Pharyngeal Discomfort Research Articles

Target gene mulations are not predictors of survival in stage II high-frequency microsatellite unstable (MSI-H) colorectal cancer

Introduction: Ambulatory 24-hour esophageal pH monitoring, considered the gold standard for the diagnosis of gastroesophageal reflux disease, is currently performed using an indwelling esophageal catheter passed through the nose. Patient complaints of nasal and pharyngeal discomfort, rhinorrhea, and social embarrassment are common. The TM pH system avoids such discomfort by using a catheter-free capsule temporarily attached to the esophageal mucosa. Data is transmitted.via radiofrequency to a receiver. The study evaluated the efficacy of the TM system in measuring esophageal pH. Methods: Seven asymptomatic subjects were randomized to receive either a TM probe only, or a TM probe and a conventional pH catheter. Each was positioned 5cm proximal to the manometrically determined upper border of the lower esophageal sphincter. Those subjects receiving both a TM probe and a conventional catheter were monitored for a comparable period. The detection of reflux characteristics was compared. Results: In 7 subjects signal reception was maintained at a median level of 88.4% for a median monitoring period of 47 hours. A chest x-ray demonstrated that all TM probes had detached from the esophagus by day 10. In 4 subjects who also had a pH catheter for the first 24 hours similar results by both techniques were demonstrated (Table). Discussion: The BRAVO probe is comparable to the conventional catheter for quantifying esophageal pH. The greater comfort of the TM catheter-free system may lead to increased patient acceptance and compliance of this clinical test for gastroesophageal reflux disease.

Absence of Proinflammatory Cytokine Gene Expression in Nasal Biopsies from Wood Surface-coating Industry Workers

Symptoms of nasal, pharyngeal and ocular discomfort have been reported among workers in the wood surface-coating industry. Symptoms were reported more often by workers using ultraviolet radiation-curable acrylate coatings (UV coatings), which contain potential chemical sensitizers, than by those using acid-curing coatings. Furthermore, increased levels of eosinophil cationic protein (ECP) and albumin, but not tryptase, in nasal lavage from workers exposed to UV coatings have been observed. To further examine whether air contaminants present in the UV-coating industry are causing the observed increase in symptoms, the inflammatory process in the nasal mucosa of workers exposed to UV coatings was investigated. Clinical and biochemical endpoints were selected to distinguish between specific and non-specific hypersensitivity and to test the hypothesis that the symptoms were consistent with Type IV hypersensitivity. The nasal lavage and nasal biopsy were performed under local anesthetic at the workplace during working hours after a minimum of 2 h of work in both the exposed and control groups. Albumin and ECP, and the cytokines tumor necrosis factor- f (TNF- f ) and interleukin-8 (IL-8), were used as inflammatory markers. A multi-probe ribonuclease protection assay was used to attempt to detect cytokine variation in human nasal biopsies. The cytokine genes analyzed were TNF- f , GM-CSF, interferon- n , IL-2, IL-4 and IL-5. L32 and GAPDH were used as control genes for mRNA expression levels. Mucosal inflammation symptoms correlated with increased levels of albumin, but not with increased levels of ECP, secreted proinflammatory cytokines or cytokine gene mRNA expression. We conclude that the symptoms are non-specific and do not correlate with occupational exposure to UV coatings under the conditions of this investigation.

咳嗽,咽喉頭異常感症例における咽頭スメア検査

The pharyngeal smears of 83 patients with cough and/or pharyngeal discomfort were examined. They were classified into three groups (eosinophilic, neutrophilic, and non-inflammatory) according to the cellular infiltration.The eosinophilic group consisted of 17 patients (20.5%), the neutrophilic group consisted of 41patients (49.4%), and the non-inflammatory group consisted of 25 patients (30.1%).We administered Azelastine (2 mg/day) and Suplatast tosilate (300 mg/day) to the patients in the eosinophilic group, Clarithromycin (400 mg/day) and L-carbocystein (1000 mg/day) to the neutrophilic group patients, and Tofisopam (150 mg/day) to the non-inflammatory group for 1-2 weeks.Of the 83 patients,19 dropped out of the study. Among the remaining 64 patients the medication was slightly effective or better in 75.0% of the eosinophilic patients,75.9% of the neutrophilic patients, and 68.4% of the non-inflammatory patients.In conclusion, the results indicate that pharyngeal smear examination, may be effective for patients with cough and/or pharyngeal discomfort.

食道異物による頚部，縦隔内血腫のため呼吸困難を生じた１例

An 81-year-old man visited our hospital because of pharyngeal discomfort after eating fish the previous day. Physical examination revealed only a slightly enlarged lymph node with tenderness on the left side of the neck. Laboratory findings showed leukocytosis but other tests were normal and the initial chest roentgenogram was also normal. During intravenous fluid administration in the emergency room, he suddenly developed severe dyspnea and the neck became swollen. After intubation the chest roentgenogram showed a widened mediastinum, and a computerized tomography scan revealed a bony density penetrating the esophagus and fluid collection in the posterior mediastinum from the level of the neck to the diaphragm. Under general anesthesia, the patient underwent rigid esophagoscopy and two fishbones were removed. A giant hematoma was detected in the posterior mediastinum and was surgically evacuated through a neck incision. He was discharged on the 17th postoperative day after an uneventful course.

Widespread Application of Topical Steroids to Decrease Sore Throat, Hoarseness, and Cough After Tracheal Intubation

Widespread Application of Topical Steroids to Decrease Sore Throat, Hoarseness, and Cough After Tracheal Intubation

Adverse reactions to nonionic iodine in contrast-enhanced computed tomography: usefulness of monitoring vital signs

To report on adverse reactions to intravenous nonionic iodine contrast media and evaluate the usefulness of monitoring vital signs. A prospective study of 1537 consecutive patients who received contrast-enhanced CT with nonionic iodine was performed. Systolic and diastolic arterial blood pressure, pulse rate and arterial blood oxygen saturation were monitored. Severity of adverse reactions was classified as minor, intermediate and severe. A total of 64 adverse reactions developed in 57 patients. The overall prevalence was 3.7% (57/1537). The most common symptom was nausea (18/64) followed by pharyngeal discomfort (11/64). One patient had a severe reaction consisting of prolonged hypotension. Four patients had an intermediate reaction, three transient hypotension or hypertension and one extensive urticaria and facial edema. In two out of four patients who became hypotensive or hypertensive, the reactions developed without any obvious clinical symptoms. Severe or life-threatening acute adverse reactions to intravenous nonionic iodine contrast media may develop without any obvious clinical symptoms. Monitoring vital signs is very helpful for early detection.

Acute mediastinitis due to esophageal perforation —A case report—

A 55-year-old female consulted her family physician because of pharyngeal discomfort after eating a fish. She underwent rigid fiberscopy and was pointed out a fish bone. Family physician failed to extract the bone and the patient was referred to our hospital. However, there was no fish bone in the esophagus when she underwent second rigid fiberscopy. After eight days she complained of dyspnea and was referred to our hospital again. Chest X ray film showed marked enlargement of the mediastinum and she was diagnosed as acute mediastinitis. She underwent mediastinal drainage by thoracotomy. So tiny perforation was found in cervical esophagus by endoscopy that primary suture was not done. After two months' follow up with intravenous hyperalimentation, there was still esophageal perforation. She underwent the second operation of primary closure with reinforcement using sternocleidomastoid muscle. Two weeks after the second operation esophagogram still showed a fistula. So she received injections of alprostadil and factor XIII. One month after the injections esophagogram showed a diverticulum without leakage.

Midazolam Premedication Improves Tolerance of Transesophageal Echocardiography

Patient premedication for transesophageal echocardiography (TEE) is still under debate, especially the use of sedatives. We performed a double-blind, placebo-controlled study to clarify the efficacy of low-dose intravenous midazolam as premedication for TEE. Placebo or midazolam (≤50 kg, 2.0 mg intravenously; 50 to 80 kg, 2.5 mg; and ≥80 kg, 3.0 mg intravenously) was given in addition to topical anesthesia to 200 consecutive in- and outpatients. Blood pressure, heart rate, and oxygen saturation were monitored. Patients were interviewed immediately, and 2 to 10 days after TEE. Sixteen patients received an additional dose of midazolam, and in 12 follow-up was incomplete. Patients taking midazolam reported less gag reflex at probe introduction and during TEE, as did the examiners (p <0.05 to 0.0001). Probe manipulations were found to produce less discomfort after midazolam administration (p <0.005). Midazolam patients experienced less dyspnea (p <0.01) despite a minimal decrease in oxygen saturation of 2% (p <0.0001). The following day patients taking midazolam reported less sore throats, and painful swallowing was less frequent (p <0.01 to 0.001). Systolic blood pressure decreased slightly in the midazolam group (132 ± 24 to 121 ± 20 mm Hg, p <0.0001). The rate of minor complications showed no difference. Thus, TEE probe introduction and manipulation was tolerated better after low-dose midazolam premedication, and patients experienced less pharyngeal discomfort the day after. Midazolam was well tolerated and the complication rate did not increase. Thus low-dose, short-acting benzodiazepine premedication improves patient comfort during and after TEE and generous use can be recommended.

SELECTIVE ENDOSCOPY IN MANAGEMENT OF INGESTED FOREIGN BODIES OF THE UPPER GASTROINTESTINAL TRACT: IS IT SAFE?

SUMMARYDuring a four‐year period, 308 patients presented following ingestion of foreign bodies. Ingestion was accidental in 272 cases (88.3%) and deliberate in the remainder. Symptoms at presentation included dysphagia, odynophagia, nausea and vomiting, chest pain and pharyngeal discomfort. Sixty‐eight patients were asymptomatic. A policy of expectant management and selective endoscopy was employed. Following initial assessment 202 patients (65.6%) were discharged without treatment, 30 (9.7%) of whom were later reviewed as outpatients and did not require admission. Forty‐nine patients (16%) were admitted for treatment; 27 had oesophagoscopy, five bronchoscopy and two had foreign body extraction with direct laryngoscopy. In nine patients who were endoscoped, no foreign body was identified. Twenty‐seven others were referred to the otorhinolaryngology service in another hospital. There were no deaths in the group and morbidity was 1.2%. We conclude that a policy of selective endoscopy is safe and effective in the management of patients following ingestion of foreign bodies.

耳鼻咽喉科におけるメイラックス使用経験 咽喉頭異常感と耳鳴に対して

The incidence of psychosomatic disorders was assessed using the Kyusyu Medical Index (KMI) in 52 patients with pharyngeal discomfort and 50 patients with tinnitus. The effectiveness of ethyl loflazepate, an antianxiety drug, in the alleviation of their complaints was evaluated after 2 and 4 weeks of drug administration at a dose of 2 mg/day.The male/female ratio and KMI assessment results were markedly similar in patients with pharyngeal discomfort and those with tinnitus, which suggests a common psychosomatic factor in both groups. Most female patients showed a somewhat psychosomatic tendency in both disorders. The KMI is a useful screening test for detection of psychosomatic disorders, because the relation ship between assessment results and the effectiveness of the antianxiety drug was more evident with the KMI than with other psychological tests. Ethyl loflazepate treated patients were evaluated as “slightly improved” or better in about 70% of the patients in both groups. This drug was found to be useful for the treatment of pharyngeal discomfort and tinnitus.

Palliative treatment of obstructing esophageal cancer with nitinol stents: value, safety, and long-term results.

The purpose of our study was to evaluate the effectiveness of nitinol stents for palliation of dysphagia due obstructing esophageal cancer, safety of stent placement, and long-term results. Self-expanding uncoated nitinol stents were inserted either radiologically (14 patients) or endoscopically (12 patients) on an outpatient basis in 26 consecutive patients with dysphagia grade 3 or 4 caused by incurable malignant obstructions in the middle or distal third of the esophagus (n = 22) or at esophagojejunal anastomoses (n = 4). No esophagotracheal fistulas were seen in any patient. In 22 patients prior treatments had failed. Following insertion, the stent lumen was dilated to the maximum diameter. Finally, esophagography or esophagoscopy was done to confirm the position of the stent and patency of the esophageal lumen. Twenty-four hours after the procedure, esophageal function was investigated by a barium swallow. Patients were encouraged to ingest solid food thereafter. Improvement in dysphagia was evaluated 1 week after stent placement and during monthly interviews. Complications were defined as major (aspiration, bleeding, stent misplacement or dislocation, perforation) or minor (reflux esophagitis, chest pain, pharyngeal discomfort). Tumor ingrowth or overgrowth was considered a treatment failure. Twenty-three patients (88%) were followed until death: three patients (12%) were followed for a mean of 14 months. Exact positioning of the stent and dilation to its maximum diameter were technically feasible in all patients. No stents were placed in the stomach. Patency of the esophageal lumen was successfully restored in 25 patients. In one patient a broken strut of the stent after dilation caused a partial obstruction, which was detected endoscopically. Two patients had recurrent dysphagia due to tumor ingrowth or overgrowth, one after 1 month and the other after 3 months. In these patients an additional overlapping stent was successfully placed. No procedure-related mortalities or major complications occurred. The mean dysphagia grade of 3.5 was improved to a mean grade of 0.6 after stent placement. All patients could take liquids within the first 24 hr. Fifteen patients improved to dysphagia grade 0, seven patients to grade 1, and four patients to grade 2 within 1 week after the procedure. Twenty-three patients (88%) died during the follow-up period (mean survival, 5 months) as a result of their disease. Latest evaluation of the mean dysphagia grade was 0.7. Three patients (12%) are still alive (mean survival, 14 months) with a dysphagia grade 1 in one patient and grade 0 in two. Implantation of nitinol stents proved to be an effective and safe method of palliating severe dysphagia in patients with obstructing esophageal cancer. The improvement in dysphagia was impressive and long lasting. Placement of the stents was feasible without major procedure-related complications.

内頚動脈蛇行による咽頭異常感例

内頚動脈蛇行による咽頭異常感例

後頭下開頭を要した舌下神経鞘腫

Neurilemmomas of the hypoglossal nerve are uncommon; our report is the 49th case in the world.A 55-year-old female was admitted to Kyoto University hospital for relief of pharyngeal discomfort. Paralysis and atrophy of the left side of the tongue and curtain's sign were noted. Computerized tomography showed tumor of the left parapharyngeal space extending to the intracranial region with destruction of the hypoglossal canal. Magnetic resonance imaging was useful in defining the extent of the tumor. One-stage suboccipital craniectomy was performed through an infratemporal fossa approach.Examination of the intracranial region by CT or MRI is necessary for the diagnosis of hypoglossal neurilemmoma of the parapharyngeal space.

左扁桃上極部に生じた扁桃結石の一例

A large tonsillolith in a 48-year-old woman is reported. The patient had complained of pharyngeal discomfort for three years. X-ray examination revealed a large calcification at the left supratonsillar fossa. CT revealed a high-density mass and MRI revealed a low density area in the same place. Tonsillectomy of the l e ft side was performed under general anesthesia. The stone was 20 X 16 mm and contained CaPO4 75% and CaCO3 25%. To date,18 cases of tonsillolith have been reported in Japan. The literature on tonsillolith is reviewed.

咽喉頭異常感を訴える頻度と治療効果

The authors treated 494 patients with abnormal sensation in the throat, such as a lump or a choking sensation, who had visited Mie University Hospital or its related hospitals from April 1985 to June 1989. The effects of various drugs for this condition were analyzed and the therapeutic response was compared in two groups : one was composed of patients with continuous complaints (continuous group), the other of patients with periodic complaints (periodic group). The purpose of this study was to determine whether patients with continuous complaints were more resistant to various kinds of medication and had more serious pathological conditions than those with periodic complaints.1) Placebo, lysozyme chloride (anti-inflammatory agent) and dosulepin hydrochloride (anti-depressant) were apparently effective for patients in the periodic group. Especially, with lysozyme chloride, there was a statistically significant difference in the complete cure rates of the two groups. Therefore, when we treat this condition with placebo or anti-inflammatory or anti-depressant drugs, continuous discomfort of the throat is much more severe than periodic discomfort.2) Tiaprofenic acid (an anti-inflammatory agent with peripheral analgesic effect) and Saiboku-to (Chinese herbal medicine) were equally effective in the two groups. Therefore, we cannot say that continuous complaints indicate a more severe condition of pharyngeal discomfort when these two drugs are used.3) Minor tranquilizers were much more effective in the periodic group than in the continuous group during the period of administration. However, within a week after the termination of the drug, a high rate of recurrence was noted in the periodic group, and final complete cure rate of this group was inferior to that of the continuous group. Therefore, when we treat this condition with minor tranquilizers, the periodic discomfort of the pharynx should be considered to be more serious than continuous discomfort.The present study has shown that continuous pharyngeal discomfort is not always more serious than periodic discomfort. The severity of this condition may depend on the therapy chosen. We should be careful in the assessment of the severity of the pharyngeal discomfort.

Gastroesophageal reflux and posterior laryngitis.

Esophageal acid exposure was assessed by 23-hour ambulatory pH monitoring and compared with a biopsy of the posterior larynx and proximal esophagus in 97 patients with hoarseness, burning pharyngeal discomfort, or globus sensation. Patient results were compared with normal acid exposure times obtained in 54 control subjects. In 24 patients there were laryngeal abnormalities but both esophageal biopsy results and acid exposure times were normal. Laryngeal disease was found in association with prolonged acid exposure time or esophagitis in only 17 of the 97 patients (17.5%) studied. Recent reports appear to have overestimated the importance of acid reflux as a cause of posterior laryngitis.

A Randomized Trial for Outpatient Management of Peritonsillar Abscess

Two protocols for outpatient management of peritonsillar abscess were evaluated. One group of patients was treated with traditional incision and drainage, while the second group underwent simple aspiration with an 18-gauge needle. Both study groups received penicillin, or, if allergic, erythromycin, and both groups were seen at 24 to 48 hours for repetition of the initial procedure if the abscess had reaccumulated. These patients were interviewed seven to ten days after the initial visit for confirmation of the drainage procedure's efficacy and for subjective evaluation of the duration of pharyngeal discomfort following the procedure. Repetition of the initial drainage procedure was necessary in 20% of those patients treated with needle aspiration and in 10% of those patients undergoing incision and drainage. After needle aspiration, subjective improvement in swallowing discomfort occurred one to two days sooner, but there was no difference in the time for resolution of symptoms. S. P. Stringen

A new transnasal sonde type fiberscope (SSIF type VII) as a pan-enteroscope.

The sonde type enteroscopes (SSIF, Olympus) are long, slender, flexible instruments which resemble the Miller-Abbott or Cantor tube. To date, six types of SSIF (types I-VI) designed for oral insertion have been available. These scopes are introduced into the lower part of the small intestine by peristalsis, and the examination was seldom risky. The patient, however, often complained of pharyngeal discomfort, which reduced his tolerance. A new enteroscope, the SSIF type VII, with no metal hood and slender enough to permit nasal insertion has been developed. Enteroscopy with this fiberscope is adequately tolerable, even in the case of a long examination, and observation of most of the small intestine is possible without risk or discomfort.

Stylohyoid syndromes: An uncommon cause of pharyngeal and neck pain

An elongated styloid process is an uncommon cause of pharyngeal and neck discomfort known as Eagle's syndrome. It and related syndromes must be included in the differential diagnosis of unexplained sore throat, dysphagia and neck pain. The varieties of the stylohyoid complex syndrome and the embryology, anatomy, diagnosis, and treatment are described.

Fixation of Foley catheter.

To the Editor .—Drs. Barton and Ray have described a method of securing an inflated catheter in the nasopharynx for control of posterior epistaxis, using a pad to distribute pressure over the external naris. 1 Several years ago Dr. Alan Nahum devised a method which avoids pressure on the nostril. A short length of plastic suction tubing is passed over the catheter prior to its insertion into the nose. After inflating the balloon and packing the nose, the tubing is slipped down against the pack and secured there with a screw clamp (Figure). A 14 F Foley catheter with a 30-ml balloon works well. If the tip is shortened there will be less pharyngeal discomfort. Reference