ABSTRACT
OBJECTIVE: The objective of our study was to assess the frequency, cause, and time course of dysphagia after anterior cervical fusion (ACF). MATERIALS AND METHODS: A review of the surgical database revealed that 1789 patients underwent ACF procedures during the 8-year study period. A radiologic database review indicated that 80 of the 1789 patients underwent radiologic evaluation for the assessment of dysphagia after ACF. Three patients were excluded from the study because they had a history of dysphagia before ACF, and three additional patients were excluded because they had more recently undergone Nissen fundoplication, intubation, and radiation therapy, respectively. Modified barium swallow (MBS) studies and esophagrams of the 74 remaining patients were collected and analyzed to determine the cause of dysphagia and time course of dysphagia onset after surgery. RESULTS: Dysphagia was evaluated radiologically in 74 of the 1789 ACF patients (4.1%) using video MBS studies (n=66) and esophagography (n=26). Patients underwent radiologic evaluation from 1 to 1150 days after surgery (mean, 120 days after surgery); 76% of the patients presented more than 2 weeks after surgery. The location of the ACF in the study group was the upper, mid, and lower cervical spine in 5.4% (n=4), 55.4% (n=41), and 39.2% (n=29) of patients, respectively. Soft-tissue swelling with displacement of the pharynx or esophagus was identified in 91% of patients (n=67). More serious complications of ACF that resulted in dysphagia included surgical hardware displacement or bone graft displacement (n=18), esophageal perforation (n=3), and a retropharyngeal abscess (n=3). Pharyngeal functional abnormalities were detected in 50 patients, with penetration, aspiration, or both seen in 32. CONCLUSION: Dysphagia is an underrecognized but significant complication of ACF. After ACF, 4.1% of patients presented for radiologic evaluation of dysphagia. Although ACF procedures are most frequently performed in the lower cervical spine, dysphagia is a more common clinical problem after ACF in the mid cervical spine. Radiologic examinations should be specifically tailored to evaluate ACF patients.
Subject(s)
Cervical Vertebrae/surgery , Deglutition Disorders/diagnosis , Deglutition Disorders/etiology , Diagnostic Imaging , Postoperative Complications/diagnosis , Postoperative Complications/etiology , Spinal Fusion/methods , Adult , Aged , Aged, 80 and over , Bone Transplantation/adverse effects , Esophagus/injuries , Female , Foreign-Body Migration/complications , Humans , Internal Fixators/adverse effects , Male , Middle Aged , Risk Factors , Spinal Fusion/instrumentationABSTRACT
A 62-year-old man with nonsmall cell lung cancer presented for a staging F-18 fluorodeoxyglucose (FDG) positron emission tomography and computed tomography. Preimaging assessment determined that the patient had a 2-week history of persistent hiccups. The hiccups were unmanageable and persisted throughout the examination from FDG injection to imaging. Persistent hiccups can be seen in patients with advanced cancer. Characteristic findings on FDG positron emission tomography and computed tomographyare presented here.
Subject(s)
Carcinoma, Non-Small-Cell Lung/complications , Fluorodeoxyglucose F18 , Hiccup/diagnostic imaging , Lung Neoplasms/complications , Carcinoma, Non-Small-Cell Lung/diagnostic imaging , Carcinoma, Non-Small-Cell Lung/pathology , Fluorodeoxyglucose F18/administration & dosage , Hiccup/complications , Humans , Lung Neoplasms/diagnostic imaging , Lung Neoplasms/pathology , Male , Middle Aged , Neoplasm Staging , Positron-Emission Tomography , Tomography, X-Ray ComputedABSTRACT
OBJECTIVE: The aim of this study was to determine the mechanism by which interleukin (IL)-4 + IL-10 costimulation regulates mast cell numbers to maintain immune homeostasis. MATERIALS AND METHODS: We employed mouse bone marrow-derived mast cells (BMMC) to measure the effects of IL-4 + IL-10 on survival and cell-cycle progression. p53-Deficient, bax-deficient, and bcl-2 transgenic BMMC were compared to wild-type cells to determine the role of these proteins in apoptosis. The molecular regulation of apoptosis and cell-cycle progression was investigated using flow cytometric analysis, RNase protection, and Western blotting. RESULTS: IL-4 + IL-10 induced BMMC apoptosis and arrest. Apoptosis was p53-dependent. Cell death was accompanied by loss of mitochondrial membrane potential, the importance of which was demonstrated by resistance to IL-4 + IL-10-mediated cell death when Bax was deleted or Bcl-2 was overexpressed. Those cells not killed by apoptosis demonstrated a p53-independent G1 cell-cycle arrest. Apoptosis and arrest may be explained by reduced IL-3 receptor signaling. CONCLUSION: Costimulation with IL-4 + IL-10 partly controls mast cell homeostasis through a delayed apoptosis and arrest program that is induced by a blockade of IL-3 receptor signaling. The delay in these negative effects would allow the protective effects of mast cell activation to occur for several days.
Subject(s)
Apoptosis/physiology , G1 Phase/physiology , Interleukin-10/pharmacology , Interleukin-4/pharmacology , Mast Cells/metabolism , Mitochondria/metabolism , Tumor Suppressor Protein p53/metabolism , Animals , Apoptosis/drug effects , Apoptosis/genetics , Cell Survival/genetics , Cell Survival/physiology , G1 Phase/genetics , Mast Cells/pathology , Mice , Mice, Knockout , Proto-Oncogene Proteins c-bcl-2/deficiency , Proto-Oncogene Proteins c-bcl-2/genetics , Proto-Oncogene Proteins c-bcl-2/metabolism , Receptors, Interleukin-3/metabolism , Signal Transduction/genetics , Signal Transduction/physiology , Tumor Suppressor Protein p53/deficiency , bcl-2-Associated X ProteinABSTRACT
This report describes the imaging findings of the first reported case of a bronchobiliary fistula that developed as a complication of liver transplantation. The diagnosis was confirmed by the aspiration of bile from the bronchus.
