Outcome of Surgery to Improve Swallowing in Patients with Lateral Medullary Syndrome: A Retrospective Cohort Study.

The study investigated surgical interventions to improve dysphagia in patients with lateral medullary syndrome (LMS), along with optimal scheduling of surgery and prognostic factors. In this retrospective, single-center cohort study, dysphagia patients with LMS who underwent surgery between January 2010 and December 2021 were enrolled. The National Outcomes Measurement System (NOMS) was used to classify swallowing function (level 1: only tube feeding, level 5: without tube feeding). Patients were divided into four groups. Groups 1 and 2, LMS onset within 1 year, and groups 3 and 4, onset after 1 year. Groups 1 and 3 had infarctions confined to the oblongata. Groups 2 and 4 had infarctions extending to the cerebellum. The primary outcome was the time to achieve NOMS ≥ 5. The final NOMS level and pathological findings were considered. Nineteen cases were included. Group 4 comprised one case and was excluded. The mean overall preoperative NOMS was 1.11. The mean time to NOMS ≥ 5 was 9.6 months (95% confidence interval: 5.04-14.2), and that to NOMS ≥ 5 was 1.67 (1.07-2.26), 11.4 (4.71-18.1), and 7.6 (5.15-10.1) months for groups 1, 2, and 3, respectively. Group 1 achieved NOMS ≥ 5 earlier than groups 2 and 3 (P = 0.01 and 0.03, respectively). The overall final NOMS value was 4.68. Fourteen patients had atrophy or fibrosis of the cricopharyngeal muscle. In conclusion, surgery was effective for effective for treating dysphagia in LMS patients. However, improvement is prolonged if > 1 year has passed since onset or the infarction extended to the cerebellum.

Prevention of cuff injury of the intubation tube by blunt window opening in tracheostomy.

One of the intraoperative complications of tracheostomy under general anesthesia is cuff injury of the intubation tube. In the present study, we investigated whether a blunt tracheal opening is a useful method to avoid cuff injury. A retrospective cohort study was conducted to examine patients who underwent tracheostomy under general anesthesia at a single institution from January 1, 2017 to July 31, 2021. Electrocautery was used to thin the connective tissue between the tracheal rings, and bluntly open the trachea with mosquito forceps or similar instruments. Primary outcomes included cuff injury rate, number of surgeons involved, and career as otolaryngologist at the time of surgery. The secondary outcome was perioperative complications. Of the 64 cases, 3 had cuff injuries. 2 of the 3 had cuff injuries during the creation of an anteriorly based flap. 16 surgeons were involved ranging from the first to sixth year as an otolaryngologist, with the third year of otolaryngologist being the most common. The median physician year for instructors was 18 years. The most common postoperative complication was granulation in 9 cases. There were no cases of incorrect cannula insertion or difficulty in cannula insertion. A blunt tracheal opening was considered useful as a method to prevent cuff injury.

Survival and Subsequent Dispersal of Rice Sclerotial Disease Fungi, Rhizoctonia oryzae and Rhizoctonia oryzae-sativae, in Paddy Fields.

In 1998 to 2001, a commercial rice (Oryza sativa) paddy field (area: ca. 0.14 ha) was surveyed for Rhizoctonia oryzae and R. oryzae-sativae, causal agents of bordered sheath spot and brown sclerotium disease of rice plants, respectively, to determine their survival in soil and stubble during the pretransplanting season, and the effect on disease development during the maturation season of rice. Then, infection by these fungi of weeds belonging to 17 families, which grew in the four neighboring fields, was examined during rice growing seasons. All field isolates of the fungi from soil, stubble, rice sclerotial disease lesions (diseased tissues), and weeds were assorted into mycelial compatibility groups (MCGs) based on the barrage zone reaction of paired isolates. In R. oryzae, 3 to 8 MCGs were annually found from soil/stubble, 2 to 4 MCGs from rice bordered sheath spot lesions, and 4 to 9 MCGs from 4 to 14 weeds. MCGs common to both soil/stubble and diseased tissues, soil/stubble and weeds, and diseased tissues and weeds numbered 1 to 2 in all cases. In R. oryzae-sativae, MCGs common to both soil/stubble and brown sclerotium disease lesions, and soil/stubble and weeds, numbered 1 to 4 and 0 to 5, respectively. In R. oryzae and R. oryzae-sativae, a few MCGs were common to soil/stubble, diseased tissues and weeds, and some were also common to diseased tissues in 1998 and soil/stubble in 1999, or weed in 1998 and diseased tissues in 1999. Members belonging to a single MCG from rice diseased tissues were detected from maximally five weeds growing in the neighboring fields. These results indicate that fungi that had caused sclerotial diseases at the maturation stage of rice plants survived on and in soil and stubble until the pretransplanting season of the next year, followed by wide dispersal in and out of fields and by infection and disease development on rice plants and various weeds.