[Study of nitric oxide synthases, nitric oxide and tumor necrosis factor in different types of ascites]

The purpose of this study was to elucidate the clinical significance of nitric oxide synthases (NOS), nitric oxide (NO) and tumor necrosis factor (TNF) in different types of ascites. NOS, NO and TNF in ascitic transudates of 21 patients with liver cirrhosis, ascitic exudate of 32 patients with liver cirrhosis and carcinogenesic ascites of 19 patients were measured by Griess, ELISA and colorimetric methods. Compares to the value in ascitic transudate of 21 patients with liver cirrhosis, NOS (7.32 +/- 3.13 nmol.min-1.g-1), NO (15.4 +/- 7.6 mumol/L) and TNF (331.7 +/- 121.2 mumol/L) in ascitic exudate of 32 patients with liver cirrhosis were significantly higher (P < 0.01). The NO (10.7 +/- 3.2 mumol/L) and TNF (185.6 +/- 84.1 mumol/L) in carcinogenesic ascites of 19 patients were between those in ascitic exudates and those in ascitic transudates of patients with liver cirrhosis (P < 0.05 or 0.01). The NOS activity was highest in carcinogenesic ascites. The decrease of 24h urine volume in patients with cirrhosis was relative to the increase of NO level in ascites. Those suggested that measurements of NOS, NO and TNF in ascites are helpful in differential diagnosis of ascites. The separation between NO level and NOS activity in ascites indicates that the ascites is carcinogenesis.

Secondary pharyngeal myotomy for tracheoesophageal speech

Pharyngeal myotomy in the post-laryngectomy patient has been described to reduce pharyngoesophageal spasm and facilitate vocal rehabilitation and tracheoesophageal speech. This report describes the complications and speech outcomes in 22 consecutive patients who underwent a secondary pharyngeal myotomy. The patients were all drawn from a hospital clinic dedicated to voice rehabilitation after laryngectomies. Their ages ranged from 54 to 81-years-old with a mean of 64. Two patients suffered surgical complications--both had pharyngocutaneous fistulas which resolved with conservative management. One patient had an incomplete myotomy and was treated with injection of boulinum toxin in the pharyngeal plexus. This treatment resulted in good vocalization. Seventeen of 22 patients in the study were long-term TEP users, and all of these were judged to have good speech quality. Our experience with myotomy for TEP speech demonstrates that many patients with pharyngoesophageal spasm can benefit from the procedure and successfully phonate. There were several complications related to the procedure, but these were successfully managed conservatively and without long-term sequela. Pharyngeal myotomy as an adjunct to TEP is useful and effective in selected patients.

Tracheoesophageal puncture in irradiated patients

Tracheoesophageal puncture (TEP) with use of a voice prosthesis is widely accepted as an excellent method of postlaryngectomy vocal rehabilitation. Many patients with advanced cancer require postoperative radiotherapy (RT), while other cancer patients have been treated with RT as a primary treatment and come to laryngectomy for salvage. The influence of RT on outcome of the TEP procedure with respect to successful speech and potential complications has not been widely discussed. We retrospectively reviewed 77 consecutive cases of TEP in patients who had received RT and laryngectomy for laryngeal cancer. All cases had a minimum of 6 months of follow-up. All 77 patients were successful in obtaining speech with the TEP, and 75 (97%) continued to be TEP users thereafter. Eight patients (10%) developed complications in the course of treatment. There was no mortality. In selected patients, TEP after RT is a relatively safe and effective method of vocal rehabilitation.

Surgical access to tumors of the cervicothoracic junction

BACKGROUND

Surgical resection of tumors of the cervicothoracic junction is often problematic due to the limitations imposed by the thoracic cage and adjacent neurovascular structures. The majority of surgical approaches to this region have been designed with the intent of providing adequate exposure for vertebrectomy with tumor resection and vertebral column stabilization. These approaches do not provide adequate exposure for a heterogeneous group of tumors which also involve the cervicothoracic junction. We used a combined cervicothoracic surgical approach to determine its efficacy in tumor resection.

METHOD

Seventeen patients with a heterogeneous group of malignancies arising in a variety of soft tissues underwent combined cervicothoracic resection. The approach consisted of anterior cervical access, median sternotomy, and anterior thoracotomy.

RESULTS

Complete gross tumor resection was accomplished in all 17 patients, 15 of whom had negative microscopic margins. Extensive reconstruction was employed in 6 patients. Three patients received intraoperative brachytherapy implants and 5 patients received external-beam postoperative radiotherapy. Local tumor control was obtained in 12 patients, and 10 patients are currently alive, free of disease (median: 12 months; range: 3-47 months). There was no inadvertent sacrifice of neurovascular structures. The sternoclavicular joint was maintained in all patients. There were 4 major complications, and no perioperative mortality associated with the surgical procedure.

CONCLUSION

The combined "trap door" technique provides sufficient exposure for resection of cervicothoracic tumors. Surgery is performed with limited morbidity with the sparing of uninvolved neurovascular structures. The sterno-clavicular joint was maintained in all patients. Preliminary results using this approach for resections of tumors of the cervicothoracic junction are encouraging.

[Spiral shaped bacteria in the human gastric biopsy]

Biopsy specimens from the gastric mucosa of 149 patients who underwent gastroduodenal endoscopy for upper gastrointestinal complaints were studied by light microscopy and culture. Spiral shaped bacteria were detected in four of the specimens by smears with Gram stain. The positive rate was 2.68%, but these bacteria and HP did not grow in culture. The characteristic helical morphology of the bacteria appears to be similar to that of the bacteria found in the stomach of cats and dogs. And what of significance in these cases is the presence of spiral shaped bacteria in association with chronic gastritis.