Scintigraphic monitoring of swallowing rehabilitation after horizontal supraglottic laryngectomy.
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Deglutition↗
Biomedical subjects
L D'Alatri
Publications and source records attributed to L D'Alatri.
[Validity of schintigraphy in the study of neurogenic dysphagia].
The purpose of the present study was to verify the validity and potential application of oropharyngealesophageal scintigraphy in the analysis of neurogenic dysphagia. Scintigraphy was used on 36 patients divided into 2 groups: Group 1 (control) comprised 17 healthy volunteers; Group 2 included 19 patients suffering from various neurological and neuromuscular pathologies (myasthenia gravis, Parkinson's disease, polymyositis, stroke, paralysis of the last cranial nerves). In group 1 scintigraphy provided normal results both for mode of swallowing and transit, and for the values of the various parameters studied. On the other hand, scintigraphy showed that in group 2 all oral, pharyngeal and esophageal phases of swallowing were altered vs the controls with a statistically significant increase in the average values for the oral transit time (OTT) (1.45 sec., p = 0.0005), pharyngeal transit time (OTT) (3.23 sec., p = 0.044), esophageal transit time (ETT) e19.87 sec., p = 0.005) as well as in the corresponding bolus retention indexes ORU (12.95%, p = 0.0003), FIR (15.05%, p = 0.0003) and ERI (28.63%, p = 0.002). Moreover, the quality and means of swallowing also proved altered while tracheobronchial aspiration was only seen in 6 of the 19 patients (maximum value: 90%, average value; 7.66%) with a marked prevalence in the stroke subgroup (4/8). In light of these results and considering the low dose of radiation (0.00043 Gy), the lack of invasiveness and excellent tolerability, scintigraphy has confirmed its clinical validity in the functional, objective and quali-quantitative study of deglutition, even in patients suffering from neurogenic dysphagia.
Adolescent↗
Purification and characterization of two recombinant human granulocyte colony-stimulating factor glycoforms. Pharmacokinetic and activity studies of single-dose administration in mice.
Two recombinant human granulocyte colony-stimulating factor (rhG-CSF) isoforms were isolated from the medium conditioned by an engineered Chinese hamster ovary (CHO) cell line. The two rhG-CSFs were characterized and were found to differ in the carbohydrate structure attached to Thr-133. The glycoform, referred to as Peak 1, contains the O-linked glycan Neu5Ac(alpha 2-3)Gal(beta 1-3)GalNAc; the Peak 2 glycoform contains the O-linked glycan Neu5Ac(alpha 2-3)Gal(beta 1-3)[Neu5Ac(alpha 2-6)]GalNAc. The two glycoforms displayed a similar biological activity in cultures of a mouse 32D C13 cell line and human bone-marrow myelo-monocytic progenitor cells (CFU-GM). In the latter test both glycoforms displayed a higher activity than nonglycosylated rMet-hG-CSF from Escherichia coli. The pharmacokinetic profile and activity of the two rhG-CSF glycoforms and of a mixture of them (Pool) were investigated in mice treated with a single injection of rhG-CSF at the doses of 125 micrograms and 250 micrograms/kg, given via the intravenous (i.v.) and the subcutaneous (s.c.) route, respectively. The plasma concentration profiles obtained were similar for all three substances and did not show any relevant differences in absorption or elimination. The pharmacokinetic parameters indicate that the three substances have similar area under the curve (AUCs), volumes of distribution, and terminal half-life. Furthermore, our data indicate a high bioavailability of the two different glycoforms of rhG-CSF when given to mice via the s.c. route either singularly or as a mixture. Detectable levels of rhG-CSF persisted for more than 8 h in the i.v. and more than 24 h in the s.c. route of administration. All three substances induced early neutrophilia in mice. All rhG-CSF-treated mice developed a two-four-fold rise in neutrophil counts as early as 4 h after the intravenous and 2 h after the subcutaneous injection. Relatively high levels of neutrophils were maintained for at least 8 and 24 h after i.v. and s.c. administration, respectively.
Amino Acid Sequence↗
Scintigraphic assessment of swallowing after horizontal supraglottic laryngectomy.
OBJECTIVE: Oral-pharyngo-esophageal scintigraphy (OPES) proved to be able to demonstrate the pharyngeal residue of the radioactive bolus after deglutition and the presence and amount of tracheobronchial aspiration, and to calculate exactly the transit time of the various swallowing phases. The aim of this study was to evaluate the real objective effectiveness of OPES in order to assess the degree of swallowing recovery after horizontal supraglottic laryngectomy (HSL). METHODS: Nineteen patients entered the study, and 17 healthy subjects were included as control group (group 1). Nineteen patients in whom HSL had been performed at least 1 year before underwent OPES. They were divided into two groups: 13 patients (group 2) in whom the tracheal cannula had been removed and swallowing, phonatory, and respiratory functions were satisfactory and 6 patients (group 3) in whom the tracheostomy tube was still in situ for aspiration of liquids and scarring of the laryngeal vestibule. RESULTS: Our results showed that in the patients who underwent HSL, all scintigraphic semiquantitative parameters and particularly aspiration percentage values and Pharyngeal Ritention Index (PRI) at 10 and 60 seconds were able to pinpoint some residual "subclinical" alteration and/or minimal surgical sequelae frequently observed after this kind of functional surgery, even though a substantially satisfactory recovery was achieved clinically (group 2 versus group 1). In addition, aspiration amounts in group 3 were markedly higher than those in group 2 (p < .0002), and mean PRI values at 10 and 60 seconds were significantly different (p < .0001) from normal mean control values (group 1). CONCLUSION: Oral-pharyngo-esophageal scintigraphy may be regarded as a noninvasive, well-tolerated technique, with a radiation body burden within satisfactory limits of radioprotection. It appeared to be also sensitive in assessing the swallowing recovery after HSL.
Adult↗
Overproduction of soluble, extracellular cytotoxin alpha-sarcin in Escherichia coli.
The goal of the present study was to establish the condition to obtain preparative amounts of the recombinant cytotoxin alpha-sarcin to be used for immunoconjugate production. alpha-Sarcin cDNA was isolated from Aspergillus giganteus strain MDH 18,894 and its expression in Escherichia coli was attempted by the use of both two-cistron and fusion protein-expression systems. Whereas the former resulted in low intracellular expression level of recombinant alpha-sarcin (r-Sar), the latter allowed high-level expression of the fusion protein in the culture supernatant. A variant form of alpha-sarcin with an additional threonine residue in position 1 (Thr-Sar) was obtained by proteolytic processing of the fusion protein with a final yield after purification of 40 mg/L of culture. Both recombinant proteins r-Sar and Thr-Sar were identical to native a-sarcin with respect to the biochemical properties and to the in vitro biological activity.
Amino Acid Sequence↗
[Functional results after cordectomy in laryngeal fissure and in microlaryngoscopy with CO2 laser].
Videolaryngostroboscopy, psychoacoustic and spectrographic analyses were performed to evaluate vocal function in two groups of male patients who had undergone CO2Laser (n = 23) and laryngofissure cordectomy (n = 21) for the treatment of T1a glottic carcinoma. None of the patients used their voices professionally. This study revealed a good correlation between the anatomical features and voice quality. Psychoacoustic and spectrographic analysis showed that the functional results were significantly worse in the patients treated by laryngofissure (p < 0.003). In this group videolaryngostroboscopy showed a higher rate of compensation in both ventricular folds than shown in the laser-treated group (p < 0.02). The authors conclude that the functional results obtained after cordectomy depend on the various combinations of scarring patterns and compensatory hyperkinesia of the ventricular or vocal folds. The better anatomical and functional results achieved following laser cordectomy may be explained by the fact that such procedures result in better, more rapid healing processes.
Aged↗
Immunoconjugates made of an anti-EGF receptor monoclonal antibody and type 1 ribosome-inactivating proteins from Saponaria ocymoides or Vaccaria pyramidata.
The present paper describes two immunoconjugates consisting of an anti-epidermal growth factor receptor (EGFR) monoclonal antibody (MAb), named Mint5, covalently linked to the type 1 ribosome-inactivating proteins (RIPs) ocymoidine (Ocy) and pyramidatine (Pyra) from Saponaria ocymoides and Vaccaria pyramidata respectively. Both antibody and toxins are shown to retain their respective biological properties upon chemical conjugation. The immunoconjugates exert specific inhibition of EGFR expressing target cell proliferation and protein synthesis in in vitro assays and also inhibit the growth of grafted human tumour cells in nude mice.
Animals↗
[Medical-legal evaluation of laryngeal dysfunction to determine disability].
The "New Table indicating the percentage of disability resulting from injury and disabling diseases" approved by the Italian Ministerial Decree dated February 5, 1992 gives a superficial, highly disorganized handling of laryngeal pathologies. This Table only considers phonatory function disorders which are included in a special section; it totally neglects dyspnea and dysphagia of laryngeal origin. This omission cannot even be overcome on the basis of similarities since there are no analogous items listed for reference. In fact, the parameters applied to evaluate dyspnea (CV, VEMS, O2 consumption) apply to ventilation disorders of a pulmonary nature and cannot, therefore, be used in cases of laryngeal dyspnea. Moreover, the Table does not deal with dysphagia at all. In addition, the basis for the Table--the concept of permanent functional damage--is not always adhered to in giving indications for evaluation of phonatory tract damage. The purpose of the present work is not, however, to propose a different way to determine the percentages for the individual items in the tables; rather, the aim is to suggest a different, highly standardized procedure for evaluating laryngeal dysfunctions which is easy to apply.
Disability Evaluation↗
[An oropharyngeal-esophageal scintigraphic study of deglutition].
The aim of the present work was to evaluate whether oro-pharyngeal-esophageal scintigraphy could be used in the dynamic study of the various phases of deglutition and to determine whether it could be applied in otorhinolaryngological practice along with videofluoroscopy and videoendoscopy. The patients were divided into four different groups according to clinical features and the scintigraphic data were analyzed on this basis. Emphasis is placed on the ease of this technique, its tolerability and the low level of radiation. It is pointed out that scintigraphy is quite useful in determinating the exact percentage of the bolus inhaled into the trachealbronchial branch and in measuring the transit time of the various phases of deglutition in detail. In patients affected by upper airway-digestive tract neoplasms it is, therefore, possible to make a semiquantitative evaluation of the results of surgery. Moreover, with this method the results of any rehabilitation can be measured as well as the onset of compensation mechanisms.
Aged↗
Ultrastructural analysis of the chorda tympani nerve in facial paralysis from different etiologies.
Twelve chorda tympani segments, removed from as many patients (7 females, 5 males) affected by otosclerosis (3, as controls) and from either idiopathic (4), or traumatic (3) or herpetic (2) facial paralysis, were examined by a transmission electron microscope, in order to verify chordal ultrastructural changes, the gravity of neural damage in the various types of facial paralysis and the role played by chorda tympani on the etiopathogenesis of the idiopathic form. The segments were obtained, while performing a stapedectomy in otosclerotic patients and, in facial palsy, while performing chordal neurotomy or direct decompression of the II and III portio of the VII nerve. The obtained data showed no noteworthy alterations concerning myelinated and unmyelinated nerve fibers and chordae stroma in otosclerotic patients, confirming their reliability as controls. In facial paralysis, both normal ultrastructures and alterations were noticed, even though polymorphic: unravelling and dissociation of the lamellae sheaths up to a point of degeneration with a more or less complete resorption of myelin, accumulation of dense bodies and electron-dense formation, particularly in unmyelinated fibers, vacuoles in myelinated fibers, intracytoplasmic vacuoles in Schwann cells and, in herpetic forms, an occasional presence of inflammatory cells. Such results demonstrate that, in any type of facial paralysis, the ultrastructure of the chorda tympani is constantly involved, probably due to main trunk involvement. In the idiopathic forms the alterations of the chorda look like to degenerative alterations caused by traumato-ischemic events, rather than to cytopathic lesions induced by herpetic virus.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
[Midline granuloma and Wegener's granulomatosis].
Necrotizing lesions of upper respiratory tract have always been among the most enigmatic diseases of the head and neck region. Nowadays a great deal of nosographic confusion still remains along with numerous doubts concerning diagnostic and therapeutic strategies to be followed in dealing with many diseases often erroneously defined "midline granuloma". In fact, a large variety of diseases appear or may appear as midline destructive lesions in the upper respiratory tract. Each of these, including infections, immune and neoplastic disorders, obviously requires a different therapy. The clinician must have a very good knowledge of the problem in order to make a rational approach to diagnosis and therapy. Wegener's granulomatosis is quite different from "midline granuloma" and must be diagnosed promptly so that an appropriate therapy may be determined as soon as possible. Unlike in the case of "midline granuloma", a prompt therapy is often very effective and gives long periods of remission. In this disease, nevertheless, the etiopathogenesis of both diseases is unknown, precise protocols for diagnosis or treatment do not exist (every case must be considered separately) and prognosis is very poor. On the basis of their personal experience and of an accurate review of Literature, the Authors present a systemic and up-to-date monographic study focusing particular attention on the most recent diagnostic techniques, such as immunohistochemical techniques which utilize monoclonal antibodies, indispensable in the cases of "midline granuloma", and immunofluorescent techniques searching antibodies to cytoplasmic antigens of neutrophil granulocytes, of great value in dealing with Wegener's granulomatosis not only in establishing an initial diagnosis, but also in making prognosis and in controlling the evolution of the disease. The paper also discusses differential diagnosis of midline destructive disorders, highly important for a correct and rational initial approach in diagnosis. Every disease described in the section concerning differential diagnosis must be excluded in order to make an accurate diagnosis of "midline granuloma" in that no typical histopathologic or clinical signs of this particular, destructive disorder. Finally, the authors focus their attention on new etiopathogenetic hypotheses and their therapeutic implications. The most interesting of them are surely those that consider "midline granuloma" the manifestation of a malignant lymphoma as well as those that explain the recent success obtained in treatment of Wegener's granulomatosis using trimethoprim and sulfamethoxazole asserting a possible essential role of infections in the etiology of the disease.
Adult↗
The external ear and the tympanic membrane. A three-dimensional study.
The study of the anatomical variations of the external ear is important for the ear surgeon who assesses the middle ear in this way. Furthermore, the design of insert earmoulds for use with either hearing aids or portable radios requires a better knowledge of the shape of the external ear. We studied the external ear structures and the drumhead in 140 cadavers with no previous history of ear pathology. A silicone resin was used, employing a dental impression technique. These permanent impressions were analysed by means of an operating microscope. Different parameters were studied, to determine the average dimensions of the structures. The clinical significance of these results is discussed.
Adult↗
Marijuana smoking as a possible cause of tongue carcinoma in young patients.
A case of T1N0M0 carcinoma of the tongue in a male 23-year-old 'regular' marijuana smoker is described. Hemiglossectomy and complete bilateral neck dissection were carried out. No post-operative radiotherapy was given as the resection margins were histologically negative. The tumour recurred one year later in the left cervical region involving the mandible and surgery was again performed, but after three months, neck disease was still evident. The case described case implies the introduction of marijuana as a possible new risk factor in the development of oral cavity tumours. Resection of the primary lesion has to be as wide as possible even in T1 cases, due to the aggressive biological behaviour of such tumours in young subjects.
Adult↗
Relationships between middle latency auditory responses (MLR) and speech discrimination tests in the elderly.
74 subjects aged between 60 and 80 years underwent tonal audiometry, speech discrimination tests (phonetically balanced words, normal sentences and compressed sentences) and middle latency responses (MLRs) in order to evaluate possible correlations between behavioural and electrophysiological tests. The results showed that in elderly patients normal sentences are better understood than phonetically balanced words, that performances decrease dramatically when listening conditions became difficult, that auditory threshold seems to influence speech discrimination scores more than does age per se. MLRs seem to be unaffected both by age and by auditory threshold and Pa occurrence is a more reliable parameter than its latency. No correlation between speech discrimination tests and MLRs could be observed; on the contrary in the presence of abnormal speech discrimination tests the MLRs were almost normal and vice versa.
Aged↗
Auditory brainstem responses in the aged.
The auditory brainstem responses (ABR) in a group of 74 aged subjects (60-80 years), affected by presbycusis were evaluated for presence of a retrocochlear involvement. The comparison of results from subjects with presbycusis with those from normally-hearing elderly subjects, and young subjects, affected by a cochlear sloping hearing loss, revealed that the latency increase of ABR observed in presbycusis is mainly correlated to the audiometric shape of the hearing loss and not to age per se.
Acoustic Impedance Tests↗
Auditory brainstem responses in noise-induced permanent hearing loss.
Fifty-four patients (108 ears) with presumed noise-induced hearing loss, were subjected to tonal and speech audiometry, impedance tests and measurements of auditory brainstem responses (ABR), in order to check for possible retrocochlear involvement. ABR data indicated that latency values of waves I, III and V, as well as III-I, V-III and V-I intervals fell within the normal range in all cases (M +/- 2 SD), even for fast repetition rates (51 stim/s). Poor waveform resolution of early components, particularly of wave I, was found in 12 ears (11.1%) and a total absence of evoked potentials not always related to the hearing loss, occurred in 5 ears (4.6%).
Acoustic Impedance Tests↗
[Our experience with mandibular fractures].
The authors relate on their own experience concerning etiology, diagnosis and treatment of mandibular fractures. 320 patients (252 males and 68 females) aged between 6 and 82 years with posttraumatic fractures of the mandible, 188 with a single and 132 with multiple fractures, underwent surgical and/or orthopedic treatment. Interosseous wiring and seldom application of metallic plates were the preferred techniques when surgery was performed. Intermaxillary fixation was carried out when the orthopedic treatment was needed. Often both methods were associated. In 10% of the condylar fractures the condyle has been removed. Functional results were excellent and no serious complications could be observed. In 11% of the cases with condylar fractures some limitation of the mandibular movements could be observed, while when condyles were not involved malocclusion could be observed in 3% of the cases. The authors discuss upon etiology, by comparing their own with other experiences, upon diagnosis, which does not seem difficult if adequate radiological investigations are carried out; finally they relate briefly on the advantages and disadvantages of the different surgical and non surgical techniques. Based on their experience they conclude that interosseous wiring and, in selected cases, the application of metallic plates, using an external approach, mostly associated with intermaxillary fixation, represent a safe and adequate treatment for almost every fracture of the mandible.
Adolescent↗
[Ultrastructural aspects of cholesteatoma of the middle ear].
Middle ear cholesteatomas were intraoperatively obtained from 6 male patients and studied under light (L.M.), transmission (T.E.M.) and scanning (S.E.M.) electron microscopy. Cholesteatoma proved to be formed by keratinizing squamous epithelium, or matrix, and by connective tissue, chorion or perimatrix. With regard to the matrix, a progressive differentiation of cells belonging to the stratum germinativum could be observed towards spinosum, granulosum and corneum cells with formation of keratinized lamellae. Moreover, keratinocytes and Langerhans cells were found in the stratum spinosum. The perimatrix consisted of granulation tissue, or inflamed subepithelial connective tissue displaying inflammatory cells. Furthermore, the advancing front of cholesteatoma proved to be formed by lymphocytes and plasma cells, partially covered by respiratory type epithelium.
Adult↗