Inter‐ and intra‐rater reliability in fibroptic endoscopic evaluation of swallowing

Summary Fibroptic endoscopic evaluation of swallowing (FEES) is a useful way for dentists to evaluate oropharyngeal dysfunction. However, no study has paid attention to inter‐ and intra‐rater reliability of FEES evaluation about oropharyngeal dysfunction. The purpose of this study is to verify whether dentist who trained and experienced for evaluation of dysphagia could diagnose oropharyngeal function with FEES. Nine dentists independently evaluated FEES images of 10 cases four times each. At first, evaluators performed the first evaluation without consulting the evaluative criteria. Subsequently, evaluators independently re‐evaluated at 1‐week intervals for three consecutive weeks, consulting the evaluative criteria. And then, inter‐ and intra‐rater reliability was calculated. Cohen’s Kappa was used to assess reliability. The results found that overall inter‐rater reliability was 0·35 ± 0·04 (first evaluation), 0·45 ± 0·05 (s), 0·44±0·05 (third) and 0·46 ± 0·04 (fourth). Most of inter‐rater reliability related to aspiration was moderate to high, but lower for categories that evaluated timing of swallowing and mastication. In contrast, intra‐rater reliability was moderate to high for overall categories, at 0·53 ± 0·04 (first vs. second evaluation), 0·55 ± 0·04 (first vs. third), 0·53 ± 0·04 (first vs. fourth), 0·55 ± 0·03 (second vs. third), 0·60 ± 0·03 (second vs. fourth) and 0·78 ± 0·03 (third vs. fourth). FEES is reliable for experienced dentists to diagnose oropharyngeal function. Moreover, repeated evaluation with the aids of evaluative criteria is useful to improve the reliability of FEES.     

Endoscopically Resected Granular Cell Tumor of the Stomach

Abstract: We report a rare case of granular cell tumor of the stomach resected endoscopically. The patient was a 53-year-old man who visited our clinic because of a protruding lesion incidentally found by X-ray examination of the stomach at a mass screening. Endoscopic examination revealed an apparent submucosal tumor at the anterior wall of the upper body of the stomach. An endoscopic ultrasonographic (EUS) study showed that the tumor was a hypoechoic lesion localized in the third layer (submucosal layer). On resection, a lesion measuring 6X5X3 mm was found to be localized in the submucosa. It was histologically diagnosed as granular cell tumor, which is quite uncommon in the stomach with only 44 cases having been reported to date.     

Exercise performance in children with hyperthyroidism

An attempt was made to define exercise performance in children with untreated hyperthyroidism using treadmill stress testing. Data were obtained for five female patients and the results were compared with those obtained for 16 normal female subjects. There were no significant differences at rest between the hyperthyroidism group and the control group in oxygen uptake, minute ventilation and respiratory rate. On the other hand, heart rate in the hyperthyroidism group was significantly higher than that in the control group. During exercise, there were significant differences between the two groups in oxygen uptake, heart rate, minute ventilation and respiratory rate. Hyperthyroid patients did not show an abrupt increase in heart rate during the first 30s of exercise. Exercise stress testing can therefore reveal cardiopulmonary abnormalities that are not evident at rest in children with hyperthyroidism.     

Transgenic Mouse as Tools for the Study of Congenital Anomalies*

Abstract The molecular events that guide pattern formation during embryonic development have been difficult to characterize in mammals, partly because of the difficulty in drawing a molecular connection between the phenotype of a dysmorphic mutation and the specific gene in which that mutation occurs. However, recent advances for recombinant DNA technique have made it possible to approach and clone the genes involved in the developmental process. The experimental insertion of retroviral or molecularly cloned DNA into mouse embryos to produce transgenic mice is one such approach that has led to information on phenotypes of dysmorphic mutation at the molecular level. During a series of transgenic experiment weobtained a developmental mutant that showed an autosomal dominant trait characterized by a short snout. The primary couse of this dys-morphism was a developmental defect in the first branchial arch. The transgene was integrated into the chromosome 13. One fragment flanking the insertion site was highly conserved in mammals.