Effect of swallowing exercises in independent elderly.

The aim of this study was to investigate the effects of swallowing exercises on oral function in independent elderly patients visiting the Department of Prosthodontics at Tokyo Dental College Chiba Hospital. Twenty-nine patients aged over 65 years (15 men and 14 women; mean age, 75.0 years) in whom treatment was completed at this college were enrolled in the study. The patients were instructed on how to perform swallowing exercises monthly (including at baseline) for the first 2 months from the start of the study and asked to perform those exercises at least once daily. At the beginning and end of the study (a 3-month study period), the Repetitive Saliva Swallowing Test was conducted and occlusal force, oral diadochokinesis, unstimulated whole saliva flow rate, stimulated whole saliva flow rate, salivary pH at rest, and salivary buffering capacity measured to determine the effects of the exercises on oral function. Analyses demonstrated significant increases in diadochokinesis rate (/ta/ and /ka/) and unstimulated whole saliva flow rate (p<0.05), suggesting that the swallowing exercises promote the maintenance and improvement of oral function in the independent elderly.

Effect of darbepoetin alfa on renal anemia in Japanese hemodialysis patients.

INTRODUCTION: A long-acting erythropoiesis-stimulating agent named "darbepoetin alfa" (CAS 11096-26-7) was recently developed. Though it is already in use worldwide, especially in western countries, its efficacy and safety for Asian patients have not been well evaluated yet. The purpose of this study was to evaluate the efficacy and safety of short-term darbepoetin alfa administration for Japanese hemodialysis patients. METHODS: Patients who had undergone maintenance hemodialysis were enrolled in this study. The erythropoiesis-stimulating agent was switched from epoetin alfa (CAS 113427-24-0) to darbepoetin alfa so as to control the hemoglobin (Hgb) value between 10 and 12 g/dl. The initial conversion ratio was made according to the manufacturer's recommendations. The factors relevant to the responsiveness to erythropoiesis were analyzed. RESULTS: One hundred and fifty-nine patients with a mean age of 67.6 years were enrolled. Two months after switching to darbepoetin alfa, the Hgb value had increased significantly (10.3 +/- 1.2 to 10.6 +/- 1.4 g/dl). Only iron supplementation correlated positively with the change of Hgb. In addition, 14.3% of patients had excess Hgb (Hgb > 12 g/dl) at the end of the study period, but only 5.6% patients at the run-in. Serious cardiovascular disease did not occur during the study period; however, the mean systolic blood pressure at the start of hemodialysis increased significantly and there was no correlation between the change of Hgb value and blood pressure. CONCLUSION: Darbepoetin alfa increases the Hgb value effectively in Japanese hemodialysis patients. Although no serious adverse events were apparent in our short-term analysis, the incidence of hypertension and excessive increase of the Hgb value must be noted.

Distribution of causes and treatments of dysphagia at dysphasia/dysphagia rehabilitation clinic of Showa University Dental Hospital: 1999-2002.

The purpose of this study was to investigate the distribution of causes of dysphagia and the types of treatments being provided at the Dysphasia/Dysphagia Rehabilitation Clinic of Showa University Dental Hospital. The subjects included 173 dysphagic patients. Fifty-three percent of patients ranged 0-12 age, and 24% of them were over 60 years old. The survey results showed that diseases of the central nervous system, such as cerebral palsy (CP), was a major diagnosis in young patients, and cerebrovascular accident (CVA) was a predominant cause in adult and elderly patients. Diagnosis distribution showed that swallowing dysfunction was the most frequent diagnosis for patients on their first visit when compared to other feeding dysfunctions including malfunction of lips, tongue, and mastication. Almost 40 % of patients still continue to have rehabilitation for their dysphagic symptoms at the end of March 2002. This suggests that dysphagia rehabilitation is needed for a long time for many disabled individuals.