Latent changes in the pharyngeal stage of swallowing in non-aspirating older adults.

PURPOSE: The characteristic changes in the swallowing mechanism with aging are collectively termed presbyphagia. Although several studies have investigated presbyphagia in older adults, few have assessed oldest-old adults. We aimed to characterize the latent changes of swallowing function in oldest-old adults and to consider risk ages for presbyphagia. METHODS: We analyzed the records of 85 individuals (44 males and 41 females, aged 25-101 years) who underwent videofluoroscopic swallowing studies. The included participants had penetration and aspiration scores of ≤ 2 and no history of aspiration, pneumonia, or diseases that affect swallowing. They were divided into four age groups: 25-64 years (non-older), 65-74 years (young-old), 75-84 years (middle-old), and ≥ 85 years (oldest-old). We analyzed and compared the pharyngeal delay time (PDT), duration of tongue base and posterior pharyngeal wall contact, duration and dimension of upper esophageal sphincter opening (UES-O), and maximal hyoid bone displacement between the age groups. RESULTS: Among the older groups, the oldest-old showed significantly longer PDT than younger-old adults, and the UES-O tended to be wider in the former. However, no other remarkable differences were found between the oldest-old and other old groups. Statistical comparisons between the < 75 and ≥ 75-year age groups revealed significant age-related changes in the PDT and duration and dimension of UES-O. CONCLUSION: On videofluoroscopic evaluation, physiological changes with aging affected few parameters of swallowing in our cohort. These findings indicate that in non-aspirating oldest-old adults, any deterioration may be adjusted for by compensatory changes to maintain swallowing function.

Functional characterization of a germline ETV6 variant associated with inherited thrombocytopenia, acute lymphoblastic leukemia, and salivary gland carcinoma in childhood.

Germline pathogenic ETV6 variants have been discovered in families with inherited thrombocytopenia and predisposition to hematological and solid malignancies. We present a patient with short stature who was initially diagnosed with chronic immune thrombocytopenia. Subsequently, the patient developed acute lymphoblastic leukemia, followed by mammary analog secretory carcinoma. Sequencing analysis identified an ETV6 c.641C > T (p.Pro214Leu) germline variant. The variant protein exhibited attenuated nuclear localization, increased protein degradation, and reduced transcription repression function. Our findings suggest that the ETV6 gene should be sequenced in patients with inherited thrombocytopenia and malignancy, and emphasize the importance of careful follow-up to identify secondary cancer in patients with pathogenic ETV6 variants.

Mano-videoendoscopic assessment in the evaluation of the pharyngeal contraction and upper esophageal sphincter function in dysphagic patients.

OBJECTIVE: Mano-videoendoscopy (MVE) is a manometry technique with endoscopic confirmation of the pressure catheter. This study aimed to investigate the possibility of replacing a videofluorographic swallowing study (VFSS) with MVE for the precise evaluation of the pharyngeal contraction and the upper esophageal sphincter (UES) function. METHODS: The data from 69 patients with dysphagia were retrospectively reviewed. All of the patients underwent both MVE and a VFSS for the evaluation of dysphagia. Manometry was performed with a transnasally inserted catheter (2.6-mm outer diameter and 4 pressure sensors) under endoscopic observation. The sensors were kept at the tongue base, upper pyriform sinus, apex of the pyriform sinus, and UES. We evaluated the pharyngeal contraction and UES function fluorographically and statistically compared the manometric parameters. RESULTS: The fluorographic pharyngeal contraction was diagnosed as good in 28 patients and poor in 41 patients. The UES opening was diagnosed as good in 44 patients and poor in 25 patients. The highest pressure values at the tongue base (sensor 1), upper pyriform sinus (sensor 2), and apex of the pyriform sinus (sensor 3) were significantly larger in the good contraction group than in the poor contraction group. A stepwise logistic regression test revealed that the peak pressure of sensor 2 (upper pyriform sinus) was a robust predictor of fluorographic pharyngeal contraction, and the cut-off level for good fluorographic pharyngeal contraction was >81.5mmHg (specificity, 0.929; sensitivity, 0.870; area under the curve, 0.923). The nadir pressure, pressure drop, and pressure rise in the UES were significantly correlated with the fluorographic UES opening. A stepwise logistic regression test revealed that the pressure drop-the gap between the resting pressure and the nadir of the UES pressure-was a robust predictor of fluorographic UES opening, and the cut-off level to anticipate good fluorographic opening was ≥33.5mmHg (specificity, 0.853; sensitivity, 0.759). CONCLUSION: MVE can supplement the information obtained regarding the pharyngeal contraction and UES function, and overcomes the drawbacks of a videoendoscopic swallowing study (VESS).

Can mano-videoendoscopy substitute for videofluorography in evaluation of upper esophageal sphincter function?

CONCLUSIONS: Mano-videoendoscopy (MVE), a manometry technique with endoscopic confirmation of the pressure catheter, can supplement the information on upper esophageal sphincter (UES) function, and overcomes the drawbacks of videoendoscopic swallowing study (VESS). OBJECTIVES: This study aimed to investigate the possibility of replacing videofluorographic swallowing study (VFSS) with MVE, as a test to precisely evaluate UES function. METHODS: Data from 52 patients with dysphagia were retrospectively reviewed. All patients underwent both MVE and VFSS for evaluation of dysphagia. The manometry was performed with a transnasally inserted catheter (2.6 mm outer diameter and four pressure sensors) under endoscopic observation. The sensors were kept at the tongue base, upper pyriform sinus, apex of pyriform sinus, and UES. We statistically compared the manometric parameters of UES relaxation with fluorographic UES opening. RESULTS: Fluorographic UES opening was diagnosed as good in 34 patients and poor in 18 patients. The nadir pressure, pressure drop, and pressure rise in the UES had significant correlation on the fluorographic UES opening. Stepwise logistic regression test revealed that pressure drop, the gap between the resting pressure and the nadir of UES pressure, was a robust parameter for predicting fluorographic UES opening, and the cut-off level to anticipate good fluorographic opening was ≥ 33.5 mmHg (specificity, 0.853; sensitivity, 0.759).

Phase I study of S-1 plus nedaplatin in patients with advanced/recurrent head and neck cancer.

BACKGROUND: Cisplatin plus fluorouracil is widely used for the treatment of head and neck cancer. However, the cisplatin plus fluorouracil regimen necessitates hospitalization. Therefore, we planned to develop a new regimen that can be administered on an outpatient basis and performed a phase I study of S-1 + nedaplatin. METHODS: S-1 was given orally at a fixed dose for 14 days, and nedaplatin was administered intravenously on day 8 of S-1 administration. The dose of nedaplatin was increased in 10-mg/m(2) steps to find the maximum tolerated dose, depending on the appearance of dose-limiting toxicities. RESULTS: A total of 14 patients were registered. The maximum tolerated dose of nedaplatin was determined to be 90 mg/m(2). The main toxicities were neutropenia and thrombocytopenia. The response rate was 57.1%. CONCLUSION: The recommended dose of nedaplatin for a phase II study was determined to be 80 mg/m(2). We concluded that our regimen was well tolerated and that the response rate was acceptable.

Relationship between globus sensation and esophageal clearance.

CONCLUSIONS: Videofluoroscopy (VF) in the prone position can diagnose a range of esophageal pathologies in all age groups. These correlate with globus sensation in younger and middle-aged patients in prone and supine positions. Abnormal esophageal clearance appears to be associated with globus sensation in young and middle-aged persons, but not in the elderly. OBJECTIVES: To assess the correlation between globus sensation and abnormal esophageal clearance by VF in relation to body position and to investigate age-related abnormal esophageal clearance, as well as to confirm the utility of VF in diagnosing globus sensation in patients. SUBJECTS AND METHODS: This was a prospective study. In 72 patients with globus sensation and 33 controls, esophageal clearance was assessed by VF in the upright, supine, and prone positions, and transfer of barium through the esophagus was classified as normal, esophageal retention, esophageal reflux, or pharyngeal reflux. The detection rate of abnormal esophageal clearance was compared among all subjects by age. RESULTS: In the upright position, VF detected no significant differences in the detection rate of abnormal esophageal clearance and reflux between the patients with globus sensation and controls; however, the detection rate of abnormal esophageal clearance was significantly higher in the prone than in the upright and supine positions (p<0.001), and in all positions was significantly higher among globus sensation patients (p<0.05). In the supine and prone positions, there were significantly higher detection rates of abnormal esophageal clearance in patients than in controls in the young group (p<0.05). Additionally in the prone position, there was a significantly higher detection rate of abnormal esophageal clearance and reflux in patients than in controls in the middle-aged group (p<0.05). In all positions, no significant differences were observed in the detection rate of abnormal esophageal clearance and reflux in the patients and controls in the elderly group.

[Emergency care of vertigo patients: suggestions for efficient management].

Some diseases in which persons show vertigo or dizziness may be life-threatening, regardless of symptom severity, and require careful attention. These include diseases of the inner ear, central nervous system, and cardiovascular manifestation. In May 2006, a group in charge of primary emergency consultation began work enabling physicians to treat vertigo patients more efficiently and safely, as detailed in this report. Of the 173 persons with vertigo hospitalized from January 2004 to March 2008, six had cerebrovascular manifestations clarified only after hospitalization, underscoring the importance of careful examination, especially of those 75 years of age older, having continuous headache, having severe trunk ataxia despite apparently mild eye nystagmus, or reporting a history of high blood pressure, diabetes mellitus, hyperlipidemia, or ischemic heart disease.

Concurrent chemoradiotherapy for organ function preservation in advanced patients with hypopharyngeal and laryngeal cancer.

Preservation of the larynx is the most critical factor influencing quality of life in the treatment of head and neck cancer. This clinical study focuses on laryngeal function-preserving chemoradiotherapy for locally advanced hypopharyngeal and laryngeal cancer. Thirty-two resectable cases with histologically proven squamous cell carcinoma undergoing function-preserving therapy were examined. Induction chemotherapy comprised cisplatin and 5-fluorouracil, and another cycle of chemotherapy was performed for responders. Chemoradiotherapy comprised conventional irradiation and weekly chemotherapy (nedaplatin plus docetaxel). Non-responder patients were excluded from further chemotherapy and were changed to other surgical treatment. Three patients were non-responders for induction chemotherapy, and 29 patients were treated with chemoradiotherapy. Thus, 21 out of 29 patients obtained preserved laryngeal function. Initial larynx preservation rate with these treatment strategies was 93.8%. This study provides a new concept for laryngeal function-preserving treatment that should be considered for locally advanced laryngeal and hypopharyngeal cancer.

[Case report on open injuries of the larynx].

While open injury of the larynx is relatively rare, prompt and emergent control of the airway, treatment of the infected wound, and surgical repair for reconstruction of the laryngeal function are required. We report on a patient who had sustained an open injury of the larynx in whom the laryngeal function could be successfully preserved intact. The case was a 46-year-old man who had attempted suicide by cutting his throat with a kitchen knife, which resulted in complete tearing of the thyroid membrane and exposure of the upper part of the larynx. Emergent tracheotomy was performed the epiglottis was pulled up, and the thyroid cartilage was sewn to prevent occlusion of the laryngeal passage by the sagging epiglottis. In addition, we sutured together the hyoid bone and thyroid cartilage, so that the larynx could be held up and the laryngeal structure could be reconstructed satisfactorily for good deglutition. Eventually, we could close his tracheostoma, following which he regained his voice and normal swallowing function.

[Effects of one-way speaking valve placement on swallowing physiology for tracheostomized patients: impact on laryngeal clearance].

Tracheostomy placement affects swallowing function, increasing the risk of aspiration. Recent studies suggest that because of increased risk of swallowing disturbance associated with tracheostomy, one-way speaking valve placement may help to reduce aspiration in tracheostomized patients. We hypothesize that airflow exhaled through the laryngeal cavity using the one-way speaking valve may improve the clearance of residual bolus from the upper airway, thus preventing bolus penetration and aspiration. We studied the effects of one way speaking valve placement on laryngeal clearance and swallowing physiology. Videoendoscopic and videofluoroscopic swallowing were examined in 16 patients with the tracheostomy, and swallowing was compared with and without the one-way speaking valve in place. Valve Valve placement significantly improved laryngeal clearance and the incidence of penetration during swallowing. placement did not, however, significantly affect pharyngeal bolus residue, laryngeal elevation, pharyngeal delay or aspiration. Factors associated with the resumption of oral feedings were sufficient laryngeal elevation during swallow and the prevention of laryngeal penetration and aspiration. We concluded that one-way speaking valve placement improves laryngeal clearance and prevents laryngeal penetration, resulting in better oropharyngeal swallowing physiology and oral feeding.