ABSTRACT
This report describes the case of a patient with cricopharyngeal dysfunction with significant piriform sinus expansion. An 80-year-old man presented with a three-year history of dysphagia. Palsy of the cricopharyngeal chalasis was identified by electromyography under both videofluorography and manofluorography. Although a widening procedure was performed in the cricopharyngeal region using a bougie, the patient gained only minor relief from his dysphagia. After the patient had had adequate time to recover spontaneously (six months), a cricopharyngeal myotomy was performed. As a result, his dysphagia resolved and the post-operative course was uneventful. The clinical and histopathological findings in this case suggested that significant piriform sinus expansion had resulted from the cricopharyngeal dysfunction, due to cricopharyngeal myopathy.
Subject(s)
Cricoid Cartilage/surgery , Deglutition Disorders/surgery , Pharynx/surgery , Aged, 80 and over , Deglutition Disorders/physiopathology , Fluoroscopy/methods , Humans , Male , Treatment Outcome , Videotape RecordingABSTRACT
The relationship between varicella-zoster virus and idiopathic associated laryngeal paralysis was examined in five patients, using complement fixation or enzyme immunoassay testing. In all cases, significant changes in serum levels of varicella-zoster virus antibody were observed. Videofluoroscopy was useful in assessing the severity of the dysphagia and in making an accurate diagnosis; both laryngeal elevation and weakness of pharyngeal wall contraction were also observed. In two cases in which antiviral therapy was delayed, the outcome was poor, with increased levels of varicella-zoster virus immunoglobulin M found on enzyme immunoassay. The outcome of the condition may thus depend both on the speed of antiviral therapy commencement following onset of symptoms, and on the levels of varicella-zoster virus immunoglobulin M antibody (measured by enzyme immunoassay). Our study suggests that varicella-zoster virus should be considered in the differential diagnosis of patients with idiopathic associated laryngeal paralysis, and rapid antiviral therapy should be initiated when necessary.
Subject(s)
Glossopharyngeal Nerve Diseases/virology , Herpes Zoster/complications , Vocal Cord Paralysis/virology , Aged , Antibodies, Viral/blood , Antiviral Agents/therapeutic use , Female , Glossopharyngeal Nerve Diseases/diagnosis , Glossopharyngeal Nerve Diseases/drug therapy , Herpes Zoster/diagnosis , Herpesvirus 3, Human , Humans , Middle Aged , Photofluorography/methods , Treatment Outcome , Vocal Cord Paralysis/drug therapyABSTRACT
A 35 year-old female patient with pelvic malignant mesothelioma is described. The patient underwent total pelvic exenteration due to a pelvic tumor. Macroscopically, the resected tumor was located in the rectovaginal lesion with invasion into the rectal and vaginal wall, and around the internal urethral ostium. Light microscopically, the tumor predominantly consisted of sheets of plump round cells with acidophilic cytoplasm, and focally of tumor cells showing papillary growth pattern. The tumor cells showed remarkable cellular pleomorphism, and were both alcian blue and periodic acid-Schiff stain negative. Electron microscopically, these tumor cells had numerous long bush-like microvilli on their surface with increased length/width ratios. Positive staining with epithelial membrane antigen, cytokeratin, and vimentin, and negative staining with the carcinoembryonic antigen and S-100 protein were observed immunohistochemically. Based on these histological and immunohistochemical estimations, the tumor was diagnosed as a primary malignant mesothelioma originating from the rectovaginal tissue. Review of the literature confirmed the rarity of pelvic malignant mesothelioma. The possibilities of the pathogenesis of the tumor include the tumor's arising from the peritoneal remnant in the rectovaginal tissues, or from the epithelium of the secondary Mullerian system, which shares the same ancestry with the peritoneum.
Subject(s)
Mesothelioma/pathology , Rectal Neoplasms/pathology , Vaginal Neoplasms/pathology , Adult , Female , Humans , Immunohistochemistry , Mesothelioma/chemistry , Mesothelioma/surgery , Pelvic Exenteration , Pelvic Neoplasms/chemistry , Pelvic Neoplasms/pathology , Pelvic Neoplasms/surgery , Rectal Neoplasms/chemistry , Rectal Neoplasms/surgery , Vaginal Neoplasms/chemistry , Vaginal Neoplasms/surgeryABSTRACT
It has been demonstrated that cultured mesangial cells (MC) express latent transforming growth factor (TGF)-beta binding protein (LTBP) mRNA, and that LTBP might be essential for the extracellular matrix (ECM) accumulation stimulated by TGF-beta in cultured MC. We performed a study to test the pathophysiological role of LTBP in mesangial ECM accumulation in human glomerulonephropathies. The expression of LTBP in 64 renal biopsies of patients with renal diseases was examined by immunohistochemical staining with the specific antibody raised against human LTBP. The biopsy specimens were divided into three groups: Group 1, IgA nephropathy; Group 2, IgA negative mesangial proliferative glomerulonephritis, which mainly consisted of diabetic nephropathy and lupus nephritis; and Group 3, non-proliferative nephropathy, which consisted of minimal change and membranous nephropathy. Immunohistochemical staining of LTBP was significantly detected in mesangial/paramesangial area of glomerulus in Group 1, but not observed in Group 2 or Group 3. The intensity of staining was well related to the grade of mesangial ECM accumulation in Group 1. These findings suggest that the LTBP-TGF-beta complex may play a pivotal role in ECM accumulation in IgA nephropathy, and that modification of LTBP-ECM interaction might provide a new therapeutic strategy against the progression of glomerulosclerosis.
