A new animal model for relapsing polychondritis, induced by cartilage matrix protein (matrilin-1).
Relapsing polychondritis (RP) differs from rheumatoid arthritis (RA) in that primarily cartilage outside diarthrodial joints is affected. The disease usually involves trachea, nose, and outer ears. To investigate whether the tissue distribution of RP may be explained by a specific immune response, we immunized rats with cartilage matrix protein (matrilin-1), a protein predominantly expressed in tracheal cartilage. After 2-3 weeks, some rats developed a severe inspiratory stridor. They had swollen noses and/or epistaxis, but showed neither joint nor outer ear affection. The inflammatory lesions involved chronic active erosions of cartilage. Female rats were more susceptible than males. The disease susceptibility was controlled by both MHC genes (f, l, d, and a haplotypes are high responders, and u, n, and c are resistant) and non-MHC genes (the LEW strain is susceptible; the DA strain is resistant). However, all strains mounted a pronounced IgG response to cartilage matrix protein. The initiation and effector phase of the laryngotracheal involvement causing the clinical symptoms were shown to depend on alphabeta T cells. Taken together, these results represent a novel model for RP: matrilin-1-induced RP. Our findings also suggest that different cartilage proteins are involved in pathogenic models of RP and RA. (+info)
Cricopharyngeal myotomy: treatment of dysphagia.
Six patients are presented who underwent cricopharyngeus myotomy for dysphagia. The clinical history and cine studies appear to be the most useful assessments in defining patients with dysphagia who may improve after a myotomy. Etiological factors which may precipitate poor coordination of the swallowing mechanism and a relative cricopharyngeus muscle obstruction include neuromuscular disorders, radical oral surgery, central nervous disease, and idiopathic disorders, although the exact physiology of the cricopharyngeus muscle in health and disease is not as yet delineated, the muscle is being implicated in many problems as the inciting factor of upper esophageal dysphagia. The operation of cricopharyngeus myotomy is a relatively simple procedure and should be done with little morbidity and mortality in properly selected cases. (+info)
Normal laryngeal CT findings after supracricoid partial laryngectomy.
BACKGROUND AND PURPOSE: Supracricoid horizontal partial laryngectomy (SCPL) is increasingly used to treat endolaryngeal carcinoma. However, few radiologic reports of these procedures exist. Our purpose was to evaluate the normal CT appearance of the neolarynx after surgery. METHODS: SCPL includes cricohyoidopexy (CHP), cricohyoidoepiglottopexy (CHEP), and tracheocricohyoidoepiglottopexy (TCHEP). We examined CT scans obtained from 18 patients without local superficial recurrence who underwent SCPL: 10, CHEP; seven, CHP; and one, TCHEP. Three reference sections were used to analyze the main surgical reconstruction: an upper section through the hyoid bone, a lower section through the cricoid cartilage, and a middle section in between. The distance between the hyoid bone and cricoid cartilage was measured. RESULTS: The epiglottis and valleculae were visible in the upper section in seven of 10 patients who underwent CHEP; this finding allowed distinction between CHEP and CHP. The arytenoids were depicted in 13 of 18 cases and reflected neolaryngeal shortening. The lower section showed the empty cricoid lumen lined by a thin mucosa; the anterior arch of the cricoid was amputated at TCHEP. The middle section showed the neovestibule, the lateral boundaries of which were the hypertrophic neoaryepiglottic folds; the anterior limit was the epiglottis for CHEP or the base of the tongue for CHP. The average distance between the hyoid bone and cricoid cartilage was 11 mm. CONCLUSION: Normal CT anatomy of the larynx after SCPL is defined. Three key sections may accurately distinguish the various types of SCPL. CT is a valuable tool for depicting tumor recurrence, especially when the tumor is submucosal. (+info)
The nature of the protein moieties of cartilage proteoglycans of pig and ox.
Proteoglycans extracted with 4M-guanidinium chloride from pig laryngeal cartilage and bovine nasal septum were purified by density-gradient centrifugation in CsCl under 'associative' followed by 'dissociative' conditions [Hascall & Sajdera (1969) J. Biol. Chem. 244, 2384-2396]. Proteoglycans were then digested exhaustively with testicular hyaluronidase, which removed about 80% of the chondroitin sulphate. The hyaluronidase was purified until no proteolytic activity was detectable under the conditions used for digestion. The resulting 'core' proteins of both species were fractionated by a sequence of gel-chromatographic procedures which gave four major fractions of decreasing hydrodynamic size. Those that on electrophoresis penetrated 5.6% (w/v) polyacrylamide gels migrated as discrete bands whose mobility increased with decreasing hydrodynamic size. The unfractionated 'core' proteins had the same N-terminal amino acids as the intact proteoglycan, suggesting that no peptide bonds had been cleaved during hyaluronidase digestion. Alanine predominated as the N-terminal residue in all the fractions of both species. Fractions were analysed for amino acid, amino sugar, uronic acid and neutral sugar compositions. In pig 'core' proteins, the glutamic acid content increased significantly with hydrodynamic size, but in bovine 'core' proteins this trend was less marked. Significant differences in amino acid composition between fractions suggested that in each species there was more than one variety of proteoglycan. The molar proportions of xylose to serine destroyed on alkaline beta-elimination were equivalent in most fractions, indicating that the serine residues destroyed were attached to the terminal xylose of chondroitin sulphate chains. The ratio of serine residues to threonine residues destroyed on beta-elimination, was similar in all fractions of both species. Since the fractions of smallest hydrodynamic size contained less keratan sulphate than those of larger size, it implies that in the former the keratan sulphate chains were shorter than in the latter. (+info)
FRACTURES OF THE LARYNX.
It is advised that in significant laryngeal trauma open exploration be done as soon as the general condition of the patient permits. The authors believe that the exact nature and severity of a laryngeal injury cannot otherwise be known, and that no method of closed reduction and fixation will accomplish as good results as open repair. Conservative expectant treatment will in many cases result in a much greater morbidity and a poor ultimate result. (+info)
Non-Hodgkin lymphoma of the larynx: CT and MR imaging findings.
BACKGROUND AND PURPOSE: Non-Hodgkin lymphoma (NHL) of the larynx is a rare tumor. The aim of this study was to report the CT and MR features of laryngeal NHL in four patients to determine if there are any features that might be helpful to distinguish NHL from other laryngeal tumors. METHODS: The CT and MR images of four patients with laryngeal NHL were retrospectively reviewed for tumor volume and distribution, appearance, local invasion, and lymphadenopathy. RESULTS: Tumor volume ranged from 4 to 45 mL(3). Tumor was based in the submucosal (2/4 [50%]), mucosal (1/4 [25%]), or both regions (1/4 [25%]) and was centered in the supraglottis (4/4 [100%]) but also involved the glottis (4/4 [100%]) and subglottis (2/4 [50%]). Laryngeal tumor involved the aryepiglottic folds (4/4 [100%)]), ventricles and false cords (4/4 [100%]), epiglottis (3/4 [75%]), paraglottis (3/4 [75%]), true cords (4/4 [100%]), anterior commissure (4/4 [100%]), and laryngeal cartilage (1/4 [25%]). The tumor extended into the hypopharynx (4/4 [100%]), strap muscles (1/4 [25%]), prevertebral muscles (1/4 [25%]), tongue base (1/4 [25%]), and walls of the oropharynx (1/4 [25%]) and nasopharynx (1/4 [25%]). Bilateral cervical lymphadenopathy with extracapsular tumor spread was present in one patient. CONCLUSION: Laryngeal NHL is a tumor that usually has a large submucosal component centered in the surpaglottis. The tumor extends into the glottis, with less frequent spread to the subglottis, laryngeal cartilage, and strap muscles. Laryngeal NHL also involves the hypopharynx, with large tumors extending superiorly into the tongue base, oropharynx, and nasopharynx. A laryngeal tumor with a large supraglottic submucosal component should alert the ragiologist to the possibility of NHL. (+info)
Clinics in diagnostic imaging (100). Migrated pharyngeal fish bone.
A 71-year-old man presented with a suspected swallowed fish bone. The lateral radiograph of the neck showed a curvilinear radio-opaque density in the swollen pre-vertebral soft tissues. The diagnosis of a migrated fish bone was confirmed on computed tomography and during subsequent surgery. The patient made a good recovery. As calcified normal structures, particularly the laryngeal cartilages, can mimic abnormal radio-opaque foreign bodies, it is important to be able to recognise the normal calcified structures seen on the neck radiograph. A sound knowledge of radiological anatomy is required in order to avoid unnecessary investigation and to provide prompt and appropriate management. (+info)
Late post radiation laryngeal chondronecrosis with pharyngooesophageal fibrosis.
Chondroradionecrosis of larynx is a well recognized complication of radiation therapy, which usually occur with in the 1st year. Review of literature shows very few accounts of late radiation induced clinical chondroradionecrosis of the larynx. This condition can mimic a local recurrence and severe and life threatening involvement will require aggressive surgical management as reported in the present case. (+info)