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Sample records for gland totally transoral

  1. [Transoral approach to thyroid gland in the experiment].

    PubMed

    Shulutko, A M; Semikov, V I; Gryaznov, S E; Gorbacheva, A V; Patalova, A R; Mansurova, G T; Boblak, Yu A

    To develop minimally invasive and safe endoscopic access to thyroid gland. Transoral pre-mandibular video-assisted gas-free access to thyroid gland was developed in experimental study that included 19 human cadavers. Stereometric modeling defined the evaluation criteria including the form of basal arch of lower jaw and its height. There was no conflict of instruments in working chamber under platysma. Additional trocar was deployed to resolve the conflict between working parts of instruments during thyroid gland mobilization. The angle of operative action between the instruments is close to 90°. Trocar hole is used for drainage. The access provides good visualization of recurrent laryngeal nerve, upper and lower thyroid arteries and parathyroid gland. It is less traumatic compared with other extra-cervical accesses to thyroid glands.

  2. Removal of the submandibular gland using a combined retroauricular and transoral approach.

    PubMed

    Chen, Wei-liang; Yang, Zhao-hui; Wang, Yong-jie; Huang, Zhi-quan; Wang, You-yuan

    2009-03-01

    To evaluate the feasibility and outcome of a combined retroauricular and transoral approach for removing the submandibular gland. Thirteen patients underwent removal of benign submandibular gland lesions (6 sialoadenitis with sialolithiasis, 4 chronic sialoadenitis, and 3 pleomorphic adenomas) using a combined retroauricular and intraoral approach. All 13 submandibular sialoadenectomies were successful and all of the wounds healed uneventfully. A temporary deficit of the lingual nerve developed in 2 cases and mild limited movement of the tongue developed in 3 cases. No patient suffered from weakness of the marginal mandibular branch of the facial nerve. The follow-up averaged 14.1 months (range, 6-24 months); no tumors recurred. The incision scars were invisible. Submandibular gland resection using a combined retroauricular and transoral approach is a feasible method for benign submandibular gland lesions that provides an acceptable cosmetic outcome.

  3. Pediatric trans-oral submandibular gland excision: A safe and effective technique.

    PubMed

    Hughes, C A; Brown, J

    2017-02-01

    In the pediatric population the submandibular gland requires removal in a number of conditions including, refractory recurrent sialoadenitis, sialolithiasis, salivary gland neoplasms and debilitating sialorrhea. In comparison to the traditional trans-cervical approach, the trans-oral route avoids a cervical scar, potential keloid formation and decreased risk of injury to the marginal mandibular branch of the facial nerve. This approach also eliminates the potentiality of remnant duct disease since the entire duct and papillae are removed. The article demonstrates the appropriateness of this method in the pediatric population and discusses the anatomy and technique. Retrospective review of ten pediatric patients who underwent trans-oral submandibular gland excision, the series was analyzed for age, gender, indication for procedure, complications, length of hospitalization, and postoperative pathology. Patients were followed for a minimum of 12 months. 7 females and 3 males aged 9 to 17 underwent the procedure. Recurrent sialoadenitis, and sialolithiasis, accounted for 6 cases while salivary neoplasms (pleomorphic adenoma) accounted for 4 cases. No patient suffered vessel or nerve injury and no patient showed recurrent disease at 12 months follow-up. All glands were completely removed and no patient required conversion to the trans-cervical approach. Trans-oral submandibular gland excision is safe and effective in the pediatric population. This method avoids a cervical scar, avoids injury to the marginal mandibular branch of the facial nerve, and completely removes the duct, eliminating the potentiality of remnant duct disease. The authors have performed ten trans-oral submandibular gland excisions in pediatric patients without complications. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  4. Transoral submandibulotomy for deep hilar submandibular gland sialolithiasis.

    PubMed

    Schapher, Mirco; Mantsopoulos, Konstantinos; Messbacher, Maria-Elena; Iro, Heinrich; Koch, Michael

    2017-09-01

    To assess the long-term results after transoral submandibulotomy for stones located in the deep hilar and intraparenchymal submandibular region. Retrospective cohort analysis. Retrospective evaluation including all patients treated with transoral submandibulotomy for sialolithiasis at a tertiary referral center. Complete stone removal at the first transoral surgical treatment was achieved in 185 of 234 patients (79.1%). One hundred seventy-five of the 234 patients were followed up for a mean of 31.2 ( ± 20.5) months. During the follow-up period, 140 of the 175 patients (80.0%) became symptom free after one operation. In patients with residual symptoms, no further treatment was needed in 12 patients (6.9%) due to the mildness of the symptoms; 23 patients (13.1%) received further therapy, which was successful in 15 cases. Submandibulectomy only had to be performed in 3.4% of the patients with follow-up (6/175). In a questionnaire survey, 91.4% of the patients stated that they would be prepared to have the same operation again. These findings show that transoral removal of submandibular sialoliths located in the deep hilum or adjacent intraglandular parenchyma is an effective treatment that can be assisted by additional measures. The techniques described show high success rates, good long-term results, low complication rates, and they avoided the need for submandibulectomy in >95% of cases. 4. Laryngoscope, 127:2038-2044, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

  5. A safe transoral surgical approach to parapharyngeal tumor arising from deep lobe of parotid gland.

    PubMed

    Casale, Manuele; Capuano, Francesco; Sabatino, Lorenzo; Pace, Annalisa; Oliveto, Giuseppe; Vella, Paola; Moffa, Antonio; Salvinelli, Fabrizio

    2016-01-01

    The management of parapharyngeal tumor is surgical, but the approach remains a challenge. Attention should be paid to avoidance intra-operative bleeding or cranial nerves damage. We report a case of a 67-year-old male complaining of left-ear fullness. A submucosal mass arising from the lateral wall of oropharynx on the left side was observed. Magnetic resonance imaging detected a mass arising from the parotid gland, in particular from the deep lobe, and a fine needle biopsy was compatible with "Warthin tumor." We performed a mini-invasive transoral approach under magnification, previous isolation of homolateral vessels. The decision on which surgical approach to be used is determined by site, size vascularity, and histology of the tumor. A literature review of the main surgical approaches was performed. We performed a combined transoral dissection under magnification with cervicotomic exposure of the neck vascular bundle allowing to dissect the tumor and manage any intra-operative complications.

  6. Cost comparison of open approach, transoral laser microsurgery and transoral robotic surgery for partial and total laryngectomies.

    PubMed

    Dombrée, Manon; Crott, Ralph; Lawson, Georges; Janne, Pascal; Castiaux, Annick; Krug, Bruno

    2014-10-01

    Activity-based costing is used to give a better insight into the actual cost structure of open, transoral laser microsurgery (TLM) and transoral robotic surgery (TORS) supraglottic and total laryngectomies. Cost data were obtained from hospital administration, personnel and vendor structured interviews. A process map identified 17 activities, to which the detailed cost data are related. One-way sensitivity analyses on the patient throughput, the cost of the equipment or operative times were performed. The total cost for supraglottic open (135-203 min), TLM (110-210 min) and TORS (35-130 min) approaches were 3,349 euro (3,193-3,499 euro), 3,461 euro (3,207-3,664 euro) and 5,650 euro (4,297-5,974 euro), respectively. For total laryngectomy, the overall cost were 3,581 euro (3,215-3,846 euro) for open and 6,767 euro (6,418-7,389 euro) for TORS. TORS cost is mostly influenced by equipment (54%) where the other procedures are predominantly determined by personnel cost (about 45%). Even when we doubled the yearly case-load, used the shortest operative times or a calculation without robot equipment costs we did not reach cost equivalence. TORS is more expensive than standard approaches and mainly influenced by purchase and maintenance costs and the use of proprietary instruments. Further trials on long-term outcomes and costs following TORS are needed to evaluate its cost-effectiveness.

  7. A safe transoral surgical approach to parapharyngeal tumor arising from deep lobe of parotid gland

    PubMed Central

    Casale, Manuele; Capuano, Francesco; Sabatino, Lorenzo; Pace, Annalisa; Oliveto, Giuseppe; Vella, Paola; Moffa, Antonio; Salvinelli, Fabrizio

    2016-01-01

    The management of parapharyngeal tumor is surgical, but the approach remains a challenge. Attention should be paid to avoidance intra-operative bleeding or cranial nerves damage. We report a case of a 67-year-old male complaining of left-ear fullness. A submucosal mass arising from the lateral wall of oropharynx on the left side was observed. Magnetic resonance imaging detected a mass arising from the parotid gland, in particular from the deep lobe, and a fine needle biopsy was compatible with “Warthin tumor.” We performed a mini-invasive transoral approach under magnification, previous isolation of homolateral vessels. The decision on which surgical approach to be used is determined by site, size vascularity, and histology of the tumor. A literature review of the main surgical approaches was performed. We performed a combined transoral dissection under magnification with cervicotomic exposure of the neck vascular bundle allowing to dissect the tumor and manage any intra-operative complications. PMID:28228953

  8. Value of sialendoscopy-assisted transoral sublingual gland resection for a plunging ranula: case report and review.

    PubMed

    Truong, K; Guerin, L A; Hoffman, H

    2015-05-01

    To highlight the value of sialendoscopy during transoral resection of the sublingual gland for a plunging ranula to prevent iatrogenic injury to the submandibular duct. The clinical course of a 20-year-old male with a plunging ranula was analysed. The patient underwent transoral resection of the affected sublingual gland and pseudocyst. Sialendoscopy was used to confirm patency of the submandibular duct with placement of a Marchal dilator to aid in preservation of the duct during sublingual gland dissection. The sublingual gland was successfully removed, with no injury to the submandibular duct or lingual nerve. During follow up, the patient had slight numbness to the tip of the tongue, which resolved after 2-3 days. Post-operative examination showed the submandibular duct to be intact and there was no swelling of the submandibular area. Sialendoscopy-assisted transoral sublingual gland resection for a plunging ranula is a safe and effective technique. Sialendoscopy aids in skeletonisation and preservation of the submandibular duct.

  9. Transoral ultrasonic total laryngectomy (TOUSS-TL): description of a new endoscopic approach and report of two cases.

    PubMed

    Fernández-Fernández, Mario M; González, Lourdes Montes-Jovellar; Calvo, Carlos Ramírez; Arias, Pablo Parente; Cabré, Francisco Clascá; Del Álamo, Primitivo Ortega

    2016-09-01

    The minimally invasive total laryngectomy avoids a wide surgical field and so it has the potential benefit of reducing the local morbidity, especially on radiated patients. This approach has been previously described on a robotic basis, the transoral robotic total laryngectomy (TORS-TL). We have designed a minimally invasive approach for total laryngectomy (TL) using the transoral ultrasonic surgery technique (TOUSS). TOUSS is a transoral, endoscopic, non-robotic approach for laryngeal and pharyngeal tumors, based on the ultrasonic scalpel as a resection tool. Two patients with a laryngeal squamous cell carcinoma with indication for total laryngectomy were surgically treated: one primary TL for a subglottic carcinoma and one salvage TL with partial pharyngectomy for a local relapse after chemoradiotherapy of a glottic carcinoma. The tumors were completely removed with free surgical margin in both patients. The functional recovery was satisfactory in terms of swallowing and speech (a tracheoesophageal puncture and voice prosthesis placement were done in the same procedure). No intraoperative complications were observed. The patient with previous chemoradiotherapy had a pharyngocutaneous fistula which closed spontaneously without additional surgery. We have demonstrated that transoral endoscopic approach to the larynx and pharynx is feasible without a robotic platform. TOUSS-TL can easily spread the transoral endoscopic philosophy as well as the benefits of a minimally invasive way to remove the entire larynx. Further research will show the advantages in terms of complications and functional outcomes.

  10. Total alleviation of downbeat nystagmus in basilar impression by transoral removal of the odontoid process.

    PubMed

    Senelick, R C

    1981-12-01

    The presence of primary position downbeat nystagmus indicates disease at the cervicomedullary junction where craniovertebral anomalies are commonly encountered. This paper reports a patient whose only symptom was disabling oscillopsia and downbeat nystagmus secondary to basilar impression and Arnold-Chiari malformation. He experienced total resolution of his symptoms following transoral removal of the odontoid process. In the past it was felt that ocular signs and symptoms did not improve with surgery for craniovertebral anomalies. In light of this report, the ocular symptoms of craniovertebral anomalies may be considered indications in themselves for surgical intervention.

  11. Anatomical recovery of the duct of the submandibular gland after transoral removal of a hilar stone without sialodochoplasty: evaluation of a phase II clinical trial.

    PubMed

    Woo, Seung Hoon; Kim, Jin Pyeong; Kim, Jong Sei; Jeong, Han-Sin

    2014-12-01

    Transoral removal of stones for the treatment of submandibular sialolithiasis has been popularised, even for stones in the hilum. Without sialodochoplasty after surgical retrieval, the affected glands seem to recover well functionally, even without sialodochoplasty. However, the anatomical changes of structural recovery have not been fully studied. We investigated the outcomes and the changes to the salivary duct system after transoral removal of hilar stones using postoperative sialography. We enrolled 28 patients (29 sides) who had transoral removal of stones for submandibular hilar sialolithiasis without sialodochoplasty, and prospectively analysed the structural outcomes 3 months and 12 months postoperatively using sialography. We found 23 ducts (79%) recovered with a normal size, while 4 ducts (14%) developed saccular dilatation and one duct (3%) partially stenosed. Saccular dilatation developed after removal of stones larger than 10mm in diameter, but patients had no recurrent symptoms. By the 12 months' follow up, one stone had formed severe adhesions to the salivary duct that caused stenosis, and this patient had recurrent symptoms. Transoral removal of submandibular hilar stones without sialodochoplasty is an effective treatment with good anatomical restoration of the salivary duct and flow. Copyright © 2014 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  12. [Transoral approach for sublingual-plunging ranula].

    PubMed

    Schiel, S; Mayer, P; Ehrenfeld, M; Probst, F A

    2013-07-01

    The case of a 7-year-old boy suffering from progressive submental/submandibular swelling is reported. Following clinical and imaging diagnostics (MRI), the suspected diagnosis of a sublingual-plunging ranula was made. Surgery was performed with transoral excision of the sublingual gland in combination with excision of the ranula. Additional submandibular gland excision should be avoided.

  13. Transoral robotic thyroidectomy (TORT): procedures and outcomes

    PubMed Central

    Kim, Hoon Yub

    2017-01-01

    Remote-access approaches to the thyroid gland have seen a rapid evolution recently with the development of various techniques to minimize the cosmetic and quality-of-life impact of a visible scar. Most approaches have required significantly more tissue dissection and have been limited in their extent to treat contralateral disease. The transoral approach is the most recent iteration of “scarless” thyroidectomy and offers various advantages over other techniques including less tissue dissection, equal access to both sides of the neck, and a superb midline view of the anatomy. Transoral thyroidectomy may be performed with either laparoscopic or robotic technology, each with various advantages and disadvantages. Herein, we discuss our experience with transoral robotic thyroidectomy (TORT). PMID:28713701

  14. Transoral robotic thyroidectomy (TORT): procedures and outcomes.

    PubMed

    Richmon, Jeremy D; Kim, Hoon Yub

    2017-06-01

    Remote-access approaches to the thyroid gland have seen a rapid evolution recently with the development of various techniques to minimize the cosmetic and quality-of-life impact of a visible scar. Most approaches have required significantly more tissue dissection and have been limited in their extent to treat contralateral disease. The transoral approach is the most recent iteration of "scarless" thyroidectomy and offers various advantages over other techniques including less tissue dissection, equal access to both sides of the neck, and a superb midline view of the anatomy. Transoral thyroidectomy may be performed with either laparoscopic or robotic technology, each with various advantages and disadvantages. Herein, we discuss our experience with transoral robotic thyroidectomy (TORT).

  15. Transoral robotic thyroid surgery

    PubMed Central

    Clark, James H.; Kim, Hoon Yub

    2015-01-01

    There is currently significant demand for minimally invasive thyroid surgery; however the majority of proposed surgical approaches necessitate a compromise between minimal tissue dissection with a visible cervical scar or extensive tissue dissection with a remote, hidden scar. The development of transoral endoscopic thyroid surgery however provides an approach which is truly minimally invasive, as it conceals the incision within the oral cavity without significantly increasing the amount of required dissection. The transoral endoscopic approach however presents multiple technical challenges, which could be overcome with the incorporation of a robotic operating system. This manuscript summarizes the literature on the feasibility and current clinical experience with transoral robotic thyroid surgery. PMID:26425456

  16. Transoral endoscopic thyroidectomy: A case report

    PubMed Central

    Pai, Vishwanath M.; Muthukumar, Pari; Prathap, Apoorva; Leo, Jayanth; A., Rekha

    2015-01-01

    Introduction Endoscopic thyroidectomy, initially an experimental procedure, is now being performed in increasing frequency. It aims to provide patients undergoing thyroidectomy with a ‘scar-free’ surgery. Transoral endoscopic thyroidectomy is one such novel procedure that is based on the principles of natural orifice translumenal surgery (NOTES) and allows for a truly scar-free surgery with minimal dissection. Presentation of case A 21-year-old female presented with a swelling over the left side of her neck. Ultrasound revealed a solitary nodule and FNAC showed features suggestive of a follicular adenoma. Discussion The patient underwent transoral endoscopic hemi-thyroidectomy. The procedure lasted for 2 h and is one of the few documented cases of transoral endoscopic thyroidectomy performed on live patients. Conclusion Transoral endoscopic thyroidectomy is proving to be a feasible technique with little or no complications as compared to other endoscopic thyroid surgeries. It provides surgeons with easy access to the thyroid gland and patients with aesthetically pleasing results. PMID:26048629

  17. Transoral robotic surgery for larynx cancer.

    PubMed

    Smith, Richard V

    2014-06-01

    Transoral robotic surgery (TORS) has become increasingly used to manage laryngeal and pharyngeal cancers, although the published experience in the larynx is small. Although there is burgeoning use of TORS for primary pharyngeal cancer, its application in the larynx is currently more limited. Successful TORS of the larynx has been predominantly as supraglottic laryngectomy, although there is some experience in total laryngectomy and cordectomy. Limitations of TORS of the larynx are primarily those of access and instrumentation, with respect to both the surgical robot and the retractors used to access the larynx transorally. Copyright © 2014 Elsevier Inc. All rights reserved.

  18. Endoscope-assisted transoral accessory parotid mass excision.

    PubMed

    Woo, Seung Hoon

    2016-01-01

    Accessory parotid gland tissue is salivary tissue adjacent to Stensen's duct that is distinctly separate from the main body of the parotid gland. Surgical removal of an accessory parotid mass is usually accomplished through an external neck incision. However, this procedure inevitably results in a neck scar. We report the case of a 55-year-old man with an accessory parotid mass. We applied a modified approach to accessory parotid mass removal through the mouth with an endoscope system. The patient, who was diagnosed with a benign pleomorphic adenoma, underwent endoscope-assisted transoral accessory parotid mass excision. The follow-up time was 6 months. The patient experienced no serious postoperative complications or recurrence. Resection of an accessory parotid mass can be performed via an endoscope-assisted transoral approach. In this study, we describe the procedure of the endoscope-assisted transoral resection. © 2015 Wiley Periodicals, Inc.

  19. Transoral Robotic Reconstructive Surgery

    PubMed Central

    Selber, Jesse C.; Sarhane, Karim A.; Ibrahim, Amir E.; Holsinger, Floyd C.

    2014-01-01

    Transoral robotic surgery (TORS) has emerged as a technique that allows head and neck surgeons to safely resect large and complex oropharyngeal tumors without dividing the mandible or performing a lip-split incision. These resections provide a reconstructive challenge because the cylinder of the oropharynx remains closed and both physical access and visualization of oropharyngeal anatomy is severely restricted. Transoral robotic reconstruction (TORRS) of such defects allows the reconstructive surgeon to inset free flaps or perform adjacent tissue transfer while seeing what the resecting surgeon sees. Early experience with this technique has proved feasible and effective. Robotic reconstruction has many distinct advantages over conventional surgery, and offers patients a less morbid surgical course. In this review, we discuss the clinical applicability of transoral robotic surgery in head and neck reconstruction, highlighting the benefits and limitations of such an approach, and outlining the guidelines for its utilization. PMID:24872777

  20. Transoral Endoscopic Adenoidectomy

    PubMed Central

    El-Badrawy, Amr; Abdel-Aziz, Mosaad

    2009-01-01

    Objective. Adenoid curette guided by an indirect transoral mirror and a headlight is a simple and quick procedure that has already been in use for a long time, but this method carries a high risk of recurrence unless done by a well-experienced surgeon. The purpose of this paper was to evaluate the efficacy of transoral endoscopic adenoidectomy in relieving the obstructive nasal symptoms. Methods. 300 children underwent transoral endoscopic adenoidectomy using the classic adenoid curette and St Claire Thomson forceps with a 70∘ Hopkins 4-mm nasal endoscope introduced through the mouth and the view was projected on a monitor. Telephone questionnaire was used to follow-up the children for one year. Flexible nasopharyngoscopy was carried out for children with recurrent obstructive nasal symptoms to detect adenoid rehypertrophy. Results. No cases presented with postoperative complications. Only one case developed recurrent obstructive nasal symptoms due to adenoid regrowth and investigations showed that he had nasal allergy which may be the cause of recurrence. Conclusion. Transoral endoscopic adenoidectomy is the recent advancement of classic curettage adenoidectomy with direct vision of the nasopharynx that enables the surgeon to avoid injury of important structures as Eustachian tube orifices, and also it gives him the chance to completely remove the adenoidal tissues. PMID:20111586

  1. Transoral endoscopic adenoidectomy.

    PubMed

    El-Badrawy, Amr; Abdel-Aziz, Mosaad

    2009-01-01

    Objective. Adenoid curette guided by an indirect transoral mirror and a headlight is a simple and quick procedure that has already been in use for a long time, but this method carries a high risk of recurrence unless done by a well-experienced surgeon. The purpose of this paper was to evaluate the efficacy of transoral endoscopic adenoidectomy in relieving the obstructive nasal symptoms. Methods. 300 children underwent transoral endoscopic adenoidectomy using the classic adenoid curette and St Claire Thomson forceps with a 70( composite function) Hopkins 4-mm nasal endoscope introduced through the mouth and the view was projected on a monitor. Telephone questionnaire was used to follow-up the children for one year. Flexible nasopharyngoscopy was carried out for children with recurrent obstructive nasal symptoms to detect adenoid rehypertrophy. Results. No cases presented with postoperative complications. Only one case developed recurrent obstructive nasal symptoms due to adenoid regrowth and investigations showed that he had nasal allergy which may be the cause of recurrence. Conclusion. Transoral endoscopic adenoidectomy is the recent advancement of classic curettage adenoidectomy with direct vision of the nasopharynx that enables the surgeon to avoid injury of important structures as Eustachian tube orifices, and also it gives him the chance to completely remove the adenoidal tissues.

  2. Robotic-assisted transoral removal of a bilateral floor of mouth ranulas

    PubMed Central

    2011-01-01

    Objective To describe the management of bilateral oral ranulas with the use of the da Vinci Si Surgical System and discuss advantages and disadvantages over traditional transoral resection. Study Design Case Report and Review of Literature. Results A 47 year old woman presented to our service with an obvious right floor of mouth swelling. Clinical evaluation and computerized tomography scan confirmed a large floor of mouth ranula on the right and an incidental asymptomatic early ranula of the left sublingual gland. After obtaining an informed consent, the patient underwent a right transoral robotic-assisted transoral excision of the ranula and sublingual gland with identification and dissection of the submandibular duct and lingual nerve. The patient had an excellent outcome with no evidence of lingual nerve paresis and a return to oral intake on the first postoperative day. Subsequently, the patient underwent an elective transoral robotic-assisted excision of the incidental ranula on the left sublingual gland. Conclusion We describe the first robotic-assisted excision of bilateral oral ranulas in current literature. The use of the da Vinci system provides excellent visualization, magnification, and dexterity for transoral surgical management of ranulas with preservation of the lingual nerve and Wharton's duct with good functional outcomes. However, the use of the robotic system for anterior floor of mouth surgery in terms of improved surgical outcomes as compared to traditional transoral surgery, long-term recurrence rates, and cost effectiveness needs further validation. PMID:21767364

  3. Transoral approach for plunging ranula--10-year experience.

    PubMed

    Huang, Shiang-Fu; Liao, Chun-Ta; Chin, Shy-Chyi; Chen, I-How

    2010-01-01

    Plunging ranulas (PRs) are infrequently encountered. The origin of PRs is mostly from the sublingual gland (SLG). Different routes to manage PRs include marsupialization, simple SLG excision, and combined SLG and submandibular gland (SMG) excision either transcervically or transorally. In this study, we demonstrated our experience managing PRs via transoral excision of the SLG with marsupialization. Retrospective study. We retrospectively reviewed 20 patients at Chang Gung Memorial Hospital, Linkou, between January 1999 and April 2009. All patients received preoperative computed tomography or magnetic resonance imaging and were clinically diagnosed with PR. At surgery, the SLG was excised transorally with preservation of Wharton's duct and lingual nerve. The mucus contents of the PRs were drained through the posterior edge of the mylohyoid muscle. Two patients were found to have final diagnosis of lymphangioma. Eighteen patients were eligible for analysis. The age distribution ranged from 6 to 48 years old. Sexual distribution was equally distributed. The successful rate was 17/18 (94.4%) with a lingual nerve paresthesia rate of 2/18 (11.1%). The paresthesia persisted for 3 and 6 months, respectively. One recurrent patient was salvaged by excision of the SMG and ranula. The other two recurrent patients received excision of the SMG and cyst and had a final diagnosis of lymphangioma. Transoral approach with excision of the SLG alone provides a high success rate (94.4%) with minor complications and could be the first choice in managing PRs. The results of this study confirm PRs mostly originate from the SLG.

  4. Male accessory gland infection: relevance of serum total testosterone levels.

    PubMed

    Condorelli, R A; Calogero, A E; Vicari, E; Favilla, V; Cimino, S; Russo, G I; Morgia, G; La Vignera, S

    2014-01-01

    Aim of the present study was to evaluate the different ultrasound characterization of fertile symptomatic patients with MAGI (male accessory gland infection) according to different serum concentrations of total T (TT). We analyzed the ultrasound and hormonal data of 200 patients aged between 24.0 and 67.0 years. Patients were divided into six groups according to the sextile distribution of TT. Patients with serum concentrations of TT < 3.6 ng mL(-1) had a higher mean duration of symptoms compared to the other examined groups. Patients with serum concentrations of TT > 6.6 ng mL(-1) showed a frequency of ultrasound criteria suggestive for bilateral form of prostatitis and prostate-vesiculo-epididymitis and significantly lower compared to the other examined groups. At multivariate logistic regression analysis adjusted for age and BMI, TT was an independent predictive factor of prostatovesiculitis (OR = 0.818 [95% CI: 0.675-0.992]; P < 0.01) and prostate-vesiculo-epididymitis (OR = 0.714 [95% CI: 0.578-0.880]; P < 0.01), which represent the main forms of complicated MAGI. The results of this study suggest that male hypogonadism could be associated with a different ultrasound characterization of these patients.

  5. Soft palate preservation after tumor resection with transoral laser microsurgery.

    PubMed

    Luna-Ortiz, Kuauhyama; Gómez-Pedraza, Antonio; Mosqueda-Taylor, Adalberto

    2013-05-01

    Management and preservation of the soft palate is dependent on clinical stage and tumor histology. However, available literature is scarce regarding the palate preservation with the use of laser CO₂. We report the results obtained after management with laser surgery and soft palate preservation in three patients with salivary gland neoplasms. Three patients with minor salivary gland tumors were treated by means of transoral laser microsurgery. All tumors were assessed using magnetic resonance imaging. All tumors were >3 cm. Soft palate function was preserved and reconstruction was performed with primary closure. Patients began oral feeding the same day and were discharged after 24 h. Transoral laser microsurgery is recommended for treatment of soft palate tumors. This treatment can be considered a better option when compared with other modalities such as radio- or chemoradiotherapy which require a longer time of treatment, are more expensive and tend to produce significant toxicity.

  6. [Transoral coronoidectomy: Technical note].

    PubMed

    Gagé, J; Gallucci, A; Stroumsa, R; Foletti, J-M; Guyot, L; Chossegros, C

    2015-12-01

    Among the skeletal causes of limited mouth opening, uni- or bilateral coronoid process hypertrophy, or Langenbeck disease, is the most frequent. It can be associated with an osteochondroma or a coronoid-malar bone conflict and is then called Jacob disease, an unilateral pathology. Treatment rests on coronoidectomy in both cases. This technique is illustrated via two cases, one Langenbeck and one Jacob disease. A transoral approach was performed. After subperiosteal dissection, the coronoid process was cleared. The process was than severed at its base by means of a burr, freed from its temporal muscular fibers and removed. Mouth opening improved peroperatively. The surgical procedure was completed by active long-term physiotherapy beginning immediately after surgery. Transoral coronoidectomy is a simple, quick and safe procedure. Extra-oral approaches present a high risk of facial nerve injury. In our first case, mouth opening improved from 24 to 36 mm after bilateral coronoidectomy and to 40 mm after physiotherapy. In our second case, mouth opening improved from 22 to 38 mm after unilateral coronoidectomy and to 43 mm after one year physiotherapy. Long-term post-operative physiotherapy is mandatory to get and maintain good results. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  7. Transoral Robotic Surgery.

    PubMed

    Yee, Shokjean

    2017-01-01

    Transoral robotic surgery (TORS) is a technique used to treat oral, throat, and skull base cancers using a minimally invasive robotic approach through the mouth and throat. The TORS procedure allows deeper access and dissection of suspicious lesions and neoplastic growths in the oral cavity and those that extend from the throat to the base of the skull. Robotic surgery allows the surgeon to operate in tight spaces without a large open incision. This article discusses symptoms and risk factors of oral, throat, and skull base cancers; types of procedures that can be performed using the TORS approach; specialized instrumentation; patient selection; surgical advantages and disadvantages; patient benefits; and the role of the surgical team in preparing to intraoperatively care for the TORS patient.

  8. Endoscopic thyroidectomy: the transoral approach

    PubMed Central

    Hellinger, Achim; Kaminski, Cornelia; Benhidjeb, Tahar

    2016-01-01

    Transoral endoscopic thyroid surgery seems to be the logical consequence in the evolution of thyroid surgery. Animal and cadaver studies have shown that different endoscopic techniques can be performed in a safe and successful way. Presently, the minimally invasive aspect and cosmetic advantage seem to be the most important factor for the patients. However, even if these procedures are feasible in patients, the transoral access must still be considered as experimental. In this study then we aim at comparing the available literature on transoral thyroid surgery with our own experience in this field. The access itself needs to be further refined, and even more suitable and better adapted instruments need to be developed so that optimal and safe results that meet all requirements on endocrine surgery can be achieved and all requirements for endocrine surgery are met. The transoral thyroidectomy should only be performed in highly specialized centres for endocrine and endoscopic surgery. As an alternative, a combination with endoscopic non-transoral techniques—so called hybrid techniques—might be useful for our patients. PMID:27294042

  9. Failure of fragmented parathyroid gland autotransplantation to prevent permanent hypoparathyroidism after total thyroidectomy.

    PubMed

    Lorente-Poch, Leyre; Sancho, Juan; Muñoz, Jose Luis; Gallego-Otaegui, Lander; Martínez-Ruiz, Carlos; Sitges-Serra, Antonio

    2017-03-01

    Parathyroid autotransplantation during total thyroidectomy leads to higher rates of postoperative hypocalcaemia. It has been argued, however, that it prevents permanent hypoparathyroidism. The impact of autografted normal parathyroid gland fragments on long-term parathyroid status has not been assessed properly. To clarify this, the short- and long-term parathyroid function was assessed in patients with three glands remaining in situ after total thyroidectomy, in whom the fourth gland was either autotransplanted (Tx) or accidentally resected (AR). Consecutive patients (n = 669) undergoing first-time total thyroidectomy were prospectively studied recording the number of parathyroid glands remaining in situ: PGRIS =4-(glands autografted + glands in the specimen). The study was focused on the subgroup of 186 patients with three parathyroid glands remaining in situ as a result of either accidental resection (AR, n = 76) or autotransplantation into the sternocleidomastoid muscle (Tx, n = 110). Prevalence of postoperative hypocalcaemia, protracted, and permanent hypoparathyroidism were compared between the two groups. Demographic, disease-related, laboratory, and surgical variables were recorded. All patients were followed for at least 1 year. Both groups were comparable in terms of disease and extent of surgery. Mean postoperative serum calcium was the same (AR: 1.97 ± 0.2 vs Tx: 1.97 ± 0.22 mmol/L). Rates of protracted (AR: 24% vs Tx: 25.5%) and permanent hypoparathyroidism (AR: 5.3% vs Tx: 7.3%) were similar in both groups. The prevalence of parathyroid failure syndromes after total thyroidectomy was similar whether a parathyroid gland was inadvertently excised or autotransplanted. Autotransplantation did not influence the permanent hypoparathyroidism rate.

  10. Lingual Thyroid Excision with Transoral Robotic Surgery

    PubMed Central

    Ersoy Callıoglu, Elif; Bozdemir, Kazım; Ulusoy, Bulent; Oguzhan, Tolga; Korkmaz, M. Hakan

    2015-01-01

    Ectopic thyroid gland may be detected at any place between foramen caecaum and normal thyroid localization due to inadequacy of the embryological migration of the thyroid gland. It has a prevalence varying between 1/10.000 and 1/100000 in the community. Usually follow-up without treatment is preferred except for obstructive symptoms, bleeding, and suspicion of malignity. Main symptoms are dysphagia, dysphonia, bleeding, dyspnea, and obstructive sleep apnea. In symptomatic cases, the first described method in surgical treatment is open approach since it is a region difficult to have access to. However, this approach has an increased risk of morbidity and postoperative complications. Transoral robotic surgery, which is a minimally invasive surgical procedure, has advantages such as larger three-dimensional point of view and ease of manipulation due to robotic instruments. In this report, a case at the age of 49 who presented to our clinic with obstructive symptoms increasing within the last year and was found to have lingual thyroid and underwent excision of ectopic thyroid tissue by da Vinci surgical system is presented. PMID:26064746

  11. Management of the thyroid gland during total laryngectomy in patients with laryngeal squamous cell carcinoma.

    PubMed

    Mourad, Moustafa; Saman, Masoud; Sawhney, Raja; Ducic, Yadranko

    2015-08-01

    The goal of the study was to determine the role of routine total thyroidectomy and hemithyroidectomy in patients undergoing total laryngectomy for laryngeal squamous cell carcinoma. The study group consisted of 343 patients who underwent total laryngectomy (98 treated with surgery alone, 136 treated following radiation failure, and 109 following chemoradiation failure). Total thyroidectomy was performed in all obstructing and bilateral lesions or if there was suspicion of contralateral lobe involvement. Hemithyroidectomy was performed in all lateralized lesions. Retrospective histopathologic analysis of thyroid specimens was subsequently performed. In all, 262 patients underwent total thyroidectomy during total laryngectomy, six of which demonstrated squamous cell carcinoma evident within the thyroid gland (4 from transglottic lesions, 2 from subglottic lesions). Hemithyroidectomy was performed in 81 patients, with only one patient demonstrating evidence of squamous cell carcinoma within the thyroid gland. Hypothyroidism was observed in 88% (n = 61) of patients who underwent thyroid lobectomy alone, requiring hormone supplementation. Routine surgical management of the thyroid gland should not be performed, except in cases of subglottic primary lesions, lesions with significant subglottic extension, or transglottic lesions. Despite efforts to preserve the contralateral thyroid lobe in cases of selective lobectomy, these patients often have a high rate of hypothyroidism, and a total thyroidectomy should be considered when involvement of the thyroid gland is suspected. N/A. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

  12. Soft palate preservation after tumor resection with transoral laser microsurgery

    PubMed Central

    Luna-Ortiz, Kuauhyama; Gómez-Pedraza, Antonio

    2013-01-01

    Background: Management and preservation of the soft palate is dependent on clinical stage and tumor histology. However, available literature is scarce regarding the palate preservation with the use of laser CO2. Objectives: We report the results obtained after management with laser surgery and soft palate preservation in three patients with salivary gland neoplasms. Method: Three patients with minor salivary gland tumors were treated by means of transoral laser microsurgery. All tumors were assessed using magnetic resonance imaging. All tumors were >3 cm. Soft palate function was preserved and reconstruction was performed with primary closure. Patients began oral feeding the same day and were discharged after 24 h. Conclusions: Transoral laser microsurgery is recommended for treatment of soft palate tumors. This treatment can be considered a better option when compared with other modalities such as radio- or chemoradiotherapy which require a longer time of treatment, are more expensive and tend to produce significant toxicity. Key words:Laser CO2, neoplasms, salivary gland. PMID:23229273

  13. Transoral robotic surgery for retromolar trigone tumours.

    PubMed

    Durmus, K; Apuhan, T; Ozer, E

    2013-12-01

    The retromolar trigone is a challenging transoral surgical site due to the difficulty of visualization. Our aim is to report a new technique of transoral robotic resection of retromolar trigone tumours. We present three patients with retromolar trigone tumours with pathological diagnosis of squamous cell carcinoma who underwent successful transoral robotic resection. Robotic retromolar trigone resection and concurrent supraomohyoid neck dissections were performed in all patients without any complication. In conclusion, transoral robotic surgery is a safe and feasible technique for resection of malignant retromolar trigone tumours with minimal complications and favourable outcomes.

  14. The First Successful Case of Transoral Robotic Surgery in a Patient with Sialadenoma Papilliferum

    PubMed Central

    Koç, Arzu-Karaman; Yegin, Yakup; Çelik, Mustafa; Sar, Mehmet; Sakiz, Damlanur; Kayhan, Fatma-Tülin

    2016-01-01

    Introduction: Sialadenoma papilliferum (SP) is a rare benign tumor, which originates from the minor salivary gland. It occurs at sites that have minor salivary glands, such as the palate, retromolar pads, buccal mucosa, and lips. The most common location for tumor development is on the hard palate. A differential diagnosis consists of ruling out other salivary gland tumors. Transoral robotic surgery (TORS) is a new technology used in head and neck surgery within certain centers around the world. Case Report: Herein, we present the first successful case of SP tumor removal by TORS. Conclusion: This particular case highlights the identification of this rare tumor in an unusual location. Furthermore, it demonstrates the utilization of TORS, leveraging the superior visualization to obtain excellent local control with minimal acute and long-term morbidity, in comparison to conventional transoral surgical approaches. PMID:27738613

  15. Transoral buccinator-pexy (TBP).

    PubMed

    Jones, Nicholas I; Gamboa, Gloria; Bhatt, Kirit

    2014-01-01

    We describe a novel surgical technique to enhance the aesthetics of the midface by creating malar dimples. Dimples are the natural cheek indentations that become more apparent with facial animation. The aim of this study is to present our technique to create the appearance of these natural indentations using a simple transoral approach and to assess its safety. The transoral buccinator-pexy is done 1.5 to 2 cm superior to a point bisecting an angle formed by the projection of the lateral commissure and the lateral canthus. Local anesthetic is injected and an 18-gauge needle is introduced perpendicular through the skin marking and brought out through the buccal mucosa. A 4-mm punch biopsy or a small incision is made in the buccal mucosa. A small amount of buccal mucosa is then excised. 4-0 Nonabsorbable suture is threaded through the needle to the desired dimple location on the skin. The suture is then rethreaded from extraoral to intraoral, taking a portion of the dermis and buccinator muscle creating the desired dimple. The procedure was done successfully without complication in our series of patients. The mean follow-up was 18 months. Cadaveric dissection demonstrated key anatomical landmarks and we created a "zone of safety." Transoral buccinator-pexy deepened the submalar soft tissue. The indentations were made slightly pronounced, making the dimples visible without animation. After several weeks, the dimples were only present with animation. Cadaveric dissection was done to illustrate the relationship of the parotid duct and buccal branches of facial nerve to the area in which it is safe to perform TBP. The position of the dimple can be adjusted based on the patient's desires; however, identifying the papilla of Stensen duct is paramount. Transoral buccinator-pexy is a safe and effective in-office procedure that can be done to produce aesthetically pleasing dimples. The technique is simple and the results are consistent.

  16. Segmentation and classification of colon glands with deep convolutional neural networks and total variation regularization.

    PubMed

    Kainz, Philipp; Pfeiffer, Michael; Urschler, Martin

    2017-01-01

    Segmentation of histopathology sections is a necessary preprocessing step for digital pathology. Due to the large variability of biological tissue, machine learning techniques have shown superior performance over conventional image processing methods. Here we present our deep neural network-based approach for segmentation and classification of glands in tissue of benign and malignant colorectal cancer, which was developed to participate in the GlaS@MICCAI2015 colon gland segmentation challenge. We use two distinct deep convolutional neural networks (CNN) for pixel-wise classification of Hematoxylin-Eosin stained images. While the first classifier separates glands from background, the second classifier identifies gland-separating structures. In a subsequent step, a figure-ground segmentation based on weighted total variation produces the final segmentation result by regularizing the CNN predictions. We present both quantitative and qualitative segmentation results on the recently released and publicly available Warwick-QU colon adenocarcinoma dataset associated with the GlaS@MICCAI2015 challenge and compare our approach to the simultaneously developed other approaches that participated in the same challenge. On two test sets, we demonstrate our segmentation performance and show that we achieve a tissue classification accuracy of 98% and 95%, making use of the inherent capability of our system to distinguish between benign and malignant tissue. Our results show that deep learning approaches can yield highly accurate and reproducible results for biomedical image analysis, with the potential to significantly improve the quality and speed of medical diagnoses.

  17. Transoral surgery for basilar impression.

    PubMed

    Pásztor, E; Vajda, J; Piffkó, P; Horváth, M

    1980-12-01

    A patient with basilar impression presented with a progressive myelopathy due to odontoid invagination. It was thought that a posterior decompression would be hazardous; therefore, the inferior clivus, odontoid process, and anterior arch of the atlas were removed transorally. We have found that, even with symptoms of long duration, marked improvement can be expected when the operation is targeted to the actual abnormality. In such cases, analysis of craniocervical tomograms will show the direction of medullary compression and thus indicate the correct surgical approach.

  18. Craniovertebral junction lesions: our experience with the transoral surgical approach.

    PubMed

    Mouchaty, Homère; Perrini, Paolo; Conti, Renato; Di Lorenzo, Nicola

    2009-06-01

    The aim of this study is to review our experience with the transoral surgical management of anterior craniovertebral junction (CVJ) lesions with particular attention to the decision making and to the indication for a consecutive stabilization. During 10 years (1998-2007), 52 consecutive patients presenting exclusively fixed anterior compression at the cervicomedullary junction underwent transoral surgery. Mean age was 55.85 years (range 17-75 years). Encountered lesions were: malformation (32 cases), rheumatoid arthritis (11 cases), tumor (5 cases) or trauma (4 cases). A total of 79% of patients presented with chronic/recurrent headache (cranial and/or high-cervical pain), 73% with varying degrees of quadrip aresis, and 29% with lower cranial nerve deficits. All of the patients but two, with posterior stabilization performed elsewhere, underwent synchronous anterior decompression and posterior occipitocervical fixation. Adjuncts to the transoral approach (Le Fort I with or without splitting of the palate), tailored to the local anatomy and to the extension of the lesions, were performed in seven cases. Follow-up ranged between 4 and 96 months. Of 35 patients with severe preoperative neurological deficits, 33 improved. The remaining 15 patients who presented with mild symptoms, healed throughout the follow-up. Perioperative mortality occurred in two cases and surgical morbidity in eight cases (dural laceration, cerebrospinal fluid leak with meningitis, malocclusion, oral wound dehiscence and occipital wound infection). Delayed instability occurred in one patient because of cranial settling of C2 vertebral body. A successful surgery achieving a stable decompression at the CVJ is an expertise demanding procedure. It requires accurate preoperative evaluation and, appropriate choice of decompression technique and stabilization instruments. Enlarged transoral approaches (despite higher morbidity) are a supportive means in cases of severe basilar invagination, cranial

  19. Evidence-based management of the thyroid gland during a total laryngectomy.

    PubMed

    Gorphe, Philippe; Ben Lakhdar, Aïcha; Tao, Yungan; Breuskin, Ingrid; Janot, François; Temam, Stéphane

    2015-10-01

    To propose an original experience-based reference framework for the management of the thyroid gland during a total laryngectomy in our institution. The steps were based on 1) the incidence and patterns of thyroid gland invasion (TGI), 2) preoperative and pathologic factors associated with TGI, and 3) the relationship between TGI and oncologic efficacy endpoints after treatment. Retrospective cohort study. We reviewed the records of 182 patients who had undergone a total laryngectomy with a total thyroidectomy or loboisthmectomy in our center. Among 23 patients (12.6%), the thyroid gland was directly invaded by disease in 22 and by metastasis in one. Subglottic primary site was the only preoperative factor associated (P =.03). TGI was associated with pathological signs of anterior extralaryngeal invasive disease (thyroid cartilage transfixion, P = .002; cricothyroid membrane invasion, P < .0001; and prelaryngeal soft tissue infiltration, P < .0001) and ipsilateral VIb lymph node metastasis (P = .004). As expected, disease-free survival was significantly lower in patients with TGI (P = .04) and peristomal control was significantly reduced in patients with TGI (P = .038). To our knowledge, this is the largest monocentric series of TGI specimens after a total laryngectomy for laryngeal neoplasms described to date. Focus must be placed on anteroinferior spread, which is likely to invade the cricothyroid membrane, because TGI is part of the extension of extralaryngeal cancer. We propose original experience-based management of thyroid management during a total laryngectomy to improve the level of accuracy of decision making during the surgical procedure whenever possible. 4 © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

  20. [Pediatric plunging ranula and its surgery with transoral approach: a case report].

    PubMed

    Eyibilen, Ahmet; Aladağ, Ibrahim; Güven, Mehmet

    2009-01-01

    The plunging ranula is an uncommon condition which presents itself as a fluctuating swelling in the neck. It is less frequent during childhood. The ranula, which is usually originated from sublingual gland, is called the plunging ranula when it affects the submandibulary space and adjacent structures in the neck. There are a lot of different methods used in surgical treatment. In this study, we present a plunging ranula case which was performed by excision of the pseudocyst and ipsilateral sublingual gland with transoral approach in a five-year-old girl. There has been no recurrence in four-year follow-up period.

  1. Transoral endoscopic thyroidectomy via vestibular approach: operative steps and video

    PubMed Central

    Bacuzzi, Alessandro; Lavazza, Matteo; Inversini, Davide; Pappalardo, Vincenzo; Boni, Luigi; Rausei, Stefano; Barczynski, Marcin; Tufano, Ralph P.; Kim, Hoon Yub; Anuwong, Angkoon

    2016-01-01

    In this video we describe transoral endoscopic thyroidectomy vestibular approach (TOETVA). Inclusion criteria are (I) patients who had a ultrasonographically (US) estimated thyroid diameter not larger than 10 cm; (II) US estimated gland volume ≤45 mL; (III) nodule size ≤50 mm; (IV) a benign tumor, such as a thyroid cyst, single-nodular goiter, or multinodular goiter; (V) follicular neoplasm; (VI) papillary microcarcinoma without evidence of metastasis. The procedure is carried out through three-port technique placed at the oral vestibule, one 10-mm port for 30° endoscope and two additional 5-mm ports for dissecting and coagulating instruments. CO2 insufflation pressure is set at 6 mmHg. An anterior cervical subplatysmal space is created from the oral vestibule down to the sternal notch, laterally to the sterncleidomuscles. Thyroidectomy is done fully endoscopically using conventional endoscopic instruments and intraoperative neuromonitoring (IONM). PMID:28149809

  2. Total and Putative Surface Proteomics of Malaria Parasite Salivary Gland Sporozoites*

    PubMed Central

    Lindner, Scott E.; Swearingen, Kristian E.; Harupa, Anke; Vaughan, Ashley M.; Sinnis, Photini; Moritz, Robert L.; Kappe, Stefan H. I.

    2013-01-01

    Malaria infections of mammals are initiated by the transmission of Plasmodium salivary gland sporozoites during an Anopheles mosquito vector bite. Sporozoites make their way through the skin and eventually to the liver, where they infect hepatocytes. Blocking this initial stage of infection is a promising malaria vaccine strategy. Therefore, comprehensively elucidating the protein composition of sporozoites will be invaluable in identifying novel targets for blocking infection. Previous efforts to identify the proteins expressed in Plasmodium mosquito stages were hampered by the technical difficulty of separating the parasite from its vector; without effective purifications, the large majority of proteins identified were of vector origin. Here we describe the proteomic profiling of highly purified salivary gland sporozoites from two Plasmodium species: human-infective Plasmodium falciparum and rodent-infective Plasmodium yoelii. The combination of improved sample purification and high mass accuracy mass spectrometry has facilitated the most complete proteome coverage to date for a pre-erythrocytic stage of the parasite. A total of 1991 P. falciparum sporozoite proteins and 1876 P. yoelii sporozoite proteins were identified, with >86% identified with high sequence coverage. The proteomic data were used to confirm the presence of components of three features critical for sporozoite infection of the mammalian host: the sporozoite motility and invasion apparatus (glideosome), sporozoite signaling pathways, and the contents of the apical secretory organelles. Furthermore, chemical labeling and identification of proteins on live sporozoites revealed previously uncharacterized complexity of the putative sporozoite surface-exposed proteome. Taken together, the data constitute the most comprehensive analysis to date of the protein expression of salivary gland sporozoites and reveal novel potential surface-exposed proteins that might be valuable targets for antibody blockage

  3. A virtual reality model of the clivus and surgical simulation via transoral or transnasal route

    PubMed Central

    Wang, Shou-Sen; Li, Jun-Feng; Zhang, Shang-Ming; Jing, Jun-Jie; Xue, Liang

    2014-01-01

    Background: Neurosurgery in areas with restricted space and complicated anatomy can be greatly aided by the virtual reality (VR) technique. The clivus represents one of such challenging surgical areas, but its VR has not been established. The present study aimed to document a VR model of clival anatomy that may be useful in clival surgery. Methods: High resolution CT angiography and MRI were used. The study included a total of 20 patients who did not have any obvious abnormalities detected in the oral, nasal, and clival areas. The images were fused with a Dextroscope. Results: In the VR model, the key structures such as the clival bone, basilar artery, brainstem, pituitary gland, and paranasal sinuses were clearly observed. The morphology of the clivus and its spatial relationships with the neighboring structures were also illustrated. Visualization of the clival model can be made flexible from various planes, angles, or orientations. In addition, surgical access to the clivus via the transoral route or transnasal route was simulated in detail. Conclusion: The simulation of the VR model offers a straightforward, three-dimensional, interactive understanding of the size and shape of the clivus, and its relationships with the surrounding blood vessels and bones. It also demonstrates simulated operational procedures such as opening the surgical window, measuring the exposure distance and angles, and determining the critical boundaries in relation to key structures such as the brainstem and arteries. Digitalized VR modeling appears to be helpful for understanding the anatomy of the clivus and its surgical approaches. PMID:25419358

  4. A virtual reality model of the clivus and surgical simulation via transoral or transnasal route.

    PubMed

    Wang, Shou-Sen; Li, Jun-Feng; Zhang, Shang-Ming; Jing, Jun-Jie; Xue, Liang

    2014-01-01

    Neurosurgery in areas with restricted space and complicated anatomy can be greatly aided by the virtual reality (VR) technique. The clivus represents one of such challenging surgical areas, but its VR has not been established. The present study aimed to document a VR model of clival anatomy that may be useful in clival surgery. High resolution CT angiography and MRI were used. The study included a total of 20 patients who did not have any obvious abnormalities detected in the oral, nasal, and clival areas. The images were fused with a Dextroscope. In the VR model, the key structures such as the clival bone, basilar artery, brainstem, pituitary gland, and paranasal sinuses were clearly observed. The morphology of the clivus and its spatial relationships with the neighboring structures were also illustrated. Visualization of the clival model can be made flexible from various planes, angles, or orientations. In addition, surgical access to the clivus via the transoral route or transnasal route was simulated in detail. The simulation of the VR model offers a straightforward, three-dimensional, interactive understanding of the size and shape of the clivus, and its relationships with the surrounding blood vessels and bones. It also demonstrates simulated operational procedures such as opening the surgical window, measuring the exposure distance and angles, and determining the critical boundaries in relation to key structures such as the brainstem and arteries. Digitalized VR modeling appears to be helpful for understanding the anatomy of the clivus and its surgical approaches.

  5. Transoral endoscopic thyroidectomy via the trivestibular route

    PubMed Central

    Kim, Mi-Ra; Kim, Do Hun; Lee, Dong Kun

    2016-01-01

    We recently experienced a case of transoral endoscopic thyroidectomy via the trivestibular approach. We identified and preserved all neighboring critical structures during surgery. The patient was discharged on postoperative day 3. There were no complications in thyroid function, vocal cord function, or lower lip sense. Transoral endoscopic thyroidectomy via a trivestibular approach provides a short and direct route to the thyroid and an adequate workspace without a skin incision. Therefore, it is worthwhile to develop and refine the surgical techniques of this promising new surgical approach. PMID:27847801

  6. Transoral parathyroid surgery--a new alternative or nonsense?

    PubMed

    Karakas, Elias; Steinfeldt, Thorsten; Gockel, Andreas; Mangalo, Anton; Sesterhenn, Andreas; Bartsch, Detlef K

    2014-08-01

    In recent years, several endoscopic techniques have been explored in thyroid and parathyroid surgery, but only few gained acceptance among patients and surgeons. Based on extensive human cadaver and animal studies, we developed a technique for transoral partial parathyroidectomy (TOPP), which was performed for the first time in a patient with primary hyperparathyroidism (pHPT). We now report on results and the acceptance of this new technique 2 years after its implementation. A pilot study was initiated to recruit a total of 10 patients with benign sporadic pHPT and a preoperatively localized parathyroid adenoma eligible for initial parathyroidectomy. The study protocol was approved by the ethics committee, and an insurance for unforeseen complications and risks was procured. Data of all patients evaluated and operated were prospectively collected, and follow-up examinations were carried out for 19 months on average, which included clinical examinations; ultrasonography; Ear, Nose, and Throat (ENT) investigations; and blood testing. Between January 2010 and May 2012, 75 patients with pHPT and a preoperative localized parathyroid adenoma were eligible for TOPP. After detailed information about the transoral procedure, only five (7 %) female patients consent to undergo TOPP. In three patients, a parathyroid adenoma could be removed via the transoral access, In two patients, the procedure had to be converted to the conventional technique. Median time until resection of a parathyroid adenoma was 122 min (range, 45-175). One patient had a transient recurrent laryngeal nerve palsy, while one patient suffered from a transient palsy of the right hypoglossal nerve and a slight but persisting dysgeusia. Three patients developed a hematoma of the mouth floor and swallowing problems. In four patients, the visual analog scale (VAS) pain score was high (>7) within the first 2 postoperative days. Although TOPP is feasible, it is poorly accepted by patients and its complication

  7. Parathyroid gland autotransplantation after total thyroidectomy in surgical management of hypopharyngeal and laryngeal carcinomas: A case series.

    PubMed

    Abd Elmaksoud, Abd Elmaksoud M; Farahat, Iman G; Kamel, Mahmoud M

    2015-06-01

    Total thyroidectomy is indicated in most cases with postcricoid carcinoma, circumferential hypopharyngeal carcinoma and in advanced laryngeal carcinoma. Persistent hypoparathyroidism is a frequent complication after total thyroidectomy which is difficult to manage unlike hypothyroidism. This study was to assess the feasibility of parathyroid gland autotranplantation after total thyroidectomy in advanced carcinomas and their effectiveness in preventing persistent hypoparathyroidism. This study included 26 patients with hypopharyngeal and laryngeal carcinoma presented to National Cancer Institute, Cairo University. Total thyroidectomy and total parathyroid gland excision were performed as a part of adequate oncologic surgical procedure. The parathyroid glands were identified, resected and stored in iced saline. Histological confirmation was necessary before implantation into separated muscle pockets in the anterior forearm muscles. Regular samples were drawn to assess serum parathormone and calcium levels. All patients experienced hypocalcaemia within 1-5 days after operation. Only one patient experienced parathyroid graft failure while the remaining patients were normocalcemic during follow up after surgery, indicating functioning parathyroid grafts. Parathyroid gland autotranplantation is a simple safe technique with high success rate in preventing persistent hypoparathyroidism after total thyroidectomy in surgical management of advanced hypopharyngeal and laryngeal carcinomas.

  8. Hemorrhage after transoral robotic-assisted surgery.

    PubMed

    Asher, Scott A; White, Hilliary N; Kejner, Alexandra E; Rosenthal, Eben L; Carroll, William R; Magnuson, J Scott

    2013-07-01

    An increasing number of head and neck surgeons have begun using transoral robotic-assisted surgery. Our objective was to examine the postoperative bleeding complications we have encountered to determine risk factors and to discuss the topic of hemorrhage control. Case series with chart review. Medical records were reviewed in 147 consecutive patients undergoing transoral robotic-assisted surgery for any indication at one tertiary academic medical center between March 2007 and September 2011. Eleven of 147 (7.5%) patients undergoing transoral robotic-assisted surgery experienced some degree of postoperative hemorrhage, with 9 patients requiring reoperation for examination and/or control of bleeding. Bleeding occurred at a mean of 11.1 ± 9.2 days after initial operation. Eight of 11 (72%) patients who bled were on antithrombotic medication (anticoagulants or antiplatelet agents) for other medical comorbidities. The postoperative hemorrhage rate in patients taking antithrombotic medication (8/48 patients = 17%) was significantly higher than in those not taking antithrombotics (3/99 patients = 3%), P = .0057. While the bleeding rate in salvage surgery (3/29 = 10.3%) was slightly higher than in primary surgery (8/118 = 6.8%), this difference did not reach statistical significance. Potential for postoperative bleeding in association with antithrombotic medications in patients undergoing transoral robotic-assisted surgery should be recognized. Various effective techniques for management of these patients without robotic assistance were demonstrated.

  9. Transoral approach to the craniovertebral junction.

    PubMed

    Landeiro, José Alberto; Boechat, Sávio; Christoph, Daniel de Holanda; Gonçalves, Mariângela Barbi; Castro, Igor de; Lapenta, Mario Alberto; Ribeiro, Carlos Henrique

    2007-12-01

    The transoral approach provides a safe exposure to lesions in the midline and the ventral side of the craniovertebral junction. The advantages of the transoral approach are 1) the impinging bony pathology and granulation tissue are accessible only via the ventral route; 2) the head is placed in the extended position, thus decreasing the angulation of the brainstem during the surgery; and 3) surgery is done through the avascular median pharyngeal raphe and clivus. We analyzed the clinical effects of odontoidectomy after treating 38 patients with basilar invagination. The anterior transoral operation to treat irreducible ventral compression in patients with basilar invagination was performed in 38 patients. The patients ages ranged from 34 to 67 years. Fourteen patients had associated Chiari malformation and eight had previously undergone posterior decompressive surgery. The main indication for surgery was significant neurological deterioration. Symptoms and signs included neck pain, myelopathy, lower cranial nerve dysfunction, nystagmus and gait disturbance. Extended exposure was performed in 24 patients. The surgery was beneficial to the majority of patients. There was one death within 10 days of surgery, due to pulmonary embolism. Postoperative complications included two cases of pneumonia, three cases of oronasal fistula with regurgitation and one cerebrospinal fluid leak. In patients with marked ventral compression, the transoral approach provides direct access to the anterior face of the craniovertebral junction and effective means for odontoidectomy.

  10. Secretory capacity of the parathyroid glands after total thyroidectomy in normocalcemic subjects.

    PubMed

    Anastasiou, Olympia E; Yavropoulou, Maria P; Papavramidis, Theodosis S; Tzouvara, Chrysoula; Triantafyllopoulou, Konstantina; Papavramidis, Spiros; Yovos, John G

    2012-07-01

    Hypocalcemia, transient or permanent, represents a common complication after total thyroidectomy, but data on the secretory capacity of the parathyroid glands in thyroidectomized patients without clinical or biochemical hypocalcemia are limited. To address this issue, we studied the parathyroid response to acute hypocalcemia induced by iv infusion of sodium bicarbonate in normocalcemic patients submitted to total thyroidectomy at the early postoperative period and 3 months later. Sixty patients who underwent total thyroidectomy for benign thyroid disease and did not develop clinical or biochemical hypocalcemia and hypoparathyroidism postoperatively and 50 healthy volunteers were included in the study. Patients (at 48 h and 3 months after surgery) and controls (after overnight fast) were subjected to a sodium bicarbonate infusion test. In healthy volunteers plasma intact PTH increased significantly at 3 min after infusion (4.42 ± 0.15 ng/ml vs. 11.22 ± 0.5 ng/ml, P < 0.001) and gradually returned to baseline values. In the thyroidectomized patients, mean PTH levels were also increased after sodium bicarbonate infusion but to a significantly lesser degree compared with healthy controls (1.77 mean fold increase vs. 2.57 mean fold increase, respectively, P < 0.001). Using as criterion the lowest fold increase of plasma PTH levels at 3 min after infusion observed in healthy volunteers, 38% of the thyroidectomized patients at 48 h after surgery and 6.6% of the patients at 3 months after surgery demonstrated a diminished PTH response to acute hypocalcemia induced by sodium bicarbonate infusion. In thyroidectomized patients, normal postoperative calcium and PTH values do not exclude a reduced secretory response of the parathyroids to hypocalcemic stimuli.

  11. Pediatric transoral robotic surgery for oropharyngeal malignancy: a case report.

    PubMed

    Wine, Todd M; Duvvuri, Umamaheswar; Maurer, Scott H; Mehta, Deepak K

    2013-07-01

    The treatment of oropharyngeal malignancy is associated with numerous functional morbidities. Transoral robotic surgery has been used with increased frequency in adult oropharyngeal malignancy. The benefits include decreased surgical morbidity and improved functional outcomes. Use of transoral robotic has been limited in children. This case represents our experience with a 17-month old child who was diagnosed with a high-grade undifferentiated sarcoma of the soft palate. She was able to be successfully treated with transoral robotic surgery as a part of her multimodal therapy, representing the first case of transoral robotic surgery for an oropharyngeal malignancy in a young child. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  12. Indocyanine green fluorescence angiography for quantitative evaluation of in situ parathyroid gland perfusion and function after total thyroidectomy.

    PubMed

    Lang, Brian Hung-Hin; Wong, Carlos K H; Hung, Hing Tsun; Wong, Kai Pun; Mak, Ka Lun; Au, Kin Bun

    2017-01-01

    Because the fluorescent light intensity on an indocyanine green fluorescence angiography reflects the blood perfusion within a focused area, the fluorescent light intensity in the remaining in situ parathyroid glands may predict postoperative hypocalcemia risk after total thyroidectomy. Seventy patients underwent intraoperative indocyanine green fluorescence angiography after total thyroidectomy. Any parathyroid glands with a vascular pedicle was left in situ while any parathyroid glands without pedicle or inadvertently removed was autotransplanted. After total thyroidectomy, an intravenous 2.5 mg indocyanine green fluorescence angiography was given and real-time fluorescent images of the thyroid bed were recorded using the SPY imaging system (Novadaq, Ontario, Canada). The fluorescent light intensity of each indocyanine green fluorescence angiography as well as the average and greatest fluorescent light intensity in each patient were calculated. Postoperative hypocalcemia was defined as adjusted calcium <2.00 mmol/L within 24 hours. The fluorescent light intensity between discolored and normal-looking indocyanine green fluorescence angiographies was similar (P = .479). No patients with a greatest fluorescent light intensity >150% developed postoperative hypocalcemia while 9 (81.8%) patients with a greatest fluorescent light intensity ≤150% did. Similarly, no patients with an average fluorescent light intensity >109% developed PH while 9 (30%) with an average fluorescent light intensity ≤109% did. The greatest fluorescent light intensity was more predictive than day-0 postoperative hypocalcemia (P = .027) and % PTH drop day-0 to 1 (P < .001). Indocyanine green fluorescence angiography is a promising operative adjunct in determining residual parathyroid glands function and predicting postoperative hypocalcemia risk after total thyroidectomy. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. The relationship between total mass and blood supply of parathyroid glands and their secretion of parathyroid hormone in hemodialysis patients with secondary hyperparathyroidism.

    PubMed

    Ahmadi, Farrokhlagha; Aghajanzadeh, Pegah; Yazdi, Hadi Rokni; Maziar, Sima; Gatmiri, Sayad Mansour

    2016-03-01

    Characteristics of parathyroid glands usually determined by ultrasonography such as its total weight or volume might be a good indicator for the induction or suppression of parathyroid hormone (PTH) secretion from these glands. In the present study, we investigated the relationship between the volume and blood supply grade of the parathyroid glands, and its PTH secretion. Study subjects included 52 consecutive patients with the secondary hyperparathyroidism undergoing maintenance hemodialysis therapy referred to dialysis wards of the Imam Khomeini and Amiralam University Hospitals in Tehran. Serum intact PTH (i-PTH) was measured by an ELISA assay. The parathyroid glands characteristics were identified by ultrasonography that was performed simultaneously with blood collection. Parathyroid blood flows were evaluated by power-Doppler color imaging. There was no significant correlation between the total mass of the glands and serum concentration of i-PTH. No significant correlations were also observed between both total central and peripheral parathyroid glands blood flow and serum i-PTH level. Dialysis duration and serum alkaline phosphatase were significantly correlated in a positive manner with i-PTH level. Furthermore, serum level of i-PTH was not correlated with the total signals of glands blood flow in a multivariable linear regression analysis. Serum secreted i-PTH level might not be predictable by a total mass of parathyroid glands as well as their blood supply.

  14. Direct Transoral Approach to C2 for Percutaneous Vertebroplasty

    SciTech Connect

    Martin, Jean-Baptiste; Gailloud, Philippe; Dietrich, Pierre-Yves; Luciani, Marc E.; Somon, Thierry; Sappino, Pascal-Andre; Ruefenach, Daniel A.

    2002-12-15

    Percutaneous vertebroplasty was performed via a transoral route in a 70-year-old woman with a C2 metastasis of thyroid origin involving anterior vertebral elements. Complete pain relief was obtained after an uncomplicated minimally invasive procedure. This preliminary experience demonstrates that a transoral approach under fluoroscopic control can provide safe access to the upper cervical spine at C2 level.

  15. Identification and preservation of the parathyroid gland during total thyroidectomy in dogs with bilateral thyroid carcinoma: a report of six cases.

    PubMed

    Fukui, Sho; Endo, Yoshifumi; Hirayama, Kazuko; Taniyama, Hiroyuki; Kadosawa, Tsuyoshi

    2015-06-01

    Simultaneous removal of bilateral thyroid tumors was performed while preserving the parathyroid gland in six dogs. At least one external parathyroid gland was identified in all dogs. In five cases, the external parathyroid gland and its blood supply were preserved intact. In one dog, the vessels supplying the external parathyroid gland had been invaded by the tumor, and the gland was thus removed and reimplanted into the sternohyoid muscle. That dog required postoperative treatment with oral calcium gluconate and vitamin D3. Local tumor recurrence was not observed in any of the cases. The mean survival time was 920 days. We found that the external parathyroid gland could be identified and preserved in most dogs undergoing total thyroidectomy.

  16. Primary hyperparathyroidism treated by transoral endoscopic parathyroidectomy vestibular approach (TOEPVA).

    PubMed

    Sasanakietkul, Thanyawat; Carling, Tobias

    2017-04-13

    Bilateral open cervical exploration with identifying all parathyroid glands and removing one or more enlarged parathyroid tumor(s) was the standard of care in primary hyperparathyroidism (pHPT). With the introduction of preoperative imaging and intraoperative parathyroid hormone (IOPTH) measurements [1, 2], various minimally invasive parathyroidectomy approaches have been developed, both open and endoscopic [3-8]. The most commonly used approach currently in the USA is the minimally invasive open parathyroidectomy (MIP), which can be performed in the ambulatory setting with excellent cure and minimal complication rates [9-12]. However, the operation requires a cervical incision, with occasionally poor cosmesis. The transoral endoscopic parathyroidectomy vestibular approach (TOEPVA) provides a novel "scarless" approach to parathyroid surgery. The aim of the video is to provide detailed instruction of the TOEPVA in pHPT and how to interpret IOPTH measurements in this setting. The TOEPVA uses three incisions in the vestibule of the oral cavity, using two 5-mm ports and one central 11-mm port. The subplatysmal space is enlarged by hydrodissection and manual dilation. The working space is enhanced by insufflation to 6 mmHg. With the adjunct of preoperative imaging and IOPTH measurements, the extent of the operation is tailored to achieve biochemical cure. TOEPVA is feasible and safe and provides an excellent cosmetic outcome. It is a more direct approach than other remote endoscopic parathyroidectomy techniques. TOEPVA is an excellent option for select patients with pHPT wishing to avoid a neck incision.

  17. Total salivary gland proteins of female Culex pipiens and Aedes caspius (Diptera: Culicidae) and their fractionation during adult development and after blood sucking.

    PubMed

    Soliman, M A; Abdel-Hamid, M E; Mansour, M M; Seif, A I; Kamel, K I; el Hamshary, E M

    1999-08-01

    Salivary glands of Culex pipiens and Aedes caspius were analyzed to determine total protein content and its fractionation during adult female development and after blood sucking. In both species, the molecular weight of proteins ranged between 26.000 and 84.000 Daltons. These proteins were not identical in the two species. In Cx. pipiens, the total protein level increased during the first 3 days of adult development from 4.94 +/- 0.84 to 6.6 +/- 0.37 micrograms/gland. During this period, the salivary gland proteins were separated into 35, 34 and 37 fractions respectively. Cx. pipiens released in the human host 64% of the total proteins while taking a blood meal compared to unfed females. This decrease in protein level was proportional to protein fractions. Over the next 6 days, the protein level increased again to attain values comparable to those obtained prior to blood sucking. In Ae. caspius, the total protein level of the salivary glands did not change during the first 4 days of adult development (range between 3.13 +/- 0.27 and 3.91 +/- 0.36 micrograms gland), but on the fifth day, 2-fold increase was observed. The total salivary gland protein increased during the next 3 days after blood sucking to reach 15.5 +/- 0.98 micrograms/gland. During this period, a tremendous change in protein patterns was observed. After oviposition, on the fourth day, a significant reduction in the total protein level was observed (4.13 +/- 0.56 micrograms/gland), but over the next 3 days the level increased again (range between 4.13 +/- 0.66 and 7.13 +/- 0.66 micrograms/gland).

  18. Transoral Fully Robotic Dissection of a Parapharyngeal Hemangioma.

    PubMed

    Granell, Jose; Alonso, Ana; Garrido, Laura; Gutierrez-Fonseca, Raimundo

    2016-10-01

    Soft tissue robotics found its trigger for success in minimally invasive surgery. The minimization of the surgical damage is more obvious as the surgical alternative is more aggressive. In head and neck surgery, potential sequelae are both functional and cosmetic. Robotic instrumentation might allow for further development of the transoral approach to the deep regions of the face.The authors present an uneventful, fully robotic, transoral surgical excision of a parapharyngeal hemangioma. The authors discuss management alternatives, surgical risks, and safety measures. The medial approach is the natural choice, provided it is safe and technically feasible. Transoral robotic surgery could be a reasonable minimally invasive approach for selected parapharyngeal tumors.

  19. [Increased bone mineral density in patients with tertiary hyperparathyroidism after total parathyroidectomy and autotransplantation of the parathyroid gland].

    PubMed

    Robin-Lersundi, Alvaro; Sánchez-Pernaute, Andrés; Ochagavía Cámara, Santiago; Díez-Valladares, Luis; Torres García, Antonio

    2012-01-01

    Changes in bone metabolism and bone mineral density are observed in renal transplant patients with tertiary hyperparathyroidism. The objective of this work was to analyse the increase in bone mineral density, as well the laboratory results, after total parathyroidectomy and autotransplantation in renal transplant patients with tertiary hyperparathyroidism. A retrospective study was conducted in which the bone mineral density values at femoral and lumbar level were analysed, together with the serum levels of calcium, phosphorous, parathyroid hormone (PTH), and alkaline phosphatase in 13 renal transplant patients with tertiary hyperparathyroidism before and after total parathyroidectomy and autotransplantation of the parathyroid glands. Parathyroidectomy is associated with an increase in bone mineral density at femoral and lumbar level, with an increase of 8.6 ± 6.7% at lumbar level, and 4 ± 16.1% at femoral level. The decrease in calcium after the parathyroidectomy was 2.8 mg/dL (95% CI; 1.9-4). The decrease in PTH was 172 pg/mL (95% CI; 98-354) and the decrease in alkaline phosphatase was 229 U/L (95% CI; 70-371). Total parathyroidectomy and autotransplantation of the parathyroid glands in renal transplant patients with tertiary hyperparathyroidism increases the bone mineral density. Furthermore, the calcium, PTH and alkaline phosphatase returned to normal in the long-term. Copyright © 2011 AEC. Published by Elsevier Espana. All rights reserved.

  20. Percutaneous radiologically guided gastrostomy tube placement: comparison of antegrade transoral and retrograde transabdominal approaches

    PubMed Central

    Haber, Zachary M.; Charles, Hearns W.; Gross, Jonathan S.; Pflager, Daniel; Deipolyi, Amy R.

    2017-01-01

    PURPOSE We aimed to compare the antegrade transoral and the retrograde transabdominal approaches for fluoroscopy-guided percutaneous gastrostomy tube (G-tube) placement. METHODS Following institutional review board approval, all G-tubes at two academic hospitals (January 2014 to May 2015) were reviewed retrospectively. Retrograde approach was used at Hospital 1 and both antegrade and retrograde approaches were used at Hospital 2. Chart review determined type of anesthesia used during placement, dose of radiation used, fluoroscopy time, procedure time, medical history, and complications. RESULTS A total of 149 patients (64 women, 85 men; mean age, 64.4±1.3 years) underwent G-tube placement, including 93 (62%) placed via the retrograde transabdominal approach and 56 (38%) placed via the antegrade transoral approach. Retrograde placement entailed fewer anesthesiology consultations (P < 0.001), less overall procedure time (P = 0.023), and less fluoroscopy time (P < 0.001). A comparison of approaches for placement within the same hospital demonstrated that the retrograde approach led to significantly reduced radiation dose (P = 0.022). There were no differences in minor complication rates (13%–19%; P = 0.430), or major complication rates (6%–7%; P = 0.871) between the two techniques. CONCLUSION G-tube placement using the retrograde transabdominal approach is associated with less fluoroscopy time, procedure time, radiation exposure, and need for anesthesiology consultation with similar safety profile compared with the antegrade transoral approach. Additionally, it is hypothesized that decreased procedure time and anesthesiology consultation using the transoral approach are likely associated with reduced cost. PMID:27911264

  1. Transoral robotic approach to parapharyngeal space tumors: Case series and technical limitations.

    PubMed

    Boyce, Brian J; Curry, Joseph M; Luginbuhl, Adam; Cognetti, David M

    2016-08-01

    The transoral robotic approach to parapharyngeal space (PPS) tumors is a new technique with limited data available on its feasibility, safety, and efficacy. We analyzed our experience with transoral robotic excisions of PPS tumors to evaluate the safety and efficacy of this technique. Retrospective chart analysis at tertiary academic medical center. From July 2010 to June 2014, 17 patients who had transoral robotic excision of PPS tumors were included in the study. Our cohort had an average age of 61.6 years and was 52.9% male. All patients had successful removal of their PPS tumors, and the average size of the tumors was 27.3 cm(3) (range 2-80 cm(3) ). Two cases (11.7%) required a cervical incision to assist with tumor removal. The average total operative time was 140.5 minutes. Two PPS PAs had focal areas of capsule rupture and one was fragmented. The average length of stay was 1.8 days (range 1-7 days), and all patients were discharged on an oral diet. Three patients experienced complications. There was no clinical or radiographic evidence of recurrence. This is the largest single-institution case series of transoral robotic approaches to PPS tumors. We demonstrate that this approach is feasible and safe but also note limitations of the robotic approaches for tumors on the far lateral and superior areas of the PPS, which required transcervical assistance. There were no patients who demonstrated recurrent tumor either radiographically or clinically. 4. Laryngoscope, 126:1776-1782, 2016. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

  2. Limits of the Transoral Approach in Craniospinal Malformations

    PubMed Central

    Laborde, G.; Gilsbach, J.; Bertalanffy, H.; Harders, A.; Hardenack, M.

    1992-01-01

    Over a 15-year period, 15 patients with craniospinal malformations were operated on using the transoral route. Ten patients had basilar impression and five had atlantoaxial dislocation; nine patients had associated lesions. Patients treated with reposition and dorsal fusion recovered well without ventral decompression. We found that transoral odontoidectomy is suitable as a primary decompressing measure only in ventral compression or nondislocated atlantoaxial conditions. ImagesFigure 1p8-b PMID:17170874

  3. The Spectrophotometric Sulfo-Phospho-Vanillin Assessment of Total Lipids in Human Meibomian Gland Secretions

    PubMed Central

    McMahon, Anne; Lu, Hua

    2013-01-01

    Human meibomian gland secretions (meibum) are the major lipid component of the human preocular tear film. The predominant lipid classes found in meibum include waxes (WE), cholesteryl esters (CE), and varying amounts of cholesterol (Chl). The classical sulfo-phospho-vanillin assay (SPVA), adapted for a microplate reader, was used to quantitate lipids in meibum. To account for varying reactivities of different lipids in SPVA, a model meibomian lipid mixture (MMx) that approximated the WE/CE/Chl composition of meibum was developed and used to quantitate meibomian lipids. The overall SPV responses of MMx and meibum were found to be close, with similar intermediate and final reaction products for both. Saturated WE that had not been expected to be reactive were found to be SPV-positive. A reaction mechanism for these compounds in SPVA which involves the formation of alkenyl ethers is proposed and discussed. Tested proteins were non-reactive in SPVA. Thus, by comparing the results of gravimetric analyses of meibum samples with the results of a properly calibrated SPVA, it was estimated that the SPV-reactive lipid content of dry meibum in tested samples was about 78 % (w/w). The SPV method can also be adopted for analyzing other types of complex lipids secretions, such as sebum, as well as whole lipid extracts from other lipid-enriched organs and tissues, if proper standards are chosen. PMID:23345137

  4. The spectrophotometric sulfo-phospho-vanillin assessment of total lipids in human meibomian gland secretions.

    PubMed

    McMahon, Anne; Lu, Hua; Butovich, Igor A

    2013-05-01

    Human meibomian gland secretions (meibum) are the major lipid component of the human preocular tear film. The predominant lipid classes found in meibum include waxes (WE), cholesteryl esters (CE), and varying amounts of cholesterol (Chl). The classical sulfo-phospho-vanillin assay (SPVA), adapted for a microplate reader, was used to quantitate lipids in meibum. To account for varying reactivities of different lipids in SPVA, a model meibomian lipid mixture (MMx) that approximated the WE/CE/Chl composition of meibum was developed and used to quantitate meibomian lipids. The overall SPV responses of MMx and meibum were found to be close, with similar intermediate and final reaction products for both. Saturated WE that had not been expected to be reactive were found to be SPV-positive. A reaction mechanism for these compounds in SPVA which involves the formation of alkenyl ethers is proposed and discussed. Tested proteins were non-reactive in SPVA. Thus, by comparing the results of gravimetric analyses of meibum samples with the results of a properly calibrated SPVA, it was estimated that the SPV-reactive lipid content of dry meibum in tested samples was about 78 % (w/w). The SPV method can also be adopted for analyzing other types of complex lipids secretions, such as sebum, as well as whole lipid extracts from other lipid-enriched organs and tissues, if proper standards are chosen.

  5. Transoral approach for epidural craniocervical pathological processes.

    PubMed

    Pásztor, E

    1985-01-01

    Transoral surgery for ventral craniocervical pathology is an integral part of modern neurosurgery. This approach should be considered in many more cases than in current practice. On the basis of our experiences with 15 operations in 13 patients we feel able to improve the surgical technique in some small details, as 1. the double, two flap incision of the posterior wall of the pharynx, 2. the method of "deep" resection of the odontoid in its high upward and backward position, and 3. insertion of bone grafts and chips in the cavity of tumorous vertebrae for fixation. Admittedly, these cases are not encountered every day in neurosurgical units. An exact knowledge of the anatomical, neurological, pathological, radiological and surgical details is of vital importance and constitutes the basis of this account. This method should not be confined to specialised regional neurosurgical centres, but is within the technical capacity of all trained neurosurgeons.

  6. [Lugol's solution and thyroid gland activity in cattle. Determination of the total thyroxine in blood plasma as a method for evaluating thyroid gland activity].

    PubMed

    Braun, U; Leidl, W

    1985-01-01

    The aim of the present investigations was to examine if an intrauterine treatment with Lugol's solution in cows influences the activity of the thyroid gland. The thyrotropin-stimulation test was used to evaluate the function of the thyroid gland. An injection of 10 I. U. thyreotropin induced within 3 hours an increase of the T4 blood concentrations which reached maximal values 9 hours after the treatment and thereafter decreased again. Thyreotropin concentrations increasing from 5 to 30 I. U. led to a dose-dependent increase of the T4 blood concentrations. The T4 values obtained by 40 i. U. thyreotropin were lower than that induced with 30 I. U. of the hormone. The T4 concentrations increased stronger and remained elevated longer in cows pretreated intrauterine with Lugol's solution than in untreated control cows. The experiments demonstrated that an intrauterine infusion of Lugol's solution may result in an increased activity of the thyroid gland.

  7. Treatment outcome of vocal cord leukoplakia by transoral laser microsurgery.

    PubMed

    Yang, Shih-Wei; Chao, Wei-Chieh; Lee, Yun-Shien; Chang, Liang-Che; Hsieh, Tsan-Yu; Chen, Tai-An; Luo, Cheng-Ming

    2017-01-01

    The aim of this study is to evaluate the treatment outcome and analyze the associated factors of postoperative recurrence in patients who received transoral laser microsurgery for vocal cord leukoplakia. The demographic, histopathological data were retrospectively reviewed and the factors associated with recurrence of vocal leukoplakia after surgery were analyzed statistically. A total of 44 patients, including 36 males and 8 females, with a mean age of 50.4 ± 13.4 years, were enrolled. All the patients received excision of the vocal leukoplakia by carbon dioxide laser (2-4 Watt, ultrapulse mode) under general anesthesia. No patients had malignant transformation after surgery. Postoperative recurrence occurred in 10 patients (22.7 %). Univariate analysis showed that patients who had the habit of cigarette smoking, alcohol drinking, and presence of gastroesophageal reflux disease tended to recur. Among these risk factors, presence of gastroesophageal reflux disease (odds ratio 8.43) was the independent prognostic factor for recurrence using multivariate logistic regression analysis. Carbon dioxide laser excision is effective for treating vocal leukoplakia that is still confined to dysplasia of any degree, with acceptable morbidity. This study suggests that the presence of gastroesophageal reflux disease is the prognostic indicator for postoperative recurrence of vocal leukoplakia. Aggressive treatment of reflux disease for those who have received surgical excision for vocal leukoplakia is indicated.

  8. Complications in CO2 Laser Transoral Microsurgery for Larynx Carcinomas

    PubMed Central

    Chiesa Estomba, Carlos Miguel; Reinoso, Frank Alberto Betances; Velasquez, Alejandra Osorio; Fernandez, Jose Luis Rodriguez; Conde, Jose Luis Fariña; Hidalgo, Carmelo Santidrian

    2015-01-01

    Introduction Transoral laser microsurgery (TLM) has established itself as an effective option in the management of malignant tumors of the glottis, supraglottis, and hypopharynx. Nonetheless, TLM is not a harmless technique. Complications such as bleeding, dyspnea, or ignition of the air may appear in this type of surgery. Objective The aim of this study is to describe the complications that occurred in a group of patients treated for glottic and supraglottic carcinomas in all stages by TLM. Methods This study is a retrospective analysis of patients diagnosed with squamous cell carcinoma of the glottis and supraglottis for all stages (T1, T2, T3, T4), N -/ + , M -/+ treated with TLM between January 2009 and March 2012 in a tertiary hospital. Results Ninety-eight patients met the inclusion criteria, which had undergone a total of 131 interventions. Ninety-four (95.9%) patients were male and 4 (4.1%) were female. The mean age was 64.2 years (± 10.7 years = min 45; max 88). The presence of intraoperative complications was low, affecting only 2% of patients. Immediate postoperative complications occurred in 6.1%, whereas delayed complications affected 13.2% of patients, without any of them being fatal. Conclusion TLM has shown good oncologic results and low complication rate compared with traditional open surgery during intervention, in the immediate and delayed postoperative period and in the long-term with respect to radiotherapy. PMID:27096020

  9. Transoral robotic-assisted laryngeal cleft repair in the pediatric patient.

    PubMed

    Leonardis, Rachel L; Duvvuri, Umamaheswar; Mehta, Deepak

    2014-09-01

    To assess the feasibility of performing robotic-assisted laryngeal cleft repair in the pediatric population. Retrospective chart review at a tertiary academic children's hospital. All patients underwent transoral robotic-assisted laryngeal cleft repair from March 2011 to June 2013. Demographics, robotic docking time, operative time, and postoperative course and swallowing function were collected and analyzed. Five children, three male and two female, underwent successful transoral robotic-assisted laryngeal cleft repair for closure of a type I laryngeal cleft. Mean age at time of surgery was 21.6 months (standard deviation 6.1 months; range, 15-29 months). From case 1 to case 5, robotic docking time (18-10 minutes), robotic operative time (102-36 minutes), and total operating room time (173-105 minutes) decreased. There were no complications with time until extubation (range, 2-3 days), length of intensive care unit stay (range, 3-4 days), and total hospital stay (range, 3-5 days) within acceptable range following laryngeal cleft repair. Modified barium swallow (two patients) or fiberoptic endoscopic evaluation of swallowing (three patients) was performed postoperatively, with all patients showing complete resolution of penetration and aspiration. In addition, all patients experienced subjective resolution of dysphagia and/or choking with feeds postoperatively. Transoral robotic-assisted laryngeal cleft repair may offer specific advantages over a traditional endoscopic approach. In our experience, the procedure was well tolerated and associated with definitive surgical cure in all patients. The scope of robotic technology continually expands and should be considered a feasible tool at an institution-based level. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

  10. Endoscopic transoral surgery for craniovertebral junction anomalies. Technical note.

    PubMed

    Husain, Mazhar; Rastogi, Manu; Ojha, Bal Krishna; Chandra, Anil; Jha, Deepak K

    2006-10-01

    Craniovertebral junction (CVJ) anomalies continue to be challenging for neurosurgeons because of the complex anatomy of this region. To date, microsurgical decompression via a transoral route is the standard treatment for anteriorly located compressive lesions of the cervicomedullary junction (CMJ). The results obtained by minimizing surgical trauma are fewer complications, shorter hospital stays, and reduced overall psychological burden. Endoscopic surgery is becoming a leading modality in minimally invasive neurosurgical treatment. The authors performed surgery in 11 patients with irreducible osseous dislocations resulting from CVJ abnormality during a 2-year period. Anterior CMJ decompression was achieved in all patients by performing neuroendoscopically controlled transoral excision of bone and soft tissues. The surgical technique and results will be discussed. The use of the endoscope offers several advantages in cases requiring a transoral approach to the lower clivus and atlantoaxial region. The use of minimally invasive endoscopic techniques has the potential to reduce the need for a wider cranial base opening and to decrease postoperative complications.

  11. Endoscopic Transoral Resection of an Axial Chordoma: A Case Report.

    PubMed

    Taran, S; Yusof, A H; Yusof, M I

    2015-11-01

    Upper cervical chordoma (UCC) is rare condition and poses unique challenges to surgeons. Even though transoral approach is commonly employed, a minimally invasive technique has not been established. We report a 44-year old Malay lady who presented with a 1 month history of insidious onset of progressive neck pain without neurological symptoms. She was diagnosed to have an axial (C2) chordoma. Intralesional resection of the tumour was performed transorally using the Destandau endoscopic system (Storz, Germany). Satisfactory intralesional excision of the tumour was achieved. She had a posterior fixation of C1-C4 prior to that. Her symptoms improved postoperatively and there were no complications noted. She underwent adjuvant radiotherapy to minimize local recurrence. Endoscopic excision of UCC via the transoral approach is a safe option as it provides an excellent magnified view and ease of resection while minimizing the operative morbidity.

  12. Transoral treatment strategies for head and neck tumors

    PubMed Central

    Arens, Christoph

    2012-01-01

    The introduction of transoral endoscopic surgery has initiated a fundamental change in the treatment of head and neck cancer. The endoscopic approach minimizes the intraoperative trauma. Due to the lower burden for the patient and the savings potential these methods have gained wide acceptance. These transoral accesses routes allow experienced surgeons to reduce the morbidity of surgical resection with no deterioration of oncologic results. This suggests a further extension of the indication spectrum and a high growth potential for these techniques and equipment in the coming years. For selected patients with selected tumors the minimally invasive transoral surgery offers improved oncological and functional results. In the present paper, different surgical access routes are presented and their indications discussed. PMID:23320057

  13. Salvage transoral laser supraglottic laryngectomy after radiation failure: a report of seven cases.

    PubMed

    Hong, Jong Chul; Kim, Sung Won; Lee, Hyoung Shin; Han, Young Jin; Park, Heon Soo; Lee, Kang Dae

    2013-02-01

    We evaluated the oncological and functional outcomes of salvage transoral laser supraglottic laryngectomy after radiation failure. In addition, we demonstrated the usefulness of laser surgery in patients with recurrent supraglottic cancer. Between December 1999 and May 2011,7 patients (6 men and 1 woman) underwent transoral laser supraglottic laryngectomy after radiation failure. We conducted 4 different types of endoscopic supraglottic laryngectomy. In the cases with lymph node metastasis, we performed neck dissection at the time of laser surgery. All patients had recurrent squamous cell carcinoma confirmed on the surgical specimen. Two patients were classified as having T1 disease, 2 as having T2 disease, and 3 as having T3 disease with preepiglottic space involvement. The 2- and 5-year overall survival rates were 85.7% and 68.6%, respectively. There was a recurrence at 8 months of followup after laser surgery in 1 patient; he underwent successful salvage total laryngectomy. The ultimate local control rate was 100%, and the laryngeal preservation rate was 85.7%. The hospitalization times ranged from 2 to 32 days (mean, 15.6 days). The mean decannulation time was 10.7 days (range, 5 to 30 days). All patients started oral feeding within 1 to 3 days after surgery. Salvage transoral laser supraglottic laryngectomy following radiation failure seems a feasible and oncologically safe procedure in recurrent supraglottic cancers ranging from T1 to selected T3 with minimal preepiglottic space involvement. It can be an option for minimally invasive organ preservation surgery with lesser morbidity for recurrent supraglottic cancer.

  14. Management of Recurrent and Metastatic HPV-Positive Oropharyngeal Squamous Cell Carcinoma after Transoral Robotic Surgery.

    PubMed

    Sims, John R; Van Abel, Kathryn; Martin, Eliot J; Lohse, Christine M; Price, Daniel L; Olsen, Kerry D; Moore, Eric J

    2017-03-01

    Objective To describe management and oncologic outcomes for patients who develop locoregional recurrence (LRR) or distant metastasis (DM) following transoral robotic surgery for human papilloma virus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC). Study Design Case series with chart review. Setting Tertiary care referral center. Subjects and Methods A total of 286 patients with HPV-positive OPSCC who underwent transoral robotic surgery-based treatment from May 2007 to May 2015. Results Of 286 patients (12.2%), 35 met inclusion criteria. Of these, 19 experienced an LRR and 16 developed a DM; 2 patients with LRR subsequently developed DM. In those patients with an LRR, 79% had T1/T2 tumors, and 47% had N0/N1 nodal disease, compared with 75% and 6% in the DM group, respectively. The median time to LRR or DM was 0.6 years (interquartile range [IQR], 0.4-1.0) and 1.8 years (IQR, 1.0-2.1), respectively. Salvage treatment with intent to cure was attempted in 23 patients (16 LRR, 7 DM). The median time from LRR or DM to last follow-up for the 18 patients who were still alive after salvage was 1.9 years (IQR, 0.4-3.8; range, 7 days-6.2 years). Estimated cancer-specific survival rates at 3 years following intent-to-cure treatment were 63% (95% CI, 39-100; number still at risk, 5) in the LRR group and 100% (95% CI, 100-100; number still at risk, 2) in the DM group. Conclusion Overall, LRR and DM for HPV-positive OPSCC following transoral robotic surgery-based therapy are infrequent. In our subset of patients who underwent intent-to-cure treatment, cancer-specific survival rates were favorable. Therefore, aggressive salvage treatment for LRR and DM for HPV-positive OPSCC should be recommended for appropriate candidates.

  15. Hybrid procedure for total laryngectomy with a flexible robot-assisted surgical system.

    PubMed

    Schuler, Patrick J; Hoffmann, Thomas K; Veit, Johannes A; Rotter, Nicole; Friedrich, Daniel T; Greve, Jens; Scheithauer, Marc O

    2017-06-01

    Total laryngectomy is a standard procedure in head-and-neck surgery for the treatment of cancer patients. Recent clinical experiences have indicated a clinical benefit for patients undergoing transoral robot-assisted total laryngectomy (TORS-TL) with commercially available systems. Here, a new hybrid procedure for total laryngectomy is presented. TORS-TL was performed in human cadavers (n = 3) using a transoral-transcervical hybrid procedure. The transoral approach was performed with a robotic flexible robot-assisted surgical system (Flex®) and compatible flexible instruments. Transoral access and visualization of anatomical landmarks were studied in detail. Total laryngectomy is feasible with a combined transoral-transcervical approach using the flexible robot-assisted surgical system. Transoral visualization of all anatomical structures is sufficient. The flexible design of the robot is advantageous for transoral surgery of the laryngeal structures. Transoral robot assisted surgery has the potential to reduce morbidity, hospital time and fistula rates in a selected group of patients. Initial clinical studies and further development of supplemental tools are in progress. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  16. [Treatment of glottic cancer involving the anterior commissure by transoral CO(2) laser surgery].

    PubMed

    Li, J J; Zhang, J L; He, F Y; Tang, S C; Zhu, Z F; Chen, W X

    2017-05-07

    Objective: To study the clinical outcome of transoral CO(2) laser surgery for glottic cancer involving the anterior commissure. Methods: Thirty-two cases of glottic cancer involving the anterior commissure treated by transoral CO(2) laser surgery between March 2009 and December 2013 were retrospectively reviewed. Among these cases, 27 were T1bM0M0, 5 were T2N0M0. All cases were followed-up for more than 3 years. Results: All the 32 cases were successfully treated. Perioperative complications included injuries in the soft palate mucosa(13/32, 40.63%), loose incisors(3/32, 9.38%) and subcutaneous emphysema in the neck(2/32, 6.25%). During the follow-up period, granulation was found in all cases. Three cases had local recurrence. Two patients treated by a secondary transoral CO(2) laser surgery and the other case had total laryngectomy, all three cases were followed up for 5 years without recurrence. Two cases had regional recurrence but no primary site recurrence. One patient was treated by neck dissection, and followed up for 5 years without recurrence. The other patient died of supraclavicular and mediastinal lymph node metastasis and lung metastasis 40 months after operation. The overall 5-year survival rate was 90.6%. There was no significant difference in survival rate between T1bN0M0(92.6%) and T2N0M0(80.0%) (Log Rank χ(2)=0.788, P=0.375). The overall 5-year local regional control rate was 84.4%. In T1bN0M0 lesions, the 5-year local regional control rate was 92.6%, which was significantly higher than that in T2N0M0 lesions(40.0%) (Log Rank χ(2)=9.504, P=0.002). Conclusion: With appropriate surgical indication, detailed preoperative evaluation, good surgical skill, transoral CO(2) laser surgery may achieve satisfactory outcome in the treatment of glottic cancer involving the anterior commissure.

  17. Transoral robotic surgery: simulation-based standardized training.

    PubMed

    Zhang, Ning; Sumer, Baran D

    2013-11-01

    Simulation-based standardized training is important for the clinical training of physicians practicing robotic surgery. To train robotic surgery-naïve student volunteers using the da Vinci Skills Simulator (dVSS) for transoral robotic surgery (TORS). Prospective inception cohort in 2012. Academic referral center. Sixteen medical student volunteers lacking experience in robotic surgery. Participants trained with the dVSS in 12 exercises until competent, defined as an overall score of at least 91%. After a 1-, 3-, 5-, or 7-week postinitial training hiatus (n = 4 per group), participants reachieved competence on follow-up. Total training time (TTT) to achieve competency, total follow-up time (TFT) to reachieve competency, and performance metrics. All participants became competent. The TTT distribution was normal based on the Anderson-Darling normality test (P > .50), but our sample was divided into a short training time (STT) group (n = 10 [63%]) and long training time (LTT) group (n = 6 [37%]). The mean (SD) TTT was 2.4 (0.6) hours for the STT group and 4.7 (0.5) hours for the LTT group. All participants reachieved competence with a mean TFT that was significantly shorter than TTT. There was no significant difference between STT and LTT in mean TFT at 1 and 3 weeks (P = .79), but the LTT group had a longer TFT at 5 and 7 weeks (P = .04) but with no difference in final follow-up scores (P = .12). Physicians in training can acquire robotic surgery competency. Participants who acquire skills faster regain robotic skills faster after a training hiatus, but, on retraining, all participants can regain equivalent competence. This information provides a benchmark for a simulator training program.

  18. Evaluation of the prevalence of residual sialolith fragments after transoral approach of Wharton's duct.

    PubMed

    Gerni, M; Foletti, J M; Collet, C; Chossegros, C

    2017-02-01

    Transoral submandibular duct sialolith removal is a simple technique with very few complications. Nevertheless, following this procedure, we have observed long-term calculus recurrence in a number of patients. We therefore elected to evaluate these cases. This was a monocentric prospective study performed between November 2013 and June 2014. All patients received surgery for submandibular gland lithiasis by intraoral removal of submandibular duct calculi. Between the day following the procedure and 3 months postsurgery, these patients systematically underwent an ultrasound examination of the submandibular gland. The study comprised 15 males and 15 females aged between 19 and 87 years, of which one male presented with bilateral calculi (n = 31). Asymptomatic sialolith fragments were found in 16% of patients. A statistically significant risk (p < 0.05) of residual sialolith was demonstrated in cases in which the calculus or multiple calculi fragmented perioperatively. Our aim was to remove the sialolith as non-traumatically as possible and to perform sialendoscopy at the end of the procedure to check the patency of the anterior ductal segment and to ensure that no residual calculus fragments were present despite the loss of fluid tightness subsequent to the opening of the hilum.

  19. Direct evidence for the function of crustacean insulin-like androgenic gland factor (IAG): total chemical synthesis of IAG.

    PubMed

    Katayama, Hidekazu; Kubota, Nozomi; Hojo, Hironobu; Okada, Ayumi; Kotaka, Sayaka; Tsutsui, Naoaki; Ohira, Tsuyoshi

    2014-11-01

    Insulin-like androgenic gland factor (IAG) is presumed to be a sex differentiation factor so-called androgenic gland hormone (AGH) in decapod crustacean, although the function of IAG peptide has not yet been reported. In this study, we synthesized IAG from the prawn, Marsupenaeus japonicus, and its function was assessed by an in vitro bioassay. As a result, IAG with the insulin-type disulfide bond arrangement showed biological activity, whereas its disulfide isomer did not. These results strongly suggest that the native IAG peptide has an insulin-type disulfide, and it is the decapod AGH. Copyright © 2014 Elsevier Ltd. All rights reserved.

  20. Adrenal glands

    MedlinePlus

    ... this page: //medlineplus.gov/ency/article/002219.htm Adrenal glands To use the sharing features on this page, please enable JavaScript. The adrenal glands are two triangle-shaped glands. One gland is ...

  1. Oncologic Outcomes After Transoral Robotic Surgery

    PubMed Central

    Magnuson, J. Scott; Smith, Richard V.; Moore, Eric; Lawson, Georges; Remacle, Marc; Ganly, Ian; Kraus, Dennis H.; Teng, Marita S.; Miles, Brett A.; White, Hilliary; Duvvuri, Umamaheswar; Ferris, Robert L.; Mehta, Vikas; Kiyosaki, Krista; Damrose, Edward J.; Wang, Steven J.; Kupferman, Michael E.; Koh, Yoon Woo; Genden, Eric M.; Holsinger, F. Christopher

    2016-01-01

    IMPORTANCE Large patient cohorts are necessary to validate the efficacy of transoral robotic surgery (TORS) in the management of head and neck cancer. OBJECTIVES To review oncologic outcomes of TORS from a large multi-institutional collaboration and to identify predictors of disease recurrence and disease-specific mortality. DESIGN, SETTING, AND PARTICIPANTS A retrospective review of records from 410 patients undergoing TORS for laryngeal and pharyngeal cancers from January 1, 2007, through December 31, 2012, was performed. Pertinent data were obtained from 11 participating medical institutions. INTERVENTIONS Select patients received radiation therapy and/or chemotherapy before or after TORS. MAIN OUTCOMES AND MEASURES Locoregional control, disease-specific survival, and overall survival were calculated. We used Kaplan-Meier survival analysis with log-rank testing to evaluate individual variable association with these outcomes, followed by multivariate analysis with Cox proportional hazards regression modeling to identify independent predictors. RESULTS Of the 410 patients treated with TORS in this study, 364 (88.8%) had oropharyngeal cancer. Of these 364 patients, information about post-operative adjuvant therapy was known about 338: 106 (31.3) received radiation therapy alone, and 72 (21.3%) received radiation therapy with concurrent chemotherapy. Neck dissection was performed in 323 patients (78.8%). Mean follow-up time was 20 months. Local, regional, and distant recurrence occurred in 18 (4.4%), 15 (3.7%), and 10 (2.4%) of 410 patients, respectively. Seventeen (4.1%) died of disease, and 13 (3.2%) died of other causes. The 2-year locoregional control rate was 91.8% (95% CI, 87.6%-94.7%), disease-specific survival 94.5% (95% CI, 90.6%-96.8%), and overall survival 91% (95% CI, 86.5%-94.0%). Multivariate analysis identified improved survival among women (P = .05) and for patients with tumors arising in tonsil (P = .01). Smoking was associated with worse overall

  2. Feasibility of the trans-umbilical route compared with the trans-oral route in gastric upper body endoscopic submucosal dissection: a porcine model.

    PubMed

    Jeong, Sang-Ho; Park, Ji-Ho; Yoo, Moon-Won; Choi, Sang-Kyung; Hong, Soon-Chan; Jung, Eun-Jung; Ju, Young-Tae; Jeong, Chi-Young; Ha, Woo-Song; Ha, Chang Yoon; Lee, Young-Joon

    2014-02-01

    Total gastrectomy is performed for early gastric cancer in the upper body of the stomach because of the high complication rate of endoscopic submucosal dissection (ESD). The aims of the present animal study in pigs were to verify: (1) the feasibility of the trans-umbilical route compared with the trans-oral route in gastric upper body ESD; (2) the non-inferiority of single port laparoscopic lymph node dissection (LLND) compared with multiport LLND; and (3) the safety of 2-basin LLND (upper greater and lesser curvature). We separated the pigs (~40 kg each) into two groups: conventional and experimental (n = 5 per group). We performed ESD in the fundus and upper body anterior wall (UBAW) via the trans-oral route and multiport LLND in the conventional group, and via the trans-umbilical route and single port LLND in the experimental group. The completion rates, tissue weights, and specimen diameters of both routes showed no statistical differences in either the fundus or the UBAW. The operative time was shorter with the trans-umbilical route than with the trans-oral route in both areas (p < 0.05). In LLND, there were no differences in surgical outcomes between the multiport and single port groups. Intraoperative perforation was seen in the trans-oral route group (n = 1). Delayed perforation was observed in 30 % of the ESD sites. The trans-umbilical route is feasible and has lower complication rates than the trans-oral route in gastric upper body ESD. Additionally, single port LLND is not inferior to multiport LLND, and one-side-basin dissection is safer than two-side.

  3. Defolliculated (dfl): a dominant mouse mutation leading to poor sebaceous gland differentiation and total elimination of pelage follicles.

    PubMed

    Porter, Rebecca M; Jahoda, Colin A B; Lunny, Declan P; Henderson, Gayle; Ross, Jane; McLean, W H Irwin; Whittock, Neil V; Wilson, Neil J; Reichelt, Julia; Magin, Thomas M; Lane, E Birgitte

    2002-07-01

    Defolliculated is a novel spontaneous mouse mutation that maps to chromosome 11 close to the type I keratin locus. Histology shows abnormal differentiation of the sebaceous gland, with the sebocytes producing little or no sebum and undergoing abnormal cornification. The hair follicles fail to regress during catagen leading to abnormally long follicles. In contrast the hair shafts are shorter than normal, suggesting altered differentiation or proliferation of matrix cells during anagen. The shafts emerge from the follicle with cornified material still attached. The dermis contains increased numbers of immune cells, including T cells (CD4-positive), macrophages, and mast cells, at all time points examined. Complete elimination of all pelage and tail follicles occurs after two to three hair cycles, apparently by necrosis. Defolliculated may be a useful model for determining further functions of the sebaceous gland, and for understanding the regulation of catagen and hair follicle immunology.

  4. Partial Superficial, Superficial, and Total Parotidectomy in the Management of Benign Parotid Gland Tumors: A 10-Year Prospective Study of 205 Patients.

    PubMed

    Stathopoulos, Panagiotis; Igoumenakis, Dimosthenis; Smith, William P

    2017-06-23

    The aim of this report is to present an overview of the authors' experience in treating parotid gland tumors for a period of 10 years. This report describes patients' demographics, surgical outcomes, and complications and discusses the management of benign disease with particular emphasis on the importance of facial nerve dissection. A total of 205 consecutive patients with different parotid gland tumors underwent surgery at Northampton General Hospital (Northampton, UK) from October 2000 to November 2010. Data were prospectively collected and entered into an electronic database. Patients' demographics, clinical tumor size, type of operation, fine-needle aspiration result, facial nerve status, final histopathologic report, and intraoperative and postoperative complications were recorded and analyzed. This study confirmed that good results in low recurrence rate and minimal risk of facial nerve weakness can be achieved with operations less aggressive than traditional superficial parotidectomy, such as partial superficial parotidectomy. Transient facial nerve palsy was significantly more frequent after total (40%; P < .001) and superficial (28%; P < .05) parotidectomy, respectively, than after partial superficial parotidectomy (9.6%). Because the risk or recurrence is higher when surgery is performed by inexperienced surgeons, the authors advocate that parotid gland surgery should be performed by adequately trained operators and the surgical specimen ideally should be examined by a histopathologist experienced in the diagnosis of salivary gland tumors. Recurrence rate for these tumors increases with time; therefore, long-term follow-up is required for these patients. Copyright © 2017 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  5. Ectopic lingual goiter treated by transoral robotic surgery.

    PubMed

    Pellini, R; Mercante, G; Ruscito, P; Cristalli, G; Spriano, G

    2013-10-01

    Multinodular goiter in lingual thyroid is quite rare. Surgical removal is indicated in symptomatic patients and when cancer is suspected. An external approach is most often used, but is associated with morbidity and sequelae. In this study, we present for the first time the technique of transoral robotic surgery (TORS) for removal of a massive lingual goiter. Prospective patient data were collected, including demographics, medical history, symptoms, comorbidities and drugs prescribed. The da Vinci Surgical System was used for a transoral approach to the oropharynx. The technique was validated in a 31-year-old woman with signs and symptoms of multinodular goiter presenting since childhood. The procedure required 115 min, with intervals as follows: tracheotomy, 25 min; robot setting time, 20 min; and console time, 70 min. TOR S is feasible in cases of multinodular goiter in a lingual thyroid. The procedure appears to be safe, with quick recovery of swallowing and speech.

  6. Evolution from microscopic transoral to endoscopic endonasal odontoidectomy.

    PubMed

    Ponce-Gómez, Juan Antonio; Ortega-Porcayo, Luis Alberto; Soriano-Barón, Hector Enrique; Sotomayor-González, Arturo; Arriada-Mendicoa, Nicasio; Gómez-Amador, Juan Luis; Palma-Díaz, Marité; Barges-Coll, Juan

    2014-01-01

    The goal of this study was to compare the indications, benefits, and complications between the endoscopic endonasal approach (EEA) and the microscopic transoral approach to perform an odontoidectomy. Transoral approaches have been standard for odontoidectomy procedures; however, the potential benefits of the EEA might be demonstrated to be a more innocuous technique. The authors present their experience with 12 consecutive cases that required odontoidectomy and posterior instrumentation. Twelve consecutive cases of craniovertebral junction instability with or without basilar invagination were diagnosed at the National Institute of Neurology and Neurosurgery in Mexico City, Mexico, between January 2009 and January 2013. The EEA was used for 5 cases in which the odontoid process was above the nasopalatine line, and was compared with 7 cases in which the odontoid process was beneath the nasopalatine line; these were treated using the transoral microscopic approach (TMA). Odontoidectomy was performed after occipital-cervical or cervical posterior augmentation with lateral mass and translaminar screws. One case was previously fused (Oc-C4 fusion). The senior author performed all surgeries. American Spinal Injury Association scores were documented before surgical treatment and after at least 6 months of follow-up. Neurological improvement after odontoidectomy was similar for both groups. From the transoral group, 2 patients had postoperative dysphonia, 1 patient presented with dysphagia, and 1 patient had intraoperative CSF leakage. The endoscopic procedure required longer surgical time, less time to extubation and oral feeding, a shorter hospital stay, and no complications in this series. Endoscopic endonasal odontoidectomy is a feasible, safe, and well-tolerated procedure. In this small series there was no difference in the outcome between the EEA and the TMA; however, fewer complications were documented with the endonasal technique.

  7. Integrated Multipoint-Laser Endoscopic Airway Measurements by Transoral Approach

    PubMed Central

    Neitsch, Marie; Horn, Iris-Susanne; Hofer, Mathias; Dietz, Andreas; Fischer, Miloš

    2016-01-01

    Objectives. Optical and technical characteristics usually do not allow objective endoscopic distance measurements. So far no standardized method for endoscopic distance measurement is available. The aim of this study was to evaluate the feasibility and accuracy of transoral airway measurements with a multipoint-laser endoscope. Methods. The semirigid endoscope includes a multipoint laser measurement system that projects 49 laser points (wavelength 639 nm, power < 5 mW) into the optical axis of the endoscopic view. Distances, areas, and depths can be measured in real-time. Transoral endoscopic airway measurements were performed on nine human cadavers, which were correlated with CT measurements. Results. The preliminary experiment showed an optimum distance between the endoscope tip and the object of 5 to 6 cm. There was a mean measurement error of 3.26% ± 2.53%. A Spearman correlation coefficient of 0.95 (p = 0.01) was calculated for the laryngeal measurements and of 0.93 (p < 0.01) for the tracheal measurements compared to the CT. Using the Bland-Altman-Plot, the 95% limits of agreement for the laryngeal measurements were satisfactory: −0.76 and 0.93. Conclusions. Integrated multipoint-laser endoscopic measurement is a promising technical supplement, with potential use in diagnostic endoscopy and transoral endoscopic surgery in daily practice. PMID:27022612

  8. Trans-oral robotic surgery and surgeon-performed trans-oral ultrasound for intraoperative location and excision of an isolated retropharyngeal lymph node metastasis of papillary thyroid carcinoma.

    PubMed

    Goepfert, Ryan P; Liu, Chienying; Ryan, William R

    2015-01-01

    Retropharyngeal metastases are uncommon but a well-known location for regional spread of well-differentiated thyroid carcinoma (WDTC). Surgeon-performed, trans-oral ultrasound (SP-TO-US) and trans-oral robot-assisted surgical (TORS) excision represent a unique combination of technology and techniques in the treatment of isolated retropharyngeal thyroid metastases. A patient with a history of T3N1b papillary thyroid carcinoma (PTC) previously treated with total thyroidectomy, left central and lateral neck dissection, and radioactive iodine presented with progressive elevations in serum thyroglobulin (Tg) from baseline of 0.2 to 0.6 μg/L. She was found to have an isolated 2.6 cm left retropharyngeal nodal metastasis on MRI that was confirmed to be PTC on fine needle aspiration biopsy. She underwent SP-TO-US for identification of the node in the operating room immediately prior to TORS excision. There were no complications. Additional radioactive iodine was administered. Post-treatment iodine scans revealed resolution of avid uptake in left retropharynx and return of Tg to 0.2 μg/L. The combination of SP-TO-US and TORS represents a novel combination of technology and technique for treatment of isolated retropharyngeal metastasis in WDTC. Trans-oral ultrasound allows for rapid localization of the lesion in relation to the adjacent neurovascular structures in the parapharynx while the robot-assisted approach affords a safe and effective dissection through the improved visualization and dexterity in a small working space. Our patient had no complications and only short-term dysphagia that resolved after temporary diet alteration. Risks and long-term morbidities associated with classical approaches to the retropharynx including trans-cervical and trans-mandibular, particularly in a previously dissected field, are avoided through this trans-oral approach. Retropharyngeal metastases are a known location for regional spread of WDTC and are amenable to evaluation and biopsy

  9. Development of a transoral robotic surgery program in Canada

    PubMed Central

    2013-01-01

    Due to significant differences in healthcare structure between the United States and Canada, there are unique barriers to adopting new medical technology in Canada. In this article, we describe our experience developing a transoral robotic surgery (TORS) program at Western University. Specifically, we outline the steps that were necessary to obtain institutional and multidisciplinary team approval, financial support, as well as surgeon and allied healthcare personnel training. This experience can potentially be used as a roadmap for other Canadian institutions pursuing a TORS program. PMID:23663280

  10. Voice Outcomes of Transoral Laser Microsurgery of the Larynx.

    PubMed

    Hartl, Dana M; Laoufi, Samia; Brasnu, Daniel F

    2015-08-01

    Transoral laser microsurgery (TLM) is the mainstay in the treatment of early (TisT1T2) glottic cancer. Current knowledge concerning voice quality and voice-related quality of life in patients treated using TLM is based on small cohort studies using various instruments to evaluate these functional results. The bulk of the literature indicates that subjective and objective measurements of voice quality can return to normal or almost normal values after TLM, generally after 6 to 12 months and particularly after cordectomy types I, II, and III. Copyright © 2015 Elsevier Inc. All rights reserved.

  11. Objective Assessment in Residency Based Training for Transoral Robotic Surgery

    PubMed Central

    Curry, Martin; Malpani, Anand; Li, Ryan; Tantillo, Thomas; Jog, Amod; Blanco, Ray; Ha, Patrick K; Califano, Joseph; Kumar, Rajesh; Richmon, Jeremy

    2015-01-01

    Objective To develop a robotic surgery training regimen integrating objective skill assessment for otolaryngology and head and neck surgery trainees consisting of training modules of increasing complexity and leading up to procedure specific training. In particular, we investigate applications of such a training approach for surgical extirpation of oropharyngeal tumors via a transoral approach using the da Vinci Robotic system. Study Design Prospective blinded data collection and objective evaluation (OSATS) of three distinct phases using the da Vinci Robotic surgical system. Setting Academic University Medical Engineering/Computer Science laboratory Methods Between September 2010 and July 2011, 8 Otolaryngology Head and Neck Surgery residents and 4 staff “experts” from an academic hospital participated in three distinct phases of robotic surgery training involving 1) robotic platform operational skills, 2) set-up of the patient side system, and 3) a complete ex-vivo surgical extirpation of an oropharyngeal “tumor” located in the base of tongue. Trainees performed multiple (4) approximately equally spaced training sessions in each stage of the training. In addition to trainees, baseline performance data was obtained for the experts. Each surgical stage was documented with motion and event data captured from the application programming interfaces (API) of the da Vinci system, as well as separate video cameras as appropriate. All data was assessed using automated skill measures of task efficiency, and correlated with structured assessment (OSATS, and similar Likert scale) from three experts to assess expert and trainee differences, and compute automated and expert assessed learning curves. Results Our data shows that such training results in an improved didactic robotic knowledge base and improved clinical efficiency with respect to the set-up and console manipulation. Experts (e.g. average OSATS 25, Stdev. 3.1, module 1 – suturing) and trainees (average

  12. Neuronavigation-assisted transoral-transpharyngeal approach for basilar invagination--two case reports.

    PubMed

    Ugur, Hasan Caglar; Kahilogullari, Gokmen; Attar, Ayhan; Caglar, Sukru; Savas, Ali; Egemen, Nihat

    2006-06-01

    Two patients presented with congenital basilar invagination manifesting as progressive myelopathy. Both patients underwent surgery using a neuronavigation-assisted transoral-transpharyngeal approach. The Brain-LAB Vector Vision navigation system was used for image guidance. The registration accuracies were 0.9 and 1.3 mm. After decompression, posterior stabilization was performed. Both patients had an uneventful postoperative course. The transoral-transpharyngeal approach with the neuronavigation system provides safe exposure and decompression for basilar invagination.

  13. Surgical anatomy of oropharynx and supraglottic larynx for transoral robotic surgery.

    PubMed

    Gun, Ramazan; Ozer, Enver

    2015-12-01

    Traditional external surgical approaches have been used for the surgical management of the oropharyngeal and laryngeal tumors. Trans-oral robotic surgery allows surgeon to operate oropharyngeal and supraglottic tumors through the mouth with preservation of functions. The surgeons must be knowledgeable about the anatomy of the oral cavity and oropharynx medial to lateral perspective. In this article, we will describe the relevant inside out surgical anatomy and its clinical implications for trans-oral robotic surgery. © 2015 Wiley Periodicals, Inc.

  14. Split gland

    DOEpatents

    Petranto, Joseph J.

    1989-01-01

    A split gland having only three parts is described. The gland has substantially the same stability to the relative motion of the constituent half-gland members during the attachment process to a female fitting as have more complicated designs. Ease of manufacture and use result from the reduction in complexity of the present invention.

  15. Split gland

    DOEpatents

    Petranto, J.J.

    1989-09-05

    A split gland having only three parts is described. The gland has substantially the same stability to the relative motion of the constituent half-gland members during the attachment process to a female fitting as have more complicated designs. Ease of manufacture and use result from the reduction in complexity of the present invention. 15 figs.

  16. TransOral Robotic Photodynamic Therapy for the Oropharynx

    PubMed Central

    Quon, Harry; Finlay, Jarod; Cengel, Keith; Zhu, Timothy; O’Malley, Bert; Weinstein, Gregory

    2015-01-01

    Photodynamic therapy (PDT) has been used for head and neck carcinomas with little experience in the oropharynx due to technical challenges in achieving adequate exposure. We present the case of a patient with a second right tonsil carcinoma following previous treatment with transoral robotic surgery (TORS) and postoperative chemoradiation for a left tonsil carcinoma. Repeat TORS for the right tonsil carcinoma reviewed multiple positive surgical margins. The power output from the robotic camera was modified to facilitate safe intraoperative three dimensional visualization of the tumor bed. The robotic arms facilitated clear exposure of the tonsil and tongue base with stable administration of the fluence. Real-time measurements confirmed stable photobleaching with augmentation of the prescribed light fluence secondary to light scatter in the oropharynx. We report a potential new role using TORS for exposure and accurate PDT in the oropharynx. PMID:21333937

  17. Transoral decompression and posterior stabilisation in Morquio's disease.

    PubMed Central

    Ashraf, J; Crockard, H A; Ransford, A O; Stevens, J M

    1991-01-01

    A 3.5 year old boy with Morquio's disease was referred with a persisting left hemiparesis four months after a fall and was found to have craniocervical junction compression due to atlantoaxial subluxation and significant anterior soft tissue compression. Transient unconsciousness at the time of the fall was probably due to medullary concussion as a result of hyperextension, not a head injury. Spinal cord compression due to atlantoaxial subluxation at the craniovertebral junction is a major cause of disability and death in these patients. Once cervical myelopathy appears, early posterior occipitocervical fusion has been advocated in order to arrest the progression of neurological disability and this is successful in most cases. This conventional approach was considered unsafe because of the significant anterior compression. A combined anterior transoral decompression with posterior fusion to deal with this particularly difficult problem is described. Images Figure 1 Figure 2 Figure 3 Figure 4 PMID:1755646

  18. Toward Intraoperative Image-Guided Transoral Robotic Surgery

    PubMed Central

    Liu, Wen P.; Reaugamornrat, Sureerat; Deguet, Anton; Sorger, Jonathan M.; Siewerdsen, Jeffrey H.; Richmon, Jeremy; Taylor, Russell H.

    2014-01-01

    This paper presents the development and evaluation of video augmentation on the stereoscopic da Vinci S system with intraoperative image guidance for base of tongue tumor resection in transoral robotic surgery (TORS). Proposed workflow for image-guided TORS begins by identifying and segmenting critical oropharyngeal structures (e.g., the tumor and adjacent arteries and nerves) from preoperative computed tomography (CT) and/or magnetic resonance (MR) imaging. These preoperative planned data can be deformably registered to the intraoperative endoscopic view using mobile C-arm cone-beam computed tomography (CBCT) [1, 2]. Augmentation of TORS endoscopic video defining surgical targets and critical structures has the potential to improve navigation, spatial orientation, and confidence in tumor resection. Experiments in animal specimens achieved statistically significant improvement in target localization error when comparing the proposed image guidance system to simulated current practice. PMID:25525474

  19. Transoral oropharyngeal resection classification: Proposal of the SCORL working group.

    PubMed

    Virós Porcuna, David; Avilés Jurado, Francisco; Pollán Guisasola, Carlos; Ramírez Ruiz, Rosa Delia; García Lorenzo, Jacinto; Tobed Secall, Marc; Vilaseca González, Isabel; Costa González, José Miguel; Soteras Olle, Josep; Casamitjana Claramunt, Francesc; Sumarroca Trouboul, Anna; Hijano Esqué, Rafael; Viscasillas Pallàs, Guillem; Mañós Pujol, Manel; Quer Agustí, Miquel

    There has been a very significant increase in the use of minimally invasive surgery has in the last decade. In order to provide a common language after transoral surgery of the oropharynx, a system for classifying resections has been created in this area, regardless of the instrumentation used. From the Oncology Working Group of the Catalan Society of Otorhinolaryngology, a proposal for classification based on a topographical division of the different areas of the oropharynx is presented, as also based on the invasion of the related structures according to the anatomical routes of extension of these tumours. The classification starts using the letter D or I according to laterality either right (D) or left (I). The number of the resected area is then placed. This numbering defines the zones beginning at the cranial level where area I would be the soft palate, lateral area II in the tonsillar area, area III in the tongue base, area IV in the glossoepiglottic folds, epiglottis and pharyngoepiglottic folds, area V posterior oropharyngeal wall and VI the retromolar trigone. The suffix p is added if the resection deeply affects the submucosal plane of the compromised area. The different proposed areas would, in theory, have different functional implications. Proposal for a system of classification by area to definedifferent types of transoral surgery of the oropharynx, and enable as sharing of results and helps in teaching this type of technique. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. All rights reserved.

  20. Reconstructive transoral laser microsurgery for posterior glottic web with stenosis.

    PubMed

    Atallah, Ihab; Manjunath, M Krishniah; Omari, Ahmad Al; Righini, Christian Adrien; Castellanos, Paul F

    2017-03-01

    To demonstrate that reconstructive transoral laser microsurgical (R-TLM) techniques can be used for the treatment of symptomatic laryngeal posterior glottic web-based stenosis (PGWS) in a large cohort of patients utilizing a postcricoid mucosal advancement flap (PCMAF). Retrospective cohort review. A consecutive series of patients with PGWS who underwent R-TLM using a PCMAF were reviewed for outcomes. After laser excision of the PGWS scar and mobilization of fixed cricoarytenoid joints, a PCMAF was raised using microinstruments and a scanning free-beam CO2 laser. The flap was advanced and attached over the scar bed using a technique with multiple novel features that make it easy to adopt. Fifty-two patients were treated. Of the cases, 42.3% had a tracheostomy at presentation with grade II to IV PGWS, and 46% of cases had grade III to IV PGWS. In all cases, R-TLM was the only treatment approach. No open reconstructions were performed. No airway stents were used. Patients without tracheostomy, regardless of the grade of stenosis, did not require a tracheostomy to undergo this operation. All tracheostomy patients were successfully decannulated. All patients without a tracheostomy had significant improvement of their respiratory symptoms on the Dyspnea Index (mean Δ = 14.75, P value <.01). RTLM using the PCMAF is a feasible, safe, and effective alternative to open approaches for airway reconstruction for PGWS. This novel transoral technique includes a much simpler endoscopic suturing alternative to knot tying among other new features. It is reproducible and reliable for laryngologists familiar with laryngeal microsurgery. 4. Laryngoscope, 127:685-690, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

  1. Endocrine glands

    MedlinePlus

    ... Diabetes Gigantism Diabetes insipidus Cushing Disease Watch this video about: Pituitary gland Testes and ovaries: Lack of sex development (unclear genitalia) Thyroid: Congenital hypothyroidism Myxedema Goiter ...

  2. Transoral Robotic Surgery and the Unknown Primary: A Cost-Effectiveness Analysis.

    PubMed

    Byrd, J Kenneth; Smith, Kenneth J; de Almeida, John R; Albergotti, W Greer; Davis, Kara S; Kim, Seungwon W; Johnson, Jonas T; Ferris, Robert L; Duvvuri, Umamaheswar

    2014-06-01

    To evaluate the cost-effectiveness of transoral robotic surgery (TORS) for the diagnosis and treatment of cervical unknown primary squamous cell carcinoma (CUP). Case series with chart review. Tertiary academic hospital. A retrospective chart review was performed on patients with new occult primary squamous cell carcinoma of the head and neck with nondiagnostic imaging and/or endoscopy who were treated with TORS at a tertiary hospital between 2009 and 2012. Direct costs were obtained from the hospital's billing system, and national data were used for inpatient hospital costs and physician fees. The proportion of tumors found in 3 strategies was used as effectiveness to calculate the incremental cost-effectiveness ratio. In total, 206 head and neck robotic cases were performed at our institution between December 2009 and December 2012. Three surgeons performed TORS on 22 patients for occult primary squamous cell carcinoma. The primary tumor was located in 19 of 22 patients (86.4%). The incremental cost-effectiveness ratio for sequential and simultaneous examination under anesthesia with tonsillectomy (EUA) and TORS base of tongue resection was $8619 and $5774 per additional primary identified, respectively. Sequential EUA followed by TORS is associated with an incremental cost-effectiveness ratio of $8619 compared with traditional EUA alone. Bilateral base of tongue resection should be considered in the workup of these patients, particularly if the palatine tonsils have already been removed. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2014.

  3. Transoral robotic surgery (TORS) for tongue base tumours.

    PubMed

    Mercante, G; Ruscito, P; Pellini, R; Cristalli, G; Spriano, G

    2013-08-01

    In recent years, transoral robotic surgery (TORS) has been used for the removal of pharyngeal and laryngeal cancers with the objective to improve functional and aesthetic outcomes without worsening the survival. This prospective single-centre cohort study described TORS in selected tumours of the tongue base in order to assess safety, efficacy and functional outcome of the procedure. From October 2010 to February 2012, TORS was performed in 13 consecutive patients affected by T1-T2 tumours of the base of the tongue. This procedure was applicable in all cases. The clinical stage demonstrated 8 T1 tumours and 5 T2 tumours. Neck node metastases were clinically evident in 6 cases (7 N0, 1 N1, 4 N2b and 1 N2c). The final pathology report confirmed malignancy in all cases (11 squamous cell carcinoma and 2 mucoepidermoid carcinoma). Negative-margin resections were obtained in all cases but one with close margins. Synchronous lymph node neck dissections were performed in 7 cases (6 monolateral, 1 bilateral). Patients underwent temporary tracheostomies for a mean time of 6 days. A naso-gastric feeding tube was positioned in 10/13 (76.9%) patients for a mean time of 7.5 days. The average time to carry out the TORS procedure was 95 min (set-up time 25 min; TORS 70 min). No deaths occurred. Surgical complications were observed in 4 cases (postoperative bleedings in 3 cases and intraoperative anaphylactic shock in 1 case). Median hospital stay was 9 days. All patients had good functional outcomes. Adjuvant treatment was indicated in 5/13 cases (35.4%). TORS represents a good tool for staging and treating neoplasm of the base of the tongue. The transoral removal is safe and can radically remove limited oropharyngeal tumours of the tongue base with good functional outcomes. The operating costs can be relatively high but they are related to the number of procedures per year, although the advantages to patients seem to justify the procedure. TORS can represent the definitive

  4. [Minimally invasive abdominothoracic esophagus resection by transoral esophagogastrostomy: interdisciplinary challenge].

    PubMed

    Gockel, I; Paschold, M; Lang, H; Heid, F

    2013-10-01

    Resection of the esophagus is an invasive 2-cavitiy procedure which requires special anesthesiological expertise during perioperative care. Furthermore, in surgery new minimally invasive techniques are continually being established which place special challenges on the treatment team because the anesthesiologist is decisively involved in the course of surgery. The aim of this article is to present the development of surgical treatment options for esophageal cancer starting from classical open resection up to the minimally invasive technique of esophagectomy (MIE). Previous experience with MIE on a cohort of patients is presented and the special anesthesiological characteristics of this innovative technique are illustrated. In the department for general, visceral and transplantation surgery of the University Medical Center of Mainz, minimally invasive abdominothoracic esophageal resection has been carried out since 2010. High thoracic anastomization was performed using the EEA™-OrVil™ system operated by the anesthesiologist. Currently 17 highly selected patients have been surgically treated using this technique. Esophagogastric anastomosis with the EEA™-OrVil™ system was feasible in all patients. Transoral introduction of the gastric probe with the connecting sheath and the angled anvil led to minor dislocation of the double lumen tube in only one patient and could immediately be corrected. Further intraoperative complications did not occur. Four of the 17 patients developed pneumonia which could be controlled by intravenous antibiotics. None of the patients had to be reintubated. One patient developed gastric tube necrosis and died 51 days postoperatively due to massive intracerebral hemorrhage. There were no complications of anastomoses following OrVil™ anastomization. In all patients an R0 resection could be achieved. Minimally invasive esophagectomy with transoral anastomization appears to be an enrichment of the minimally invasive spectrum as

  5. Preliminary functional results of endoscope-assisted transoral treatment of displaced bilateral condylar mandible fractures.

    PubMed

    Schoen, R; Fakler, O; Metzger, M C; Weyer, N; Schmelzeisen, R

    2008-02-01

    Temporomandibular joint (TMJ) function was evaluated following endoscope-assisted transoral open reduction and miniplate fixation of displaced bilateral condylar mandibular fractures. The transoral treatment of bilateral condylar fractures was performed in 13 patients from May 2000 to December 2004. Eleven of the 13 patients had additional mandibular fractures. Out of 26 fractures of the condylar process, 11 were located at the condylar neck and 15 were subcondylar. One, 6 and 12 months after surgery TMJ function was evaluated. Anatomic reduction was achieved using an endoscope-assisted transoral approach even when the condylar fragment was displaced medially and in fractures with comminution. Good TMJ function was noted 6 and 12 months after surgery. Mouth opening was measured to be more than 40 mm without deviation. Postoperative range of motion with a satisfying lateral excursion was found. Early rehabilitation and pre-injury TMJ function was achieved following minimally invasive anatomic fracture reduction.

  6. Tips and Tricks in Transoral Robotic Surgery for Challenging Vascular Tumors.

    PubMed

    Meccariello, Giuseppe; Eesa, Mohamed; Costantini, Matteo; Montevecchi, Filippo; Vicini, Claudio

    2015-07-01

    Surgical removal of head-neck vascular neoplasms may have severe complications, although surgery remains a very important treatment modality. One of the most important aspects is to avoid the rupture of the tumor's capsule and to minimize functional complications, especially in the excision of benign tumors. The transoral robotic surgery allows removing lesions in challenging anatomical areas. Furthermore, the current robotic instrumentation does not allow a fine dissection of the structures and capsule rupture is a potential event. Here, the authors describe a minimally invasive technique using transoral robotic surgery for removal of vascular tumors in head-neck. Particular attention was given to the description of the diagnostic work up, the preoperative assessment and the surgical steps. No complications were encountered postoperatively. Transoral robotic surgery for vascular tumors appears to be a safe and feasible technique with minimal complications.

  7. Transoral robotic resection of an adult laryngeal haemangioma and review of the literature.

    PubMed

    Wang, W-H; Tsai, K-Y

    2015-06-01

    Haemangioma of the adult larynx is an uncommon, benign lesion. The optimal surgical method of treating these lesions is controversial because only very limited case series are available. This paper reports the results of transoral robotic resection of a supraglottic haemangioma in an adult and reviews the literature. A 58-year-old woman presented having experienced a lump-in-the-throat sensation for 1 year. Investigations on laryngoscopy revealed a lobulated, dark red mass in the region of the supraglottis. This was successfully excised by transoral robotic excision without complications. Adult supraglottic haemangiomas can be treated successfully with transoral robotic excision; this potentially allows more of the surrounding mucosal tissue to be spared and enables easy control of bleeding.

  8. Feasibility of transoral robotic-assisted high-resolution microendoscopic imaging of oropharyngeal squamous cell carcinoma.

    PubMed

    Patsias, Alexis; Giraldez-Rodriguez, Laureano; Polydorides, Alexandros D; Richards-Kortum, Rebecca; Anandasabapathy, Sharmila; Quang, Timothy; Sikora, Andrew G; Miles, Brett

    2015-08-01

    Transoral robotic-assisted oncologic surgery of the head and neck offers promising functional results. Nonetheless, the efficacy of oncologic surgery remains critically dependent on obtaining negative margins. We aimed to integrate a miniaturized high-resolution fiber-optic microendoscope (HRME), which provides real-time histological assessment, with the da Vinci robotic system (Intuitive Surgical, Sunnyvale, CA). Three patients undergoing transoral robotic surgery (TORS) were prospectively enrolled in this study. Optical imaging of the oropharynx was performed intraoperatively with the robotic-assisted HRME. All patients underwent the procedure successfully with no complications. The HRME was successfully integrated with the da Vinci robotic system. Several sites of the oropharynx and associated malignancy were imaged, which correlated with the standard histopathological analysis. Transoral robotic-assisted HRME imaging of the oropharynx is a safe and technically feasible approach, providing a real-time histological assessment and may serve as a valuable aid in oncologic surgery. © 2015 Wiley Periodicals, Inc.

  9. Feasibility of Transoral Robotic-Assisted High Resolution Microendoscopic Imaging of Oropharyngeal Squamous Cell Carcinoma

    PubMed Central

    Patsias, Alexis; Giraldez-Rodriguez, Laureano A.; Polydorides, Alexandros D.; Richards-Kortum, Rebecca; Anandasabapathy, Sharmila; Quang, Timothy; Sikora, Andrew G.; Miles, Brett A.

    2015-01-01

    Background Transoral robotic-assisted oncologic surgery of the head and neck offers promising functional results. Nonetheless, the efficacy of oncologic surgery remains critically dependent on obtaining negative margins. We aimed to integrate a miniaturized high resolution fiberoptic microendoscope (HRME), which provides real time histological assessment, with the da Vinci robotic system (Intuitive Surgical Inc., Sunnyvale, CA). Methods Three patients undergoing transoral robotic surgery were prospectively enrolled. Optical imaging of the oropharynx was performed intraoperatively with the robotic-assisted HRME. Results All patients underwent the procedure successfully with no complications. The HRME was successfully integrated with the Da Vinci Robotic system. Several sites of the oropharynx and associated malignancy were imaged, which correlated with the standard histopathological analysis. Conclusions Transoral robotic-assisted high resolution microendoscopic imaging of the oropharynx is a safe and technically feasible approach, providing a real time histological assessment and may serve as a valuable aid in oncologic surgery. PMID:25327825

  10. Intraoral midline mandibulotomy improves laryngeal access for transoral resection of laryngeal cancer.

    PubMed

    Saini, Alok T; Parasher, Arjun K; Kass, Jason I; Altman, Kenneth W; Miles, Brett A

    2016-01-01

    Intraoral midline mandibulotomy is a technique that can be used to increase exposure for transoral endoscopic laser microsurgery (TLS). We describe the case of a 51 year old male with persistent T1 glottic carcinoma. At initial diagnosis, he had been referred for curative radiotherapy as laryngeal access was not sufficient for TLS. For treatment of his recurrence, we describe the technique of performing a midline mandibular osteotomy to improve access to the larynx allowing for safe and effective transoral endoscopic laser microsurgery. Surgical access to the larynx was greatly improved, and we were able to perform TLS in a case that would have otherwise not been amenable to TLS. An intraoral midline mandibulotomy can improve access to the larynx and allow for successful transoral resection of laryngeal cancer in patients with otherwise inaccessible tumors. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Role of transoral robotic surgery in current head & neck practice.

    PubMed

    Hamilton, David; Paleri, Vinidh

    2016-10-11

    Morbidity and mortality associated with increasingly radical doses of chemoradiotherapy have led many to question the current standard of care in head and neck cancer. Recently, surgeons have developed minimally invasive, transoral techniques which have demonstrated excellent survival and favourable functional outcomes. Transoral robotic surgery (TORS) is the most recent, cutting edge in the evolution of transoral techniques; TORS allows surgeons unprecedented access to and visualisation of the upper aerodigestive tract. Early reports of TORS in the head and neck are favourable in both primary and recurrent disease. TORS has a role in the assessment of the patient with unknown primary and in the de-intensification of therapy in patients with cancers secondary to human papilloma virus. In this review we discuss the practical set up and technical features of TORS surgery and the application of TORS in primary and recurrent disease, and carcinoma of unknown primary. We outline the current ongoing research into the use of this technique and set out the vision for the future of this surgical modality. Surgical care for upper aerodigestive tract cancers has changed dramatically over the last three decades with technological advances in tumour imaging and resection. Recent advances in mechanical instrumentation and energy devices allow surgeons to remove head and neck cancers transorally; it is only rarely that the extrinsic muscles of the neck and the tongue are involved and the transoral route leads to reduced disruption of the external musculature, quicker recovery and a better functional outcome. In this review we will focus exclusively on the advances in transoral robotic surgery which have transformed the shape of resective head and neck cancer surgery.

  12. Transoral robotic surgery in head and neck cancer.

    PubMed

    Hans, S; Delas, B; Gorphe, P; Ménard, M; Brasnu, D

    2012-02-01

    Robots have invaded industry and, more recently, the field of medicine. Following the development of various prototypes, Intuitive Surgical® has developed the Da Vinci surgical robot. This robot, designed for abdominal surgery, has been widely used in urology since 2000. The many advantages of this transoral robotic surgery (TORS) are described in this article. Its disadvantages are essentially its high cost and the absence of tactile feedback. The first feasibility studies in head and neck cancer, conducted in animals, dummies and cadavers, were performed in 2005, followed by the first publications in patients in 2006. The first series including more than 20 patients treated by TORS demonstrated the feasibility for the following sites: oropharynx, supraglottic larynx and hypopharynx. However, these studies did not validate the oncological results of the TORS technique. TORS decreases the number of tracheotomies, and allows more rapid swallowing rehabilitation and a shorter length of hospital stay. Technical improvements are expected. Smaller, more ergonomic, new generation robots, therefore more adapted to the head and neck, will probably be available in the future. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

  13. Transoral robotic surgery in retrostyloid parapharyngeal space schwannomas.

    PubMed

    Ansarin, Mohssen; Tagliabue, Marta; Chu, Francesco; Zorzi, Stefano; Proh, Michele; Preda, Lorenzo

    2014-01-01

    Parapharyngeal space (PPS) tumors are very rare, representing about 0.5% of head and neck neoplasms. An external surgical approach is mainly used. Several recent papers show how transoral robotic surgery (TORS) excision could be a prospective tool to remove mainly benign lesions in PPS; no cases of neurogenic tumors from the retrostyloid space treated with TORS have been reported. We present two cases which underwent TORS for schwannomas from the retrostyloid compartment of the parapharyngeal space. Clinical diagnosis of schwannoma was performed by magnetic resonance imaging (MRI). In the first case a 6 cm neurogenic tumor arose from the vagus nerve and in the second case a 5 cm mass from the sympathetic chain was observed. Both cases were treated successfully by the TORS approach using a new "J"-shaped incision through the mucosa and superior pharyngeal constrictor muscle. Left vocal cord palsy and the Claude Bernard Horner syndrome, respectively, were observed as expected postsurgical sequelae. In case 1 the first bite syndrome developed after three months, while no complications were observed in case 2. Both patients regained a normal swallowing function. TORS seems to be a feasible mini-invasive procedure for benign PPS masses including masses in the poststyloid space.

  14. First use of a computer-assisted operator-controlled flexible endoscope for transoral surgery.

    PubMed

    Schuler, Patrick J; Duvvuri, Uma; Friedrich, Daniel T; Rotter, Nicole; Scheithauer, Marc O; Hoffmann, Thomas K

    2015-03-01

    Transoral robotic surgery (TORS) has become an accepted treatment option for head and neck cancer. However, anatomical limitations and a relevant financial burden require alternative developments in this field. To this end, a patient presenting with a T2 squamous cell carcinoma of the lower lateral oropharyngeal wall was effectively treated with a new Conformité Européene-certified, computer-assisted, operator-controlled flexible endoscope (Flex). Intraoperative visualization and tissue handling were acceptable and safe. Transoral surgery with the flexible endoscope was safely conducted in a clinical setting. The introduction of alternative TORS systems will increase competition, drive scientific improvement, and reduce financial expenses.

  15. Robot-assisted Sistrunk's operation, total thyroidectomy, and neck dissection via a transaxillary and retroauricular (TARA) approach in papillary carcinoma arising in thyroglossal duct cyst and thyroid gland.

    PubMed

    Byeon, Hyung Kwon; Ban, Myung Jin; Lee, Jeon Mi; Ha, Jong Gyun; Kim, Eun Sung; Koh, Yoon Woo; Choi, Eun Chang

    2012-12-01

    internal papillary carcinoma measuring 1.1 cm with infiltrative tumor margins and papillary microcarcinoma measuring 0.9 cm within the left thyroid lobe with extrathyroidal soft tissue extension. There was no evidence of tumor in the right lobe and the pyramidal lobe of the thyroid gland. As for the lymph nodes resected, 7 out of 9 paratracheal nodes and 2 out of 7 left level III, IV nodes revealed metastatic carcinomas. The patient was discharged on the 8th day after the operation with no complications. The patient was extremely satisfied with the cosmetic results. The patient has received high-dose radioiodine ablation (RAI) therapy and is currently doing well with no evidence of recurrence. Although there is still a great deal of controversy regarding the treatment of TGDCa, there is little debate that for the cases of synchronous TGDCa and PTC, total thyroidectomy in addition to the Sistrunk procedure must be performed. As for the patient in our case where left level IV lymph node metastasis was detected under preoperative ultrasonography (USG), if the usual method of surgical procedure was to be selected, double incisions or a single extended transverse incision must be adopted for the Sistrunk's operation and total thyroidectomy with lateral neck dissection. The conventional method to remove neck masses was to do so by placing an incision on the overlying skin. This 'open' approach to viewing the lesion has an advantage of providing the operator with the best surgical view, but the recognizable surgical scar that results from the surgery can be displeasing for patients. Therefore the surgeon can try to make a small incision and camouflage the scar by placing the incision in natural skin creases, yet the cosmetic results can still be displeasing for the patient due to its visibility and permanence. This can be an even greater problem if the patient is young and an active member of his/her society and if the lesion is benign or low-grade malignancy which can be simply

  16. Endocrine glands

    MedlinePlus Videos and Cool Tools

    ... and nervous systems work very closely together. The brain continuously sends instructions to the endocrine system, and ... master switchboard because it's the part of the brain that controls the endocrine system. The pituitary gland, ...

  17. Bartholin gland cancer.

    PubMed

    Di Donato, Violante; Casorelli, Assunta; Bardhi, Erlisa; Vena, Flaminia; Claudia, Marchetti; Muzii, Ludovico; Benedetti Panici, Pierluigi

    2017-09-01

    Bartholin gland carcinoma is an extremely rare condition. Because of its, phase III trials have not been carried out, there exists no unanimous consensus on treatment and guidelines are missing. All studies reporting cases of Bartholin cancer were collected and screened for the evaluations. Baseline characteristics of studies were extracted and were queried in a database. A total number of 133 manuscripts collected were available for the review process, representing a total number of 275 reported cases. The histological type of Bartholin gland cancer was specified in 90.4% cases: 30.7% cases were squamous cell carcinoma, 29.6% adenoid cystic carcinoma, 25% adenocarcinomas. At multivariate analysis adenocarcinoma histotype and positive lymph node were statistical correlated with worse prognosis. Bartholin gland cancer remains a challenge for gynecologic oncologists. To better understand and treat this disease, centralization to referral centers and design of multi institutional trials is crucial. Copyright © 2017 Elsevier B.V. All rights reserved.

  18. Volumetric MRI analysis pre- and post-Transoral robotic surgery for obstructive sleep apnea.

    PubMed

    Chiffer, Rebecca C; Schwab, Richard J; Keenan, Brendan T; Borek, Ryan C; Thaler, Erica R

    2015-08-01

    To quantitatively measure volumetric changes in upper airway soft tissue structures using magnetic resonance imaging (MRI) pre- and post transoral robotic surgery for obstructive sleep apnea (OSA-TORS). Prospective, nonrandomized, institutional board-approved study. Apneics undergoing OSA-TORS, which included bilateral posterior hemiglossectomy with limited pharyngectomy and uvulopalatopharyngoplasty, had upper airway MRIs pre- and postoperatively. Changes (percent and absolute values) in upper airway and surrounding soft tissue volumes were calculated. We assessed whether there were significant volumetric changes and if changes correlated with apnea-hypopnea index (AHI) changes. Nineteen MRIs and 18 polysomnograms were analyzed pre- and postoperation. Total airway volume increased by 19.4% (P = 0.030). Soft palate and tongue volumes decreased by 18.3% (P = 0.002) and 5.8% (P = 0.013), respectively. Retropalatal and total lateral wall volumes decreased by 49.8% (P = 0.0001) and 17.9% (P = 0.008), respectively. Changes in other structures were not significant. Eleven patients had surgical success, with a mean AHI decrease of 52.9; six were nonsuccesses with a mean AHI decrease of 4.5 (P =0.006). Decreased retropalatal lateral wall volume correlated with decreased AHI. Airway, tongue, soft palate, and lateral wall volumes change significantly after OSA-TORS. Changes in the volume of the lateral walls correlated with changes in AHI. Volumetric upper airway MRI may be a helpful tool to better understand reasons for surgical success. 4. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

  19. Applications for transoral robotic surgery in the pediatric airway.

    PubMed

    Ferrell, Jay K; Roy, Soham; Karni, Ron J; Yuksel, Sancak

    2014-11-01

    To report preliminary experience in the utilization of transoral robotic surgical (TORS) techniques in pediatric airway surgery. Retrospective case series. A retrospective chart review was performed on all pediatric patients undergoing robotic airway surgery at a university-based children's hospital between August 2010 and December 2012. Three pediatric patients underwent robotic repair of various airway anomalies between August 2010 and December 2012. Case 1 is a 15-year-old boy with posterior glottic stenosis for which a robotic-assisted posterior cricoid split with cartilage graft placement was attempted but ultimately required conversion to an open technique. Case 2 is a 6-year-old male with Trisomy 21 who had robotic-assisted endoscopic repair of a type II laryngeal cleft, with subsequent resolution of his chronic aspiration and successful initiation of oral feeding. Case 3 is a 3-year-old female who underwent robotic-assisted left posterior cordectomy and subtotal arytenoidectomy for idiopathic bilateral vocal cord paralysis, resulting in improved Passy-Muir valve tolerance. TORS is being increasingly utilized in the field of head and neck surgery as it is frequently less invasive and often demonstrates improved outcomes compared with traditional approaches. This study details our experience utilizing TORS in the management of pediatric airway anomalies and represents one of the earliest such series in the literature. Although TORS has the potential to improve the management of pediatric airway disorders, larger, prospective studies are needed to better elucidate its feasibility and efficacy. 4. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

  20. [Outcomes following transoral resection of oropharyngeal squamous cell carcinoma].

    PubMed

    López, Fernando; Llorente, José L; Álvarez-Marcos, César; Morato, Marta; Suárez, Carlos; Rodrigo, Juan P

    2015-01-01

    The aim of our study was to evaluate outcomes of a minimally invasive approach, using transoral surgery (TOS) as the primary treatment for oropharyngeal carcinoma. We reviewed 43 previously untreated patients with oropharyngeal carcinoma, who were treated with TOS. Distribution of the primary tumor site was: tonsil (52%), soft palate (23%), base of the tongue (21%) and posterior wall (4%). Eight patients had a stage I disease, 9 had a stage II disease, 7 had a stage III disease, 16 had a stage IVA, and 3 had stage IVB disease. Eighteen patients underwent postoperative radiotherapy. Records of these patients were reviewed to obtain measures such as local and regional control, overall and disease-specific survival, and speech and swallowing function. The overall recurrence rate was 44%, and the local recurrence rate was 18%. The 5-year overall survival and disease-specific survival rates were 55% and 66%, respectively. Five-year disease-specific survival rates by site were as follows: 100%, 85%, 44%, and 30% for posterior wall, tonsil, soft palate and base of the tongue, respectively. Five-year estimates for local control were 100%, 90%, and 0% for palate, tonsil and for base of the tongue tumors, respectively. All of the patients preserved the larynx and live without tracheotomy and oral alimentation was successfully without feeding tube. TOS as the primary treatment approach offers a surgical alternative for treatment of the primary oropharyngeal tumor, in the era of chemoradiation therapy. This approach confers a good local control and functional outcomes. Copyright © 2014 Elsevier España, S.L.U. y Sociedad Española de Otorrinolaringología y Patología Cérvico-Facial. All rights reserved.

  1. Transoral endoscopic nasopharyngectomy with a flexible next-generation robotic surgical system.

    PubMed

    Tsang, Raymond K; Holsinger, F Christopher

    2016-10-01

    To determine the feasibility of transoral endoscopic nasopharyngectomy without division of the soft plate using a flexible, next-generation robotic surgical system. Preclinical anatomic study using four human cadavers. Transoral resection of the nasopharyngeal wall with en-bloc resection of the cartilaginous Eustachian tube and dissection of the parapharyngeal fat space. The first flexible robotic surgical system has recently been described. We performed a series of laboratory experiments to determine whether this flexible system could be used to perform transoral robotic nasopharyngectomy. This novel system allowed docking of the patient-side cart at the side of the operating table. The cannula tip was placed approximately 12 cm from the edge of the retractor pointing superiorly toward the nasopharynx (NP). Retraction of the soft palate anteriorly and tonsillar pillars laterally with stay sutures expanded the velopharyngeal inlet, providing adequate space to deploy all four instruments (three surgical instruments and a camera) into the NP for dissection. All instruments could be deployed into the NP, without collision or restriction of joint movement in this cadaver model. Using this position and docking location, the new flexible surgical robot provided sufficient access, reach, and visualization to complete robotic nasopharyngectomy with en-bloc resection of the cartilaginous Eustachian tube. This feasibility study showed that transoral endoscopic nasopharyngectomy could be performed without compromising the integrity of the soft palate using a novel flexible robotic surgical system. N/A. Laryngoscope, 126:2257-2262, 2016. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

  2. Morphometric measurements of the anterior skull base for endoscopic transoral and transnasal approaches.

    PubMed

    Lega, Bradley C; Kramer, Daniel R; Newman, Jason G; Lee, John Y K

    2011-01-01

    The objective of this study is to determine the bony limits of the transnasal and transoral approaches to the anterior skull base. The data we present are meant to assist surgeons in preoperative planning for lesions of the sella, clivus, foramen magnum, and odontoid. Using precise measurements undertaken on 41 high-resolution computed tomography scans from patients at the University of Pennsylvania without any history of sinus or sellar pathology, we sought to define the bony limits of transoral and transnasal approaches. Direct measurements and calculated angles were used to assess the dimensions of the anterior skull base. Using our measurements, a transnasal approach can reach an average of 22.5 mm below the plane of the hard palate to the body of C2, and a transoral route can reach 38 mm above the basion along the length of the clivus. Analysis of variance demonstrated no significant differences when subjects were grouped based on race or gender. The measurements outlined within this article help to define the relative dimensions necessary for adapted transoral and transnasal skull base surgeries.

  3. Transoral surgery for laryngo-pharyngeal cancer - The paradigm shift of the head and cancer treatment.

    PubMed

    Tateya, Ichiro; Shiotani, Akihiro; Satou, Yasuo; Tomifuji, Masayuki; Morita, Shuko; Muto, Manabu; Ito, Juichi

    2016-02-01

    Transoral surgery is a less invasive treatment that is becoming a major strategy in the treatment of laryngo-pharyngeal cancer. It is a minimally invasive approach that has no skin incision and limits the extent of tissue dissection, disruption of speech and swallowing muscles, blood loss, damage to major neurovascular structures, and injury to normal tissue. Transoral approaches to the laryngo-pharynx, except for early glottis cancer, had been limited traditionally to tumors that can be observed directly and manipulated with standard instrumentation and lighting. Since the 1990s, transoral laser microsurgery (TLM) has been used as an organ preservation strategy with good oncological control and good functional results, although it has not been widely used because of its technical difficulty. Recently, transoral robotic surgery (TORS) is becoming popular as a new treatment modality for laryngo-pharyngeal cancer, and surgical robots are used widely in the world since United States FDA approval in 2009. In spite of the global spread of TORS, it has not been approved by the Japan FDA, which has led to the development of other low-cost transoral surgical techniques in Japan. Transoral videolaryngoscopic surgery (TOVS) was developed as a new transoral surgery system for laryngo-pharyngeal lesions to address the problems of TLM. In TOVS, a rigid endoscope is used to visualize the surgical field instead of a microscope and the advantages of TOVS include the wide operative field and working space achieved using the distending laryngoscope and videolaryngoscope. Also, with the spread of narrow band imaging (NBI), endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), which are widely used for superficial cancers in the gastrointestinal tract, have been applied for the superficial laryngo-pharyngeal cancer. Both EMR and ESD are performed mainly by gastroenterologists with a sharp dissector and magnifying endoscopy (ME)-NBI with minimal surgical margin

  4. Ultrasound studies on the shift of cervical tissues in different head and neck positions--impact on transoral endoscopic, minimally invasive and conventional thyroid surgery.

    PubMed

    Wilhelm, Thomas; Krüger, Jochen

    2011-09-01

    During the development of a transoral endoscopic, minimally invasive approach for thyroidectomy, the question arose as to how the distances of the submandibular gland (SG)-hyoid bone (HB)-thyroid gland (TG) change in differing head positions and how the TG itself changes shape. In a prospective, two-armed ultrasound study we studied 20 healthy volunteers each, all with no history of neck surgery or thyroid disease. Distances were measured in normal, reclined and "reclined with open mouth" positions. We found no remarkable differences and the distances were comparable with conventional open or minimally invasive thyroidectomy approaches. The TG lengthened significantly during reclination. This may result in a difficult preparation in the region of the suspensory ligament and may therefore increase the rate of postoperative vocal cord palsy caused by stretching of the recurrent laryngeal nerve. A supine flat position may minimize the risk of this postoperative complication of thyroidectomy. Copyright © 2011 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

  5. Reconstructive techniques in transoral robotic surgery for head and neck cancer: a North American survey.

    PubMed

    Konofaos, Petros; Hammond, Sarah; Ver Halen, Jon P; Samant, Sandeep

    2013-02-01

    Although the use of transoral robotic surgery for tumor extirpation is expanding, little is known about national trends in the reconstruction of resultant defects. An 18-question electronic survey was created by an expert panel of surgeons from the Department of Otolaryngology-Head and Neck Surgery and the Department of Plastic and Reconstructive Surgery at the University of Tennessee. Eligible participants were identified by the American Head and Neck Society Web site and from the Intuitive Surgical, Inc., Web site after review of surgeons trained in transoral robotic surgery techniques. Twenty-three of 27 preselected head and neck surgeons (85.18 percent) completed the survey. All respondents use transoral robotic surgery for head and neck tumor extirpation. The majority of the respondents [n = 17 (77.3 percent)] did not use any means of reconstruction. With respect to methods of reconstruction following transoral robotic surgery defects, the majority [n = 4 (80.0 percent)] used a free flap, a pedicled local flap [n = 3 (60.0 percent)], or a distant flap [n = 3 (60.0 percent)]. The radial forearm flap was the most commonly used free flap by all respondents. In general, the majority of survey respondents allow defects to heal secondarily or close primarily. Based on this survey, consensus indications for pedicled or free tissue transfer following transoral robotic surgery defects were primary head and neck tumors (stage T3 and T4a), pharyngeal defects with exposure of vital structures, and prior irradiation or chemoradiation to the operative site and neck.

  6. Sialolipoma of the parotid gland: Case report with literature review comparing major and minor salivary gland sialolipomas

    PubMed Central

    Qayyum, Sohail; Meacham, Ryan; Sebelik, Merry; Zafar, Nadeem

    2013-01-01

    Sialolipoma is a rare tumor found within both major and minor salivary glands. Here we discuss sialolipoma of the parotid gland and briefly review the English literature. Including our case, a total of 35 sialolipomas have been reported, 18 within major salivary glands and 17 within minor salivary glands. Major gland sialolipomas most often are presented in the parotid gland (77%) and those from minor glands were most often seen in the palate (41%). All lesions were well circumscribed and contained mature adipose tissue intimately admixed with benign salivary gland components. Ductal dilatation was found in 100% of minor salivary gland sialolipomas but in only 28% of major salivary gland tumors. Nerve entrapment has also rarely been noted in major salivary glands (14%) whereas myxoid degeneration has been identified in rare minor salivary glands tumors (13%). Treatment is surgical excision and is curative with no reports of recurrence. PMID:23798838

  7. Transoral robotic surgery for sellar tumors: first clinical study.

    PubMed

    Chauvet, Dorian; Hans, Stéphane; Missistrano, Antoine; Rebours, Celeste; Bakkouri, Wissame El; Lot, Guillaume

    2016-12-23

    OBJECTIVE The aim of this study was to confirm the feasibility of an innovative transoral robotic surgery (TORS), using the da Vinci Surgical System, for patients with sellar tumors. This technique was designed to offer a new minimally invasive approach, without soft-palate splitting, that avoids the rhinological side effects of classic endonasal approaches. METHODS The authors performed a prospective study of TORS in patients with symptomatic sellar tumors. Specific anatomical features were required for inclusion in the study and were determined on the basis of preoperative open-mouth CT scans of the brain. The main outcome measure was sellar accessibility using the robot. Resection quality, mean operative time, postoperative changes in patients' vision, side effects, and complications were additionally reported. RESULTS Between February and May 2016, 4 patients (all female, mean age 49.5 years) underwent TORS for resection of sellar tumors as participants in this study. All patients presented with symptomatic visual deficits confirmed as bitemporal hemianopsia. All tumors had a suprasellar portion and a cystic part. In all 4 cases, the operation was performed via TORS, without the need for a second surgery. Sella turcica accessibility was satisfactory in all cases. In 3 cases, tumor resection was complete. The mean operative time was 2 hours 43 minutes. Three patients had a significant visual improvement at Day 1. No rhinological side effects or complications in patients occurred. No pathological examination was performed regarding the fluid component of the tumors. There was 1 postoperative delayed CSF leak and 1 case of transient diabetes insipidus. Side effects specific to TORS included minor sore throat, transient hypernasal speech, and 1 case of delayed otitis media. The mean length of hospital stay and mean follow up were 8.25 days and 82 days, respectively. CONCLUSIONS To our knowledge, this is the first report of the surgical treatment of sellar tumors by

  8. Endoscope-assisted transoral removal of a thyroglossal duct cyst using a frenotomy incision: A prospective clinical trial.

    PubMed

    Woo, Seung Hoon; Park, Jung Je; Hong, Jong Chul; Wang, Soo-Geun; Park, Gi Cheol; Eun, Young Gyu; Kim, Jin Pyeong; Jeong, Han-Sin

    2015-12-01

    Endoscope-assisted transoral removal of a thyroglossal duct cyst (TGDC) has been introduced to clinical practice. However, the technical feasibility, efficacy, and safety of this procedure have not been studied. Herein, we conducted a prospective clinical trial to evaluate endoscope-assisted transoral removal of a TGDC. Prospective cohort study. Thirty patients were included. We performed endoscope-assisted transoral removal of TGDCs and evaluated the clinical results and complications over more than 2 years. Endoscope-assisted transoral resection was successful in all cases. However, transient morbidity was noted in one patient. The mean operation time was 67.33 ± 17.26 minutes. Surgery was not required for recurrence or revision during a follow-up. Endoscope-assisted transoral resection of a TGDC is a potentially safe and effective procedure leading to excellent functional and cosmetic outcomes. Additionally, considering the embryological development of TGDCs, the transoral approach can open a new access route to these cysts. 2b. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

  9. Transoral carotid ultrasonography using a micro convex probe with B-flow imaging for extracranial internal carotid artery dissection.

    PubMed

    Sakima, Hirokuni; Isa, Katsunori; Anegawa, Takahiro; Kokuba, Kazuhito; Nakachi, Koh; Goya, Yoshino; Tokashiki, Takashi; Ishiuchi, Shogo; Ohya, Yusuke

    2012-11-01

    We report on transoral carotid ultrasonography using a micro convex probe with B-flow imaging for determining spontaneous extracranial internal carotid artery dissection just below the petrous portion. A 49-year-old man suffered cortical and subcortical infarction in the region of the right middle cerebral artery. Magnetic resonance angiography on the third day of admission revealed spontaneous recanalization of the right internal carotid artery associated with an intimal flap-like structure at the petrous portion. Transoral carotid ultrasonography using a micro convex probe revealed right extracranial internal carotid artery dissection, showing an increased diameter of the right extracranial internal carotid artery with double lumen formation, stenosis of the true lumen, and a mobile intimal flap in B-flow imaging. Transoral carotid ultrasonography using a micro convex probe was helpful to attempt a self-expanding stent for recanalizing right extracranial internal carotid artery dissection. The patient recovered and was discharged ambulatory. The size of the micro convex probe was optimum for transoral carotid ultrasonography in our patient. Micro convex probe is more commonly used than the standard transoral carotid ultrasonography probe, which lacks versatility. We consider that transoral carotid ultrasonography using a micro convex probe could be routinely used for ultrasonographic evaluation of extracranial internal carotid artery dissection.

  10. Characterization of human pineal gland proteome.

    PubMed

    Yelamanchi, Soujanya D; Kumar, Manish; Madugundu, Anil K; Gopalakrishnan, Lathika; Dey, Gourav; Chavan, Sandip; Sathe, Gajanan; Mathur, Premendu P; Gowda, Harsha; Mahadevan, Anita; Shankar, Susarla K; Prasad, T S Keshava

    2016-11-15

    The pineal gland is a neuroendocrine gland located at the center of the brain. It is known to regulate various physiological functions in the body through secretion of the neurohormone melatonin. Comprehensive characterization of the human pineal gland proteome has not been undertaken to date. We employed a high-resolution mass spectrometry-based approach to characterize the proteome of the human pineal gland. A total of 5874 proteins were identified from the human pineal gland in this study. Of these, 5820 proteins were identified from the human pineal gland for the first time. Interestingly, 1136 proteins from the human pineal gland were found to contain a signal peptide domain, which indicates the secretory nature of these proteins. An unbiased global proteomic profile of this biomedically important organ should benefit molecular research to unravel the role of the pineal gland in neuropsychiatric and neurodegenerative diseases.

  11. Measurement of p-nitrophenyl acetate esterase activity (EA), total antioxidant capacity (TAC), total oxidant status (TOS) and acetylcholinesterase (AChE) in gills and digestive gland of Mytilus galloprovincialis exposed to binary mixtures of Pb, Cd and Cu.

    PubMed

    Franco-Martinez, Lorena; Romero, Diego; García-Navarro, José A; Tecles, Fernando; Teles, Mariana; Tvarijonaviciute, Asta

    2016-12-01

    The aims of the present work were (1) to evaluate oxidative stress biomarkers and AChE in two tissues of wild mussel (Mytilus galloprovincialis) of high biochemical activity and accumulation capacity (gills and digestive gland) and (2) to study the behaviour of these biomarkers in presence of heavy metals. For this, EA, TOS, TAC and AChE were measured in tissues of mussels exposed to binary combination of Pb, Cd and Cu. Mussels (n = 36) were exposed to one of the binary mixtures of Pb (1000 μg L(-1)), Cd (100 μg L(-1)) and Cu (100 μg L(-1)) for 7 days, under controlled conditions. Gills and digestive gland were extracted and frozen at -80 °C until analysis. The automatic methods employed for the measurement of EA, TAC, TOS and AChE in M. galloprovincialis revealed higher levels of these biomarkers in digestive gland than gills. Study results suggest that gills would be the tissue of election for study oxidative stress markers, whereas digestive tissue should be selected for AChE measurements in case of evaluation of combined metal toxicity in mussels.

  12. [An alternative dorsal fusion technique after transoral dens resection in basilar impression with atlas assimilation].

    PubMed

    Kaden, B; Schramm, J; Koch, W; Solymosi, L

    1998-01-01

    Current therapy of basilar impression includes transoral dens resection. The essential disadvantage of this procedure is the instability of C1/C2 due to loss of the transverse ligament. We describe two patients in whom this instability was treated by modified screwing. Using MAGERL-screws between C0-C2 an interposition of an iliac graft between the occiput and the arc of C2 was made. Neurological symptoms improved in both patients postoperatively. In both cases stable fusion C0/C2 was achieved with an additional treatment with a HALO-fixateur for eight weeks. In our opinion the combined transoral/dorsal procedure is most suitable and efficient in treatment of basilar impressions. By this approach both, decompression of the myelon as well as stable fusion C0/C2, is achieved.

  13. Uncovering head gland diversity in neotropical Polistinae wasps (Hymenoptera, Vespidae): comparative analysis and description of new glands.

    PubMed

    Penagos-Arévalo, Andrea C; Billen, Johan; Sarmiento, Carlos E

    2015-09-01

    Exocrine glands are involved in several wasp colony activities; however, the number of known glands in the Vespidae is rather low when compared to other social insect groups. The aim of this study is to survey the head of Neotropical social wasps and to provide a detailed comparative study of the glands found in the Polistinae. A total of 33 species distributed over 13 genera were studied with serial histological sections of the head, excluding the labiomaxillary complex. Additionally, the exoskeleton was explored using scanning electron microscopy looking for associated modifications. A total of eleven exocrine glands were observed, five are structures recorded for the first time for the Hymenoptera, three are new records for the Polistinae and three are previously known organs. The glands studied are: ocellar gland I, ocellar gland II, periocular gland, subantennal gland, hypopharyngeal gland, clypeal gland, posterobasal genal gland, ectal mandibular gland, mesal mandibular gland, intramandibular gland I, and intramandibular gland II. The widespread distribution of most of these glands suggests an origin prior to the evolution of the Polistinae. Our results highlight the importance of detailed morphological studies to unveil the significance of chemical communication in one of the most characteristic groups of social animals. Copyright © 2015 Elsevier Ltd. All rights reserved.

  14. Trans-oral endoscopic partial adenoidectomy does not worsen the speech after cleft palate repair.

    PubMed

    Abdel-Aziz, Mosaad; Khalifa, Badawy; Shawky, Ahmed; Rashed, Mohammed; Naguib, Nader; Abdel-Hameed, Asmaa

    2016-01-01

    Adenoid hypertrophy may play a role in velopharyngeal closure especially in patients with palatal abnormality; adenoidectomy may lead to velopharyngeal insufficiency and hyper nasal speech. Patients with cleft palate even after repair should not undergo adenoidectomy unless absolutely needed, and in such situations, conservative or partial adenoidectomy is performed to avoid the occurrence of velopharyngeal insufficiency. Trans-oral endoscopic adenoidectomy enables the surgeon to inspect the velopharyngeal valve during the procedure. The aim of this study was to assess the effect of transoral endoscopic partial adenoidectomy on the speech of children with repaired cleft palate. Twenty children with repaired cleft palate underwent transoral endoscopic partial adenoidectomy to relieve their airway obstruction. The procedure was completely visualized with the use of a 70° 4mm nasal endoscope; the upper part of the adenoid was removed using adenoid curette and St. Claire Thompson forceps, while the lower part was retained to maintain the velopharyngeal competence. Preoperative and postoperative evaluation of speech was performed, subjectively by auditory perceptual assessment, and objectively by nasometric assessment. Speech was not adversely affected after surgery. The difference between preoperative and postoperative auditory perceptual assessment and nasalance scores for nasal and oral sentences was insignificant (p=0.231, 0.442, 0.118 respectively). Transoral endoscopic partial adenoidectomy is a safe method; it does not worsen the speech of repaired cleft palate patients. It enables the surgeon to strictly inspect the velopharyngeal valve during the procedure with better determination of the adenoidal part that may contribute in velopharyngeal closure. Copyright © 2015 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

  15. Early assessment of feasibility and technical specificities of transoral robotic surgery using the da Vinci Xi.

    PubMed

    Gorphe, Philippe; Von Tan, Jean; El Bedoui, Sophie; Hartl, Dana M; Auperin, Anne; Qassemyar, Quentin; Moya-Plana, Antoine; Janot, François; Julieron, Morbize; Temam, Stephane

    2017-01-07

    The latest generation Da Vinci(®) Xi™ Surgical System Robot released has not been evaluated to date in transoral surgery for head and neck cancers. We report here the 1-year results of a non-randomized phase II multicentric prospective trial aimed at assessing its feasibility and technical specificities. Our primary objective was to evaluate the feasibility of transoral robotic surgery using the da Vinci(®) Xi™ Surgical System Robot. The secondary objective was to assess peroperative outcomes. Twenty-seven patients, mean age 62.7 years, were included between May 2015 and June 2016 with tumors affecting the following sites: oropharynx (n = 21), larynx (n = 4), hypopharynx (n = 1), parapharyngeal space (n = 1). Eighteen patients were included for primary treatment, three for a local recurrence, and six for cancer in a previously irradiated field. Three were reconstructed with a FAMM flap and 6 with a free ALT flap. The mean docking time was 12 min. "Chopsticking" of surgical instruments was very rare. During hospitalization following surgery, 3 patients experienced significant bleeding between day 8 and 9 that required surgical transoral hemostasis (n = 1) or endovascular embolization (n = 2). Transoral robotic surgery using the da Vinci(®) Xi™ Surgical System Robot proved feasible with technological improvements compared to previous generation surgical system robots and with a similar postoperative course. Further technological progress is expected to be of significant benefit to the patients.

  16. Case of pharyngeal cancer not detected during preoperative transoral endoscopy with narrow band imaging.

    PubMed

    Tsuji, Kunihiro; Doyama, Hisashi; Nakanishi, Hiroyoshi; Takemura, Kenichi; Moriyama, Hideki; Sakumoto, Makoto; Tsuyama, Sho; Kurumaya, Hiroshi

    2015-04-01

    We herein report a case of pharyngeal cancer that was not detected during preoperative transoral endoscopy with narrow band imaging (NBI). A 61-year-old female was referred to our hospital for further evaluation of a pharyngeal lesion. Endoscopy revealed a small, elevated lesion, approximately 7 mm in size, at the right pyriform sinus. We performed endoscopic resection to remove this lesion under general anesthesia based on the biopsy results. Intraoperatively, we detected another tumor in the left oropharyngeal wall with Lugol staining after insertion of a curved laryngoscope. Although this lesion was ≥20 mm in diameter, we were unable to detect it during preoperative transoral endoscopy with NBI and white light imaging. We performed endoscopic treatment for this lesion 2 months later. The pathological diagnosis was pharyngeal cancer; the lesion had low vascularity. This case report provides an example of false-negative endoscopy with NBI. Although transoral endoscopy with NBI has improved the early diagnosis of superficial squamous cell carcinomas of the head and neck, pharyngeal cancers that are less vascular may be missed with NBI.

  17. Transoral removal of hiloparenchymal submandibular calculi: a long-term clinical experience.

    PubMed

    Capaccio, Pasquale; Clemente, Ignazio Alessandro; McGurk, Mark; Bossi, Anna; Pignataro, Lorenzo

    2011-07-01

    Traditional management of hiloparenchymal submandibular calculi is based on sialadenectomy. Recently, different minimally invasive and conservative techniques have been developed for the treatment of the submandibular calculi. We aimed to investigate the effectiveness of transoral surgical removal of large hiloparenchymal calculi by monitoring the trend for recurrence with clinical and ultrasonographic follow-up. A consecutive series of 84 patients with large (>7 mm) hilar or hiloparenchymal submandibular calculi underwent the transoral surgical removal under general anaesthesia. A video-assisted endoscopic procedure was performed in eight patients. All the patients underwent diagnostic ultrasonography and colour Doppler ultrasonography and clinical evaluation to define the exact location (hilar vs. parenchymal) and the diameter of the stone. The surgical procedure was successful in all but one of the patients. Stone recurrence was observed in 16 patients but obstructive symptoms were observed in only 12 patients during a median follow-up time of 52 months. The risk for recurrence was higher in patients who previously underwent extracorporeal shockwave lithotripsy. Conservative transoral removal of large hiloparenchymal submandibular calculi is a safe and effective surgical procedure. Future studies with longer follow-up will confirm the risk for recurrence of calculi.

  18. Trans-oral glasses-free three-dimensional endoscopic thyroidectomy—preliminary single center experiences

    PubMed Central

    Li, Zhi-Yu; Xuan, Wen-Liang

    2016-01-01

    Glass-free three-dimensional (3D) endoscopic provide excellent depth perception without decreasing light quality and fog formation. Herein we report our first case-serial of trans-oral endoscopic thyroidectomy by means of our newly developed glasses-free 3D endoscopic system. Four patients with thyroid goiter undergone trans-oral glasses-free 3D endosocpic thyroidectomy were reviewed. Mean BMI of these patients was 20.98±2.91 kg/m2. The dominate nodule of the thyroid was no more than 5 cm in diameter in all patients. Operation duration was 189.00±39.14 min, and mean Intraoperative blood loss was 7.50±2.89 mL. No postoperative complications were observed. All patients were satisfied with the cosmetic result. The use of a glasses-free 3D system in trans-oral endoscopic thyroidectomy is safe and effective. The clear image casted to the surgeon can greatly facilitate precise surgical movement and reduce eye fatigue. Further comparative studies should be conducted to confirm our conclusions. PMID:28149810

  19. Toward Transoral Peripheral Lung Access: Combining Continuum Robots and Steerable Needles.

    PubMed

    Swaney, Philip J; Mahoney, Arthur W; Hartley, Bryan I; Remirez, Andria A; Lamers, Erik; Feins, Richard H; Alterovitz, Ron; Webster, Robert J

    2017-03-01

    Lung cancer is the most deadly form of cancer in part because of the challenges associated with accessing nodules for diagnosis and therapy. Transoral access is preferred to percutaneous access since it has a lower risk of lung collapse, yet many sites are currently unreachable transorally due to limitations with current bronchoscopic instruments. Toward this end, we present a new robotic system for image-guided trans-bronchoscopic lung access. The system uses a bronchoscope to navigate in the airway and bronchial tubes to a site near the desired target, a concentric tube robot to move through the bronchial wall and aim at the target, and a bevel-tip steerable needle with magnetic tracking to maneuver through lung tissue to the target under closed-loop control. In this work, we illustrate the workflow of our system and show accurate targeting in phantom experiments. Ex vivo porcine lung experiments show that our steerable needle can be tuned to achieve appreciable curvature in lung tissue. Lastly, we present targeting results with our system using two scenarios based on patient cases. In these experiments, phantoms were created from patient-specific computed tomography information and our system was used to target the locations of suspicious nodules, illustrating the ability of our system to reach sites that are traditionally inaccessible transorally.

  20. Transoral robotic-assisted skull base surgery to approach the sella turcica: cadaveric study.

    PubMed

    Chauvet, Dorian; Missistrano, Antoine; Hivelin, Mikaël; Carpentier, Alexandre; Cornu, Philippe; Hans, Stéphane

    2014-10-01

    Transoral robotic surgery (TORS) offers new possibilities that have not been experimented in the field of minimally invasive skull base neurosurgery. We propose to evaluate the feasibility of transoral approach to the sella turcica with the da Vinci system on cadavers. We performed four robot-assisted dissections on human fresh cadavers in order to reach the pituitary fossa by the oral cavity. Cavum mucosa dissection was performed by the head and neck surgeon at the console and then the sphenoid was drilled by the neurosurgeon at the bedside, with intraoperative fluoroscopy and a "double surgeon" control. Mucosa closure was attempted with robotic arms. We succeeded in performing a sellar opening in all cadavers with a minimally invasive approach, as the hard palate was never drilled. The video endoscope offered a large view inside the sphenoidal sinus, as observed in transnasal endoscopy, but with 3D visualization. The camera arm could be inserted into the sphenoidal sinus, and instrument arms in the pituitary fossa. Operative time to reach the pituitary fossa was approximately 60 min in all procedures: 20 min of initial setup, 10 min of mucosal dissection, and 30 min of sphenoid surgery. New anatomical landmarks were defined. Advantages and pitfalls of such an unpublished technique were discussed. This is the first cadaveric study reported da Vinci robotic transoral approach to the sella turcica with a minimally invasive procedure. This innovative technique may modify the usual pituitary adenoma removal as the sella is approached infero-superiorly.

  1. Intensity Modulated Radiotherapy Improves Target Coverage and Parotid Gland Sparing When Delivering Total Mucosal Irradiation in Patients With Squamous Cell Carcinoma of Head and Neck of Unknown Primary Site

    SciTech Connect

    Bhide, Shreerang Clark, Catherine; Harrington, Kevin; Nutting, Christopher M.

    2007-10-01

    Head and neck squamous cell carcinoma with occult primary site represents a controversial clinical problem. Conventional total mucosal irradiation (TMI) maximizes local control, but at the expense of xerostomia. IMRT has been shown to spare salivary tissue in head and cancer patients. This study has been performed to investigate the potential of IMRT to perform nodal and TMI and also allow parotid gland sparing in this patient group. Conventional radiotherapy (CRT) and IMRT plans were produced for six patients to treat the ipsilateral (involved) post-operative neck (PTV1) and the un-operated contralateral neck and mucosal axis (PTV2). Plans were produced with and without the inclusion of nasopharynx in the PTV2. The potential to improve target coverage and spare the parotid glands was investigated for the IMRT plans. There was no significant difference in the mean doses to the PTV1 using CRT and IMRT (59.7 and 60.0 respectively, p = 0.5). The maximum doses to PTV1 and PTV2 were lower for the IMRT technique as compared to CRT (P = 0.008 and P < 0.0001), respectively, and the minimum doses to PTV1 and PTV2 were significantly higher for IMRT as compared to CRT (P = 0.001 and P = 0.001), respectively, illustrating better dose homogeneity with IMRT. The mean dose to the parotid gland contralateral to PTV1 was significantly lower for IMRT (23.21 {+-} 0.7) as compared to CRT (50.5 {+-} 5.8) (P < 0.0001). There was a significant difference in parotid dose between plans with and without the inclusion of the nasopharynx. IMRT offers improved dose homogeneity in PTV1 and PTV2 and allows for parotid sparing.

  2. Transoral outlet reduction for weight regain after gastric bypass: long-term follow-up.

    PubMed

    Kumar, Nitin; Thompson, Christopher C

    2016-04-01

    Dilated gastrojejunal anastomosis aperture is associated with weight regain after Roux-en-Y gastric bypass (RYGB). Transoral outlet reduction (TORe) has proved safe and effective for the treatment of weight regain. The objective of this study was to determine the long-term weight trend and number needed to treat for TORe. This prospective series included consecutive post-RYGB patients with weight regain and a gastrojejunal anastomosis aperture greater than 15 mm. TORe was performed with a full-thickness endoscopic suturing device. A total of 150 patients who had regained 49.9% ± 3.6% of the weight lost after gastric bypass (4.1 ± 0.3 kg/y after nadir) before TORe. At TORe, body mass index was 40.2 ± 0.8 kg/m(2) and weight was 110.7 ± 2.2 kg. At 1 year, weight loss was 10.5 ± 1.2 kg or 24.9 ± 2.6% excess weight loss (EWL); at 2 years, weight loss was 9.0 ± 1.7 kg or 20.0% ± 6.4% EWL; at 3 years, weight loss was 9.5 ± 2.1 kg or 19.2% ± 4.6% EWL. The number needed to treat for arrest of weight regain was 1.0 at 6 months, 1.1 at 1 year, and 1.2 at 2 and 3 years. The number needed to treat to maintain weight loss of ≥5 kg from TORe was 1.2 at 6 months, 1.5 at 1 year, 1.9 at 2 years, and 2.0 at 3 years. TORe safely and effectively arrested weight regain and provided durable weight loss with a low number needed to treat. Patients with weight regain after RYGB should be evaluated for dilation of the gastrojejunal anastomosis, as TORe can be part of a multidisciplinary strategy to address post-RYGB weight regain. Copyright © 2016 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

  3. Transoral laser microsurgery versus radiotherapy for T1 glottic carcinoma: a systematic review and meta-analysis.

    PubMed

    Mo, Hai-Lan; Li, Jie; Yang, Xiang; Zhang, Feng; Xiong, Jun-Wei; Yang, Zhi-Ling; Tan, Jian; Li, Bing

    2017-02-01

    Transoral laser microsurgery (TLM) and radiotherapy (RT) are both accepted treatment modalities for glottic cancer. The objective of the study was to assess the oncologic outcomes and life quality of TLM in comparison with RT for T1 glottic carcinoma. We searched Medline/PubMed, Web of knowledge, EMBASE, the Cochrane Library, the Wiley online library, Springer, Google, China National Knowledge Infrastructure (CNKI), etc. We screened the literature, assessed the quality of the studies, and extracted the relevant data through the establishment of inclusion and exclusion criteria. Meta-analysis was done using the Cochrane collaboration' s RevMan 5.0 for data analysis. A total of 11 studies were included in this meta-analysis. The laryngeal preservation for patients undergoing TLM was significantly better than that for RT (P < 0.00). The laser surgery significantly improved the overall survival of patients with T1 glottic carcinoma (P = 0.04). No statistically significant differences were found between TLM and RT regarding the local control (P = 0.91). The funnel plot demonstrates no apparent publication bias in the overall survival and laryngeal preservation comparison. Our meta-analysis suggested that laser surgery was a preferred method than radiotherapy with respect to significantly better overall survival and laryngeal preservation. But the local control was not significant different. Further prospective randomized controlled studies will be needed.

  4. Utility and stability of transnasal endoscopy for examination of the pharynx - a prospective study and comparison with transoral endoscopy.

    PubMed

    Tsuboi, Masaru; Arai, Makoto; Maruoka, Daisuke; Matsumura, Tomoaki; Nakagawa, Tomoo; Katsuno, Tatsuro; Yokosuka, Osamu

    2013-01-01

    Transnasal endoscopy may be used to observe the head and neck part readily without excessive reflexes. We aimed to evaluate the utility and stability of transnasal esophagogastroduodenoscopy (TN-EGD) in comparison with transoral EGD (TO-EGD) for observation of the pharynx. Prospective study A total of 497 patients received unsedated TN-EGD with a 5.5 mm diameter endoscope or unsedated TO-EGD with endoscopes of 6.5 mm, 7.9 mm and 9.2 mm diameter. The rate of completion of pharyngeal observation and numbers of gag reflexes and cough reflexes were recorded. TN-EGD was performed in 175 patients and TO-EGD was performed in 322 patients. Pharyngeal observation was completed in 173 patients (98.9%) in the TN-EGD group and 235 patients (73.2%) in the TO-EGD group, a significant difference (p<0.001). The TN-EGD group had a low rate of occurrence of gag reflex (0.57%), in contrast, 28.3% of the TO-EGD group had a gag reflex, a significant difference (p<0.01). Multivariable analyses revealed that the use of TN-EGD was the only predictive factor for completion of pharyngeal observation (p<0.0001). TN-EGD is ideally suited to observation of the pharynx by unsedated EGD.

  5. Transoral robotic surgery for the management of obstructive sleep apnea: a systematic review and meta-analysis.

    PubMed

    Meccariello, Giuseppe; Cammaroto, Giovanni; Montevecchi, Filippo; Hoff, Paut T; Spector, Matthew E; Negm, Hesham; Shams, Medhat; Bellini, Chiara; Zeccardo, Ermelinda; Vicini, Claudio

    2017-02-01

    Obstructive sleep apnea-hypopnea syndrome (OSAHS) is a serious social health problem with significant implications on quality of life. Surgery for OSAHS has been criticized due to a lack of evidence to support its efficacy as well as the heterogeneous reporting of published outcomes. Moreover, the transoral robotic surgery (TORS) in the management of OSAHS is still in a relative infancy. Nevertheless, a review and meta-analysis of the published articles may be helpful. Among 195 articles, eight studies were included in the analysis. The mean of enrolled patients was 102.5 ± 107.9 (range 6-289) comprising a total of 820 cases. The mean age was 49 ± 3.27 and 285 patients underwent a previous sleep apnea surgery. The uvulopalatopharyngoplasty (UPPP) was the most common palatal procedure. The mean rate of failure was 34.4 % (29.5-46.2 %). Complications occurred in 21.3 % of the patients included in the analysis, most of them were classified as minor. Transient dysphagia represented the most common complication (7.2 %) followed by bleeding (4.2 %). TORS for the treatment of OSAHS appears to be a promising and safe procedure for selected patients seeking an alternative to continuous positive airway pressure (CPAP), although further researches are urgently needed.

  6. Salivary gland biopsy

    MedlinePlus

    Biopsy - salivary gland ... You have several pairs of salivary glands that drain into your mouth: A major pair in front of the ears (parotid glands) Another major pair beneath your jaw (submandibular ...

  7. Thymus Gland Anatomy

    MedlinePlus

    ... historical Searches are case-insensitive Thymus Gland, Adult, Anatomy Add to My Pictures View /Download : Small: 720x576 ... Large: 3000x2400 View Download Title: Thymus Gland, Adult, Anatomy Description: Anatomy of the thymus gland; drawing shows ...

  8. Adrenal Gland Disorders

    MedlinePlus

    ... adrenal gland disorders include Genetic mutations Tumors including pheochromocytomas Infections A problem in another gland, such as the pituitary, which helps to regulate the adrenal gland Certain medicines Treatment depends on which problem you have. Surgery or ...

  9. Adrenal Gland Tumors: Statistics

    MedlinePlus

    ... Gland Tumor: Statistics Request Permissions Adrenal Gland Tumor: Statistics Approved by the Cancer.Net Editorial Board , 03/ ... primary adrenal gland tumor is very uncommon. Exact statistics are not available for this type of tumor ...

  10. The vallecular line: an objective measure in evaluating the base of the tongue and vallecular cancers for transoral robotic surgery.

    PubMed

    Hai, Nabila; Taheri, M Reza; Sadeghi, Nader

    2013-01-01

    We hypothesized that the degree of the exophytic nature of the base of the tongue and vallecular cancers (BOTs) impacts the feasibility of transoral resection. The growth pattern of these cancers can be measured by the vallecular line (VL), which is the distance between the hyoid bone and the vallecular tip. The normal VL was measured by 3 radiologists on 50 magnetic resonance imaging scans. The VL was then measured on magnetic resonance imaging scans of patients with BOT cancers. The mean VL was 8.2 mm (6.4-10 mm) in the healthy patients. The mean VL of the patients with predominantly exophytic BOT cancer was 22.7 mm (20.6-24.8 mm). Postoperative images of these patients demonstrate minimal loss of the native tongue after transoral resection. The VL is a valuable objective measurement of the exophytic nature of BOT cancers. Predominantly exophytic BOT cancers are deemed more amenable for successful and functional transoral surgical resection.

  11. Computer-assisted transoral surgery with flexible robotics and navigation technologies: a review of recent progress and research challenges.

    PubMed

    Ren, Hongliang; Lim, Chwee Ming; Wang, Jiaole; Liu, Wei; Song, Shuang; Li, Zheng; Herbert, Geraint; Tse, Zion Tsz Ho; Tan, Zeqi

    2013-01-01

    This article reviews the flexible robotic surgery and navigation technologies that are currently available and under research development, in particular for transoral robotic surgery, in both broad and narrow senses. The clinical background, classifications, associated biomedical robotics applications, and surgical outcomes are illustrated in this new paradigm of minimally invasive surgery. The state-of-the-art robotic and navigation systems for transoral procedures are reviewed by identifying their key properties and considerations. The use of different materials and actuation methods by current robotic systems offers various movements for different purposes, and their characteristics are compared. The future research trends of robotic and navigation systems for transoral procedures are discussed in terms of emerging new material, actuation, and sensing technologies.

  12. Transoral robotic-assisted tongue base resection in pediatric obstructive sleep apnea syndrome: case presentation, clinical and technical consideration.

    PubMed

    Montevecchi, Filippo; Bellini, Chiara; Meccariello, Giuseppe; Hoff, Paul T; Dinelli, Elisa; Dallan, Iacopo; Corso, Ruggero M; Vicini, Claudio

    2017-02-01

    Pediatric obstructive sleep apnea syndrome (OSAS) is primarily caused by adenotonsillar hypertrophy. However, tongue base hypertrophy is increasingly being recognized as a cause, even after adenotonsillectomy. We report three cases of pediatric OSAS successfully treated by transoral robotic reduction of the tongue base. In all children, we were able to achieve improved retrolingual patency while avoiding significant procedure-related morbidity. In conclusion, tongue base reduction by transoral robotic surgery appears to be a feasible solution for the base of tongue obstruction due to lingual tonsil hypertrophy in pediatric patients.

  13. Pethidine hydrochloride is a better sedation method for pharyngeal observation by transoral endoscopy compared with no sedation and midazolam.

    PubMed

    Yamasaki, Yasushi; Ishihara, Ryu; Hanaoka, Noboru; Matsuura, Noriko; Kanesaka, Takashi; Akasaka, Tomofumi; Kato, Minoru; Hamada, Kenta; Tonai, Yusuke; Yamamoto, Sachiko; Takeuchi, Yoji; Higashino, Koji; Uedo, Noriya; Ito, Yuri; Yano, Masahiko; Iishi, Hiroyasu

    2017-01-01

    Standard surveillance methods for pharyngeal cancer have not been established. We conducted a randomized controlled trial to investigate the best sedation method for pharyngeal observation using transoral endoscopy. In total, 120 patients who underwent surveillance or diagnostic examinations for esophageal cancer were enrolled and divided equally into three groups (no sedation, midazolam, or pethidine hydrochloride). In the midazolam group, midazolam was given i.v. maintaining a Ramsay score of 3. In the pethidine group, pethidine hydrochloride (35 mg) given i.v. Seven sites in five pharyngeal regions were observed on insertion of the endoscope, and graded (0 = poor, 1 = good). After examination, the five pharyngeal regions were scored using a seven-point scale. Primary endpoint was the total score from the five pharyngeal regions. Secondary endpoints were the proportion of the perfect score using the seven-point scale, discomfort score, and adverse events. Mean total scores for the no sedation group, the midazolam group and the pethidine group were 5.7, 5.5, and 6.8, respectively (P < 0.0001). Proportion of patients with a perfect score for the no sedation group, the midazolam group and the pethidine group were 53%, 35%, and 89%, respectively (P < 0.0001). The pethidine group had better results than the other two groups. Discomfort score and adverse events were low in the pethidine group. Pethidine hydrochloride is a feasible and safe sedation method, and was superior to no sedation and midazolam regarding pharyngeal observation of esophageal cancer patients. © 2016 Japan Gastroenterological Endoscopy Society.

  14. Transbuccal versus transoral approach for management of mandibular angle fractures: a prospective, clinical and radiographic study

    PubMed Central

    2016-01-01

    Objectives We compared the transbuccal and transoral approaches in the management of mandibular angle fractures. Materials and Methods Sixty patients with mandibular angle fractures were randomly divided into two equal groups (A, transoral approach; group B, transbuccal approach) who received fracture reduction using a single 2.5 mm 4 holed miniplate with a bar using either of the two approaches. Intraoperatively, the surgical time and the ease of surgical assess for fixation were noted. Patients were followed at 1 week, 3 months, and 6 months postoperatively and evaluated clinically for post-surgical complications like scarring, infection, postoperative occlusal discrepancy, malunion, and non-union. Radiographically, the interpretation of fracture reduction was also performed by studying the fracture gap following reduction using orthopantomogram tracing. The data was tabulated and subjected to statistical analysis. A P-value less than 0.05 was considered significant. Results No significant difference was seen between the two groups for variables like surgical time and ease of fixation. Radiographic interpretation of fracture reduction revealed statistical significance for group B from points B to D as compared to group A. No cases of malunion/non-union were noted. A single case of hypertrophic scar formation was noted in group B at 6 months postsurgery. Infection was noted in 2 patients in group B compared to 6 patients in group A. There was significantly more occlusal discrepancy in group A compared to group B at 1 week postoperatively, but no long standing discrepancy was noted in either group at the 6 months follow-up. Conclusion The transbuccal approach was superior to the transoral approach with regard to radiographic reduction of the fracture gap, inconspicuous external scarring, and fewer postoperative complications. We preferred the transbuccal approach due to ease of use, minimal requirement for plate bending, and facilitation of plate placement in the

  15. An Assessment of Radiologically Inserted Transoral and Transgastric Gastroduodenal Stents to Treat Malignant Gastric Outlet Obstruction

    SciTech Connect

    Miller, Bethany H. T.; Griffiths, Ewen A.; Pursnani, Kishore G. Ward, Jeremy B.; Stockwell, Robert C.

    2013-12-15

    IntroductionSelf-expanding metallic stents (SEMS) are used to palliate malignant gastric outlet obstruction (GOO) and are useful in patients with limited life expectancy or severe medical comorbidity, which would preclude surgery. Stenting can be performed transorally or by a percutaneous transgastric technique. Our goal was to review the outcome of patients who underwent radiological SEMS insertion performed by a single consultant interventional radiologist. Methods: Patients were identified from a prospectively collected database held by one consultant radiologist. Data were retrieved from radiological reports, multidisciplinary team meetings, and the patients' case notes. Univariate survival analysis was performed. Results: Between December 2000 and January 2011, 100 patients (63 males, 37 females) had 110 gastroduodenal stenting procedures. Median age was 73 (range 39-89) years. SEMS were inserted transorally (n = 66) or transgastrically (n = 44). Site of obstruction was the stomach (n = 37), duodenum (n = 50), gastric pull-up (n = 10), or gastroenterostomy (n = 13). Seven patients required biliary stents. Technical success was 86.4 %: 83.3 % for transoral insertion, 90.9 % for transgastric insertion. Eleven patients developed complications. Median GOO severity score: 1 pre-stenting, 2 post-stenting (p = 0.0001). Median survival was 54 (range 1-624) days. Post-stenting GOO severity score was predictive of survival (p = 0.0001). Conclusions: The technical success rate for insertion of palliative SEMS is high. Insertional technique can be tailored to the individual depending on the location of the tumor and whether it is possible to access the stomach percutaneously. Patients who have successful stenting and return to eating a soft/normal diet have a statistically significant increase in survival.

  16. Transoral robotic surgery for parapharyngeal lesions: a case series of four benign tumours.

    PubMed

    Samoy, K; Lerut, B; Dick, C; Kuhweide, R; Vlaminck, S; Vauterin, T

    2015-01-01

    The parapharyngeal space (PPS) is an anatomically complex space in the vicinity of vital structures. With the introduction of the daVinci robot in head and neck surgery, the surgical robotic system is now being used to gain direct access to the parapharyngeal space and to excise the tumors endoscopically. This study evaluates the outcomes of four patients with benign PPS tumors treated with a transoral robotic surgery approach in a single centre. All patients with benign tumors of the PPS who underwent transoral resection (between January 2012 and June 2014) using the robot were included in this retrospective study. The study population comprised of two males and two females with a mean age of 52 (range 34-66 years). The parapharyngeal mass was successfully transorally removed in all cases. Overall, mean length of stay was 3.25 days with mean time to oral diet of one day. No intraoperative, perioperative or postoperative complications were encountered. The histological diagnosis was pleomorphic adenoma in two cases (50%). The other two cases were: schwannoma and angioma. There were no recurrences on radiological investigations during a mean follow-up of 14.5 months. MRI scan showed a stable residual fibrotic lesion in case of the angioma. The preoperative complaints of mucus in the throat, painless swelling of the soft palate or throat burden of all patients resolved after surgery. With the assistance of the surgical robotic system, benign tumors within the PPS can be excised safely without neck incisions. Further long-term evaluation is needed to define patient selection and the role of TORS for PPS neoplasms.

  17. Salivary Gland Disorders

    MedlinePlus

    Your salivary glands are in your mouth. You have three pairs of major salivary glands and hundreds of small (minor) glands. They make ... contains antibodies that can kill germs. Problems with salivary glands can cause them to become irritated and swollen. ...

  18. Long-term outcome and quality of life after transoral stapling for Zenker diverticulum

    PubMed Central

    Bonavina, Luigi; Aiolfi, Alberto; Scolari, Federica; Bona, Davide; Lovece, Andrea; Asti, Emanuele

    2015-01-01

    AIM: To investigate long-term results and quality of life after transoral stapling of Zenker diverticulum. METHODS: The data of all patients admitted to our institution for the surgical treatment of Zenker diverticulum were entered into a prospective database. Demographics, symptoms, intraoperative and postoperative data, morbidity, time to oral feeding, and length of hospital stay were recorded. All patients underwent upper gastrointestinal endoscopy and a barium swallow study to measure the length of the diverticulum from the apex of the septum to the bottom of the pouch. Transoral stapling was performed using a Weerda diverticuloscope under general anesthesia. Over time, the technique was modified by applying traction sutures to ease engagement of the common septum inside the stapler jaws. Perioperative variables, symptoms, long-term outcome, and quality of life were analyzed. The operation was considered successful if the patient reported complete remission (grade 1) or marked improvement (grade 2) of dysphagia, regurgitation, and respiratory symptoms. Statistical analysis was performed using Statistical Package for Social Science (SPSS, Version 15, SPSS, Inc., Chicago, IL). RESULTS: Between 2001 and 2013, the transoral approach was successfully completed in 100 patients with a median age of 75 years. Patients with a larger (≥ 3 cm) diverticulum were older than those with a smaller pouch (P < 0.038). Complications occurred in 4% of the patients but there was no mortality. A statistically significant improvement of dysphagia and regurgitation scores (P < 0.001) was recorded over a median follow-up of 63 mo. Similarly, a significant decrease in the median number of pneumonia episodes per year (P < 0.001) was recorded after surgery. The overall long-term success rate of the procedure was 76%. The success rate of the operation was greater in patients of 70 years of age or older compared to younger individuals (P = 0.038). Use of traction sutures on the septum was

  19. Identification of parathyroid glands: anatomical study and surgical implications.

    PubMed

    Melo, Catarina; Pinheiro, Susana; Carvalho, Lina; Bernardes, António

    2015-03-01

    While performing thyroid surgery, the unintentional lesion of parathyroid glands and laryngeal nerves results in a profound alteration in patient's quality of life. To minimize thyroid surgery morbidity, the surgeon must have an in-depth knowledge of the thyroid gland morphology and its anatomical relations in the anterior compartment of the neck. This work intended to simulate total thyroidectomies using cadaver parts and isolate fragments that may correspond to parathyroid glands. The thyroid glands and "eventual" parathyroid glands were then submitted to histological study. Ninety-two cadaver parts were used for macroscopic dissection. A total of 242 fragments were isolated, 154 of which were confirmed through histological study to be parathyroid glands. In 36 cases, all "eventual" parathyroid glands isolated during dissection were confirmed through histological verification. In 40 cases, some glands were confirmed. In 16 cases, none of the "eventual" parathyroid glands was confirmed. The 92 thyroid glands isolated during dissection were also submitted to histological study. In 21 thyroid glands, 16 parathyroid glands were identified in the histological cuts: 8 sub-capsular, 8 extra-capsular, 6 intra-thyroidal. There was no statistical difference between the dimensions of the parathyroid glands. Parathyroid gland identification and preservation are sometimes a challenge during thyroid surgery, difficulty that has been demonstrated during dissection of cadaver parts.

  20. Adrenal gland disorders.

    PubMed

    Berry, Matthew E

    2009-01-01

    Medical imaging of the adrenal glands is an important aspect of the diagnosis of any adrenal gland disorder. This article discusses the normal anatomy and functions of the adrenal glands, as well as specific adrenal gland disorders and how they are diagnosed and treated. Radiologic technologists need to understand the causes, signs, symptoms, diagnosis and management of disorders that prevent the adrenal glands from functioning properly.

  1. The University of Pennsylvania curriculum for training otorhinolaryngology residents in transoral robotic surgery.

    PubMed

    Sperry, Steven M; O'Malley, Bert W; Weinstein, Gregory S

    2014-01-01

    To define a curriculum for the development of robotic surgical skills in otorhinolaryngology residency training. A systematic review of the current literature on robotic surgery training was performed. Based on prior reports in other specialties, a curriculum for otorhinolaryngology residents was created that progresses through several modules, including didactics, inanimate skills laboratory, and operative experience. The curriculum for residents in otorhinolaryngology was designed as follows: didactics include an overview of the robotic device and instruments, a tutorial in basic controls and function, and a room setup and positioning. The anatomy and steps of transoral procedures are taught through books, videos, operative observations, and cadaver dissections. Skills are developed with a virtual reality robotic simulator and robotics labs. The operative experience progresses from case observation to bedside assistant to console surgeon. The role of the console surgeon progresses in a stepwise fashion, and the procedures of radical tonsillectomy, supraglottic partial laryngectomy, and base of tongue resection have been organized as a series of steps. A structured curriculum for training residents in transoral robotic surgery was developed. This training is important for otorhinolaryngology residents to acquire the knowledge and skills to perform robotic surgery safely. © 2015 S. Karger AG, Basel.

  2. Transoral incisionless fundoplication for gastro-esophageal reflux disease: Techniques and outcomes

    PubMed Central

    Testoni, Pier Alberto; Mazzoleni, Giorgia; Testoni, Sabrina Gloria Giulia

    2016-01-01

    Gastro-esophageal reflux disease (GERD) is a very common disorder that results primarily from the loss of an effective antireflux barrier, which forms a mechanical obstacle to the retrograde movement of gastric content. GERD can be currently treated by medical therapy, surgical or endoscopic transoral intervention. Medical therapy is the most common approach, though concerns have been increasingly raised in recent years about the potential side effects of continuous long-term medication, drug intolerance or unresponsiveness, and the need for high dosages for long periods to treat symptoms or prevent recurrences. Surgery too may in some cases have consequences such as long-lasting dysphagia, flatulence, inability to belch or vomit, diarrhea, or functional dyspepsia related to delayed gastric emptying. In the last few years, transoral incisionless fundoplication (TIF) has proved an effective and promising therapeutic option as an alternative to medical and surgical therapy. This review describes the steps of the TIF technique, using the EsophyX® device and the MUSETM system. Complications and their management are described in detail, and the recent literature regarding the outcomes is reviewed. TIF reconfigures the tissue to obtain a full-thickness gastro-esophageal valve from inside the stomach, by serosa-to-serosa plications which include the muscle layers. To date the procedure has achieved lasting improvement of GERD symptoms (up to six years), cessation or reduction of proton pump inhibitor medication in about 75% of patients, and improvement of functional findings, measured by either pH or impedance monitoring. PMID:27158533

  3. Augmented reality and cone beam CT guidance for transoral robotic surgery.

    PubMed

    Liu, Wen P; Richmon, Jeremy D; Sorger, Jonathan M; Azizian, Mahdi; Taylor, Russell H

    2015-09-01

    In transoral robotic surgery preoperative image data do not reflect large deformations of the operative workspace from perioperative setup. To address this challenge, in this study we explore image guidance with cone beam computed tomographic angiography to guide the dissection of critical vascular landmarks and resection of base-of-tongue neoplasms with adequate margins for transoral robotic surgery. We identify critical vascular landmarks from perioperative c-arm imaging to augment the stereoscopic view of a da Vinci si robot in addition to incorporating visual feedback from relative tool positions. Experiments resecting base-of-tongue mock tumors were conducted on a series of ex vivo and in vivo animal models comparing the proposed workflow for video augmentation to standard non-augmented practice and alternative, fluoroscopy-based image guidance. Accurate identification of registered augmented critical anatomy during controlled arterial dissection and en bloc mock tumor resection was possible with the augmented reality system. The proposed image-guided robotic system also achieved improved resection ratios of mock tumor margins (1.00) when compared to control scenarios (0.0) and alternative methods of image guidance (0.58). The experimental results show the feasibility of the proposed workflow and advantages of cone beam computed tomography image guidance through video augmentation of the primary stereo endoscopy as compared to control and alternative navigation methods.

  4. Augmented reality and cone beam CT guidance for transoral robotic surgery

    PubMed Central

    Richmon, Jeremy D.; Sorger, Jonathan M.; Azizian, Mahdi; Taylor, Russell H.

    2015-01-01

    In transoral robotic surgery preoperative image data do not reflect large deformations of the operative workspace from perioperative setup. To address this challenge, in this study we explore image guidance with cone beam computed tomographic angiography to guide the dissection of critical vascular landmarks and resection of base-of-tongue neoplasms with adequate margins for transoral robotic surgery. We identify critical vascular landmarks from perioperative c-arm imaging to augment the stereoscopic view of a da Vinci si robot in addition to incorporating visual feedback from relative tool positions. Experiments resecting base-of-tongue mock tumors were conducted on a series of ex vivo and in vivo animal models comparing the proposed workflow for video augmentation to standard non-augmented practice and alternative, fluoroscopy-based image guidance. Accurate identification of registered augmented critical anatomy during controlled arterial dissection and en bloc mock tumor resection was possible with the augmented reality system. The proposed image-guided robotic system also achieved improved resection ratios of mock tumor margins (1.00) when compared to control scenarios (0.0) and alternative methods of image guidance (0.58). The experimental results show the feasibility of the proposed workflow and advantages of cone beam computed tomography image guidance through video augmentation of the primary stereo endoscopy as compared to control and alternative navigation methods. PMID:26531203

  5. [Transoral vertebroplasty: an alternative for operative treatment of metastases of the upper cervical spine].

    PubMed

    Krüger, A; Schnabel, M; Hegele, A; Ruchholtz, S; Stiletto, R

    2009-04-01

    Analogue to the demographic changes and the accompanying increased incidence of tumorous diseases, the number of patients with metastatic bone tumors of the spine is also increasing. Metastatic bone tumors are the most significant cause of pain in cancer patients. Pain and instability are the main indications for surgery. Minimally invasive procedures are recommended in patients with a poor medical condition and with a poor prognosis.Transoral vertebroplasty can be successfully used to reduce pain and provide stability in the palliative treatment of metastases of the vertebral axis. This procedure has the advantage of providing rapid pain relief and spinal stabilization.The operative technique is described and discussed with reference to the current literature. As an example the case of a 67-year-old patient is described, who was suffering from prostate cancer and a painful metastasis of the dens axis. After interdisciplinary consensus, transoral vertebroplasty was performed. The procedure was effective in achieving pain relief and providing stability and 7 months after the operation no further spinal metastases had occurred.

  6. Tendons, Concentric Tubes, and a Bevel Tip: Three Steerable Robots in One Transoral Lung Access System.

    PubMed

    Swaney, Philip J; Mahoney, Arthur W; Remirez, Andria A; Lamers, Erik; Hartley, Bryan I; Feins, Richard H; Alterovitz, Ron; Webster, Robert J

    2015-05-01

    Lung cancer is the most deadly form of cancer, and survival depends on early-stage diagnosis and treatment. Transoral access is preferable to traditional between-the-ribs needle insertion because it is less invasive and reduces risk of lung collapse. Yet many sites in the peripheral zones of the lung or distant from the bronchi cannot currently be accessed transorally, due to the relatively large diameter and lack of sufficient steerablity of current instrumentation. To remedy this, we propose a new robotic system that uses a tendon-actuated device (bronchoscope) as a first stage for deploying a concentric tube robot, which itself is a vehicle through which a bevel steered needle can be introduced into the soft tissue of the lung outside the bronchi. In this paper we present the various components of the system and the workflow we envision for deploying the robot to a target using image guidance. We describe initial validation experiments in which we puncture ex vivo bronchial wall tissue and also target a nodule in a phantom with an average final tip error of 0.72 mm.

  7. Tendons, Concentric Tubes, and a Bevel Tip: Three Steerable Robots in One Transoral Lung Access System

    PubMed Central

    Swaney, Philip J.; Mahoney, Arthur W.; Remirez, Andria A.; Lamers, Erik; Hartley, Bryan I.; Feins, Richard H.; Alterovitz, Ron; Webster, Robert J.

    2015-01-01

    Lung cancer is the most deadly form of cancer, and survival depends on early-stage diagnosis and treatment. Transoral access is preferable to traditional between-the-ribs needle insertion because it is less invasive and reduces risk of lung collapse. Yet many sites in the peripheral zones of the lung or distant from the bronchi cannot currently be accessed transorally, due to the relatively large diameter and lack of sufficient steerablity of current instrumentation. To remedy this, we propose a new robotic system that uses a tendon-actuated device (bronchoscope) as a first stage for deploying a concentric tube robot, which itself is a vehicle through which a bevel steered needle can be introduced into the soft tissue of the lung outside the bronchi. In this paper we present the various components of the system and the workflow we envision for deploying the robot to a target using image guidance. We describe initial validation experiments in which we puncture ex vivo bronchial wall tissue and also target a nodule in a phantom with an average final tip error of 0.72 mm. PMID:26157600

  8. [A case of basilar impression treated with mandible splitting transoral approach].

    PubMed

    Young-Su, P; Ishikawa, J; Matsumoto, M; Sato, T; Owaki, H

    1997-05-01

    We report a case of basilar impression treated with mandible splitting transoral approach surgery. A 39-year-old man presented a ten-year history of gait disturbance. He had experienced acceleration of his spastic paraparesis for the past few years. Neurological examination on admission demonstrated tetraparesis (MMT4/5), severe hyperreflexia in his arms and legs, severe sensory loss below C2, urinary retention and inability to open his mouth widely. Radiological findings showed the dens and the body of C2 are deeply invaginated to the atlas and the foramen magnum and medulla and upper cervical cord were markedly compressed by this basilar invagination. After carrying out posterior decompression and occipito-cervical fixation, we attempted to remove the invaginated dens and the C2 vertebral body using a conventional transoral approach. But limitation of mouth opening made operative fields narrow. Consequently because of insufficient anterior decompression his neurological deficits could not be alleviated. Employment of mandible splitting procedure brought about a wide operative view so that complete removal of the residual dens and 70% drilling out of the C2 body was made possible. Postoperative complications were negligible. Finally, great alleviation of his deficits was achieved. Mandible splitting procedure is effective for obtaining a wide operative field on the anterior approach to the craniocervical junction.

  9. Transoral robotic-assisted surgery for the approach to anterior cervical spine lesions.

    PubMed

    Molteni, Gabriele; Greco, Marco Giuseppe; Presutti, Livio

    2017-09-01

    The Da Vinci robotic surgical system is increasingly being used by head and neck surgeons in transoral approaches for head and neck cancer. Our experience using the Da Vinci system for transoral robotic-assisted surgery (TORS) is presented. The feasibility of TORS for lesions involving the anterior portion of C1-C2 and the cranio-cervical junction has been evaluated from an anatomical viewpoint in a cadaveric laboratory. Two patients treated using the Da Vinci system to reach C1-C2 benign lesions are presented. The anatomical cadaveric study showed that this approach is safe and feasible. The first two cases which we describe confirmed the advantages of the Da Vinci system in the anterior approach to the cervical spine and allowed the limitations of this procedure to be assessed. TORS may be useful to reach anterior lesions of the cervical spine localized at the level of C1 and C2: first, for removal of small benign and well-delineated lesions; and second, for diagnostic purposes with biopsy of large lesions. Further studies and new instruments are needed to confirm the safety and results of this approach in terms of morbidity.

  10. Gap arthroplasty of temporomandibular joint ankylosis by transoral access: a case series.

    PubMed

    Rajan, R; Reddy, N V V; Potturi, A; Jhawar, D; Muralidhar, P V; Reddy, B

    2014-12-01

    This article describes a technique of gap arthroplasty in temporomandibular joint (TMJ) ankylosis performed by transoral access. The treatment of TMJ ankylosis by creating an adequate gap is of paramount importance in preventing any future recurrence and this can be achieved only when good access is gained to this complex anatomical joint. Five patients with TMJ ankylosis (eight TMJ) were treated by gap arthroplasty using an intraoral approach. The average mouth opening before surgery was 8.6mm and the average mouth opening achieved postsurgery was 37.9 mm. The average follow-up time was 13 months and none of the patients had any recurrence or significant complications during or after surgery. Our technique relies on the use of a stable landmark to trace the superior-most extent of the ankylotic mass thereby facilitating the removal of the entire mass including the medial extent. We found that even though transoral access is technically challenging and took an average time of 84 min, it has many advantages over conventional extraoral approaches in terms of facial scars and facial nerve injury. The authors also emphasize the importance of good postoperative physiotherapy and presurgical patient counselling to prevent future recurrences.

  11. Salvage total laryngectomy after conservation laryngeal surgery for recurrent laryngeal squamous cell carcinoma.

    PubMed

    De Virgilio, A; Greco, A; Bussu, F; Gallo, A; Rosati, D; Kim, S-H; Wang, C-C; Conte, M; Pagliuca, G; De Vincentiis, M

    2016-10-01

    The aim of the present study was to evaluate the oncological efficacy of salvage total laryngectomy in patients who had previously undergone supracricoid partial laryngectomy or transoral laser microsurgery for treatment of laryngeal squamous cell carcinoma. We retrospectively reviewed the medical, surgical and pathological records of 35 patients who underwent salvage total laryngectomy after recurrence of laryngeal cancer (following supracricoid partial laryngectomy or transoral laser microsurgery). Kaplan-Meier survival curves as well as univariate and multivariate analyses of prognostic factors were performed. No statistically significant differences were seen comparing the supracricoid partial laryngectomy group with the transoral laser microsurgery group for overall survival and disease-specific survival at 3 years (OS = 38% vs. 52%, p = 0.16; DSS = 40% vs. 61%, p = 0.057) or locoregional control at 2 years (LRC = 40% vs. 54%, p = 0.056). A trend indicating worse survival and locoregional control for supracricoid partial laryngectomy patients emerged. Preservation of the osteocartilaginous frame in transoral laser microsurgery could hypothetically result in better salvageability of anterior recurrences with extralaryngeal spread.

  12. Congenital deficiency of meibomian glands.

    PubMed Central

    Bron, A J; Mengher, L S

    1987-01-01

    A 16-year-old girl presented with contact lens intolerance. She was found to have a marked deficiency of meibomian glands in the upper lids and almost total absence in the lower lids. Evidence of tear film instability was found and attributed to deficient lid oil production. A daily wear soft contact lens was later fitted and tolerated. PMID:3580344

  13. Does drug-induced sleep endoscopy predict surgical success in transoral robotic multilevel surgery in obstructive sleep apnea?

    PubMed

    Meraj, Taha S; Muenz, Daniel G; Glazer, Tiffany A; Harvey, Rebecca S; Spector, Matthew E; Hoff, Paul T

    2017-04-01

    The aim of this study was to determine if drug-induced sleep endoscopy (DISE) was predictive of success for patients undergoing transoral robotic surgery (TORS) and multilevel procedures for sleep apnea. Retrospective case series of patients who underwent TORS surgery for sleep apnea METHODS: Before and after polysomnograms were analyzed to assess improvement, success, and cure. Improvement was defined as any decrease in apnea-hypopnea index (AHI), success as an AHI <20 with a decrease >50%, and cure as an AHI <5. DISE videos were scored using the NOHL (nose, oropharynx, hypopharynx, larynx) and VOTE (velum, oropharynx, tongue, epiglottis) classification systems. One hundred one patients were available for analysis. Eighty-seven percent of patients had an improvement in their AHI. Fifty-one percent met criteria for success, whereas 17% were cured. The degree of collapse at individual NOHL and VOTE subsites as well as total additive scores did not predict improvement, success, or cure. Patients with no oropharyngeal lateral collapse in the VOTE classification system were more likely to improve following surgery (P = .001); however, this effect did not hold for success or cure. Multivariate analysis of DISE variables was not predictive of success. In obstructive sleep apnea patients, there is a 51% success rate and a 17% cure rate. DISE, as scored by the NOHL and VOTE system, did not readily identify patients who would benefit most from surgery. Patients with lateral oropharyngeal collapse may be poorer candidates. Prospective, larger studies are required to further evaluate the use of DISE in predicting success following TORS. 4 Laryngoscope, 127:971-976, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

  14. The development and evaluation of individualized templates to assist transoral C2 articular mass or transpedicular screw placement in TARP-IV procedures: adult cadaver specimen study

    PubMed Central

    Li, Xue-Shi; Wu, Zeng-Hui; Xia, Hong; Ma, Xiang-Yang; Ai, Fu-Zhi; Zhang, Kai; Wang, Jian-Hua; Mai, Xiao-Hong; Yin, Qing-Shui

    2014-01-01

    OBJECTIVES: The transoral atlantoaxial reduction plate system treats irreducible atlantoaxial dislocation from transoral atlantoaxial reduction plate-I to transoral atlantoaxial reduction plate-III. However, this system has demonstrated problems associated with screw loosening, atlantoaxial fixation and concealed or manifest neurovascular injuries. This study sought to design a set of individualized templates to improve the accuracy of anterior C2 screw placement in the transoral atlantoaxial reduction plate-IV procedure. METHODS: A set of individualized templates was designed according to thin-slice computed tomography data obtained from 10 human cadavers. The templates contained cubic modules and drill guides to facilitate transoral atlantoaxial reduction plate positioning and anterior C2 screw placement. We performed 2 stages of cadaveric experiments with 2 cadavers in stage one and 8 in stage two. Finally, guided C2 screw placement was evaluated by reading postoperative computed tomography images and comparing the planned and inserted screw trajectories. RESULTS: There were two cortical breaching screws in stage one and three in stage two, but only the cortical breaching screws in stage one were ranked critical. In stage two, the planned entry points and the transverse angles of the anterior C2 screws could be simulated, whereas the declination angles could not be simulated due to intraoperative blockage of the drill bit and screwdriver by the upper teeth. CONCLUSIONS: It was feasible to use individualized templates to guide transoral C2 screw placement. Thus, these drill templates combined with transoral atlantoaxial reduction plate-IV, may improve the accuracy of transoral C2 screw placement and reduce related neurovascular complications. PMID:25518033

  15. Salivary Gland Cancer: Risk Factors

    MedlinePlus

    ... Cancer > Salivary Gland Cancer: Risk Factors Request Permissions Salivary Gland Cancer: Risk Factors Approved by the Cancer.Net ... f t k e P Types of Cancer Salivary Gland Cancer Guide Cancer.Net Guide Salivary Gland Cancer ...

  16. Pituitary Gland Disorders Overview

    MedlinePlus

    ... y Cuidadores Hormones and Health Journey Through the Endocrine System Endocrine Disrupting Chemicals (EDCs) Endocrine Glands and Types ... Clinical Trials Hormones and Health Journey Through the Endocrine System Endocrine Disrupting Chemicals (EDCs) Endocrine Glands and Types ...

  17. Parathyroid glands (image)

    MedlinePlus

    The 4 parathyroid glands are located near or attached to the back side of the thyroid gland and produce pararthyroid hormone (PTH). Parathyroid hormone regulates calcium, phosphorus, and magnesium balance within ...

  18. Salivary gland tumors

    MedlinePlus

    ... cancers Salivary duct stones Salivary gland infections Dehydration Sarcoidosis Sjögren syndrome The most common type of salivary ... Cancer Cirrhosis Salivary duct stones Salivary gland infections Sarcoidosis Tumor Review Date 10/30/2015 Updated by: ...

  19. Adrenal Gland Cancer

    MedlinePlus

    ... either benign or malignant. Benign tumors aren't cancer. Malignant ones are. Most adrenal gland tumors are ... and may not require treatment. Malignant adrenal gland cancers are uncommon. Types of tumors include Adrenocortical carcinoma - ...

  20. Contact endoscopy for identifying the parathyroid glands during thyroidectomy.

    PubMed

    Guimarães, A V; Brandão, L G; Dedivitis, R A

    2010-02-01

    Aim of this study was to analyse contact endoscopy as an auxiliary method for identifying parathyroid glands during thyroid surgery and to identify other variables that may interfere with this correlation. Overall, 125 patients underwent thyroid surgery between January 2004 and February 2006. The variables analysed were: the total duration of surgery; time taken to locate and identify parathyroid glands; improvement in identifying these; numbers of parathyroid glands located by the surgeon and confirmed by contact endoscopy; histopathological diagnosis; presence of thyroiditis; thyroid weight; number of parathyroid glands left in thyroid specimens; and number of parathyroid gland autotransplantations. A total of 331 parathyroid glands were observed by the surgeon. However, 282 glands were identified by contact endoscopy. Nine parathyroid glands (7.2%) were observed together with thyroid specimens (Kappa = 0.534). The longer the total duration of surgery (p = 0.03) and time taken to locate and identify (p = 0.00) the parathyroid glands by contact endoscopy, the lower the observed agreement. The second year of performing contact endoscopy led to better agreement between the results (p = 0.02). In conclusion, contact endoscopy is an efficient auxiliary method for identifying parathyroid glands during thyroid surgery. During the period studied, association between total duration of surgery and time taken to locate and identify parathyroid glands was statistically significant.

  1. Assessment of Surgical Learning Curves in Transoral Robotic Surgery for Squamous Cell Carcinoma of the Oropharynx.

    PubMed

    Albergotti, William G; Gooding, William E; Kubik, Mark W; Geltzeiler, Mathew; Kim, Seungwon; Duvvuri, Umamaheswar; Ferris, Robert L

    2017-06-01

    Transoral robotic surgery (TORS) is increasingly employed as a treatment option for squamous cell carcinoma of the oropharynx (OPSCC). Measures of surgical learning curves are needed particularly as clinical trials using this technology continue to evolve. To assess learning curves for the oncologic TORS surgeon and to identify the number of cases needed to identify the learning phase. A retrospective review of all patients who underwent TORS for OPSCC at the University of Pittsburgh Medical Center between March 2010 and March 2016. Cases were excluded for involvement of a subsite outside of the oropharynx, for nonmalignant abnormality or nonsquamous histology, unknown primary, no tumor in the main specimen, free flap reconstruction, and for an inability to define margin status. Transoral robotic surgery for OPSCC. Primary learning measures defined by the authors include the initial and final margin status and time to resection of main surgical specimen. A cumulative sum learning curve was developed for each surgeon for each of the study variables. The inflection point of each surgeon's curve was considered to be the point signaling the completion of the learning phase. There were 382 transoral robotic procedures identified. Of 382 cases, 160 met our inclusion criteria: 68 for surgeon A, 37 for surgeon B, and 55 for surgeon C. Of the 160 included patients, 125 were men and 35 were women. The mean (SD) age of participants was 59.4 (9.5) years. Mean (SD) time to resection including robot set-up was 79 (36) minutes. The inflection points for the final margin status learning curves were 27 cases (surgeon A) and 25 cases (surgeon C). There was no inflection point for surgeon B for final margin status. Inflection points for mean time to resection were: 39 cases (surgeon A), 30 cases (surgeon B), and 27 cases (surgeon C). Using metrics of positive margin rate and time to resection of the main surgical specimen, the learning curve for TORS for OPSCC is surgeon

  2. A possible sequela of transoral approach to the upper cervical spine. Velopharyngeal incompetence.

    PubMed

    Cantarella, G; Mazzola, R F; Benincasa, A

    1998-03-01

    The authors describe a case of velopharyngeal incompetence (VPI), as a consequence to the neurosurgical treatment for a complex malformation of the cranio-spinal junction. A 61-year-old woman underwent a transoral-transvelar surgical approach for odontoid resection. One month later surgical fixation of the posterior spine with autologous iliac bone graft was performed. Following these operations the patient presented a marked alteration of speech intellegibility due to hypernasal voice resonance and through incapability to articulate the oral phonemes correctly. She also complained of nasal regurgitation of fluids and solids while swallowing. She underwent a clinical phoniatric assessment of voice and speech. Videonasopharyngoscopy allowed us to inspect the velopharyngeal sphincter and to show clearly the type and morphology of its closure defect. Correction of VPI was achieved by means of a velopharyngoplasty (pharyngeal flap), in spite of technical difficulties due to local scarring and to a problematic exposure of the surgical field.

  3. Transoral robotic surgery (TORS): a new tool for high risk tracheostomy decannulation.

    PubMed

    Montevecchi, F; Cammaroto, G; Meccariello, G; Hoff, P T; Corso, R M; Galletti, C; Al-Rawashdeh, M F H; Vicini, C

    2017-02-01

    Tracheostomy decannulation has always been considered a procedure with an attendant risk, especially in patients with a reduced upper airway diameter as is commonly observed in the obstructive sleep apnoea (OSA) population. We report on 4 cases where transoral robotic surgery (TORS) helped in the management of long-term cannulated patients. The aims of our paper are: 1. To demonstrate how the otolaryngology team can help identify patients at high risk for decannulation failure; and 2. To demonstrate how TORS may aid in the decannulation process of patients at high risk for failure due to severe tongue base hypertrophy. From our experience, TORS appears to offer an effective option to aid in the decannulation of patients with a severe hypertrophy of the base of tongue and floppy epiglottis.

  4. Transoral robotic surgery for the pediatric head and neck surgeries.

    PubMed

    Erkul, Evren; Duvvuri, Umamaheswar; Mehta, Deepak; Aydil, Utku

    2017-03-01

    Pediatric robotic surgery is a relatively new technology that has been shown to be safe and feasible for a number of pediatric procedures. Our literature analysis was performed using Pubmed database between January 2005 and December 2015, using key words: "robotic," "robotic surgery," "TORS," "pediatric," "children," "head and neck," and "da Vinci". We selected only publications in English. Eight published reports met the selection criteria. We totally found 41 patients, and the age range was between 2 months and 19 years. The cases are 16 only lingual tonsillectomy, nine base of tongue and lingual tonsillectomy, two malignant disease in the oropharynx (high-grade undifferentiated sarcoma and biphasic synovial sarcoma), one tongue base thyroglossal duct cyst, 11 laryngeal cleft cyst, one posterior glottic stenosis, and one congenital true vocal cord paralysis surgeries. One intraoperative complication was reported. No patient needed postoperative tracheotomy. Hospital duration time had a range of 1-16 days. TORS is new for pediatric patients in head and neck areas, and there were few reports. It is becoming increasingly used in head and neck surgeries and those reports above are encouraging for pediatric robotic airway surgeries in otolaryngology in the future.

  5. Transoral robotic surgery in the seated position: Rethinking our operative approach.

    PubMed

    Moore, Eric J; Van Abel, Kathryn M; Olsen, Kerry D

    2017-01-01

    Transoral surgery (TOS) is commonly performed in a supine patient with an oral retractor. Paradoxically, this strategy can create difficulty with visualizing and accessing pathology at the base of tongue, inferior pharynx, and larynx. We investigate the feasibility of TOS with the patient in the seated position. Pilot study. TOS utilizing the da Vinci Robotic Surgical Xi and Si systems (Intuitive Surgical, Sunnyvale, CA) was performed on a fresh cadaver placed in both the traditional supine position and the seated position. Transoral robotic surgery (TORS) in the seated position was then performed on two patients for a supraglottic laryngectomy and a hypopharyngeal carcinoma resection. Visualization of the entire upper aerodigestive tract was possible in the cadaver and two patients in the seated position. The Si was superior for docking, instrumentation, and assistant access. The minimum operating table height is critical for successful access. Advantages of this position included increased posterior airway/operative space by approximately 2 cm, ability to manipulate the surgical field (nonrigid retraction), and improved visualization. Surgical procedures were completed in comparable times compared with standard TORS procedures. There were no complications related to seated TORS. TORS in the seated position was both safe and effective in this pilot study. It allows the surgeon to optimally operate in the inferior pharynx and larynx without the limitation of line of site access and visualization. A paradigm shift in patient positioning during TOS may allow improved surgical access and even greater patient candidacy. Further clinical investigation into this technique is warranted. NA Laryngoscope, 127:122-126, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

  6. Autofluorescence lifetime imaging during transoral robotic surgery: a clinical validation study of tumor detection (Conference Presentation)

    NASA Astrophysics Data System (ADS)

    Lagarto, João. L.; Phipps, Jennifer E.; Unger, Jakob; Faller, Leta M.; Gorpas, Dimitris; Ma, Dinglong M.; Bec, Julien; Moore, Michael G.; Bewley, Arnaud F.; Yankelevich, Diego R.; Sorger, Jonathan M.; Farwell, Gregory D.; Marcu, Laura

    2017-02-01

    Autofluorescence lifetime spectroscopy is a promising non-invasive label-free tool for characterization of biological tissues and shows potential to report structural and biochemical alterations in tissue owing to pathological transformations. In particular, when combined with fiber-optic based instruments, autofluorescence lifetime measurements can enhance intraoperative diagnosis and provide guidance in surgical procedures. We investigate the potential of a fiber-optic based multi-spectral time-resolved fluorescence spectroscopy instrument to characterize the autofluorescence fingerprint associated with histologic, morphologic and metabolic changes in tissue that can provide real-time contrast between healthy and tumor regions in vivo and guide clinicians during resection of diseased areas during transoral robotic surgery. To provide immediate feedback to the surgeons, we employ tracking of an aiming beam that co-registers our point measurements with the robot camera images and allows visualization of the surgical area augmented with autofluorescence lifetime data in the surgeon's console in real-time. For each patient, autofluorescence lifetime measurements were acquired from normal, diseased and surgically altered tissue, both in vivo (pre- and post-resection) and ex vivo. Initial results indicate tumor and normal regions can be distinguished based on changes in lifetime parameters measured in vivo, when the tumor is located superficially. In particular, results show that autofluorescence lifetime of tumor is shorter than that of normal tissue (p < 0.05, n = 3). If clinical diagnostic efficacy is demonstrated throughout this on-going study, we believe that this method has the potential to become a valuable tool for real-time intraoperative diagnosis and guidance during transoral robot assisted cancer removal interventions.

  7. Load evaluation of the da Vinci surgical system for transoral robotic surgery.

    PubMed

    Fujiwara, Kazunori; Fukuhara, Takahiro; Niimi, Koji; Sato, Takahiro; Kitano, Hiroya

    2015-12-01

    Transoral robotic surgery, performed with the da Vinci surgical system (da Vinci), is a surgical approach for benign and malignant lesions of the oral cavity and laryngopharynx. It provides several unique advantages, which include a 3-dimensional magnified view and ability to see and work around curves or angles. However, the current da Vinci surgical system does not provide haptic feedback. This is problematic because the potential risks specific to the transoral use of the da Vinci include tooth injury, mucosal laceration, ocular injury and mandibular fracture. To assess the potential for intraoperative injuries, we measured the load of the endoscope and the instrument of the da Vinci Si surgical system. We pressed the endoscope and instrument of the da Vinci Si against Load cell six times each and measured the dynamic load and the time-to-maximum load. We also struck the da Vinci Si endoscope and instrument against the Load cell six times each and measured the impact load. The maximum dynamic load was 7.27 ± 1.31 kg for the endoscope and 1.90 ± 0.72 for the instrument. The corresponding time-to-maximum loads were 1.72 ± 0.22 and 1.29 ± 0.34 s, but the impact loads were significantly lower than the dynamic load. It remains possible that a major load is exerted on adjacent structures by continuous contact with the endoscope and instrument of da Vinci Si. However, there is a minor delay in reaching the maximum load. Careful monitoring by an on-site assistant may, therefore, help prevent contiguous injury.

  8. Adjuvant radiotherapy after transoral laser microsurgery for advanced squamous carcinoma of the head and neck

    SciTech Connect

    Pradier, Olivier . E-mail: opradier@gwdg.de; Christiansen, Hans; Schmidberger, Heinz; Martin, Alexios; Jaeckel, Martin C.; Steiner, Wolfgang; Ambrosch, Petra; Kahler, Elke; Hess, Clemens F.

    2005-12-01

    Purpose: To evaluate the efficacy of an adjuvant radiotherapy after transoral laser microsurgery for advanced squamous cell carcinoma of the head and neck and to show that a less invasive surgery with organ preservation in combination with radiotherapy is an alternative to a radical treatment. Patients and Methods: Between 1987 and 2000, 208 patients with advanced squamous cell carcinoma of the head and neck were treated with postoperative radiotherapy after surgical CO{sub 2} laser resection. Primary sites included oral cavity, 38; oropharynx, 88; larynx, 36; hypopharynx, 46. Disease stages were as follows: Stage III, 40 patients; Stage IV, 168 patients. Before 1994, the treatment consisted of a split-course radiotherapy with carboplatinum (Treatment A). After 1994, the patients received a conventional radiotherapy (Treatment B). Results: Patients had 5-year locoregional control and disease-specific survival (DSS) rates of 68% and 48%, respectively. The 5-year DSS was 70% and 44% for Stages III and IV, respectively (p = 0.00127). Patients treated with a hemoglobin level greater or equal to 13.5 g/dL before radiotherapy had a 5-year DSS of 55% as compared with 39% for patients treated with a hemoglobin level greater than 13.5 g/dL (p = 0.0054). Conclusion: In this series of patients with advanced head-and-neck tumors, transoral laser surgery in combination with adjuvant radiotherapy resulted in locoregional control and DSS rates similar to those reported for radical surgery followed by radiotherapy. Treatment B has clearly been superior to Treatment A. A further improvement of our treatment regimen might be expected by the combination of adjuvant radiotherapy with concomitant platinum-based chemotherapy.

  9. [Comparative ultrastructural study of parotid gland, lacrimal gland and pituitary gland between miniature pig and mouse].

    PubMed

    Yan, Xing; Hai, Bo; Sun, Yi-lin; Zhang, Chun-mei; Wang, Song-ling

    2009-02-01

    To study the ultrastructure of parotid glands, lacrimal glands and pituitary glands between miniature pig and mouse. Five adult miniature pigs and 5 mice were studied. Ultrastructure of their parotid glands, lacrimal glands, and pituitary glands was observed. The secretary granules in acinar cell of miniature pig parotid glands showed higher density and more aequalis than those of mice. The cell apparatus in acinar cell of mouse parotid glands were more plentiful than those of miniature pigs. The secretary granules on blood vessel wall were richer in parotid gland of miniature pigs compared with mouse parotid gland. Lacrimal gland had the similar ultrastructure to parotid gland in these two animals. Many blood vessel antrum were found in pituitary glands of these two animals. Compared with mouse parotid glands, there are more secretary granules in acinar cells and vascular endothelial cells in miniature pig parotid glands, which might enter blood stream and have function of endocrine secretion.

  10. Voluminous Myoepithelioma of the Minor Salivary Glands Involving the Base of the Tongue

    PubMed Central

    Policarpo, Mario; Longoni, Valentina; Spina, Paolo; Pia, Francesco

    2016-01-01

    Myoepithelioma is an extremely rare tumour subtype and diagnosis is based on a wide variation of cellular morphology. FNAC specimens do not always suffice for a definitive differential diagnosis which depends on histology and immunohistochemistry of the lesion. Case Presentation. A 54-year-old female came to our attention with dysphagia and dyslalia of 6-month standing. Ear, Nose, and Throat (ENT) examination revealed a voluminous mass on the right portion of the base of her tongue, where postcontrast T2-weighted Magnetic Resonance Imaging (MRI) evidenced a hyperintense lesion. The fine-needle aspiration specimen taken for cytology was not diagnostic, as a differential diagnosis between myoepithelioma and a malignant neoplasm of the salivary glands necessitates parameters that cytology alone cannot provide. Therefore, the whole lesion was excised by diode laser through a transoral approach. Histology and immunohistochemistry of the completely excised lesion confirmed a myoepithelioma. PMID:27034872

  11. Voluminous Myoepithelioma of the Minor Salivary Glands Involving the Base of the Tongue.

    PubMed

    Policarpo, Mario; Longoni, Valentina; Garofalo, Pietro; Spina, Paolo; Pia, Francesco

    2016-01-01

    Myoepithelioma is an extremely rare tumour subtype and diagnosis is based on a wide variation of cellular morphology. FNAC specimens do not always suffice for a definitive differential diagnosis which depends on histology and immunohistochemistry of the lesion. Case Presentation. A 54-year-old female came to our attention with dysphagia and dyslalia of 6-month standing. Ear, Nose, and Throat (ENT) examination revealed a voluminous mass on the right portion of the base of her tongue, where postcontrast T2-weighted Magnetic Resonance Imaging (MRI) evidenced a hyperintense lesion. The fine-needle aspiration specimen taken for cytology was not diagnostic, as a differential diagnosis between myoepithelioma and a malignant neoplasm of the salivary glands necessitates parameters that cytology alone cannot provide. Therefore, the whole lesion was excised by diode laser through a transoral approach. Histology and immunohistochemistry of the completely excised lesion confirmed a myoepithelioma.

  12. Transoral endoscopic thyroidectomy vestibular approach (TOETVA) for Graves’ disease: a comparison of surgical results with open thyroidectomy

    PubMed Central

    Jitpratoom, Pornpeera; Ketwong, Khwannara; Sasanakietkul, Thanyawat

    2016-01-01

    Background Transoral endoscopic thyroidectomy vestibular approach (TOETVA) provides excellent cosmetic results from its potential for scar-free operation. The procedure has been applied successfully for Graves’ disease by the authors of this work and compared with the standard open cervical approach to evaluate its safety and outcomes. Methods From January 2014 to November 2016, a total of 97 patients with Graves’ disease were reviewed retrospectively. Open thyroidectomy (OT) and TOETVA were performed in 49 patients and 46 patients, respectively. For TOETVA, a three-port technique through the oral vestibule was utilized. The thyroidectomy was done endoscopically using conventional laparoscopic instruments and an ultrasonic device. Patient demographics and surgical variables, including operative time, blood loss, and complications, were investigated and compared. Results TOETVA was performed successfully in all 45 patients, although conversion to open surgery was deemed necessary in one patient. All patient characteristics for both groups were similar. Operative time was shorter for the OT group compared to the TOETVA group, which totaled 101.97±24.618 and 134.11±31.48 minutes, respectively (P<<0.5). Blood loss was comparable for both groups. The visual analog scale (VAS) pain score for the TOETVA group was significantly lower than for the OT group on day 1 (2.08±1.53 vs. 4.57±1.35), day 2 (0.84±1.12 vs. 2.57±1.08) and day 3 (0.33±0.71 vs. 1.08±1.01) (P<<0.05). Transient recurrent laryngeal nerve (RLN) palsy was found in four and two cases of TOETVA and OT group, respectively. Transient hypocalcemia was found in ten and seven cases of TOETVA and OT group, respectively. No other complications were observed. Conclusions TOETVA is a feasible and safe treatment for Graves’ disease in comparison to the standard open cervical approach. It is considered a viable alternative for patients who have been indicated for surgery with excellent cosmetic results. PMID

  13. Transoral, retromolar, para-tonsillar approach to the styloid process in 6 patients with Eagle’s syndrome

    PubMed Central

    Eckert, Alexander W.; Scheller, Christian

    2014-01-01

    Objectives: Eagle’s syndrome is caused by an elongated or mineralised styloid process and characterised by facial and pharyngeal pain, odynophagia and dysphagia. Diagnosis is based on clinical findings. However radiologic imaging, like panoramic radiograph, helps to confirm the diagnosis. There are different treatments of the Eagle’s syndrome. Anti-inflammatory medication (carbamazepime, corticosteroids) and/or surgical interventions are established. The aim of the different surgical techniques is to resect the elongated styloid process near the skull base. Study Design: A transoral, retromolar, para-tonsillar approach was performed to expose and resect the elongated calcified styloid process in a consecutive series of six patients. The use of different angled ring curettes, generally used in hypophysis surgery, facilitated the preparation of the styloid process through the surrounding tissue to the skull base, without a compromise to the surrounding tissue. Clinical examinations were performed pre- and postoperatively (3 month and after 1 year after surgery) in all patients. Results: No intra- or postoperative complications were observed. The hypophysis ring curettes facilitated the preparation of the styloid process to the skull base. Conclusions: The transoral, retromolar, para-tonsillar approach is a secure and fast method to resect an elongated symptomatic styloid process. Side effects of the classical transoral trans-tonsillar approach did not occur. Key words:Retromolar, para-tonsillar approach, Eagle syndrome, clinical features. PMID:24121903

  14. Salivary gland disorders.

    PubMed

    Mandel, Louis

    2014-11-01

    Patients with salivary gland disease present with certain objective and/or subjective signs. An accurate diagnosis for these patients requires a range of techniques that includes the organized integration of information derived from their history, clinical examination, imaging, serology, and histopathology. This article highlights the signs and symptoms of the salivary gland disorders seen in the Salivary Gland Center, and emphasizes the methodology used to achieve a definitive diagnosis and therapy. Copyright © 2014 Elsevier Inc. All rights reserved.

  15. Endocrine glands (image)

    MedlinePlus

    Endocrine glands release hormones (chemical messengers) into the bloodstream to be transported to various organs and tissues throughout the body. For instance, the pancreas secretes insulin, which ...

  16. Application of a computer-assisted flexible endoscope system for transoral surgery of the hypopharynx and upper esophagus.

    PubMed

    Friedrich, Daniel T; Scheithauer, M O; Greve, J; Rotter, N; Doescher, J; Hoffmann, T K; Schuler, P J

    2017-05-01

    Zenker's diverticulum is a common pathology in the transition zone of the posterior hypopharynx and esophagus. Surgical treatment is routinely performed by ENT and general surgeons. Besides the traditional open transcervical diverticulectomy, the introduction of transoral rigid treatment led to a paradigm change and is now the preferred treatment option for patients who are fit for general anesthesia. The implementation of interventional flexible endoscopy has opened another new micro-invasive approach for patients with high morbidity. Here, we present the potential utilization of a flexible, single port, robot-assisted, and physician-controlled endoscope system to facilitate transoral surgical access to the hypopharynx and upper esophagus. Transoral surgery of the hypopharynx and upper esophagus was performed in human cadavers (n = 5) using the Flex System (Medrobotics, Raynham, USA). Anatomical landmarks were identified, and posterior cricothyroid myotomy was performed with compatible flexible instruments in all cases. The approach to the hypopharynx and upper esophagus using the Flex system is feasible in a cadaveric model. Myotomy with a flexible tool and needle knife (from the perspective of treatment of Zenker´s diverticulum) was successful in all cases. Visualization of the surgical site with the system's HD camera is suitable and the flexible instruments meet the special needs of a micro-invasive transoral approach. Zenker´s diverticulum can be potentially treated with a transoral minimally invasive approach using a computer-assisted flexible endoscope system. This setup could be of advantage in patients with reduced mobility of the cervical spine to prevent open transcervical surgery. In our study, the Flex system enabled advanced visualization of the surgical site and extended intervention options, compared to standard flexible endoscopic treatment. However, general anesthesia is mandatory for the presented approach. Application in live patients

  17. Long-term follow-up after transoral laser microsurgery and adjuvant radiotherapy for advanced recurrent squamous cell carcinoma of the head and neck

    SciTech Connect

    Christiansen, Hans . E-mail: hchrist@gwdg.de; Hermann, Robert Michael; Martin, Alexios; Florez, Rodrigo; Kahler, Elke; Nitsche, Mirko; Hille, Andrea; Steiner, Wolfgang; Hess, Clemens F.; Pradier, Olivier

    2006-07-15

    Purpose: The aim of this study was to evaluate the efficacy of adjuvant radiotherapy after transoral laser microsurgery for advanced recurrent head-and-neck squamous cell carcinoma (HNSCC). Patients and Methods: Between 1988 and 2000, 37 patients with advanced local recurrences (23 local and 14 locoregional recurrences) of HNSCC without distant metastases were treated in curative intent with organ-preserving transoral laser microsurgery and adjuvant radiotherapy (before 1994 split-course radiotherapy with carboplatinum, after 1994 conventional radiotherapy). Initial therapy of the primary (8.1% oral cavity, 35.1% oropharynx, 13.5% hypopharynx, and 43.3% larynx) before relapse was organ-preserving transoral laser microsurgery without any adjuvant therapy. Results: After a median follow-up of 124 months, the 5-year overall survival rate was 21.3%, the loco-regional control rate 48.3%, respectively. In multivariate analysis, stage of original primary tumor (Stage I/II vs. Stage III/IV), and patient age (<58 years vs. {>=}58 years) showed statistically significant impact on prognosis. In laryngeal cancer, larynx preservation rate after treatment for recurrent tumor was 50% during follow-up. Conclusion: Our data show that organ-preserving transoral laser microsurgery followed by adjuvant radiotherapy is a curative option for patients who have advanced recurrence after transoral laser surgery and is an alternative to radical treatment.

  18. Adrenal gland hormone secretion (image)

    MedlinePlus

    The adrenal gland secretes steroid hormones such as cortisol and aldosterone. It also makes precursors that can be converted to ... steroids (androgen, estrogen). A different part of the adrenal gland makes adrenaline (epinephrine). When the glands produce more ...

  19. Improved transoral surgical tool design by CT measurements of the oral cavity and pharynx.

    PubMed

    Cox, Emily; Ghasemloonia, Ahmad; Nakoneshny, Steven C; Zareinia, Kourosh; Hudon, Mark; Lysack, John T; Sutherland, Garnette R; Dort, Joseph C

    2016-09-23

    The majority of head and neck cancers arise from the oral cavity and oropharynx. Many of these lesions will be amenable to surgical resection using transoral approaches including transoral robotic surgery (TORS). To develop and control TORS tools, precise dimensions of the oral cavity and pharynx are desirable. CT angiograms of 76 patients were analyzed. For the oral cavity, only the maximum length and width were measured, while for the pharynx, the width, length, and areas of the airway were all measured and the volume calculated. A prototype TORS tool was developed and tested based on the findings and dimensions. The design modification of the tool is in progress. The mean male oral cavity width and length were 93.3 ± 4.3 and 77.0 ± 7.2 mm, respectively, and the mean male pharyngeal width, length, area, and volume were 26.5 ± 7.2 mm, 16.2 ± 8.8 mm, 325 ± 149 mm(2), and 28,440 ± 14,100 mm(3), respectively, while the mean female oral cavity width and length were 84.5 ± 12.9 and 71.0 ± 6.3 mm, respectively, and the mean female pharyngeal width, length, area, and volume were 24.8 ± 5.6 mm, 13.7 ± 3.2 mm, 258 ± 98 mm(2), and 17,660 ± 7700 mm(3), respectively. The developed TORS tool was tested inside the oral cavity of an intubation mannequin. These data will also be used to develop an electronic no-go cone-shape tunnel to improve the safety of the surgical field. Reporting the oral cavity and pharyngeal dimensions is important for design of TORS tools and creating control zones for the workspace of the tool inside the oral cavity.

  20. Thyroid gland biopsy (image)

    MedlinePlus

    The thyroid is a gland located in the neck. It is a part of the endocrine (hormone) system, and plays a major role in regulating ... sample of cells is needed from the thyroid gland a fine needle biopsy can be performed. During ...

  1. Salivary Gland Secretion.

    ERIC Educational Resources Information Center

    Dorman, H. L.; And Others

    1981-01-01

    Describes materials and procedures for an experiment utilizing a live dog to demonstrate: (1) physiology of the salivary gland; (2) parasympathetic control of the salivary gland; (3) influence of varying salivary flow rates on sodium and potassium ions, osmolarity and pH; and (4) salivary secretion as an active process. (DS)

  2. Rare Parotid Gland Diseases.

    PubMed

    Sanan, Akshay; Cognetti, David M

    2016-04-01

    The differential diagnosis for "rare" parotid gland diseases is broad and encompasses infectious, neoplastic, autoimmune, metabolic, and iatrogenic etiologies. The body of knowledge of parotid gland diseases has grown owing to advances in imaging and pathologic analysis and molecular technology. This article reviews rare parotid diseases, discussing the respective disease's clinical presentation, diagnosis, imaging, pathogenesis, treatment, and prognosis.

  3. Salivary Gland Secretion.

    ERIC Educational Resources Information Center

    Dorman, H. L.; And Others

    1981-01-01

    Describes materials and procedures for an experiment utilizing a live dog to demonstrate: (1) physiology of the salivary gland; (2) parasympathetic control of the salivary gland; (3) influence of varying salivary flow rates on sodium and potassium ions, osmolarity and pH; and (4) salivary secretion as an active process. (DS)

  4. Salivary Gland Cancer

    MedlinePlus

    ... contains antibodies that can kill germs. Salivary gland cancer is a type of head and neck cancer. It is rare. It may not cause any ... pain in your face Doctors diagnose salivary gland cancer using a physical exam, imaging tests, and a ...

  5. Transoral Endoscopic Head and Neck Surgery and Its Role Within the Multidisciplinary Treatment Paradigm of Oropharynx Cancer: Robotics, Lasers, and Clinical Trials.

    PubMed

    Holsinger, F Christopher; Ferris, Robert L

    2015-10-10

    Transoral endoscopic head and neck surgery is a new approach for the treatment of oropharyngeal tumors. Using either a robotic system and/or laser, surgeons gain access through the mouth via minimally invasive technique and thus have improved visualization of the tumors of the oropharynx, without disfiguring incisions. This transoral route of access minimizes long-term speech and swallowing dysfunction. Surgeons view this approach as a considerable technologic advance, analogous to the evolution in radiation therapy from conventional two- and three-dimensional conformal techniques to intensity-modulated techniques. Although the use of radiation with or without chemotherapy to treat oropharyngeal cancer (OPC) is supported by evidence from prospective clinical trials, there are no prospective data supporting the use of this new surgical approach for OPC. Here, we review the fundamentals of transoral endoscopic head and neck surgery, with robotics and laser technology, and discuss ongoing clinical trials for patients with OPC. © 2015 by American Society of Clinical Oncology.

  6. Transoral vertebral augmentation with polymethylmethacrylate in the treatment of a patient with a dens fracture nonunion and subarticular vertebral body fracture of C2.

    PubMed

    Beall, Douglas P; Stanfield, Matthew; Martin, Hal D; Stapp, Annette M

    2007-05-01

    The injection of polymethylmethacrylate (PMMA) is a minimally invasive, image-guided procedure used to treat vertebral fractures due to osteoporosis, metastatic lesions, multiple myeloma, and benign but destabilizing bone tumors. The injection of PMMA into the C2 vertebral body using the transoral technique has been reported in three separate patients for treatment of benign tumors (a vertebral hemangioma and an aneurysmal bone cyst) and for multiple myeloma in the third patient. Although the injection of PMMA into the vertebral body is most commonly performed to treat benign vertebral compression fractures, a transoral C2 approach has not been reported in the English literature as a treatment for a benign fracture of C2. We report the treatment of a fracture and nonunion of the base of the dens and a subarticular fracture of the vertebral body of C2 using a bilateral transoral approach.

  7. Transoral Endoscopic Head and Neck Surgery and Its Role Within the Multidisciplinary Treatment Paradigm of Oropharynx Cancer: Robotics, Lasers, and Clinical Trials

    PubMed Central

    Holsinger, F. Christopher; Ferris, Robert L.

    2015-01-01

    Transoral endoscopic head and neck surgery is a new approach for the treatment of oropharyngeal tumors. Using either a robotic system and/or laser, surgeons gain access through the mouth via minimally invasive technique and thus have improved visualization of the tumors of the oropharynx, without disfiguring incisions. This transoral route of access minimizes long-term speech and swallowing dysfunction. Surgeons view this approach as a considerable technologic advance, analogous to the evolution in radiation therapy from conventional two- and three-dimensional conformal techniques to intensity-modulated techniques. Although the use of radiation with or without chemotherapy to treat oropharyngeal cancer (OPC) is supported by evidence from prospective clinical trials, there are no prospective data supporting the use of this new surgical approach for OPC. Here, we review the fundamentals of transoral endoscopic head and neck surgery, with robotics and laser technology, and discuss ongoing clinical trials for patients with OPC. PMID:26351337

  8. Novel modular 2-DOF microsurgical forceps for transoral laser microsurgeries: Ergonomic design and preliminary evaluation.

    PubMed

    Chauhan, Manish; Barresi, Giacinto; Deshpande, Nikhil; Caldwell, Darwin G; Mattos, Leonardo S

    2016-08-01

    Transoral Laser Microsurgeries (TLM) demand a great level of control and precision in intraoperative tissue manipulation. The optimal eradication of the diseased tissue is possible only with coordinated control of the laser aiming for incision and the microsurgical tools for orienting and stretching the tissue. However, the traditional microsurgical tools are long, single purpose, one degree-of-freedom (DOF), rigid tools with small range of motion and a normal grasping handle inducing non-ergonomic usage. This paper presents a novel, modular microsurgical tool to overcome the challenges of the traditional tools and improve the surgeon-tool usage experience. The novel design adds a rotational DOF to expand the reach and functionality of the tool. The device is provided with an ergonomic grasping handle that avoids extreme wrist excursions and is capable of adapting to the variety of tools used in TLM within the same design. The performance of the new microsurgical tool was evaluated through a subjective assessment with both medical students and expert surgeons. The evaluation demonstrated a general acceptance of the new forceps tool, with the expert surgeons providing positive appraisals for the improved functionality and user experience with the tool, which indicates towards the potential suitability of the device for TLM. The parameters assessed in the preliminary evaluation not only provide a sense of the advantages of the novel design, but also guide future evolution of the tool design.

  9. Robot-assisted microsurgical forceps with haptic feedback for transoral laser microsurgery.

    PubMed

    Deshpande, Nikhil; Chauhan, Manish; Pacchierotti, Claudio; Prattichizzo, Domenico; Caldwell, Darwin G; Mattos, Leonardo S

    2016-08-01

    In this paper, a novel, motorized, multi-degrees-of-freedom (DoF), microsurgical forceps tool is presented, which is based on a master-slave teleoperation architecture. The slave device is a 7-DoF manipulator with: (i) 6-DoF positioning and orientation, (ii) 1 open/close gripper DoF; and (iii) an integrated force/torque sensor for tissue grip-force measurement. The master device is a 7-DoF haptic interface which teleoperates the slave device, and provides haptic feedback in its gripper interface. The combination of the device and the surgeon interface replaces the manual, hand-held device providing easy-to-use and ergonomic tissue control, simplifying the surgical tasks. This makes the system suitable to real surgical scenarios in the operating room (OR). The performance of the system was analysed through the evaluation of teleoperation control and characterization of gripping force. The new system offers an overall positioning error of less than 400 μm demonstrating its safety and accuracy. Improved system precision, usability, and ergonomics point to the potential suitability of the device for the OR and its ability to advance haptic-feedback-enhanced transoral laser microsurgeries.

  10. Transoral laser microsurgery for laryngeal cancer: a primer and review of laser dosimetry.

    PubMed

    Rubinstein, Marc; Armstrong, William B

    2011-01-01

    Transoral laser microsurgery (TLM) is an emerging technique for the management of laryngeal and other head and neck malignancies. It is increasingly being used in place of traditional open surgery because of lower morbidity and improved organ preservation. Since the surgery is performed from the inside working outward as opposed to working from the outside in, there is less damage to the supporting structures that lie external to the tumor. Coupling the laser to a micromanipulator and a microscope allows precise tissue cutting and hemostasis; thereby improving visualization and precise ablation. The basic approach and principles of performing TLM, the devices currently in use, and the associated dosimetry parameters will be discussed. The benefits of using TLM over conventional surgery, common complications and the different settings used depending on the location of the tumor will also be discussed. Although the CO(2) laser is the most versatile and the best-suited laser for TLM applications, a variety of lasers and different parameters are used in the treatment of laryngeal cancer. Improved instrumentation has lead to an increased utilization of TLM by head and neck cancer surgeons and has resulted in improved outcomes. Laser energy levels and spot size are adjusted to vary the precision of cutting and amount of hemostasis obtained.

  11. [A Case of Transoral Penetrating Head Injury from a Crossbow-Fired Arrow].

    PubMed

    Nakamura, Naoto; Fujita, Yuichi; Nakamizo, Satoshi; Sakagami, Yoshio; Okazaki, Ken; Kida, Kouta

    2017-09-01

    Penetrating head injuries are extremely rare in Japan. The authors describe a case involving a penetrating head injury from an arrow fired from a crossbow. A 52-year-old man who had shot himself transorally in a suicide attempt was admitted to the authors' hospital. On admission, he was conscious and exhibited no neurological deficits. The end of the arrow was visible inside his oral cavity. Computed tomography revealed the arrow had penetrated the right cerebellum and occipital lobe, resulting in a very small hematoma. Digital subtraction angiography revealed no significant vascular injuries. After considering these findings and the nature of the object, the authors decided to remove the arrow from the cranium by pulling it from the patient's oral cavity. To remove the arrow, surgery was performed with several devices, including intraoperative X-ray, endoscopy, and intraoperative angiography. The authors were able to completely remove the arrow, and the patient experienced no new deficits, except mild ataxia and mild dysphasia, and no signs of cerebral infection or cerebrospinal fluid leakage after the surgery. Although most cases of penetrating head injuries require craniotomies, the authors were able to safely remove the foreign object in this case without performing a craniotomy. Because guidelines for the treatment of penetrating head injuries have not been established, the treatment of each case must be modified according to the nature of the foreign object and the findings of preoperative imaging techniques.

  12. The rise of transoral robotic surgery in the head and neck: emerging applications.

    PubMed

    Van Abel, Kathryn M; Moore, Eric J

    2012-03-01

    The use of robotics in the field of head and neck surgery has provided surgeons with the ability to access anatomic locations that were previously only managed via open techniques. This has resulted in decreased overall morbidity, excellent functional results and the promise of equivalent oncologic outcomes. Transoral robotic surgery (TORS) provides access to the oropharynx, hypopharynx, larynx, oral cavity, parapharyngeal space and skull base vial the oral aperture. Studies reviewing the application of TORS to these subsites have been promising, and for many applications TORS has been accepted as a safe and efficacious option for surgical management. However, despite these promising results, TORS remains a surgical instrument that requires sound surgical skill, clinical judgment and oncologic principles, and should be chosen based on the needs of the individual patient and the comfort of the treating surgeon. In this article, we review the history of TORS, relevant anatomy and provide a review of the literature, highlighting the applications, advantages, functional outcomes and disadvantages of TORS for each anatomic subsite.

  13. Intraoperative image-guided transoral robotic surgery: pre-clinical studies.

    PubMed

    Liu, Wen P; Reaugamornrat, Sureerat; Sorger, Jonathan M; Siewerdsen, Jeffrey H; Taylor, Russell H; Richmon, Jeremy D

    2015-06-01

    Adequate resection of oropharyngeal neoplasms with transoral robotic surgery (TORS) poses multiple challenges, including difficulty with access, inability to palpate the tumor, loss of landmarks, and intraoperative patient positioning with mouth retractor and tongue extended creating significant tissue distortion from preoperative imaging. This study evaluates a workflow integrating intraoperative cone beam computed tomography (CBCT) for image-guided TORS through robotic experimentation locating 8-10 embedded targets in five porcine tongues and a cadaveric head phantom, conducted under various modes of visualization and integration of preoperative/intraoperative imaging. A statistically significant improvement in mean target localization error was achieved for both the porcine tongue ((9.8 ± 4.0) mm vs. (5.3 ± 1.3) mm, P-value = 0.0151) and cadaver ((11.2 ± 5.0) mm vs. (5.8 ± 2.5) mm P-value = 0.0189) in experiments comparing scenarios simulating current standard-of-care practice and the proposed image guidance system. Intraoperative image guidance with augmentation of critical surgical structures has the potential to improve target localization for TORS. Copyright © 2014 John Wiley & Sons, Ltd.

  14. Transoral Robotic Surgery and the Unknown Primary: A Cost-Effective Technique to Identify the Tumor

    PubMed Central

    Byrd, J. Kenneth; Smith, Kenneth J.; de Almeida, John R.; Albergotti, W. Greer; Davis, Kara S.; Kim, Seungwon W.; Johnson, Jonas T.; Ferris, Robert L.; Duvvuri, Umamaheswar

    2014-01-01

    Objective To evaluate the cost-effectiveness of transoral robotic surgery (TORS) for diagnosis and treatment of cervical unknown primary squamous cell carcinoma (CUP). Study Design Retrospective Review Subjects and Methods A retrospective chart review was performed on patients with new occult primary squamous cell carcinoma of the head and neck with non-diagnostic imaging and/or endoscopy who were treated with TORS at a tertiary hospital between 2009 and 2012. Direct costs ($) were obtained from the hospital’s billing system, and national data were used for inpatient hospital costs and physician fees. The proportion of tumors found in three strategies was used as effectiveness to calculate the incremental cost-effectiveness ratio. Results 206 head and neck robotic cases were performed at our institution between December 2009 and December 2012. Three surgeons performed TORS on 22 patients for occult primary squamous cell carcinoma. The primary tumor was located in 19/22 (86.4%) patients. The incremental cost-effectiveness ratio for sequential and simultaneous EUA and TORS base of tongue resection was $8619 and $5774 per additional primary identified, respectively. Conclusion TORS is a cost-effective procedure to locate the primary tumor in patients with cervical lymph node metastases and no obvious source. Bilateral base of tongue resection should be considered as part of the exam under anesthesia for these patients, particularly if the palatine tonsils have already been removed. PMID:24618502

  15. Transoral laser microsurgery for laryngeal cancer: A primer and review of laser dosimetry

    PubMed Central

    Rubinstein, Marc

    2010-01-01

    Transoral laser microsurgery (TLM) is an emerging technique for the management of laryngeal and other head and neck malignancies. It is increasingly being used in place of traditional open surgery because of lower morbidity and improved organ preservation. Since the surgery is performed from the inside working outward as opposed to working from the outside in, there is less damage to the supporting structures that lie external to the tumor. Coupling the laser to a micromanipulator and a microscope allows precise tissue cutting and hemostasis; thereby improving visualization and precise ablation. The basic approach and principles of performing TLM, the devices currently in use, and the associated dosimetry parameters will be discussed. The benefits of using TLM over conventional surgery, common complications and the different settings used depending on the location of the tumor will also be discussed. Although the CO2 laser is the most versatile and the best-suited laser for TLM applications, a variety of lasers and different parameters are used in the treatment of laryngeal cancer. Improved instrumentation has lead to an increased utilization of TLM by head and neck cancer surgeons and has resulted in improved outcomes. Laser energy levels and spot size are adjusted to vary the precision of cutting and amount of hemostasis obtained. PMID:20835840

  16. Feasibility of robot-assisted neck dissection followed by transoral robotic surgery.

    PubMed

    Byeon, H K; Holsinger, F C; Kim, D H; Kim, J W; Park, J H; Koh, Y W; Choi, E C

    2015-01-01

    Our aim was to evaluate the feasibility of robot-assisted neck dissection (RAND) followed by transoral robotic surgery (TORS) in treatment of cancers of the head and neck, which is expected to improve cosmesis and function. We studied 37 patients with biopsy-confirmed cNO or cN+ tumours of the oropharynx (n=22), hypopharynx (n=8), larynx (n=6), and oral cavity (n=1) who were treated by RAND then TORS from May 2010 to December 2012. Patients' characteristics and clinical details were recorded, together with operative complications and functional variables such as management of the airway and nasogastric or enterogastric feeding. All endoscopic TORS and RAND were successful, with no serious intraoperative complications or need to convert to open operation. All patients were satisfied with the cosmesis according to the answers given to a questionnaire. RAND followed by TORS in some cancers of the head and neck are feasible and showed a clear cosmetic benefit, although the longer operating time is a drawback. Studies of more patients with longer follow-up are required to evaluate long-term oncological and functional outcomes in more detail.

  17. Gland With Cantilever Seal

    NASA Technical Reports Server (NTRS)

    Melton, Patrick B.

    1989-01-01

    Single-piece gland forms tight seal on probe or tube containing liquid or gas at high pressure. Gland and probe align as assembled by simple torquing procedure. Disconnected easily and reused at same site. Made from any of wide variety of materials so compatible with application. Cantilever ring at top of gland bites into wall of tube or probe, sealing it. Wall of tube or probe must be thick enough to accommodate deformation without rupturing. Maximum deformation designed in coordination with seating and deformation of boss or conical seal.

  18. Male accessory gland infection.

    PubMed

    Krause, W

    2008-04-01

    Male accessory gland infection (MAGI) is a consequence of canalicular spreading of agents via urethra, prostate gland, seminal vesicles, deferent duct, epididymis and testis. Haematogenous infections are rare. The main infectious agents are Neisseria gonorrhoeae and Chlamydia trachomatis, and also enterobacteriae at a lesser frequency. Characteristic symptoms of MAGI are leukocytospermia, enhanced concentration of cytokines and reactive oxygen species. As complications, obstruction of the ductus epididymidis and/or another duct section, impairment of spermatogenesis in orchitis, impairment of sperm function, and dysfunctions of the male accessory glands may occur. Reduction of male fertility is a rare consequence. The treatment has to consider specific antibiotics.

  19. Lacrimal Gland Radiosensitivity in Uveal Melanoma Patients

    SciTech Connect

    Muller, Karin Nowak, Peter J.C.M.; Naus, Nicole; Pan, Connie de; Santen, Cornelis A. van; Levendag, Peter; Luyten, Gre P.M.

    2009-06-01

    Purpose: To find a dose-volume effect for inhomogeneous irradiated lacrimal glands. Methods and Materials: Between 1999 and 2006, 72 patients (42 men and 30 women) were treated with fractionated stereotactic radiotherapy in a prospective, nonrandomized clinical trial (median follow-up, 32 months). A total dose of 50 Gy was given on 5 consecutive days. The mean of all Schirmer test results obtained {>=}6 months after treatment was correlated with the radiation dose delivered to the lacrimal gland. Also, the appearance of dry eye syndrome (DES) was related to the lacrimal gland dose distribution. Results: Of the 72 patients, 17 developed a late Schirmer value <10 mm; 9 patients developed DES. A statistically significant relationship was found between the received median dose in the lacrimal gland vs. reduced tear production (p = 0.000) and vs. the appearance of DES (p = 0.003), respectively. A median dose of 7 Gy/fraction to the lacrimal gland caused a 50% risk of low Schirmer results. A median dose of 10 Gy resulted in a 50% probability of DES. Conclusion: We found a clear dose-volume relationship for irradiated lacrimal glands with regard to reduced tear production and the appearance of DES.

  20. Surgical complications of submandibular gland excision.

    PubMed

    Hernando, Monica; Echarri, Rosa Maria; Taha, Muhammad; Martin-Fragueiro, Luz; Hernando, Ana; Mayor, Guillermo Plaza

    2012-01-01

    Submandibular gland excision is the treatment of choice in chronic pathology resistant to medical treatments or in oncological cases. The aim of this study was to analyse its current postoperative complications. Retrospective study on submandibular gland excisions performed at our University Hospital between 2004 and 2010. A total of 29 submandibular gland excisions were performed: 44.8% (13) for chronic sialadenitis, 37.9% (11) for salivary gland neoplasm and 17.2% (5) for adjacent tumours. Median length of hospital stay was 2 days. Complications were more common after gland excision due to inflammatory causes. There were only 2 cases of paralysis of the marginal facial nerve branch (6.8%); 1 was due to neoplastic pathology and 1, from inflammatory pathology. Despite marginal facial nerve paresis being one of the most relevant issues after submandibular gland excision, this type of surgery is a safe technique in our experience. Copyright © 2011 Elsevier España, S.L. All rights reserved.

  1. Iatrogenic causes of salivary gland dysfunction

    SciTech Connect

    Schubert, M.M.; Izutsu, K.T.

    1987-02-01

    Saliva is important for maintaining oral health and function. There are instances when medical therapy is intended to decrease salivary flow, such as during general anesthesia, but most instances of iatrogenic salivary gland dysfunction represent untoward or unavoidable side-effects. The clinical expression of the salivary dysfunction can range from very minor transient alteration in saliva flow to a total loss of salivary function. The most common forms of therapy that interfere with salivation are drug therapies, cancer therapies (radiation or chemotherapy), and surgical therapy. These therapies can affect salivation by a number of different mechanisms that include: disruption of autonomic nerve function related to salivation, interference with acinar or ductal cell functions related to salivation, cytotoxicity, indirect effects (vasoconstriction/dilation, fluid and electrolyte balance, etc.), and physical trauma to salivary glands and nerves. A wide variety of drugs is capable of increasing or decreasing salivary flow by mimicking autonomic nervous system actions or by directly acting on cellular processes necessary for salivation: drugs can also indirectly affect salivation by altering fluid and electrolyte balance or by affecting blood flow to the glands. Ionizing radiation can cause permanent damage to salivary glands, damage that is manifest as acinar cell destruction with subsequent atrophy and fibrosis of the glands. Cancer chemotherapy can cause changes in salivation, but the changes are usually much less severe and only transient. Finally, surgical and traumatic injuries interfere with salivation because of either disruption of gland innervation or gross physical damage (or removal) of glandular tissue (including ducts).

  2. Modification of the submandibular gland transfer procedure.

    PubMed

    Marzouki, Hani Z; Elkhalidy, Youness; Jha, Naresh; Scrimger, Rufus; Debenham, Brock J; Harris, Jeffrey R; O'Connell, Daniel A; Seikaly, Hadi

    2016-11-01

    The treatment for most advanced head and neck cancers (stage III and IV) usually includes radiation, and the most common side effect of this treatment modality is a permanent decrease in salivary production. Xerostomia is a devastating complication that significantly affects patients' quality of life by interfering with functions of taste, mastication, deglutition, and speech production. Treatment of xerostomia is varied, but one of the strategies developed by our group was to preserve one submandibular gland by surgically transferring it to the submental space and shielding it from the full dose of radiation. This procedure is proven to reduce the rate of radiation-induced xerostomia, but its main disadvantage is that it is contraindicated in oral cavity cancer. This study describes and evaluates a modification of the submandibular gland transfer (SGT) procedure, where the submandibular gland contralateral to the disease process is relocated to the parotid region. This modification has the potential of expanding the benefits of submandibular gland transfer procedures to patients with oral cavity cancers. Prospective feasibility study. This study involved nine patients with a new diagnosis of advanced head and neck cancer undergoing major head and neck cancer resection with postoperative adjuvant radiation therapy. The new modified salivary gland transfer procedure was performed on all nine patients, and the glands total dose received with radiation therapy was assessed. All the modified SGT procedures were successful with no post-operative complications. The radiation oncology team has been able to successfully localize the transferred submandibular glands and shield them from the radiation beam postoperatively. We have successfully demonstrated that surgical transfer of a submandibular salivary gland to the parotid region is feasible, surgically viable, oncologically sound, and does not interfere with radiation therapy. 4 Laryngoscope, 126:2492-2496, 2016.

  3. Computer tomography navigation for the transoral anterior release of a complex craniovertebral junction deformity: A report of two cases.

    PubMed

    Miyahara, Junya; Hirao, Yujiro; Matsubayashi, Yoshitaka; Chikuda, Hirotaka

    2016-01-01

    The surgical correction of deformities of the craniovertebral junction (CVJ) remains a challenge due to its complex anatomy. Despite the well-known usefulness of computed tomography (CT) navigation in posterior spinal surgery, it is applied far less frequently in anterior spinal surgery, mainly due to registration difficulties. Case 1 was a 68-year-old female with rheumatoid arthritis, with a complaint of neck pain, motor weakness, and dysesthesia in the upper extremities. Case 2 was a 61-year-old male with Chiari malformation, with a complaint of neck pain and gait disturbance after a fall. Magnetic resonance imaging (MRI) showed severe atlantoaxial dislocation and multilevel cervical spinal cord compression in both patients. Continuous halo traction failed to reduce atlantoaxial dislocation, even under general anesthesia, and they were treated with combined anterior release and posterior decompression and fixation using CT navigation. Occipitocervical assimilation, which was present in both patients, enabled precise registration for navigation. The lack of anatomically characteristic landmarks on the vertebral surface makes obtaining accurate registration difficult in anterior CVJ surgery using CT navigation. The remaining mobility in the occipitocervical joint precludes the use of facial or cranial landmarks. However, occipitocervical assimilation, which is not uncommon in patients with CVJ deformities, enables accurate navigation during transoral surgery. Transoral anterior release using CT navigation is an effective treatment option for rigid complex CVJ deformities. The accurate identification of the patients' anatomical features such as occipitoatlantal assimilation, is crucial for the conducting accurate preoperative CT-based navigation during transoral surgery. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  4. Use of Frameless Stereotactic Neuronavigation and O-arm for Transoral Transpalatal Odontoidectomy to Treat a Very High Basilar Invagination

    PubMed Central

    Moorthy, Skanda; Raheja, Amol; Agrawal, Deepak

    2016-01-01

    Frameless stereotactic neuronavigation system has been in wide use since many years for precise localization of cranial tumors and navigation for spinal instrumentation. We present its usage in the localization of odontoid process in a very high basilar invagination for a transoral transpalatal resection of the same. We discuss the technical aspects of assembly of neuronavigation system, O-arm and Mayfield head frame on Allen spine system to achieve precise and accurate localization of high riding odontoid process through an extremely narrow operative corridor. PMID:28163511

  5. Successful treatment of adult Arnold-Chiari malformation associated with basilar impression and syringomyelia by the transoral anterior approach.

    PubMed

    Kohno, K; Sakaki, S; Shiraishi, T; Matsuoka, K; Okamura, H

    1990-04-01

    A case of adult type I Arnold-Chiari malformation associated with basilar impression, syringomyelia, atlantoaxial dislocation, and occipitalization of the atlas is reported. Preoperative magnetic resonance imaging clearly revealed evidence of severe anterior compression of the cervicomedullary junction due to basilar impression and a sharp clivoaxial angle. Therefore, transoral anterior decompression and fusion were performed, resulting in an improvement of the patient's neurologic signs and symptoms. Postoperative magnetic resonance imaging showed an obvious reduction of the tonsillar herniation and syringomyelia, as well as an improvement of the cervicomedullary compression.

  6. Transoral decompression evaluated by cine-mode magnetic resonance imaging: a case of basilar impression accompanied by Chiari malformation.

    PubMed

    Tominaga, T; Koshu, K; Ogawa, A; Yoshimoto, T

    1991-06-01

    Cine-mode magnetic resonance imaging provides simultaneous images of cerebrospinal fluid flow dynamics. A patient with a basilar impression accompanied by a Chiari malformation and von Recklinghausen's disease who underwent transoral decompression is reported. Preoperative cine-mode magnetic resonance imaging visualized an associated obstruction of cerebrospinal fluid pulsatile flow at the level of the foramen magnum. Tonsilar herniation (Chiari I malformation) and hydrocephalus were also present. Postoperatively, the obstruction of cerebrospinal fluid flow was resolved concomitant with the correction of the cervicomedullary angulation. On the basis of observations made by magnetic resonance imaging, the surgical treatment of basilar impression accompanied by Chiari malformation is briefly discussed.

  7. Enlarged prostate gland

    MedlinePlus

    ... enlarges in size in a process called benign hypertrophy, which means that the gland got larger without ... in several of the symptoms of benign prostatic hypertrophy, or BPH. Symptoms may include a slowed or ...

  8. [Salivary gland diseases].

    PubMed

    Gudziol, H

    1995-11-01

    Only about 1% of head and neck tumors are neoplasms of the salivary glands. The majority [80%] of these tumors are benign. Pleomorphic adenomas, the most frequent benign tumors of the salivary glands, can transform into malignancy, especially after a long duration. Treatment of salivary gland tumors consists of complete surgical excision by a surgeon experienced in microsurgery of the facial nerve. Acute suppurative and viral sialadenitis is usually treated by the general practitioner either symptomatically or, if possible, specifically. Chronic sialadenitis, sialadenosis, Sjögren's syndrome, and Frey's syndrome often need long-term follow-up and medical treatment, which is also usually delivered by the general practitioner, after the diagnosis has been established. Trauma to the salivary gland with transsection of the duct or facial nerve needs immediate microsurgical repair by an otolaryngologist. Sialolithiasis is also treated surgically in most cases.

  9. Adrenal glands (image)

    MedlinePlus

    Triangular-shaped glands located on top of the kidneys. They produce hormones such as estrogen, progesterone, steroids, cortisol, and cortisone, and chemicals such as adrenalin (epinephrine), norepinephrine, and dopamine.

  10. Lacrimal gland tumor

    MedlinePlus

    ... B. Lacrimal gland tumors. In: Tasman W, Jaeger EA, eds. Duane's Ophthalmology . 16th ed. Philadelphia, PA: Lippincott ... JA. Secondary orbital tumors. In: Tasman W, Jaeger EA, eds. Duane's Ophthalmology . 16th ed. Philadelphia, PA: Lippincott ...

  11. Benign Pediatric Salivary Gland Lesions.

    PubMed

    Carlson, Eric R; Ord, Robert A

    2016-02-01

    Salivary gland lesions are rare in pediatric patients. In addition, the types of salivary gland tumors are different in their distribution in specific sites in the major and minor salivary glands in children compared with adults. This article reviews benign neoplastic and nonneoplastic salivary gland disorders in pediatric patients to help clinicians to develop an orderly differential diagnosis that will lead to expedient treatment of pediatric patients with salivary gland lesions. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. Mammary gland development.

    PubMed

    Macias, Hector; Hinck, Lindsay

    2012-01-01

    The mammary gland develops through several distinct stages. The first transpires in the embryo as the ectoderm forms a mammary line that resolves into placodes. Regulated by epithelial–mesenchymal interactions, the placodes descend into the underlying mesenchyme and produce the rudimentary ductal structure of the gland present at birth. Subsequent stages of development—pubertal growth, pregnancy, lactation, and involution—occur postnatally under the regulation of hormones. Puberty initiates branching morphogenesis, which requires growth hormone (GH) and estrogen, as well as insulin-like growth factor 1 (IGF1), to create a ductal tree that fills the fat pad. Upon pregnancy, the combined actions of progesterone and prolactin generate alveoli, which secrete milk during lactation. Lack of demand for milk at weaning initiates the process of involution whereby the gland is remodeled back to its prepregnancy state. These processes require numerous signaling pathways that have distinct regulatory functions at different stages of gland development. Signaling pathways also regulate a specialized subpopulation of mammary stem cells that fuel the dramatic changes in the gland occurring with each pregnancy. Our knowledge of mammary gland development and mammary stem cell biology has significantly contributed to our understanding of breast cancer and has advanced the discovery of therapies to treat this disease.

  13. Mammary Gland Development

    PubMed Central

    Macias, Hector

    2012-01-01

    The mammary gland develops through several distinct stages. The first transpires in the embryo as the ectoderm forms a mammary line that resolves into placodes. Regulated by epithelial/mesenchymal interactions, the placodes descend into the underlying mesenchyme and produce the rudimentary ductal structure of the gland present at birth. Subsequent stages of development – pubertal growth, pregnancy, lactation and involution – occur postnatally under the regulation of hormones. Puberty initiates branching morphogenesis, which requires growth hormone and estrogen, as well as IGF1, to create a ductal tree that fills the fat pad. Upon pregnancy the combined actions of progesterone and prolactin generate alveoli, which secrete milk during lactation. Lack of demand for milk at weaning initiates the process of involution whereby the gland is remodeled back to its pre-pregnancy state. These processes require numerous signaling pathways that have distinct regulatory functions at different stages of gland development. Signaling pathways also regulate a specialized subpopulation of mammary stem cells that fuel the dramatic changes in the gland occurring with each pregnancy. Our knowledge of mammary gland development and mammary stem cell biology has significantly contributed to our understanding of breast cancer and has advanced the discovery of therapies to treat this disease. PMID:22844349

  14. Radionuclide salivary gland imaging

    SciTech Connect

    Mishkin, F.S.

    1981-10-01

    Salivary gland imaging with 99mTc as pertechnetate provides functional information concerning trapping and excretion of the parotid and submandibular glands. Anatomic information gained often adds little to clinical evaluation. On the other hand, functional information may detect subclinical involvement, which correlates well with biopsy of the minor labial salivary glands. Salivary gland abnormalities in systemic disease such as sarcoidosis, rheumatoid arthritis, lupus erythematosus, and other collagenvascular disorders may be detected before they result in the clinical manifestaions of Sjoegren's syndrome. Such glands, after initially demonstrating increased trapping in the acute phase, tend to have decreased trapping and failure to discharge pertechnetate in response to an appropriate physiologic stimulus. Increased uptake of gallium-67 citrate often accompanies these findings. Inflammatory parotitis can be suspected when increased perfusion is evident on radionuclide angiography with any agent. The ability of the salivary gland image to detect and categorize mass lesions, which result in focal areas of diminished activity such as tumors, cysts, and most other masses, is disappointing, while its ability to detect and categorize Warthin's tumor, which concentrates pertechnetate, is much more valuable, although not specific.

  15. Management of the thyroid gland during laryngectomy.

    PubMed

    Li, S X; Polacco, M A; Gosselin, B J; Harrington, L X; Titus, A J; Paydarfar, J A

    2017-08-01

    This study aimed to: describe the incidence of thyroid gland involvement in advanced laryngeal cancer, analyse patterns of spread to the thyroid and elucidate predictors of thyroid involvement. A retrospective review was performed on patients who underwent laryngectomy from 1991 to 2015 as a primary or salvage treatment for squamous cell carcinoma of the larynx, hypopharynx or base of tongue. The incidence of thyroidectomy during total laryngectomy, type of thyroidectomy, incidence of gland involvement, route of spread, and positive predictors of spread were analysed and reported. A total of 188 patients fit the inclusion criteria. Of these, 125 (66 per cent) underwent thyroidectomy. The thyroid was involved in 10 of the 125 patients (8 per cent), 9 by direct extension and 1 by metastasis. Cartilage invasion was a predictor of thyroid gland involvement, with a positive predictive value of 26 per cent. There is a low incidence of thyroid gland involvement in laryngeal carcinoma. Most cases of gland involvement occurred by direct extension. Thyroidectomy during laryngectomy should be considered for advanced stage tumours with cartilage invasion.

  16. Complications in transoral CO2 laser surgery for carcinoma of the larynx and hypopharynx.

    PubMed

    Vilaseca-González, Isabel; Bernal-Sprekelsen, Manuel; Blanch-Alejandro, José-Luis; Moragas-Lluis, Miguel

    2003-05-01

    Because of the increase in indications for laser surgery to treat malignant tumors of the larynx and hypopharynx, a higher number of complications may be expected. We prospectively evaluated the frequency and characteristics of intraoperative and postoperative complications of early and advanced tumors of the larynx and hypopharynx treated with CO(2) laser surgery and the potential influence of the surgical learning curve on the complication rate. Two hundred seventy-five patients operated in a tertiary referral center. Complications were classified either as major, requiring intensive medical treatment, blood transfusion, surgery, or ICU admission, or minor, resolving spontaneously or with conventional ambulatory treatment without sequelae. The surgical learning curve was analyzed by dividing the patients into two groups according to the date of surgery and then comparing the number of complications. Complications occurred in 18.9% of patients; 9.8% were considered major and 9.1% minor. Complications included local infection (0.7%), emphysema (1%), cutaneous fistula (0.3%), postoperative bleeding (8%), airway ignition (0.3%), dyspnea (because of edema or stenosis) (1.8%), and swallowing difficulties or aspiration pneumonia (6.1%). The complication rate correlated significantly with tumor extension (p <.0001), the presence of diabetes mellitus (p =.01), and less surgical experience (p <.0001). Complications with severe sequelae occurred in two patients (p =.7). Complications after transoral laser surgery of larynx and hypopharynx carcinomas are relatively frequent (18.9%), but serious sequelae and mortality rate are low. Complications are associated with tumor extension, limited surgical experience, and diabetes mellitus. Copyright 2003 Wiley Periodicals, Inc.

  17. Cost-Effectiveness Analysis of Radiation Therapy Versus Transoral Robotic Surgery for Oropharyngeal Squamous Cell Carcinoma.

    PubMed

    Rodin, Danielle; Caulley, Lisa; Burger, Emily; Kim, Jane; Johnson-Obaseki, Stephanie; Palma, David; Louie, Alexander V; Hansen, Aaron; O'Sullivan, Brian

    2017-03-15

    The objective of this study was to compare the cost-effectiveness of transoral robotic surgery (TORS) versus the standard treatment modality for oropharyngeal squamous cell carcinoma (OPSCC), radiation therapy (RT), in a subset of patients with early-stage OPSCC. We developed a microsimulation state-transition model associated with RT and TORS for patients with clinically staged T1N0M0 to T2N1M0 OPSCC. Transition probabilities, utilities, and costs for each health state were estimated from recently published data and discounted by 3% annually over a lifetime time horizon. Model outcomes included lifetime costs (in 2014 US dollars), health benefits (quality-adjusted life-years [QALYs]), and cost-effectiveness ratios from a societal perspective. Under base-case assumptions, TORS was associated with modest gains in QALYs. RT yielded 10.43 QALYs at a cost of $123,410 per patient, whereas TORS yielded 11.10 QALYs at a cost of $178,480. This resulted in an incremental cost-effectiveness ratio of $82,190/QALY gained. The incremental cost-effectiveness ratio was most sensitive to the need for adjuvant therapy, cost of late toxicity, age at diagnosis, disease state utilities, and discount rate. Accounting for joint parameter uncertainty, RT had a higher probability of demonstrating a cost-effective profile compared with TORS, at 54% compared with 46%. By use of standard benchmarks for cost-effectiveness in the United States, TORS may be a cost-effective alternative for the subset of patients with early-stage OPSCC but demonstrates considerable sensitivity to assumptions around quality of life. Copyright © 2016. Published by Elsevier Inc.

  18. Comparison of fiber delivered CO2 laser and electrocautery in transoral robot assisted tongue base surgery.

    PubMed

    Karaman, Murat; Gün, Taylan; Temelkuran, Burak; Aynacı, Engin; Kaya, Cem; Tekin, Ahmet Mahmut

    2017-05-01

    To compare intra-operative and post-operative effectiveness of fiber delivered CO2 laser to monopolar electrocautery in robot assisted tongue base surgery. Prospective non-randomized clinical study. Twenty moderate to severe obstructive sleep apnea (OSA) patients, non-compliant with Continuous Positive Airway Pressure (CPAP), underwent Transoral Robotic Surgery (TORS) using the Da Vinci surgical robot in our University Hospital. OSA was treated with monopolar electrocautery in 10 patients, and with flexible CO2 laser fiber in another 10 patients. The following parameters in the two sets are analyzed: Intraoperative bleeding that required cauterization, robot operating time, need for tracheotomy, postoperative self-limiting bleeding, length of hospitalization, duration until start of oral intake, pre-operative and post-operative minimum arterial oxygen saturation, pre-operative and post-operative Epworth Sleepiness Scale score, postoperative airway complication and postoperative pain. Mean follow-up was 12 months. None of the patients required tracheotomy and there were no intraoperative complications related to the use of the robot or the CO2 laser. The use of CO2 laser in TORS-assisted tongue base surgery resulted in less intraoperative bleeding that required cauterization, shorter robot operating time, shorter length of hospitalization, shorter duration until start of oral intake and less postoperative pain, when compared to electrocautery. Postoperative apnea-hypopnea index scores showed better efficacy of CO2 laser than electrocautery. Comparison of postoperative airway complication rates and Epworth sleepiness scale scores were found to be statistically insignificant between the two groups. The use of CO2 laser in robot assisted tongue base surgery has various intraoperative and post-operative advantages when compared to monopolar electrocautery.

  19. Transoral CO2 Laser Microsurgery Outcomes for Early Glottic Carcinomas T1-T2

    PubMed Central

    Chiesa Estomba, Carlos Miguel; Reinoso, Frank Alberto Betances; Velasquez, Alejandra Osorio; Fernandez, Jose Luis Rodriguez; Conde, Jose Luis Fariña; Hidalgo, Carmelo Santidrian

    2016-01-01

    Introduction  Transoral laser microsurgery (TLM) has won territory in larynx oncology, establishing itself as an effective option in treatment of glottic, supraglottic, and hypopharynx tumors. Its advantages include limited resections, a reduction in number of tracheostomies, and the use of nasogastric tubes. Moreover, its oncological benefits are similar to those from open surgery in patients with early or advanced stages, when correctly selected. Objective  The objective of this study is to review oncologic outcomes obtained with the treatment of a series of glottic tumors, treated by TLM. Methods  Retrospective analysis of patients previously untreated, diagnosed with squamous cell carcinoma of the glottis (T1a, T1b, T2) in a tertiary university hospital. Endpoints for analysis were local control, overall and disease-specific survival, and larynx preservation rate. Results  The study group included 58 patients that met the inclusion criteria: 57 (98.3%) men and 1 (1.7%) woman. Mean age was 65.5 ± 10.7 years (Min: 46/Max: 88). The tumor stages of the patients included were 30 T1a, 11 (19%) T1b, and 17 (29.3%) T2. Three-year overall survival rate was 89.7% (Fig. 1), and three-year disease-specific survival rate was 96.5%, three-year local control rate was 98.3%, and three-year organ preservation rate was 98.3%. Conclusion  TLM is a safe and effective option in the treatment of glottis carcinomas, associated with less morbidity and a high percentage of local control, overall survival, specific survival, and organ preservation. PMID:27413401

  20. Comparative analysis of resection tools suited for transoral robot-assisted surgery.

    PubMed

    Hoffmann, Thomas K; Schuler, Patrick J; Bankfalvi, Agnes; Greve, Jens; Heusgen, Lukas; Lang, Stephan; Mattheis, Stefan

    2014-05-01

    Introduction of transoral robot-assisted surgery (TORS) has a strong potential to facilitate surgical therapy of head and neck squamous cell cancer (HNSCC) by decreasing the indication for an external surgical approach. However, the availability of resection tools is limited and comparative studies in the context of TORS are not available. In the context of the newest da Vinci Si HD(®) robotic system, various dissection methods were compared in a surgical animal model using porcine tongue at three different sites representing mucosal, muscular and lymphatic tissue. Resection methods included (a) CO2 laser tube, (b) flexible fiber Tm:YAG laser, (c) monopolar blade, and (d) radio frequency (RF) needle. Specimens were formalin-fixed, paraffin-embedded, cut, and stained with haematoxylin-eosin. Dissected tissue was examined for the width of the incision as well as the individual coagulation zone of each tool at various tissue sites. In addition, instrument costs and performance were determined. The incisions made by the RF needle had the most favourable cutting width and also smaller coagulation defects, as opposed to other tools, granting the best preservation of tumour-adjacent structures and improved pathological assessment. Instrument performance was best evaluated for CO2 laser and RF needle, whereas financial expenses were lowest for RF needle and monopolar blade. Improvement and modification of resection tools for TORS become a relevant criterion in order to facilitate routine usage in the surgical therapy of HNSCC. A consequent decrease in surgical mortality and improved precision of surgical tumour resection could lead to a significant clinical growth potential of TORS.

  1. Transoral laser microsurgery: a new approach for unknown primaries of the head and neck.

    PubMed

    Karni, Ron J; Rich, Jason T; Sinha, Parul; Haughey, Bruce H

    2011-06-01

    To evaluate the efficacy of transoral laser microsurgery (TLM) used at examination under anesthesia (EUA) for detection and management of an unidentified primary site and to determine survival with both TLM EUA and traditional rigid pharyngolaryngoscopy EUA, with directed biopsies. Comparative retrospective review of patients who underwent two different procedures, TLM EUA and traditional EUA, to identify a primary site. Thirty patients presenting with occult primary met the study criteria. Eighteen underwent TLM EUA and 12 underwent traditional EUA. We collected data on the treatment approach, detection rate of the primary site, neck dissection, postoperative radiotherapy, and disease-free survival (DFS). The primary site detection rate with TLM EUA was 94% (17 of 18) and with traditional EUA was 25% (3 of 12). Overall, the occult primary was identified in 20 of 30 patients. The majority of patients (95%) had a primary in the oropharynx (19 of 20). Sixteen occult primaries in the TLM EUA group were immediately resected with TLM. At median follow-up of 30 months, there was no recurrence in the TLM EUA group. There was a 41.6% (5 of 12) recurrence rate in traditional EUA group. The Kaplan-Meier 5-year DFS was 100% for the TLM EUA group and 44% for the traditional EUA group (log rank value = 0.0006). TLM management of occult primary malignancies allowed high detection rates of primary tumor and was associated with a high level of DFS. Application of TLM during EUA both detects and treats the primary and may decrease the number of patients requiring wide-field irradiation. Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.

  2. Endosonography of the adrenal glands: normal size--pathological findings.

    PubMed

    Kann, P; Hengstermann, C; Heussel, C P; Bittinger, F; Engelbach, M; Beyer, J

    1998-01-01

    Transabdominal sonography of the adrenal glands frequently is non-successful. It was the aim of this project to improve the imaging of the adrenal glands using high resolution sonography in order to obtain information about even small changes in these organs. Therefore, endosonographic imaging was investigated using an endosonoscope PENTAX FG32UA. The correct identification of the adrenal glands was examined in five human cadavers. A total of 58 patients with 113 adrenal glands (in 3 cases history of unilateral adrenalectomy) were investigated. 109 adrenal glands (97%) were identified and evaluated. Healthy adrenal glands are slightly hyperechoich and regarding their echogeneity comparable to other endocrine organs such as the testes or the thyroid. Adrenal size can be determined as largest cross sectional area and was found to be 216 +/- 93 mm2 right and 231 +/- 98 mm2 left. In the adrenal glands which could be imaged by endosonography, all findings detected by CT (n = 33) or MRI (n = 19) could also be demonstrated endosonographically. Additional information as compared to CT/MRI was obtained in 7 out of 33 and in 6 out of 19 patients. This concerns in particular differentiation between tumor and hyperplasia and detection of small adrenal adenomas. High resolution endosonography of the adrenal glands can provide information about adrenal gland morphology which cannot be obtained by any other diagnostic approach.

  3. Physiological and biochemical aspects of the avian uropygial gland.

    PubMed

    Salibian, A; Montalti, D

    2009-05-01

    This review discusses different aspects of the uropygial gland of birds. The gland exhibits a striking morphological diversity in size, shape and presence/absence of tufts of feathers. It was shown that acidic mucins, neutral lipids, glycolipids and phospholipids are normal components of secretion. Several morphological and physiological aspects of the gland were studied on Rock Pigeon Columba livia Gmelin, 1879. The amount of the uropygial gland secretion, its lipid content and fatty acids profile were determined. The extracted lipid mixture contained of C14 to C20 fatty acids, mostly unsaturated; the saturated fatty acids were mainly 14:0, 16:0 and 18:0. No correlation was found between the size of the gland and the aquatic/terrestrial nature of the species. Ablation of the gland did not affect survival, body weight, feeding rate and serum cholesterol, total lipids or calcium levels after 32-120 days. The possible role of the gland in the protection against lipophilic compounds was discussed. The function of the gland is still a subject of controversy. It is accepted that its secretion confers water-repellent properties on the feather coat and maintain the suppleness of the feathers. Other physiological roles of the gland secretion may be associated to pheromone production, control of plumage hygiene, thermal insulation and defence against predators. Concerning the endocrine regulation of the uropygial function, there is scarce information presenting evidence for steroid regulated mechanisms.

  4. Role of vitamin C on the uropygial gland function in juvenile pigeons.

    PubMed

    Maiti, B R; Bose, S

    1980-01-01

    The role of the vitamin C was explored in the uropygial gland of the juvenile pigeons from histological and karyodynamic standpoints. Furthermore, the total lipid of the gland was also measured. Vitamin C loading increased the gland weight without causing any perceptible change in the mitotic activity of the gland or in the glandular lipid level in either sex of the juvenile pigeons. Significance of these findings has been briefly discussed.

  5. Accessory parotid gland tumors.

    PubMed

    Ramachar, Sreevathsa M; Huliyappa, Harsha A

    2012-01-01

    Tumors of accessory parotid gland are considered in the differential diagnosis of a mid cheek mass. Parotidectomy is the procedure of choice. All pathological types of parotid main gland tumors occur in the accessory parotid gland also. Presenting as a mid cheek or infrazygomatic mass, the tumors of this accessory parotid gland are notorious for recurrences, if adequate margins are not achieved. We describe two such cases of such a tumor. 40-year-old male with a slowly progressive mid cheek mass was operated by a mid cheek incision. Histopathology of the tumor was pleomorphic adenoma. Facial nerve paresis recovered complelety in 6 months. A 52-year-old female with progressive mid cheek mass who underwent parotidectomy and neck dissection by a modified Blair's incision was diagnosed with extranodal marginal zone lymphoma with focal transformation to a diffuse large B-cell lymphoma. Chemotherapy with CHOP regime was initiated. There was no recurrence at 6 months of follow-up. Lymphoma of accessory parotid gland is a very rare tumor. Standard parotidectomy incision is advocated to prevent damage to facial nerve branches.

  6. Accessory parotid gland tumors

    PubMed Central

    Ramachar, Sreevathsa M.; Huliyappa, Harsha A.

    2012-01-01

    Tumors of accessory parotid gland are considered in the differential diagnosis of a mid cheek mass. Parotidectomy is the procedure of choice. All pathological types of parotid main gland tumors occur in the accessory parotid gland also. Presenting as a mid cheek or infrazygomatic mass, the tumors of this accessory parotid gland are notorious for recurrences, if adequate margins are not achieved. We describe two such cases of such a tumor. 40-year-old male with a slowly progressive mid cheek mass was operated by a mid cheek incision. Histopathology of the tumor was pleomorphic adenoma. Facial nerve paresis recovered complelety in 6 months. A 52-year-old female with progressive mid cheek mass who underwent parotidectomy and neck dissection by a modified Blair's incision was diagnosed with extranodal marginal zone lymphoma with focal transformation to a diffuse large B-cell lymphoma. Chemotherapy with CHOP regime was initiated. There was no recurrence at 6 months of follow-up. Lymphoma of accessory parotid gland is a very rare tumor. Standard parotidectomy incision is advocated to prevent damage to facial nerve branches. PMID:23483721

  7. Lymphopoiesis in the chicken pineal gland

    SciTech Connect

    Cogburn, L.A.; Glick, B.

    1981-10-01

    Pineal lymphoid development was studied in two breeds of chickens from hatching until sexual maturity. No lymphocytes were found in the pineal prior to 9 days of age (da). Lymphocytes migrate through the endothelium of venules into the pineal stroma. Lymphoid tissue reached its maximal accumulation in 32-da pineal glands of both breeds. At this age, the New Hampshire (NH) breed had a larger proportion of lymphoid volume to total pineal volume (32%) than did pineal glands from White Leghorn (WL) chickens (18%).

  8. The evolution of sweat glands

    NASA Astrophysics Data System (ADS)

    Folk, G. Edgar; Semken, A.

    1991-09-01

    Mammals have two kinds of sweat glands, apocrine and eccrine, which provide for thermal cooling. In this paper we describe the distribution and characteristics of these glands in selected mammals, especially primates, and reject the suggested development of the eccrine gland from the apocrine gland during the Tertiary geological period. The evidence strongly suggests that the two glands, depending on the presence or absence of fur, have equal and similar functions among mammals; apocrine glands are not primitive. However, there is a unique and remarkable thermal eccrine system in humans; we suggest that this system evolved in concert with bipedalism and a smooth hairless skin.

  9. Objective image analysis of the meibomian gland area.

    PubMed

    Arita, Reiko; Suehiro, Jun; Haraguchi, Tsuyoshi; Shirakawa, Rika; Tokoro, Hideaki; Amano, Shiro

    2014-06-01

    To evaluate objectively the meibomian gland area using newly developed software for non-invasive meibography. Eighty eyelids of 42 patients without meibomian gland loss (meiboscore=0), 105 eyelids of 57 patients with loss of less than one-third total meibomian gland area (meiboscore=1), 13 eyelids of 11 patients with between one-third and two-thirds loss of meibomian gland area (meiboscore=2) and 20 eyelids of 14 patients with two-thirds loss of meibomian gland area (meiboscore=3) were studied. Lid borders were automatically determined. The software evaluated the distribution of the luminance and, by enhancing the contrast and reducing image noise, the meibomian gland area was automatically discriminated. The software calculated the ratio of the total meibomian gland area relative to the total analysis area in all subjects. Repeatability of the software was also evaluated. The mean ratio of the meibomian gland area to the total analysis area in the upper/lower eyelids was 51.9±5.7%/54.7±5.4% in subjects with a meiboscore of 0, 47.7±6.0%/51.5±5.4% in those with a meiboscore of 1, 32.0±4.4%/37.2±3.5% in those with a meiboscore of 2 and 16.7±6.4%/19.5±5.8% in subjects with a meiboscore of 3. The meibomian gland area was objectively evaluated using the developed software. This system could be useful for objectively evaluating the effect of treatment on meibomian gland dysfunction. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  10. Thyroid gland involvement in advanced laryngeal cancer: association with clinical and pathologic characteristics.

    PubMed

    Hilly, Ohad; Raz, Raanan; Vaisbuch, Yona; Strenov, Yulia; Segal, Karl; Koren, Rumelia; Shvero, Jacob

    2012-11-01

    Indications for thyroidectomy during laryngectomy are controversial. We examined whether clinicopathologic features can predict thyroid gland involvement, and the prognostic effect of thyroid gland involvement in patients undergoing total laryngectomy. The study set out to review preoperative assessment, operation findings, pathologic findings, and follow-up data. Thyroid gland involvement was found in 11 of 53 patients (21%) undergoing total laryngectomy and thyroidectomy. Preoperative work-up failed to predict thyroid gland involvement. Thyroid gland involvement was associated with salvage procedures (p = .025), paratracheal metastases (p = .003), and poor overall survival (hazard ratio = 2.74, p = .008). Thyroid gland involvement in patients undergoing total laryngectomy is frequent and is associated with poor prognosis. Preoperative assessment failed to predict thyroid gland involvement. We believe that thyroidectomy should be considered in cases with paratracheal lymphatic spread irrespective of tumor location within the larynx. Copyright © 2011 Wiley Periodicals, Inc.

  11. Pictorial essay: Salivary gland imaging

    PubMed Central

    Rastogi, Rajul; Bhargava, Sumeet; Mallarajapatna, Govindarajan Janardan; Singh, Sudhir Kumar

    2012-01-01

    Salivary glands are the first organs of digestion secreting their digestive juices into the oral cavity. Parotid, submandibular, and sublingual glands are the major paired salivary glands in the decreasing order of their size. In addition, multiple small minor salivary glands are noted randomly distributed in the upper aerodigestive tract, including paranasal sinuses and parapharyngeal spaces. The imaging is directed to the major salivary glands. Commonly used imaging methods include plain radiography and conventional sialography. Recently, high-resolution ultrasonography (HRUS) is being increasingly used for targeted salivary gland imaging. However, the advent of cross-sectional imaging techniques such as computed tomography (CT) and magnetic resonance imaging (MRI) have revolutionized the imaging of salivary glands. This article illustrates the role of imaging in evaluating the variegated disease pattern of the major salivary glands. PMID:23833425

  12. Deformable image registration for cone-beam CT guided transoral robotic base-of-tongue surgery.

    PubMed

    Reaungamornrat, S; Liu, W P; Wang, A S; Otake, Y; Nithiananthan, S; Uneri, A; Schafer, S; Tryggestad, E; Richmon, J; Sorger, J M; Siewerdsen, J H; Taylor, R H

    2013-07-21

    Transoral robotic surgery (TORS) offers a minimally invasive approach to resection of base-of-tongue tumors. However, precise localization of the surgical target and adjacent critical structures can be challenged by the highly deformed intraoperative setup. We propose a deformable registration method using intraoperative cone-beam computed tomography (CBCT) to accurately align preoperative CT or MR images with the intraoperative scene. The registration method combines a Gaussian mixture (GM) model followed by a variation of the Demons algorithm. First, following segmentation of the volume of interest (i.e. volume of the tongue extending to the hyoid), a GM model is applied to surface point clouds for rigid initialization (GM rigid) followed by nonrigid deformation (GM nonrigid). Second, the registration is refined using the Demons algorithm applied to distance map transforms of the (GM-registered) preoperative image and intraoperative CBCT. Performance was evaluated in repeat cadaver studies (25 image pairs) in terms of target registration error (TRE), entropy correlation coefficient (ECC) and normalized pointwise mutual information (NPMI). Retraction of the tongue in the TORS operative setup induced gross deformation >30 mm. The mean TRE following the GM rigid, GM nonrigid and Demons steps was 4.6, 2.1 and 1.7 mm, respectively. The respective ECC was 0.57, 0.70 and 0.73, and NPMI was 0.46, 0.57 and 0.60. Registration accuracy was best across the superior aspect of the tongue and in proximity to the hyoid (by virtue of GM registration of surface points on these structures). The Demons step refined registration primarily in deeper portions of the tongue further from the surface and hyoid bone. Since the method does not use image intensities directly, it is suitable to multi-modality registration of preoperative CT or MR with intraoperative CBCT. Extending the 3D image registration to the fusion of image and planning data in stereo-endoscopic video is anticipated

  13. Oncologic Outcomes After Transoral Robotic Surgery: A Multi-institutional Study.

    PubMed

    de Almeida, John R; Li, Ryan; Magnuson, J Scott; Smith, Richard V; Moore, Eric; Lawson, Georges; Remacle, Marc; Ganly, Ian; Kraus, Dennis H; Teng, Marita S; Miles, Brett A; White, Hilliary; Duvvuri, Umamaheswar; Ferris, Robert L; Mehta, Vikas; Kiyosaki, Krista; Damrose, Edward J; Wang, Steven J; Kupferman, Michael E; Koh, Yoon Woo; Genden, Eric M; Holsinger, F Christopher

    2015-12-01

    Large patient cohorts are necessary to validate the efficacy of transoral robotic surgery (TORS) in the management of head and neck cancer. To review oncologic outcomes of TORS from a large multi-institutional collaboration and to identify predictors of disease recurrence and disease-specific mortality. A retrospective review of records from 410 patients undergoing TORS for laryngeal and pharyngeal cancers from January 1, 2007, through December 31, 2012, was performed. Pertinent data were obtained from 11 participating medical institutions. Select patients received radiation therapy and/or chemotherapy before or after TORS. Locoregional control, disease-specific survival, and overall survival were calculated. We used Kaplan-Meier survival analysis with log-rank testing to evaluate individual variable association with these outcomes, followed by multivariate analysis with Cox proportional hazards regression modeling to identify independent predictors. Of the 410 patients treated with TORS in this study, 364 (88.8%) had oropharyngeal cancer. Of these 364 patients, information about post-operative adjuvant therapy was known about 338: 106 (31.3) received radiation therapy alone, and 72 (21.3%) received radiation therapy with concurrent chemotherapy. Neck dissection was performed in 323 patients (78.8%). Mean follow-up time was 20 months. Local, regional, and distant recurrence occurred in 18 (4.4%), 15 (3.7%), and 10 (2.4%) of 410 patients, respectively. Seventeen (4.1%) died of disease, and 13 (3.2%) died of other causes. The 2-year locoregional control rate was 91.8% (95% CI, 87.6%-94.7%), disease-specific survival 94.5% (95% CI, 90.6%-96.8%), and overall survival 91% (95% CI, 86.5%-94.0%). Multivariate analysis identified improved survival among women (P = .05) and for patients with tumors arising in tonsil (P = .01). Smoking was associated with worse overall all-cause mortality (P = .01). Although advanced age and tobacco use were associated with locoregional

  14. A comparative study of early and late extubation following transoral odontoidectomy and posterior fixation

    PubMed Central

    Marda, Manish; Pandia, Mihir Prakash; Rath, Girija Prasad; Kale, Shashank Sharad; Dash, Harihara

    2016-01-01

    Background and Aims: Elective ventilation is the usual practice after transoral odontoidectomy (TOO) and posterior fixation. This practice of elective ventilation is not based on any evidence. The primary objective of our study was to find out the difference in oxygenation and ventilation in patients extubated early compared to those extubated late after TOO and posterior fixation. The secondary objectives were to compare the length of Intensive Care Unit (ICU)/hospital stay and pulmonary complications between the two groups. Material and Methods: After TOO and posterior fixation, patients were either extubated in the operating room (Group E) or extubated next day (Group D). The oxygenation (PaO2:FiO2 ratio) and ventilation (PaCO2) of the two groups before surgery, at 30 min and at 6/12/24 and 48 h after extubation were compared. Complications, durations of ICU and hospital stay were noted. Results: The base-line PaO2:FiO2 and PaCO2 was comparable between the groups. No significant change in the PaO2:FiO2 was noted in the postoperative period in either group as compared to the preoperative values. Except for at 12 h after surgery, there was no significant difference between the two groups at various time intervals. No significant change in the PaCO2 level was seen during the study period in either group. PaCO2 measured at 30 min after surgery was more in Group E (37.5 ± 3.2 mmHg in Group E vs. 34.6 ± 2.9 mmHg in Group D), otherwise there was no significant difference between the two groups at various time intervals. One patient in Group E (7.1%) and two patients in Group D (13%) developed postoperative respiratory complication, but the difference was not statistically significant. The mean ICU stay (Group D = 42 ± 25 h vs. Group E = 25.1 ± 16.9 h) and mean hospital stay (Group D = 9.9 ± 4 days vs. Group E = 7.6 ± 2.2 days) were longer in Group D patients. Conclusion: Ventilation and oxygenation in the postoperative period in patients undergoing TOO and

  15. Deformable image registration for cone-beam CT guided transoral robotic base-of-tongue surgery

    NASA Astrophysics Data System (ADS)

    Reaungamornrat, S.; Liu, W. P.; Wang, A. S.; Otake, Y.; Nithiananthan, S.; Uneri, A.; Schafer, S.; Tryggestad, E.; Richmon, J.; Sorger, J. M.; Siewerdsen, J. H.; Taylor, R. H.

    2013-07-01

    Transoral robotic surgery (TORS) offers a minimally invasive approach to resection of base-of-tongue tumors. However, precise localization of the surgical target and adjacent critical structures can be challenged by the highly deformed intraoperative setup. We propose a deformable registration method using intraoperative cone-beam computed tomography (CBCT) to accurately align preoperative CT or MR images with the intraoperative scene. The registration method combines a Gaussian mixture (GM) model followed by a variation of the Demons algorithm. First, following segmentation of the volume of interest (i.e. volume of the tongue extending to the hyoid), a GM model is applied to surface point clouds for rigid initialization (GM rigid) followed by nonrigid deformation (GM nonrigid). Second, the registration is refined using the Demons algorithm applied to distance map transforms of the (GM-registered) preoperative image and intraoperative CBCT. Performance was evaluated in repeat cadaver studies (25 image pairs) in terms of target registration error (TRE), entropy correlation coefficient (ECC) and normalized pointwise mutual information (NPMI). Retraction of the tongue in the TORS operative setup induced gross deformation >30 mm. The mean TRE following the GM rigid, GM nonrigid and Demons steps was 4.6, 2.1 and 1.7 mm, respectively. The respective ECC was 0.57, 0.70 and 0.73, and NPMI was 0.46, 0.57 and 0.60. Registration accuracy was best across the superior aspect of the tongue and in proximity to the hyoid (by virtue of GM registration of surface points on these structures). The Demons step refined registration primarily in deeper portions of the tongue further from the surface and hyoid bone. Since the method does not use image intensities directly, it is suitable to multi-modality registration of preoperative CT or MR with intraoperative CBCT. Extending the 3D image registration to the fusion of image and planning data in stereo-endoscopic video is anticipated to

  16. Antireflux Transoral Incisionless Fundoplication Using EsophyX: 12-Month Results of a Prospective Multicenter Study

    PubMed Central

    Buset, Michel; Muls, Vinciane; Rajan, Amin; Rösch, Thomas; Eckardt, Alexander J.; Weerts, Joseph; Bastens, Boris; Costamagna, Guido; Marchese, Michele; Louis, Hubert; Mana, Fazia; Sermon, Filip; Gawlicka, Anna K.; Daniel, Michael A.; Devière, Jacques

    2008-01-01

    Background A novel transoral incisionless fundoplication (TIF) procedure using the EsophyX system with SerosaFuse fasteners was designed to reconstruct a full-thickness valve at the gastroesophageal junction through tailored delivery of multiple fasteners during a single-device insertion. The safety and efficacy of TIF for treating gastroesophageal reflux disease (GERD) were evaluated in a prospective multicenter trial. Methods Patients (n = 86) with chronic GERD treated with proton pump inhibitors (PPIs) were enrolled. Exclusion criteria included an irreducible hiatal hernia > 2 cm. Results The TIF procedure (n = 84) reduced all hiatal hernias (n = 49) and constructed valves measuring 4 cm (2–6 cm) and 230° (160°–300°). Serious adverse events consisted of two esophageal perforations upon device insertion and one case of postoperative intraluminal bleeding. Other adverse events were mild and transient. At 12 months, aggregate (n = 79) and stratified Hill grade I tight (n = 21) results showed 73% and 86% of patients with ≥50% improvement in GERD health-related quality of life (HRQL) scores, 85% discontinuation of daily PPI use, and 81% complete cessation of PPIs; 37% and 48% normalization of esophageal acid exposure; 60% and 89% hiatal hernia reduction; and 62% and 80% esophagitis reduction, respectively. More than 50% of patients with Hill grade I tight valves had a normalized cardia circumference. Resting pressure of the lower esophageal sphincter (LES) was improved significantly (p < 0.001), by 53%. EsophyX-TIF cured GERD in 56% of patients based on their symptom reduction and PPI discontinuation. Conclusion The 12-month results showed that EsophyX-TIF was safe and effective in improving quality of life and for reducing symptoms, PPI use, hiatal hernia, and esophagitis, as well as increasing the LES resting pressure and normalizing esophageal pH and cardia circumference in chronic GERD patients. PMID:18443855

  17. Deformable Image Registration for Cone-Beam CT Guided Transoral Robotic Base of Tongue Surgery

    PubMed Central

    Reaungamornrat, S.; Liu, W. P.; Wang, A. S.; Otake, Y.; Nithiananthan, S.; Uneri, A.; Schafer, S.; Tryggestad, E.; Richmon, J.; Sorger, J. M.; Siewerdsen, J. H.; Taylor, R. H.

    2013-01-01

    Transoral robotic surgery (TORS) offers a minimally invasive approach to resection of base of tongue tumors. However, precise localization of the surgical target and adjacent critical structures can be challenged by the highly deformed intraoperative setup. We propose a deformable registration method using intraoperative cone-beam CT (CBCT) to accurately align preoperative CT or MR images with the intraoperative scene. The registration method combines a Gaussian mixture (GM) model followed by a variation of the Demons algorithm. First, following segmentation of the volume of interest (i.e., volume of the tongue extending to the hyoid), a GM model is applied to surface point clouds for rigid initialization (GM rigid) followed by nonrigid deformation (GM nonrigid). Second, the registration is refined using the Demons algorithm applied to distance map transforms of the (GM-registered) preoperative image and intraoperative CBCT. Performance was evaluated in repeat cadaver studies (25 image pairs) in terms of target registration error (TRE), entropy correlation coefficient (ECC), and normalized pointwise mutual information (NPMI). Retraction of the tongue in the TORS operative setup induced gross deformation >30 mm. The mean TRE following the GM rigid, GM nonrigid, and Demons steps was 4.6, 2.1, and 1.7 mm, respectively. The respective ECC was 0.57, 0.70, and 0.73 and NPMI was 0.46, 0.57, and 0.60. Registration accuracy was best across the superior aspect of the tongue and in proximity to the hyoid (by virtue of GM registration of surface points on these structures). The Demons step refined registration primarily in deeper portions of the tongue further from the surface and hyoid bone. Since the method does not use image intensities directly, it is suitable to multi-modality registration of preoperative CT or MR with intraoperative CBCT. Extending the 3D image registration to the fusion of image and planning data in stereo-endoscopic video is anticipated to support

  18. Anatomy of the thymus gland.

    PubMed

    Safieddine, Najib; Keshavjee, Shaf

    2011-05-01

    In the case of the thymus gland, the most common indications for resection are myasthenia gravis or thymoma. The consistency and appearance of the thymus gland make it difficult at times to discern from mediastinal fatty tissues. Having a clear understanding of the anatomy and the relationship of the gland to adjacent structures is important. Copyright © 2011 Elsevier Inc. All rights reserved.

  19. Adrenal Gland Disorders: Condition Information

    MedlinePlus

    ... source of sex steroids, such as estrogen and testosterone. What are adrenal gland disorders? Adrenal gland disorders occur when the adrenal glands do not work properly. They can be classified into disorders that occur when too much hormone is produced or when too little hormone is produced. These ...

  20. Human Lacrimal Gland Gene Expression

    PubMed Central

    Aakalu, Vinay Kumar; Parameswaran, Sowmya; Maienschein-Cline, Mark; Bahroos, Neil; Shah, Dhara; Ali, Marwan; Krishnakumar, Subramanian

    2017-01-01

    Background The study of human lacrimal gland biology and development is limited. Lacrimal gland tissue is damaged or poorly functional in a number of disease states including dry eye disease. Development of cell based therapies for lacrimal gland diseases requires a better understanding of the gene expression and signaling pathways in lacrimal gland. Differential gene expression analysis between lacrimal gland and other embryologically similar tissues may be helpful in furthering our understanding of lacrimal gland development. Methods We performed global gene expression analysis of human lacrimal gland tissue using Affymetrix ® gene expression arrays. Primary data from our laboratory was compared with datasets available in the NLM GEO database for other surface ectodermal tissues including salivary gland, skin, conjunctiva and corneal epithelium. Results The analysis revealed statistically significant difference in the gene expression of lacrimal gland tissue compared to other ectodermal tissues. The lacrimal gland specific, cell surface secretory protein encoding genes and critical signaling pathways which distinguish lacrimal gland from other ectodermal tissues are described. Conclusions Differential gene expression in human lacrimal gland compared with other ectodermal tissue types revealed interesting patterns which may serve as the basis for future studies in directed differentiation among other areas. PMID:28081151

  1. Parathyroid gland removal

    MedlinePlus

    ... and will remove the diseased glands with the instruments. Endoscopic parathyroidectomy: Your surgeon will make two or three small cuts in the front of your neck and one cut above the top of your collarbone. This reduces visible scarring, pain, and recovery time. This cut is less than ...

  2. Canine mammary gland tumors.

    PubMed

    Sorenmo, Karin

    2003-05-01

    The National Consensus Group recommends that all women with tumors larger than 1 cm be offered chemotherapy regardless of tumor histology of lymph node status. This recommendation is to ensure that everyone at risk for failing, even though the risk may be low in women with relatively small tumors and favorable histology, has a choice and receives the benefit of adjuvant chemotherapy. This type of treatment recommendation may also be made in dogs based on recognized, well-accepted prognostic factors such as tumor size, stage, type, and histologic differentiation. Based on the limited clinical information available in veterinary medicine, the drugs that are effective in human breast cancer, such as cyclophosphamide, 5-fluorouracil, and doxorubicin, may also have a role in the treatment of malignant mammary gland tumors in dogs. Randomized prospective studies are needed, however, to evaluate the efficacy of chemotherapy in dogs with high-risk mammary gland tumors and to determine which drugs and protocols are the most efficacious. Until such studies are performed, the treatment of canine mammary gland tumors will be based on the individual oncologist's understanding of tumor biology, experience, interpretation of the available studies, and a little bit of gut-feeling. Table 2 is a proposal for treatment guidelines for malignant canine mammary gland tumors according to established prognostic factors, results from published veterinary studies, and current recommendations for breast cancer treatment in women.

  3. Suprasellar salivary gland-like pleomorphic adenoma.

    PubMed

    Yao, Kun; Duan, Zejun; Bian, Yu; Wang, Mengyang; Qi, Xueling

    2014-01-01

    Suprasellar salivary gland-Like pleomorphic adenoma is not a common disease and seldom reported so far. We are reporting a case of a 23-year-old man with recurrent suprasellar salivary gland-like pleomorphic adenoma, who underwent an operation of subtotal, subfrontal resection under the wrong pathology diagnosis of benign teratoma in another hospital 4-year-ago. Four years later, he was admitted to our hospital for additional visual loss of the right eye (left, 1.0; right, 0.4) resulting from tumor regrowth. Magnetic resonance imaging revealed that suprasellar extension and compressed optic chiasm resulted in visual disturbance of the patient. The tumor was totally excised and histological examination evidenced the pathological features of intrasellar salivary gland-like pleomorphic adenoma. The patient did not receive any further treatment and he is free from tumor recurrence for 30 months after the operation. From this point of view, clinical prognosis of intrasellar salivary gland-like pleomorphic adenoma was good after total surgical resection.

  4. Radioisotope study of salivary glands

    SciTech Connect

    De Rossi, G.

    1987-01-01

    The book discusses the use of radioisotope methods in the diagnosis of salivary gland diseases. Anatomical and physiological features of the salivary gland are summarized and radiotracer deposition processes are described. Clinical applications of scintigraphy are detailed. The degree of functional impairment due to various inflammatory diseases is contrasted by means of semiquantitative computerized methods with follow-up therapeutic results. Post-irradiatory involvement and possible functional recovery of salivary glands are also considered. The contents discussed are: Salivary Gland Physiology and Radioisotope Uptake. Radioisotope Study of Salivary Glands. Radioisotope Studies Under Normal Conditions. Survey of Radiographic Methods. Dosimetric Assessment. Conclusions and Index.

  5. Real-time navigation in transoral robotic nasopharyngectomy utilizing on table fluoroscopy and image overlay software: a cadaveric feasibility study.

    PubMed

    Tsang, Raymond K; Sorger, Jonathan M; Azizian, Mahdi; Holsinger, Christopher F

    2015-12-01

    Inability to integrate surgical navigation systems into current surgical robot is one of the reasons for the lack of development of robotic endoscopic skull base surgery. We describe an experiment to adapt current technologies for real-time navigation during transoral robotic nasopharyngectomy. A cone-beam CT was performed with a robotic C-arm after the injecting contrast into common carotid artery. 3D reconstruction of the skull images with the internal carotid artery (ICA) highlighted red was projected on the console. Robotic nasopharyngectomy was then performed. Fluoroscopy was performed with the C-arm. Fluoroscopic image was then overlaid on the reconstructed skull image. The relationship of the robotic instruments with the bony landmarks and ICA could then been viewed in real-time, acting as a surgical navigation system. Navigation during robotic skull base surgery is feasible with available technologies and can increase the safety of robotic skull base surgery.

  6. A fatal iatrogenic right vertebral injury after transoral odontoidectomy and posterior cervical stabilization for a type II odontoid fracture.

    PubMed

    Scalici, Edoardo; Indorato, Francesca; Portelli, Francesca; Savì, Tommaso; Maresi, Emiliano; Busardò, Francesco P

    2014-02-01

    The authors present a singular case of an iatrogenic right vertebral artery injury, involving a 67 year-old man, who reported a type II odontoid fracture (Anderson and D'Alonzo Classification) and posterior atlantoaxial dislocation following a road traffic accident. A small injury involving the right vertebral artery occurred as a consequence of transoral odontoidectomy and posterior cervical stabilization. It was caused by bone spicules of spinal origin and their presence was confirmed by the histological section of the right vertebral artery at the level of C1-C2. The case confirms how iatrogenic vertebral artery injuries during cervical spine surgery may be potentially lethal, especially where complications arise some days after surgery.

  7. Operative Technique for En Bloc Resection of Upper Cervical Chordomas: Extended Transoral Transmandibular Approach and Multilevel Reconstruction

    PubMed Central

    Ortega-Porcayo, Luis Alberto; Cabrera-Aldana, Eibar Ernesto; Arriada-Mendicoa, Nicasio; Gómez-Amador, Juan Luis; Granados-García, Martín

    2014-01-01

    Anterior exposure for cervical chordomas remains challenging because of the anatomical complexities and the restoration of the dimensional balance of the atlanto-axial region. In this report, we describe and analyze the transmandibular transoral approach and multilevel spinal reconstruction for upper cervical chordomas. We report two cases of cervical chordomas (C2 and C2-C4) that were treated by marginal en bloc resection with a transmandibular approach and anterior-posterior multilevel spinal reconstruction/fixation. Both patients showed clinical improvement. Postoperative imaging was negative for any residual tumor and revealed adequate reconstruction and stabilization. Marginal resection requires more extensive exposure to allow the surgeon access to the entire pathology, as an inadequate tumor margin is the main factor that negatively affects the prognosis. Anterior and posterior reconstruction provides a rigid reconstruction that protects the medulla and decreases axial pain by properly stabilizing the cervical spine. PMID:25558326

  8. Transoral endoscopic mediastinal surgery (TOEMS)—results of a first clinical study for scarless mediastinal lymph node biopsies

    PubMed Central

    Frese, Steffen; Leschber, Gunda; Nemat, André; Wilhelm, Thomas

    2016-01-01

    Background Video-assisted mediastinoscopy (VAM) represents the standard procedure for mediastinal lymph node biopsies. This operation results in a scar at prominent position at the anterior neck. Since there is a trend to less invasive procedures, natural orifice transluminal endoscopic surgery (NOTES) was introduced to different fields of surgery. Based on NOTES we developed a new approach for mediastinoscopy: transoral endoscopic mediastinal surgery (TOEMS). In previous studies using human cadavers and living pigs the feasibility of TOEMS was shown. It was unclear whether TOEMS could be safely applied in patients requiring mediastinal lymph node biopsies. Methods We conducted a clinical phase I study recruiting ten patients with unclear mediastinal lymphadenopathy not resolved by prior bronchoscopy. All patients underwent TOEMS for mediastinal lymph node biopsy. The duration of the procedure and complications were monitored. In addition, all patients were examined for pain, swallowing dysfunction and sensation disturbance. Results TOEMS was accomplished in eight patients. In two patients operation was converted to VAM due to technical problems. Mediastinal lymph nodes were dissected in all patients who finished with TOEMS. On average, two separate lymph stations were reached by TOEMS. Duration of the procedure was 159±22 min. Permanent palsy of the right recurrent laryngeal nerve was noticed in one patient postoperatively. Conclusions This is the first report for a human application of NOTES in thoracic surgery. In fact, transoral endoscopic surgery seems to be a feasible approach for mediastinal lymph node biopsies. Further studies are needed to show whether this procedure has an advantage over VAM in terms of pain, complications and accessibility of mediastinal lymph node stations. PMID:27867546

  9. Salivary gland disorders.

    PubMed

    Mandel, Louis

    2011-01-01

    Salivary gland abnormalities and salivary dysfunction are important orofacial disorders. Patients with such problems are usually seen in the dental office for evaluation and therapy, and the dental practitioner is required to make a diagnosis and institute care. Therefore, it is necessary for the dentist to be knowledgeable regarding the more common pathologic entities that involve the salivary apparatus, and also be familiar with the diagnostic and therapeutic tools that are available. Successful diagnosis is dependent on the organized integration of the information derived from past history, clinical examination, salivary volume study, imaging, serology, and histopathologic examination. This article discusses the most common disorders seen in the Salivary Gland Center and indicates the current approaches to diagnosis. Improvement in diagnostic skills will avoid serious complications and lead to specific and effective therapy.

  10. [Tissue engineering of parathyroid gland].

    PubMed

    Iovino, F; Armano, G; Auriemma, P P; Sergio, R; De Sena, G; Capuozzo, V; Rosso, F; Marino, G; Papale, F; Grimaldi, A; Barbarisi, A

    2010-01-01

    The postoperative hypoparathyroidism is a not rare complication after total thyroidectomy and/or total parathyroidectomy. Attempts to transplant parathyroid tissue began in 1975 with the work of Wells, but still today results are disappointing. However, with the development of tissue engineering techniques, some experimental approaches to build artificial parathyroid are been made. Bioengineered device, actively secreting PTH, for transplant in patients with iatrogenic hypoparathyroidism is unavailable. Parathyroid cells were obtained from three chronic uremic patients in hemodialysis, operated for secondary hyperparathyroidism. Cell cultures in RPMI medium were subsequently seeded on collagen scaffold (three-dimensional matrix with slow biodegradation). Collagen is the major component of the extracellular matrix and thus is a good substrate for cell adhesion and growth. Culture media, with a low calcium concentration, were optimised to physiologically stimulate parathyroid hormone secretion. Cell cultures were morphologically observed in optical and electron (ESEM) microscopy and metabolically assayed by MTT method until the tenth week. Besides, concentration of parathyroid hormone in the culture medium has been measured for several weeks. After 24 hours of culture in RPMI, cells extracted from human parathyroid glands were nearly all adherent and organised in clusters to resemble the glandular organization. The cellular population consisted predominantly of parathyroid cells (90-95%). On collagen scaffolds, cells maintains an epithelial-like morphology also after 10 weeks, colonizing the scaffold surface and keeping a good proliferative rate with a discrete production of parathyroid hormone. The use of parathyroid cells extracted from patients with secondary hyperparathyroidism was certainly an appropriate choice that enabled us to achieve these results, that albeit partial bode well for the experimental in vivo animal model. The bioengineered scaffolds when

  11. Pediatric Salivary Gland Malignancies.

    PubMed

    Ord, Robert A; Carlson, Eric R

    2016-02-01

    Pediatric malignant salivary gland tumors are extremely rare. The percentage of malignant tumors is higher than that seen in adults, although the outcomes in terms of survival are better in pediatric patients. The mainstay of treatment is surgical excision with negative margins. This article reviews current concepts in demographics, etiology, management, and outcomes of malignant salivary tumors in children. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. Comparison of imaging methods for diagnosing enlarged parathyroid glands in chronic renal failure

    SciTech Connect

    Takagi, H.; Tominaga, Y.; Uchida, K.; Yamada, N.; Kano, T.; Kawai, M.; Morimoto, T.

    1985-07-01

    Three noninvasive imaging methods, CT, scintigraphy with /sup 201/TlCl and /sup 99m/TcO4-, and ultrasonography, were performed on 36 patients with chronic renal failure and secondary hyperparathyroidism. The patients subsequently underwent total parathyroidectomy and parathyroid autograft. The detection rates of the three methods for the 143 excised parathyroid glands were compared according to gland weight and location. Computed tomography detected 53.8% of all glands and 77.6% of 76 glands weighing more than 500 mg. Scintigraphy detected 51.0% of all glands and 77.6% of glands heavier than 500 mg. Ultrasonography detected 42.7% of all glands and 65.8% of glands heavier than 500 mg. The detection rate of upper glands was best with CT (53.5 and 87.9%): that of lower glands was best with scintigraphy (62.0 and 78.6%). Although the combination of the three methods diagnosed 66.4% of all glands and 89.5% of glands heavier than 500 mg, CT and scintigraphy, the best two combinations, visualized 64.3 and 88.2%.

  13. [Computed tomographic anatomy of the salivary glands in the cat].

    PubMed

    Fromme, V; Köhler, C; Piesnack, S; Oechtering, G; Ludewig, E

    2016-01-01

    The aim of the study was to define anatomical characteristics of the feline salivary glands in cross-sectional images obtained by unenhanced computed tomography (CT) and to describe landmarks for a reliable identification. Heads of adult normocephalic cats without indications of cephalic disease were examined. Cats were included in the prospective part of the study when examined no later than 1 hour post mortem (n = 16). In the retrospective part of the study, previous CT-studies were evaluated (n = 25). The results of both groups were evaluated separately. Initially, the possibility of identifying and delineating the salivary glands from the surrounding tissue was assessed. Anatomical structures of the head were then defined as landmarks. Dimensions and density (Hounsfield units, HU) of the salivary glands were determined based on transversal and reconstructed sagittal images. In total, 94.3% of the parotid glands, 90.7% of the mandibular glands and 96.8% of the zygomatic glands could be delineated. The remaining salivary glands could not be identified. Anatomical landmarks, including the external ear canal, the musculus (M.) masseter, the M. pterygoideus medialis and the bulbus oculi facilitated the identification. Comparing the size of the salivary glands of both groups revealed differences (measured lateromedially and rostrocaudally) in size of ≤   2 mm. The definable salivary glands varied significantly in their density. The mean density of the glandula (Gl.) parotis was 65 HU, of the Gl. mandibularis 62 HU and of the Gl. zygomatica 57 HU. The comparisons of densities of both sides of the glands did not show statistically significant differences. The large salivary glands (Gl. parotis and Gl. mandibularis) and the Gl. zygomatica of the cat can be reliably identified in CT-images. CT landmarks and data regarding the size and density of each gland could be gathered. The remaining minor salivary glands could not be delineated accurately. The difference in

  14. Salivary duct carcinoma of the parotid gland

    PubMed Central

    Mlika, Mona; Kourda, Nadia; Zidi, YSH; Aloui, Raoudha; Zneidi, Nadia; Rammeh, Soumaya; Zermani, Rachida; Jilani, Sarah Ben

    2012-01-01

    Salivary duct carcinoma of the parotid gland is an uncommon tumor, highly aggressive. About 200 cases have been reported in the English literature. Pathomorphologically, these tumors showed great similarities to ductal carcinoma of the female breast, which is why they described this tumor as “salivary duct carcinoma.” The authors describe a new case of salivary duct carcinoma of the parotid gland. We present the case of a 50-year-old patient with progressive facial paralysis. The MRI examination of the head showed two ill-defined formations. A malignant tumor was strongly suspected, so that a total left parotidectomy with excision of the adjacent facial nerve and left lymph node dissection was performed. Microscopic examination concluded to a salivary duct carcinoma of the left parotid gland negative with Her2/neu antibody with lymph node metastasis. There were no recurrences or metastases within 3 years of follow-up. Salivary duct carcinoma of the parotid gland is a rare tumor with an aggressive behavior. This is due to its propensity to infiltrate distant organs. The diagnosis is based on microscopic examination. Treatment modalities are non-consensual, but some authors advocate the necessity of aggressive approach, especially in tumors negative with Heur2/neu antibody. This is due to the fact that the overexpression of this antigen was reported to be associated with a poor prognosis. PMID:22434951

  15. Late Consequential Surgical Bed Soft Tissue Necrosis in Advanced Oropharyngeal Squamous Cell Carcinomas Treated With Transoral Robotic Surgery and Postoperative Radiation Therapy

    SciTech Connect

    Lukens, J. Nicholas; Lin, Alexander; Gamerman, Victoria; Mitra, Nandita; Grover, Surbhi; McMenamin, Erin M.; Weinstein, Gregory S.; O'Malley, Bert W.; Cohen, Roger B.; Orisamolu, Abimbola; Ahn, Peter H.; Quon, Harry

    2014-08-01

    Purpose: A subset of patients with oropharyngeal squamous cell carcinoma (OP-SCC) managed with transoral robotic surgery (TORS) and postoperative radiation therapy (PORT) developed soft tissue necrosis (STN) in the surgical bed months after completion of PORT. We investigated the frequency and risk factors. Materials and Methods: This retrospective analysis included 170 consecutive OP-SCC patients treated with TORS and PORT between 2006 and 2012, with >6 months' of follow-up. STN was defined as ulceration of the surgical bed >6 weeks after completion of PORT, requiring opioids, biopsy, or hyperbaric oxygen therapy. Results: A total of 47 of 170 patients (28%) had a diagnosis of STN. Tonsillar patients were more susceptible than base-of-tongue (BOT) patients, 39% (41 of 104) versus 9% (6 of 66), respectively. For patients with STN, median tumor size was 3.0 cm (range 1.0-5.6 cm), and depth of resection was 2.2 cm (range 1.0-5.1 cm). Median radiation dose and dose of fraction to the surgical bed were 6600 cGy and 220 cGy, respectively. Thirty-one patients (66%) received concurrent chemotherapy. Median time to STN was 2.5 months after PORT. All patients had resolution of STN after a median of 3.7 months. Multivariate analysis identified tonsillar primary (odds ratio [OR] 4.73, P=.01), depth of resection (OR 3.12, P=.001), total radiation dose to the resection bed (OR 1.51 per Gy, P<.01), and grade 3 acute mucositis (OR 3.47, P=.02) as risk factors for STN. Beginning May 2011, after implementing aggressive avoidance of delivering >2 Gy/day to the resection bed mucosa, only 8% (2 of 26 patients) experienced STN (all grade 2). Conclusions: A subset of OP-SCC patients treated with TORS and PORT are at risk for developing late consequential surgical bed STN. Risk factors include tonsillar location, depth of resection, radiation dose to the surgical bed, and severe mucositis. STN risk is significantly decreased with carefully avoiding a radiation dosage of >2 Gy/day to the

  16. Late consequential surgical bed soft tissue necrosis in advanced oropharyngeal squamous cell carcinomas treated with transoral robotic surgery and postoperative radiation therapy.

    PubMed

    Lukens, J Nicholas; Lin, Alexander; Gamerman, Victoria; Mitra, Nandita; Grover, Surbhi; McMenamin, Erin M; Weinstein, Gregory S; O'Malley, Bert W; Cohen, Roger B; Orisamolu, Abimbola; Ahn, Peter H; Quon, Harry

    2014-08-01

    A subset of patients with oropharyngeal squamous cell carcinoma (OP-SCC) managed with transoral robotic surgery (TORS) and postoperative radiation therapy (PORT) developed soft tissue necrosis (STN) in the surgical bed months after completion of PORT. We investigated the frequency and risk factors. This retrospective analysis included 170 consecutive OP-SCC patients treated with TORS and PORT between 2006 and 2012, with >6 months' of follow-up. STN was defined as ulceration of the surgical bed >6 weeks after completion of PORT, requiring opioids, biopsy, or hyperbaric oxygen therapy. A total of 47 of 170 patients (28%) had a diagnosis of STN. Tonsillar patients were more susceptible than base-of-tongue (BOT) patients, 39% (41 of 104) versus 9% (6 of 66), respectively. For patients with STN, median tumor size was 3.0 cm (range 1.0-5.6 cm), and depth of resection was 2.2 cm (range 1.0-5.1 cm). Median radiation dose and dose of fraction to the surgical bed were 6600 cGy and 220 cGy, respectively. Thirty-one patients (66%) received concurrent chemotherapy. Median time to STN was 2.5 months after PORT. All patients had resolution of STN after a median of 3.7 months. Multivariate analysis identified tonsillar primary (odds ratio [OR] 4.73, P=.01), depth of resection (OR 3.12, P=.001), total radiation dose to the resection bed (OR 1.51 per Gy, P<.01), and grade 3 acute mucositis (OR 3.47, P=.02) as risk factors for STN. Beginning May 2011, after implementing aggressive avoidance of delivering >2 Gy/day to the resection bed mucosa, only 8% (2 of 26 patients) experienced STN (all grade 2). A subset of OP-SCC patients treated with TORS and PORT are at risk for developing late consequential surgical bed STN. Risk factors include tonsillar location, depth of resection, radiation dose to the surgical bed, and severe mucositis. STN risk is significantly decreased with carefully avoiding a radiation dosage of >2 Gy/day to the surgical bed. Copyright © 2014 Elsevier Inc. All

  17. Transoral transclival approach for intradural lesions using a protective bone baffle to block cerebrospinal fluid pulse energy--two case reports.

    PubMed

    Imamura, J; Ikeyama, Y; Tsutida, E; Moroi, J

    2001-04-01

    The transoral transclival approach for the treatment of intradural lesions of the clivus is often associated with serious complications such as cerebrospinal fluid (CSF) leakage and meningitis. CSF pulse energy may be the most significant factor in CSF leakage and meningitis, but a bone baffle can block such CSF pulse energy. A 64-year-old female presented with sudden onset of severe headache. She had subarachnoidal hemorrhage due to a rupture of the vertebral-posterior inferior cerebellar artery aneurysm. A 66-year-old female complaining of occipitalgia and numbness of the extremities had a foramen magnum meningioma. Both patients were treated via the transoral transclival route with a protective bone baffle, obtained from the iliac bone, securely fixed in the bone window to protect the repaired dura from injury by CSF pulse energy. Neither patient showed CSF leakage or meningitis, and the period of continuous lumbar CSF drainage was only 7 days. The transoral transclival approach with a bone baffle is still very effective in selected cases.

  18. Transoral open reduction and fixation of mandibular condylar base and neck fractures in children and young teenagers--a beneficial treatment option?

    PubMed

    Schiel, Sebastian; Mayer, Peter; Probst, Florian; Otto, Sven; Cornelius, Carl-Peter

    2013-07-01

    To evaluate the possible benefits of open surgery, endoscopically assisted reduction and fixation using a transoral route was used in a selected series of pediatric patients with displaced condylar base and neck fractures. A cohort of 6 patients (1 male and 5 female; age range, 7 to 15 yr; mean, 13.4 yr) with displaced condylar base and neck fractures (n = 9) were included. Inclusion criteria were age younger than 16 years, fracture of the condylar base or neck, and displacement of the fracture by at least 45°. Fractures were classified using conventional radiography, cone-beam computed tomography, or computed tomography. Patients underwent transoral endoscopically assisted open reduction and fixation using miniplate osteosynthesis. Postoperatively, patients were followed clinically and radiographically for 18 months. Complete follow-up varied from 18 to 35 months (median, 24.5 months). All patients showed normal occlusion and pain-free unrestricted function of the temporomandibular joint at 3, 6, 12, and 18 months postoperatively. There were no signs of incomplete remodeling or deformation of the condyles. Transoral endoscopically assisted surgical treatment of severely displaced condylar base and neck fractures in children and young teenagers offers a reliable solution to preclude the sequelae of closed treatment, such as altered morphology and functional disturbances, eliminates visible scars, and lowers the risk of facial nerve damage compared with open reduction using an extraoral approach. Crown Copyright © 2013. Published by Elsevier Inc. All rights reserved.

  19. [2 cases of adenolymphoma of the parotid gland].

    PubMed

    Andreini, A; Avogadro, M; Trassini, R

    1979-01-01

    Starting from two cases of adenolymphoma of the parotid gland they had under observation, the Authors underline their doubts regarding the histogenesis, discuss the clinical approach and show their attitude towards the therapy. It consists of an enucleation or nucleoresection of the tumour in case only the superficial part of the gland is affected; a total parotidectomy with facial nerve preservation and without any radiotherapy, in case of a radical operation; with complementary radiotherapy if the operation has not been radical for certain.

  20. USF-1 as an Inhibitor of Mammary Gland Carcinogenesis

    DTIC Science & Technology

    2001-09-01

    The hypothesis tested in this proposal is that overexpression of USF in the mammary glands of transgenic mice will inhibit myc-dependent...tumorigenesis. To test this hypothesis, a transgene was constructed to target the overexpression of FLAG-tagged USF-2 to the mammary glands of transgenic mice ...under the control of the mouse mammary tumor virus (mmtv) long terminal repeat. A total of eight lines of transgenic mice were generated. Of these, one

  1. Sialadenosis of the salivary glands.

    PubMed

    Pape, S A; MacLeod, R I; McLean, N R; Soames, J V

    1995-09-01

    Sialadenosis (sialosis) is an uncommon, non-inflammatory condition which usually causes bilateral, diffuse enlargement of the salivary glands, particularly the parotid. We present a series of 7 patients with sialadenosis. Two had bilateral and 4 unilateral parotid involvement. One patient had unilateral submandibular gland sialadenosis. One patient had bilateral parotid and bilateral submandibular gland sialadenosis. The clinicopathological features and management of the condition are reviewed.

  2. Thyroid gland involvement in carcinoma of the hypopharynx.

    PubMed

    Joshi, P; Nair, S; Chaturvedi, P; Nair, D; Shivakumar, T; D'Cruz, A K

    2014-01-01

    The thyroid gland is removed en bloc during laryngectomy. There are no objective criteria for deciding the extent of thyroid gland resection in primary hypopharyngeal cancer cases. The present study aimed to determine the incidence of thyroid gland involvement in hypopharyngeal cancer and identify the various predictors of this involvement. This paper reports a retrospective analysis of 358 patients with hypopharyngeal cancer, who underwent total laryngectomy with partial or total pharyngectomy at Tata Memorial Hospital, Mumbai between 2004 and 2010. The mean age of this population was 61 years. The pyriform sinus was the most common hypopharyngeal subsite involved (in 89 per cent of cases). Most patients underwent hemi-thyroidectomy as part of their surgery. The thyroid gland was involved in only 13 per cent of cases. Thyroid gland involvement is not common in hypopharyngeal cancer. Cases that involved the post-cricoid area, subglottic extension, extralaryngeal spread or prior tracheostomy were associated with a higher risk of thyroid gland involvement. Ipsilateral thyroidectomy is sufficient in most patients undergoing surgery (laryngectomy with partial or total pharyngectomy) for hypopharyngeal cancers.

  3. [Sonography of the adrenal glands].

    PubMed

    Rüeger, R

    2005-03-02

    In the abdominal ultrasonography, the representation of normal adrenal glands is frequently problematic, also for experienced practitioners in ultrasonography. During a seminary at the congress of the SGUM in Davos, in June 2004, it was specially entered to this problematic by anatomical illustrations and live demonstrations. These statements will be summarized in the following article. Also, the technics of examination of the adrenal glands will be explained, especially in comparison to anatomical cut-preparations. It will be entered to particular pathological statements of the adrenal glands. The proceeding will be described by the localisation of accidentally detected tumours of adrenal glands.

  4. Patterns of innervation of the lacrimal gland with clinical application.

    PubMed

    Scott, Gabriel; Balsiger, Heather; Kluckman, Matthew; Fan, Jerry; Gest, Thomas

    2014-11-01

    Parasympathetic stimulation of the lacrimal gland is responsible for tear production, and this innervation originates from fibers conveyed in the facial nerve. After synapse in the pterygopalatine ganglion, postsynaptic parasympathetic fibers travel within the zygomatic and zygomaticotemporal nerves (ZTN) into the orbit. As described in most anatomy texts, ZTN communicates with the lacrimal nerve (LN) posterior to the gland and then secretomotor fibers enter the gland. This study was performed to gain a better understanding of the innervation of the lacrimal gland. Seventeen cadaver heads were bisected for a total of 34 sides, which then underwent dissection of the superolateral orbital region to observe the course for the LN and ZTN. Three variations of the course of the LN and ZTN were found. In 20 (60.6%) dissections it was documented that the ZTN entered directly into the lacrimal gland with no communication with the LN. In 12 (36.4%) of the bisected heads, ZTN had both a direct connection into the gland and a communicating branch with the LN. In only one (3.0%) bisected head, ZTN communicated with the LN before entering the gland as it is commonly described in anatomy texts. Our study reveals that the ZTN usually takes a different course than is classically described in most anatomy textbooks. A greater understanding of the typical course these nerves take may help surgeons identify them more easily and avoid damaging them.

  5. Stress and Salivary Glands.

    PubMed

    Kerémi, Beáta; Beck, Anita; Fábián, Tibor Károly; Fábián, Gábor; Szabó, Géza; Nagy, Ákos; Varga, Gábor

    2017-02-15

    Salivary glands produce a bicarbonate-rich fluid containing digestive and protective proteins and other components to be delivered into the gastrointestinal tract. Its function is under strict control of the autonomic nervous system. Salivary electrolyte and fluid secretion is primarily controlled by parasympathetic activity, while protein secretion is primaily triggered by sympathetic stimulation. Stress activates the hypothalamic - pituitary - adrenal axis. The peripheral limb of this axis is the efferent sympathetic/adrenomedullary system. Stress reaction, even if it is sustained for long, does not cause obvious damage to salivary glands. However, stress induces dramatic changes in the constituents of secreted saliva. Since salivary protein secretion is strongly dependent on sympathetic control, changes in saliva can be utilized as sensitive stress indicators. Some of the secreted compounds are known for their protective effect in the mouth and the gut, while others may just pass through the glands from blood plasma because of their chemical nature and the presence of transcellular salivary transporting systems. Indeed, most compounds that appear in blood circulation can also be identified in saliva, although at different concentrations. This work overviews the presently recognized salivary stress biosensors, such as amylase, cortisol, heat shock proteins and other compounds. It also demonstrates that saliva is widely recognised as a diagnostic tool for early and sensitive discovery of salivary and systemic conditions and disorders. At present it may be too early to introduce most of these biomarkers in daily routine diagnostic applications, but advances in salivary biomarker standardisation should permit their wide-range utilization in the future including safe, reliable and non-invasive estimation of acute and chronic stress levels in patients.

  6. Functional swallowing outcomes following treatment for oropharyngeal carcinoma: a systematic review of the evidence comparing trans-oral surgery versus non-surgical management.

    PubMed

    Dawe, N; Patterson, J; O'Hara, J

    2016-08-01

    Trans-oral surgical and non-surgical management options for oropharyngeal squamous cell carcinoma (OPSCC) appear to offer similar survival outcomes. Functional outcomes, in particular swallowing, have become of increasing interest in the debate regarding treatment options. Contemporary reviews on function following treatment frequently include surrogate markers and limit the value of comparative analysis. A systematic review was performed to establish whether direct comparisons of swallowing outcomes could be made between trans-oral surgical approaches (trans-oral laser microsurgery (TLM)/trans-oral robotic surgery (TORS)) and (chemo)radiotherapy ((C)RT). Systematic review. MEDLINE, Embase and Cochrane databases were interrogated using the following MeSH terms: antineoplastic protocols, chemotherapy, radiotherapy, deglutition disorders, swallowing, lasers, and trans-oral surgery. Two authors performed independent systematic reviews and consensus was sought if opinions differed. The WHO ICF classification was applied to generate analysis based around body functions and structure, activity limitations and participation restriction. Thirty-seven citations were included in the analysis. Twenty-six papers reported the outcomes for OPSCC treatment following primary (C)RT in 1377 patients, and 15 papers following contemporary trans-oral approaches in 768 patients. Meta-analysis was not feasible due to varying methodology and heterogeneity of outcome measures. Instrumental swallowing assessments were presented in 13/26 (C)RT versus 2/15 TLM/TORS papers. However, reporting methods of these studies were not standardised. This variety of outcome measures and the wide-ranging intentions of authors applying the measures in individual studies limit any practical direct comparisons of the effects of treatment on swallowing outcomes between interventions. From the current evidence, no direct comparisons could be made of swallowing outcomes between the surgical and non

  7. The chemical composition of the uropygial gland secretion of rock dove Columba livia.

    PubMed

    Montalti, Diego; Gutiérrez, Ana María; Reboredo, Guillermo; Salibián, Alfredo

    2005-03-01

    The uropygial gland is a holocrine secretory gland of birds. The lipid and the waxy sebum that the gland secretes is coated on the beak and transferred to the plumage in preening. The composition of the gland secretions from birds of different species has been determined, but little is known about the lipids of the secretion of the gland of the rock dove Columba livia. The amount of secretion, the total lipid content and the fatty acids composition of the secretion of C. livia captured in the nonbreeding season was reported. The mean amount of the secretion within the gland was 30 mg; the mean lipid content of the secretion was 0.385 mg/mg of secretion, which was equivalent to approximately 38% of the secretion. The weight of the secretion relative to gland weight was 32%. If we assume that the amount of the gland secretion constitutes a valid parameter to determine the degree of the gland development, our results indicate that the physiological role of the gland does not depend upon gland mass (GW); the rock dove in particular has a small gland, but its secretion represented 32% of the gland's mass. The composition of the lipids extracted from the gland secretion consisted of C14 to C20 fatty acids, most of them were unsaturated. The secretion of the gland contained approximately 59% of unsaturated fatty acids with a prevalence of oleic acid (37%) and a low content of linoleic (6%) and arachidonic acids (7%). The saturated long chain fatty acids were mainly 14:0, 16:0 and 18:0 in a percentage of approximately 34%. No sexual differences were found in any of the evaluated parameters.

  8. Fractionated irradiation and early changes in salivary glands. Different effects on potassium efflux, exocytotic amylase release and gland morphology

    SciTech Connect

    Franzen, L.; Funegard, U.S.; Sundstroem, S.G.; Gustafsson, H.; Danielsson, A.; Henriksson, R. )

    1991-02-01

    Irradiation is a potent treatment modality of head and neck cancer. However, the irradiation is usually associated with an influence on salivary glands with ensuing dryness and discomfort for the patients. In the present study we used different in vitro secretory models and morphologic characterization of rat parotid gland. Radiation was given to one gland on a 5-day schedule with 6 MV photons (total dose 20, 30, 35, 40, 45 Gy). The contralateral gland served as control, and the analysis of glands were performed 10 days after the last irradiation treatment. The noradrenaline stimulated electrolyte secretion (86rubidium tracer for potassium) was decreased in relation to the irradiation dose and in comparison to contralateral control glands. Noradrenaline stimulated exocytotic amylase release was not affected by irradiation and, there were no signs of obvious quantitative morphologic alterations after irradiation compared with controls. The results suggest that there are differences in the sensitivity to radiation for the two different secretory processes in salivary glands, and, thus, the structures regulating electrolyte and fluid secretion seem to be more vulnerable to irradiation than the process of exocytosis. The results, however, do not allow discrimination between temporary cellular impairment and irreversible damage leading to cell death.

  9. Giant salivary calculi of the submandibular gland

    PubMed Central

    Fowell, C; MacBean, A

    2012-01-01

    Sialolithasis is the most common salivary gland disease. A case of an unusually large sialolith arising in the submandibular gland is presented, along with a review of the management of giant salivary gland calculi. PMID:24960792

  10. Arterial vascularization and morphological characteristics of adrenal glands in the Pampas deer (Ozotoceros bezoarticus, Linnaeus 1758).

    PubMed

    Erdoğan, S; Pérez, W

    2014-10-01

    This research presents morphological characteristics of adrenal glands and a demonstration of arterial vascularization in the Pampas deer, which is considered to be in extreme danger of extinction. A total of ten deer constituted the material of the study. Vascularization of organs was investigated by using latex injection technique. Left adrenal glands were basically supplied by coeliac, cranial mesenteric, renal and lumbal arteries. The arterial vascularization of the left adrenal glands was very complex in comparison with right adrenal glands. In two examples, branch of the lumbal artery was divided into phrenic caudal artery and cranial adrenal artery. In six examples, it was observed that the caudomedial and ventral regions of the left adrenal glands were also supplied by thinner branches that stemmed from second left lumbal artery. Besides, coeliac and cranial mesenteric arteries also gave off shorter branches supplying the cranial region of the left adrenal glands in five examples. It was determined that two branches originated from abdominal aorta directly for supplying left adrenal glands in only two examples. In four examples, two caudal adrenal arteries stemmed separately from left renal artery in a short distance. Arterial vascularization of right adrenal glands was more constant and supplied by lumbal and renal arteries. The adrenal glands were generally oval or round shaped. In only two examples, left adrenal glands were 'V-' or heart-shaped. There was no significant difference (P > 0.05) in sizes between right and left adrenal glands. © 2013 Blackwell Verlag GmbH.

  11. Spectrum of Salivary Gland Lesions in a Tertiary Level Hospital.

    PubMed

    Begum, A; Baten, M A; Alam, M M; Huq, M H; Ahsan, M M; Khan, M K; Saleh, F M; Talukder, S I

    2015-07-01

    Salivary gland tumors are relatively infrequent and account for less than 2% of all human tumors. This study was conducted to see the prevalence of patterns of non neoplastic and neoplastic lesions of salivary glands in greater Mymensingh. It was a retrospective study carried out in the department of Pathology, Community Based Medical College Bangladesh from January 2010 to December 2012. Heamatoxylin and eosin stained sections were studied in all cases. Total 98 cases of salivary gland lesions were retrieved and evaluated. Out of them 55 cases were female and 43 were male. Mean age of the cases were 42 years. Among the salivary gland lesions non-neoplastic lesions 24.48% and neoplastic lesions 75.51%. Among neoplastic lesions benign tumor comprises 91.89% and malignant tumor comprises 8.10%.

  12. What Is Salivary Gland Cancer?

    MedlinePlus

    ... into or spread to the salivary glands. Non-Hodgkin lymphoma: Most non-Hodgkin lymphomas start in lymph nodes. Rarely, these cancers ... cells). For more information on lymphomas, see Non-Hodgkin Lymphoma . Sarcomas: The salivary glands contain blood vessels, ...

  13. Salivary gland diseases in children

    PubMed Central

    Iro, Heinrich; Zenk, Johannes

    2014-01-01

    Salivary gland diseases in children are rare, apart from viral-induced diseases. Nevertheless, it is essential for the otolaryngologist to recognize these uncommon findings in children and adolescents and to diagnose and initiate the proper treatment. The present work provides an overview of the entire spectrum of congenital and acquired diseases of the salivary glands in childhood and adolescence. The current literature was reviewed and the results discussed and summarized. Besides congenital diseases of the salivary glands in children, the main etiologies of viral and bacterial infections, autoimmune diseases and tumors of the salivary glands were considered. In addition to the known facts, new developments in diagnostics, imaging and therapy, including sialendoscopy in obstructive diseases and chronic recurrent juvenile sialadenitis were taken into account. In addition, systemic causes of salivary gland swelling and the treatment of sialorrhoea were discussed. Although salivary gland diseases in children are usually included in the pathology of the adult, they differ in their incidence and some­times in their symptoms. Clinical diagnostics and especially the surgical treatment are influenced by a stringent indications and a less invasive strategy. Due to the rarity of tumors of the salivary glands in children, it is recommended to treat them in a specialized center with greater surgical experience. Altogether the knowledge of the differential diagnoses in salivary gland diseases in children is important for otolaryngologists, to indicate the proper therapeutic approach. PMID:25587366

  14. Sclerosing mucoepidermoid carcinoma of the sublingual gland.

    PubMed

    Lee, D H; Kim, J H; Lee, J K; Lim, S C

    2017-10-01

    Sclerosing mucoepidermoid carcinoma of the salivary gland is a rare subtype of mucoepidermoid carcinoma. The most common site of sclerosing mucoepidermoid carcinoma of the salivary glands is the parotid gland, followed by the submandibular gland, and the minor salivary glands. Here we report the first case of sclerosing mucoepidermoid carcinoma of the sublingual gland. Clinicians should consider sclerosing mucoepidermoid carcinoma in the differential diagnosis of salivary gland neoplasm. Surgical excision with clear margins seems to be a sufficient initial treatment option for sclerosing mucoepidermoid carcinoma of the salivary gland. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  15. [Magnetic resonance imaging anatomy of the feline salivary glands].

    PubMed

    Fromme, Vivian; Köhler, Claudia; Piesnack, Susann; Oechtering, Gerhard; Ludewig, Eberhard

    2016-12-05

    The aim of the study was to define anatomical characteristics of feline salivary glands using magnetic resonance imaging (MRI) and to describe landmarks for their reliable identification. Heads of 37 adult cats without signs of diseased salivary glands on clinical examination or history were examined. In cats included in the prospective part of the study, the MRI study was completed within one hour after euthanasia (n = 16). In the retrospective part, previously performed MRI studies were evaluated (n = 21). The prospective part of the study included the following standardized sequences: T2-weighted (T2W) turbo spin echo (TSE), T2W fat-suppressed TSE and proton density weighted (PDW) TSE images in a transverse plane as well as T1-weighted (T1W) fast field echo (FFE) in the transverse, sagittal and dorsal planes. In the retrospective part, T2W TSE and T1W TSE transverse images pre- and post-contrast were analyzed. Initially, identification and delineation of the salivary glands from surrounding tissue was assessed. Anatomical structures of the head were then identified and defined as landmarks. The dimensions of the glands were measured on T2W TSE images and the signal intensity in relation to that of fat and muscle was described using all sequences. In total, 95.9% of the parotid glands and 100% of the mandibular glands could be visualized on T1W TSE and FFE images and on T2W TSE images. Additionally, 93.3% of the zygomatic glands were identified on T2W TSE sequences and 82.5% on T1W TSE and FFE images. The ventral buccal glands could be demarcated in some sequences (T2W TSE: 51.4%, T1W TSE and FFE: 18.9%). Anatomical landmarks facilitated gland identification. Comparing the size of the salivary glands of both groups revealed differences of up to 2 mm. Both the large salivary glands (Glandula [Gl.]. parotis and Gl. mandibularis) and the small salivary glands (Gl. zygomatica and Gl. buccalis ventralis) of the cat can be reliably identified on MRI images.

  16. Trastuzumab in Treating Patients With Metastatic or Recurrent Salivary Gland Cancer

    ClinicalTrials.gov

    2013-02-27

    High-grade Salivary Gland Mucoepidermoid Carcinoma; Recurrent Salivary Gland Cancer; Salivary Gland Acinic Cell Tumor; Salivary Gland Adenocarcinoma; Salivary Gland Poorly Differentiated Carcinoma; Stage IVA Salivary Gland Cancer; Stage IVB Salivary Gland Cancer; Stage IVC Salivary Gland Cancer

  17. Organizing the thymus gland.

    PubMed

    Muñoz, Juan José; García-Ceca, Javier; Alfaro, David; Stimamiglio, Marco Augusto; Cejalvo, Teresa; Jiménez, Eva; Zapata, Agustín G

    2009-02-01

    Eph receptors and their ligands, ephrins, are molecules involved in the morphogenesis of numerous tissues, including the central nervous system in which they play a key role in determining cell positioning and tissue domains containing or excluding nerve fibers. Because common features have been suggested to occur in the microenvironmental organization of brain and thymus, a highly compartmentalized organ central for T cell differentiation, we examined the expression and possible role of Eph/ephrins in the biology of the thymus gland. We reviewed numerous in vivo and in vitro results that confirm a role for Eph and ephrins in the maturation of the thymic epithelial cell (TEC) network and T cell differentiation. Their possible involvement in different steps of early thymus organogenesis, including thymus primordium branching, lymphoid colonization, and thymocyte-TEC interactions, that determine the organization of a mature three-dimensional thymic epithelial network is also analyzed.

  18. [Thyroid gland and sleep].

    PubMed

    Steiger, A

    1999-01-01

    A set of data suggests that the thyroid gland plays a role in the bi-directional interaction between the electrophysiological and the endocrine components of sleep, e.g. the nonREM-REM-cycle and the patterns of nocturnal hormone secretion, respectively. In detail thyroid-stimulating hormone (TSH) and thyroxin (T4) show circadian rhythms. A specific relationship was observed between TSH and REM sleep. Blunted TSH levels were found in healthy elderly subjects and, probably due to overactivity of corticotropin-releasing hormone in patients with depression in comparison to young normal controls. Pulsatile administration of thyrotropin-releasing hormone induced a decrease of sleep efficiency and an earlier occurrence of the cortisol rise in normal controls. Slow wave sleep was reduced in patients with hypothyroidism in comparison to normal controls. The sleep EEG normalised after therapy.

  19. Cryopreservation of parathyroid glands.

    PubMed

    Guerrero, Marlon A

    2010-01-01

    The risk of permanent hypoparathyroidism following thyroid and parathyroid surgery is around 1% in the hands of experienced endocrine surgeons. Although this complication is rare, rendering a patient permanently aparathyroid has significant consequences on the health and quality of life of the patient. Immediate autotransplantation of parathyroid glands that are injured or unintentionally removed offers the best possibility of graft viability and functionality. However, since the majority of cases of hypoparathyroidism are transient, immediate autotransplantation can complicate postoperative surveillance in certain patients, especially those with primary hyperparathyroidism. Cryopreservation of parathyroid tissue is an alternate technique that was developed to treat patients with permanent hypoparathyroidism. This method allows for parathyroid tissue to be stored and then autotransplanted in a delayed fashion once permanent hypoparathyroidism is confirmed. This article provides a contemporary review on cryopreservation of parathyroid tissue and its current role in thyroid and parathyroid surgery.

  20. Cryopreservation of Parathyroid Glands

    PubMed Central

    Guerrero, Marlon A.

    2010-01-01

    The risk of permanent hypoparathyroidism following thyroid and parathyroid surgery is around 1% in the hands of experienced endocrine surgeons. Although this complication is rare, rendering a patient permanently aparathyroid has significant consequences on the health and quality of life of the patient. Immediate autotransplantation of parathyroid glands that are injured or unintentionally removed offers the best possibility of graft viability and functionality. However, since the majority of cases of hypoparathyroidism are transient, immediate autotransplantation can complicate postoperative surveillance in certain patients, especially those with primary hyperparathyroidism. Cryopreservation of parathyroid tissue is an alternate technique that was developed to treat patients with permanent hypoparathyroidism. This method allows for parathyroid tissue to be stored and then autotransplanted in a delayed fashion once permanent hypoparathyroidism is confirmed. This article provides a contemporary review on cryopreservation of parathyroid tissue and its current role in thyroid and parathyroid surgery. PMID:21197072

  1. REGULATION OF PROTEIN SYNTHESIS IN THE VENOM GLAND OF VIPERID SNAKES

    PubMed Central

    Oron, U.; Bdolah, A.

    1973-01-01

    Morphological changes in the venom gland of V. ammodytes were studied after the removal of the venom from the gland lumina (milking) It was found that the height of the secretory cells was changed during the secretory cycle. The patterns of the rough endoplasmic reticulum and of the Golgi complex were changed as well Milking induced an increased incorporation of [14C]amino acids into total and venom proteins In V ammodytes, during the first day after milking, 25% of the total counts in protein were precipitable by anti-venom serum, while at 8 days, 80% of the proteins synthesized were venom proteins At this stage, the incorporation was 10- and 20-fold that of unmilked glands for total and venom proteins, respectively. Venom was accumulated (secreted) in the gland lumina of V. ammodytes at a relatively high rate up to 2 wk after milking and leveled off afterwards. Intact glands and gland slices of V ammodytes and V palaestinae, taken from snakes a few days after milking, incorporated [14C]amino acids into proteins in vitro at a rate higher than that of unmilked glands. The activity of two exportable enzymes (phosphodiesterase and benzoyl arginyl ethyl esterase) was assayed in gland homogenates of V. ammodytes. It was found that 2–3 wk after milking, the intracellular level of these enzymes was up to 2-fold that of unmilked glands. PMID:4345163

  2. Transoral laser microsurgery for locally advanced (T3-T4a) supraglottic squamous cell carcinoma: Sixteen years of experience.

    PubMed

    Vilaseca, Isabel; Blanch, José Luis; Berenguer, Joan; Grau, Juan José; Verger, Eugenia; Muxí, África; Bernal-Sprekelsen, Manuel

    2016-07-01

    Controversy exists regarding treatment of advanced laryngeal cancer. The purpose of this study was to evaluate the oncologic and functional outcomes of T3 to T4a supraglottic squamous carcinomas treated with transoral laser microsurgery (TLM). We conducted a retrospective analysis from an SPSS database. Primary outcomes were: locoregional control, overall survival (OS), disease-specific survival (DSS), laryngectomy-free survival, and function-preservation rates. Secondary objectives were: rate of tracheostomies and gastrostomies according to age. Risk factors for local control and larynx preservation were also evaluated. One hundred fifty-four consecutive patients were chosen for this study. Median follow-up was 40.7 + /- 32.8 months. Five and 10-year OS, DSS, and laryngectomy-free survival were 55.6% and 47%, 67.6% and 58.6%, and 75.2% and 59.5%, respectively. Paraglottic involvement was an independent factor for larynx preservation. Six patients (3.9%) needed a definitive tracheostomy, a gastrostomy, or both. The gastrostomy rate was higher in the group of patients above 65 years of age (p = .03). Five-year laryngectomy-free survival with preserved function was 74.5%. TLM constitutes a true alternative for organ preservation in locally advanced supraglottic carcinomas with good oncologic and functional outcomes. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1050-1057, 2016. © 2016 Wiley Periodicals, Inc.

  3. Voice and Functional Outcomes of Transoral Laser Microsurgery for Early Glottic Cancer: Ventricular Fold Resection as a Surrogate

    PubMed Central

    Berania, Ilyes; Dagenais, Christophe; Moubayed, Sami P.; Ayad, Tareck; Olivier, Marie-Jo; Guertin, Louis; Bissada, Eric; Tabet, Jean-Claude; Christopoulos, Apostolos

    2015-01-01

    Background The aim of the study was to evaluate the oncological and functional outcomes with transoral laser microsurgery (TOLM) of patients with early glottic cancer. Methods We have prospectively evaluated patients treated with TOLM for Tis, T1 or T2 glottic squamous cell carcinoma. Evaluation of oncological outcomes, and voice and functional outcomes was assessed using voice-handicap index 10 (VHI-10) and performance status scale for head & neck cancer patients (PSS-H&N). Predictors of poor voice quality were evaluated using Student’s t-test. Results Thirty patients were included, with 17.7 months mean follow-up. There were no cases of locoregional recurrence. Twelve patients (40%) were considered as having a problematic voice outcome. Four subjects out of 30 (13.3%) had significant problems with understandability of speech. Significant differences (P < 0.05) in VHI-10 score were found with tumor stage and partial resection of the ventricular fold. Conclusions We report excellent oncological and functional outcomes in early glottic cancer treated with TOLM, with advanced tumors and partial resection of the ventricular fold as a surrogate predicting worse voice outcomes. PMID:26124910

  4. Robot-assisted sialolithotomy with sialendoscopy for the management of large submandibular gland stones.

    PubMed

    Razavi, Christopher; Pascheles, Celine; Samara, Ghassan; Marzouk, Mark

    2016-02-01

    The objectives of this study were to describe robot-assisted sialolithotomy with sialendoscopy (RASS) for the management of large palpable hilar submandibular gland (SMG) stones and analyze procedural success and lingual nerve damage following RASS in comparison to the combined transoral sialendoscopic approach. Retrospective chart review. A retrospective chart review was performed on patients with large palpable hilar SMG stones managed with RASS following institutional review board approval. Large stones were defined as ≥5 mm, the upper limit that can be removed via sialendoscopy. Twenty-two patients between January 2012 and June 2014, with mean stone size of 12.3 mm, were identified. Data collected included symptoms of recurrence, postoperative lingual nerve function, and patient satisfaction at a mean follow-up of 14 months. Procedural success was defined as absence of symptom recurrence in conjunction with gland preservation. These measures were compared with the combined approach (CA) outcomes reported in the English literature. Procedural success was 100% (22/22) for our cohort. No patients reported symptoms of lingual nerve damage at follow-up, whereas four patients reported transient lingual nerve paresthesia (mean duration, 2.5 weeks). Mean patient satisfaction was 9.9 out of 10. Literature review identified 135 patients in the CA cohort. Procedural success rate for these patients was 75%, and lingual nerve damage was reported in 2% of patients. Our study demonstrates the safety and efficacy of RASS in the management of large SMG sialoliths. We attribute this preliminary success of RASS to the enhanced visualization, magnification, and technical advantages of the procedure. 4. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

  5. [Thoracoscopic resection of mediastinal hypersecretant parathyroid gland].

    PubMed

    Gramática, Luis; Mercado Luna, Andrés; Verasay, Guillermo; Brizuela, Adrián; Gramática, Luis

    2004-01-01

    In general experienced hands, the inferior parathyroid glands, localized in the thymus or low extrathymus are the main cause or surgical therapeutic failure. When they could not be approached through cervicotomy, or when they were diagnosed after surgery the sternotomy or the angiographic ablation were chosen as treatment. The limited number of thoracoscopic approach whit good results published so far, moved us to use this method. Patient of 49 years with a 7 year secondary hiperprathyroidism due to CRI. After a sub total parathyroidectomy with bilateral thimectomy, the patient did not present clinical or laboratory improvement. Through a thoracic centellogram sixth MIBI, NMR and CAT, a tumor in the middle mediastinum was fond. The mediastinal structures have been easily identified through a left thoracoscopic approach. At the level of the aortopulmonary window, a tumoral mass is located and, with a simple dissection, et is easily extracted in bag. The biopsy through freezing confirms the parathyroid etiology of the gland. Clinical and laboratory evolution has been favorable, with hospital discharged at the 3 day, and being asymptomatic after two years. The hipersecretant parathyroid glands, located in middle mediastinum, that can not be approach through cervicotomy, can be successfully approach through thoracoscopic technique.

  6. [Immunoendocrine associations in adrenal glands].

    PubMed

    Sterzl, I; Hrdá, P

    2010-12-01

    Immune and endocrine systems are basic regulatory mechanisms of organism and, including the nervous system, maintain the organism's homeostasis. The main immune system representatives are mononuclear cells, T- and B-cells and their products, in the endocrine system the main representatives are cells of the glands with inner secretion and their products. One of the most important glands for maintaining homeostasis are adrenal glands. It has been proven that either cells of the immune system, either endocrine cells can, although in trace amounts, produce mutually mediators of both systems (hormones, cytokines). Disorders in one system can lead to pathological symptoms in the other system. Also here represent adrenals an important model.

  7. Neoplasms of the salivary glands in a Turkish adult population.

    PubMed

    Kara, Muhammed Isa; Göze, Fahrettin; Ezirganli, Seref; Polat, Serkan; Muderris, Suphi; Elagoz, Sahende

    2010-11-01

    This retrospective study aimed to investigate the types and distribution of neoplasm of salivary glands in a Turkish population. The histological diagnosis records of the Department of Pathology at Cumhuriyet University were reevaluated for 125 patients who were treated for salivary gland tumors from 1987 to 2008. The neoplasms were analyzed for histological diagnosis, age, sex, and site. The histological diagnoses were analyzed according to the 2005 WHO classification. A total of 125 primary salivary gland neoplasms, consisting of 95 (76%) benign and 30 (24%) malignant groups were recorded. The most common major and minor salivary gland sites were the parotid (61.6%) and palatal glands (9.6%), respectively. Pleomorphic adenoma was the most frequent benign tumor followed by Warthin's tumor. Among the malignant group, adenoid cystic carcinoma was the most prevalent. Age for all cases ranged from 16-80 years; mean age was 41.97 years, with a female to male ratio of 1:1.15. Although there were some discrepancies, the characteristics of salivary gland tumors of Turkish patients are in line with those of patients from other countries according to tumor type, tumor site distribution, and age and sex of patients.

  8. [Regeneration of the parathyroid glands after partial resection].

    PubMed

    Pavlov, A V

    1986-09-01

    By means of morphometrical methods, as well as by the method of volumetric reconstruction of the organs in 33 rats during 1-30 days regeneration of parathyroid glands have been studied after a simultaneous resection of the whole left and a half of the right gland. Total calcium content in blood serum in the experimental animals decreases on the 1st-2d day and normalizes by the 3d day. Regeneration of the remained part of the gland is realized at the expense of increasing mitotic activity and hypertrophy of parathyrocytes along the whole organ from the 3d up to the 13th day. There are no signs of the glandular parenchyma growth from the wound surface. On the 3d-5th day dividing parathyrocytes predominate in the half of the gland that adjoins the wound. This promotes a predominant longitudinal growth of the gland remnant and restoration of the organ's ellipsoid form on the 20th-30th day. The main pattern of the parathyroid gland restoration after its partial resection is regenerative hypertrophy.

  9. Thyroid storm induced by blunt thyroid gland trauma.

    PubMed

    Delikoukos, Stylianos; Mantzos, Fotios

    2007-12-01

    Isolated thyroid gland injury due to blunt neck trauma is uncommon and rarely complicated by thyroid storm in patients without known hyperthyroidism. The aim of this study was to report our experience on blunt thyroid gland injury followed by massive gland hemorrhage, acute airway obstruction, and symptoms of thyroid storm. Among 231 patients with neck trauma, four patients appeared with isolated thyroid gland injury. In two of them, the diagnosis of simultaneous thyrotoxic crisis was made on the basis of clinical findings and confirmed on emergency laboratory tests. The diagnosis of thyroid gland injury was supposed by the history and physical examination and established after neck exploration. Therapy was directed at stabilizing the patients by correcting the hyperthyroid state, followed by operative treatment. Left lobectomy and total thyroidectomy were performed and, along with postoperative medical measures, led to uneventful recovery. This study demonstrates that thyroid gland injury due to blunt neck trauma, although uncommon, may result in potentially life-threatening thyroid storm due to rupture of acini and liberation of thyroid hormones into the bloodstream. This may occur in patients without known hyperthyroidism.

  10. Hydatid cyst of the thyroid gland: report of three cases.

    PubMed

    Yilmaz, Mehmet; Akbulut, Sami; Sogutlu, Gokhan; Arabaci, Ebru; Kayaalp, Cuneyt

    2013-08-01

    Cystic Echinococcosis is a parasitic infestation that is distributed world-wide. It may be found in nearly any part of the body, most often in the liver and the lungs, but occasionally in other structures such as the thyroid gland. The present study reports three cases of hydatid cysts of the thyroid gland, in patient ranging from 18 to 25 years of age. Two patients had concomitant hydatid disease involving organs other than the thyroid gland (secondary disease), and one had, sole, involvement of the thyroid gland itself (primary disease). Moreover, an occult papillary thyroid carcinoma was detected incidentally in one case, involving the unilateral thyroid lobe as the hydatid cyst. While several surgical procedures including left lobectomy and isthmectomy were undertaken in one patient, two patients underwent total thyroidectomy. No disease recurrence was observed in any of the three patients during the postoperative follow-up period. No study reporting the concomitance of hydatid cyst and neoplasia of the thyroid gland has been previously published. This concomitance indicates the importance of the differential diagnosis of lesions characterized by calcifications in the thyroid gland, especially in endemic regions.

  11. Control of salt gland activity in the hatchling green sea turtle, Chelonia mydas.

    PubMed

    Reina, R D; Cooper, P D

    2000-02-01

    We studied the control of salt gland secretion in hatchling Chelonia mydas. The threshold salt load to activate salt secretion was between 400 mumol NaCl 100 g bodymass (BM)-1 and 600 mumol NaCl 100 g BM-1, which caused an increase in plasma sodium concentration of 13% to 19%. Following a salt load of 2700 mumol NaCl 100 g BM-1, salt gland secretion commenced in 12 +/- 1.3 min and reached maximal secretory concentration within 2-7 min. Maximal secretory rate of a single gland averaged 415 mumol Na 100 g BM-1 h-1. Plasma sodium concentration and total osmotic concentration after salt loading were significantly higher than pretreatment values within 2 min. Adrenalin (25 micrograms kg BM-1) and the cholinergic agonist methacholine (1 mg kg BM-1) inhibited salt gland activity. Atropine (10 mg kg BM-1) reversed methacholine inhibition and stimulated salt gland secretion when administered with a subthreshold salt load. Arginine vasotocin produced a transient reduction in sodium secretion by the active gland, while atrial natriuretic factor, vasoactive intestinal peptide and neuropeptide Y had no measurable effect on any aspect of salt gland secretion. Our results demonstrated that secretion of the salt gland in C. mydas can be modified by neural and hormonal chemicals in vivo and that the cholinergic and adrenergic stimulation of an exocrine gland do not appear to have the typical, antagonist actions on the chelonian salt gland.

  12. Increased myoepithelial cells of bronchial submucosal glands in fatal asthma.

    PubMed

    Green, F H Y; Williams, D J; James, A; McPhee, L J; Mitchell, I; Mauad, T

    2010-01-01

    Fatal asthma is characterised by enlargement of bronchial mucous glands and tenacious plugs of mucus in the airway lumen. Myoepithelial cells, located within the mucous glands, contain contractile proteins which provide structural support to mucous cells and actively facilitate glandular secretion. To determine if myoepithelial cells are increased in the bronchial submucosal glands of patients with fatal asthma. Autopsied lungs from 12 patients with fatal asthma (FA), 12 patients with asthma dying of non-respiratory causes (NFA) and 12 non-asthma control cases (NAC) were obtained through the Prairie Provinces Asthma Study. Transverse sections of segmental bronchi from three lobes were stained for mucus and smooth muscle actin and the area fractions of mucous plugs, mucous glands and myoepithelial cells determined by point counting. The fine structure of the myoepithelial cells was examined by electron microscopy. FA was characterised by significant increases in mucous gland (p = 0.003), mucous plug (p = 0.004) and myoepithelial cell areas (p = 0.017) compared with NAC. When the ratio of myoepithelial cell area to total gland area was examined, there was a disproportionate and significant increase in FA compared with NAC (p = 0.014). Electron microscopy of FA cases revealed hypertrophy of the myoepithelial cells with increased intracellular myofilaments. The NFA group showed changes in these features that were intermediate between the FA and NAC groups but the differences were not significant. Bronchial mucous glands and mucous gland myoepithelial cell smooth muscle actin are increased in fatal asthma and may contribute to asphyxia due to mucous plugging.

  13. Milk composition and health status from mammary gland quarters adjacent to glands affected with naturally occurring clinical mastitis.

    PubMed

    Paixão, Marcel G; Abreu, Luiz R; Richert, Roxann; Ruegg, Pamela L

    2017-09-01

    Mammary gland quarters have usually been considered to be anatomically and physiologically independent, but some recent research has indicated more interdependence than previously reported. The objective of this study was to compare milk composition (fat, total protein, lactose, solids-not-fat, and chloride) and health status (somatic cell count, differential leukocyte count, and lactate dehydrogenase) of milk samples from unaffected mammary glands of an udder with a single clinically inflamed quarter to results of milk samples from healthy mammary glands of healthy cows. The study was designed as a prospective case control study with case and control cows matched by parity and days in milk. Cases were defined as cows (n = 59) experiencing clinical mastitis in a single mammary gland, and controls (n = 59) were defined as cows that had not experienced clinical mastitis during the current lactation. Quarter milk samples were collected from all mammary glands adjacent to clinically affected quarters of cases and from the same mammary glands of controls. Samples were used to assess concentration of chloride and lactate dehydrogenase, fat, total protein, solids-not-fat, somatic cell count, and differential leukocyte count. Microbiological analysis was also performed on milk samples obtained from clinically affected mammary glands (n = 59). Logistic regression models were used to assess possible associations among quarter somatic cell count (≥150,000 cells/mL) and quarter type (adjacent to case or control). Multivariate linear models were used to compare milk composition and health status between quarter types. A total of 170 quarters were enrolled per group. Milk obtained from adjacent quarters of cases contained a lesser concentration of total protein, lactose, and solids-not-fat, but had a greater concentration of fat and chloride. The somatic cell count, total leukocyte count, and absolute numbers of neutrophils, lymphocytes, and macrophages were all increased in

  14. Rat parotid gland amylase: evidence for alterations in an exocrine protein with increased age.

    PubMed

    Baum, B J; Levine, R L; Kuyatt, B L; Sogin, D B

    1982-05-01

    The content of alpha-amylase, the major exocrine secretory protein from rat parotid glands, was studied in young adult and aged rat tissue. alpha-Amylase protein was determined with an enzyme-linked immunosorbent assay. This employed antisera, produced against alpha-amylase purified from young adult rats, but which recognized and precipitated alpha-amylase enzyme activity equally well from both age groups. The parotid gland content of alpha-amylase was reduced about 50% in aged rats. Furthermore, the percentage of total gland protein which was alpha-amylase was decreased about 40% in aged animals. The data suggest that a somewhat specific alteration in alpha-amylase production (synthesis and/or degradation) occurs in parotid glands from aged rats. In addition, alpha-amylase functional activity was followed. The specific enzyme activity (U amylase activity per mg immunoreactive amylase) was about 35% higher in extracts from aged rat parotid glands compared to that of young adult glands.

  15. [Inflammation of the parathyroid glands].

    PubMed

    Ting, S; Synoracki, S; Sheu, S-Y; Schmid, K W

    2016-05-01

    Inflammation of the parathyroid glands is rare when compared to other endocrine organs. This leads to the use of descriptive terms as well as the lack of a generally accepted classification for inflammatory disorders of the parathyroid glands. This review article proposes that parathyroid inflammation be subdivided morphologically into (a) non-specific lymphocytic infiltration, which is more an expression of damage to small vessels, due to e. g. severe systemic inflammation or myocardial infarction, (b) autoimmunogenic lymphocytic parathyroiditis, (c) nonimmunogenic inflammation caused by granulomatous diseases or infections and (d) invasive sclerosing (peri) parathyroiditis. As only parathyroid glands removed due to hyperparathyroidism and normal parathyroid glands incidentally removed during thyroid surgery are seen almost exclusively in routine histopathology, virtually no information about the morphological correlate of hypoparathyroidism is available.

  16. Ultrasound of the Thyroid Gland

    MedlinePlus

    ... Index A-Z Ultrasound - Thyroid Thyroid ultrasound uses sound waves to produce pictures of the thyroid gland ... pictures of the inside of the body using sound waves. Ultrasound imaging, also called ultrasound scanning or ...

  17. Making artificial honey using yeast cells from salivary glands of honey bees.

    PubMed

    Kathiresan, K; Srinivasan, K

    2005-07-01

    The salivary glands of a honey bee, Apis cerana and the yeast cells isolated from these glands were studied for their effects on sucrose solution. This solution exhibited lowered pH and increased levels of fructose and total amino acids as the time of incubation proceeded. The solution thus made was similar to the natural honey.

  18. Modified iodine-paper technique for the standardized determination of sweat gland activation.

    PubMed

    Gagnon, Daniel; Ganio, Matthew S; Lucas, Rebekah A I; Pearson, James; Crandall, Craig G; Kenny, Glen P

    2012-04-01

    Quantifying sweat gland activation provides important information when explaining differences in sweat rate between populations and physiological conditions. However, no standard technique has been proposed to measure sweat gland activation, while the reliability of sweat gland activation measurements is unknown. We examined the interrater and internal reliability of the modified-iodine paper technique, as well as compared computer-aided analysis to manual counts of sweat gland activation. Iodine-impregnated paper was pressed against the skin of 35 participants in whom sweating was elicited by exercise in the heat or infusion of methylcholine. The number of active glands was subsequently determined by computer-aided analysis. In total, 382 measurements were used to evaluate: 1) agreement between computer analysis and manual counts; 2) the interrater reliability of computer analysis between independent investigators; and 3) the internal reliability of sweat gland activation measurements between duplicate samples. The number of glands identified with computer analysis did not differ from manual counts (68 ± 29 vs. 72 ± 24 glands/cm(2); P = 0.27). These measures were highly correlated (r = 0.77) with a mean bias ± limits of agreement of -4 ± 38 glands/cm(2). When comparing computer analysis measures between investigators, values were highly correlated (r = 0.95; P < 0.001) and the mean bias ± limits of agreement was 4 ± 18 glands/cm(2). Finally, duplicate measures of sweat gland activation were highly correlated (r = 0.88; P < 0.001) with a mean bias ± limits of agreement of 3 ± 29 glands/cm(2). These results favor the use of the modified-iodine paper technique with computer-aided analysis as a standard technique to reliably evaluate the number of active sweat glands.

  19. Impact of selective pituitary gland incision or resection on hormonal function after adenoma or cyst resection.

    PubMed

    Barkhoudarian, Garni; Cutler, Aaron R; Yost, Sam; Lobo, Bjorn; Eisenberg, Amalia; Kelly, Daniel F

    2015-12-01

    With the resection of pituitary lesions, the anterior pituitary gland often obstructs transsphenoidal access to the lesion. In such cases, a gland incision and/or partial gland resection may be required to obtain adequate exposure. We investigate this technique and determine the associated risk of post-operative hypopituitarism. All patients who underwent surgical resection of a pituitary adenoma or Rathke cleft cyst (RCC) between July 2007 and January 2013 were analyzed for pre- and post-operative hormone function. The cohort of patients with gland incision/resection were compared to a case-matched control cohort of pituitary surgery patients. Total hypophysectomy patients were excluded from outcome analysis. Of 372 operations over this period, an anterior pituitary gland incision or partial gland resection was performed in 79 cases (21.2 %). These include 53 gland incisions, 12 partial hemi-hypophysectomies and 14 resections of thinned/attenuated anterior gland. Diagnoses included 64 adenomas and 15 RCCs. New permanent hypopituitarism occurred in three patients (3.8 %), including permanent DI (3) and growth hormone deficiency (1). There was no significant difference in the rate of worsening gland dysfunction nor gain of function. Compared to a control cohort, there was a significantly lower incidence of transient DI (1.25 vs. 11.1 %, p = 0.009) but no significant difference in permanent DI (3.8 vs. 4.0 %) in the gland incision group. Selective gland incisions and gland resections were performed in over 20 % of our cases. This technique appears to minimize traction on compressed normal pituitary gland during removal of large lesions and facilitates better visualization and removal of cysts, microadenomas and macroadenomas.

  20. Effects of first radioiodine ablation on functions of salivary glands in patients with differentiated thyroid cancer.

    PubMed

    Upadhyaya, Arun; Meng, Zhaowei; Wang, Peng; Zhang, Guizhi; Jia, Qiang; Tan, Jian; Li, Xue; Hu, Tianpeng; Liu, Na; Zhou, Pingping; Wang, Sen; Liu, Xiaoxia; Wang, Huiying; Zhang, Chunmei; Zhao, Fengxiao; Yan, Ziyu

    2017-06-01

    The aim of this study was to evaluate the effects of the first radioactive iodine (I) therapy on functions of salivary glands in patients with differentiated thyroid carcinoma (DTC).There were 36 consented patients with DTC enrolled in this study, who received 3.7 GBq (100mCi) I for ablation after total thyroidectomy. Salivary gland function was assessed using salivary gland scintigraphy in two phases, one 4 hours before and the other 6 months after I therapy (both under thyrotropin stimulation condition). Quantitative parameters including uptake fraction (UF), uptake index (UI), excretion fraction (EF), and excretion ratio (ER) were measured and compared. Blood parameters were also compared. Associations between sex and outcome of the first I therapy as well as individual salivary gland function were measured. Wilcoxon Signed Rank Sum test and χ test were used for statistical analysis.When compared between pre-ablation and post-ablation, UF of bilateral parotid and submandibular glands were significantly increased (all P < .01). UI of both submandibular glands were significantly increased (P < .05). This seemingly increased uptake function after the first I therapy was actually compensatory mechanism of salivary gland, which indicated a possible intermediate state after radiation. But salivary glands' secretory function had not changed significantly except for left submandibular gland; we demonstrated that only left submandibular gland showed significantly decreased ER (P < .05). Thyroglobulin and thyroglobulin antibody significantly decreased after I therapy (P < .05). There were no sex differences on therapeutic outcome and salivary gland dysfunctions after the first I therapy. Salivary gland of both males and females could be affected by I therapy.The first I ablative therapy may impair the salivary uptake and secretory function of patients with DTC. There was no association between sex and salivary gland dysfunction.

  1. Thyroid gland removal

    MedlinePlus

    Total thyroidectomy; Partial thyroidectomy; Thyroidectomy; Subtotal thyroidectomy; Thyroid cancer - thyroidectomy; Papillary cancer - thyroidectomy; Goiter - thyroidectomy; Thyroid nodules - thyroidectomy

  2. Autophagy in the endocrine glands.

    PubMed

    Weckman, Andrea; Di Ieva, Antonio; Rotondo, Fabio; Syro, Luis V; Ortiz, Leon D; Kovacs, Kalman; Cusimano, Michael D

    2014-04-01

    Autophagy is an important cellular process involving the degradation of intracellular components. Its regulation is complex and while there are many methods available, there is currently no single effective way of detecting and monitoring autophagy. It has several cellular functions that are conserved throughout the body, as well as a variety of different physiological roles depending on the context of its occurrence in the body. Autophagy is also involved in the pathology of a wide range of diseases. Within the endocrine system, autophagy has both its traditional conserved functions and specific functions. In the endocrine glands, autophagy plays a critical role in controlling intracellular hormone levels. In peptide-secreting cells of glands such as the pituitary gland, crinophagy, a specific form of autophagy, targets the secretory granules to control the levels of stored hormone. In steroid-secreting cells of glands such as the testes and adrenal gland, autophagy targets the steroid-producing organelles. The dysregulation of autophagy in the endocrine glands leads to several different endocrine diseases such as diabetes and infertility. This review aims to clarify the known roles of autophagy in the physiology of the endocrine system, as well as in various endocrine diseases.

  3. Sebaceous gland lipids

    PubMed Central

    Ottaviani, Monica; Camera, Emanuela; Mastrofrancesco, Arianna

    2009-01-01

    The principal activity of mature sebaceous glands is producing and secreting sebum, which is a complex mixture of lipids. Sebum composition is different among species and this difference is probably due to the function that sebum has to absolve. In human sebum there are unique lipids, such as squalene and wax esters not found anywhere else in the body nor among the epidermal surface lipids. Moreover, they correspond to major components supplying the skin with protection. However, the ultimate role of human sebum, as well the metabolic pathways regulating its composition and secretion rate, are far from a complete understanding. Increased sebum secretion is considered, among all features, the major one involved in the pathophysiology of acne. Along with increased sebum secretion rate, quali- and quantitative modifications of sebum are likely to occur in this pathology. Understanding the factors and mechanisms that regulate sebum production is needed in order to identify new targets that can be addressed to achieve a selective modulation of lipid biosynthesis as a novel therapeutic strategy to correct lipid disregulations in acne and other disorders of the pilosebaceous unit. PMID:20224686

  4. Telocytes in parotid glands.

    PubMed

    Nicolescu, Mihnea I; Bucur, Alexandru; Dinca, Octavian; Rusu, Mugurel C; Popescu, Laurentiu M

    2012-03-01

    The parotid histological structure includes acinar, ductal, and myoepithelial cells, surrounded by a connective stromal component. The parotid stroma is mostly regarded as an inert shell, consisting of septa, which divide the parenchyma. Telocytes were recently identified as a new stromal cell type in various organs, including exocrine pancreas. We aimed to evaluate telocytes presence in parotid stroma and whether their topographical features might support an involvement in parotid function modulation. Serial ultrathin sections of human and rat parotid glands were studied and compared by transmission electron microscopy. Two-dimensional concatenation of sequenced micrographs allowed the ultrastructural identification of parotid telocytes, with their specific long, thin, and moniliform prolongations (telopodes). Telocyte location appeared frequently as a strategic one, in close contact or vicinity of both secretory (acini and ducts) and regulatory (nerves and blood vessels) apparatuses. They were also found in the interacinar and the subductal stroma. Two previously reported telocyte markers (c-kit/CD117 and vimentin) were assayed by immunohistochemistry. Actin expression was also evaluated. Telocytes are making a network, especially by branching of their long telopodes. Elements of this telocyte network are interacting with each other (homocellular connections) as well as with other cell types (heterocellular connections). These interactions are achieved either by direct contact (stromal synapse), or mediated via shed microvesicles/exosomes. Since telocyte connections include both neurovascular and exocrine elements (e.g., acini and ducts), it is attractive to think that telocytes might mediate and integrate neural and/or vascular input with parotid function.

  5. Primary leiomyosarcoma of the thyroid gland.

    PubMed

    Wang, Tracy S; Ocal, Idris Tolgay; Oxley, Keri; Sosa, Julie Ann

    2008-04-01

    Primary leiomyosarcomas of the thyroid gland are rare. We present the case of a 65-year-old woman with a rapidly enlarging neck mass for 2 months. The preoperative differential diagnosis included medullary thyroid cancer, anaplastic thyroid cancer, and primary versus metastatic sarcoma. The patient underwent total thyroidectomy, bilateral central neck dissections, and cervical thymectomy; she is currently being treated with ifosfamide and adriamycin. We review the literature on leiomyosarcoma of the thyroid, including the differential diagnoses, pathology, and alternative treatment strategies, including surgery and adjuvant therapy.

  6. Primary cavernous hemangioma of the thyroid gland.

    PubMed

    Michalopoulos, Nikolaos V; Markogiannakis, Haridimos; Kekis, Panagiotis B; Papadima, Artemisia; Lagoudianakis, Emmanuel; Manouras, Andreas

    2010-07-01

    A 78-year-old euthyroid patient presented for evaluation of a symptomatic, slowly growing neck mass. Ultrasound scan revealed a multinodular goiter and a hypoechoic nodule of the right thyroid lobe. Total thyroidectomy was performed and the lesion was completely excised. Definite diagnosis was obtained after histological examination of the surgical specimen. Cavernous hemangiomas of the thyroid gland are infrequent lesions which may escape diagnosis preoperatively. An effort should be made not to rupture these lesions in order to ensure a bloodless procedure.

  7. Post-operative therapy following transoral robotic surgery for unknown primary cancers of the head and neck.

    PubMed

    Patel, Sapna A; Parvathaneni, Aarthi; Parvathaneni, Upendra; Houlton, Jeffrey J; Karni, Ron J; Liao, Jay J; Futran, Neal D; Méndez, Eduardo

    2017-09-01

    Our primary objective is to describe the post- operative management in patients with an unknown primary squamous cell carcinoma of the head and neck (HNSCC) treated with trans-oral robotic surgery (TORS). We conducted a retrospective multi-institutional case series including all patients diagnosed with an unknown primary HNSCC who underwent TORS to identify the primary site from January 1, 2010 to June 30, 2016. We excluded those with recurrent disease, ≤6months of follow up from TORS, previous history of radiation therapy (RT) to the head and neck, or evidence of primary tumor site based on previous biopsies. Our main outcome measure was receipt of post-operative therapy. The tumor was identified in 26/35 (74.3%) subjects. Post-TORS, 2 subjects did not receive adjuvant therapy due to favorable pathology. Volume reduction of RT mucosal site coverage was achieved in 12/26 (46.1%) subjects who had lateralizing tumors, ie. those confined to the palatine tonsil or glossotonsillar sulcus. In addition, for 8/26 (30.1%), the contralateral neck RT was also avoided. In 9 subjects, no primary was identified (pT0); four of these received RT to the involved ipsilateral neck nodal basin only without pharyngeal mucosal irradiation. Surgical management of an unknown primary with TORS can lead to deintensification of adjuvant therapy including avoidance of chemotherapy and reduction in RT doses and volume. There was no increase in short term treatment failures. Treatment after TORS can vary significantly, thus we advocate adherence to NCCN guideline therapy post-TORS to avoid treatment-associated variability. Published by Elsevier Ltd.

  8. Adoption of Transoral Robotic Surgery Compared With Other Surgical Modalities for Treatment of Oropharyngeal Squamous Cell Carcinoma

    PubMed Central

    Cracchiolo, Jennifer R.; Roman, Benjamin R.; Kutler, David I.; Kuhel, William I.; Cohen, Marc A.

    2016-01-01

    Background and Objectives Transoral robotic surgery (TORS) has increased for treatment of oropharyngeal squamous cell carcinoma (OPSCC). To define the adoption of TORS, we analyzed patterns of surgical treatment for OPSCC in the US. Methods Cases of T1–T3 OPSCC treated with surgery between 2010 and 2013 from the National Cancer Database were queried. Results Of 3,071 patients who underwent primary surgical management for T1–T3 OPSCC, 846 (28%) underwent TORS. On multivariable analysis, low tumor stage (T2 vs T1: OR 0.75, CI 0.37–0.51, p<0.0001; T3 vs T1: O.R. 0.33, CI 0.28–0.38, p<0.0001), treatment at an academic cancer center (O.R. 2.23, C.I. 1.29–3.88, p=0.004) and treatment at a high volume hospital (34–155 cases vs 1–4 cases: O.R. 9.07, C.I. 3.19–25.79, p<0.0001) were associated with increased TORS approach. Significant geographic variation was observed, with high adoption in the Middle Atlantic. Positive margin rates were lower when TORS was performed at a high volume vs. low volume hospital (8.2% vs 16.7% respectively, p=0.001). Conclusions Tumor and non-tumor factors are associated with TORS adoption. This analysis suggests uneven diffusion of this technology in the treatment of OPSCC. PMID:27392812

  9. Adrenal gland and bone.

    PubMed

    Hardy, Rowan; Cooper, Mark S

    2010-11-01

    The adrenal gland synthesizes steroid hormones from the adrenal cortex and catecholamines from the adrenal medulla. Both cortisol and adrenal androgens can have powerful effects on bone. The overproduction of cortisol in Cushing's disease leads to a dramatic reduction in bone density and an increase risk of fracture. Overproduction of adrenal androgens in congenital adrenal hyperplasia (CAH) leads to marked changes in bone growth and development with early growth acceleration but ultimately a significant reduction in final adult height. The role of more physiological levels of glucocorticoids and androgens on bone metabolism is less clear. Cortisol levels measured in elderly individuals show a weak correlation with measures of bone density and change in bone density over time with a high cortisol level associated with lower bone density and more rapid bone loss. Cortisol levels and the dynamics of cortisol secretion change with age which could also explain some age related changes in bone physiology. It is also now clear that adrenal steroids can be metabolized within bone tissue itself. Local synthesis of cortisol within bone from its inactive precursor cortisone has been demonstrated and the amount of cortisol produced within osteoblasts appears to increase with age. With regard to adrenal androgens there is a dramatic reduction in levels with aging and several studies have examined the impact that restoration of these levels back to those seen in younger individuals has on bone health. Most of these studies show small positive effects in women, not men, but the skeletal sites where benefits are seen varies from study to study.

  10. The thyroid gland.

    PubMed

    Hellman, D E

    1980-01-01

    Disorders of the thyroid gland are frequently unrecognized and untreated by the attending physician and present the anesthesiologist with a diagnostic and therapeutic challenge. Very large goiters distort and compress the larynx and require an experienced anesthesiologist for safe intubation. If surgery is elective and can be postponed in patients suspected of being hypo- or hyperthyroid, there is sufficient time to permit the anesthesiologist and the attending physician to obtain appropriate tests of thyroid function and institute appropriate therapeutic measures to restore the metabolic rate to normal. When there is insufficient time to confirm a clinical diagnosis of thyroid disease, the anesthesiologist is faced with important therapeutic decisions. It is the author's opinion that therapeutic intervention is, in most instances, preferable to therapeutic nihilism. In the case of a patient suspected of hypothyroidism, it is usually safe to administer a physiologic replacement dose of thyroxine to support the patient intraoperatively or postoperatively. If hypothyroidism is associated with cardiovascular disease, other debilitating illness, or advanced age, thyroxine must be given with extreme caution in order to avoid dangerous tachyarrhythmias or too rapid acceleration of the metabolic rate. The hyperthyroid patient facing nonelective surgery represents a very serious challenge to the anesthesiologist, since marked accentuation of clinical hyperthyroidism (thyroid storm) is a major risk of such surgery. In such a situation, intravenous propranolol and intravenous iodine are the optimal drugs for a safe and uncomplicated clinical course during and following surgery. In both instances, the anesthesiologist must use skillful clinical judgment in making the appropriate diagnosis and selecting appropriate therapy. Careful and continuous supervision of the patient is necessary during and following surgery and appropriate treatment and support of the patient should be

  11. Dasatinib in Treating Patients With Recurrent or Metastatic Malignant Salivary Gland Tumors

    ClinicalTrials.gov

    2016-11-01

    High-grade Salivary Gland Mucoepidermoid Carcinoma; Low-grade Salivary Gland Mucoepidermoid Carcinoma; Recurrent Salivary Gland Cancer; Salivary Gland Acinic Cell Tumor; Salivary Gland Adenocarcinoma; Salivary Gland Adenoid Cystic Carcinoma; Salivary Gland Anaplastic Carcinoma; Salivary Gland Malignant Mixed Cell Type Tumor; Salivary Gland Poorly Differentiated Carcinoma; Salivary Gland Squamous Cell Carcinoma; Stage IV Salivary Gland Cancer

  12. Post-natal growth in the rat pineal gland: a stereological study.

    PubMed

    Erbagci, H; Kizilkan, N; Ozbag, D; Erkilic, S; Kervancioglu, P; Canan, S; Gumusburun, E

    2012-10-01

    The purpose was to observe the changes in a rat pineal gland using stereological techniques during lactation and post-weaning periods. Thirty Wistar albino rats were studied during different post-natal periods using light microscopy. Pineal gland volume was estimated using the Cavalieri Method. Additionally, the total number of pinealocytes was estimated using the optical fractionator technique. Pineal gland volume displayed statistically significant changes between lactation and after weaning periods. A significant increase in pineal gland volume was observed from post-natal day 10 to post-natal day 90. The numerical density of pinealocytes became stabilized during lactation and decreased rapidly after weaning. However, the total number of pinealocytes continuously increased during post-natal life of all rats in the study. However, this increment was not statistically significant when comparing the lactation and after weaning periods. The increase in post-natal pineal gland volume may depend on increment of immunoreactive fibres, capsule thickness or new synaptic bodies.

  13. Management of thyroid gland invasion in laryngeal and hypopharyngeal squamous cell carcinoma.

    PubMed

    Arslanoğlu, Seçil; Eren, Erdem; Özkul, Yılmaz; Ciğer, Ejder; Kopar, Aylin; Önal, Kazım; Etit, Demet; Tütüncü, G Yazgı

    2016-02-01

    The objective of this study was to determine the incidence of thyroid gland invasion in laryngeal and hypopharyngeal squamous cell carcinoma; and the association between clinicopathological parameters and thyroid gland invasion. Medical records of 75 patients with laryngeal and hypopharyngeal squamous cell carcinoma who underwent total laryngectomy with thyroidectomy were reviewed, retrospectively. Preoperative computed tomography scans, clinical and operative findings, and histopathological data of the specimens were evaluated. There were 73 male and two female patients with an age range of 41-88 years (mean 60.4 years). Hemithyroidectomy was performed in 62 (82.7 %) and total thyroidectomy was performed in 13 patients (17.3 %). Four patients had histopathologically proven thyroid gland invasion (5.3 %). In three patients, thyroid gland involvement was by means of direct invasion. Thyroid gland invasion was significantly correlated with thyroid cartilage invasion. Therefore, prophylactic thyroidectomy should not be a part of the treatment policy for these tumors.

  14. [A case of gigantic pleomorphic adenoma of the parotid gland].

    PubMed

    Namysłowski, G; Misiołek, M; Kubik, P; Misiołek, H; Morawski, K

    1996-01-01

    The case of big size pleomorphic adenoma of the partoid gland was presented. Attention was paid on the necessity of the surgical treatment of pleomorphic adenomas by superficial or total parotidectomies. Possibility of the post operative complications avoidance, even in such big cases was emphasized.

  15. Nivolumab and Ipilimumab in Treating Patients With Metastatic Recurrent Major or Minor Salivary Gland Cancer

    ClinicalTrials.gov

    2017-09-25

    Major Salivary Gland Carcinoma; Minor Salivary Gland Carcinoma; Recurrent Salivary Gland Carcinoma; Stage IV Major Salivary Gland Carcinoma; Stage IVA Major Salivary Gland Carcinoma; Stage IVB Major Salivary Gland Carcinoma; Stage IVC Major Salivary Gland Carcinoma

  16. Assessment of parathyroid glands in hemodialysis patients by using color Doppler sonography.

    PubMed

    Ozcan, Umit Aksoy; Oktay, Ilay

    2009-11-01

    The aim of this study was to assess the role of color and spectral Doppler ultrasound (CDU) in the evaluation of enlarged parathyroid glands in hemodialysis patients with secondary hyperparathyroidism. Fourteen hemodialysis patients with elevated intact parathyroid hormone (iPTH) levels were evaluated prospectively with CDU. The volume of each observed parathyroid gland and the spectral CDU data (velocities, resistance and pulsatility indices, systolic to diastolic ratio, and flow volume output (FVO)) were noted. The biochemical data (iPTH, calcium, phosphate levels), and CDU results were analyzed with the Spearman correlation test. Two patients were excluded, and 27 enlarged parathyroid glands were observed in 12 patients. The mean total volume of enlarged parathyroid glands per patient was 1.95 cm(3) (0.06-5.5 cm(3)). Arterial supply was demonstrated in 78% (21/27) of enlarged parathyroid glands. Mean total FVO of enlarged glands per patient was 238.5 ml/min (620-0 ml/min) and mean iPTH level was 1,477 pg/ml (643-3,132 pg/ml). The positive correlations of total volume (p = 0.022), iPTH (p = 0.024), and FVO (p = 0.022) were statistically significant. In secondary hyperparathyroidism, total volume of the visualized enlarged parathyroid glands and the total of FVOs per patient are positively correlated with iPTH levels which may help clinical management and follow-up of end-stage renal disease patients.

  17. A false-negative sentinel lymph node in the parotid gland of a melanoma patient: a new algorithm for SLN biopsy in the parotid gland.

    PubMed

    Hayashi, Toshihiko; Furukawa, Hiroshi; Tsutsumida, Arata; Yoshida, Tetsunori

    2010-10-01

    The sentinel lymph node (SLN) is the first node in the lymphatic basin to be affected by metastatic tumor cells from a primary lesion. It provides a way to avoid elective neck dissection in a case in which there is no metastasis to the SLN. However, identification and excision of the SLN may be difficult due to the shine-through phenomenon, as the SLN in the parotid gland is either located close to the primary lesion or, in many cases, the lymph node of the parotid gland is small and covered by fibrous capsula. When we conducted an SLN biopsy on a 68-year-old male patient with malignant melanoma of the cheeks, the metastasis to the node of the parotid gland identified as the SLN was negative; however, 1 year later, the melanoma recurred on the lymph node of the parotid gland, or in other words, we experienced a false-negative SLN. SLN biopsy in the parotid gland is difficult because the lymph node is small and covered by fibrous capsula. We may consider a total or partial resection of the superficial lobe of the parotid gland, particularly when identification of an SLN in the parotid gland is difficult. Therefore, we propose a new algorithm for SLN biopsy in the parotid gland.

  18. Absence of ductal hyper-keratinization in Mouse age-related meibomian gland dysfunction (ARMGD)

    PubMed Central

    Parfitt, Geraint J.; Xie, Yilu; Geyfman, Mikhail; Brown, Donald J.; Jester, James V.

    2013-01-01

    Meibomian gland dysfunction (MGD) is frequent with aging and is the primary cause of dry eye disease, the most prevalent ocular complaint. We used a novel 3-D reconstruction technique, immunofluorescent computed tomography (ICT), to characterize meibomian gland keratinization and cell proliferation in a mouse model of age-related meibomian gland dysfunction (ARMGD). To visualize the changes associated with ARMGD, 5-month and 2-year old mouse eyelids were 3-D reconstructed by ICT using antibodies to cytokeratin (CK) 1, 5 and 6 and the proliferation marker Ki67. We quantified total gland, ductal and lipid volume from the reconstructions, observing a dramatic decrease in old glands. In young glands, proliferative ductules suggest a potential site of acinar progenitors that were found to be largely absent in aged, atrophic glands. In the aged mouse, we observed an anterior migration of the mucocutaneous junction (MCJ) and an absence of hyper-keratinization with meibomian gland atrophy. Thus, we propose that changes in the MCJ and glandular atrophy through a loss of meibocyte progenitors are most likely responsible for ARMGD and not ductal hyper-keratinization and gland obstruction. PMID:24259272

  19. Association of the macrophage migration inhibitory factor promoter polymorphisms with benign lymphoepithelial lesion of lacrimal gland.

    PubMed

    Li, Qin-Jian; Zhao, Peng-Xiang; Zhang, Xu-Juan; Yi, Yang; Cheng, Dan-Ying; Ma, Jian-Min; Ma, Xue-Mei

    2017-01-01

    To identify the association of the macrophage migration inhibitory factor (MIF) gene polymorphism with the susceptibility of benign lymphoepithelial lesions (BLEL) of the lacrimal gland. A total of 40 BLEL of lacrimal gland cases were matched with 40 healthy subjects (HS). Extraction the plasma and whole blood DNA of patients of lacrimal gland BLEL and HS. Elisa and polymerase chain reaction was used to determine in plasma contents of MIF and MIF gene SNP-173G>C and STR -794 CATT(5-8) polymorphism, respectively. The MIF levels in plasma were significantly higher in patients with lacrimal gland BLEL versus HS (P<0.001). The -173 G>C MIF polymorphism was significantly associated with lacrimal gland BLEL, with a significantly higher frequency of the C allele in lacrimal gland BLEL patients compared with HS (OR=2.38, 95% CI=1.07-5.31, P=0.032), and the -173 C/x is more frequent in patients than in HS, P=0.037. Besides, we found that the carriage rate of the MIF -173C/x is associated with higher plasma levels of MIF in the BLEL of lacrimal gland. MIF -173G/C variants play an insidious role in susceptibility of BLEL of lacrimal gland. Otherwise, there is no statistically significant correlation exists between MIF-794 CATT (5-8) and BLEL of lacrimal gland.

  20. Salivary glands - "an unisex organ'?

    PubMed

    Konttinen, Y T; Stegaev, V; Mackiewicz, Z; Porola, P; Hänninen, A; Szodoray, P

    2010-10-01

    Usually no distinction is made between female and male salivary glands although cyclic changes of and ⁄ or differences in serum and salivary sex steroid concentrations characterize women and men. Moreover, sexual dimorphism is well recognized in salivary glands of rodents.Salivary glands contain estrogen and androgen receptors and are, according to modern high throughput technologies,subjected to gender differences not explainable by gene dose effects by the X chromosome alone. Because sex steroids are lipophilic, it is often thought that approximately 10% of them passively diffuse from plasma to saliva. Indeed, saliva can find use as sample material in sports medicine, pediatrics, veterinary medicine and behavioral sciences. Last but not least, humans and other primates are unique in that they have a reticular zone in their adrenal cortex, which produces dehydroepiandrosterone and androstendione pro-hormones. These are processed in peripheral tissues, not only in female breast and uterus and male prostate, but also in salivary glands by an intracrine enzymatic machinery to active 17b-estradiol,dihydrotestosterone and others, to satisfy and buffer against a constantly changing needs caused by circadian,menstrual, pregnancy and chronobiological hormonal changes in the systemic circulation. Female dominance of Sjögren's syndrome and certain forms of salivary gland cancer probably reflect these gender-based differences.

  1. Salivary Gland Cancer Stem Cells

    PubMed Central

    Adams, April; Warner, Kristy; Nör, Jacques E.

    2013-01-01

    Emerging evidence suggests the existence of a tumorigenic population of cancer cells that demonstrate stem cell-like properties such as self-renewal and multipotency. These cells, termed cancer stem cells (CSC), are able to both initiate and maintain tumor formation and progression. Studies have shown that CSC are resistant to traditional chemotherapy treatments preventing complete eradication of the tumor cell population. Following treatment, CSC are able to re-initiate tumor growth leading to patient relapse. Salivary gland cancers are relatively rare but constitute a highly significant public health issue due to the lack of effective treatments. In particular, patients with mucoepidermoid carcinoma or adenoid cystic carcinoma, the two most common salivary malignancies, have low long-term survival rates due to the lack of response to current therapies. Considering the role of CSC in resistance to therapy in other tumor types, it is possible that this unique sub-population of cells is involved in resistance of salivary gland tumors to treatment. Characterization of CSC can lead to better understanding of the pathobiology of salivary gland malignancies as well as to the development of more effective therapies. Here, we make a brief overview of the state-of-the-science in salivary gland cancer, and discuss possible implications of the cancer stem cell hypothesis to the treatment of salivary gland malignancies. PMID:23810400

  2. Innervation of eccrine sweat glands.

    PubMed

    Sokolov, V E; Shabadash, S A; Zelikina, T I

    1980-01-01

    In recent years it has been shown on the example of primate skin that in addition to abundant cholinergic innervation, the eccrine glands are also supplied by adrenergic fibers, containing catecholamines. The presence of an adrenergic component of the innervation is demonstrated on the plantar eccrine sweat glands of a number of rodents and the cat by the detection of monoamine oxidase in it. The myelin nerve trunks, the short unmyelinated varicose terminals in direct contact with the secretory cells, as well as the mitochondria of cells of the eccrine sweat glands are rich in monoamine oxidase. Specific and nonspecific cholinesterases are localized in the dense network of nerves in lacing the secretory portions of the glands; individual fibers accompany the excretory ducts. The acetylcholinesterase concentration is lower than the concentration of nonspecific cholinesterase. In rats with chemical sympathectomy, induced by four-week administration of 25 mg/kg guanethidine from the first day of birth, in which 99% of the neurons in the stellate ganglia die, the monoamine oxidase concentration in the myelin nerves and in the mitochondria of the secretory cells drops very sharply, and acetylcholinesterase disappears from the nerves surrounding the glands.

  3. Analysis of residual saliva and minor salivary gland secretions.

    PubMed

    Won, S; Kho, H; Kim, Y; Chung, S; Lee, S

    2001-07-01

    Residual saliva and minor salivary gland secretions are important for the maintenance of oral mucosal wetness. Salivary proteins and glycoproteins are the major components of the oral mucosal film, which functions as a moisture retainer and a protective barrier. Here, the correlations between the amounts of residual saliva and minor salivary gland secretions and their protein concentrations were investigated in 30 normal healthy individuals. The thickness of the mucosal film was measured at six mucosal surfaces and minor salivary gland secretion rate was measured at two mucosal surfaces. The thickness of residual saliva was determined by placing filter-paper strips against the mucosa at each site for 5 s and then measuring the volume electronically with a Periotron 8000 micro-moisture meter. The unstimulated rate of minor salivary gland secretion was measured for 30 s by the same method. Unstimulated whole salivary flow rate was measured with the spitting method. The total protein concentration of all salivary samples was measured by bicinchoninic acid assay. Before the experiment, the intra-/inter-examiner reliability of the method using the Periotron and the filter-paper strips was investigated. With a range of 0.4256-0.8846, the intraclass correlation coefficient, measured within and between examiners, was indicative of good reliability. The oral mucosal site with the thinnest coat of residual saliva was the anterior hard palate. Mucosal wetness on the hard palate and buccal mucosa showed significant positive correlations with the unstimulated whole salivary flow rate and significant negative correlations with the total protein concentration of residual saliva. Mucosal wetness on the upper and lower labial mucosa also showed significant negative correlations with the total protein concentration of residual saliva. Mucosal wetness on the soft palate was correlated with the minor salivary gland secretion rate (r=0.477, P<0.01). Among the minor salivary glands, the

  4. [Rhabdomyosarcoma of the salivary glands. Report of 3 cases].

    PubMed

    BenJelloun, H; Jouhadi, H; Maazouzi, A; Benchakroun, N; Acharki, A; Tawfiq, N; Sahraoui, S; Benider, A

    2005-09-01

    Rhabdomyosarcoma of the salivary glands is rare. Tumours develop mostly in children and young patients but can be diagnosed in older people. We report three new cases in women 7, 14 and 75 years old. Tumefaction of the parotid region and facial paralysis were the principle clinical symptoms. Two patients underwent a total parotidectomy and radiotherapy. The third patient had a locally advanced tumour and received chemotherapy followed by radiotherapy. Loco-regional recurrence was observed in all cases and median survival was 12 months. Rhabdomyosarcoma of the salivary glands is locally aggressive. Treatments include surgery and radiotherapy. The role of chemotherapy remains to be discussed.

  5. Metachronous bilateral pleomorphic adenoma of the parotid gland.

    PubMed

    Silva, Sindeval José da; Costa Junior, Gabriel Tadeu; Brant Filho, Adalberto Caldeira; Faria, Paulo Rogério; Loyola, Adriano Mota

    2006-03-01

    Bilateral salivary gland tumors are very rare, accounting for 3% of all parotid gland tumors. Although the most common tumor with bilateral development is the Warthin tumor, pleomorphic adenomas (PA) have been diagnosed simultaneously as well, but in a smaller incidence. Because of this, the prevalence, etiology, pathogenesis, and behavior of the PA in this context are poorly understood. We present a case of bilateral metachronous PA affecting the parotid gland in a 63-year-old woman. Clinically, the lesions presented with similar aspects as seen in cases of solitary PA with slow-growing asymptomatic nodule. Both lesions were diagnosed by fine-needle aspiration biopsy at an interval of 2 years between them. A total and superficial parotidectomy for left and right tumors, respectively, was performed. Only on the left side some facial nerve branches were removed that induced partial paralysis in the patient. A review of the pertinent literature is included.

  6. Volatile compounds from anal glands of the wolverine, Gulo gulo.

    PubMed

    Wood, William F; Terwilliger, Miranda N; Copeland, Jeffrey P

    2005-09-01

    Dichloromethane extracts of wolverine (Gulo gulo, Mustelinae, Mustelidae) anal gland secretion were examined by gas chromatography-mass spectrometry. The secretion composition was complex and variable for the six samples examined: 123 compounds were detected in total, with the number per animal ranging from 45 to 71 compounds. Only six compounds were common to all extracts: 3-methylbutanoic acid, 2-methylbutanoic acid, phenylacetic acid, alpha-tocopherol, cholesterol, and a compound tentatively identified as 2-methyldecanoic acid. The highly odoriferous thietanes and dithiolanes found in anal gland secretions of some members of the Mustelinae [ferrets, mink, stoats, and weasels (Mustela spp.) and zorillas (Ictonyx spp.)] were not observed. The composition of the wolverine's anal gland secretion is similar to that of two other members of the Mustelinae, the pine and beech marten (Martes spp.).

  7. Intravascular lymphoma and thyroid gland.

    PubMed

    Katalinić, Darko; Valković, Toni; Lucin, Ksenija; Rudez, Josip

    2006-03-01

    Intravascular lymphoma (IVL) is a rare disease characterized by the proliferation of neoplastic cells in the small blood vessels that frequently goes undiagnosed until the time of autopsy. The neoplastic cells are usually of B-cell origin. The clinical course was examined to determine factors that would facilitate antemortem diagnosis. IVL is observed with clinical, histopathological and immunohystochemical methods. This is a unique case because the thyroid gland is a rare place for IVL. Accent is given on immunohystochemical methods and tissue biopsy in the differential diagnosis of IVL when nervous system and thyroid gland dysfunction occur This report indicates that micro-ecosystem of multinodular goitrous might influence the expression of chemokines and/or adhesion moleculs on endothelial and lymphoma cells, leading to heavy infiltration of thyroid gland. Concurrently, that may guide the physician to tissue biopsy facilitating antemortem diagnosis and institution of appropriate therapy.

  8. Adrenal gland disease in ferrets.

    PubMed

    Simone-Freilicher, Elisabeth

    2008-01-01

    Adrenal gland disease in ferrets is unique to this species, with clinical signs and pathophysiology different from those seen in the dog. Its prevalence is increasing; 70% of pet ferrets in the United States were affected in 2003. The exact causes of the adrenal gland changes that lead to the disease are not known. Early oophorohysterectomies and neutering, combined with the artificially prolonged photoperiod experienced by indoor pet ferrets, and a possible genetic component, may be contributing factors. Signs of adrenal gland disease include progressive hair loss, pruritus, lethargy, atrophy, and, in female ferrets, vulvar swelling. An understanding of the signs and physiologic changes is necessary for diagnosis and treatment. A review of anatomy, physiology, and current surgical and medical options is presented.

  9. [Phosphate sensing and parathyroid gland].

    PubMed

    Mizobuchi, Masahide; Suzuki, Taihei

    2012-10-01

    In the latter 1990s, phosphate, as well as calcium, has been shown to have a direct action on parathyroid function. Since then although many researchers have tried to detect the phosphate sensor in parathyroid gland, none has found it yet. In 2000s, the importance of FGF23 was revealed in patients with autosomal dominant hypophosphatemic rickets and then investigating the role of FGF23 in mineral metabolism has spread. FGF23 target organs comprise those that express coreceptor Klotho, such as kidney and parathyroid glands. While associations of calcium sensing receptor or vitamin D receptor with parathyroid function have been mainly investigated for parathyroid dysfunction, many efforts recently have made to study the effects of FGF23 on parathyroid glands.

  10. Bilateral isolated submandibular gland mumps.

    PubMed

    Cheung, Linnea; Henderson, Arthur Harry; Banfield, Graham; Carswell, Andrew

    2017-06-05

    Isolated submandibular swellings pose a diagnostic challenge to the practising otolaryngologist. We report an unusual case of mumps isolated to bilateral submandibular glands. We discuss the case and the literature surrounding this condition and remind clinicians that mumps should be considered as a diagnosis in the presence of submandibular gland swelling in the absence of typical parotid swelling associated with mumps. Early consideration of this differential diagnosis, serological testing and a multidisciplinary approach may help to clinch the diagnosis earlier and prevent spread of the virus. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  11. Changes of pituitary gland volume in Kennedy disease.

    PubMed

    Pieper, C C; Teismann, I K; Konrad, C; Heindel, W L; Schiffbauer, H

    2013-12-01

    Kennedy disease is a rare X-linked neurodegenerative disorder caused by a CAG repeat expansion in the first exon of the androgen-receptor gene. Apart from neurologic signs, this mutation can cause a partial androgen insensitivity syndrome with typical alterations of gonadotropic hormones produced by the pituitary gland. The aim of the present study was therefore to evaluate the impact of Kennedy disease on pituitary gland volume under the hypothesis that endocrinologic changes caused by partial androgen insensitivity may lead to morphologic changes (ie, hypertrophy) of the pituitary gland. Pituitary gland volume was measured in sagittal sections of 3D T1-weighted 3T-MR imaging data of 8 patients with genetically proven Kennedy disease and compared with 16 healthy age-matched control subjects by use of Multitracer by a blinded, experienced radiologist. The results were analyzed by a univariant ANOVA with total brain volume as a covariant. Furthermore, correlation and linear regression analyses were performed for pituitary volume, patient age, disease duration, and CAG repeat expansion length. Intraobserver reliability was evaluated by means of the Pearson correlation coefficient. Pituitary volume was significantly larger in patients with Kennedy disease (636 [±90] mm(3)) than in healthy control subjects (534 [±91] mm(3)) (P = .041). There was no significant difference in total brain volume (P = .379). Control subjects showed a significant decrease in volume with age (r = -0.712, P = .002), whereas there was a trend to increasing gland volume in patients with Kennedy disease (r = 0.443, P = .272). Gland volume correlated with CAG repeat expansion length in patients (r = 0.630, P = .047). The correlation coefficient for intraobserver reliability was 0.94 (P < .001). Patients with Kennedy disease showed a significantly higher pituitary volume that correlated with the CAG repeat expansion length. This could reflect hypertrophy as the result of elevated gonadotropic

  12. Pituitary gland volumes in bipolar disorder.

    PubMed

    Clark, Ian A; Mackay, Clare E; Goodwin, Guy M

    2014-12-01

    Bipolar disorder has been associated with increased Hypothalamic-Pituitary-Adrenal axis function. The mechanism is not well understood, but there may be associated increases in pituitary gland volume (PGV) and these small increases may be functionally significant. However, research investigating PGV in bipolar disorder reports mixed results. The aim of the current study was twofold. First, to assess PGV in two novel samples of patients with bipolar disorder and matched healthy controls. Second, to perform a meta-analysis comparing PGV across a larger sample of patients and matched controls. Sample 1 consisted of 23 established patients and 32 matched controls. Sample 2 consisted of 39 medication-naïve patients and 42 matched controls. PGV was measured on structural MRI scans. Seven further studies were identified comparing PGV between patients and matched controls (total n; 244 patients, 308 controls). Both novel samples showed a small (approximately 20mm(3) or 4%), but non-significant, increase in PGV in patients. Combining the two novel samples showed a significant association of age and PGV. Meta-analysis showed a trend towards a larger pituitary gland in patients (effect size: .23, CI: -.14, .59). While results suggest a possible small difference in pituitary gland volume between patients and matched controls, larger mega-analyses with sample sizes greater even than those used in the current meta-analysis are still required. There is a small but potentially functionally significant increase in PGV in patients with bipolar disorder compared to controls. Results demonstrate the difficulty of finding potentially important but small effects in functional brain disorders. Copyright © 2014 Elsevier B.V. All rights reserved.

  13. Oxidative Modification in the Salivary Glands of High Fat-Diet Induced Insulin Resistant Rats

    PubMed Central

    Kołodziej, Urszula; Maciejczyk, Mateusz; Miąsko, Agnieszka; Matczuk, Jan; Knaś, Małgorzata; Żukowski, Piotr; Żendzian-Piotrowska, Małgorzata; Borys, Jan; Zalewska, Anna

    2017-01-01

    Still little is known about the role of oxidative stress (OS) in the pathogenesis of the salivary gland dysfunction in the course of insulin resistance (IR). To induce IR rats was fed with a high fat diet (HFD) during 8 weeks. Stimulated and non-stimulated salivary flow rate, total protein, as well as oxidative damage markers: 4-HNE protein adduct, 8-isoprostanes (8-isoP), 8-hydroxy-D-guanosine (8-OHdG), advanced oxidation protein product (AOPP), and protein carbonyls (PC) were determined in the plasma and submandibular and parotid glands of IR and control rats. We have shown a significant decrease (45%) of the stimulated salivary flow rate, and in the total protein concentration in the parotid (35%) and submandibular (10%) glands of HFD IR as compared to the control rats. The level of 4-HNE protein adduct (15%) and 8-isoP (20%) in the submandibular glands of IR rats as well as total level of 4-HNE protein adduct (39%), 8-isoP (27%), AOPP (25%), PC (32%), and 8-OHdG (18%) in the parotid glands of IR rats were significantly higher as compared to the control group. We showed no correlation between the assessed OS parameters in the plasma and salivary glands. However, the redox balance in both glands shifted toward the oxidative status, parotid glands of IR rats are exposed to greater intensity OS. Stimulated secretory ability and mechanisms involved in the synthesis/secretion of proteins in the salivary glands are depressed in the course of IR. Oxidative damage in the salivary glands arises independently from the general OS in the course of insulin resistance induced by a high fat diet. PMID:28184199

  14. Oxidative Modification in the Salivary Glands of High Fat-Diet Induced Insulin Resistant Rats.

    PubMed

    Kołodziej, Urszula; Maciejczyk, Mateusz; Miąsko, Agnieszka; Matczuk, Jan; Knaś, Małgorzata; Żukowski, Piotr; Żendzian-Piotrowska, Małgorzata; Borys, Jan; Zalewska, Anna

    2017-01-01

    Still little is known about the role of oxidative stress (OS) in the pathogenesis of the salivary gland dysfunction in the course of insulin resistance (IR). To induce IR rats was fed with a high fat diet (HFD) during 8 weeks. Stimulated and non-stimulated salivary flow rate, total protein, as well as oxidative damage markers: 4-HNE protein adduct, 8-isoprostanes (8-isoP), 8-hydroxy-D-guanosine (8-OHdG), advanced oxidation protein product (AOPP), and protein carbonyls (PC) were determined in the plasma and submandibular and parotid glands of IR and control rats. We have shown a significant decrease (45%) of the stimulated salivary flow rate, and in the total protein concentration in the parotid (35%) and submandibular (10%) glands of HFD IR as compared to the control rats. The level of 4-HNE protein adduct (15%) and 8-isoP (20%) in the submandibular glands of IR rats as well as total level of 4-HNE protein adduct (39%), 8-isoP (27%), AOPP (25%), PC (32%), and 8-OHdG (18%) in the parotid glands of IR rats were significantly higher as compared to the control group. We showed no correlation between the assessed OS parameters in the plasma and salivary glands. However, the redox balance in both glands shifted toward the oxidative status, parotid glands of IR rats are exposed to greater intensity OS. Stimulated secretory ability and mechanisms involved in the synthesis/secretion of proteins in the salivary glands are depressed in the course of IR. Oxidative damage in the salivary glands arises independently from the general OS in the course of insulin resistance induced by a high fat diet.

  15. Uneven Meibomian Gland Dropout Over the Tarsal Plate and its Correlation With Meibomian Gland Dysfunction.

    PubMed

    Yin, Yue; Gong, Lan

    2015-10-01

    To evaluate the distribution of meibomian gland dropout and analyze the correlation between dropout and meibomian gland dysfunction (MGD). A total of 161 eyes of 85 patients with MGD were recruited as the MGD group; 88 eyes of 46 health volunteers were enrolled as the control group (2:1 matched for age and sex). Examinations included the Schirmer I test, breakup time, symptom questionnaire, corneal fluorescein staining, meibum quality, meibomian gland expressibility, and meibomian gland dropout. (1) The incidences of chalazion and eyelid surgery were significantly higher in patients with MGD. (2) All clinical indexes were better in healthy volunteers (all P < 0.05). (3) The dropout in the upper eyelid was statistically lower (P < 0.01) in both groups. The nasal and/or temporal part had higher dropout than did the middle part, except in the lower eyelid of the control group. (4) The entire or partial dropout was positively related to MGD occurrence. Both additive dropout of the entire 2 eyelids and that of the 2 nasal parts had the strongest correlation (r = 0.792, P < 0.01). (5) In the MGD group, breakup time was most negatively related to upper nasal dropout (r = -0.229, P < 0.05). The corneal staining score was positively related only to the dropout of additive (r = 0.185, P < 0.05) and lower (r = 0.258, P < 0.05) middle parts. (1) Uneven dropouts exist in different or single eyelids. (2) Dropout evaluation is better when covering the entire area of both upper and lower meibomians. (3) Nasal part dropout plays a more essential role than the other dropouts in MGD occurrence.

  16. Adrenal glands transabdominal ultrasonography - pictorial essay.

    PubMed

    Chira, Romeo Ioan; Chira, Alexandra; Manzat-Saplacan, Roberta Maria; Nagy, Georgiana; Valea, Ana; Silaghi, Alina Cristina; Mircea, Petru Adrian; Valean, Simona

    2017-05-03

    Adrenal gland ultrasonography is one of the corner stones of the abdominal ultrasonography examination for many medical specialties. The adrenal areas can be easily overlooked though adrenal gland pathology is diverse. We present the normal aspects and various transabdominal ultrasonography findings of the adrenal glands, both common and rare. Even though ultrasound examination is operator and patient dependent, we consider the examination of the adrenal glands very important, due to relatively frequent incidental detection of an adrenal mass.

  17. Lidocaine spray alone is similar to spray plus viscous solution for pharyngeal observation during transoral endoscopy: a clinical randomized trial

    PubMed Central

    Hayashi, Tomoyuki; Asahina, Yoshiro; Waseda, Yohei; Kitamura, Kazuya; Kagaya, Takashi; Seike, Takuya; Okada, Kazuhiro; Inada, Yuki; Takabatake, Hisashi; Orita, Noriaki; Yanase, Yuko; Yamashita, Tatsuya; Ninomiya, Itasu; Yoshimura, Kenichi; Kaneko, Shuichi

    2017-01-01

    Background and study aims It is important to examine the pharynx during upper gastrointestinal endoscopy. Pharyngeal anesthesia using topical lidocaine is generally used as pretreatment. In Japan, lidocaine viscous solution is the anesthetic of choice, but lidocaine spray is applied when the former is considered insufficient. However, the relationship between the extent of pharyngeal anesthesia and accuracy of observation is unclear. We compared the performance of lidocaine spray alone versus lidocaine spray combined with lidocaine viscous solution for pharyngeal observation during transoral endoscopy. Patients and methods In this prospective, double-blinded, randomized clinical trial conducted between January and March 2015, 327 patients were randomly assigned to lidocaine spray alone (spray group, n = 157) or a combination of spray and viscous solution (combination group, n = 170). We compared the number of pharyngeal observable sites (non-inferiority test), pain by visual analogue scale, observation time, and the number of gag reflexes between the two groups. Results The mean number of images of suitable quality taken at the observable pharyngeal sites in the spray group was 8.33 (95 % confidence interval [CI]: 7.94 – 8.72) per patient, and 8.77 (95 % CI: 8.49 – 9.05) per patient in the combination group. The difference in the number of observable pharyngeal sites was – 0.44 (95 % CI: – 0.84 to – 0.03, P = 0.01). There were no differences in pain, observation time, or number of gag reflexes between the 2 groups. Subgroup analysis of the presence of sedation revealed no differences between the two groups for the number of pharyngeal observation sites and the number of gag reflexes. However, the number of gag reflexes was higher in the spray group compared to the combination group in a subgroup analysis that looked at the absence of sedation. Conclusions Lidocaine spray for pharyngeal anesthesia was not

  18. [Unilateral congenital aplasia of the submandibular gland].

    PubMed

    Damar, Murat; Kalaycı, Cem Burak; Bekar, Ulkü; Turhan, Bünyamin

    2013-01-01

    Aplasia of the major salivary glands is very uncommon, whereas isolated aplasia of unilateral submandibular gland is even rarer. In this article, we report a 55-year-old female case in whom unilateral aplasia of the left submandibular gland was detected incidentally by ultrasonography with no other congenital comorbidities in the light of literature data.

  19. Undifferentiated carcinoma of parotid gland.

    PubMed Central

    López, J I; Alfaro, J; Ballestin, C

    1991-01-01

    Two cases of undifferentiated carcinomas of the major salivary glands were studied using immunohistochemical techniques. Results showed that this entity was a high grade malignant neoplasm arising from the excretory duct. Despite the undifferentiated appearance multiple immunophenotypes were evident in both cases. PMID:2045506

  20. Classification of Salivary Gland Neoplasms.

    PubMed

    Bradley, Patrick J

    2016-01-01

    Presently, there is no universal 'working' classification system acceptable to all clinicians involved in the diagnosis and management of patients with salivary gland neoplasms. The most recent World Health Organization Classification of Tumours: Head and Neck Tumours (Salivary Glands) (2005) for benign and malignant neoplasms represents the consensus of current knowledge and is considered the standard pathological classification based on which series should be reported. The TNM classification of salivary gland malignancies has stood the test of time, and using the stage groupings remains the current standard for reporting treated patients' outcomes. Many developments in molecular and genetic methods in the meantime have identified a number of new entities, and new findings for several of the well-established salivary malignancies need to be considered for inclusion in any new classification system. All clinicians involved in the diagnosis, assessment and treatment of patients with salivary gland neoplasms must understand and respect the need for the various classification systems, enabling them to work within a multidisciplinary clinical team environment.

  1. Cyst of accessory lacrimal gland.

    PubMed Central

    Durán, J. A.; Cuevas, J.

    1983-01-01

    We present a case of an epithelial cyst of the conjunctiva caused by the dilatation of an accessory lacrimal gland. The case is peculiar in regard to the size of the cyst and the absence of traumatic or inflammatory factors to explain the retention of fluid. Images PMID:6860616

  2. Primary peripheral nerve sheath tumors of the thyroid gland: A case report and literature review

    PubMed Central

    CHEN, GUANG; LIU, ZENGGUANG; SU, CHANG; GUAN, QIANG; WAN, FANG; DONG, BINGFEI; BAO, LIANG; ZHANG, WENXIN; WANG, YINPING; WANG, GUIMIN

    2016-01-01

    Primary peripheral nerve sheath tumors (PNSTs) of the thyroid gland are rare, with fewer than 30 cases reported in the medical literature to date. Primary PNSTs of the thyroid gland are classified into malignant and benign PNSTs. The benign PNSTs may be further subclassified into neurofibromas and Schwannomas. This is the case report of a 51-year-old male patient presenting with multiple primary PNSTs involving the left lobe of the thyroid gland. The patient underwent total excision of the thyroid gland and the pathological results indicated a Schwannoma with Antoni type A and B cells. The literature was reviewed briefly and, to the best of our knowledge, this is the first case report of multiple primary PNSTs of the thyroid gland. PMID:26893864

  3. Primary peripheral nerve sheath tumors of the thyroid gland: A case report and literature review.

    PubMed

    Chen, Guang; Liu, Zengguang; Su, Chang; Guan, Qiang; Wan, Fang; Dong, Bingfei; Bao, Liang; Zhang, Wenxin; Wang, Yinping; Wang, Guimin

    2016-02-01

    Primary peripheral nerve sheath tumors (PNSTs) of the thyroid gland are rare, with fewer than 30 cases reported in the medical literature to date. Primary PNSTs of the thyroid gland are classified into malignant and benign PNSTs. The benign PNSTs may be further subclassified into neurofibromas and Schwannomas. This is the case report of a 51-year-old male patient presenting with multiple primary PNSTs involving the left lobe of the thyroid gland. The patient underwent total excision of the thyroid gland and the pathological results indicated a Schwannoma with Antoni type A and B cells. The literature was reviewed briefly and, to the best of our knowledge, this is the first case report of multiple primary PNSTs of the thyroid gland.

  4. Measurement of the normal feline pituitary gland in brachycephalic and mesocephalic cats.

    PubMed

    Häußler, Thomas Christian; von Pückler, Kerstin Heike; Thiel, Cetina; Enderlein, Sylke; Failing, Klaus; Ondreka, Nele; Kramer, Martin; Schmidt, Martin Jürgen

    2017-08-01

    Objectives The purpose of this study was to determine differences in normal feline pituitary dimensions in brachycephalic and mesocephalic cats as a basis for establishing cryohypophysectomy in cats. Methods Measurements were performed on sagittal T2-weighted and transverse post-gadolinium T1-weighted or T1 3D fast field echo-weighted MRI images. A total of 32 brachycephalic and 27 mesocephalic cats were examined. Inter-observer reproducibility was assessed by t-test and Bland-Altman analysis. Results The cats were 0.6-15.9 years of age with a body weight range of 1.84-6.60 kg. For brachycephalic cats, the mean pituitary gland sagittal height was 2.15 ± 0.15 mm, pituitary gland transverse height was 2.42 ± 0.21 mm, pituitary gland transverse width was 4.44 ± 0.27 mm and pituitary gland sagittal length was 3.14 ± 0.30 mm. In mesocephalic cats, the pituitary gland dimensions were 2.94 ± 0.16 mm, 3.09 ± 0.26 mm, 4.73 ± 0.31 mm and 4.88 ± 0.30 mm for pituitary gland sagittal height, transverse height, transverse width and sagittal length, respectively. There was a highly significant correlation between brachycephalic and mesocephalic cats and pituitary gland height and length ( P <0.0001), respectively. Sex also had an effect on pituitary gland measurements. Neutering status had no significant effect on hypophyseal measurements. Age had a significant influence on pituitary gland height, width and length in the brachycephalic population. Inter-observer reproducibility was good to excellent. Conclusions and relevance The different pituitary measurements in brachycephalic and mesocephalic cats has to be considered if surgery comes into question. There are ranges in pituitary gland sizes, even among the mesocephalic cat population. Thus, exact measuring of the pituitary gland is crucial before any surgical intervention.

  5. Shear wave velocity of the healthy thyroid gland in children with acoustic radiation force impulse elastography.

    PubMed

    Ceyhan Bilgici, Meltem; Sağlam, Dilek; Delibalta, Semra; Yücel, Serap; Tomak, Leman; Elmalı, Muzaffer

    2017-04-19

    Acoustic radiation force impulse imaging is a kind of shear wave elastography that can be used in children for differentiating thyroid pathologies. Possible changes in the healthy thyroid gland in children may create difficulties in the use of shear wave velocities (SWV) in thyroid pathologies. The aim of this study was to define the normal values of SWV for the healthy thyroid gland in children, elucidate the correlation of the SWV values with potential influencing factors, and evaluate intra-operator reproducibility of the SWV. Between January 2015 and December 2015, a total of 145 healthy children (81 girls, 64 boys; mean age, 10.5 ± 3.14 years; range 6-17 years) were enrolled in the study. The SWV and volume of the thyroid gland were determined. The mean shear wave velocity of the thyroid gland was 1.22 ± 0.20 m/s. There was no correlation between age and the mean SWV of the thyroid gland (Spearman Rho = 0.049, p = 0.556). There was also no correlation between the thyroid gland volume or BSA and the mean SWV. The only correlation detected was between BSA and total thyroid gland volume (p < 0.001). In the present study, the SWV of the healthy thyroid gland in children was determined. There was no correlation between the SWV of the thyroid gland and age, BSA, or thyroid gland volume.

  6. The reptilian thyroid and parathyroid glands.

    PubMed

    Rivera, Sam; Lock, Brad

    2008-01-01

    The field of reptilian clinical endocrinology is still in its infancy. The thyroid and parathyroid glands are intimately involved with many basic metabolic functions. These glands have been the subject of extensive research studies in reptilian species; however, the effects of abnormal gland function have been poorly documented in clinical cases. These glands play a major role in maintaining physiologic homeostasis in all vertebrates. With the advent of more sensitive assays, it should be possible to measure the small amounts of hormones found in reptilian species. The purpose of this article is to review the literature regarding clinical endocrinology of the thyroid and parathyroid glands in reptiles.

  7. Epidemiological and histopathological patterns of salivary gland tumors in Cameroon

    PubMed Central

    Sando, Zacharie; Fokouo, Jean Valentin; Mebada, Arlette Onomo; Djomou, François; NDjolo, Alexis; Oyono, Jean Louis Essame

    2016-01-01

    Introduction Tumors of salivary glands are rare. According to Johns and Goldsmith in 1989, their annual incidence is less than 1/100000 without noteworthy geographical gap. But other authors suggest that their distribution may vary according to the race and geographical location. In Cameroon, existing studies give incomplete data. Hence, we underwent this study in order to draw the general profile of salivary gland tumors in Cameroon. Methods A retrospective study was carried out on the period spanning from January 2000 to December 2010 (11 years). It was done in nine Pathology services of different hospitals in Yaoundé, Douala and Bamenda. We consulted the archive registers of those services, retaining any patient with salivary gland tumor, whatever the histological type or location. Information gathered was the year of diagnosis, the service, the age and sex, the site of the tumor (gland) the histological type and the benign/ malignant character. Results We recruited a total of 275 files. Women were 56% (154/275) and men 44% (121/275) of the sample. Fifty eight tumors were malignant (21.9%) while 217 were benign (78.1%). The overall mean age was 37.44 years, with extremes between 1 and 84 years. Pleomorphic adenoma (60.36%) was the most common benign tumor. Adenoid cystic carcinoma (31%), mucoepidermoid carcinoma (22.4%) and adenocarcinoma (19%) were the most common malignant tumors. Palate (66.7%), cheek (30%) and lips (3.3%) were the sites were the minor salivary glands were mostly involved. Conclusion The differences with western world authors suggest a geographical variability of salivary gland tumors. PMID:27217890

  8. Comparison of three methods for the estimation of pineal gland volume using magnetic resonance imaging.

    PubMed

    Acer, Niyazi; Ilıca, Ahmet Turan; Turgut, Ahmet Tuncay; Ozçelik, Ozlem; Yıldırım, Birdal; Turgut, Mehmet

    2012-01-01

    Pineal gland is a very important neuroendocrine organ with many physiological functions such as regulating circadian rhythm. Radiologically, the pineal gland volume is clinically important because it is usually difficult to distinguish small pineal tumors via magnetic resonance imaging (MRI). Although many studies have estimated the pineal gland volume using different techniques, to the best of our knowledge, there has so far been no stereological work done on this subject. The objective of the current paper was to determine the pineal gland volume using stereological methods and by the region of interest (ROI) on MRI. In this paper, the pineal gland volumes were calculated in a total of 62 subjects (36 females, 26 males) who were free of any pineal lesions or tumors. The mean ± SD pineal gland volumes of the point-counting, planimetry, and ROI groups were 99.55 ± 51.34, 102.69 ± 40.39, and 104.33 ± 40.45 mm(3), respectively. No significant difference was found among the methods of calculating pineal gland volume (P > 0.05). From these results, it can be concluded that each technique is an unbiased, efficient, and reliable method, ideally suitable for in vivo examination of MRI data for pineal gland volume estimation.

  9. Comparison of Three Methods for the Estimation of Pineal Gland Volume Using Magnetic Resonance Imaging

    PubMed Central

    Acer, Niyazi; Ilıca, Ahmet Turan; Turgut, Ahmet Tuncay; Özçelik, Özlem; Yıldırım, Birdal; Turgut, Mehmet

    2012-01-01

    Pineal gland is a very important neuroendocrine organ with many physiological functions such as regulating circadian rhythm. Radiologically, the pineal gland volume is clinically important because it is usually difficult to distinguish small pineal tumors via magnetic resonance imaging (MRI). Although many studies have estimated the pineal gland volume using different techniques, to the best of our knowledge, there has so far been no stereological work done on this subject. The objective of the current paper was to determine the pineal gland volume using stereological methods and by the region of interest (ROI) on MRI. In this paper, the pineal gland volumes were calculated in a total of 62 subjects (36 females, 26 males) who were free of any pineal lesions or tumors. The mean ± SD pineal gland volumes of the point-counting, planimetry, and ROI groups were 99.55 ± 51.34, 102.69 ± 40.39, and 104.33 ± 40.45 mm3, respectively. No significant difference was found among the methods of calculating pineal gland volume (P > 0.05). From these results, it can be concluded that each technique is an unbiased, efficient, and reliable method, ideally suitable for in vivo examination of MRI data for pineal gland volume estimation. PMID:22619577

  10. Location, number and morphology of parathyroid glands: results from a large anatomical series.

    PubMed

    Lappas, Dimitrios; Noussios, George; Anagnostis, Panagiotis; Adamidou, Fotini; Chatzigeorgiou, Antonios; Skandalakis, Panagiotis

    2012-09-01

    Surgical management of parathyroid gland disease may sometimes be difficult, due mainly to the surgeon's failure to successfully detect parathyroids in unusual locations. The records of 942 cadavers (574 men and 368 women) who underwent autopsy in the Department of Forensic Medicine in Athens during the period 1988-2009 were reviewed. In total, 3,796 parathyroid glands were resected and histologically verified. Parathyroid glands varied in number. In 47 cases (5 %), one supernumerary (fifth) parathyroid was found, while in 19 cases (2 %) three parathyroid glands found. Superior glands were larger than inferior ones. However, there was no significant difference between the genders with respect to gland size. In 324 (8.5 %) out of 3,796, the glands were detected in an ectopic location: 7 (0.2 %) in the thyroid parenchyma, 79 (2 %) in different sites in the neck and 238 (6.3 %) in the mediastinum, 152 (4.1 %) of which were found in the upper and 86 (2.2 %) in the lower mediastinum. Significant anatomical variations of normal parathyroid glands may exist regarding number and location-knowledge that is essential for their successful identification and surgical management.

  11. [Quantitative analysis of age-related changes of human major salivary glands using magnetic resonance imaging].

    PubMed

    Xu, Liang; Zhao, Danlei; Zhang, Hongli; Tian, Ye; Fan, Guohua; Shen, Junkang; Gong, Jianping; Qian, Minghui

    2015-01-20

    To analyze the age-related characteristics of volumes, signal intensities (SIs) of T1-weighted images (T1WI), T2-weighted images (T2WI) and apparent diffusion coefficients (ADCs) of three major salivary glands. A total of 300 subjects with normal salivary glands were divided into 4 different age groups and examined with a 1.5 T magnetic resonance (MR) unit. T1WI, T2WI and diffusion-weighted MR images (DW MRI) were obtained and bilateral parotid, submandibular and sublingual glands segmented manually. The volumes, T1WI, T2WI SIs and ADCs of three major salivary glands were measured. And the relative SIs (RSIs) were assessed by comparing with cerebrospinal fluid. The volumes, T1WI and T2WI RSIs of parotid glands were significantly correlated with age (P < 0.01) and showed similar significant tendencies of growing from minority to middle age and decreasing slightly after old age. Significant differences existed between minority and middle age groups in all above-mentioned parameters (P < 0.01). The ADCs of submandibular glands also showed that there was a significant difference between the minority and middle age groups (P < 0.01). MRI may be applied for studying the morphological and functional changes of normal major salivary glands with aging. Thus clinical rationales can be provided for assessing the subjects of any age during salivary gland imaging and aging-related researches.

  12. Anatomy, biogenesis, and regeneration of salivary glands

    PubMed Central

    Holmberg, Kyle V.; Hoffman, Matthew P.

    2014-01-01

    An overview of the anatomy and biogenesis of salivary glands is important in order to understand the physiology, functions and disorders associated with saliva. A major disorder of salivary glands is salivary hypofunction and resulting xerostomia, or dry mouth, which affects hundreds of thousands of patients per year who suffer from salivary gland diseases or undergo head and neck cancer treatment. There is currently no curative therapy for these patients. To improve these patients’ quality of life, new therapies are being developed based on findings in salivary gland cell and developmental biology. Here we discuss the anatomy and biogenesis of the major human salivary glands and the rodent submandibular gland (SMG), which has been used extensively as a research model. We also include a review of recent research on the identification and function of stem cells in salivary glands, and the emerging field of research suggesting nerves play an instructive role during development and may be essential for adult gland repair and regeneration. Understanding the molecular mechanisms involved in gland biogenesis provides a template for regenerating, repairing or reengineering diseased or damaged adult human salivary glands. We provide an overview of three general approaches currently being developed to regenerate damaged salivary tissue, including gene therapy, stem cell-based therapy, and tissue engineering. In the future, it may be that a combination of all three will be used to repair, regenerate and reengineer functional salivary glands in patients to increase the secretion of their saliva, the focus of this monograph. PMID:24862590

  13. Anatomy, biogenesis and regeneration of salivary glands.

    PubMed

    Holmberg, Kyle V; Hoffman, Matthew P

    2014-01-01

    An overview of the anatomy and biogenesis of salivary glands is important in order to understand the physiology, functions and disorders associated with saliva. A major disorder of salivary glands is salivary hypofunction and resulting xerostomia, or dry mouth, which affects hundreds of thousands of patients each year who suffer from salivary gland diseases or undergo head and neck cancer treatment. There is currently no curative therapy for these patients. To improve these patients' quality of life, new therapies are being developed based on findings in salivary gland cell and developmental biology. Here we discuss the anatomy and biogenesis of the major human salivary glands and the rodent submandibular gland, which has been used extensively as a research model. We also include a review of recent research on the identification and function of stem cells in salivary glands, and the emerging field of research suggesting that nerves play an instructive role during development and may be essential for adult gland repair and regeneration. Understanding the molecular mechanisms involved in gland biogenesis provides a template for regenerating, repairing or reengineering diseased or damaged adult human salivary glands. We provide an overview of 3 general approaches currently being developed to regenerate damaged salivary tissue, including gene therapy, stem cell-based therapy and tissue engineering. In the future, it may be that a combination of all three will be used to repair, regenerate and reengineer functional salivary glands in patients to increase the secretion of their saliva, the focus of this monograph.

  14. Neuropeptidergic control of Octopus oviducal gland.

    PubMed

    Di Cristo, Carlo; Di Cosmo, Anna

    2007-01-01

    The oviducal gland of the female of Octopus vulgaris lies about halfway along the oviduct. Progesterone and 17beta-estradiol receptors have been immunolocalized in the nuclei of the cells of the glandular compartment of previtellogenic glands. We also have evidence of FMRFamide-like and cGnRH-I-like immunoreactivity in the nerve endings that reach the oviducal gland. Moreover, we have recently shown APGWamide immunoreactivity in the glandular cells of the inner part of the oviducal gland. Here we report a review on these findings as well as our latest studies on the effect that neuropeptides may exert on the secretory activity of the oviducal gland. cAMP seems to be a possible second messenger involved in such a process. We discuss the findings of a neuropeptidergic action on the glandular cells of oviducal gland in a more complex frame of molecules, such as steroids, biogenic amines and neuromodulators, controlling the activity of the gland.

  15. Use of a midline mandibular osteotomy to improve surgical access for transoral robotic resection of the base of tongue in a patient with trismus.

    PubMed

    Tay, Gerald; Ferrell, Jay; Andersen, Peter

    2017-09-01

    The utilization of transoral robotic surgery (TORS) in patients with trismus is limited because of poor surgical exposure. This report is about a 46-year-old man with a recurrent right base of tongue cancer who had severe postradiation trismus. We performed a midline mandibular osteotomy without a lip split and this resulted in a markedly improved surgical exposure. He underwent a TORS resection of the right base of the tongue with no significant complications. The midline mandibular osteotomy significantly improved the surgical exposure and facilitated exposure for TORS in a patient who otherwise would not be able to undergo TORS. Utilization of a midline mandibular osteotomy allowed for increased exposure for TORS in a patient with limited mouth opening from postradiation trismus. Postoperative hemorrhage remains a significant concern and appropriate measures to mitigate the catastrophic consequences of this should be considered. © 2017 Wiley Periodicals, Inc.

  16. Relationship between the dimension of parathyroid glands estimated by ultrasonography and the hyperplastic pattern in patients with renal hyperparathyroidism.

    PubMed

    Matsuoka, Susumu; Tominaga, Yoshihiro; Sato, Tetsuhiko; Uno, Nobuaki; Hiramitu, Takahisa; Goto, Norihiko; Nagasaka, Takaharu; Uchida, Kazuharu

    2008-10-01

    In renal hyperparathyroidism (HPT), the parathyroid glands initially proliferate diffusely and polyclonally, and are then transformed to monoclonal nodular hyperplasia with aggressive growth potential. In this study we evaluated the relationship between the maximal dimension of parathyroid glands estimated by ultrasonography (US) and the hyperplastic pattern of parathyroid glands in patients with renal HPT. Between October 1999 and December 2006, 141 patients who underwent total parathyroidectomy (PTx) with forearm autograft in our department were enrolled in this study. In these patients 308 parathyroid glands were detected by US before PTx. The largest dimension of the gland estimated preoperatively by US was correlated closely with its measurement at surgery (R2 was 0.31, P < 0.001). The maximal dimension of diffuse hyperplastic glands was significantly smaller than that of the glands with nodular hyperplastic glands (P < 0.001). There was a strong correlation between the pattern of parathyroid hyperplasia and the glandular diameter when we defined 8 mm as the maximal diameter estimated by US as a cut-off value. As a result of receiver operating characteristic analyses, using these criteria the US technique could predict nodular hyperplasia with a high sensitivity (78.9%) and specificity (78.7%). Parathyroid glands that are enlarged by more than 8 mm in the largest dimension estimated by US may represent glands with nodular hyperplasia.

  17. Effect of transoral endoscopic adenoidectomy on peripheral blood T-lymphocyte subsets in children with obstructive sleep apnea-hypopnea syndrome and its treatment strategy.

    PubMed

    Yang, Na; Ji, Yaofeng; Liu, Yin

    2017-10-01

    The objective of the present study was to investigate the effect of transoral endoscopic adenoidectomy on peripheral blood T lymphocyte subsets in pediatric patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) and its treatment strategy. Ninety-eight pediatric patients with adenoidal hypertrophy associated with OSAHS admitted to the Department of Otolaryngology, Xuzhou Children's Hospital were selected. After admission, patients received perfected 24 h polysomnogram monitoring, routine blood examination, fasting blood biochemistry examination, T-lymphocyte subset count, 24 h ambulatory blood pressure monitoring, and nasopharyngeal computed tomography. After patients were diagnosed with adenoidal hypertrophy associated with OSAHS, they underwent transoral endoscopic adenoidectomy with a power microdebrider. Patients were evaluated at 3-, 6- and 12-week follow-up visits. The CD3(+), CD4(+), and CD8(+) T-cell counts, CD4(+)/CD8(+) T lymphocyte ratio, and changes of 24 h ambulatory blood pressure before and after surgery were recorded. After the 6-week follow-up visit, the mean CD4(+) T lymphocyte count in patients was increased significantly compared with that before surgery, the CD4(+)/CD8(+) T lymphocyte ratio increased gradually, and the differences were statistically significant (P<0.05). The frequency of nocturnal awakening of patients was decreased significantly after surgery and the duration of nocturnal sleep was extended significantly (P<0.05). Through analysis of the preoperative and postoperative clinical data of pediatric patients, the CD4(+)/CD8(+) T lymphocyte ratio was negatively correlated with mean arterial pressure (MAP) (r=-1.06, P=0.003). In conclusion, adenoidectomy can significantly decrease the MAP in pediatric patients with OSAHS and increase the duration of nocturnal sleep. The peripheral blood CD4(+)/CD8(+) T lymphocyte ratio in pediatric patients was significantly negatively correlated with MAP.

  18. The effect of the transplanted pineal gland on the sympathetic innervation of the rat sublingual gland.

    PubMed

    Chanthaphavong, R S; Murphy, S M; Anderson, C R

    2004-08-01

    We investigated the effect of the pineal on sympathetic neurons that normally innervate the sublingual gland of the rat. When the pineal gland was transplanted into the sublingual gland, it remained as a distinct mass that was innervated by sympathetic axons. Injection of the retrograde tracer, Fast Blue, into the sublingual gland labelled sympathetic neurons in the ipsilateral superior cervical ganglion (SCG). Thirty per cent of all neurons labelled retrogradely by Fast Blue injection into transplanted pineal glands were immunoreactive for both neuropeptide Y (NPY) and calbindin. This combination is characteristic of sympathetic neurons innervating the pineal gland in its normal location, but not the sympathetic vasoconstrictor neurons normally innervating the sublingual gland. This, and our previous study in which the pineal gland was shown to similarly influence the phenotype of salivary secretomotor neurons, suggests that a range of different functional classes of sympathetic neuron are able to change their phenotype in response to signals released by the pineal gland.

  19. Unintentional parathyroidectomy during total thyroidectomy surgery

    PubMed Central

    Du, Wei; Fang, Qigen; Zhang, Xu; Cui, Meng; Zhao, Ming; Lou, Weihua

    2017-01-01

    Abstract In this study, we investigated incidental parathyroidectomy during total thyroidectomy surgery that required central lymph node dissection and the potential risk factors. Patients requiring total thyroidectomy and tracheoesophageal groove node dissection were enrolled in the study from January 2013 to June 2015 and we obtained all medical information, including pathology reports. Furthermore, we recorded the parathyroid hormone level in all patients prior to operation and then 3 further times: 1 day, 1 week, and 3 months after surgery. A total of 341 patients (66 male and 275 female) were enrolled in the study. Microscopic examination of postoperative specimens revealed that incidental parathyroidectomy existed in 35 (10.3%) cases: 32 (91.4%) patients had 1 parathyroid gland excised, 3 (8.6%) patients had 2 parathyroid glands excised, and no patients had 3 or more parathyroid glands resected. The mean size of the resected glands was 4.6 mm. Parathyroid tissue from 16 (42.1%) cases was located in the intrathyroidal position, 6 glands were located in central lymphatic adipose tissue, and 16 glands were located within or along with thymus tissue. Lateral neck dissection significantly increased the risk of incidental parathyroidectomy (P < 0.001). No other factors including age, sex, and postoperative symptomatic hypocalcemia were significantly associated with incidental parathyroidectomy (all P > 0.05), though incidental parathyroidectomy tended to cause transient hypoparathyroidism (P = 0.051). Therefore, the risk of incidental parathyroidectomy in total thyroidectomy is relatively low; the majority of the resected parathyroid tissue is situated outside the thyroid, therefore we suggest future operations focus on preserving the parathyroid gland when the node dissection is close to the thymus. Incidental parathyroidectomy appears to have an effect on the expression of parathyroid hormone and it is significantly associated with lateral cervical

  20. [Distant metastases to the parotid gland--review of the literature and report of own two cases].

    PubMed

    Markowski, Jarosław; Gierek, Tatiana; Zielińska-Pajak, Ewa; Witkowska, Małgorzata; Wodołazski, Anatol; Pajak, Jacek; Paluch, Jarosław

    2005-01-01

    Metastatic tumors to the parotid gland are very uncommon and it accounts for 8% of all cancers of parotid gland. The parotid gland and its lymph nodes are possible sites of metastases from head and neck cancers. However, metastasis from distant primary neoplasm below clavicle is possible, too. The authors presented the two cases of distant metastases to the parotid gland. The women with breast cancer and metastases to the parotid gland 11 years after surgery, radio- and chemotherapy of breast cancer. She died 7 months after parotid surgery of systemically advanced disease. The man with metastasis of malignant melanoma of unknown primary site. He underwent total parotid surgery with the tumor and lymph nodes. He died 7 months after surgery. In spite of intensive exam the primary location of the melanoma was unknown. The authors described pathophysiology of distant metastases to the parotid gland with special attention to possibilities of treatment and survival.

  1. Morphological Changes of Myoepithelial Cells in the Rat Submandibular Gland Following the Application of Surgical Stimuli

    PubMed Central

    Kawabe, Yoshihiro; Mizobe, Kenich; Bando, Yasuhiko; Sakiyama, Koji; Taira, Fuyoko; Tomomura, Akito; Araki, Hisao; Amano, Osamu

    2016-01-01

    Myoepithelial cells (MECs) exist on the basal surface of acini in major exocrine glands, include myofilaments and various constructive proteins, and share characteristics with smooth muscle and epithelial cells. MECs project several ramified processes to invest acini, and possibly contract to compress acini to support the secretion by the glandular cells. However, the functional roles of MECs in salivary secretion are still unclear. We investigated morphological changes in immunostained MECs using the anti-α-smooth muscle actin (αSMA) antibody in operated or non-operated contralateral (NC) submandibular glands after partial or total resection. Furthermore, we investigated and discuss other salivary glands of rats. MECs in the parotid, sublingual and submandibular gland of adult rats exhibited different shapes and localizations. After surgery, in both operated and NC glands, the number of MECs and αSMA-immunopositive areas increased significantly. Three-dimensional analysis using a confocal laser-scanning microscope revealed that substantial and significant enhancement became evident in the number, length, and thickness of MEC-processes covering acini of the operated and NC submandibular glands. The preset findings indicate that MECs alter the morphology of their processes in operated and NC glands after surgery of the partial or total resection. It is suggested that MECs promote salivary secretion using elongated, thickened, and more ramified processes. PMID:28127104

  2. Pituitary gland development: an update.

    PubMed

    Bancalari, Rodrigo E; Gregory, Louise C; McCabe, Mark J; Dattani, Mehul T

    2012-01-01

    The embryonic development of the pituitary gland involves a complex and highly spatio-temporally regulated network of integrating signalling molecules and transcription factors. Genetic mutations in any of these factors can lead to congenital hypopituitarism in association with a wide spectrum of craniofacial/midline defects ranging from incompatibility with life to holoprosencephaly (HPE) and cleft palate and septo-optic dysplasia (SOD). Increasing evidence supports a genotypic overlap with hypogonadotrophic hypogonadal disorders such as Kallmann syndrome, which is consistent with the known overlap in phenotypes between these disorders. This chapter reviews the cascade of events leading up to the successful development of the pituitary gland and to highlight key areas where genetic variations can occur thus leading to congenital hypopituitarism and associated defects. Copyright © 2012 S. Karger AG, Basel.

  3. Long-term dexamethasone treatment alters the histomorphology of acinar cells in rat parotid and submandibular glands

    PubMed Central

    Bighetti, Bruna B; Assis, Gerson F d; Vieira, Danilo C; Violato, Natalia M; Cestari, Tania M; Taga, Rumio; Bosqueiro, José R; Rafacho, Alex

    2014-01-01

    Glucocorticoids (GCs) induce insulin resistance (IR), a condition known to alter oral homeostasis. This study investigated the effects of long-term dexamethasone administration on morphofunctional aspects of salivary glands. Male Wistar rats received daily injections of dexamethasone [0.1 mg/kg body weight (b.w.), intraperitoneally] for 10 days (DEX), whereas control rats received saline. Subsequently, glycaemia, insulinaemia, insulin secretion and salivary flow were analysed. The parotid and submandibular glands were collected for histomorphometric evaluation and Western blot experiments. The DEX rats were found to be normoglycaemic, hyperinsulinaemic, insulin resistant and glucose intolerant (P < 0.05). DEX rat islets secreted more insulin in response to glucose (P < 0.05). DEX rats had significant reductions in the masses of the parotid (29%) and submandibular (16%) glands (P < 0.05) that was associated with reduced salivary flux rate. The hypotrophy in both glands observed in the DEX group was associated with marked reduction in the volume of the acinar cells in these glands of 50% and 26% respectively (P < 0.05). The total number of acinar cells was increased in the submandibular glands of the DEX rats (P < 0.05) but not in the parotid glands. The levels of proteins related to insulin and survival signalling in both glands did not differ between the groups. In conclusion, the long-term administration of dexamethasone caused IR, which was associated with significant reductions in both mass and flux rate of the salivary glands. The parotid and submandibular glands exhibited reduced acinar cell volume; however, the submandibular glands displayed acinar hyperplasia, indicating a gland-specific response to GCs. Our data emphasize that GC-based therapies and insulin-resistant states have a negative impact on salivary gland homeostasis. PMID:25186305

  4. Effect of selenium supplementation for protection of salivary glands from iodine-131 radiation damage in patients with differentiated thyroid cancer.

    PubMed

    Son, Haiyoung; Lee, Sang Mi; Yoon, Ra Gyoung; Lee, Hakmin; Lee, Ilkyun; Kim, Soon; Chung, Woong Youn; Lee, Jeong Won

    2017-01-01

    In the current study, we examined whether selenium supplementation during iodine-131 ((131)I) treatment had a radio-protective effect on salivary glands. Sixteen patients with differentiated thyroid cancer were prospectively enrolled in the study. Patients after total thyroidectomy, before (131)I treatment, were divided into two groups; 8 patients in the selenium group and 8 patients in the control group. Patients in the selenium group received 300νg of selenium orally for 10 days, from 3 days before to 6 days after (131)I treatment. The control group received a placebo over the same period. To assess salivary gland function, salivary gland scintigraphy was performed before and 6 months after (131)I treatment. Serum amylase and whole blood selenium levels were measured before and 2 days and 6 months after (131)I treatment. Using salivary gland scintigraphy, maximum uptake ratio (MUR), maximum secretion percentage (MSP), and ejection fraction (EF) of each salivary gland were calculated. Baseline clinical characteristics, baseline amylase and selenium levels, and parameters of baseline salivary gland scintigraphy were not significantly different between selenium and control groups (P>0.05). On a blood test performed 2 days after (131)I treatment, the selenium group showed a significantly higher whole blood selenium level (P=0.008) and significantly lower serum amylase level (P=0.009) than the control group. On follow-up salivary gland scintigraphy, the control group showed significantly decreased, MUR of the bilateral parotid and left submandibular glands, MSP of the bilateral parotid and submandibular glands, and EF of the left submandibular glands (P<0.05), while the selenium group only had a significant decrease in MSP of the right submandibular gland and EF of the left submandibular gland (P<0.05). Selenium supplementation during (131)I treatment was effective to reduce salivary glands damage by (131)I radiation in patients with differentiated thyroid cancer.

  5. Microwave thermolysis of sweat glands.

    PubMed

    Johnson, Jessi E; O'Shaughnessy, Kathryn F; Kim, Steve

    2012-01-01

    Hyperhidrosis is a condition that affects a large percentage of the population and has a significant impact on peoples' lives. This report presents a technical overview of a new noninvasive, microwave-based device for creating thermolysis of sweat glands. The fundamental principles of operation of the device are presented, as well as the design and optimization of the device to target the region where the sweat glands reside. An applicator was designed that consists of an array of four waveguide antennas, a cooling system, and a vacuum acquisition system. Initially, the performance of the antenna array was optimized via computer simulation such that microwave absorption was maximized near the dermal/hypodermal interface. Subsequently, hardware was implemented and utilized in pre-clinical testing on a porcine model to optimize the thermal performance and analyze the ability of the system to create thermally affected zones of varying size yet centered on the target region. Computer simulation results demonstrated absorption profiles at a frequency of 5.8 GHz that had low amounts of absorption at the epidermis and maximal absorption at the dermal/hypodermal interface. The targeted zone was shown to be largely independent of skin thickness. Gross pathological and histological response from pre-clinical testing demonstrated the ability to generate thermally affected zones in the desired target region while providing protection to the upper skin layers. The results demonstrate that microwave technology is well suited for targeting sweat glands while allowing for protection of both the upper skin layers and the structures beneath the subcutaneous fat. Promising initial results from simulation and pre-clinical testing demonstrate the potential of the device as a noninvasive solution for sweat gland thermolysis. Copyright © 2011 Wiley Periodicals, Inc.

  6. Protein and Peptide Composition of Male Accessory Glands of Apis mellifera Drones Investigated by Mass Spectrometry.

    PubMed

    Gorshkov, Vladimir; Blenau, Wolfgang; Koeniger, Gudrun; Römpp, Andreas; Vilcinskas, Andreas; Spengler, Bernhard

    2015-01-01

    In honeybees, reproductive females usually mate early in their life with more than 10 males in free flight, often within 10 minutes, and then store male gametes for up to five years. Because of the extreme polyandry and mating in free flight special adaptations in males are most likely. We present here the results of an investigation of the protein content of four types of male reproductive glands from the Western honeybee (Apis mellifera) drone, namely seminal vesicles (secretion in ejaculate), as well as bulbus, cornua and mucus glands (secretions for the mating plug). Using high resolution and accuracy mass spectrometry and a combination of database searching and de novo sequencing techniques it was possible to identify 50 different proteins in total, inside all mentioned glands, except in the mucus gland. Most of the proteins are unique for a specific gland type, only one of them (H9KEY1/ATP synthase subunit O) was found in three glands, and 7 proteins were found in two types of glands. The identified proteins represent a wide variety of biological functions and can be assigned to several physiological classes, such as protection, energy generation, maintaining optimal conditions, associated mainly with vesicula seminalis; signaling, cuticle proteins, icarpin and apolipoproteins located mainly in the bulbus and cornua glands; and some other classes. Most of the discovered proteins were not found earlier during investigation of semen, seminal fluid and tissue of reproductive glands of the bee drone. Moreover, we provide here the origin of each protein. Thus, the presented data might shed light on the role of each reproductive gland.

  7. Protein and Peptide Composition of Male Accessory Glands of Apis mellifera Drones Investigated by Mass Spectrometry

    PubMed Central

    Gorshkov, Vladimir; Blenau, Wolfgang; Koeniger, Gudrun; Römpp, Andreas; Vilcinskas, Andreas; Spengler, Bernhard

    2015-01-01

    In honeybees, reproductive females usually mate early in their life with more than 10 males in free flight, often within 10 minutes, and then store male gametes for up to five years. Because of the extreme polyandry and mating in free flight special adaptations in males are most likely. We present here the results of an investigation of the protein content of four types of male reproductive glands from the Western honeybee (Apis mellifera) drone, namely seminal vesicles (secretion in ejaculate), as well as bulbus, cornua and mucus glands (secretions for the mating plug). Using high resolution and accuracy mass spectrometry and a combination of database searching and de novo sequencing techniques it was possible to identify 50 different proteins in total, inside all mentioned glands, except in the mucus gland. Most of the proteins are unique for a specific gland type, only one of them (H9KEY1/ATP synthase subunit O) was found in three glands, and 7 proteins were found in two types of glands. The identified proteins represent a wide variety of biological functions and can be assigned to several physiological classes, such as protection, energy generation, maintaining optimal conditions, associated mainly with vesicula seminalis; signaling, cuticle proteins, icarpin and apolipoproteins located mainly in the bulbus and cornua glands; and some other classes. Most of the discovered proteins were not found earlier during investigation of semen, seminal fluid and tissue of reproductive glands of the bee drone. Moreover, we provide here the origin of each protein. Thus, the presented data might shed light on the role of each reproductive gland. PMID:25955586

  8. Mixtures of environmentally relevant endocrine disrupting chemicals affect mammary gland development in female and male rats.

    PubMed

    Mandrup, Karen Riiber; Johansson, Hanna Katarina Lilith; Boberg, Julie; Pedersen, Anne Stilling; Mortensen, Mette Sidsel; Jørgensen, Jennifer Solgaard; Vinggaard, Anne Marie; Hass, Ulla

    2015-07-01

    Estrogenic chemicals are able to alter mammary gland development in female rodents, but little is known on the effects of anti-androgens and mixtures of endocrine disrupting chemicals (EDCs) with dissimilar modes of action. Pregnant rat dams were exposed during gestation and lactation to mixtures of environmentally relevant EDCs with estrogenic, anti-androgenic or dissimilar modes of action (TotalMix) of 100-, 200- or 450-fold high end human intake estimates. Mammary glands of prepubertal and adult female and male offspring were examined. Oestrogens increased mammary outgrowth in prepubertal females and the mRNA level of matrix metalloproteinase-3, which may be a potential biomarker for increased outgrowth. Mixtures of EDCs gave rise to ductal hyperplasia in adult males. Adult female mammary glands of the TotalMix group showed morphological changes possibly reflecting increased prolactin levels. In conclusion both estrogenic and anti-androgenic chemicals given during foetal life and lactation affected mammary glands in the offspring.

  9. [Generation of transgenic mice expressing human lysozyme in mammary gland].

    PubMed

    Yan, Hua; Li, Guo-cai; Sun, Huai-chang

    2005-10-01

    To evaluate the feasibility of generating animal mammary gland bioreactors expressing human lysozyme (hLYZ). The recombinant vector p205C3-hLYZ, as a result of connecting the hLYZ cDNA with the mammry gland expression vector p205C3, was used to generate transfer genic mice by microinjection. A total of 136 F0 mice were obtained, of which 7 (2 females and 5 males) and 4 (1 females and 3 males) were found to contain the transfer-gene by PCR and Southern blotting respectively. The results of Western blotting indicated that the expressed protein had the same molecular weight as that of normal hLYZ. From the F1 generation on, the mice mated only with their brothers or sisters and a colony of F7 transgenic mice was obtained. Among the offspring, the female transgenic mice maintained and expressed the transfer-gene stably with an expression level as high as 750 mg/L. The expressed protein had strong tissue specificity, and in addition to the mammary glands, some degree of ectropic expression in the spleens and intestines of the transgenic mice was confirmed by dot blotting assay. These data indicate that the mice mammary gland bioreactors expressing hLYZ have been successfully generated.

  10. Thyroid gland function in ovariectomized ewes exposed to phytoestrogens.

    PubMed

    Madej, Andrzej; Persson, Elisabeth; Lundh, Torbjörn; Ridderstråle, Yvonne

    2002-09-25

    Phytoestrogens are by definition plant-derived substances that are able to activate the mammalian oestrogen receptors. We examined the possible effects of phytoestrogens on the secretion of thyroid hormones as well as on the immunoreactivity to oestrogen receptor alpha (ER alpha) in the thyroid glands of ovariectomized ewes. Eight ovariectomized ewes were fed 3.5 kg of 100% red clover silage for 14 days. Blood samples were collected before and on day 14 of exposure to phytoestrogens. After 5 months, four of the ewes were re-exposed to red clover silage as described above and the other four served as controls. Blood samples were collected as above. All ewes were slaughtered at the end of the experiment and the thyroid glands were weighed and examined for macroscopical changes. Tissue samples were taken for immunohistochemistry and image analysis. Ewes exposed to red clover silage had significantly higher plasma concentrations of total T(3) and free T(3) than ewes fed hay. The cross-section area of thyroid follicles tended to be larger in ewes fed red clover silage than in the control animals. ER alpha immunoreactivity was stronger in thyroid glands from ewes exposed to phytoestrogens than in ewes fed hay. In conclusion, daily ingestion of 81-95 mg phytoestrogens per kg body weight for 14 days stimulated secretion of thyroid hormones and tended to increase follicle size and ER alpha immunoreactivity of thyroid glands of ovariectomized ewes.

  11. Surface characteristics of isopod digestive gland epithelium studied by SEM.

    PubMed

    Millaku, Agron; Leser, Vladka; Drobne, Damjana; Godec, Matjaz; Torkar, Matjaz; Jenko, Monika; Milani, Marziale; Tatti, Francesco

    2010-05-01

    The structure of the digestive gland epithelium of a terrestrial isopod Porcellio scaber has been investigated by conventional scanning electron microscopy (SEM), focused ion beam-scanning electron microscopy (FIB/SEM), and light microscopy in order to provide evidence on morphology of the gland epithelial surface in animals from a stock culture. We investigated the shape of cells, extrusion of lipid droplets, shape and distribution of microvilli, and the presence of bacteria on the cell surface. A total of 22 animals were investigated and we found some variability in the appearance of the gland epithelial surface. Seventeen of the animals had dome-shaped digestive gland "normal" epithelial cells, which were densely and homogeneously covered by microvilli and varying proportions of which extruded lipid droplets. On the surface of microvilli we routinely observed sparsely distributed bacteria of different shapes. Five of the 22 animals had "abnormal" epithelial cells with a significantly altered shape. In three of these animals, the cells were much smaller, partly or completely flat or sometimes pyramid-like. A thick layer of bacteria was detected on the microvillous border, and in places, the shape and size of microvilli were altered. In two animals, hypertrophic cells containing large vacuoles were observed indicating a characteristic intracellular infection. The potential of SEM in morphological investigations of epithelial surfaces is discussed.

  12. [Intraductal meibomian gland probing for the treatment of blepharitis].

    PubMed

    Fermon, S; Zaga, I Hindi; Alvarez Melloni, D

    2015-02-01

    To describe the results of the meibomian gland probing as a treatment of severe posterior blepharitis. Prospective, longitudinal study of patients with signs and symptoms of severe posterior blepharitis, who were treated with meibomian gland probing in Centro Oftalmológico Interlomas (CENOFI). A total of 16 patients were included, 62.5% female and 32.5% male, diagnosed with severe posterior blepharitis. Treatment was performed in one eye. The time of rupture of the tear film was evaluated, using a subjective scale of 0-10 photophobia, the improvement in pain and visual acuity was measured before the procedure, and at one week and 6 months after. All the patients showed a statistically significant improvement in all 4 variables al 6 months. There were no complications. The dysfunction of the meibomian glands is a common reason for ophthalmology consulting. The study describes the results obtained by performing an intraductal survey, which was shown to be safe and effective in 100% of the sample. It can be concluded from this study that meibomian gland probing is an effective and promising treatment for blepharitis resistant to conservative treatment. Copyright © 2013 Sociedad Española de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.

  13. Acute urinary morbidity following I-125 interstitial implantation of the prostate gland.

    PubMed

    Desai, J; Stock, R G; Stone, N N; Iannuzzi, C; DeWyngaert, J K

    1998-01-01

    The objective of this paper was to evaluate the acute urinary morbidity associated with I-125 interstitial implantation of the prostate gland. From 1991-1995, 117 patients underwent ultrasound (U/S)-guided implantation of the prostate gland. Median dose to 90% of the gland (d90) was 14.68 Gy (range = 1.65-21.75 Gy). The patients' urinary symptoms were recorded pre-implantation and at regular intervals after implantation using the International Prostate Symptom Score (IPSS), a self-assessment questionnaire in which patients scored 7 symptoms: incomplete emptying, frequency, intermittency, urgency, weak stream, straining, and nocturia. Median follow-up was 12 months. The natural history of implant-related urinary symptoms was assessed in this manner. In addition, dosimetric factors including U/S prostate volume, total activity, activity per seed, dose volume histogram (DVH) values for dose to gland, and dose area histogram (DAH) values for dose to urethra and bladder were examined for correlation to the severity of each symptom as well as to total IPSS (sum of the individual symptom scores). Total IPSS peaked at 1 month post-implant and gradually returned to approximately baseline at 24 months. Total IPSS directly correlated with total activity and DVH for the prostate. Total IPSS, however, did not correlate with bladder or urethral DAH. With the exception of frequency, individual symptoms did not correlate with dose to gland, bladder, or urethra. Frequency scores did, however, correlate not only with dose to prostate gland but also dose to urethra. The acute urinary side effects of I-125 prostate implantation are transient and peak at 1 month post-implant. The severity of the urinary irritative symptoms developed are closely related to total dose to the gland. Urethral dose appears to affect frequency most significantly. Urinary symptoms, therefore, may be a limiting factor when considering dose escalation with I-125.

  14. Viruses and Salivary Gland Disease (SGD)

    PubMed Central

    Jeffers, L.; Webster-Cyriaque, J.Y.

    2011-01-01

    Viral infections are often associated with salivary gland pathology. Here we review the pathogenesis of HIV-associated salivary gland disease (HIV-SGD), a hallmark of diffuse infiltrative lymphocytosis syndrome. We investigate the presence and contributions of viral diseases to the pathogenesis of salivary gland diseases, particularly HIV-SGD. We have detected BK viral shedding in the saliva of HIV-SGD patients consistent with viral infection and replication, suggesting a role for oral transmission. For further investigation of BKV pathogenesis in salivary glands, an in vitro model of BKV infection is described. Submandibular (HSG) and parotid (HSY) gland salivary cell lines were capable of permissive BKV infection, as determined by BKV gene expression and replication. Analysis of these data collectively suggests the potential for a BKV oral route of transmission and salivary gland pathogenesis within HIV-SGD. PMID:21441486

  15. Simulation of flow in the silk gland.

    PubMed

    Breslauer, David N; Lee, Luke P; Muller, Susan J

    2009-01-12

    Spiders and silkworms employ the complex flow of highly concentrated silk solution as part of silk fiber spinning. To understand the role of fluidic forces in this process, the flow of silk solution in the spider major ampullate and silkworm silk glands was investigated using numerical simulation. Our simulations demonstrate significant differences between flow in the spider and silkworm silk glands. In particular, shear flow effects are shown to be much greater in the spider than the silkworm, the silkworm gland exhibits a much different flow extension profile than the spider gland, and the residence time within the spider gland is eight times greater than in the silkworm gland. Lastly, simulations on the effect of spinning speed on the flow of silk solution suggest that a critical extension rate is the initiating factor for fiber formation from silk solution. These results provide new insight into silk spinning processes and will guide the future development of novel fiber spinning technologies.

  16. [Unknown hepatoid glands of some species of cats and deer].

    PubMed

    Shabadash, S A; Zelikina, T I

    2003-01-01

    Our histological description of the fourth type of mammalian skin glands--hepatiod glands--allowed us to revise the obtained and published data mistaking the alveolar glands of the anal sacs in cats and the limb glands in deers as sebaceous. Large clusters of hepatiod glands were discovered in the anal sacs of the cat, lynx, and tiger, interdigital gland of elk, and the tarsal gland of reindeer. These glands secrete considerable amounts of protein to the clearance of the intercellular canaliculi and contain hydrophobic lipids. The available data substantiate revision of the data on the structure of many skin glandular organs with atypical sebaceous glands.

  17. The parathyroid gland in health and disease.

    PubMed Central

    Ghandur-Mnaymneh, L.; Cassady, J.; Hajianpour, M. A.; Paz, J.; Reiss, E.

    1986-01-01

    The authors studied the parathyroid glands from 100 previously healthy subjects who died suddenly and were admitted to the Dade County Medical Examiner's (ME) morgue and from 66 inpatients who died at Jackson Memorial Hospital (JMH). Parathyroid glands in patients with diseases (JMH series) were heavier than those in healthy persons (ME series), and both groups of glands were significantly heavier than those previously reported. Mean glandular weight in white subjects was 42.6 +/- 20.3 mg, with a range of 22-103 mg. The 95% upper limit of gland weight for healthy white subjects was 73.1 mg and for black subjects, 91.6 mg. The size and weight exhibited a skewed distribution. Gland weight varied with age, increasing to a maximum in the 41-60 year old age group in all subsets except white women, in whom it continued to increase till after age 70. There was slight correlation (r2 = 0.15) of gland weight with body weight within series and race groups; parenchymal content of the glands was not constant but correlated positively with glandular weight. Glands from both series had a comparable fat content. Fat was unevenly distributed throughout the gland, and its amount was highly variable, ranging between 0 and 90%, with a mean of 26% for white subjects and 24% for black subjects in both series. Therefore, percentage fat may not be used as an index of hyperplasia. Healthy back subjects had heavier glands than healthy white subjects, unaccounted for by differences in body weights; this difference was not statistically significant in subjects with disease. Within the black race, glands were not significantly heavier in disease than in health, and in the few cases with serum calcium determinations, the gland weight did not vary inversely with serum calcium levels as in white subjects, suggesting a basic difference in parathyroid calcium metabolism between the two races. PMID:3789088

  18. Thyroid Gland Hematoma After Blunt Neck Trauma

    PubMed Central

    Saylam, Baris; Çomçali, Bülent; Ozer, Mehmet Vasfi; Coskun, Faruk

    2009-01-01

    Hemorrhage of a previously normal thyroid gland as a result of blunt trauma is a very rare condition. We report a case of blunt trauma that caused acute hemorrhage into the thyroid gland and presented with hoarseness. The diagnosis of thyroid gland hematoma was made with a combination of fiberoptic laryngoscopy, cervical computed tomography, and carotid angiography. The patient was treated conservatively, had a favorable course without further complications, and was discharged four days after admission. PMID:20046242

  19. Sexual dimorphism involving steroidal pheromones and their binding protein in the submaxillary salivary gland of the Göttingen miniature pig.

    PubMed

    Booth, W D

    1984-02-01

    Submaxillary glands of mature Göttingen miniature pigs were examined for the presence of a sexual dimorphism. Gland weights, serous cell hypertrophy and total protein in the glands were much greater in male than female pigs. High concentrations of the pheromonal 16-androstene steroids were present in the glands of males and exceeded 2 mmol/g in some animals; this was primarily due to 5 alpha-androst-16-en-3 alpha-ol. The high concentration of 16-androstene steroids in boar glands was correlated with the presence of large amounts of binding protein for these steroids in the glands; smaller amounts of the binding protein were detected in female glands. These findings are similar to those found in domestic pigs, but the degree of sexual dimorphism assessed from these findings is more extreme in the miniature pig.

  20. Cell biology of the harderian gland.

    PubMed

    Chieffi, G; Baccari, G C; Di Matteo, L; d'Istria, M; Minucci, S; Varriale, B

    1996-01-01

    The harderian gland is an orbital gland of the majority of land vertebrates. It is the only orbital gland in anuran amphibians since the lacrimal gland develops later during phylogenesis in some reptilian species. Perhaps because it is not found in man, little interest was paid to this gland until about four decades ago. In recent years, however, the scientific community has shown new interest in analyzing the ontogenetic and morphofunctional aspects of the harderian gland, particularly in rodents, which are the preferred experimental model for physiologists and pathologists. One of the main characteristics of the gland is the extreme variety not only in its morphology, but also in its biochemical properties. This most likely reflects the versatility of functions related to different adaptations of the species considered. The complexity of the harderian gland is further shown in its control by many exogenous and endogenous factors, which vary from species to species. The information gained so far points to the following functions for the gland: (1) lubrication of the eye and nictitating membrane, (2) a site of immune response, particularly in birds, (3) a source of pheromones, (4) a source of saliva in some chelonians, (5) osmoregulation in some reptiles, (6) photoreception in rodents, (7) thermoregulation in some rodents, and (8) a source of growth factors.

  1. Distribution of calcification within the pineal gland.

    PubMed

    Pilling, J R; Hawkins, T D

    1977-11-01

    The distribution of calcification in the normal pineal gland was investigated by a macroradiographic in vitro technique. The centre of calcification in 72 out of 73 glands studied was within 2 mm of the mid-line of the gland. In one gland it lay 2.6 mm from the mid-line. These findings explain the accepted normal limits for pineal calcification on the standard semi-axial projection of the skull of up to 2 mm to either side of the mid-line and the occasional measurement in excess of this in normal subjects.

  2. Salivary Gland Development: A Template for Regeneration

    PubMed Central

    Patel, Vaishali N.; Hoffman, Matthew P.

    2014-01-01

    The mammalian salivary gland develops as a highly branched structure designed to produce and secrete saliva. This review will focus on research on mouse submandibular gland development and the translation of this basic research towards therapy for patients suffering from salivary hypofunction. Here we review the most recent literature that has enabled a better understanding of the mechanisms of salivary gland development. Additionally, we discuss approaches proposed to restore salivary function using gene and cell-based therapy. Increasing our understanding of the developmental mechanisms involved during development is critical to design effective therapies for regeneration and repair of damaged glands. PMID:24333774

  3. Parotitis and Sialendoscopy of the Parotid Gland.

    PubMed

    Hernandez, Stephen; Busso, Carlos; Walvekar, Rohan R

    2016-04-01

    Nonneoplastic disorders of the salivary glands involve inflammatory processes. These disorders have been managed conservatively with antibiotics, warm compresses, massage, sialogogues, and adequate hydration. Up to 40% of patients may have an inadequate response or persistent symptoms. When conservative techniques fail, the next step is operative intervention. Sialendoscopy offers a minimally invasive option for the diagnosis and management of chronic inflammatory disorders of the salivary glands and offers the option of gland and function preservation. In this article, we review some of the more common nonneoplastic disorders of the parotid gland, indications for diagnostic and interventional sialendoscopy, and operative techniques.

  4. [Development of the human adrenal glands].

    PubMed

    Folligan, K; Bouvier, R; Targe, F; Morel, Y; Trouillas, J

    2005-09-01

    The human adrenal is an endocrine gland located at the superior part of the kidney. Composed of the adrenal cortex of mesoblastic origin and the adrenal medulla of neuroectoblastic origin, the human fetal adrenal grows considerably during the first three months of development. From 12 to 18 weeks of development (WD), the weight of the adrenals increases seven-fold. The gland's weight doubles from 18 to 28 WD and from 28 to 36 WD. At birth, the two adrenals weigh on average 10 g. At the 8th week, two zones are individualized in the adrenal cortex: the definitive zone and the fetal inner zone. At the second trimester, according to ultrastructural and biochemical studies, a third zone, called the transition zone, is individualized between the definitive zone and the fetal inner zone. The definitive zone persists, but the origin of the three zones (glomerular, fascicular and reticular) of adult adrenal cortex is not known. The fetal inner zone regresses from the 5th month of gestation and disappears totally one year after birth. At the 8th week, the immature neuroblasts migrate to the definitive zone, then to the fetal inner zone to compose the adrenal medulla, which develops essentially after birth and during the first year. Before the 10th week, the human fetal adrenal is able to produce steroid hormones, in particular dehydroepiandrosterone sulfate (DHEA-S); the secretion of cortisol remains discussed. The development of the human fetal adrenal is complex and is under the control of hormones (ACTH, LH and betaHCG), growth factors (ACTH essentially) and transcription factors (essentially SF1 and DAX-1). Knowledge of morphological and molecular phenomena of this development permits to understand the pathophisiology of congenital adrenal deficiencies.

  5. Overexpression of DCLK1 is predictive for recurrent disease in major salivary gland malignancies.

    PubMed

    Kadletz, Lorenz; Aumayr, Klaus; Heiduschka, Gregor; Schneider, Sven; Enzenhofer, Elisabeth; Lill, Claudia

    2017-01-01

    Salivary gland carcinomas are a rare malignancy. Therefore, little is known about biomarkers and cancer stem cells in salivary gland malignancies. Double cortin-like kinase 1 (DCLK1) is a promising therapeutic target and cancer stem cell marker, predominantly investigated in pancreatic and colorectal cancer. The purpose of this study was to investigate the expression of DCLK1 in major and minor salivary gland carcinomas and its influence on survival. We examined a total of 80 patients with major or minor salivary gland cancer in this retrospective study. Immunohistochemistry with anti-DCLK1 antibody was applied to assess the expression of DCLK1. Moreover, we evaluated the impact of DCLK1 on overall and disease-free survival. DCLK1 expression could be detected in 66.3 % of all examined cases. Overexpression of DCLK1 was associated with reduced overall and disease-free survival in patients with major salivary gland cancer. Disease-free survival reached statistical significance (p = 0.0107). However, expression of DCLK1 had no influence on survival in patients with minor salivary gland cancer. Since treatment of recurrent disease in oncologic patients is utterly challenging, DCLK1 may be a promising prognostic biomarker that helps to identify patients with a high risk for recurrence of major salivary gland carcinoma.

  6. [Estimation of the Average Glandular Dose Using the Mammary Gland Image Analysis in Mammography].

    PubMed

    Otsuka, Tomoko; Teramoto, Atsushi; Asada, Yasuki; Suzuki, Shoichi; Fujita, Hiroshi; Kamiya, Satoru; Anno, Hirofumi

    2016-05-01

    Currently, the glandular dose is evaluated quantitatively on the basis of the measured data using phantom, and not in a dose based on the mammary gland structure of an individual patient. However, mammary gland structures of the patients are different from each other and mammary gland dose of an individual patient cannot be obtained by the existing methods. In this study, we present an automated estimation method of mammary gland dose by means of mammary structure which is measured automatically using mammogram. In this method, mammary gland structure is extracted by Gabor filter; mammary region is segmented by the automated thresholding. For the evaluation, mammograms of 100 patients diagnosed with category 1 were collected. Using these mammograms we compared the mammary gland ratio measured by proposed method and visual evaluation. As a result, 78% of the total cases were matched. Furthermore, the mammary gland ratio and average glandular dose among the patients with same breast thickness was matched well. These results show that the proposed method may be useful for the estimation of average glandular dose for the individual patients.

  7. Unraveling dual feeding associated molecular complexity of salivary glands in the mosquito Anopheles culicifacies

    PubMed Central

    Sharma, Punita; Sharma, Swati; Mishra, Ashwani Kumar; Thomas, Tina; Das De, Tanwee; Rohilla, Suman Lata; Singh, Namita; Pandey, Kailash C.; Valecha, Neena; Dixit, Rajnikant

    2015-01-01

    ABSTRACT Mosquito salivary glands are well known to facilitate meal acquisition, however the fundamental question on how adult female salivary gland manages molecular responses during sugar versus blood meal uptake remains unanswered. To investigate these responses, we analyzed a total of 58.5 million raw reads generated from two independent RNAseq libraries of the salivary glands collected from 3–4 day-old sugar and blood fed Anopheles culicifacies mosquitoes. Comprehensive functional annotation analysis of 10,931 contigs unraveled that salivary glands may encode diverse nature of proteins in response to distinct physiological feeding status. Digital gene expression analysis and PCR validation indicated that first blood meal significantly alters the molecular architecture of the salivary glands. Comparative microscopic analysis also revealed that first blood meal uptake not only causes an alteration of at least 12–22% of morphological features of the salivary glands but also results in cellular changes e.g. apoptosis, confirming together that adult female salivary glands are specialized organs to manage meal specific responses. Unraveling the underlying mechanism of mosquito salivary gene expression, controlling dual feeding associated responses may provide a new opportunity to control vector borne diseases. PMID:26163527

  8. Adrenal glands in hypovolemic shock: preservation of contrast enhancement at dynamic computed tomography.

    PubMed

    Ito, Katsuyoshi; Higashi, Hiroki; Kanki, Akihiko; Tamada, Tsutomu; Yamashita, Takenori; Yamamoto, Akira; Watanabe, Shigeru

    2010-07-01

    To evaluate contrast enhancement effects of the adrenal glands at dynamic computed tomography (CT) in adult severe trauma patients with hypovolemic shock in comparison with patients without hypovolemic shock. This study population included a total of 74 patients with (n = 24) and without (n = 50) blunt trauma and hypovolemic shock. Measurement of CT attenuation values of the adrenal gland and calculation of the enhancement washout percentages were performed. The mean +/- SD CT attenuation values of the adrenal glands in the arterial phase of dynamic CT in patients with hypovolemic shock (137.3 +/- 41.7 Hounsfield unit [HU]) were not significantly different (P = 0.16) from those in control subjects (127.3 +/- 19.6 HU). The mean CT attenuation values of the adrenal glands in the delayed phase of dynamic CT in patients with hypovolemic shock (82.0 +/- 14.7 HU) were also not significantly different (P = 0.89) from those in control subjects (82.4 +/- 10.0 HU). The mean percentage (35%) of enhancement washout of the adrenal glands in patients with hypovolemic shock was not significantly different (P = 0.81) from that (34%) in control subjects. Contrast enhancement effects of the adrenal glands at contrast-enhanced dynamic CT in patients with hypovolemic shock were similar to those in control subjects, indicating the preserved enhancement and perfusion of the adrenal gland rather than intense and persistent enhancement in patients with hypovolemic shock.

  9. The function of very long chain polyunsaturated fatty acids in the pineal gland.

    PubMed

    Catalá, Angel

    2010-02-01

    The mammalian pineal gland is a prominent secretory organ with a high metabolic activity. Melatonin (N-acetyl-5-methoxytryptamine), the main secretory product of the pineal gland, efficiently scavenges both the hydroxyl and peroxyl radicals counteracting lipid peroxidation in biological membranes. Approximately 25% of the total fatty acids present in the rat pineal lipids are represented by arachidonic acid (20:4n-6) and docosahexaenoic acid (22:6n-3). These very long chain polyunsaturated fatty acids play important roles in the pineal gland. In addition to the production of melatonin, the mammalian pineal gland is able of convert these polyunsaturated fatty acids into bioactive lipid mediators. Lipoxygenation is the principal lipoxygenase (LOX) activity observed in the rat pineal gland. Lipoxygenation in the pineal gland is exceptional because no other brain regions express significant LOX activities under normal physiological conditions. The rat pineal gland expresses both 12- and 15-lipoxygenase (LOX) activities, producing 12- and 15-hydroperoxyeicosatetraenoic acid (12- and 15-HpETE) from arachidonic acid and 14- and 17-hydroxydocosahexaenoic acid (14- and 17-HdoHE) from docosahexaenoic acid, respectively. The rat pineal also produces hepoxilins via LOX pathways. The hepoxilins are bioactive epoxy-hydroxy products of the arachidonic acid metabolism via the 12S-lipoxygenase (12S-LOX) pathway. The two key pineal biochemical functions, lipoxygenation and melatonin synthesis, may be synergistically regulated by the status of n-3 essential fatty acids.

  10. Unraveling dual feeding associated molecular complexity of salivary glands in the mosquito Anopheles culicifacies.

    PubMed

    Sharma, Punita; Sharma, Swati; Mishra, Ashwani Kumar; Thomas, Tina; Das De, Tanwee; Rohilla, Suman Lata; Singh, Namita; Pandey, Kailash C; Valecha, Neena; Dixit, Rajnikant

    2015-07-10

    Mosquito salivary glands are well known to facilitate meal acquisition, however the fundamental question on how adult female salivary gland manages molecular responses during sugar versus blood meal uptake remains unanswered. To investigate these responses, we analyzed a total of 58.5 million raw reads generated from two independent RNAseq libraries of the salivary glands collected from 3-4 day-old sugar and blood fed Anopheles culicifacies mosquitoes. Comprehensive functional annotation analysis of 10,931 contigs unraveled that salivary glands may encode diverse nature of proteins in response to distinct physiological feeding status. Digital gene expression analysis and PCR validation indicated that first blood meal significantly alters the molecular architecture of the salivary glands. Comparative microscopic analysis also revealed that first blood meal uptake not only causes an alteration of at least 12-22% of morphological features of the salivary glands but also results in cellular changes e.g. apoptosis, confirming together that adult female salivary glands are specialized organs to manage meal specific responses. Unraveling the underlying mechanism of mosquito salivary gene expression, controlling dual feeding associated responses may provide a new opportunity to control vector borne diseases. © 2015. Published by The Company of Biologists Ltd.

  11. Proteomic analysis in the Dufour’s gland of Africanized Apis mellifera workers (Hymenoptera: Apidae)

    PubMed Central

    2017-01-01

    The colony of eusocial bee Apis mellifera has a reproductive queen and sterile workers performing tasks such as brood care and foraging. Chemical communication plays a crucial role in the maintenance of sociability in bees with many compounds released by the exocrine glands. The Dufour’s gland is a non-paired gland associated with the sting apparatus with important functions in the communication between members of the colony, releasing volatile chemicals that influence workers roles and tasks. However, the protein content in this gland is not well studied. This study identified differentially expressed proteins in the Dufour’s glands of nurse and forager workers of A. mellifera through 2D-gel electrophoresis and mass spectrometry. A total of 131 spots showed different expression between nurse and forager bees, and 28 proteins were identified. The identified proteins were categorized into different functions groups including protein, carbohydrate, energy and lipid metabolisms, cytoskeleton-associated proteins, detoxification, homeostasis, cell communication, constitutive and allergen. This study provides new insights of the protein content in the Dufour’s gland contributing to a more complete understanding of the biological functions of this gland in honeybees. PMID:28542566

  12. Salt-gland secretion and blood flow in the goose.

    PubMed

    Hanwell, A; Linzell, J L; Peaker, M

    1971-03-01

    1. Salt-gland blood flow in the domestic goose has been measured using a combination of Sapirstein's indicator fractionation technique for organ blood flow and Fegler's thermodilution method for cardiac output.2. Nasal salt secretion was induced by giving 0.5 M-NaCl or 0.154 M-NaCl I.V. or by giving artificial sea water by stomach tube into the proventriculus.3. During secretion, salt-gland blood flow increased from 82.7 +/- 21.9 ml./100 g tissue. min to as high as 2179 ml./100 g. min (mean 1209 +/- 140).4. The rate of secretion in response to salt loading was very variable and was not correlated with the rate of blood flow.5. From the data obtained, it could be calculated that the median values for the percentage extraction of ions from the arterial plasma were Na 15%, K 35%, Cl 21% and water 5.8%.6. Atropine abolished secretion but not the increase in blood flow produced by salt loading.7. Unilateral complete denervation abolished secretion from and the increase in blood flow through the operated but not the control gland.8. Anaesthesia, induced by pentobarbitone sodium, almost completely blocked secretion and the increase in blood flow in the salt-gland in response to salt loading.9. In geese given 0.5 or 0.154 M-NaCl I.V. a positive, significant correlation was found between the total amount of nasal secretion collected over 30 min and the concentrations of Na and Cl in the nasal fluid. However, when the time course of secretion was followed in any one bird, the rate of secretion was inversely related to the concentrations of Na and Cl.10. Harderian gland blood flow was not affected by salt loading.

  13. Estrogen prevention of lacrimal gland cell death and lymphocytic infiltration.

    PubMed

    Azzarolo, Ana Maria; Eihausen, Heather; Schechter, Joel

    2003-09-01

    Previous studies have shown that ovariectomy causes necrosis of lacrimal acinar cells, apoptosis of plasma cells and gland lymphocytic infiltration. Both, lacrimal gland cell death and lymphocytic infiltration were prevented by androgen treatment. Since estrogens are removed by ovariectomy, and the synthetic estrogen diethylstilbestrol has been shown to affect some biochemical correlates of lacrimal secretion, the purpose of this study was to determine the effect of 17-beta-estradiol treatment on ovariectomy-induced cell death and lymphocytic infiltration. Sexually mature female New Zealand white rabbits (4-4.5 kg) were ovariectomized and divided into two groups. One group was treated with 0.5 mg kg(-1) per day 17-beta-estradiol, and the other group with vehicle alone. A third group of sham operated rabbits was used as controls and they also were treated with vehicle alone. Six days after surgery, the animals were euthanized, the lacrimal glands removed and processed for analysis of apoptosis as assessed by DNA fragmentation, and for morphological examination. DNA fragmentation was determined using the TUNEL assay and agarose gel electrophoresis. Sections were also stained for rabbit thymic lymphocyte antigen (RTLA), and rabbit CD18. Labelled nuclei and stained areas were quantified by automated densitometry. Ovariectomized rabbits showed a significant increase in the values for degraded DNA as a percent of total nuclear area (2.90+/-0.40%) compared to sham operated rabbits (0.73+/-0.22%). 17-beta-estradiol treatment in ovariectomized rabbits prevented the increase in DNA degradation. Examination of TUNEL assay at higher magnification (40x) confirmed previous studies showing that ovariectomy caused apoptosis of interstitial cells. Significant numbers of bulging cells of very pale appearance under light microscopy, also confirm previously identified necrotic cells in acinar regions. Treatment with 17-beta-estradiol prevented this necrosis. Increased numbers of RTLA

  14. [MRI of the pineal gland].

    PubMed

    Langevad, Line; Madsen, Camilla Gøbel; Siebner, Hartwig; Garde, Ellen

    2014-11-10

    The pineal gland (CP) is located centrally in the brain and produces melatonin. Cysts and concrements are frequent findings on MRI but their significance is still unclear. The visualization of CP is difficult due to its location and surrounding structures and so far, no standardized method exists. New studies suggest a correlation between CP-morphology and melatonin secretion as well as a connection between melatonin, disturbed circadian rhythm, and the development of cancer and cardiovascular diseases, underlining the need for a standardized approach to CP on MRI.

  15. [Epidemiology of non-malignant salivary gland tumours based on 675 cases].

    PubMed

    Wierzbicka, Małgorzata; Kopeć, Tomasz; Szyfter, Witold; Bem, Grazyna

    2010-01-01

    Neoplasm of salivary glands constitutes about 3% of all tumours of head and neck. Within the category we can differentiate tumours of a very different histological structure. What lies behind such great differences in the changes within the salivary glands is complex embryogenesis of the glands. About 80% of all tumours of salivary glands is located in parotid gland, from 10 to 20% - in submandibular gland and several percent in sublingual and small salivary gland. This work aims at the assessment of the frequency of occurrence of non-malignant neoplasm in parotid and submandibular gland based on the material collected at the ENT Department of the Medical University in Poznan in the years 1995-2006. In the 12-year period, 778 patients in total suffered from tumours of large salivary glands. The number of non-malignant neoplasm was 675, and the number of malignant neoplasm was 103. With regard to paroid glands, 586 non-malignant tumours and 82 malignant tumours were identified, with regard to submandibular glands the numbers were respectively: 89 and 21. Main aim of this work has been achieved through the execution of partial steps: the analysis of the trends in occurrence of non-malignant neoplasm in the 12-year period, the analysis of the epidemiological differences: sex, age, place of residence - town or country, duration of symptoms, diameter of the tumour at the time the patient reported for treatment, histological structures that were carried on the basis of the comparison of data collected in the two periods of time: period I--the years 1995-2000 and period II--the years 2001-2006. The frequency of operations on non-malignant tumours of salivary glands (as compared to the total number of operations) was 4.11% in the first period and 4.18% in the second. In both periods the most frequent benign tumour was the mixed tumour (54.9% of all tumours) and constituted 60% and 54% of all tumours in the respective periods analyzed. The next most frequently occurring

  16. How Do Health Care Providers Diagnose Adrenal Gland Disorders?

    MedlinePlus

    ... Gland Disorders > About > Diagnosis Page Content ​ ​How do health care providers diagnose adrenal gland disorders? Methods for diagnosing ... Tumors To diagnose an adrenal gland tumor, a health care provider may order one or more tests. 3 ...

  17. What's New in Salivary Gland Cancer Research and Treatment?

    MedlinePlus

    ... Salivary Gland Cancer About Salivary Gland Cancer What’s New in Salivary Gland Cancer Research and Treatment? Medical ... they hope to use this information to develop new treatments that work better and cause fewer side ...

  18. Sonographic Evaluation of Fetal Adrenal Gland in Gestational Diabetes: Relation to Fetal Growth and Maternal Biochemical Markers.

    PubMed

    Garcia-Flores, Jose; Cruceyra, Mireia; Cañamares, Marina; Garicano, Ainhoa; Espada, Mercedes; Nieto, Olga; Tamarit, Ines; Sainz de la Cuesta, Ricardo

    2017-05-01

    To relate measurements and volume of the fetal adrenal gland in third trimester ultrasound in diabetic pregnancies (1) to birth weight; (2) to other sonographic markers of diabetic fetopathy (expected fetal weight, sectional area, and fractional volume in fetal limbs); and (3) to maternal biochemical markers of diabetes (HbA1c, leptin). Fetal adrenal gland measurements were obtained between 32 and 34 weeks. The gland length, width, depth, and volume (by Virtual Organ Computer-Aided Analysis [VOCAL]) were measured for total gland and fetal zone. Fetal total and fat sectional area and fractional volume were obtained in arm and thigh. A maternal blood sample was obtained. Univariate and multivariate models were used to assess the associations. Thirty-nine diabetic pregnancies were included. Birth weight related significantly to total and fetal zone adrenal depth, and total adrenal volume in third trimester. Total adrenal length and corrected adrenal gland volume also showed a significant correlation to birth weight percentile in univariate and multivariate models. Total adrenal volume associated significantly to total and fat areas and volumes in fetal limbs. Both maternal leptin and HbA1c levels found a significant positive relation to fetal total adrenal volume and corrected adrenal gland volume. Total adrenal gland volume showed a significant association to maternal HbA1c level in multivariate model. An enlargement of the fetal adrenal gland may be observed in gestational diabetes, not only related to birth weight, but also to distinctive features of diabetic pregnancies, such as fat tissue fetal deposits or maternal biochemical markers. © 2017 by the American Institute of Ultrasound in Medicine.

  19. Localization of aquaporin-5 in sweat glands and functional analysis using knockout mice

    PubMed Central

    Song, Yuanlin; Sonawane, Nitin; Verkman, A S

    2002-01-01

    Sweat secretion involves the transport of salt and water into the lumen of the secretory coil of the sweat gland. By analogy to salivary and submucosal glands, where fluid secretion is aquaporin-5 (AQP5) dependent, we postulated that aquaporin water channels might facilitate sweat secretion. Immunolocalization with specific antibodies revealed strong expression of AQP5 at the luminal membrane of secretory epithelial cells in sweat glands in mouse paw skin. Novel quantitative methods were developed to compare sweat secretion in wild-type mice and mice lacking AQP5. Total hindpaw sweat secretion was measured by proton nuclear magnetic resonance of sweat-derived 1H2O in 2H2O solvent, and sweat secretion from individual glands was measured by real-time video imaging of sweat droplet formation under oil. Sweat secretion rates after pilocarpine stimulation did not differ in wild-type mice (0.21 ± 0.03 nl min−1 gland−1) vs. mice lacking AQP5 (0.19 ± 0.04 nl min−1 gland−1). The lack of effect of AQP5 on sweat secretion rate was confirmed by microcapillary collections of sweat from defined regions of mouse paws. Also, as by direct counting of droplets, the number of functional sweat glands was not affected by AQP5 deletion. Sweat gland morphology was similar in wild-type and AQP5 null mice. From sweat coil geometry and gland secretion rate, the rate of fluid secretion was estimated to be 130 nl min−1 cm−2 of secretory epithelium, substantially lower than that of > 500 nl min−1 cm−2 in kidney proximal tubules and salivary glands, where active fluid absorption or secretion is aquaporin dependent. These results indicate the expression of AQP5 in sweat gland secretory epithelium, but provide direct evidence against its physiological involvement in sweat fluid secretion in mice. PMID:12042359

  20. Thyroid gland morphology in young adults: normal subjects versus those with prior low-dose neck irradiation in childhood

    SciTech Connect

    Hanson, G.A.; Komorowski, R.A.; Cerletty, J.M.; Wilson, S.D.

    1983-12-01

    Thyroid glands obtained at autopsy from young adults were studied to establish more accurately the ''normal'' morphology in the groups 20 to 40 years of age. A total of 56 autopsy specimens (many obtained from trauma victims) were examined in detail by totally embedding and sectioning the thyroid glands. The morphology of these thyroid glands also was compared to that of surgically removed thyroid glands from 47 young adult patients with prior low-dose neck irradiation. The ''normal'' thyroid specimens frequently showed morphologic features, such as thyroid tissue outside the recognizable capsule of the gland (40 of 56 patients) and in the strap muscles of the neck (six of 56 patients), which are conditions commonly considered as evidence for invasive thyroid carcinoma. The thyroid glands from the ''normal'' young adult population were significantly different from those thyroid glands surgically removed from patients who had received irradiation. The irradiated thyroid glands invariably showed multiple nodules of a wide variety of histologic types, extensive lymphocytic infiltrates, and distorting fibrosis as well as a high incidence of malignancy (27 of 47 patients). A single 0.1 cm focus of papillary carcinoma was found in one specimen in the nonirradiated thyroid group. This study suggests that ''occult'' thyroid carcinomas in the group 20 to 40 years of age are rare and are significantly fewer in number than in the older population (P less than 0.02).

  1. Pituitary gland imaging and outcome.

    PubMed

    Di Iorgi, Natascia; Morana, Giovanni; Gallizia, Anna Lisa; Maghnie, Mohamad

    2012-01-01

    Magnetic resonance imaging (MRI) allows a detailed and precise anatomical study of the pituitary gland by differentiating between the anterior and posterior pituitary lobes. The identification of posterior pituitary hyperintensity, now considered a marker of neurohypophyseal functional integrity, has been the most striking advance for the diagnosis and understanding of anterior and posterior pituitary diseases. The advent of MRI has in fact led to a significant improvement in the understanding of the pathogenesis of disorders that affect the hypothalamo-pituitary area. Today, there is convincing evidence to support the hypothesis that marked MRI differences in pituitary morphology indicate a diverse range of disorders which affect the organogenesis and function of the anterior pituitary gland with different prognoses. Furthermore, the association of extrapituitary malformations accurately defined by MRI has supported a better definition of several conditions linked to pituitary hormone deficiencies and midline defects. MRI is a very informative procedure that should be used to support a diagnosis of hypopituitarism. It is useful in clinical management, because it helps endocrinologists determine which patients to target for further molecular studies and genetic counselling, which ones to screen for additional hormone deficits, and which ones may need growth hormone replacement into adult life.

  2. Primitive neuroectodermal adrenal gland tumour.

    PubMed

    Tsang, Y P; Lang, Brian H H; Tam, S C; Wong, K P

    2014-10-01

    Ewing's sarcoma, also called primitive neuroectodermal tumour of the adrenal gland, is extremely rare. Only a few cases have been reported in the literature. We report on a woman with adult-onset primitive neuroectodermal tumour of the adrenal gland presenting with progressive flank pain. Computed tomography confirmed an adrenal tumour with invasion of the left diaphragm and kidney. Radical surgery was performed and the pain completely resolved; histology confirmed the presence of primitive neuroectodermal tumour, for which she was given chemotherapy. The clinical presentation of this condition is non-specific, and a definitive diagnosis is based on a combination of histology, as well as immunohistochemical and cytogenic analysis. According to the literature, these tumours demonstrate rapid growth and aggressive behaviour but there are no well-established guidelines or treatment strategies. Nevertheless, surgery remains the mainstay of local disease control; curative surgery can be performed in most patients. Adjuvant chemoirradiation has been advocated yet no consensus is available. The prognosis of patients with primitive neuroectodermal tumours remains poor.

  3. The aflatoxin-detoxifizyme specific expression in mouse parotid gland.

    PubMed

    Guan, Li-zeng; Sun, Yu-ping; Cai, Jin-shun; Wu, Han-dong; Yu, Long-zheng; Zhang, Yong-liang; Xi, Qian-yun

    2015-06-01

    The aflatoxin-detoxifizyme (ADTZ) gene derived from Armillariella tabescens was cloned into parotid gland-specific expression vector (pPSPBGPneo) to construct the parotid gland-specific vector expressing ADTZ (pPSPBGPneo-ADTZ). Transgenic mice were generated by microinjection and identified by using PCR and Southern blotting analysis. PCR and Southern blotting analysis showed that total six transgenic mice carried the ADTZ gene were generated. RT-PCR analysis indicated that the expression of ADTZ mRNA could be detected only in parotid glands of the transgenic mice. The ADTZ activity in the saliva was found to be 3.72 ± 1.64 U/mL. After feeding a diet containing aflatoxin B1 (AFB1) for 14 days, the effect of ADTZ on serum biochemical indexes and AFB1 residues in serum and liver of mice were evaluated. The results showed that total protein and globulin contents in the test treatment (transgenic mice) produced ADTZ were significantly higher than that of the positive control, while alanine aminotransferase and aspartate aminotransferase activity in serum of the test treatment (transgenic mice) were remarkably lower compared to that of the positive control (P < 0.05). Moreover, AFB1 residues in serum and liver of the test treatment (transgenic mice) were significantly lower compared with that of the positive control (P < 0.05). These results in the study confirmed that ADTZ produced in transgenic mice could reduce, even eliminate the negative effects of AFB1 on mice.

  4. Accessory parotid gland tumours: 24 years of clinical experience.

    PubMed

    Lukšić, I; Suton, P; Rogić, M; Dokuzović, S

    2012-12-01

    The accessory parotid gland (APG) is salivary tissue anterior to and anatomically separate from the parotid gland. APG is a common anatomical variation, but APG tumours are extremely rare. The authors report 6 patients with APG tumours emphasizing the diagnosis, clinical features, indications and rationales for different treatment approaches. Patients with primary tumours of the parotid gland or APG tumours who underwent surgical treatment were included. APG tumours comprised 1.23% of overall parotid tumours (6/488) and had a malignancy rate of 33.3% (2/6). There were three male and three female patients with a mean age of 39 years (range 14-70 years). 5 of 6 parotidectomies entailed superficial lobectomy, while one was a total parotidectomy with composite resection of masseter muscle. Concomitant selective lymphadenectomy was carried out in 3 of 6 patients. At 5 years disease-free survival was 83.3%. Mean follow-up was 161 months (range 14-253 months). Although nonsalivary diagnoses frequently occur in the buccal area, APG tumours should be considered in every differential diagnosis in patients presenting with a mid-cheek mass. From oncosurgical, cosmetic and functional standpoints, treatment by facelift parotidectomy or 'S-incision' with concomitant superficial lobectomy is the recommended surgical approach; high-grade malignancies require total parotidectomy with regional lymphadenectomy. Copyright © 2012 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  5. Predictors of thyroid gland involvement in hypopharyngeal squamous cell carcinoma.

    PubMed

    Chang, Jae Won; Koh, Yoon Woo; Chung, Woong Youn; Hong, Soon Won; Choi, Eun Chang

    2015-05-01

    Decision to perform concurrent ipsilateral thyroidectomy on patients with hypopharyngeal cancer is important, and unnecessary thyroidectomy should be avoided if oncologically feasible. We hypothesized that concurrent ipsilateral thyroidectomy is not routinely required to prevent occult metastasis. This study aimed to determine the prevalence of histological thyroid invasion in patients with hypopharyngeal cancer, and to refine the indications for prophylactic ipsilateral thyroidectomy in patients with hypopharyngeal cancer. A retrospective review of the medical records from the Department of Otolaryngology at Yonsei University College of Medicine was conducted from January 1994 to December 2009. A total of 49 patients underwent laryngopharyngectomy with thyroidectomy as a primary treatment of hypopharyngeal cancer. The incidence of thyroid gland involvement was 10.2%. The most common route of invasion was direct extension through the thyroid cartilage. Thyroid cartilage invasion (p=0.034) was the most significant factor associated with thyroid invasion. Disease-specific survival at 5 years was lower in patients with than without thyroid gland invasion (26.7% vs. 55.2%, respectively; p=0.032). Disease-free survival at 5 years was also lower in patients with than without thyroid gland invasion (20.0% vs. 52.1%, respectively; p=0.024). Ipsilateral thyroidectomy in combination with total laryngopharyngectomy is indicated when invasion of the thyroid cartilage is suspected in patients with hypopharyngeal cancer.

  6. Predictors of Thyroid Gland Involvement in Hypopharyngeal Squamous Cell Carcinoma

    PubMed Central

    Chang, Jae Won; Koh, Yoon Woo; Chung, Woong Youn; Hong, Soon Won

    2015-01-01

    Purpose Decision to perform concurrent ipsilateral thyroidectomy on patients with hypopharyngeal cancer is important, and unnecessary thyroidectomy should be avoided if oncologically feasible. We hypothesized that concurrent ipsilateral thyroidectomy is not routinely required to prevent occult metastasis. This study aimed to determine the prevalence of histological thyroid invasion in patients with hypopharyngeal cancer, and to refine the indications for prophylactic ipsilateral thyroidectomy in patients with hypopharyngeal cancer. Materials and Methods A retrospective review of the medical records from the Department of Otolaryngology at Yonsei University College of Medicine was conducted from January 1994 to December 2009. A total of 49 patients underwent laryngopharyngectomy with thyroidectomy as a primary treatment of hypopharyngeal cancer. Results The incidence of thyroid gland involvement was 10.2%. The most common route of invasion was direct extension through the thyroid cartilage. Thyroid cartilage invasion (p=0.034) was the most significant factor associated with thyroid invasion. Disease-specific survival at 5 years was lower in patients with than without thyroid gland invasion (26.7% vs. 55.2%, respectively; p=0.032). Disease-free survival at 5 years was also lower in patients with than without thyroid gland invasion (20.0% vs. 52.1%, respectively; p=0.024). Conclusion Ipsilateral thyroidectomy in combination with total laryngopharyngectomy is indicated when invasion of the thyroid cartilage is suspected in patients with hypopharyngeal cancer. PMID:25837190

  7. Function of parotid gland following irradiation and its relation to biological parameters

    SciTech Connect

    Sasaki, T.; Yamamoto, M.; Takeda, M.

    1980-09-01

    The function of the parotid gland in the mouse (synthesis and secretion of ..cap alpha..-amylase) following X irradiation was analyzed in relation to the parameters of surviving acinar cell fraction, DNA or protein content, and wet weight of the gland. Both synthesis and secretion of amylase in parotid were essentially unchanged when mice were irradiated with a dose of up to 3000 rad. When mice were irradiated and then given a proliferative stimulus of isoproterenol, latent lethal damage in the acinar cell population was expressed and resulted in cell degeneration in a dose-dependent manner. The mean value of amylase activity per gland in similarly treated parotids was, however, totally unaffected. The relationship between amylase activity per gland and the other biological parameters was analyzed by regression analysis. The results indicate that amylase activity per surviving acinar cell increased proportionately to compensate for the loss of acinar cells.

  8. [The role of the adrenal gland in sex determination of the duck embryo].

    PubMed

    van Deth, J H; van Limborgh, J; van Faassen, F

    1978-11-01

    In duck embryos, a study was made of the role the suprarenal glands might play in the process of sex determination. The experiments included the transplantation of suprarenal gland taken from embryos aged from 9 to 25 days, into the coelomic cavity of embryos ranging from 71 to 139 hours of age. Out of a total of 388 transplantations, 222 succeeded in the sense that the hosts reached the age, at which the gonads have sexually differentiated. The results show that the implantation of a suprarenal gland does not influence the sex-ratio. Moreover, no disturbances in the development of the gonads were observed. Hence, the conclusion may be drawn that it is highly improbable that the suprarenal gland plays an essential role in the production of substances guiding the differentiation of the gonadal primordia into ovaries or testes.

  9. Classification of the venous architecture of the pineal gland by 7T MRI.

    PubMed

    Cho, Zang-Hee; Choi, Sang-Han; Chi, Je-Gun; Kim, Young-Bo

    2011-10-01

    Magnetic resonance imaging (MRI) at 7.0 Tesla (7T) can show many details of anatomical structures with unprecedented resolution and contrast. In this report, we describe for the first time the unexpected wide variation in pineal gland structure, as visualized by MR images obtained with 7T in a group of healthy young volunteers. A total of 34 volunteers (22 men and 12 women) were enrolled in the study. Their 7T MR images revealed such wide variations in pineal gland shape that it led us to attempt to classify the patterns seen in these pineal glands. Indeed, they were successfully correlated with a previous human cadaver study of venous structures by Tamaki et al., who classified the venous structures of the pineal gland into three categories. This is the first human in vivo pineal vein imaging study using 7T MRI. Pineal venous imaging may permit the early diagnosis of a pineal tumor.

  10. Recurrent inflammation of accessory parotid tissue associated with unilateral parotid gland aplasia: diagnostic and therapeutic implications.

    PubMed

    Capaccio, Pasquale; Luca, Nicola; Sigismund, Paolo Enrico; Pignataro, Lorenzo

    2012-05-01

    Aplasia of the major salivary glands is a rare condition due to an alteration in the development of the ectodermal tissue of the oral cavity often related to other craniofacial abnormalities or alteration of structures deriving from the first or second archial branch, in particular the lacrimal glands; it can be total or partial and determine clinical states ranging from an asymptomatic condition to a severe xerostomia. The accessory parotid tissue is similar to normal parotid tissue, completely independent from the main gland and susceptible to the same pathological disorders. We describe a very unusual case of an inflammatory disorder of accessory parotid tissue in a 44-year-old male patient with concomitant, and previously unknown, aplasia of the main ipsilateral parotid gland. We also discuss the role of imaging and conservative therapeutic modalities such as botulinum toxin therapy and, in the future, minimally invasive endoscopic-assisted resection in the management of such salivary disorder.

  11. Myoepithelioma of the Parotid Gland Presenting as a Retroauricular Cutaneous nodule: A Case Report.

    PubMed

    Mochizuki, Yumi; Omura, Ken; Tanaka, Kae; Sakamoto, Kei; Yamaguchi, Akira

    2013-06-01

    We are reporting a case of recurrent myoepithelioma of the parotid gland, that emerged as a cutaneous mass. She had a retroauricular subcutaneous mass with an underlying diagnosis of a cutaneous myoepithelioma, which was excised at a hospital's Dermatology Department 2 years earlier. The tumour was observed above the platysma and it was considered as a cutaneous myoepithelioma without the parotid gland structures. She had undergone a partial parotidectomy approximately 20 years earlier. At her first visit to our department, there was no evidence of facial nerve palsy or cervical lymphadenopathy. The radiological findings showed a multinodular growing mass of the parotid gland, just beneath the retroauricular skin and a total parotidectomy was performed. It was considered that even if the cutaneous mass emerged, the relationship between the cutaneous mass and the parotid gland should be pre-surgically examined by computed tomography (CT) or Magnetic resonance image (MRI). A long-term continuous follow-up was also needed.

  12. [Regularities in the distribution of sweat glands and the principles of their grouping in man].

    PubMed

    Zagoruchenko, E A

    1975-05-01

    Under study were skin pieces from 80 regions of the body of 41 human fetuses and embryos, 5 corpses of newborns and 43 corpses of people of different age. Series of paraffin sections stained by conventional methods as well as total preparations and thick sections stained with methylene blue were examined. The laying of eccrine and apocrine sweat glands in the skin covered or not with hair was shown to occur repeatedly. Basing on the succession of their appearance they are called the glands of the first, second and third generations. The principle of grouping of eccrine sweat glands is shown both in the composition of glandular-hair complexes and in the groups independent of hair. The author proposes using of letter and figure symbols to signify variations of their disposition in formulars. The appocrine sweat glands are also laid repeatedly in the sites of their typical localization.

  13. Effects of methotrexate on rat parotid and submandibular glands and their secretions

    SciTech Connect

    McBride, R.K.

    1986-01-01

    Experimental animals were injected intraperitoneally with methotrexate for 3 days. Parotid and submandibular main ducts were cannulated and saliva flow was evoked by either intravenous infusion of acetylcholine or an intravenous injection of benthanechol. Methotrexate was found to reduce significantly mean food consumption, body weight, and parotid gland wet weights. Experimental animal salivary total gland DNA levels were not different, but total parotid gland RNA, protein, amylase and water content, and submandibular gland RNA were significantly lower compared to control. Acetylcholine, but not bethanechol, evoked parotid protein and amylase outputs and submandibular protein output from experimental animals were significantly higher than the control groups'. The increased outputs were apparently linked to ..beta..-adrenergic receptor activation, since hexamethonium or propranolol eliminated the significant increases while phenoxybenzamine did not. Plasma catecholamine levels were significantly higher in the methotrexate treated animals and probably played a role in the salivary gland ..beta..-adrenergic activation. Methotrexate treatment significantly increased the submandibular gland ..beta..-adrenergic receptor concentration as determined by (/sup 3/H)-dihydroalprenolol receptor binding assays. Muscarinic receptor concentrations determined with (/sup 3/H)-quinuclidninyl benzilate were not changed.

  14. Extracapsular dissection for Warthin tumor in the tail of parotid gland.

    PubMed

    Lee, Dong Hoon; Yoon, Tae Mi; Lee, Joon Kyoo; Lim, Sang Chul

    2017-09-01

    Extracapsular dissection conferred the advantage of reduced operation time and morbidity without any recurrence, and it could be considered as the treatment of choice for Warthin tumors in the tail of the parotid gland. The purpose of this study is to confirm the appropriate surgical procedure for Warthin tumor in the tail of the parotid gland, by comparing the results of extracapsular dissection and superficial parotidectomy. The medical records of 72 patients with Warthin tumor in the tail of the parotid gland who underwent surgery between January 2006 and December 2016 were retrospectively reviewed. In the extracapsular dissection group, a total of 44 parotid gland operations were performed in 40 patients. In the superficial parotidectomy group, a total of 34 parotid gland operations were performed in 32 patients. The operation time was significantly shorter in the extracapsular dissection group than in the superficial parotidectomy group (p<.001, Table 1). One patient in the extracapsular dissection group and five patients in the superficial parotidectomy group had postoperative facial nerve palsy. Recurrence of Warthin tumor in the tail portion of the parotid gland was identified in one patient who underwent superficial parotidectomy.

  15. Flagelliform or coronata glands of Nephila clavipes.

    PubMed

    Rodríguez, R; Candelas, G C

    1995-07-01

    The flagelliform or coronata glands of the orb-web spider, Nephila clavipes, have been studied and compared to other silk-producing glands from the organism. The glands, which produce silk for the double filament of the core thread in the sticky spiral, exhibit three distinct morphological areas: tail, sac, and duct. Electrophoretic separation of the solubilized contents of the glands yields an uppermost diffuse band of high molecular size, preceded by a stepladder of well-defined peptides, which have been shown to be products of discontinuous translation in three other sets of glands. The luminal contents do not migrate as a discrete and well-defined band as those of the other glands, but rather as a diffuse area, typical of glycosylated proteins. Fibroin synthesis is stimulated by the mechanical depletion of the organism's stored silks, as in other Nephila glands, judged by the increased intensity of the bands and also by the structural alterations seen in cross sections of the glands' tails.

  16. Salivary Gland Tumors: Current Concepts and Controversies.

    PubMed

    Seethala, Raja R

    2017-03-01

    This current review focuses on current concepts and controversies for select key salivary gland epithelial neoplasms. Rather than the traditional organization of benign and malignant tumors, this review is structured around select key topics: biphasic tumors, mammary analogue secretory carcinoma, and the controversy surrounding polymorphous low-grade adenocarcinoma and cribriform adenocarcinoma of (minor) salivary gland origin.

  17. Pineal Gland Agenesis: Review and Case Illustration

    PubMed Central

    Cox, Marcus A; Voin, Vlad; Shoja, Mohammadali; Oskouian, Rod J; Loukas, Marios; Tubbs, R. Shane

    2017-01-01

    Agenesis of the pineal gland has rarely been reported in the medical literature. Herein, we report a cadaveric specimen found to have agenesis of the pineal gland. The remaining gross examination of the brain was normal. A review of the literature was performed on this unusual finding. PMID:28690948

  18. The adrenal glands and their functions.

    PubMed

    De Silva, Deepthi C; Wijesiriwardene, Bandula

    2007-09-01

    The adrenal glands secrete hormones essential for metabolism, regulation of blood pressure, and sodium and glucose homeostasis. Hypo- or hypersecretion of these hormones is life threatening. Understanding the physiological functions of adrenal hormones is a prerequisite to the management of adrenal gland disease.

  19. Pathology of the parathyroid glands in hyperparathyroidism.

    PubMed

    Baloch, Zubair W; LiVolsi, Virginia A

    2013-08-01

    This paper reviews the embryology, histology and pathology of the human parathyroid glands. It emphasizes those pathologic lesions which are found in the setting of clinical hyperparathyroidism. Also discussed are certain molecular features of hyperfunctioning parathyroid glands. The difficulties encountered in parathyroid FNA are reviewed and illustrated.

  20. Mantle irradiation of the major salivary glands

    SciTech Connect

    Kaplan, P.

    1985-11-01

    Radiation given to the mantle field for treatment of Hodgkin's disease impinges on the submandibular and parotid glands at levels that have been both measured and calculated to be the complete tumor dose. This dosage is above the level of irradiation that has been shown to cause partial or complete loss of salivary gland function.

  1. Aquaporins in salivary glands and pancreas.

    PubMed

    Delporte, Christine

    2014-05-01

    Salivary glands and pancreas are involved in saliva secretion, pancreatic fluid secretion and insulin secretion. These functions are essential for proper oral, pancreatic and glucose homeostasis. Aquaporins are water-permeable transmembrane protein involved in the physiology of these secretory gland functions. This review gives an overview of the morphology of salivary glands and pancreas, the expression and localization of aquaporins, the secretion roles and mechanisms, the physiological roles of aquaporins, and the role of aquaporins in pathophysiological conditions. Several aquaporins are expressed in salivary glands and pancreas, and some play important physiological roles. Modulation of aquaporin expression and/or trafficking may contribute to the pathogenesis of diseases affecting salivary glands and pancreas glands such as xerostomic conditions, pancreatic insufficiencies and diabetes. Aquaporins are involved in physiological and pathophysiological processes in salivary glands and pancreas. They could represent therapeutic targets for the treatment of diseases affecting the salivary glands and pancreas. This article is part of a Special Issue entitled Aquaporins. © 2013.

  2. The human meibomian gland epithelial cell line as a model to study meibomian gland dysfunction.

    PubMed

    Hampel, Ulrike; Garreis, Fabian

    2017-10-01

    The meibomian gland dysfunction (MGD) is the leading cause of dry eye disease (DED) throughout the world. The investigation of MGD lacks suitable in vivo and in vitro models. In 2010 a human meibomian gland epithelial cell line (HMGEC) was established, so far the only available meibomian gland cell line. The characterization of HMGEC is of major importance to clarify its suitability for studying the meibomian gland (patho)physiology in vitro. The current culture protocol and new concepts of HMGEC culture will be compared. Hormones are believed to be a key factor in meibomian gland dysfunction thus HMGEC responsiveness to hormone stimulation is crucial to elucidate the hormonal influence on the meibomian gland. This review will summarize current findings about HMGEC and discuss its role in the meibomian gland dysfunction research. Copyright © 2017 Elsevier Ltd. All rights reserved.

  3. Liquid secretion properties of airway submucosal glands

    PubMed Central

    Ballard, Stephen T; Inglis, Sarah K

    2004-01-01

    The tracheobronchial submucosal glands secrete liquid that is important for hydrating airway surfaces, supporting mucociliary transport, and serving as a fluid matrix for numerous secreted macromolecules including the gel-forming mucins. This review details the essential structural elements of airway glands and summarizes what is currently known regarding the ion transport processes responsible for producing the liquid component of gland secretion. Liquid secretion most likely arises from serous cells and is principally under neural control with muscarinic agonists, substance P, and vasoactive intestinal peptide (VIP) functioning as effective secretogogues. Liquid secretion is driven by the active transepithelial secretion of both Cl− and HCO3− and at least a portion of this process is mediated by the cystic fibrosis transmembrane conductance regulator (CFTR), which is highly expressed in glands. The potential role of submucosal glands in cystic fibrosis lung disease is discussed. PMID:14660706

  4. Submaxillary gland mucocele: presentation of a case.

    PubMed

    Boneu-Bonet, Fernando; Vidal-Homs, Enric; Maizcurrana-Tornil, Aránzazu; González-Lagunas, Javier

    2005-01-01

    The term mucocele is referred to two concepts: the extravasation cysts resulting from salivary glandular duct rupture, with mucin leakage into the surrounding peri-glandular soft tissue, and the retention cysts, caused by a glandular duct obstruction and resulting in a decrease or even an absence of glandular secretion. Mucocele can not be considered as a true cyst because its wall lacks an epithelial lining. These lesions are very common in the minor salivary glands (particularly in the labial glands), but are very infrequent in the major salivary glands--including the submaxillary glands. The present study describes a clinical case of a right submaxillary gland mucocele resolved by surgical treatment and reviews the differential diagnosis with other clinical entities.

  5. Gordon Research Conference on Mammary Gland Biology

    SciTech Connect

    Not Available

    1989-01-01

    The 1989 conference was the tenth in the series of biennial Gordon Research Conferences on Mammary Gland Biology. Traditionally this conference brings together scientists from diverse backgrounds and experience but with a common interest in the biology of the mammary gland. Investigators from agricultural and medical schools, biochemists, cell and molecular biologists, endocrinologists, immunologists, and representatives from the emerging biotechnology industries met to discuss current concepts and results on the function and regulation of the normal and neoplastic mammary gland in a variety of species. Of the participants, approximately three-fourths were engaged in studying the normal mammary gland function, whereas the other quarter were engaged in studying the neoplastic gland. The interactions between scientists, clinicians, veterinarians examining both normal and neoplastic cell function serves to foster the multi-disciplinary goals of the conference and has stimulated many cooperative projects among participants in previous years.

  6. Microscopy of the echidna sublingual glands.

    PubMed

    Krause, William J

    2011-10-01

    The secretory units and duct system of the echidna sublingual glands exhibit subtle architectural modifications to accommodate the viscous secretion produced by these glands. The glands are compound tubular glands, the secretory units of which are elongate with open lumina and consist only of mucous cells. Closely packed spindle-shaped myoepithelial cells invest the secretory units, but are absent around the ducts. The branched secretory tubules open into an abbreviated duct system characterized by wide lumina. Striated ducts normally associated with the second portion of the intralobular duct system are absent. The duct system shows the most obvious modification of general salivary gland architecture presumably to accommodate the viscous secretion propelled from the secretory units by surrounding myoepithelial cells.

  7. Distribution of transglutaminase in quail uropygial glands.

    PubMed

    Suzuki, T; Maruyama, T; Morohashi, M

    1995-02-01

    The holocrine secretion of the uropygial gland has been explained as autolysis due to intracellular lysosomal enzymes. In the present study, the distribution of transglutaminase, a marker of epidermal differentiation, in quail uropygial glands was observed by histochemical methods to confirm whether a mechanism similar to epidermal differentiation also exists in the uropygial gland. The transglutaminase activity was positive in the deep and shallow portions of the secretory tubules as well as the transitional and degenerating cell layers of the uropygial gland. This activity was stronger in the deep portions than the shallow portions. These findings suggest that the process of secretion in the quail uropygial gland involves not only the autolysis due to lysosomal enzymes but also a mechanism similar to that of epidermal differentiation, and that a phenomenon similar to epidermal differentiation is more evident in the deep portions than the shallow portions.

  8. Imaging of the major salivary glands.

    PubMed

    Afzelius, Pia; Nielsen, Ming-Yuan; Ewertsen, Caroline; Bloch, Klaus Poulsen

    2016-01-01

    The major salivary glands, submandibular, parotid and sublingual glands play an important role in preserving the oral cavity and dental health. Patients with problems of the major salivary glands may present with symptoms such as dry mouth, dysphagia and obstruction of duct, inflammation, severe dental caries or swelling. Imaging plays an important role in visualization of morphology and function, to establish a diagnosis, for treatment, and for surgical planning. There are several options for diagnostic imaging: plain radiography, sialography, ultrasound (US), magnetic resonance imaging (MRI), computed tomography (CT), salivary gland scintigraphy and (18)F-FDG positron emission tomography (PET). We present an overview of the modalities in relation to common salivary gland disease. © 2014 Scandinavian Society of Clinical Physiology and Nuclear Medicine. Published by John Wiley & Sons Ltd.

  9. PEPTIDASE INCREASE ACCOMPANYING GROWTH OF THE LARVAL SALIVARY GLAND OF DROSOPHILA MELANOGASTER

    PubMed Central

    Patterson, Elizabeth K.; Dackerman, Marjorie E.; Schultz, Jack

    1949-01-01

    1. The larval salivary gland of Drosophila melanogaster offers an opportunity to study growth in a tissue in which no cell division occurs but in which the cells increase in size. 2. Measurements of alanylglycine (AG)-peptidase content have been made in three stocks of Drosophila melanogaster at different growth stages of the larval salivary gland, and have been correlated with its total nitrogen and volume. 3. During the prepupal instar, the AG-peptidase content of the gland increases parallel with total nitrogen but decreases when histolysis of the gland begins. Conversely, a benzoyl-l-arginineamide-hydrolyzing endopeptidase is not measurable until histolysis sets in. 4. In the final larval growth period of a giant mutant, there is a concomitant increase in peptidase, total nitrogen, and volume of the gland. 5. A similar association of peptidase content and total nitrogen is found in comparing glands of different sizes from the giant stock, at the time of maximal peptidase content in the prepupa. 6. The data are interpreted as evidence for an association of AG-peptidase with growth of the cells in the gland. This agrees with the earlier interpretation by Linderstrøm-Lang and Holter of data obtained from study of more complex tissues. 7. A survey of the available measurements of peptidase content in other organisms shows that wherever an increase of cell substance occurs, peptidase content increases. Conversely, peptidase remains constant where cell division is unaccompanied by an increase of cell substances. 8. The joint association of peptidases and pentosenucleic acids with protein synthesis is pointed out. 9. The possiblity is considered that peptidases may be essential parts of a unit in which coupled reactions necessary for protein synthesis occur. The rôle of the peptidases in this system is discussed. They may act either synthetically to form new peptide linkages (problematic), or hydrolytically to mobilize the necessary specific amino acids. PMID

  10. Associations between xerostomia, histopathological alterations, and autonomic innervation of labial salivary glands in men in late midlife.

    PubMed

    Sørensen, Christiane Elisabeth; Larsen, Jytte Overgaard; Reibel, Jesper; Lauritzen, Martin; Mortensen, Erik Lykke; Osler, Merete; Pedersen, Anne Marie Lynge

    2014-09-01

    One aim of the present study was to investigate whether symptoms of oral dryness (xerostomia) during daytime, assessed in a study group of middle-aged male positive and negative outliers in cognition scores, were associated with age-related degenerative changes in human labial salivary glands and with quantitative measures of the glandular autonomic innervation. Another aim was to study the relation between the autonomic innervation and loss of secretory acinar cells in these glands. Labial salivary gland biopsies were taken from the lower lip from 190 men, born in 1953 and members of the Danish Metropolit birth cohort, who were examined for age-related changes in cognitive function and dental health as part of the Copenhagen University Center for Healthy Aging clinical neuroscience project. The glands were routinely processed and semi-quantitatively analyzed for inflammation, acinar atrophy, fibrosis, and adipocyte infiltration. Sections of labial salivary gland tissue were stained with the panneuronal marker PGP 9.5. In a subsample of 51 participants, the autonomic innervation of the glands was analyzed quantitatively by use of stereology. Labial salivary gland tissue samples from 33% of all participants displayed moderate to severe acinar atrophy and fibrosis (31%). Xerostomia was not significantly associated with structural changes of labial salivary glands, but in the subsample it was inversely related to the total nerve length in the glandular connective tissue. Acinar atrophy and fibrosis were negatively correlated with the parenchymal innervation and positively related to diffuse inflammation. The results from the present study indicate that aspects of the autonomic innervation of labial salivary glands may play a role in the occurrence of xerostomia which in the present study group was not significantly associated with degenerative changes in these glands. The findings further indicate that the integrity of labial salivary gland acini is related to the

  11. Preserving Parathyroid Gland Vasculature to Reduce Post-thyroidectomy Hypocalcemia.

    PubMed

    Park, Inhye; Rhu, Jinsoo; Woo, Jung-Woo; Choi, Jun-Ho; Kim, Jee Soo; Kim, Jung-Han

    2016-06-01

    The failure to preserve parathyroid function in patients who have undergone total thyroidectomy is of major concern, because hypocalcemia is difficult to prevent and remains a common postoperative complication. Here, we describe procedures designed to preserve the vasculature supplying the parathyroid glands and examine both recent outcomes and retrospective reports of results obtained prior to the application of these preservation techniques. Our technique for preserving parathyroid function during thyroidectomy was adopted in 2009 and involves separating a relatively long segment of a vessel distally from the thyroid gland. We reviewed the medical records of 1,411 patients who underwent total thyroidectomy, with or without lateral neck dissection, at the Samsung Medical Center from January 2006 through June 2014 to determine outcomes. Patients were divided into three groups according to the time period during which the surgery took place: Group A, 2006-2008 (before the vasculature-preserving technique was applied); Group B, 2009-2011 (the time when the technique was first adopted); and Group C, 2012-2014 (more recent results of the technique). We analyzed the incidence of hypoparathyroidism in the three groups, as well as risk factors that influenced its development. The rates of transient and permanent hypoparathyroidism in Group A were 25.4 and 4.3 %, respectively. However, the incidence of hypoparathyroidism decreased significantly over time after the vasculature-preserving procedure was adopted. Transient hypoparathyroidism developed in 4.8 % of Group C patients, and only four (0.7 %) of the 565 patients in this group required calcium supplementation, despite the fact that a greater number of patients were included who underwent total thyroidectomy combined with lateral neck dissection. Although female sex and lateral neck dissection tended to increase the rate of transient hypoparathyroidism, multivariate analysis showed that the vasculature

  12. Human papillomavirus-related cell cycle markers can predict survival outcomes following a transoral lateral oropharyngectomy for tonsillar squamous cell carcinoma.

    PubMed

    Ryu, Chang Hwan; Ryu, Junsun; Cho, Kwan Ho; Moon, Sung Ho; Yun, Tak; Lee, Sang-Hyun; Choi, Moon Kyung; Park, Weon Seo; Jung, Yuh-S

    2014-09-01

    To identify the prognostic implications of human papillomavirus (HPV)-related cell cycle marker profiles in patients who have received a transoral lateral oropharyngectomy (TLO) as a primary treatment for tonsillar squamous cell carcinoma (TSCC). Immunohistochemical profiles of HPV-related cell cycle markers, including p16, pRb, cyclin D1, p53, and the HPV DNA status of 42 consecutive TSCC patients who underwent TLO-based treatments were analyzed. The prognostic value of each marker was evaluated. Univariate analysis indicated that high p16, low pRb, and low p53 expression levels are significantly associated with a good disease-free and overall survival outcome. Clinicopathological parameters and the HPV DNA status did not show prognostic significance. When adjusted for age, overall stage and treatment strategy, a high p16 and low pRb level remained an effective prognostic marker for good survival outcomes. A high p16/low pRb combination showed superior survival prediction ability over high p16 or low pRb alone. HPV-related cell cycle markers may also be good indicators for predicting survival after TLO for TSCC. The de-escalation TLO surgery approach would be more effective if performed under the stringent guidance of these markers. © 2014 Wiley Periodicals, Inc.

  13. The Settings, Pros and Cons of the New Surgical Robot da Vinci Xi System for Transoral Robotic Surgery (TORS): A Comparison With the Popular da Vinci Si System.

    PubMed

    Kim, Da Hee; Kim, Hwan; Kwak, Sanghyun; Baek, Kwangha; Na, Gina; Kim, Ji Hoon; Kim, Se Heon

    2016-10-01

    The da Vinci system (da Vinci Surgical System; Intuitive Surgical Inc.) has rapidly developed in several years from the S system to the Si system and now the Xi System. To investigate the surgical feasibility and to provide workflow guidance for the newly released system, we used the new da Vinci Xi system for transoral robotic surgery (TORS) on a cadaveric specimen. Bilateral supraglottic partial laryngectomy, hypopharyngectomy, lateral oropharyngectomy, and base of the tongue resection were serially performed in search of the optimal procedures with the new system. The new surgical robotic system has been upgraded in all respects. The telescope and camera were incorporated into one system, with a digital end-mounted camera. Overhead boom rotation allows multiquadrant access without axis limitation, the arms are now thinner and longer with grabbing movements for easy adjustments. The patient clearance button dramatically reduces external collisions. The new surgical robotic system has been optimized for improved anatomic access, with better-equipped appurtenances. This cadaveric study of TORS offers guidance on the best protocol for surgical workflow with the new Xi system leading to improvements in the functional results of TORS.

  14. Transoral Decompression and Anterior Stabilization of Atlantoaxial Joint in Patients with Basilar Impression and Chiari Malformation Type I: A Technical Report of 2 Clinical Cases.

    PubMed

    Shkarubo, Alexey N; Kuleshov, Alexander A; Chernov, Ilia V; Vetrile, Marchel S

    2017-06-01

    Presentation of clinical cases involving successful anterior stabilization of the C1-C2 segment in patients with invaginated C2 odontoid process and Chiari malformation type I. Clinical case description. Two patients with C2 odontoid processes invagination and Chiari malformation type I were surgically treated using the transoral approach. In both cases, anterior decompression of the upper cervical region was performed, followed by anterior stabilization of the C1-C2 segment. In 1 of the cases, this procedure was performed after posterior decompression, which led to transient regression of neurologic symptoms. In both cases, custom-made cervical plates were used for anterior stabilization of the C1-C2 segment. During the follow-up period of more than 2 years, a persistent regression of both the neurologic symptoms and Chiari malformation was observed. Anterior decompression followed by anterior stabilization of the C1-C2 segment is a novel and promising approach to treating Chiari malformation type I in association with C2 odontoid process invagination. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Small ampullate glands of Nephila clavipes.

    PubMed

    Ortíz, R; Céspedes, W; Nieves, L; Robles, I V; Plazaola, A; File, S; Candelas, G C

    2000-02-01

    The small ampullate glands of the orb-web spider, Nephila clavipes, have been studied and compared to other of the silk producing glands from this organism. They exhibit the same gross morphological features of the other glands. Electrophoretic analyses show that the gland's luminal contents migrate as a single band, while the contents of the secretory epithelium reveal a step-ladder array of peptides in addition to the full size product. Previous studies from our laboratory identified these peptides as products generated by translational pauses. This alternate mode of translation is typical of fibroin synthesis in all the spider glands thus far studied as well as in those of the silkworm. The correlation of the peptides to the process of fibroin synthesis is shown through experimental evidence in this paper. The gradual ultrastructural changes in Golgi vesicles elicited by the fibroin synthesis stimulus can be seen in this paper. The response to stimulation is of a higher magnitude in these glands than in any of those previously analyzed. These studies show the small ampullate glands are a promising and certainly exploitable model system for studies on the synthesis of tissue-specific protein product and its control. J. Exp. Zool. 286:114-119, 2000.

  16. Historical vignettes of the thyroid gland.

    PubMed

    Lydiatt, Daniel D; Bucher, Gregory S

    2011-01-01

    Although "glands" in the neck corresponding to the thyroid were known for thousands of years, they were mainly considered pathological when encountered. Recognition of the thyroid gland as an anatomical and physiological entity required human dissection, which began in earnest in the 16th century. Leonardo Da Vinci is generally credited as the first to draw the thyroid gland as an anatomical organ. The drawings were subsequently "lost" to medicine for nearly 260 years. The drawings were probably of a nonhuman specimen. Da Vinci vowed to produce an anatomical atlas, but it was never completed. Michelangelo Buonarroti promised to complete drawings for the anatomical work of Realdus Columbus, De Re Anatomica, but these were also never completed. Andreas Vesalius established the thyroid gland as an anatomical organ with his description and drawings in the Fabrica. The thyroid was still depicted in a nonhuman form during this time. The copper etchings of Bartholomew Eustachius made in the 1560s were obviously of humans, but were not actually published until 1714 with a description by Johannes Maria Lancisius. These etchings also depicted some interesting anatomy, which we describe. The Adenographia by Thomas Wharton in 1656 named the thyroid gland for the first time and more fully described it. The book also attempted to assign a function to the gland. The thyroid gland's interesting history thus touches a number of famous men from diverse backgrounds.

  17. Mammary gland tumors in male dogs.

    PubMed

    Saba, Corey F; Rogers, Kenita S; Newman, Shelley J; Mauldin, Glenna E; Vail, David M

    2007-01-01

    Reports of mammary-gland tumors in male dogs are lacking. To describe the clinical characteristics of mammary-gland tumors in male dogs. Eight male dogs diagnosed with mammary-gland tumors. Retrospective study. Medical databases from 3 institutions were searched. Medical records were abstracted, and owners and referring veterinarians contacted for follow-up information. Tissues were reviewed for histologic type, and immunohistochemical staining for estrogen and progesterone receptors (ER, PR) was performed. Eight dogs with histologically confirmed mammary-gland tumors were included in this retrospective study. Median age at diagnosis was 11.5 years. Four dogs were sexually intact; 4 were neutered. All were purebred. Mammary-gland tumors were incidental findings in 7 of 8 dogs. All dogs were treated with only surgical excision. All but 1 dog had benign epithelial tumors. The dog with the malignant tumor was the only dog to develop possible local recurrence but de novo tumor development cannot be excluded. No dog had evidence of metastatic disease at diagnosis. Based on institutional population data, it was determined that female dogs are 62 times more likely to develop mammary-gland tumors than male dogs (P < .001). Estrogen-receptor expression was strong in the majority of tumors; progesterone-receptor expression, although present in all tumors, was less intense. CONCLUSIONS/CLINICAL IMPORTANCE: This study suggests that mammary-gland tumors in male dogs are rare, usually benign, and surgery alone can provide long-term control in most dogs.

  18. Bioengineered Lacrimal Gland Organ Regeneration in Vivo

    PubMed Central

    Hirayama, Masatoshi; Tsubota, Kazuo; Tsuji, Takashi

    2015-01-01

    The lacrimal gland plays an important role in maintaining a homeostatic environment for healthy ocular surfaces via tear secretion. Dry eye disease, which is caused by lacrimal gland dysfunction, is one of the most prevalent eye disorders and causes ocular discomfort, significant visual disturbances, and a reduced quality of life. Current therapies for dry eye disease, including artificial tear eye drops, are transient and palliative. The lacrimal gland, which consists of acini, ducts, and myoepithelial cells, develops from its organ germ via reciprocal epithelial-mesenchymal interactions during embryogenesis. Lacrimal tissue stem cells have been identified for use in regenerative therapeutic approaches aimed at restoring lacrimal gland functions. Fully functional organ replacement, such as for tooth and hair follicles, has also been developed via a novel three-dimensional stem cell manipulation, designated the Organ Germ Method, as a next-generation regenerative medicine. Recently, we successfully developed fully functional bioengineered lacrimal gland replacements after transplanting a bioengineered organ germ using this method. This study represented a significant advance in potential lacrimal gland organ replacement as a novel regenerative therapy for dry eye disease. In this review, we will summarize recent progress in lacrimal regeneration research and the development of bioengineered lacrimal gland organ replacement therapy. PMID:26264034

  19. Dysfunctional ectopic thyroid gland: a case report.

    PubMed

    Stokić, Edita; Kljajić, Vladimir; Idjuški, Stevan; Benc, Damir; Popović, Djordje; Protić, Mladjan; Crnobrnja, Veljko

    2014-01-01

    Lingual thyroid gland is a rare anomaly of thyroid gland development, occurring more frequently in females. If it causes local symptomatology such as dysphagia, dysphonia or dyspnea it is diagnosed in childhood, however, if it is asymptomatic it is usually diagnosed in adulthood. We present a 23-year-old female patient in whom we diagnosed lingual thyroid gland coincidentally during diagnostic procedures of a concomitant disease. The application of 131I scintigraphy showed an oval field of intensive accumulation of radio markers in the zone of medial face line, around tongue base, with the absence of thyroid gland in its physiological position. Functional testing proved primary hypothyroidism and we started the application of substitution therapy. The application of levothyroxine resulted in reaching euthyroid state and the reduction of thyroid gland size. We present a very rare anomaly of the thyroid gland, and so far there have been no clear attitudes about further treatment. The general condition of the patient, age, the size of ectopic thyroid gland and the existence of local symptomatology or complications represent the factors that have influence on the choice of treatment method.

  20. On the mechanism of salivary gland radiosensitivity

    SciTech Connect

    Konings, Antonius W.T. . E-mail: a.w.t.konings@med.rug.nl; Coppes, Rob P.; Vissink, Arjan

    2005-07-15

    Purpose: To contribute to the understanding of the enigmatic radiosensitivity of the salivary glands by analysis of appropriate literature, especially with respect to mechanisms of action of early radiation damage, and to supply information on the possibilities of amelioration of radiation damage to the salivary glands after radiotherapy of head-and-neck cancer. Methods and Materials: Selected published data on the mechanism of salivary gland radiosensitivity and radioprotection were studied and analyzed. Results: From a classical point of view, the salivary glands should not respond as rapidly to radiation as they appear to do. Next to the suggestion of massive apoptosis, the leakage of granules and subsequent lysis of acinar cells was suggested to be responsible for the acute radiation-induced function loss of the salivary glands. The main problem with these hypotheses is that recently performed assays show no cell loss during the first days after irradiation, while saliva flow is dramatically diminished. The water secretion is selectively hampered during the first days after single-dose irradiation. Literature is discussed that shows that the compromised cells suffer selective radiation damage to the plasma membrane, disturbing signal transduction primarily affecting watery secretion. Although the cellular composition of the submandibular gland and the parotid gland are different, the damage response is very alike. The acute radiation-induced function loss in both salivary glands can be ameliorated by prophylactic treatment with specific receptor agonists. Conclusions: The most probable mechanism of action, explaining the enigmatic high radiosensitivity for early effects, is selective radiation damage to the plasma membrane of the secretory cells, disturbing muscarinic receptor stimulated watery secretion. Later damage is mainly due to classical mitotic cell death of progenitor cells, leading to a hampered replacement capacity of the gland for secretory cells

  1. High follicle density does not decrease sweat gland density in Huacaya alpacas.

    PubMed

    Moore, K E; Maloney, S K; Blache, D

    2015-01-01

    When exposed to high ambient temperatures, mammals lose heat evaporatively by either sweating from glands in the skin or by respiratory panting. Like other camelids, alpacas are thought to evaporate more water by sweating than panting, despite a thick fleece, unlike sheep which mostly pant in response to heat stress. Alpacas were brought to Australia to develop an alternative fibre industry to sheep wool. In Australia, alpacas can be exposed to ambient temperatures higher than in their native South America. As a young industry there is a great deal of variation in the quality and quantity of the fleece produced in the national flock. There is selection pressure towards animals with finer and denser fleeces. Because the fibre from secondary follicles is finer than that from primary follicles, selecting for finer fibres might alter the ratio of primary and secondary follicles. In turn the selection might alter sweat gland density because the sweat glands are associated with the primary follicle. Skin biopsy and fibre samples were obtained from the mid-section of 33 Huacaya alpacas and the skin sections were processed into horizontal sections at the sebaceous gland level. Total, primary, and secondary follicles and the number of sweat gland ducts were quantified. Fibre samples from each alpaca were further analysed for mean fibre diameter. The finer-fibred animals had a higher total follicle density (P<0.001) and more sweat glands (P<0.001) than the thicker-fibred animals. The fibre diameter and total follicle density were negatively correlated (R(2)=0.56, P<0.001). Given that the finer-fibred animals had higher follicle density and more sweat glands than animals with thicker fibres, we conclude that alpacas with high follicle density should not be limited for potential sweating ability.

  2. In situ preservation of the inferior parathyroid gland during central neck dissection for papillary thyroid carcinoma.

    PubMed

    Wang, J B; Wu, K; Shi, L H; Sun, Y Y; Li, F B; Xie, L

    2017-10-01

    Postoperative hypocalcaemia due to dysfunction of the parathyroid glands is the most common complication after total thyroidectomy plus central neck dissection (CND). There is a lack of surgical techniques described to help preserve the inferior parathyroid gland in situ during CND. The objective of this study was to introduce the 'TBP layer' (layer of thymus-blood vessel-inferior parathyroid gland) concept for preserving the inferior parathyroid gland in situ during CND, and to evaluate its effectiveness. The study group included patients with primary papillary thyroid cancer who underwent total thyroidectomy with CND using the new surgical concept between January and December 2014. The control group included sex- and age-matched patients who underwent conventional total thyroidectomy with CND between January 2012 and December 2013. The proportion of inferior parathyroid glands preserved in situ and postoperative hypoparathyroidism rates in the two groups were compared. There were 181 patients in the study group and 306 in the control group. There were no significant differences between the groups in tumour size, multifocality, extrathyroidal extension, and number of harvested and metastatic central lymph nodes. The rate of inferior parathyroid gland preservation in situ was significantly improved from 37·9 to 76·3 per cent on the left side (P < 0·001), and from 52·0 to 77·9 per cent on the right side (P < 0·001), in the study group compared with the control group. The incidence of transient hypoparathyroidism decreased significantly from 35·0 to 7·2 per cent (P < 0·001). Applying the proposed surgical concept improved the rate of inferior parathyroid gland preservation in situ and decreased the incidence of transient postoperative hypoparathyroidism. © 2017 BJS Society Ltd Published by John Wiley & Sons Ltd.

  3. Changes in meibomian gland morphology and ocular higher-order aberrations in eyes with chalazion

    PubMed Central

    Fukuoka, Shima; Arita, Reiko; Shirakawa, Rika; Morishige, Naoyuki

    2017-01-01

    Purpose To examine the changes in meibomian gland morphology and ocular higher-order aberrations (HOAs) in eyes with chalazion and its excision. Methods Seven male patients with previous history of chalazion excision and seven control male subjects were enrolled. Changes in meibomian gland morphology (meiboscores, gland dropout, and shortening) were evaluated by using meibography equipped in a wavefront analyzer KR-1W and in a slit-lamp device BG-4M. Ocular HOAs were measured sequentially with KR-1W. The tear film breakup time (BUT) was measured. Results Both KR-1W and BG-4M visualized meibomian gland as clear similar images. The tear film BUT (mean ± SD, 5.6±3.0 vs 9.4±2.3 seconds, P=0.025), the total meiboscore (median [interquartile range], 2 (2−3) vs 0 (0−1), P=0.007) as well as the meibomian gland dropout rate (86% vs 14%, P=0.008) and shortening rate (100% vs 29%, P=0.031) differed significantly between the patient and control groups. The first total ocular HOAs (0.142±0.063 vs 0.130±0.015, P=0.80) were similar in both groups, whereas the stability index of the total HOAs over time (0.0041±0.0048 vs −0.0012±0.0020, P=0.030) differed significantly between the patient and control groups. Conclusions Chalazion and its excision were associated with dropout and shortening rate of meibomian glands. The morphological changes of meibomian glands in chalazion may be associated to instability of the tear film, which was suggested by the tear film BUT and the stability of ocular HOAs. PMID:28615923

  4. Morphological Variations of the Thyroid Gland among the People of Upper Assam Region of Northeast India: A Cadaveric Study.

    PubMed

    Rajkonwar, Anjan Jyoti; Kusre, Giriraj

    2016-12-01

    The morphological variations of the thyroid gland have been reported from different parts of the world. The variations are due to remnant or non-specific development of the parts of the thyroid gland. Surgical operation of the thyroid gland has been the treatment of choice in various thyroid pathologies. Prior knowledge of the morphological variation is important to ensure better results from these surgical operations. To study the prevalence of morphological variations seen in the thyroid glands in the upper Assam region of Northeast India. This was a hospital based cadaveric study. Total number of Thyroid glands dissected were 80. The thyroid gland was examined properly for the presence of pyramidal lobe, levator glandulae thyroideae and complete absence of isthmus. Statistical analysis was done by SPSS 21.0. It was found that 17 (21.25%) cadavers did not show an isthmus. The pyramidal lobe was present in 31(38.75%) cases and frequently arising from the left side (74.2%) of the isthmus. Levator glandulae thyroideae was found in 15 (18.75%) of the thyroid specimens. In all cases, it was extended from the apex of the pyramidal lobe to the hyoid bone. Morphological variation of the thyroid gland is very common hence requires detection prior to any surgery on the thyroid gland.

  5. Superior parathyroid gland approach to the recurrent laryngeal nerve.

    PubMed

    Elsheikh, Ezzeddin

    2017-07-01

    The superior parathyroid gland is known to be almost constant in its location under the false thyroid capsule. Could it be a landmark to point to the site of incision of the false thyroid capsule and find the plane of the recurrent laryngeal nerve (RLN) during thyroidectomy? The study included 48 patients with benign goiter scheduled for hemithyroidectomy or total thyroidectomy; there were 16 cases of solitary thyroid nodules, 27 cases of multinodular goiter, and 5 cases of toxic goiter. This study included 80 lobectomies. All patients showed no evidence of postoperative RLN palsy, bleeding, or hypoparathyroidism. The superior parathyroid gland was consistently found within the false capsule in all cases, whereas the inferior parathyroid was found within the same layer in 64 sides (80%). The described approach can accurately guide dissection between true and false capsules of the thyroid to reach and preserve both the RLN and the superior parathyroid gland. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1287-1290, 2017. © 2017 Wiley Periodicals, Inc.

  6. Cystic parathyroid glands in MEN1: A rare entity?

    PubMed

    Cavalli, Tiziana; Giudici, Francesco; Nesi, Gabriella; Amorosi, Andrea; Santi, Raffaella; Brandi, Maria Luisa; Tonelli, Francesco

    2017-04-01

    Approximately 300 cases of sporadic parathyroid cyst (PCs) have been reported to date. Only two cases have been described in MEN1 so far. Detection by imaging could be challenging, especially in multiglandular primary hyperparathyroidism (HPT) and clinical outcome could be different. During the period 1990-2014, 71 MEN1 patients were operated for primary hyperparathyroidism in our centre. We report three cases of PCs in MEN1 patients affected by HPT, who underwent a total or subtotal parathyroidectomy with transcervical thymectomy. In our series, all three patients had an unsatisfactory postoperative course, at variance with the high percentage (over 90 %) of long-term success in MEN1 patients operated at our centre. One patient affected by cystic degeneration of all the four parathyroid glands reported persistent hypoparathyroidism, despite autografts of parathyroid tissue. For the other two cases, surgery failed to cure hyperparathyroidism, perhaps because of the presence of undetected ectopic parathyroid tissue. In the context of a multiglandular disease such as MEN1 syndrome, PCs seem rare but our experience shows about a 4 % incidence. Furthermore their presence, even in expert hands, could affect the preoperative identification of the parathyroid glands due to the difficult differential diagnosis between PC and other cystic lesions of the neck, and intraoperative detection of the glands as well as the postoperative outcome.

  7. Oral mucosal status and major salivary gland function

    SciTech Connect

    Wolff, A.; Fox, P.C.; Ship, J.A.; Atkinson, J.C.; Macynski, A.A.; Baum, B.J. )

    1990-07-01

    Normal salivary function is considered to be critical for the maintenance of healthy oral mucosa. However, few studies have examined mucosal changes in patients with objectively documented salivary gland performance. In the present report, the mucosal status of 298 subjects being evaluated in a dry mouth clinic was assessed. A complete oral examination was performed and unstimulated and stimulated salivary samples were collected separately from the parotid and submandibular/sublingual glands. Data were analyzed according to diagnosis and salivary output after the assignment of an oral mucosal rating to each subject. In general, the mucosal surfaces were well preserved and infections were not seen. Patients evaluated for Sjoegren's syndrome and radiation-induced xerostomia had the lowest salivary gland performance but displayed a mucosal status similar to denture-wearing healthy subjects or patients with normal salivary flow who had idiopathic xerostomia. However, those patients with a total lack of salivary flow rarely had normal-appearing oral mucosa. These results confirm a role for saliva in oral mucosal preservation and also suggest that other factors may act to maintain oral mucosal integrity.

  8. Lateral nasal gland secretion in the anaesthetized dog.

    PubMed Central

    Wells, U; Widdicombe, J G

    1986-01-01

    The effects of pharmacological and nervous stimuli on the flow of secretion from the dog lateral nasal gland following catheterization are described. Drugs were injected close-arterially into the arterial supply to the nose, or intravenously. Cholinergic agonists (pilocarpine, methacholine), given intravenously (I.V.) or intra-arterially (I.A.), and stimulation of the vidian nerve produced a copious flow of secretion which was blocked by atropine. The adrenoceptor agonists phenylephrine (alpha) and salbutamol (beta 2), given I.V. or I.A., and stimulation of the vagosympathetic nerve produced a small but consistent flow of secretion. Histamine (50 micrograms), substance P (0.1 micrograms) and prostaglandin E1 (1-5 micrograms), injected I.A., produced small flows of secretion. Bradykinin (25 ng-50 micrograms), 5-hydroxytryptamine (100 ng-50 micrograms) and vasoactive intestinal peptide (VIP) (10 ng-50 micrograms) did not cause secretion. The total protein content, the composition of secretions as revealed by sodium dodecyl sulphate-polyacrylamide agarose gel electrophoresis, and changes in [Na] and [K] in relation to flow of secretion are described. Differences in ion and protein concentrations, and in protein composition, are described for vidian nerve-induced and vagosympathetically induced secretions. Electron microscopy revealed that the gland contains serous cells in the secretory region, and ducts morphologically similar to the intercalated, striated and excretory ducts of salivary glands. Images Fig. 5 Fig. 6 PMID:3746694

  9. Mammary gland tumors in captive African hedgehogs.

    PubMed

    Raymond, J T; Gerner, M

    2000-04-01

    From December 1995 to July 1999, eight mammary gland tumors were diagnosed in eight adult captive female African hedgehogs (Atelerix albiventris). The tumors presented as single or multiple subcutaneous masses along the cranial or caudal abdomen that varied in size for each hedgehog. Histologically, seven of eight (88%) mammary gland tumors were malignant. Tumors were classified as solid (4 cases), tubular (2 cases), and papillary (2 cases). Seven tumors had infiltrated into the surrounding stroma and three tumors had histologic evidence of neoplastic vascular invasion. Three hedgehogs had concurrent neoplasms. These are believed to be the first reported cases of mammary gland tumors in African hedgehogs.

  10. [Acinar cell carcinoma of submaxillary gland].

    PubMed

    Comeche, C; Calabuig, C; Barona, R

    1997-01-01

    Although acine cell neoplasms have for a long time been regarded as benign tumors, they are presently considered to represent the carcinomas. These rare tumors mainly affect the parotid glands, and only exceptionally involve other salivary glands. Clinically, acic cell carcinoma present as isolated tumors simulating a pleomorphic adenoma. The diagnosis is histopathological, and complete surgical removal of the tumor is the treatment of choice, with cervical lymphatic voiding and/or postoperative radiotherapy in selected cases. A prolonged patient follow-up is required, for the tumor may recur many years after surgery. We report a case of acinic cell carcinoma in submaxillary gland.

  11. Humanization of the mouse mammary gland.

    PubMed

    Wronski, A; Arendt, L M; Kuperwasser, Charlotte

    2015-01-01

    Although mouse models have provided invaluable information on the mechanisms of mammary gland development, anatomical and developmental differences between human and mice limit full understanding of this fundamental process. Humanization of the mouse mammary gland by injecting immortalized human breast stromal cells into the cleared murine mammary fat pad enables the growth and development of human mammary epithelial cells or tissue. This facilitates the characterization of human mammary gland development or tumorigenesis by utilizing the mouse mammary fat pad. Here we describe the process of isolating human mammary stromal and epithelial cells as well as their introduction into the mammary fat pads of immunocompromised mice.

  12. Anesthetic Considerations on Adrenal Gland Surgery

    PubMed Central

    Domi, Rudin; Sula, Hektor; Kaci, Myzafer; Paparisto, Sokol; Bodeci, Artan; Xhemali, Astrit

    2015-01-01

    Adrenal gland surgery needs a multidisciplinary team including endocrinologist, radiologist, anesthesiologist, and surgeon. The indications for adrenal gland surgery include hormonal secreting and non-hormonal secreting tumors. Adrenal hormonal secreting tumors present to the anesthesiologist unique challenges requiring good preoperative evaluation, perioperative hemodynamic control, corrections of all electrolytes and metabolic abnormalities, a detailed and careful anesthetic strategy, overall knowledge about the specific diseases, control and maintaining of postoperative adrenal function, and finally a good collaboration with other involved colleagues. This review will focus on the endocrine issues, as well as on the above-mentioned aspects of anesthetic management during hormone secreting adrenal gland tumor resection. PMID:25368694

  13. CULTIVATION IN VITRO OF THE THYROID GLAND

    PubMed Central

    Carrel, Alexis; Burrows, M. T.

    1911-01-01

    The thyroid gland of mammals can be cultivated outside the body. The proliferated elements consist of connective tissue and epithelial cells, the former predominating. The cells survive in cultures for two weeks or longer, which period can be increased by secondary and sometimes by tertiary cultivations. It is to be noted that the method of growing in vitro organs such as the thyroid gland may come to be used with advantage in the study of the substances concerned with the internal secretion of certain glands. PMID:19867423

  14. Adenoma of anogenital mammary-like glands.

    PubMed

    Ahmed, Sartaj; Campbell, Ross M; Li, Jin Hong; Wang, Li Juan; Robinson-Bostom, Leslie

    2007-11-01

    Adenomas in the anogenital region are uncommon. There has been debate about the origin, including ectopic breast tissue, cutaneous apocrine gland, and most recently anogenital mammary-like gland. An anogenital mass in a 36-year-old woman was excised, and histopathologic examination and immunostaining were performed. Microscopic tissue sections showed a morphologic pattern similar to that of a mammary fibroadenoma, and immunostaining demonstrated the presence of estrogen receptors and progesterone receptors. The possibility of adenomas of anogenital mammary-like glands should be considered when evaluating patients with a mass in this area with confirmation by tissue biopsy or aspiration cytology.

  15. Antioxidant enzymatic defense in salivary glands of streptozotocin-induced diabetic rats: a temporal study.

    PubMed

    Ibuki, Flavia Kazue; Simões, Alyne; Nogueira, Fernando Neves

    2010-08-01

    Hyperglycemia induces overproduction of superoxide and it is related to diabetic complications. In this study, we analyzed the antioxidant enzymatic defense and the lipid peroxidation of rat salivary glands in six different periods of diabetic condition. Ninety-six rats were divided into 12 groups: C7/14/21/28/45/60 (non-diabetic animals) and D7/14/21/28/45/60 (diabetic animals). Diabetes was induced by streptozotocin and the rats were euthanized after 7, 14, 21, 28, 45, or 60 days. Their parotid (PA) and submandibular (SM) glands were removed soon after the sacrifice and the total protein and malondialdehyde (MDA) concentrations, as well as, the superoxide dismutase (SOD), glutathione peroxidase (GPx), and catalase (CAT) activities were determined. Twenty-one days after the diabetes induction, the SM glands showed an increase in SOD, CAT, and GPx activities, as well as, MDA concentration. Concerning the PA glands, an increase in the CAT activity and MDA content was observed throughout the observation period. The results suggest that diabetes can cause alterations on the salivary glands and that PA and SM glands react differently when exposed to diabetes condition. However, no impairment of antioxidant system was observed in the group whose diabetic condition had been induced 60 days earlier, herein named 60-day group.

  16. Cervical lymph node metastasis in adenoid cystic carcinoma of the major salivary glands.

    PubMed

    2017-02-01

    To verify the prevalence of cervical lymph node metastasis in adenoid cystic carcinoma of major salivary glands, and to establish recommendations for elective neck treatment. A search was conducted of the US National Library of Medicine database. Appropriate articles were selected from the abstracts, and the original publications were obtained to extract data. Among 483 cases of major salivary gland adenoid cystic carcinoma, a total of 90 (18.6 per cent) had cervical metastasis. The prevalence of positive nodes from adenoid cystic carcinoma was 14.5 per cent for parotid gland, 22.5 per cent for submandibular gland and 24.7 per cent for sublingual gland. Cervical lymph node metastasis occurred more frequently in patients with primary tumour stage T3-4 adenoid cystic carcinoma, and was usually located in levels II and III in the neck. Adenoid cystic carcinoma of the major salivary glands is associated with a significant prevalence of cervical node metastasis, and elective neck treatment is indicated for T3 and T4 primary tumours, as well as tumours with other histological risk factors.

  17. Evaluation of Dry Eye and Meibomian Gland Dysfunction in Teenagers with Myopia through Noninvasive Keratograph

    PubMed Central

    Wang, Xiu; Lu, Xiaoxiao; Yang, Jun; Wei, Ruihua; Yang, Liyuan; Zhao, Shaozhen; Wang, Xilian

    2016-01-01

    Purpose. This study aims to evaluate dry eye and ocular surface conditions of myopic teenagers by using questionnaire and clinical examinations. Methods. A total of 496 eyes from 248 myopic teenagers (7–18 years old) were studied. We administered Ocular Surface Disease Index (OSDI) questionnaire, slit-lamp examination, and Keratograph 5M. The patients were divided into 2 groups based on OSDI dry eye standard, and their ocular surfaces and meibomian gland conditions were evaluated. Results. The tear meniscus heights of the dry eye and normal groups were in normal range. Corneal fluorescein scores were significantly higher whereas noninvasive break-up time was dramatically shorter in the dry eye group than in the normal group. All three meibomian gland dysfunction parameters (i.e., meibomian gland orifice scores, meibomian gland secretion scores, and meibomian gland dropout scores) of the dry eye group were significantly higher than those of the normal group (P < 0.0001). Conclusions. The prevalence of dry eye in myopic teenagers is 18.95%. Meibomian gland dysfunction plays an important role in dry eye in myopic teenagers. The Keratograph 5M appears to provide an effective noninvasive method for assessing ocular surface situation of myopic teenagers. PMID:26881059

  18. Relationship of the recurrent laryngeal nerve to the superior parathyroid gland during thyroidectomy.

    PubMed

    Persky, Michael; Fang, Y; Myssiorek, D

    2014-03-25

    Design: The relationship of the recurrent laryngeal nerve to the superior parathyroid gland during consecutive thyroidectomies was prospectively evaluated. When one structure was noted, careful dissection was performed to locate the other structure, to preserve their natural anatomical relationship. Patients: In total, 103 consecutive thyroid lobectomies were performed on 73 patients. The distance from the superior parathyroid gland to the recurrent laryngeal nerve was recorded. Results: In 88 cases (88.9 per cent), the superior parathyroid gland was identified within 5 mm of the recurrent laryngeal nerve. In 62 cases (62.6 per cent), the gland was within 1 mm of the recurrent laryngeal nerve. The height of the thyroid lobe was positively associated with the distance between the two structures (p = 0.001), as was the incidence of cancer (p = 0.033). The incidence of recurrent laryngeal nerve paresis was less than 4 per cent. Conclusion: In most cases, the recurrent laryngeal nerve was found in close proximity to the superior parathyroid gland. In a thyroid gland with a large height, or in a cancerous lobe, this relationship is less reliable.

  19. Meibography and meibomian gland measurements in ocular graft-versus-host disease.

    PubMed

    Engel, L A; Wittig, S; Bock, F; Sauerbier, L; Scheid, C; Holtick, U; Chemnitz, J-M; Hallek, M; Cursiefen, C; Steven, P

    2015-07-01

    Meibomian gland loss in ocular GvHD was described as a mechanism contributing to dry eye and severe damage to the ocular surface. Infrared images of upper eyelid meibomian glands from 86 ocular GvHD patients, from 10 patients after allogeneic stem cell transplantation (aSCT) without ocular GvHD, from 32 patients prior to aSCT and from 30 healthy controls were analyzed retrospectively and evaluated using two grading schemes. The upper meibomian gland area (uMGA) was calculated and set in relation to the total tarsal area of the lid. Results demonstrate that meibomian gland loss is significantly increased in patients with ocular GvHD as well as in patients prior to aSCT in comparison with controls (P between 0.05 and <0.001). Patients after aSCT without ocular GvHD had no significant difference in uMGA in comparison with controls. This study suggests that meibomian gland loss in GvHD patients is likely to be a multifactorial process that also occurs prior to aSCT, possibly due to underlying diseases and/or secondary to chemotherapy or irradiation. In addition, the question has to be addressed whether meibomian gland loss could serve as a predictor for the development of ocular GvHD. Overall, infrared meibography should be included in routine examination of patients undergoing aSCT and during follow-up.

  20. [Primary sarcoma of the mammary gland].

    PubMed

    Coronel-Brizio, Pedro Guillermo; Quistian Navarrete, Fernando; Guzmán Garcia, Raúl E; Zoloeta Dominguez, Pedro A; Venegas Espinosa, Berenice

    2012-12-01

    Breast cancer occupies the chief place in incidence after the cervix. This gland sarcomas are rare with less than 1% at this location. Its diagnosis is difficult and its evolution is aggressive. Primary breast osteogenic sarcomas are a subset of lower frequency so that their behavior, evolution, prognosis ytratamiento no much experience and often are diagnosed as benign tumors. We report the case of a woman of 59 years which initially arose from a tumor in the right breast was performed with tru-cut biopsy with inconclusive results, using the tumor 7 months after the presence of a multilobulated solid tumor 20 cm, tumor compatible with mammography Phylodes (BIRADS 2). It was decided to perform right total mastectomy and pectoral muscle resection reconstruction with latissimus dorsi more and histochemical review pathology diagnosed with malignant mesenchymal neoplasm, osteosarcoma osteoblast osteoclast type and complemented the treatment with radiotherapy and chemotherapy. The prognosis is poor because the five-year survival is less than 40%. In the fast-growing breast tumors and large mammographic calcifications with signs and antecedentesde irradiation, trauma and Phyllodes tumor must be aware of this disease and that early diagnosis improves survival. In the surgical treatment of axillary dissection is not indicated and adjuvant treatment with radiotherapy and chemotherapy.

  1. Diagnostic value of metabolic heterogeneity as a reliable parameter for differentiating malignant parotid gland tumors.

    PubMed

    Kim, Bum Soo; Kim, Seong-Jang; Pak, Kyoungjune

    2016-06-01

    Exact classifying between malignant and benign tumors in the parotid gland is important because the cancer has relatively poor prognosis. There have been several studies that F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) can differentiate between malignant and benign parotid gland tumors. However, the role of FDG PET is still controversial because many benign parotid gland tumors, such as Warthin's tumor and pleomorphic adenoma, show high FDG uptake. We hypothesized that metabolic heterogeneity would differentiate malignant parotid tumors because tumoral heterogeneity is an important characteristic in the malignancies. From January 2010 to April 2015, we retrospectively reviewed the 46 patients who showed FDG uptake at the parotid gland. To differentiate malignant parotid gland tumors, we obtained maximum SUV and mean SUV. Metabolic tumor volume and total lesion glycolysis were measured as metabolic volumetric parameters. We also included heterogeneity parameters of FDG PET such as heterogeneity factor (HF) and the coefficient of variation for all patients. There was significant difference of HF between malignant (-0.30 ± 0.25; range -0.937 to -0.084) and benign parotid gland tumors (-0.06 ± 0.05; range -0.291 to -0.012; p < 0.0001). In receiver operating characteristic analysis, when ≤-0.084 was used as the cut-off value for HF, the sensitivity and specificity were 100 % (95 % CI 81.5-100) and 89.2 % (95 % CI 71.8-97.7), respectively. HF showed the highest area under the curve of 0.947 among the parameters. In logistic regression analysis, the HF was the most powerful factor for differentiation of the parotid gland tumors (p = 0.002). Our results suggest that HF can be utilized as a reliable and non-invasive method for differentiation of malignant and benign parotid gland tumors.

  2. Influence of intramammary infection of a single gland in dairy cows on the cow's milk quality.

    PubMed

    Bezman, Dror; Lemberskiy-Kuzin, Liubov; Katz, Gil; Merin, Uzi; Leitner, Gabriel

    2015-08-01

    Intramammary infection (IMI), comprises a group of costly diseases affecting dairy animals worldwide. Many dairy parlours are equipped with on-line computerised data acquisition systems designed to detect IMI. However, the data collected is related to the cow level, therefore the contribution of infected glands to the recorded parameters may be over estimated. The present study aimed at evaluating the influence of single gland IMI by different bacteria species on the cow's overall milk quality. A total of 130 cows were tested 239 times; 79 cows were tested once and the others were examined 2-8 times. All of the analysed data refer to the number of tests performed, taking into account the repeated testing of the same cows. Of the cows tested ~50% were free of infection in all 4 glands and the others were infected in one gland with different coagulase negative staphylococci (CNS), Streptococcus dysgalactiae, or were post infected with Escherichia coli (PIEc), i.e., free of bacterial infection at the time of sampling but 1-2 months after clinical infection by E. coli. Overall, infection with bacteria had significant effects on somatic cell count (SCC) and lactose concentration. Examining each bacterium reveals that the major influence on those parameters was the sharp decrease in lactose in the PIEc and curd firmness in PIEc and Strep. Individual gland milk production decreased ~20% in Strep. dysgalactiae- and ~50% in PIEc-infected glands with respect to glands with no bacterial findings. Significant differences were found in lactose, SCC, rennet clotting time and curd firmness in the milk of infected glands and among those, these parameters were significantly higher in Strep. dysgalactiae and PIEc than in CNS infected cows. The current results using quarter-milking reinforces the importance of accurate IMI detection in relation to economic and welfare factors, and moreover, emphasises the need for technical sensing and constant reporting to the farmer about changes

  3. Postmortem acinar autolysis in rat sublingual gland: a morphometric study

    PubMed Central

    NERY, Leticia Rodrigues; MOREIRA, Carla Ruffeil; CESTARI, Tania Mary; TAGA, Rumio; DAMANTE, José Humberto

    2010-01-01

    Objective To analyze and to quantify morphological acinar postmortem changes in rat sublingual glands (SLG). Material and Methods Fifty rats were divided into two groups of 25 animals each. Group I was used for morphological and morphometric evaluations and group II for the determination of gland density and processed gland volume. Acinar autolytic changes were studied at 0 (control group), 3, 6, 12 and 24 h postmortem periods. The morphometric analysis of the volume density (Vv) and total volume (VT) of intact (ia) and autolyzed (aa) acini was performed under light microscopy using a Zeiss II integration grid with 100 symmetrically distributed points. Results Morphologically, temporal progressive nuclear alterations and gradual loss of the structural architecture of acinar cells were found. Regarding quantitative results, both the Vvaa and the Vvia showed statistically significant differences among all postmortem periods (p<0.05). Vvaa increased from 0.42% at 0 h to 75.84% at 24 h postmortem and Vvia decreased from 71.16% to 0% over the same period. For VTaa and VTia, no statistically significant differences occurred between 12-24 h and 0-3 h (p>0.05), respectively. Vtaa increased from 0.18 mm3 at 0 h to 38.17 mm3 at 12 h, while Vtia showed a decrease from 33.47 mm3 to 0 mm3 between 3-24 h postmortem. Data concerning VTaa were adjusted by twovariable linear regression, obtaining the equation: y=-3.54 + 3.38x (r2=0.90). The VTaa growth rate calculated by this equation was 3.38 mm3/h between 0-12 h. Conclusion Acinar autolysis on rat SLG demonstrated the most significant signs during the first 6 h postmortem and was widely spread through the gland at 12 h. PMID:21085809

  4. Postmortem acinar autolysis in rat sublingual gland: a morphometric study.

    PubMed

    Nery, Leticia Rodrigues; Moreira, Carla Ruffeil; Cestari, Tania Mary; Taga, Rumio; Damante, José Humberto

    2010-01-01

    To analyze and to quantify morphological acinar postmortem changes in rat sublingual glands (SLG). MATERIAL AND METHODSs: Fifty rats were divided into two groups of 25 animals each. Group I was used for morphological and morphometric evaluations and group II for the determination of gland density and processed gland volume. Acinar autolytic changes were studied at 0 (control group), 3, 6, 12 and 24 h postmortem periods. The morphometric analysis of the volume density (Vv) and total volume (Vt) of intact (ia) and autolyzed (aa) acini was performed under light microscopy using a Zeiss II integration grid with 100 symmetrically distributed points. Morphologically, temporal progressive nuclear alterations and gradual loss of the structural architecture of acinar cells were found. Regarding quantitative results, both the Vvaa and the Vvia showed statistically significant differences among all postmortem periods (p<0.05). Vvaa increased from 0.42% at 0 h to 75.84% at 24 h postmortem and Vvia decreased from 71.16% to 0% over the same period. For Vtaa and Vtia, no statistically significant differences occurred between 12-24 h and 0-3 h (p>0.05), respectively. Vtaa increased from 0.18 mm³ at 0 h to 38.17 mm³ at 12 h, while Vtia showed a decrease from 33.47 mm³ to 0 mm³ between 3-24 h postmortem. Data concerning Vtaa were adjusted by two-variable linear regression, obtaining the equation: y=-3.54+3.38x (r²=0.90). The Vtaa growth rate calculated by this equation was 3.38 mm³/h between 0-12 h. Acinar autolysis on rat SLG demonstrated the most significant signs during the first 6 h postmortem and was widely spread through the gland at 12 h.

  5. Pineal gland calcification (PGC) in Ugandans. A radiological study of 200 isolated pineal glands.

    PubMed

    Mugondi, S G; Poltera, A A

    1976-07-01

    Two hundred formalin-fixed pineal glands from consecutive unselected post-mortems on Ugandan Africans have been X-rayed. The degree of pineal gland calcification has been divided into four stages and it is shown that 43 per cent of all pineal glands after the age of ten years are likely to be detected in an ordinary skull X ray. This high percentage of calcification contrasts with the previously reported low figure from races other than whites. The pineal glands from females were more often calcified and heavier than those from males; however, the stalks of pineal glands from males were calcified more frequently than those of females. The average weight per decade was almost constant. In Ugandan Africans the pineal glands were significantly lighter than in Caucasians, and a possible reason for this is briefly discussed.

  6. New exocrine glands in ants: the hypostomal gland and basitarsal gland in the genus Melissotarsus (Hymenoptera: Formicidae).

    PubMed

    Hölldobler, Bert; Obermayer, Malu; Plowes, Nicola J R; Fisher, Brian L

    2014-07-01

    Fisher and Robertson (Insect Soc 46: 78-83, 1999) discovered the production of silk-like secretions emerging from slit-shaped openings along the anterior margin of the ventral hypostoma of Melissotarsus ant workers. The current histological study describes a hitherto unknown hypostomal gland from which this silk-like substance originates. In addition, this study describes a new basitarsal gland in the three pairs of legs of Melissotarsus workers.

  7. New exocrine glands in ants: the hypostomal gland and basitarsal gland in the genus Melissotarsus (Hymenoptera: Formicidae)

    NASA Astrophysics Data System (ADS)

    Hölldobler, Bert; Obermayer, Malu; Plowes, Nicola J. R.; Fisher, Brian L.

    2014-07-01

    Fisher and Robertson (Insect Soc 46: 78-83, 1999) discovered the production of silk-like secretions emerging from slit-shaped openings along the anterior margin of the ventral hypostoma of Melissotarsus ant workers. The current histological study describes a hitherto unknown hypostomal gland from which this silk-like substance originates. In addition, this study describes a new basitarsal gland in the three pairs of legs of Melissotarsus workers.

  8. 9 CFR 310.17 - Inspection of mammary glands.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 9 Animals and Animal Products 2 2011-01-01 2011-01-01 false Inspection of mammary glands. 310.17... INSPECTION AND CERTIFICATION POST-MORTEM INSPECTION § 310.17 Inspection of mammary glands. (a) Lactating mammary glands and diseased mammary glands of cattle, sheep, swine, and goats shall be removed...

  9. 9 CFR 310.17 - Inspection of mammary glands.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 9 Animals and Animal Products 2 2014-01-01 2014-01-01 false Inspection of mammary glands. 310.17... INSPECTION AND CERTIFICATION POST-MORTEM INSPECTION § 310.17 Inspection of mammary glands. (a) Lactating mammary glands and diseased mammary glands of cattle, sheep, swine, and goats shall be removed...

  10. 9 CFR 310.17 - Inspection of mammary glands.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 9 Animals and Animal Products 2 2010-01-01 2010-01-01 false Inspection of mammary glands. 310.17... INSPECTION AND CERTIFICATION POST-MORTEM INSPECTION § 310.17 Inspection of mammary glands. (a) Lactating mammary glands and diseased mammary glands of cattle, sheep, swine, and goats shall be removed...

  11. 9 CFR 310.17 - Inspection of mammary glands.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 9 Animals and Animal Products 2 2012-01-01 2012-01-01 false Inspection of mammary glands. 310.17... INSPECTION AND CERTIFICATION POST-MORTEM INSPECTION § 310.17 Inspection of mammary glands. (a) Lactating mammary glands and diseased mammary glands of cattle, sheep, swine, and goats shall be removed...

  12. 9 CFR 310.17 - Inspection of mammary glands.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 9 Animals and Animal Products 2 2013-01-01 2013-01-01 false Inspection of mammary glands. 310.17... INSPECTION AND CERTIFICATION POST-MORTEM INSPECTION § 310.17 Inspection of mammary glands. (a) Lactating mammary glands and diseased mammary glands of cattle, sheep, swine, and goats shall be removed...

  13. The influence of postnatal nutrition on reproductive tract and endometrial gland development in dairy calves.

    PubMed

    Wilson, Meghan L; McCoski, Sarah R; Geiger, Adam J; Akers, R Michael; Johnson, Sally E; Ealy, Alan D

    2017-02-01

    Uterine gland development occurs after birth in cattle and other mammals. The timeline of gland development has been described in various species, but little is known about how postnatal diet influences uterine gland development. This is especially concerning in dairy heifers, where a variety of milk replacer and whole milk nutrition options exist. Little work also exists in cattle to describe how early exposure to steroids influences reproductive tract and uterine gland development. The objective of this work was to determine the effects of early postnatal plane of nutrition and estrogen supplementation on uterine gland development in calves. In both studies, Holstein heifer calves were assigned to restricted milk replacer (R-MR) or enhanced milk replacer (EH-MR) diets. In study 1, calves (R-MR, n = 6; EH-MR, n = 5) were euthanized at 8 wk. In study 2, calves were weaned at 8 wk and administered estradiol (R-MR, n = 6; EH-MR, n = 6) or placebo (R-MR, n = 6; EH-MR, n = 5) for an additional 14 d before euthanasia. Average daily gain and final body weight was greater in both studies in heifers fed the enhanced diet. At 8 wk, EH-MR calves had a greater number of glands and a smaller average gland size, but total gland area was not different from the R-MR group. At 10 wk, uterine gland number and size were not affected by diet or estrogen. Expression profiles of several paracrine mediators of gland development were examined. Increases in transcript abundance for IGF1 and IGFBP3 and a decrease in abundance of WNT7A were detected in calves fed the enhanced diet at 8 wk of age. Plane of nutrition did not affect transcript profiles at 10 wk of age, but estradiol supplementation decreased MET and WNT7A transcript abundance. To conclude, heifer calves on a restricted diet exhibited a uterine morphology and transcript profile suggestive of delayed uterine gland development. These changes appear to be corrected by wk 10 of life. Also, this work provides evidence supporting the

  14. The effects of 5-bromodeoxyuridine and isoproterenol on the postnatal differentiation of rat submandibular gland.

    PubMed

    Fukushima, M; Barka, T

    1976-10-01

    The effects of 5-bromodeoxyuridine (BrdU) on the postnatal differentiation of rat submandibular gland and on the isoproterenol-induced changes of differentiation were studied. The rats were injected with BrdU for three consecutive days, beginning at two days of age. The total dose of BrdU was 0.9 mg/g body weight. BrdU caused a severe retardation of growth up to 15 days of age. A rapid growth of the animals between 15 and 22 days indicated a recovery from the effect of BrdU. The growth of the submandibular gland was retarded similarly with a corresponding decrease in DNA, RNA and protein content. Incorporation of tritiated thymidine into the submandibular gland was not altered in the BrdU-treated animals at one and three days after the last injection of the analog. At days 15 and 22 the rate of thymidine incorporation was greater in the submandibular gland of BrdU-treated rats as compared to littermate controls. Isoproterenol stimulated thymidine incorporation into the submandibular glands of two-week-old rats. This stimulation was not observed in rats which received BrdU at age 7-9 days, prior to the administration of isoproterenol. Election microscopic observations, including a quantitative analysis of the frequency distribution of the various cell types in the terminal tubules and developing acini, indicated a retardation of acinar cell differentiation in the glands of BrdU-treated rats. In addition, there was an increase in the number and size of the secretory granules in the terminal tubule cells. BrdU treatment, however, caused no obvious pathologic alterations in the submandibular gland. Administration of isoproterenol for five days, beginning at five days of age, caused an apparent acceleration of the differentiation of acinar cells. In the glands of isoproterenol-treated rats the acinar cells were enlarged and were filled with homogeneous secretory granules. Pretreatment with BrdU partially inhibited the effects of isoproterenol on differentiation and

  15. Association of Parathyroid Gland Biopsy Excision Technique With Ex Vivo Radiation Counts During Radioguided Parathyroid Surgery.

    PubMed

    Hinson, Andrew M; Lawson, Bradley R; Franco, Aime T; Stack, Brendan C

    2017-06-01

    Parathyroid biopsy represents a means for normal and hyperfunctional glands to be distinguished intraoperatively. However, no data exist to guide surgeons regarding how much of a parathyroid gland must be biopsied to satisfy the 20% rule. To quantify the relative proportion of a hyperfunctional parathyroid gland that must be evaluated with the gamma probe to satisfy the 20% rule. A retrospective review of surgical data for 24 consecutive patients (16 women, 18 men; mean [SD] age, 66.6 [10] years; range, 51-83 years) who underwent surgery for primary hyperparathyroidism between May and October, 2015, in a tertieary academic medical center. Extirpated parathyroid glands were sectioned into parallel or pie-shaped biopsies and evaluated ex vivo with a gamma probe to determine what percentage of a hyperfunctional gland must be sampled to meet the Norman 20% rule. The hypothesis was formulated during data collection. In total, 253 ex vivo biopsy specimens were obtained from 33 surgically removed parathyroid glands. Parathyroid biopsies satisfied the 20% rule with an accuracy that depended on the relative proportion of the parent gland represented: half or more (96.6%; 95% CI, 91.7%-100.0%), a quarter to one-half (87.0%; 95% CI, 79.3%-94.7%), less than a quarter (63.6%; 95% CI, 54.5%-72.8%). When less than a quarter of the gland was removed, pie-shaped biopsies were more likely to satisfy the 20% rule compared with parallel biopsies of the same weight (78.4% vs 56.2%; absolute difference, 22.2%; 95% CI, 4.7%-39.7%). Unless half of a parathyroid gland is biopsied during radioguided parathyroidectomy, the 20% rule cannot reliably rule out the presence of a hyperfunctional parathyroid lesion. Pie-shaped biopsies originating from the center of the gland are associated with a lower rate of false-negative results compared with peripheral biopsies of similar size. Pie-shaped biopsies and biopsy of half or more of each nonexcised parathyroid gland for ex vivo counts may increase

  16. [Pheochromocytomas as adrenal gland incidentalomas].

    PubMed

    Cerović, Snezana; Cizmić, Milica; Milović, Novak; Ajdinović, Boris; Brajusković, Goran

    2002-07-01

    Adrenal incidentalomas are a heterogeneous group of pathological entities, including benign or malignant adrenocortical or medullary tumors, hormonally active or inactive lesions, which are identified incidentally during the examination of nonadrenal-related abdominal complaints. About 1.5% to 23% of adrenal incidentalomas are pheochromocytomas. Composite pheochromocytoma is a rare tumour of adrenal medulla with divergente clinical course. This type of pheochromocytoma is designated "composite" or "mixed," depending on whether pheochromocytoma and nonpheochromocytoma components show the same embryologic origin. Nonpheochromocytoma components found in the composite pheochromocytoma include ganglioneuroma, ganglioneuroblastoma, neuroblastoma, and malignant schwannoma. The biologic behavior of composite pheochromocytomas may be as difficult to predict as more traditional pheochromocytomas; based on the number of cases reported to date the presence of areas resembling ganglioneuroblastoma or neuroblastoma does not necessary indicate a poor prognosis. Some may behave in a malignant fashion with metastasis by a component of the tumour which has neural features. Pheochromocytomas and paragangliomas are well-defined entities. Some of their nonsporadic associations and unusual morphological appearances are not universally appreciated. We report on a rare association of left adrenal CP, with typical right adrenal phochromocytoma and retroperitoneal paraganglioma, and a review of literature. We analyzed the clinical and immunohistochemical features in a 24-year-old woman with composite pheochromocytoma localized in the left adrenal gland and associated with blood pressure of 200/140 mmHg. Abdominal computed tomography and 131-J MIBG revealed a 65 x 60 mm mass in the right adrenal gland, but no revealed 45 x 40 mm retroperitoneal mass and 20 x 20 mm mass in the left adrenal region. Serum and urinary adrenaline levels were high, and catecholamine levels in the blood sample of

  17. Structure and context in prostatic gland segmentation and classification.

    PubMed

    Nguyen, Kien; Sarkar, Anindya; Jain, Anil K

    2012-01-01

    A novel gland segmentation and classification scheme applied to an H&E histology image of the prostate tissue is proposed. For gland segmentation, we associate appropriate nuclei objects with each lumen object to create a gland segment. We further extract 22 features to describe the structural information and contextual information for each segment. These features are used to classify a gland segment into one of the three classes: artifact, normal gland and cancer gland. On a dataset of 48 images at 5x magnification (which includes 525 artifacts, 931 normal glands and 1,375 cancer glands), we achieved the following classification accuracies: 93% for artifacts v. true glands; 79% for normal v. cancer glands, and 77% for discriminating all three classes. The proposed method outperforms state of the art methods in terms of segmentation and classification accuracies and computational efficiency.

  18. Adenoid Cystic Carcinoma of Sublingual Salivary Gland Obstructing the Submandibular Salivary Gland Duct

    PubMed Central

    Kumar, Venkata Suneel; Prathi, Venkata Sarath; Manne, Rakesh Kumar; Beeraka, Swapna; Natarajan, Kannan

    2013-01-01

    Sublingual salivary gland malignancies are extremely rare and account for only 0.3-1% of all epithelial salivary gland tumors. Here, we report a case of adenoid cystic carcinoma (ACC) of the sublingual salivary gland that presented as a swelling in the right anterior floor of the mouth obstructing the submandibular duct. Sublingual salivary gland ACC obstructing the submandibular duct is rare and only three cases have been reported in the literature until date. We discuss the different patterns of ACC seen during the pathologic investigations and its radiologic features. PMID:24516773

  19. Salivary gland progenitor cell biology provides a rationale for therapeutic salivary gland regeneration.

    PubMed

    Lombaert, I M A; Knox, S M; Hoffman, M P

    2011-07-01

    An irreversible loss of salivary gland function often occurs in humans after removal of salivary tumors, after therapeutic radiation of head and neck tumors, as a result of Sjögren's syndrome and in genetic syndromes affecting gland development. The permanent loss of gland function impairs the oral health of these patients and broadly affects their quality of life. The regeneration of functional salivary gland tissue is thus an important therapeutic goal for the field of regenerative medicine and will likely involve stem/progenitor cell biology and/or tissue engineering approaches. Recent reports demonstrate how both innervation of the salivary gland epithelium and certain growth factors influence progenitor cell growth during mouse salivary gland development. These advances in our understanding suggest that developmental mechanisms of mouse salivary gland development may provide a paradigm for postnatal regeneration of both mice and human salivary glands. Herein, we will discuss the developmental mechanisms that influence progenitor cell biology and the implications for salivary gland regeneration.

  20. The nasus gland: a new gland in soldiers of Angularitermes (Termitidae, Nasutitermitinae).

    PubMed

    Šobotník, Jan; Bourguignon, Thomas; Carrijo, Tiago F; Bordereau, Christian; Robert, Alain; Křížková, Barbora; Constantini, Joice P; Cancello, Eliana M

    2015-09-01

    Termites have developed many exocrine glands, generally dedicated to defence or communication. Although a few of these glands occur in all termite species, or represent synapomorphies of larger clades, others are morphological innovations of a single species, or a few related species. Here, we describe the nasus gland, a new gland occurring at the base of the nasus of Angularitermes soldiers. The nasus gland is composed of class 1, 2, and 3 secretory cells, a rare combination that is only shared by the sternal and tergal glands of some termites and cockroaches. The ultrastructural observations suggest that the secretion is produced by class 2 and 3 secretory cells, and released mostly by class 3 cells. The base of the nasus has a rough appearance due to numerous pits bearing openings of canals conducting the secretion from class 3 secretory cells to the exterior. We tentatively assign a defensive function to the nasus gland, although further research is needed to confirm this function. Although the gland is described only from species of Angularitermes, other genera of Nasutitermitinae also present a rough nasus base, suggesting the presence of a similar, possibly homologous, gland.