RESUMO
OBJECTIVE: To investigate the relationship between dysphagia severity and opening of the upper esophageal sphincter (UES), and to assess the effect of balloon size on functional improvement after rehabilitative balloon swallowing treatment in patients with severe dysphagia with cricopharyngeus muscle dysfunction (CPD). METHODS: We reviewed videofluoroscopic swallowing studies (VFSS) conducted in the Department of Physical Medicine and Rehabilitation, Myongji Hospital from January through December in 2012. All subjects diagnosed with CPD by VFSS further swallowed a 16-Fr Foley catheter filled with barium sulfate suspension for three to five minutes. We measured the maximum diameter of the balloon that a patient could swallow into the esophagus and subsequently conducted a second VFSS. Then, we applied a statistical technique to correlate the balloon diameter with functional improvement after the balloon treatment. RESULTS: Among 283 inpatients who received VFSS, 21 subjects were diagnosed with CPD. It was observed that the degree of UES opening evaluated by swallowing a catheter balloon had inverse linear correlations with pharyngeal transit time and post-swallow pharyngeal remnant. Videofluoroscopy guided iterative balloon swallowing treatment for three to five minutes, significantly improved the swallowing ability in terms of pharyngeal transit time and pharyngeal remnant (p<0.005 and p<0.001, respectively). Correlation was seen between balloon size and reduction in pharyngeal remnants after balloon treatment (Pearson correlation coefficient R=-0.729, p<0.001), whereas there was no definite relationship between balloon size and improvement in pharyngeal transit time (R=-0.078, p=0.738). CONCLUSION: The maximum size of the balloon that a patient with CPD can swallow possibly indicates the maximum UES opening. The iterative balloon swallowing treatment is safe without the risk of aspiration, and it can be an effective technique to improve both pharyngeal motility and UES relaxation.
RESUMO
OBJECTIVE: To investigate the therapeutic effectiveness of trigger point injection into the muscles around the groin in patients with clinically diagnosed chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). DESIGN: Prospective, unicenter trial. SETTING: University rehabilitation hospital. PARTICIPANTS: Patients (N=21) with clinically diagnosed CP/CPPS who are suspected of having myofascial pain syndrome. INTERVENTION: Ultrasound-guided trigger point injection. MAIN OUTCOME MEASURES: Visual analog scale (VAS), National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) score, and injection-associated complications. RESULTS: Ultrasound (US)-guided trigger point injection of the iliopsoas, hip adductor, and lower abdominal muscles resulted in excellent outcomes. The mean values of the NIH-CPSI score decreased significantly from 20.2 pretreatment to 12.5 after the first treatment (P<.05). The mean values of VAS decreased significantly from 6.3 pretreatment to 2.9 after the first treatment (P<.05). CONCLUSIONS: In patients with CP/CPPS, US-guided trigger point injections of the iliopsoas, hip adductor, and abdominal muscles are safe and effective for both diagnosis and treatment when the cause of groin pain is suspected to originate from muscles. In particular, the iliopsoas muscle was affected in all patients in this study.