Esophageal Entrance Research Articles

Esophageal dedifferentiated liposarcoma resected by the cervical approach: a case report

BackgroundWhile liposarcomas tend to mainly occur in the soft tissues of the extremities and retroperitoneum, esophageal liposarcoma is rare. Herein, we report a case of a patient who underwent complete resection of an esophageal dedifferentiated liposarcoma via the cervical approach, leading to the preservation of the esophagus.Case presentationA 69-year-old man underwent an upper gastrointestinal endoscopy, as a result of which a submucosal-like tumor was observed. Upper gastrointestinal imaging showed a 12-cm tumor with a stalk arising from the esophageal entrance, extending to the middle intrathoracic esophagus, with a normal surface mucosa. Endoscopic ultrasound-fine needle aspiration biopsy showed that the nuclei of tumors cells were positive for murine double minute (MDM) and weakly positive for cyclin-dependent kinase 4 (CDK4). We diagnosed the tumor as the esophageal dedifferentiated liposarcoma, and planed tumor resection via the cervical approach. The tumor was successfully resected and the postoperative course was uneventful.ConclusionThis case report highlights the use of tumor resection via the cervical approach as a good option for esophageal liposarcoma.

Clinical Analysis of Supraclavicular Flaps for the Repair of the Pharyngeal Fistula.

Objectives: We explored the value of supraclavicular flaps in repairing pharyngeal fistula. Methods: Patients treated with supraclavicular flaps were included. Data on preoperative radiotherapy, surgical modality, flap size, postoperative healing, and other clinical outcomes were collected. Techniques, indications, and postoperative complications after repairing with supraclavicular flaps were described. A total of 16 male patients aged 58 to 79 years were involved, including 10 cases of postoperative pharyngeal fistula after hypopharyngeal cancer, 5 cases of postoperative pharyngeal fistula after laryngeal cancer, and 1 case of postoperative pharyngeal fistula after laryngeal and esophageal cancer. In 12 patients, the pharyngeal fistula was repaired by double island folding of the supraclavicular flap; in the remaining 4 patients, the pharyngeal fistula was repaired by the supraclavicular flaps combined with the pectoralis major flaps. The supraclavicular flap was 6 to 8 cm in width and 6 to 15 cm in length. Results: One patient developed partial necrosis at the distal end of the flap, which was successfully treated with debridement and dressing. The flaps grew well in the remaining 15 patients. Among them, a patient with a postoperative pharyngeal fistula after hypopharyngeal carcinoma was implanted with radioactive particles for tumor recurrence at the esophageal entrance, and died in the 11th month after surgery. Conclusions: The supraclavicular flap can achieve excellent results in the repair of pharyngeal fistula.

Feasibility and safety of a self-developed sleeve for the endoscopic removal of refractory foreign body incarceration.

This study aimed to assess the feasibility and safety of a novel self-designed sleeve for the endoscopic removal of a refractory incarcerated foreign body in the upper gastrointestinal tract (UGIT). An interventional study was conducted between June and December 2022. A total of 60 patients who underwent an endoscopic removal of a refractory incarcerated foreign body from the UGIT were randomly allocated to the self-developed sleeve and the conventional transparent cap. The study evaluated and compared the operation time, successful removal rate, new injury length at the entrance of the esophagus, new injury length at the impaction site, visual field clarity, and postoperative complications between the two groups. The success rates of the two cohorts in the foreign body removal display no significant discrepancy (100% vs. 93%, P = 0.529). Nevertheless, the methodology of the novel overtube-assisted endoscopic foreign body removal has culminated in a significant reduction in the removal duration [40 (10, 50) min vs. 80 (10, 90) min, P = 0.01], reduction in esophageal entrance traumas [0 (0, 0) mm vs. 4.0 (0, 6) mm, P < 0.001], mitigation of injuries at the location of the foreign body incarceration [0 (0, 2) mm vs. 6.0 (3, 8) mm, P < 0.001], an enhanced visual field (P < 0.001), and a decrement in postoperative mucosal bleeding (23% vs. 67%, P < 0.001). The self-developed sleeve effectively negated the advantages of incarceration exclusion during removal. The study findings support the feasibility and safety of the self-developed sleeve for the endoscopic removal of a refractory incarcerated foreign body in the UGIT, with advantages over the conventional transparent cap.

Revealing the Boundaries of Selected Gastro-Intestinal (GI) Organs by Implementing CNNs in Endoscopic Capsule Images.

The detection of where an organ starts and where it ends is achievable and, since this information can be delivered in real time, it could be quite important for several reasons. For one, by having the practical knowledge of the Wireless Endoscopic Capsule (WEC) transition through an organ's domain, we are able to align and control the endoscopic operation with any other possible protocol, i.e., delivering some form of treatment on the spot. Another is having greater anatomical topography information per session, therefore treating the individual in detail (not "in general"). Even the fact that by gathering more accurate information for a patient by merely implementing clever software procedures is a task worth exploiting, since the problems we have to overcome in real-time processing of the capsule findings (i.e., wireless transfer of images to another unit that will apply the necessary real time computations) are still challenging. This study proposes a computer-aided detection (CAD) tool, a CNN algorithm deployed to run on field programmable gate array (FPGA), able to automatically track the capsule transitions through the entrance (gate) of esophagus, stomach, small intestine and colon, in real time. The input data are the wireless transmitted image shots of the capsule's camera (while the endoscopy capsule is operating). We developed and evaluated three distinct multiclass classification CNNs, trained on the same dataset of total 5520 images extracted by 99 capsule videos (total 1380 frames from each organ of interest). The proposed CNNs differ in size and number of convolution filters. The confusion matrix is obtained by training each classifier and evaluating the trained model on an independent test dataset comprising 496 images extracted by 39 capsule videos, 124 from each GI organ. The test dataset was further evaluated by one endoscopist, and his findings were compared with CNN-based results. The statistically significant of predictions between the four classes of each model and the comparison between the three distinct models is evaluated by calculating the p-values and chi-square test for multi class. The comparison between the three models is carried out by calculating the macro average F1 score and Mattheus correlation coefficient (MCC). The quality of the best CNN model is estimated by calculations of sensitivity and specificity. Our experimental results of independent validation demonstrate that the best of our developed models addressed this topological problem by exhibiting an overall sensitivity (96.55%) and specificity of (94.73%) in the esophagus, (81.08% sensitivity and 96.55% specificity) in the stomach, (89.65% sensitivity and 97.89% specificity) in the small intestine and (100% sensitivity and 98.94% specificity) in the colon. The average macro accuracy is 95.56%, the average macro sensitivity is 91.82%.

Indications and complications of secondary tracheoesophageal puncture in Chinese laryngectomees

Background Although there are many literatures about secondary tracheoesophageal puncture (TEP) for voice prosthesis. Most of the description of indications is not specific and the description of complications is not so vivid, which is not of great value for novice doctors. Objective To show specific indications and vivid complications of secondary TEP with typical clinical pictures for novice doctors. Material and methods The clinical data of 20 patients undergoing secondary TEP for Provox Vega voice prosthesis in our hospital were analyzed. The surgical indications and the prevention and treatment of common perioperative complications were summarized. Results The surgical indications included: no obvious stenosis of the stoma and the entrance of esophagus; no obvious scar constitution, mouth opening restriction and backward restraint of the neck, etc. The common postoperative complications included: TEP fistula infection (2 cases), bleeding of the fistula (1 case), deep neck abscess (1 case), granulation hyperplasia at the inner side of the fistula (1 case), invagination of the voice prosthesis (2 cases) and leakage (2 cases). Conclusions and significance The secondary TEP for Provox Vega voice prosthesis is clinically safe, but certain indications should be mastered. Common postoperative complications can be solved through preventive and remedial treatment schemes.

473. SAFETY AND USEFULNESS OF LARYNX- PRESERVING HIGH-LEVEL CERVICAL ANASTOMOSIS FOR CERVICAL ESOPHAGEAL CANCER

Abstract In cases of cervical esophageal cancer, total Pharyngo-Laryngo-Esophagectomy is often performed when the oral edge of the primary tumor is less than 2 cm from the esophageal entrance. In our hospital, we provide neo-adjuvant chemotherapy for cervical esophageal cancer and perform larynx-preserving esophagectomy whenever possible. The aim of this study was to evaluate the safety and efficacy of larynx- preserving high-level cervical anastomosis for cervical esophageal cancer. 41 patients underwent larynx- preserving esophagectomy for cervicothoracic esophageal cancer between January 2009 and September 2021 at our hospital were included. The distance from the oral edge of the primary tumor to the esophageal entrance was measured by esophagography and endoscopy. Patients with the distance of 2 cm or less were classified as the high cervical anastomosis group (H group: n=23), and patients with the distance of 2.1 cm or more were classified as the low cervical anastomosis group (L group: n=18). We compared the short-term and long-term results between the H and L groups. There were no differences between H and L groups in terms of patient characteristics, such as clinical depth of tumor invasion, grading of lymph node metastasis, frequency neo-adjuvant chemotherapy. The incidence of postoperative complications was similar in the two groups such as pneumonia, anastomotic leakage, anastomotic stenosis, recurrent nerve palsy. In histopathological examination, the rate of positive proximal resection margin was significantly higher in H group. (34.8 vs 5.6%(P=0.028). 3-year recurrence-free survival rate and 3-year survival rate were similar in the two groups. The anastomotic recurrence rates did not differ between the two groups. (5.0 vs 5.9% (P=0.715)) In the H group, the rate of positive proximal resection margin was significantly higher. However, there was no difference in the anastomotic recurrence rate and the 3-year survival rate between the two groups. Therefore, we believe that larynx- preserving high-level cervical anastomosis is useful to maintain QOL in cervical esophageal cancer patients with the oral edge of the primary tumor is less than 2 cm from the esophageal entrance.

Application of transverse cervical artery flap in laryngeal function preservation surgery of hypopharyngeal carcinoma

To explore the value and limitation of transverse cervical artery flap in laryngeal function preservation surgery of hypopharyngeal carcinoma. Between January 2013 and December 2019, 18 male patients with hypopharyngeal carcinoma were admitted. The patients' age ranged from 48 to 77 years, with a median age of 65 years. The disease duration ranged from 3 to 8 months (mean, 5 months). All patients were diagnosed as squamous cell carcinoma by biopsy before operation. According to the American Joint Committee on Cancer (AJCC) guidelines (2017, 8th ed), TNM staging was T2N0M0 in 9 cases, T2N1M0 in 2 cases, and T3N0M0 in 7 cases, and cTNM staging was stage Ⅱ in 9 cases and stage Ⅲ in 9 cases. The lesions of 15 cases were located in the piriform fossa of hypopharynx on one side, among which the esophageal entrance was involved in 4 cases. The lesions of 3 cases were located in the posterior wall of the hypopharynx with esophageal entrance involvement. After partial pharyngo- laryngectomy and bilateral neck lymph node dissection, the hypopharyngeal and laryngeal defects were repaired with transverse cervical artery flaps, the size of the flap ranged from 4 cm×3 cm to 6 cm×4 cm. The accompanying vein of transverse cervical artery (7 cases), external jugular vein (6 cases), and combination of both (5 cases) served as venous reflux. Retrograde external jugular venous reflux exercise was performed in 2 flaps with venous reflux obstruction during operation. The incisions at donor sites were directly sutured or via relaxed incision sutured. Radiotherapy and chemotherapy were supplemented within 3 months after operation. Tracheal cannula with air bag was used to prevent patients from aspiration in the early postoperative stage. The operation time was 4-6 hours, with an average of 4.5 hours. All patients were followed up 1-5 years (mean, 2 years and 6 months). Postoperative pathological examination showed that 7 cases had cervical lymph node metastases on the affected side, and there was no lymph node metastasis in cervical region Ⅴ; the remaining 11 cases had no lymph node metastasis. After operation, 16 flaps survived successfully, and 2 flaps with external jugular vein reflux were covered with white pseudomembrane, no flap necrosis was found after the pseudomembrane fell off. Four cases had no obvious accidental aspiration after operation; 14 cases had obvious accidental aspiration, of which 13 cases were significantly reduced at 3 months after operation, and 1 case still had obvious accidental aspiration at 6 months after operation, and the accidental aspiration decreased significantly after pulling out the gastric tube. All patients had no aspiration pneumonia. One case developed upper mediastinal lymph node metastasis at 1 year and 2 months after operation, and died of recurrence and pulmonary infection at 1 year and 3 months after operation. No recurrence or metastasis was found in the remaining 17 cases during follow-up. Tracheal cannula was successfully removed in 7 cases at 2-5 months after operation. Different degrees of accidental aspiration in 11 patients were confirmed by esophagography, so the tracheal cannula was retained. All patients had pronunciation function after operation. All incisions at the donor sites healed by first intention, and the shoulder joint function was normal. Using transverse cervical artery flap to repair the hypopharyngeal and laryngeal defects during hypopharyngeal carcinoma surgery in patients without lymph node metastasis in cervical region Ⅴ, can achieve good results of laryngeal function preservation. In cases with suspected lymph node metastasis in cervical region Ⅴ or venous dysplasia of accompanying vein of transverse cervical artery, there is a risk of tumor recurrence or flap necrosis, and the repair method needs to be cautiously employed.

Giant esophageal liposarcoma with squamous cell carcinoma resected via the cervical approach: a case report

BackgroundLiposarcoma is one of the most common soft tissue sarcomas, but is extremely rarely found in the esophagus. There have been no reports of esophageal liposarcoma together with superficial carcinoma of the esophagus. Here, we report a patient who underwent complete resection of esophageal liposarcoma with carcinoma via a cervical approach.Case presentationA 66-year-old man was diagnosed with an esophageal tumor 11 years ago, but he left it untreated. He presented to our hospital with progressive dysphagia and appetite loss since the previous year. Esophagogastroduodenoscopy (EGD) showed a large pedunculated submucosal tumor (SMT) originating at the esophageal entrance, extending to the gastroesophageal junction. Additionally, there was a superficial carcinoma on the surface of the SMT, 30 cm from the incisor teeth. Three-dimensional computed tomography (3D-CT) showed a giant elongated intraluminal tumor extending downwards from the cervical esophagus. We diagnosed a giant esophageal polyp accompanied by a superficial carcinoma and performed tumor resection via a cervical approach. The excised specimen consisted of a 23.0 × 8.5 cm polypoid mass. The final diagnosis by histopathological and immunohistochemical examination was well-differentiated liposarcoma and esophageal squamous cell carcinoma. He was discharged on postoperative day 14 with drastic improvement in his swallowing ability.ConclusionWe reported an extremely rare case of esophageal liposarcoma together with esophageal squamous cell carcinoma that was successfully resected through a small cervical incision.

Clinical analysis of 40 newborns with head and neck occupying lesions

Objective: To investigate the clinical features, diagnoses and treatments of head and neck occupying lesions in newborns. Methods: All newborns with head and neck occupying lesions admitted to Neonatel Intensive Care Unit of the First Affiliated Hospital of Zhengzhou University form January 2014 to November 2019 were included. There were 23 males and 17 females, admission age was from 2 d-28 d, and the clinical manifestations, examinations, treatments and outcomes were evaluated. Results: Among 40 newborns with head and neck occupying lesions, 22 cases were admitted with dyspnea, 15 cases with masses in oral cavity or head and neck, 2 cases with fever as the first symptom, and 1 case with hoarseness as the first symptom. There were 5 cases with local infection. All cases were examined with local ultrasound and CT or MRI. Nine cases with severe dyspnea were treated with invasive ventilationm, of them 6 cases underwent invasive ventilation for more than 48 hours, 4 cases received tracheal intubation and artificial nose. Diagnostic punctures were performed in 2 cases. Seven cases received conservative treatments. Surgeries were performed in 31 cases, and 25 cases obtained pathologic diagnoses, including 3 cases of soft palate mature teratomas, 1 case of hard palate teratoma, 1 case of granulosa cell tumor, 1 case of lobulated spindle cell tumor in tongue base, 1 case of polyp in right glottis, 1 case of polyp at esophageal entrance, 4 cases of lingual root cysts, 1 case of laryngeal cyst, 2 cases of thyroglossal duct cysts, 2 cases of lymphangiomas, 1 case of lymphangioma with hibernoma, 1 case of tracheal cyst, 1 case of esophageal cyst, 3 cases of left neck abscesses, 1 case of occipital hemangioma, and 1 case of left temporoparietal abscess. Conclusions: The head and neck occupying lesions in the newborn is prone to upper airway obstruction. Imaging examination can assist the diagnosis. Different treatments can be selected according to the natures of occupying lesions.

Correlating Dysphagia Severity with Fluoroscopic Parameters in Patients with Zenker's Diverticulum.

Zenker's diverticulum (ZD) is an uncommon condition characterized by formation of a pseudodiverticulum in the hypopharynx that presents with considerable variability in swallowing symptomatology. Identifying radiographic features of ZD most associated with clinical impact could prove useful in counseling patients and predicting treatment response. This study was a retrospective case series of patients undergoing videofluoroscopic swallowing studies (VFSS) for Zenker's diverticulum at a tertiary dysphagia center. Anatomic parameters identified on VFSS of patients with ZD were correlated with subjective perception of swallowing using Eating Assessment Tool (EAT-10) scores. Upper esophageal sphincter (UES) opening at the point of maximal distention, area of diverticulum on the lateral view, height of the diverticulum, and entrance angle of the esophagus were measured. We identified 40 patients with ZD (52.5% male, mean age = 71.2years). Narrow UES opening was significantly correlated with dysphagia severity (r = - 0.3445, p = 0.035). Largest area of diverticulum (r = 0.0188, p = 0.87), diverticulum height (r = 0.1435, p = 0.45), and esophageal entrance angle (r = 0.1677, p = 0.42) were not correlated with EAT-10 scores. Maximum UES opening size was predictive of severity of swallowing dysfunction in patients with ZD. Size of ZD and the angle of bolus entry in patients with ZD are not predictive of swallowing dysfunction. Understanding the predictors of swallowing dysfunction will assist in counseling patients on postoperative expectations.

Application of rigid curved laryngoscope in the examination of hypopharynx and the treatment of early hypopharyngeal cancer

Objective: To evaluate the efficacy of curved suspension laryngoscope assistant transoral surgery (CLATOS) in the examination of hypopharynx, and diagnosis and surgery of early hypopharyngeal carcinoma. Methods: Thirty-four patients who underwent detailed examination for lower part of hypopharynx and surgery for early hypopharyngeal carcinoma with CLATOS technique in the Second Affiliated Hospital of Harbin Medical University from January 2019 to January 2020 were analyzed retrospectively. The age ranged from 42 to 74 years old including 28 males and 6 females. Among them, 25 patients complaining of foreign body sensation in the pharynx for more than half a year with a poor exposure of the lower pharynx in the examination with flexible laryngoscope in the outpatient department were admitted to the hospital for the further examination with rigid curved laryngoscopy and 9 patients with stage T1-2 hypopharyngeal squamous cell carcinoma were operated with CLATOS technique. Preoperative, intraoperative and postoperative data were analized. Results: One case of squamous cell carcinoma in esophageal entrance (T1N0M0) and one case of carcinoma in pyriform sinus (T1N0M0) with cervical esophageal carcinoma (T1N0M0) were found in the 25 patients with foreign body sensation in the pharynx. En bloc resection of cancer was obtained in 9 patients with stage T1-2 hypopharyngeal carcinomas and 2 of them underwent tracheotomy. One patient with T1 retrocricoid carcinoma was found to have a carcinoma in situ at the lower part of posterior hypopharyngeal wall in the examination during follow-up, which was resected simultaneously. Postoperatively this patient developed a stenosis in the esophageal entrance, which was dilated twice until swallowing normally. Two patients of T2N0M0 and one of T2N1M0 underwent bilateral neck lymph node dissection just after the removal of primary tumors. During follow-up, none of the 9 patients showed tumor recurrence and complications such as dysphonia and dyspnea. Conclusion: CLATOS technique can provide a promising way in the examination of hypopharynx and the detection of early lesions of hypopharynx and esophageal entrance, and this technique has also the advantages such as full visual angle and easy operation for the resection of early hypopharyngeal carcinoma. The quality of life of patients can be improved while the tumor is removed en bloc with this technique.

Analysis on clinical characteristics, diagnosis and treatment of 13 cases of infant hairy polyp

Objective: To explore and analyze the clinical characteristics, diagnosis and treatment of infant hairy polyp. Methods: A retrospective analysis was made on 13 cases of hairy polyp confirmed by pathology, who were admitted to the Children's Hospital of Hebei Province from January 2010 to September 2019, including 4 males and 9 females, with a male-female ratio of 1∶2.25. The age ranged from 3 hours to 1 year, and the median age was 1 month. Twelve of the 13 children were found to have difficulty breathing or feeding. All the children received coblation resection under general anesthesia. The root pedicle of the mass was found in the lateral nasopharyngeal wall in 8 cases, in the junction of palatine and palatopharyngeal arch of tonsil and the tongue and esophageal entrance in 1 case, respectively. Nasal septum was found in 2 cases, including 1 case located between two incisors. The wound at the root pedicle was ablated and the bleeding was stopped completely. Results: Postoperative follow-up lasted from 3 months to 2 years, and there was no recurrence in 12 cases. Fibrolaryngoscope showed a mass of the right eustachian tube and pharyngeal mouth in 1 case 2 years after the surgery, which was considered recurrence of hairy polyps and lost after that. Conclusion: Hairy polyps in infants is a rare clinical disease, and its main symptom is upper respiratory tract obstruction. Early diagnosis and radical surgery are the key to the treatment of the disease.

Laryngeal elevation for endoscopic submucosal dissection in cervical superficial esophageal cancer at esophageal entrance.

Laryngeal elevation for endoscopic submucosal dissection in cervical superficial esophageal cancer at esophageal entrance.

Recurrent dysphagia after lower posterior cervical fusion

Background: Although dysphagia following posterior craniocervical fixation is well known, the incidence after mid-lower posterior cervical fixation is not well described. Here, we presented a case of recurrent dysphagia in a 72-year-old male following C3–T3 posterior cervical fixation and discussed its etiology.Case Description: A 72-year-old male sustained a cervical fracture in a fall; he was neurologically intact. The cervical/thoracic MR and CT studies documented ankylosing spondylitic changes in the cervicothoracic spine, a C5/6 disc herniation, and a C7 vertebral fracture. He underwent posterior cervical C3 to T3 fusion without decompression. For the 1st postoperative day, he complained of dysphagia without hoarseness, and fiberoptic endoscopy revealed poor esophageal mobility. For the next 6 postoperative years, he continued to require repeated attempts at the dilation of the esophageal entrance but remained reliant on a feeding tube.Conclusion: Posterior cervical fixation restricts cervical motion and may restrict expansion of the esophageal duct leading to permanent postoperative dysphagia requiring continued feeding tube utilization.

Clinical outcomes of end-flexible-rigidscopic transoral surgery (E-TOS) in patients with T1-selected T3 pharyngeal and supraglottic cancers

Background: Endoscopic laryngo-pharyngeal surgery (ELPS), which is a transoral minimally invasive surgery using a gastrointestinal endoscope and a curved laryngopharyngeal retractor, is effective to treat primary lesions of superficial laryngopharyngeal cancers. To extend concepts of ELPS to invasive laryngopharyngeal cancers, we developed end-flexible-rigidscopic transoral surgery (E-TOS) from ELPS by changing a gastrointestinal endoscope to a flexible-tip rigid endoscope.Aims/Objectives: To retrospectively evaluate oncological outcomes and laryngopharyngeal functional preservation of E-TOS in patients with T1-selected T3 laryngopharyngeal cancers.Material and methods: In 47 patients T1-selected T3 pharyngeal and supraglottic cancers were resected by E-TOS using the flexible-tip rigid endoscope and curved instruments. Negative resection margin was histopathologically evaluated. The survival, preservation of larynx, and disease control rates were estimated using Kaplan-Meier method.Results: Curative resection was achieved in 94% of patients. No patient complained prolonged swallowing dysfunction or hoarseness after E-TOS. Postoperative bleeding, stenosis of the pharynx and esophageal entrance, and local recurrence was observed each in one patient. The 3-year overall survival, disease-specific survival, laryngeal preservation, local control, and locoregional control rates were, 86%, 93%, 100%, 98%, and 79%, respectively.Conclusion: E-TOS is an effective minimally invasive surgery for T1-selected T3 pharyngeal and supraglottic cancers with preserving laryngeal function.

Swallowing Function before and after Subtotal Glossectomy and Reconstruction with a Rectus Abdominis Musculocutaneous Flap: A Case Report

Purpose: Swallowing function was in a patient with tongue cancer that was evaluated with video fluorography before and after subtotal glossectomy and reconstruction with a rectus abdominis muscuocutaneous flap. Materials and Methods: A 41-year-old man underwent subtotal glossectomy and retained the unilateral posterior mylohyoid and unilateral stylohyoid muscles. The structure of the flap was evaluated postoperatively. To assess swallowing function, video fluorography was performed before surgery, 1 month after surgery and 1 year after surgery. Testing involved 1) ability to hold 10 mL of liquid in the oral cavity, 2) epiglottis turnover, 3) the presence of aspiration, 4) hyoid bone movement, and 5) maximum width of the esophageal entrance. Results: The flap was protuberant postoperatively. The patient was able to hold the test diet in the oral cavity before and after surgery. Epiglottis turnover was good before surgery but insufficient after surgery. Aspiration during swallowing was not observed before or after surgery. At rest, the hyoid bone sagged postoperatively, in comparison with preoperatively. Hyoid bone movement and width of the esophageal entrance decreased after surgery; however, they demonstrated gradual recovery. Conclusions: For good postoperative swallowing function after subtotal glossectomy, it is necessary to perform reconstruction with protuberant flap and to retain the suprahyoid muscles as much as possible.

Establishment of a novel and effective reflux laryngitis model in rabbits: a preliminary study.

To establish a novel and effective reflux model with a modified nasogastric aspiration tube and to investigate the association between different types of nasogastric aspiration tubes and reflux laryngitis, we conducted this study. Thirty-eight healthy New Zealand albino rabbits (2.5-3.5kg) were divided into three groups: control (CTR, n = 6)-non-intubated; normal nasogastric intubation (NNI, n = 16)-intubated with 4#, 6#, 8#, and 10# normal nasogastric aspiration tubes; and modified nasogastric intubation (MNI, n = 16)-intubated with 4#, 6#, 8#, and 10# modified nasogastric aspiration tubes. The laryngoscopy, body weight, and pH values at the esophageal entrance were recorded before and 1, 2, and 4 weeks after intubation. After the final laryngoscopy, the animals in groups with a pH below 4 were sacrificed to obtain histological and gene expression analysis results. The reflux finding score (RFS) after 4 weeks showed that there was a statistically significant difference in the 8# NNI group (7 ± 0.816, P < 0.001), the 8# MNI group (11.5 ± 2.517, P < 0.001) and the 10# MNI (12.75 ± 1.893, P < 0.001) group compared with the control group (1.83 ± 1.602). The pH values of these three groups were lower than 4. However, the weight loss of the rabbits in the 10# NNI and 10# MNI groups was more obvious. Submucous gland hyperplasia and inflammation were significantly increased in the 8# NNI group, 8# MNI group and the 10# MNI group, but in the level of some pro-inflammatory cytokines and COX-2, the MNI group was significantly higher than the NNI group (8# NNI × 8# MNI, P < 0.01; 8# MNI × 10# MNI, P < 0.01). This study showed that 8# modified nasogastric intubation (MNI) produces effective reflux laryngitis in the rabbits.

Comparison of the safety of the application of painless gastroscopy and ordinary gastroscopy in chronic hypertension patients combined with early gastric cancer.

The aim of the present study was to compare the safety of the application of painless gastroscopy and ordinary gastroscopy for chronic hypertension patients combined with early gastric cancer. A total of 123 patients with early gastric cancer were selected at the Dongying People's Hospital from June, 2014 to August, 2016. The patients were randomly divided into the painless (n=63) and ordinary (n=60) gastroscopy groups. Proper pretreatment was performed according to whether anesthesia was performed or not. Arterial pressure, heart rate, and blood oxygen saturation were detected and compared before anesthesia, when gastroscope passed through the esophageal entrance plane, and after recovery from anesthesia. The incidence of nausea and vomiting, cough, dysphoria, throat discomfort and other adverse reactions during and after surgery were recorded and compared. Compared with the levels before anesthesia, the mean arterial pressure, heart rate and blood oxygen saturation were significantly reduced in painless gastroscopy when the gastroscope passed through the esophageal entrance plane (P<0.05). In the ordinary gastroscopy group, the mean arterial pressure, heart rate and blood oxygen saturation were significantly increased when the gastroscope passed through the esophageal entrance plane compared with the levels before anesthesia (P<0.05). Blood pressure decreased in the painless gastroscopy group whereas it increased in the ordinary gastroscopy group after anesthesia. The decrease in the painless gastroscopy group was lower than in the ordinary group. The incidence of intraoperative and postoperative adverse reactions including nausea, vomiting, cough, dysphoria, pharyngeal discomfort and other adverse reactions was significantly decreased in the painless gastroscopy group than in the ordinary gastroscopy group (P<0.05). The results suggest that the application of painless gastroscopy in chronic hypertension patients can significantly reduce the incidence of intraoperative and postoperative adverse reactions compared with that of the Gastric cancer ordinary gastroscopy. Thus, painless gastroscopy is safer than ordinary gastroscopy.

The Cricoid Force Necessary to Occlude the Esophageal Entrance: Is There a Gender Difference?

(Anesth Analg. 2017;124(4):1168–1173) Cricoid force (CF) is used to occlude the esophageal lumen and prevent regurgitation during surgery. However, excessive CF can deform the cricoid cartilage, oppose the vocal cords, interfere with tracheal tube passage, and result in ineffective gas exchange. Due to differences in cricoid plate size, women may require less CF than is recommended in the literature (at least 44 N). The authors of the present study hypothesized that gender differences exist in the necessary CF application to prevent regurgitation. Using a Glidescope video laryngoscope in anesthetized and paralyzed patients, they assessed the effectiveness of different CFs in occluding the esophageal entrance in men and women.

Herpes simplex esophagitis

One of the well-known complications of immunosuppression is herpes simplex esophagitis and It is rarely found in immunocompetent patients. We present a case of 75-year-old female known case of diabetes mellitus, hypertension and dyslipidemia with two months’ history of dysphagia and odynophagia to solid mainly and cough tinged with blood. On esophagogastroduodenoscopy there was right side of oropharynx ulcer, edema and focal erythema with compression on the esophageal entrance. Biopsy confirmed esophagitis and findings characteristic of herpes simplex virus infection. After the diagnosis was made, the patient was treated with prednisone for 10 days and famciclovir for 14 days and showed significant improvement in period of nearly 2 weeks. We recommend antiviral treatment even for immunocompetent patients for the clear acceleration of the recovery time and prevention of possible complications.