃 食管残端吻合时 ,一期行预防性低位胸导管结扎术 (第 8胸椎水平以下 ) ;另 92例 (B组 )作对照组 ,仅做食管癌切除加胃 -食管残端吻合术。结果　两组患者在术后乳糜胸发生率 (A :1/ 45 ;B :9/ 92 ,P =0 0 3)、术后 48h胸腔引流量〔第 1个 2 4h :A :(2 5 4 33± 45 15 )ml,B :(4 93 6 1± 76 6 7)ml;第 2个 2 4h :A :(141 11± 2 5 5 3)ml,B :(32 3 39± 5 8 17)ml;P <0 0 5 )〕、3天内拨管率 (A :94 78% ;B :6 2 2 1% ,P =0 0 0 1)、并发症 (A :3/ 45 ,B :0 / 92 ,P =0 0 34)以及随访锁骨上淋巴结转移 (A :0 / 45 ,B :9/ 92 ,P =0 0 3)等方面有统计学意义。结论　术中行预防性低位胸导管结扎术可明显减少甚至消除食管癌患者术后乳糜胸的发生。     

良性上消化道疾病的食管动力学变化

目的：探讨良性上消化道疾病患者食管动力学的变化情况。方法：对３２例良性上消化道疾病患者进行食管测压检查。结果：３４．３８％的病例ＬＥＳＰ减低,８７．５％出现吞咽后同不收缩,５３．１３％出现自发性同步收缩,２８．１３％正常需动收缩完全消失,５０％出现远端食管平均收缩压力减低,５６．２５％出现远端食管低压收缩。结论：本组病例多有远端食管运动功能障碍,以吞咽后同步收缩为主,其与反流性食管炎以及一些临床症     

奥曲肽及垂体后叶素治疗食管胃底静脉曲张破裂出血的效果观察

①目的 比较奥曲肽和垂体后叶素治疗肝硬化食管胃底静脉曲张破裂出血的临床效果。②方法 将９２例（１０５次）食管胃底静脉曲张破裂出血病人随机分为奥曲肽组（５０例５８次）和垂体后叶素组（４２例４７次）,分别给予奥曲肽和垂体后叶素治疗,每隔０．５ｈ冲洗胃腔吸取胃液１次,比较两组止血率。③结果 奥曲肽组和垂体后叶素组８ｈ内止血率分别为６０．３％,１７．０％,差异有极显著性（Ｘ＾２＝２０．１５,Ｐ〈０．０１）     

Study on genetic polymorphisms of DCC gene VNTR in esophageal cancer

The abeted in Colo~ cancer gene (DCC) is re~ as a susceptibility gene in colol'eCtal cancer, whichis located on chlomesome 18qZI. 2. Ihactivation of thisgene may Play an i~ role dndng some Pimessessuch as ~ p~ssion and metastasis. With its ~allycloned, in lop, casinger et alllJ found that a vocablenumber tandem repeat (VNTR) is located wick an intwOf the DCC gene, its lepeat act is 2 hp,the core seqUence of (TA)n ~ numbers ~ 10 -- to tinies, whichis an ideal genetic rnalker. Esophageal…     

食管癌APC/MCC基因杂合缺失的研究

目的 研究ＡＰＣ／ＭＣＣ基因杂合性缺失（ＬＯＨ）与食管癌发生发展的关系。方法 多聚酶锭反应技术及限制性片段长度多态现象对４６例食管癌ＡＰＣ和ＭＣＣ基因的ＬＯＨ进行了分析。结果 食管癌ＡＰＣ和ＭＣＣ基因ＬＯＨ阳性表达分别为２９．０％和３３．３％。结论ＡＰＣ、ＭＣＣ基因的ＬＯＨ是食管癌的常见改变,可能参与了食管癌的发生。     

不同实体瘤体外药敏试验的可行性研究

目的：研究体外药敏试验用于不同原代培养肿瘤细胞的可行性,方法：采用MTT比色分析法,结果：非小细胞肺癌,食管癌,贲门癌对乐铂均较敏感,不同病理类型和同一类型的不同个体对乐铂的敏感性差异较大,且其抑制作 病理类型无密切关系。结论：MTTI地操作简便,快捷,敏感,可应用于实体瘤临床个体化的药敏检测。     

Nitric oxide mediates inhibitory nerve effects in human esophagus and lower esophageal sphincter

The effect of inhibition of nitric oxide synthase on nonadrenergic, noncholinergic nerve-mediated responses in circular smooth muscle of the human esophageal body and lower esophageal sphincter (LES) was examinedin vitro. Tissues were obtained from 10 patients (eight esophageal resection for cancer, two transplant donors). Muscle strips from the LES developed significant spontaneous tension (11.6 ± 2.1 mN/mm²,N=6) and relaxed in response to electrical stimulation. The nitric oxide synthase inhibitor,N -nitro-l-arginine (NNA), at 10^–5 M, inhibited the relaxation, but had no significant effect on the spontaneous tension (13.0 ± 2.6 mN/mm²,P=0.07). Esophageal body strips developed little spontaneous tension, demonstrated an off contraction following the cessation of the electrical stimulus, and when contracted with 10^–5 M carbachol, relaxed during electrical stimulation. NNA (10^–5 M) inhibited the off contraction and the relaxation seen after carbachol and unmasked a prominent intrastimulus contraction. This intrastimulus contraction was enhanced by eserine and inhibited by atropine and tetrodotoxin. NNA showed similar potency in the esophageal body and LES and its effects were reversed byl-arginine, but notd-arginine. The results indicate that nitric oxide is an important mediator for nonadrenergic, noncholinergic nerve effects in the human esophagus and lower esophageal sphincter.This research was supported in part by an ICI Pharma/Medical Research Council of Canada Research Fellowship grant awarded to H.G. Preiksaitis and a Medical Research Council Program Grant PG8.     

Velocity of peristaltic propagation in distal esophageal segments

Recent studies of the peristaltic pressure wave have suggested the presence of two sequential but overlapping contraction segments in the distal esophageal body. In this report, propagation velocity of esophageal peristalsis was determined in these segments in normal subjects (N=35) and in patients with high-amplitude peristalsis (nutcracker esophagus,N=25) to see if intersegment differences were present in the normal or abnormal setting. Velocity measurements were made from conventional manometric tracings in two 4-cm regions representing the distal smooth-muscle segments. A novel method of velocity measurement was employed that used regression lines established from contraction onset times. In normal subjects, propagation velocity decreased significantly from the proximal to distal segment (4.9±0.5 cm/sec, vs 3.2±0.2 cm/sec,P<0.01). Velocity also decreased across segments in nutcracker-esophagus patients (5.3±0.6 cm/sec, vs 3.6±0.7 cm/sec,P=0.06), but the difference reached statistical significance only when the subset with highest amplitudes (180 mm Hg) was analyzed separately. Greater variance in velocity in the distal smooth-muscle segment of nutcracker-esophagus patients (P<0.01) was, in part, responsible for this statistical observation. We conclude that normal propagation velocity decreases across regions corresponding to the smooth-muscle contraction segments defined by recent studies of peristalsis, supporting the assumption that they represent separate neuromuscular units. The mechanisms responsible for contraction wave abnormalities in the nutcracker esophagus have a minimal effect on propagation velocity, an effect that is restricted to the distal smooth-muscle segment of the esophageal body.Supported in part by a grant from the United States Public Health Service (AM07130).     

PCNA immunostaining combined with AgNOR staining in esophageal squamous cell carcinoma to identify patients with a poor prognosis

Immunostaining of the proliferating cell nuclear antigen (PCNA) provides important information about cell kinetics and is easily performed on routinely obtained formalin-fixed, paraffin-embedded materials. We report herein the results of a retrospective study on PCNA staining in esophageal cancer undertaken to determine its significance. As this study indicated that immunoreactivity was preserved in specimens fixed within 24 h, only 31 specimens from surgical patients were available for this investigation. The mean PCNA index of the patients without invasion to the adventitia (35.7±17.9) was significantly lower than that of those with invasion to the adventitia or neighboring structures (49.7±14.5), while the PCNA index did not correlate with other clinicopathologic parameters such as histologic type, lymph node metastases, or prognosis. However, when an analysis of PCNA staining was combined with an analysis of argyrophilic nucleolar organizer region (AgNOR) staining, a correlation with prognosis was found. In fact, seven patients with a high PCNA index (44) and AgNOR count (6) had a significantly poorer prognosis than the remaining 22 (P=0.0014), and six of these seven patients died within 2 years. These results indicate that this combined evaluation may be useful for the identification of patients with a poor prognosis among those undergoing surgery for esophageal squamous cell carcinoma.