RESUMO
OBJECTIVES: To evaluate the range of multiple swallowing in normal subjects by ultrasonography. METHODS: Twenty-two normal subjects swallowed 5 or 10 ml of tap water or a semisolid meal. RESULTS: With water multiple swallows were seen in 41% of the subjects examined and was related to the volume of the bolus:18% of the cases were 5 ml and 36% were 10 ml. Sixty-eight percent of subjects had multiple swallows with semisolid boluses. CONCLUSION: These results differ from those reported with videofluoroscopy of modified barium swallowing. Ultrasonography should be used in future studies of normal and pathological oral swallowing.
Assuntos
Deglutição/fisiologia , Osso Hioide/diagnóstico por imagem , Adulto , Humanos , Osso Hioide/fisiologia , Pessoa de Meia-Idade , Movimento , Estudos Prospectivos , Valores de Referência , Transdutores , Ultrassonografia/instrumentação , Ultrassonografia/métodosRESUMO
The aim of the study was to identify a number of sonographic landmarks in the evaluation of the oral phase of swallowing. Forty non-dysphagic adults (average age 38 years) and 20 normal bottle-fed newborns (average age 13 days) were submitted to videorecorded sonographic examination using two types of transducers (5 and 7.5 MHz). The adults were asked to swallow a 20 ml bolus of water and the newborns were examined while sucking from a bottle containing milk. Preliminary transverse scans of the neck were obtained to evaluate laryngeal movements during swallowing. The mouth was examined through the submental window using sagittal and coronal scans. In the newborn, additional transbuccal scans were employed. In both adults and newborns highly significant and reproducible images of single-element motor events involved in swallowing were obtained. Normal sonographic images of the oral stage of deglutition form the baseline from which abnormal patterns may then be recognized.
Assuntos
Deglutição/fisiologia , Laringe/diagnóstico por imagem , Orofaringe/diagnóstico por imagem , Adulto , Feminino , Humanos , Recém-Nascido , Laringe/fisiologia , Masculino , Pessoa de Meia-Idade , Orofaringe/fisiologia , Valores de Referência , UltrassonografiaRESUMO
Impaired intestinal function, negatively affecting food digestion and absorption, is called chronic intestinal failure (CIF). The clinical conditions leading to CIF are: fistulas, wide resections and severe damage to small bowel, and chronic intestinal stasis. In the etiology of CIF, the most frequent conditions are: Crohn's disease, postoperative peptic ulcer, mesenteric arteriopathy, radiation enteropathy, acute pancreatitis, jejunoileal diverticulosis and intestinal pseudo-obstruction. The radiologic approach to CIF can aim at: 1) diagnosing the disease and the clinical conditions causing it; 2) morphometric analysis: lesion spread, length of the extant normal small bowel and adaptive changes. Digestive tube radiology has always been considered a fundamental investigation technique to study malabsorption. Double contrast enema has increased the diagnostic capabilities of radiology. Moreover, double contrast enema allows the extraoperative evaluation, in vivo, of a new anatomic feature--i.e., intestinal length--which is a valuable sign for an exhaustive interpretation of CIF, especially of the short bowel syndrome. Thanks to double contrast enema, the changes in the length of mesenteric small bowel can be calculated in vivo (range: 150-430 cm; mean: 291 cm, SD 59). Intestinal length < 150 cm was observed only in resected patients. In 25% of cases, short small bowels were associated with CIF. Such morphometric studies, if applied to clinical practice, may yield valuable information for both diagnosis and prognosis.
Assuntos
Enteropatias/diagnóstico por imagem , Doença Crônica , Humanos , Enteropatias/etiologia , Enteropatias/fisiopatologia , Intestino Delgado/fisiopatologia , RadiografiaRESUMO
Intestinal tuberculosis still exists in the Western world, where it is usually underestimated and often mistaken for Crohn's ileo-colitis or cancer. The authors report the results of 4 cases of intestinal tuberculosis observed between 1983 and 1988. The cases are discussed in the light of the epidemiological data emerging from a review of recent medical literature. The danger is that the disease, which is endemic in Asian and African regions, may spread again in the Western world fostered by intensifying migrations of people and by the spreading of AIDS. According to recent experience, a negative chest film and Mantoux skin-test no longer have a negative predictive value for intestinal tuberculosis. In the radiological differentiation from Crohn's disease it is useful to keep in mind some topographic features of TBC: the systemic non-discontinuous involvement of both sides of ileocecal junctions; the unusual presence of ileal lesions, with no cecal lesions, and localizations below the transverse colon. Useful differential morphological criteria can be: star-like or transverse ring-shaped profile of isolated ulcerations, tubular ileocolic junction with retracted cecum and open valve, and uniformity of lesion in the comprehensive picture of the clinical case.
Assuntos
Enteropatias/diagnóstico por imagem , Intestino Grosso/diagnóstico por imagem , Intestino Delgado/diagnóstico por imagem , Tuberculose Gastrointestinal/diagnóstico por imagem , Doença de Crohn/diagnóstico por imagem , Diagnóstico Diferencial , Humanos , RadiografiaRESUMO
One of the major reference points for both prognosis and treatment of ulcerative colitis is the assessment of its extent. Plain abdominal radiographs were performed on 97 patients previously diagnosed, by means of rectoscopy and histobiopsy, as having acute ulcerative colitis. Within the following 36 hours they underwent either full colonoscopy or colectomy. The extent of colitis was evaluated by means of double-blind radiography. The results were then statistically compared with those obtained from endoscopy or from direct study of surgical colonic specimens. There was agreement between the final X-ray results and the actual extent of ulcerative colitis in 78 of 97 patients (80.4%, r = 0.86). The highest agreement was observed in those patients whose lesions were localized in the rectosigma (81%) and in those with fully extended colitis (90%). The most useful radiological findings in predicting the extent of colic lesions were irregular mucosal profile and thickening of colic wall. The presence of these two signs, together with the flattening or swelling of interhaustral folds and the impossible visualization of the right colon, are invariably suggestive of fully extended colitis. On the contrary, no abnormal findings were present on plain abdominal films in 74% of proctosigmoiditis cases. Plain abdominal radiography seems to be useful for the initial evaluation of acute ulcerative colitis. It allows the early discrimination between diffuse and localized forms, and makes it possible to postpone more invasive and dangerous investigations to a remissive phase of the disease.
Assuntos
Colite Ulcerativa/diagnóstico por imagem , Doença Aguda , Adulto , Colite Ulcerativa/patologia , Feminino , Humanos , Masculino , RadiografiaRESUMO
The videotape recording of the cinefluorographic images obtained with barium swallowing, proved to be very useful in studying pharyngo-esophageal motility. On the contrary, the method failed to be exhaustive in the study of the oral phase of swallowing. In 1983 Shawker et al. were the first authors to suggest the use of US to record tongue motility and the upward movement of hyoid bone. In a previous paper the authors had reported on the value of US videorecording in the dynamic study of oral swallowing, and of lingual bolus development and shape. In the present paper, the authors investigated how frequently the formation of lingual bolus can be recorded by means of US in patients with no dysphagic disorders. Sagittal and transverse scans were acquired in all patients with US units with 5 MHz probes connected to a U-matic videorecorder. In 98% of 50 examined patients, US demonstrated the presence of a lingual bolus in the preparatory phase of oral swallowing. Since lingual bolus formation in the oral phase of swallowing can be considered quite a normal event, the authors believe this finding to be a reliable reference-point in the study of oral swallowing.
Assuntos
Transtornos de Deglutição/diagnóstico por imagem , Deglutição , Língua/diagnóstico por imagem , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valores de Referência , Ultrassonografia/instrumentação , Gravação em Vídeo/instrumentaçãoRESUMO
Dysphagia is more frequently observed in patients with neurologic diseases (stroke, bulbar or pseudo-bulbar syndrome, amyotrophic lateral sclerosis, cranial trauma). Furthermore, the presence of this pathology is obviously more frequently noted in the light of the increase in the length of the human life span. It has become evident that alternative feeding procedures such as the nasogastric tube or gastrostomy may bring about complications and deprive patients of the oral phase of deglutition which plays a leading role in stimulating digestive functions. The Authors report a systematic research on the rehabilitation aspects of neurogenous dysphagia. All the patients studied underwent a neurological examination and oropharyngeal functional evaluation using echo-videorecording of the oral phase of deglutition and fluoro-videorecording of the pharyngeal phase. The data obtained allowed for the selection of five patients considered suitable for the rehabilitation program. One of them had a multi-infarct encephalopathy, two a spastic hemiplegia f.b.c., a fourth a cerebellar syndrome and the last a sequela of meningioma removal of the ponto-cerebellar angle with peripheral paralysis of the right VII, IX, X, XI cranial nerves. This last patient also underwent a crico-pharyngeal myotomy. Therapy consisted in making the patient sensitive to swallowing movements and in training them to assume a compensatory posture as well as functional rehabilitation of the organs involved in deglutition. The first datum emerging from the study is the lack of etiological homogeneity found in the cases treated with evident variability in different deglutition organ impairment, even though there was the common denominator of the dysphagia symptom. With regard to the results obtained, there was a complete resolution in one patient, while in the other four there was such an improvement as to allow the patients a safe autonomous oral assumption of food. The positive results obtained are not only linked to the recovery of damaged organs, but also to the development of compensatory strategies such as the choice of appropriate food consistency and the assumption of postures which protect the respiratory tract from aspiration and favor crico-pharyngeal relaxation.
Assuntos
Transtornos de Deglutição/reabilitação , Deglutição , Boca/fisiopatologia , Faringe/fisiopatologia , Adulto , Idoso , Transtornos de Deglutição/diagnóstico por imagem , Transtornos de Deglutição/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Boca/diagnóstico por imagem , Doenças do Sistema Nervoso/complicações , Faringe/diagnóstico por imagem , Modalidades de Fisioterapia , Radiografia , Ultrassonografia , Gravação em VídeoRESUMO
Hypopharyngeal diverticula are relatively unknown, with the exception of Zenker's diverticulum. Spot-camera and videorecording techniques were employed for the examination of 95 dysphagic and 250 asymptomatic patients. On the whole, 345 cases. 40% of diverticula were found in dysphagic patients, and 14% in asymptomatic ones. Fifty diverticula were detected through the thyrohyoid membrane, and 14 pseudodiverticula, 4 Zenker's diverticula, 4 lateral diverticula at the pharyngoesophageal junction, and 2 outpouchings through the tonsillar fossa. A statistically significant correlation (p less than 0.001) with dysphagia was demonstrated only for diverticula through the thyrohyoid membrane. Most pathologic findings were associated with other swallowing dysfunctions.
Assuntos
Divertículo Esofágico/diagnóstico por imagem , Divertículo/diagnóstico por imagem , Doenças Faríngeas/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Transtornos de Deglutição/diagnóstico por imagem , Divertículo/epidemiologia , Divertículo/etiologia , Divertículo Esofágico/epidemiologia , Divertículo Esofágico/etiologia , Esôfago/diagnóstico por imagem , Feminino , Fluoroscopia , Humanos , Hipofaringe/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Orofaringe/diagnóstico por imagem , Doenças Faríngeas/epidemiologia , Doenças Faríngeas/etiologia , TelevisãoRESUMO
Twenty-three patients with small intestinal Crohn's disease were studied by barium-methylcellulose infusion. All patients underwent surgery within 1-24 months (average 7 months). The extent of the lesions and the small bowel length were radiologically evaluated by means of a map measurer. The same measurements were performed at surgery. Radiological and surgical data concerning the extent of enteritis were statistically correlated (r = 0.7). The correlation between radiological and surgical measurements of total small bowel length was not significant.
Assuntos
Doença de Crohn/diagnóstico por imagem , Sulfato de Bário , Doença de Crohn/patologia , Doença de Crohn/cirurgia , Enema , Feminino , Humanos , Ileíte/diagnóstico por imagem , Ileíte/patologia , Ileíte/cirurgia , Intestino Delgado/diagnóstico por imagem , Intestino Delgado/patologia , Masculino , Metilcelulose , RadiografiaRESUMO
The jejunoileal length was measured on double-contrast small bowel enema radiographs, obtained from 10 patients who had been investigated for abdominal pain. Previous endoscopic and radiologic examinations had excluded lesions of the upper and lower GI tract. The length of the small bowel ranged from 230 to 370 cm, with an average length of 280 cm.
Assuntos
Íleo/anatomia & histologia , Jejuno/anatomia & histologia , Adulto , Estatura , Peso Corporal , Feminino , Humanos , Íleo/diagnóstico por imagem , Jejuno/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , RadiografiaRESUMO
The value of double contrast small bowel enema via duodenal intubation using barium sulphate and methylcellulose as contrast media was assessed in 250 patients. In cases of small bowel obstruction it represented the first-line investigation after a plain abdominal film. It was performed electively in patients of painful bowel syndrome, in cases of malabsorption, in cases of endoscopically or radiologically diagnosed colitis and in patients with Crohn's disease. On the basis of our results we believe double contrast small bowel enema to be the most reliable investigation in the localization and identification of small bowel lesions.