Correction to: Swallowing evaluation by the Kuchikara Taberu Balance Chart and videoendscopic examination reveals that respiratory conditions,chewing, and position are strongly related to dysphagia

This study focused on the Kuchikara Taberu Balance Chart (KTBC) as a tool for swallowing function evaluation. To clarify the relationship between videoendoscopic (VE) examination of swallowing function and the KTBC, we compared median KTBC scores with and without laryngeal penetration identified by VE. Sixty-five patients with a mean age of 84.3 ± 7.9 years were examined at the Towada City Hospital. The patients were classified into groups based on laryngeal penetration, including 28 patients with and 37 patients without penetration. We found no significant differences in patient backgrounds. The median KTBC score (interquartile range) was 36.5 (31–44.5) in the group with laryngeal penetration and 42 (35–48.5) in the group without penetration, but the scores were not significantly different (level of statistical significance at α = 0.0036 determined by the Bonferroni correction method) when compared with the Mann–Whitney U test (36.5 vs. 42, z = -2.33, p = 0.020). The median respiratory condition (3 vs. 4, z = − 3.23; p < 0.0036), oral preparatory and propulsive phases (3 vs. 4, z = − 2.96; p < 0.0036), and position and endurance (1 vs. 3, z = − 3.25; p < 0.0036) scores were significantly lower in the group with laryngeal penetration. This study revealed a correlation between laryngeal penetration confirmed by VE and KTBC scores. Consequently, respiratory condition, oral preparatory and propulsive phases, and position and endurance may be useful as tools for the assessment of swallowing. In particular, we recommend adding respiratory status to dysphagia screening.

     

Ruptured aneurysm of the sinus of valsalva with single coronary artery

This paper will report the case of a patient with an aneurysm of Valsalva's sinus accompanied by single coronary artery (the presence of only a single ostium of the coronary arteries), who survived for 14 years, under conservative treatment, after a rupture of the aneurysm. In this patient the aneurysm of Valsalva's sinus ruptured from the right coronary sinus into the right ventricular outflow tract. The single coronary artery originated from the left coronary sinus, and the right coronary artery branched from the left main trunk and ran dorsally to the aorta. No case of ruptured aneurysm of Valsalva's sinus accompanied by a single coronary artery has been reported in the literature. After 14 years of conservative treatment, the patient was surgically treated by direct suture of the ruptured aneurysm and by aortic valve replacement. The postoperative course was uneventful.     

TRANSCARDIAC 5-HYDROXYTRYPTAMINE RELEASE AND IMPAIRED CORONARY ENDOTHELIAL FUNCTION IN PATIENTS WITH VASOSPASTIC ANGINA

1. The present study was designed to test the hypotheses whether platelet degranulation across the coronary bed is detectable during non-ischaemic periods in patients with vasospastic angina (VSA) and whether the exogenous nitric oxide (NO) donor nitroglycerin (GTN) is able to modify platelet degranulation, reflecting an impaired endothelial production of NO. 2. We studied 13 patients with VSA and 10 controls. The time course of coronary sinus (CS) plasma 5-hydroxytryptamine (5-HT) levels was evaluated every 4 h before and after intravenous infusion of GTN over a period of 40 h. Coronary sinus plasma 5-HT levels were significantly higher at any measured time point in patients with VSA compared with control and were significantly decreased in patients with VSA following treatment with GTN, but not in controls. Femoral artery plasma 5-HT levels remained almost constant throughout the study. The ratio of CS:aorta 6-keto-prostaglandin F_1α was significantly and inversely correlated with the transcardiac plasma 5-HT difference only in patients with VSA (r=?0.68; P < 0.02; n= 13). 3. The time course of CS 5-HT levels confirmed significant platelet degranulation across the coronary bed supplied by the spasming artery in patients with VSA and this was modified by GTN. The present data suggest that platelet degranulation occurs during non-ischaemic periods in patients with VSA and that prostacyclin biosynthesis may be a compensatory response to an impaired endothelial release of NO, limiting the degree of the effects of platelet degranulation.     

Ethanol sclerosis can be a safe and useful treatment for pericardial cyst

We report the case of a 41-year-old man with a pericardial cyst treated by percutaneous aspiration and ethanol injection. He was referred to our hospital because of elec-trocardiographic abnormality. On admission, chest x-ray revealed a large pericardial cyst in the right cardiophrenic angle. The cyst was examined by echocardiograpy, computed tomography, and cytological analysis of aspiration fluid from the cyst. Ethanol sclerosis was applied for treatment of the cyst, which had continued to increase in size. There was no recurrence of the cyst 6 months after the treatment. Percutaneous ethanol sclerosis can be the first choice of treatment for pericardial cyst.     

Morphological observation by intravascular ultrasound in superior vena cava syndrome after pacemaker implantation

We report a case of superior vena cava (SVC) syndrome that was assessed by intravascular ultrasound (IVUS). A highly echogenic eccentric lesion was demonstrated by IVUS. The use of IVUS also confirmed in vivo that SVC syndrome following pacemaker insertion occurs as a result of intimal thickening of the venous wall. © 1996 Wiley-Liss, Inc.     

Successful surgical treatment for an aortoesophageal fistula due to a descending aortic aneurysm.

The patient was a 68-year-old man who consulted another hospital with a chief complaint of dysphagia, and was referred to our hospital based on a suspicion of esophageal submucosal tumor. However, the patient was emergently admitted due to hematemesis and hypotension, which occurred immediately after the acquisition of computed tomographic (CT) images for further examinations at the outpatient clinic. Contrast-enhanced chest CT demonstrated a thoracic aortic aneurysm measuring 45 mm in maximal diameter, in addition to pneumatization adhering to mural thrombus, which appeared to be the esophagus. Upper gastrointestinal endoscopy also demonstrated ulcerative lesions accompanied by coagulations in the middle thoracic esophagus. Therefore, emergency surgery was performed based on a diagnosis of an aortoesophageal fistula due to a descending aortic aneurysm. Graft replacement was performed under partial extracorporeal circulation, followed by total thoracic esophagectomy, esophagostomy, and gastrostomy after weaning from extracorporeal circulation. This study reports the course of a patient with an aortoesophageal fistula due to a thoracic aortic aneurysm whose life was successfully saved by emergency surgery, together with literature.