Use of tandem stents for treatment of helicoidal dissection of the right coronary artery.

Coronary dissection occurs frequently and in several degrees during coronary angioplasty, which is one of the mechanisms for increasing the lumen diameter of a vessel. However the length of the dissection may affect the procedure, becoming the most frequent cause of total occlusion after coronary angioplasty. We report here a case of extensive dissection that occurred during the coronary angioplasty of a focused lesion, which we treated with two long stents.

Vagal paraganglioma. A case report.

Vagal paragangliomas are rare tumors and difficult to differentiate from carotid body tumors or schwannomas of the vagus nerve. We present a patient who could be preoperatively diagnosed as having a vagal paraganglioma by ultrasonography and color Doppler sonography.

[Telomerase activity of tumors in the head and neck].

Telomerase is a maintaining enzyme of telomere repeats. Telemorase is expressed in immortal and cancer cells, but not in the normal tissues. We investigated telomerase activity of tumors in the head and neck. Telomerase activity was found in all of the cell lines derived from squamous cell carcinomas of the head and neck. Six of 9 (67%) primary fresh tissues from squamous cell carcinomas of the head and neck contained detectable telomerase activity. There were no apparent relationship between telomerase activity and clinical stage. Telomerase activity differed, depend on the responses to chemotherapy and radiotherapy: complete response, 0 of 3(0%); partial response; 0 of 1(0%); no change; 7 of 7 (100%). Therapy-resistant tumor seemed to have much telomerase activity and much malignant potential. In benign tumors, neither of 2 benign parotid tumors expressed telomerase activity, but one of 2(50%)papillomas had the telomerase activity. Telomerase is considered useful tumor marker for the diagnosis and prognosis.

Telemedicine in laryngology.

OBJECTIVE: The significance and usefulness of image transmission in laryngology were evaluated retrospectively on the basis of daily clinical practice. MATERIALS AND METHODS: The subjects consisted of 29 patients with laryngeal disease, whose laryngeal findings had been already recorded on videotape. Patient data were sent to a major hospital by Internet e-mail. Two laryngeal images, during breathing at rest and phonation, were transmitted as an attached file. Using a rigid or flexible endoscope coupled with a one-chip CCD camera, laryngeal images were recorded. Pictures of these laryngeal images were printed by a video printer, digitized by a compact print scanner, and saved as JPEG files. RESULTS: The diagnosis made by the three specialists in laryngology (receivers), who referred to the transmitted images and text files of the patient's history, was identical to the diagnosis made by the general otolaryngologist (sender), who referred to the original pictures and patient data. All images were displayed with sufficient quality to evaluate morphologic abnormalities, and the disturbance of cordal movements was detectable by comparing images during breathing at rest with those obtained during phonation. CONCLUSION: The image-transmitting system was a useful tool for consultation between otolaryngologists and for referrals from general practitioners to otolaryngologists.

Differentiation between schwannoma of the vagus nerve and schwannoma of the cervical sympathetic chain by imaging diagnosis.

Ultrasonography, computed tomography, and magnetic resonance imaging were performed to differentiate preoperatively between schwannomas of the vagus nerve and schwannomas of the cervical sympathetic chain by observing the position of schwannomas in regard to the surrounding blood vessels. Ultrasonography also permitted direct visualization of the vagus nerve, so its position relative to the schwannoma could be examined. In schwannomas of the vagus nerve the schwannoma grew between the common carotid artery and the internal jugular vein or between the internal carotid artery and the internal jugular vein, resulting in an increase in the distance between the artery and vein (separation). In schwannomas of the cervical sympathetic chain, no separation was observed between the internal jugular vein and the common carotid artery or internal carotid artery. Ultrasonography with a 7.5-MHz transducer showed the derivation of the tumor from the vagus nerve in schwannomas of the vagus nerve but showed the vagus nerve on the tumor surface in schwannomas of the cervical sympathetic chain.

Statistical analysis of malignant tumors detected as the cause of vocal cord paralysis.

It is well known that vocal cord paralysis is sometimes the only sign of an otherwise symptom-free malignant tumor. We report 69 cases of vocal cord paralysis caused by malignant tumor experienced at our clinic over the past 18 years. They consisted of 28 cases of thyroid cancer, 21 lung cancer, 14 esophageal cancer, 3 mediastinal tumors and 3 tumors of miscellaneous origin: 41 cases were male and 28 female. In the 65 patients with unilateral paralysis, the left side was affected in 45 and the right in 20. The remaining 4 patients had bilateral paralysis. There was a marked sex difference in the origin of malignant tumors; the incidence of lung cancer was higher in males with paralysis on the left side, while that of thyroid cancer was higher in females. Ultrasonography (US) of the neck, chest X-ray, CT scan of the chest and contrast esophagography should be performed for the detection of malignant tumors in cases with left paralysis, while US of the neck and chest X-ray appear to be sufficient in cases of right paralysis.

[Fine needle aspiration cytology under ultrasonographic imaging].

Although fine needle aspiration cytology (FNA) is widely used in the otolaryngology, few hospitals perform it in conjunction with ultrasonographic imaging. Despite the benefits of ultrasonographic imaging-assisted FNA, it is not widely utilized due to the prevalent misperception that the procedure is exceedingly complicated. In an effort to refine FNA procedures under ultrasonographic imaging (focusing on safety and simplification), we conducted a study on outpatients with neck tumors. We developed the following guidelines. 1. The aspiration was conducted free-hand without the use of mechanical devices such as special probes and/or aspiration adaptors. 2. Positioning of the probe was adjusted so that the puncture site was centered in the image. 3. When the tumor was located near the carotid artery or jugular vein, the probe was adjusted so that both the tumor and the blood vessel could be observed in the same image. 4. The needle was introduced at the center of the probe from the sliced direction. The needle injection route was then adjusted in line with phase crossing at right angles with the scanning field of the probe. 5. The depth of the puncture was adjusted in accordance with the angles between the probe and the needle. From June 1985 to December 1990, FNA under ultrasonographic imaging was conducted on 149 patients. It was possible to compare both cytological and histological studies. According to site, lymph nodes ranked highest in 52 cases, followed by parotid glands (45) and thyroid glands (27). A 5 or 7.5 MHz probe was used with 21- or 22-gauge injection needles.(ABSTRACT TRUNCATED AT 250 WORDS)