Gastroesophageal reflux disease (GERD) as a possible cause of chronic cough is known for decades. However, more than 75% of patients with extraoesophageal symptoms do not suffer from typical symptoms of GERD like pyrosis and regurgitations and have negative upper gastrointestinal endoscopy. For such a condition term laryngopharyngeal reflux (LPR) was introduced and is used for more than two decades. Since the comprehensive information on relationship between chronic cough and LPR is missing the aim of this paper is to summarize current knowledge based on review of published information during last 13 years. Laryngopharyngeal reflux is found in 20% of patients with chronic cough. The main and recognized diagnostic method for LPR is 24-h multichannel intraluminal impedance-pH (MII-pH) monitoring, revealing reflux episodes irritating the upper and lower respiratory tract mucosa. The treatment of LPR should be initiated with dietary and lifestyle measures, followed by proton pump inhibitor (PPI) therapy and other measures. Despite progress, more research is needed for accurate diagnosis and targeted therapies. Key areas for exploration include biomarkers for diagnosis, the impact of non-acid reflux on symptom development, and the efficacy of new drugs. Further studies with a focused population, excluding other causes like asthma, and using new diagnostic criteria for LPR are essential. It's crucial to consider LPR as a potential cause of unexplained chronic cough and to approach diagnosis and treatment with a multidisciplinary perspective.
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
BACKGROUND: Scattered, small, dot-like intraepithelial papillary capillary loops (IPCLs) represent type IV epithelial vascularization according to "Ni classification" and are considered to be nonmalignant. According to the European Laryngological Society classification, these loops are malignant vascular changes. This contradiction has high clinical importance; therefore, clarification of the clinical significance of type IV vascularization according to the Ni classification is needed. METHODS: The study was performed between June 2015 and December 2022. All recruited patients (n = 434) were symptomatic, with macroscopic laryngeal lesions (n = 674). Patients were investigated using the enhanced endoscopic methods of narrow band imaging (NBI) and the Storz Professional Image Enhancement System (IMAGE1 S). The microvascular patterns in the lesions were categorized according to Ni classification from 2011 and all lesions were examined histologically. RESULTS: A total of 674 lesions (434 patients) were investigated using flexible NBI endoscopy and IMAGE1 S endoscopy. Type IV vascularization was recognized in 293/674 (43.5%) lesions. Among these 293 lesions, 178 (60.7%) were benign (chronic laryngitis, hyperplasia, hyperkeratosis, polyps, cysts, granulomas, Reinkeho oedema and recurrent respiratory papillomatosis); 9 (3.1%) were squamous cell carcinoma; 61 (20.8%) were mildly dysplastic, 29 (9.9%) were moderately dysplastic, 14 (4.8%) were severe dysplastic and 2 (0.7%) were carcinoma in situ. The ability to recognize histologically benign lesions in group of nonmalignant vascular pattern according to Ni (vascularization type I-IV) and distinguish them from precancers and malignancies was with accuracy 75.5%, sensitivity 54.4%, specificity 94.4%, positive predictive value 89.6% and negative predictive value 69.9%. CONCLUSION: Laryngeal lesions with type IV vascularization as defined by Ni present various histological findings, including precancerous and malignant lesions. Patients with type IV vascularization must be followed carefully and, in case of progression mucosal lesion microlaryngoscopy and excision are indicated.
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Lung cancer poses a significant challenge with high mortality rates. Minimally invasive surgical approaches, including the uniportal thoracoscopic technique, offer potential benefits in terms of recovery and patient compliance. This study focuses on evaluating the radicality of mediastinal lymphadenectomy during uniportal thoracoscopic lung resection, specifically assessing the reachability of established lymphatic stations. METHODS: A comparative study was conducted at the University Hospital Ostrava from January 2015 to July 2022, focusing on the evaluation of radicality in mediastinal lymphadenectomy across three patient subgroups: uniportal thoracoscopic approach, multiportal thoracoscopic approach, and thoracotomy approach. The study implemented the routine identification and excision of 8 lymph node stations from the respective hemithorax to assess the radicality of lymph node harvesting. RESULTS: A total of 428 patients were enrolled and evaluated. No significant differences were observed in the number of lymph nodes removed between the subgroups. The mean number of lymph nodes removed was 6.50 in the left hemithorax and 6.49 in the right hemithorax. The 30-day postoperative morbidity rate for the entire patient population was 27.3%, with 17.5% experiencing minor complications and 6.5% experiencing major complications. Statistically significant differences were observed in major complications between the uniportal approach and the thoracotomy approach (3.5% vs 12.0%, p = 0.002). The overall mortality rate in the study population was 3%, with a statistically significant difference in mortality between the uniportal and multiportal approaches (1.0% vs 6.4%, p = 0.020). CONCLUSIONS: The uniportal approach demonstrated comparable accessibility and lymph node yield to multiportal and thoracotomy techniques. It is equivalent to established methods in terms of postoperative complications, with fewer major complications compared to thoracotomy. While our study indicates a potential for lower mortality following uniportal lung resection in comparison to multiportal lung resection, and demonstrates comparable outcomes to thoracotomy, it is important to approach these findings cautiously and refrain from drawing definitive conclusions.
PURPOSE: Narrow-band imaging is the state of the art in the diagnosis of mucosal lesions of the vocal cords. It is also used in the follow-up of patients after surgical therapy. Unfortunately, if a patient has received radiotherapy the follow-up is much more difficult. Radiation induces inflammatory changes in the mucosa, which lead to changes in the vascular architecture and thus affect the results of the examination. The dynamics and time dependence of vascular changes after radiotherapy have not yet been described. The purpose of this study is to describe the evolution of the vascular pattern in vocal cords after primary radiotherapy for glottic cancer. METHODS: This was a retrospective cohort study. Each patient underwent NBI videolaryngoscopy and was followed every 3 months. RESULTS: The tumor-related mucosal changes diminished at 3 months after radiotherapy. Afterward, growth of new longitudinal vasculature was observed and significantly slowed after 9 months. No perpendicular vasculature or tumor recurrence was observed during the course of the study. CONCLUSIONS: According to our data, we can conclude that post-radiation mucosal vasculature changes are only longitudinal.
Endoscopic methods are critical in the early diagnosis of mucosal lesions of the head and neck. In recent years, new examination methods and classification systems have been developed and introduced into clinical practice. All of these new techniques target the notion of optical biopsy, which tries to assess the nature of the lesion before histology examination. Many methods suffer from interpretation issues due to subjective interpretation of the findings. Therefore, multiple classification systems have been developed to assist the proper interpretation of mucosal findings and reduce the error rate. They provide various perspectives on the assessment and interpretation of mucosa changes. This article provides a comprehensive and critical view of the available classification systems as well as their advantages and disadvantages.
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
Diagnostika časných slizničních lézí hlavy a krku není v klinické praxi jednoduchá. Léze jsou často malé, obtíže pacientů nespecifické, maligní tumory někdy imponují benigně a naopak. Proto může na jedné straně dojít k pozdní diagnostice u zhoubných nádorů, na straně druhé pak ke zbytečně rychlé indikaci k anestezii a histologické verifikaci u lézí nezhoubných. Vývoj v posledních letech umožnil zlepšit předhistologickou diagnostiku, a to pomocí moderních endoskopických metod (zejména narrow band imaging – NBI a IMAGE1 STM), které umožňují zobrazení slizniční vaskularizace léze a jejího okolí. Další vyšetřovací metodou je „vylepšená kontaktní endoskopie“ (enhanced contact endoscopy – ECE). Kombinace zvětšovací optiky a speciálního zobrazovacího režimu umožňuje posoudit slizniční vaskularizaci pozorovaných lézí a jejich okolí ještě podrobněji. Na základě změn architektoniky vaskularizace sliznice lze v současnosti s velkou mírou přesností odhadnout biologický charakter léze. Cílem článku je podat komplexní přehled o ECE.
Early diagnosis of mucosal lesions of the head and neck is difficult. The lesions are usually small, malignant tumours sometimes seem benign and vice versa, and the patients' symptoms are nonspecific. These problems may lead to a delay in the diagnosis of malignant tumours, or on the contrary, to unnecessarily quick indication for histologic verification of the tumour. Technological advances in recent years improved the pre-histological diagnosis with new endoscopic methods (especially Narrow Band Imaging – NBI and IMAGE1 STM), which allowed a better visualization of the mucosal vessels and their surroundings. Another method, called Enhanced Contact Endoscopy (ECE), combines magnifying optics and enhanced imaging modes (such as NBI and IMAGE1 S) and enables accurate assessment of the mucosal vessels of the examined lesion. Based on the changes in the vascular architecture, it is possible to assess the biological character of the lesion with great precision. The aim of this article is to provide a complex overview of ECE.
- MeSH
- endoskopie metody MeSH
- intravitální mikroskopie metody MeSH
- laryngoskopie metody MeSH
- lidé MeSH
- nádory hlavy a krku * diagnostické zobrazování MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
