RESUMO
Cryptococcal meningitis (CM) is mostly seen in immunocompromised patients, particularly human immunodeficiency virus (HIV)-positive patients, but CM may also occur in apparently immunocompetent individuals. Outcome analyses have been performed in such patients but, due to the high prevalence of HIV infection worldwide, CM patients today may be admitted to hospitals with unknown HIV status, particularly in underdeveloped countries. The objective of this multicenter study was to analyze all types of CM cases in an aggregate cohort to disclose unfavorable outcomes. We retrospectively reviewed the hospitalized CM patients from 2000 to 2015 in 26 medical centers from 11 countries. Demographics, clinical, microbiological, radiological, therapeutic data, and outcomes were included. Death, neurological sequelae, or relapse were unfavorable outcomes. Seventy (43.8%) out of 160 study cases were identified as unfavorable and 104 (65%) were HIV infected. On multivariate analysis, the higher Glasgow Coma Scale (GCS) scores (p = 0.021), cerebrospinal fluid (CSF) leukocyte counts > 20 (p = 0.038), and higher CSF glucose levels (p = 0.048) were associated with favorable outcomes. On the other hand, malignancy (p = 0.026) was associated with poor outcomes. Although all CM patients require prompt and rational fungal management, those with significant risks for poor outcomes need to be closely monitored.
Assuntos
Antifúngicos/uso terapêutico , Meningite Criptocócica/tratamento farmacológico , Meningite Criptocócica/mortalidade , Adulto , Líquido Cefalorraquidiano/microbiologia , Comorbidade , Cryptococcus/classificação , Cryptococcus/isolamento & purificação , Feminino , Infecções por HIV/complicações , Humanos , Hospedeiro Imunocomprometido , Masculino , Meningite Criptocócica/diagnóstico , Pessoa de Meia-Idade , Estudos Retrospectivos , Inquéritos e Questionários , Resultado do TratamentoRESUMO
In the original version of this article, Mustafa Sunbul was not included in the list of authors for this article. The name has been added accordingly.
RESUMO
Renal involvement due to European Puumala virus (PUUV) is frequent but pulmonary involvement is quite rare. We present here, a 24-year-old male with atypical clinical presentation of acute PUUV infection with gross pulmonary and minimal renal involvement. Severe pulmonary manifestations of PUUV infection, in this case, highlights that hantavirus infection should be considered in the differential diagnosis of atypical pneumonia.
Assuntos
Infecções por Hantavirus/virologia , Pneumonia/virologia , Virus Puumala , Humanos , Masculino , Adulto JovemRESUMO
Tetanus is an acute, severe infection caused by a neurotoxin secreting bacterium. Various prognostic factors affecting mortality in tetanus patients have been described in the literature. In this study, we aimed to analyze the factors affecting mortality in hospitalized tetanus patients in a large case series. This retrospective multicenter study pooled data of tetanus patients from 25 medical centers. The hospitals participating in this study were the collaborating centers of the Infectious Diseases International Research Initiative (ID-IRI). Only adult patients over the age of 15 years with tetanus were included. The diagnosis of tetanus was made by the clinicians at the participant centers. Izmir Bozyaka Education and Research Hospital's Review Board approved the study. Prognostic factors were analyzed by using the multivariate regression analysis method. In this study, 117 adult patients with tetanus were included. Of these, 79 (67.5%) patients survived and 38 (32.5%) patients died. Most of the deaths were observed in patients >60 years of age (60.5%). Generalized type of tetanus, presence of pain at the wound area, presence of generalized spasms, leukocytosis, high alanine aminotransferase (ALT) and C-reactive protein (CRP) values on admission, and the use of equine immunoglobulins in the treatment were found to be statistically associated with mortality (p < 0.05 for all). Here, we describe the prognostic factors for mortality in tetanus. Immunization seems to be the most critical point, considering the advanced age of our patients. A combination of laboratory and clinical parameters indicates mortality. Moreover, human immunoglobulins should be preferred over equine sera to increase survival.
Assuntos
Tétano/mortalidade , Tétano/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Medição de Risco , Análise de Sobrevida , Tétano/epidemiologia , Adulto JovemRESUMO
The aim of this study was to compare the responses of colistin treatment alone vs. a combination of colistin and rifampicin in the treatment of ventilator-associated pneumonia (VAP) caused by a carbapenem-resistant A. baumannii strain. Forty-three patients were randomly assigned to one of two treatment groups. Although clinical (P = 0·654), laboratory (P = 0·645), radiological (P = 0·290) and microbiological (P = 0·597) response rates were better in the combination group, these differences were not significant. However, time to microbiological clearance (3·1 ± 0·5 days, P = 0·029) was significantly shorter in the combination group. The VAP-related mortality rates were 63·6% (14/22) and 38·1% (8/21) for the colistin and the combination groups (P = 0·171), respectively. Our results suggest that the combination of colistin with rifampicin may improve clinical and microbiological outcomes of VAP patients infected with A. baumannii.
Assuntos
Infecções por Acinetobacter/tratamento farmacológico , Acinetobacter baumannii/efeitos dos fármacos , Antibacterianos/uso terapêutico , Colistina/uso terapêutico , Pneumonia Associada à Ventilação Mecânica/tratamento farmacológico , Rifampina/uso terapêutico , Infecções por Acinetobacter/microbiologia , Antibacterianos/administração & dosagem , Carbapenêmicos/uso terapêutico , Colistina/administração & dosagem , Quimioterapia Combinada , Feminino , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Pneumonia Associada à Ventilação Mecânica/microbiologia , Rifampina/administração & dosagem , Resultado do Tratamento , Resistência beta-LactâmicaRESUMO
OBJECTIVE: The aims of the study were to compare: a) the thermogenic responses in subclinical hypothyroidism (SH) and euthyroid state; b) the relationship between thermogenic response and leptin level. METHODS: Thirty women diagnosed with SH (mean age 39.9+/-4.1 yr; body mass index 23.2+/-2.5 kg/m(2)) were enrolled in the study. Thyroid function tests, leptin, and lipid profiles were measured during SH and after stable euthyroidism was recovered. Thermogenic response was measured by Water Immersion Calorimetry during SH and after the euthyroid state was attained. RESULTS: The mean level of thermogenic response was found to be 1.45+/-0.43 kcal/kg*h in women with SH. It changed to 1.54+/-0.77 kcal/kg*h (p=0.01) in the euthyroid state; the change was statistically significant. Mean level of leptin was found to be 7.22+/-2.6 ng/ml in SH; and 15.8+/-8.0 ng/ml in the euthyroid state. There was a positive correlation between leptin and free T(3) (r=0.460, p=0.009) levels in SH. There were positive correlations between leptin level and fat mass in SH (r=0.820, p=0.01) and in the euthyroid state (r=0.700, p=0.03). CONCLUSIONS: No correlations were found between thermogenic response and leptin levels in SH and in the euthyroid state. Thermogenic response and leptin levels rose after the euthyroid state was recovered.
Assuntos
Hipotireoidismo/sangue , Hipotireoidismo/fisiopatologia , Leptina/sangue , Termogênese/fisiologia , Adulto , Índice de Massa Corporal , Feminino , HumanosRESUMO
BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is among the most common causes of chronic liver disease and cirrhosis. In NAFLD, histological course of steatosis is usually macrovesicular (MacroS), but it may be accompanied by varying degrees of microvesicular steatosis (MicroS). Thus, in this study, we aimed to evaluate the prevalence and significance of MicroS in subjects with NAFLD. METHODS: A retrospective analysis of clinical and laboratory data of patients with histologically proven NAFLD was performed. The liver biopsy specimens which stained with hematoxylin eosin, reticulin, and Masson's Trichrome stains were evaluated by single expert liver pathologist. Scoring and semiquantitative assessment of steatosis and NAFLD severity was done according to Kleiner scale known as NAFLD activity score (NAS). Grading for steatosis, steatosis type, zonal distribution of steatosis and other histological findings were also determined. RESULTS: The prevalence of MicroS among the study population (n= 191) was 30.4%. There was no difference regarding the demographic and biochemical parameters between patients with or without MicroS. On the other hand, the prevalence of ballooning injury and megamitochondria were higher in patients with MicroS (p= 0.019 and p= 0.036, respectively). There was a significant association of MicroS with ballooning injury (OR 2.65, 95% CI= 1.26-5.55 ; p= 0.005) and the presence of megamitochondria (OR 3.72, 95% CI= 1.00-13.72 ; p= 0.037). CONCLUSION: MicroS is common in patients with NAFLD and is associated with early histological findings in this clinically relevant condition. Further longitudinal studies are needed to characterize the role of MicroS in the natural history of NAFLD.
Assuntos
Hepatopatia Gordurosa não Alcoólica , Biópsia , Humanos , Fígado/patologia , Cirrose Hepática/patologia , Hepatopatia Gordurosa não Alcoólica/diagnóstico , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Hepatopatia Gordurosa não Alcoólica/patologia , Estudos Retrospectivos , Índice de Gravidade de DoençaRESUMO
Glucose utilization studies show that sibutramine-induced thermogenesis is mediated via selective sympathetic activation of brown adipose tissue. The goal of the present study was to use a new calorimetry method in which resting metabolic rate is enhanced to evaluate the effects of sibutramine treatment on thermogenesis. Sixty obese women were included in the study. Subjects were divided into 2 equal groups-the placebo and sibutramine treatment groups. The sibutramine group was given sibutramine 10 mg daily for 12 wk. At baseline and at the end of the 12-wk treatment period, thermogenic measurements were taken with the use of water immersion calorimetry. Subjects were examined at weeks 4, 8, and 12 of treatment to identify adverse effects. Body mass index, measured at 31.5+/-2.05 kg/m2 in the placebo group, decreased to 30.4+/-2.94 kg/m(2) after 12 wk (P=.07). In the sibutramine group, it decreased from 33.5+/-4.1 kg/m(2) to 30.9+/-4.8 kg/m(2) (P<.05). In the sibutramine group, mean thermogenic response changed from a baseline value of 1.27+/-0.29 kcal/kg/h to 1.44+/-0.13 kcal/kg/h after 12 wk of treatment. In the placebo group, the baseline value was 1.56+/-0.27 kcal/kg/h; it changed to 1.33+/-0.36 kcal/kg/h at the end of 12 wk. The findings of this study suggest that sibutramine treatment promotes thermogenesis, thus facilitating weight loss. Calorimetry enhances resting metabolism through more efficient heat transfer from the body.
Assuntos
Depressores do Apetite/uso terapêutico , Ciclobutanos/uso terapêutico , Obesidade/tratamento farmacológico , Termogênese/efeitos dos fármacos , Adulto , Pressão Sanguínea/efeitos dos fármacos , Índice de Massa Corporal , Calorimetria/métodos , Interação do Duplo Vínculo , Feminino , Frequência Cardíaca/efeitos dos fármacos , Humanos , Obesidade/fisiopatologia , Relação Cintura-QuadrilRESUMO
OBJECTIVE: Pentraxin-3 (PTX-3) is an acute-phase protein belonging to the PTX family. It has been reported that PTX-3 is significantly associated with obesity, metabolic syndrome, and cardiovascular diseases (CVD). Non-alcoholic fatty liver disease (NAFLD) is strongly associated with atherosclerosis and CVD. In this study, we aimed to investigate the relationship of PTX-3 with circulating markers of endothelial dysfunction and atherosclerosis in patients with NAFLD. PATIENTS AND METHODS: Seventy patients with biopsy-proven NAFLD and seventy healthy controls were enrolled in the study. Plasma asymmetric dimethylarginine (ADMA), adiponectin, and PTX-3 levels were determined using enzyme-linked immunosorbent assay (ELISA). High-sensitivity C-reactive protein (hsCRP) serum levels were measured with the immunoturbidimetric assay. Insulin resistance was estimated using the HOMA-IR index. RESULTS: PTX-3 and hsCRP levels were higher and adiponectin levels were lower in the NAFLD group compared to the healthy controls (p < 0.001 for all). In correlation analysis, a significant association was observed between PTX-3 and ADMA levels (r = 0.423, p < 0.001). CONCLUSIONS: Our study demonstrated for the first time that increased circulating PTX-3 is strongly associated with endothelial dysfunction in subjects with NAFLD. However, large prospective studies are needed to establish the independent predictive value of PTX-3 for CVD endpoints in this clinically relevant condition.
Assuntos
Proteína C-Reativa , Hepatopatia Gordurosa não Alcoólica/genética , Componente Amiloide P Sérico , Estudos de Casos e Controles , Ensaio de Imunoadsorção Enzimática , Humanos , Estudos ProspectivosRESUMO
It was theoretically predicted earlier that if a periodic force without constant component is applied to a particle, then the particle can produce a directed drift in some direction. The effect is named nonlinear electrofrictiophoresis, because it is crucial for its appearance that the friction force depends on the particle's velocity in a nonlinear manner. We test a possibility to observe this effect when a mixture of fragments of DNA (the DNA ladder) moves in the agarose gel. For this purpose, we study the nonlinear characteristics of a DNA ladder movement in the gel. The gels with the ladder were run under various electric field strengths. It was found that the friction coefficient for each DNA fragment in the ladder depends on the migration velocity, suggesting that energy dissipation during migration is a nonlinear function of velocity. This nonlinearity makes the system under consideration suitable for observing nonlinear electrofrictiophoresis. A possible velocity of directed drift under periodic electric drive without constant component was estimated numerically for experimentally observed dependencies. The velocity appeared to be comparable with that of migration under a constant field of moderate strength. A possible mechanism of energy dissipation during movement of DNA through the gel is discussed.
Assuntos
Eletroforese em Gel de Ágar/métodos , Raios UltravioletaRESUMO
In the past 15 yrs, a number of investigators have applied spectral analysis to respiratory sounds recorded from the chest wall or the trachea in order to objectively characterize them and to relate them with different pulmonary diseases. In the present study, we have applied multivariate linear discriminant analysis to the spectral features of respiratory sounds. Lung sounds and the airflow velocity were recorded from 15 normal adults and 37 patients falling into three different disease categories: chronic obstructive lung disease, bronchial asthma and bronchiectasis. All patients had prominent adventitious lung sounds (i.e. either wheezes or crackles). Amplitude spectra of five selected inspiratory and expiratory sound segments of each subject were calculated using the Fast Fourier Transform algorithm. Multi-variate linear discriminant analysis was then applied to the normalized and averaged spectral area values calculated for 10 unequal and arbitrarily selected frequency bands for each patient in the frequency range between 80 Hz and 1 kHz. Inspiratory and expiratory sounds were treated separately. Discriminant functions were computed from the spectral area values and plotted on graphs to classify the subjects into one of the disease categories or as normal (training set). While some separation was achieved among the different disease groups, a clearer separation was evident between normals and patients as a whole on the basis both of inspiratory and expiratory sounds. Inspiratory and expiratory sound frequency bands having the largest weights in classification were determined. Admittedly, the specific results of this study are preliminary or even tentative in view of the inadequacies of sound recording and signal conditioning techniques that were available to us at the time of recording. However, we believe that the investigation serves to illustrate the potential of multivariate discriminant analysis in the diagnostic classification of patients on the basis of their lung sound patterns. We suggest that this technique be considered by investigators involved in lung sound research, because it also allows other patient variables to be combined with the selected parameters of lung sounds.
Assuntos
Asma/diagnóstico , Bronquiectasia/diagnóstico , Pneumopatias Obstrutivas/diagnóstico , Análise Multivariada , Sons Respiratórios , Adulto , Asma/fisiopatologia , Bronquiectasia/fisiopatologia , Diagnóstico Diferencial , Análise Discriminante , Feminino , Volume Expiratório Forçado , Humanos , Pneumopatias Obstrutivas/fisiopatologia , Masculino , Valor Preditivo dos Testes , Sons Respiratórios/fisiopatologia , Sensibilidade e Especificidade , Capacidade VitalRESUMO
In this multicentre study, which is the largest case series ever reported, we aimed to describe the features of tularaemia to provide detailed information. We retrospectively included 1034 patients from 41 medical centres. Before the definite diagnosis of tularaemia, tonsillitis (n = 653, 63%) and/or pharyngitis (n = 146, 14%) were the most frequent preliminary diagnoses. The most frequent clinical presentations were oropharyngeal (n = 832, 85.3%), glandular (n = 136, 13.1%) and oculoglandular (n = 105, 10.1%) forms. In 987 patients (95.5%), the lymph nodes were reported to be enlarged, most frequently at the cervical chain jugular (n = 599, 58%), submandibular (n = 401, 39%), and periauricular (n = 55, 5%). Ultrasound imaging showed hyperechoic and hypoechoic patterns (59% and 25%, respectively). Granulomatous inflammation was the most frequent histological finding (56%). The patients were previously given antibiotics for 1176 episodes, mostly with ß-lactam/ß-lactamase inhibitors (n = 793, 76%). Antituberculosis medications were provided in seven (2%) cases. The patients were given rational antibiotics for tularaemia after the start of symptoms, with a mean of 26.8 ± 37.5 days. Treatment failure was considered to have occurred in 495 patients (48%). The most frequent reasons for failure were the production of suppuration in the lymph nodes after the start of treatment (n = 426, 86.1%), the formation of new lymphadenomegalies under treatment (n = 146, 29.5%), and persisting complaints despite 2 weeks of treatment (n = 77, 15.6%). Fine-needle aspiration was performed in 521 patients (50%) as the most frequent drainage method. In conclusion, tularaemia is a long-lasting but curable disease in this part of the world. However, the treatment strategy still needs optimization.
Assuntos
Tularemia/patologia , Adolescente , Adulto , Idoso , Antibacterianos/uso terapêutico , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Tularemia/tratamento farmacológico , Turquia , Adulto JovemRESUMO
The emergence of carbapenem resistance in Pseudomonas aeruginosa threatens the efficacy of this important anti-pseudomonal antibiotic class. Between 2003 and 2006, an increase in the number of carbapenem-resistant P. aeruginosa isolates at the Zonguldak Karaelmas University Hospital was observed (Zonguldak, Turkey). To assess the imipenem resistance mechanisms emerging in these P. aeruginosa isolates, they were characterized by amplified fragment length polymorphism typing, which revealed diversity among imipenem-resistant isolates as well as two clonally related outbreak groups. The molecular mechanism of carbapenem resistance was characterized in a representative isolate from each clonal group. Mutational disruption of oprD was the most frequently encountered resistance mechanism (23/27 isolates).
Assuntos
Antibacterianos/farmacologia , Imipenem/farmacologia , Infecções por Pseudomonas/microbiologia , Pseudomonas aeruginosa/efeitos dos fármacos , Resistência beta-Lactâmica , Análise do Polimorfismo de Comprimento de Fragmentos Amplificados , Técnicas de Inativação de Genes , Variação Genética , Hospitais Universitários , Humanos , Porinas/genética , Pseudomonas aeruginosa/classificação , Pseudomonas aeruginosa/genética , Pseudomonas aeruginosa/isolamento & purificação , TurquiaRESUMO
Tigecycline seems to be a promising agent for treatment of resistant Acinetobacter baumannii infections, however approved criteria for susceptibility testing are still lacking. The aim of this study was to evaluate tigecycline activity against multidrug resistant A. baumannii clinical isolates, as well as susceptibility testing methods and disk diffusion (DD) breakpoints. Reference broth microdilution (BMD), Etest and DD methods were used. MIC(50 )and MIC(90 )by the reference method were 1 and 8 microg/ml, respectively. Applying the breakpoints for enterobactericeae, 85.7% of the isolates were sensitive to tigecycline. The Etest resulted in lower susceptibility rates (63.7%). Essential agreement between Etest and BMD was 75.8%. 21.9% of the strains were susceptible by BMD and intermediate by Etest. Provisional DD breakpoints >or=19/Assuntos
Infecções por Acinetobacter/microbiologia
, Acinetobacter baumannii/efeitos dos fármacos
, Antibacterianos/farmacologia
, Erros de Diagnóstico/estatística & dados numéricos
, Farmacorresistência Bacteriana
, Minociclina/análogos & derivados
, Infecções por Acinetobacter/tratamento farmacológico
, Acinetobacter baumannii/isolamento & purificação
, Humanos
, Testes de Sensibilidade Microbiana
, Minociclina/farmacologia
, Controle de Qualidade
, Tigeciclina
RESUMO
Reported here is the first isolation of vancomycin-resistant Enterococcus (VRE) at a hospital in northwestern Turkey and a description of the ensuing outbreak investigation. The first isolate was obtained from a wound culture of a patient in an intensive care unit. Thereafter, a total of 205 rectal swabs, 67 skin swabs and 123 environmental samples were screened, revealing five more VRE isolates. All isolates showed similar antibiotic resistance patterns, except for two that differed regarding gentamicin resistance. The vanA gene was present in all isolates. Pulsed-field gel electrophoresis demonstrated that all isolates belonged to a single clone, with the gentamicin-resistant isolates demonstrating two-band differences. This is the first outbreak to be caused by spread of a single VRE clone in Turkey; it was successfully controlled by strict adherence to appropriate infection control practices.
Assuntos
Infecção Hospitalar/microbiologia , Surtos de Doenças , Enterococcus faecium/efeitos dos fármacos , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/epidemiologia , Resistência a Vancomicina/genética , Idoso , Eletroforese em Gel de Campo Pulsado , Enterococcus faecium/genética , Enterococcus faecium/isolamento & purificação , Infecções por Bactérias Gram-Positivas/genética , Hospitais Universitários , Humanos , Controle de Infecções/métodos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Turquia/epidemiologiaRESUMO
Since it is known that turbulent flow exists in aneurysms, we have investigated whether pressure might be distributed unevenly on the aneurysmal wall, and whether it varies with the shape and size of the aneurysm and its orifice diameter as well as with the direction of blood flow in the parent vessel. It was found that in some instances, such as with aneurysms having narrow necks and situated at 90 degrees to the parent vessel blood flow, aneurysmal pressure is relatively low.
Assuntos
Aneurisma Intracraniano/fisiopatologia , Animais , Fenômenos Biomecânicos , Pressão Sanguínea , Gatos , Modelos Animais de Doenças , Aneurisma Intracraniano/patologiaRESUMO
Peripheral sympathetic activity was investigated in 25 Parkinson's disease (PD) patients and 27 healthy subjects by measuring the skin resistance level (SRL) and skin resistance response (SRR) at the palm of the hand during rest, auditory stimulation and patellar tendon tapping. Blood flow to the hand was also monitored. Normal responses were obtained from all the 27 healthy subjects with both stimuli. All but one of the 25 PD patients responded to sound, six patients failed to respond to patellar tendon tapping and one patient failed to respond to both stimuli. The SRRs (when detectable) of PD patients were always smaller in amplitude than those of normal subjects. It was also observed that while an electrodermal response was present, no vasomotor response could be elicited by either stimulus in some patients. The opposite was true in some other patients. When response latencies were evaluated, it was found that although the mean latency of SRRs evoked by tendon taping was shorter than the mean latency of responses to auditory stimuli in normal subjects, this was not the case in PD patients. SRR mean latency to patellar tendon tapping was significantly longer in PD patients compared with that in normal subjects. Mean latencies of responses to auditory stimuli were the same for both normal subjects and patients. The ratio of the SRR amplitude to SRL (i.e. relative change in SRL) during both types of stimulation was significantly smaller in PD patients than in normal subjects. All the above findings were also true when blood flow to the tissue was interrupted briefly. These findings support the conjecture that the abnormal peripheral sympathetic neural responses associated with PD may arise from a functional disorder in the basal ganglia that influence the efferent autonomic pathway, from impairment of the intermediolateral column of the spinal cord, and possibly from cognitive deficits.
Assuntos
Resposta Galvânica da Pele/fisiologia , Doença de Parkinson/fisiopatologia , Estimulação Acústica , Idoso , Antiparkinsonianos/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/tratamento farmacológico , Fotopletismografia , Reflexo de Estiramento/fisiologiaRESUMO
OBJECTIVE: Swallowing mechanisms and neurogenic dysphagia have not been systematically studied by the EMG technique. It is desirable to evaluate neurogenic dysphagia for diagnostic and possibly for therapeutic purposes using electrophysiological methods. METHODS: The following methods were described: mechanical upward/downward movements of the larynx were detected using a piezoelectric sensor, while submental integrated EMG activity was recorded during dry and wet swallowing. The EMG activity of cricopharyngeal muscle of the upper oesophageal sphincter was also recorded in some normal subjects and patients. Piecemeal deglutition and the dysphagia limit were determined in all patients to detect dysphagia objectively. In this study 75 normal subjects and 177 neurological patients with various degrees of dysphagia were investigated. RESULTS: Voluntarily triggered oropharyngeal swallowing was commonly pathological in the majority of patients, with or without overt dysphagia. The dysphagia limit appeared to be an objective measure of the degree of dysphagia in more than 90% of patients. Pathophysiological mechanisms were different in at least three groups of patients with neurogenic dysphagia. In the group of patients with muscular disorders, laryngeal elevators were involved while the CP-sphincter was intact. The second group included patients with the clinical signs of corticobulbar fibre involvement such as amyotrophic lateral sclerosis and pseudobulbar palsy. In these patients, there was incoordination between paretic laryngeal elevators and hyperreflexic CP-sphincter. In the third group (patients with Parkinson's disease), the swallowing reflex was delayed and prolonged. CONCLUSIONS: EMG methods described in the present study are very useful for the diagnosis of neurogenic dysphagia, objectively and quickly. They are important to understand the physiological mechanisms for deglutition and its disorders.