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1.
J Oral Rehabil ; 48(1): 55-60, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33025615

RESUMO

OBJECTIVE: To verify the validity of the prediction of oral intake recovery for inpatients with aspiration pneumonia using the Hyodo-Komagane score. BACKGROUND: Patients admitted for treatment of aspiration pneumonia sometimes have difficulty in resuming oral intake due to decreased swallowing function. Predicting whether the swallowing function will recover enough to achieve oral ingestion at discharge is an important factor in developing a treatment strategy. No studies have investigated the prediction of oral intake recovery using videoendoscopic examination. METHODS: Subjects were 65 patients who were admitted to an acute care hospital for the treatment of aspiration pneumonia. The patients were divided into two groups, the oral feeding group and the tube feeding group, according to their oral intake status at discharge or transfer. Logistic regression analysis was performed using the condition that tube feeding was not required as an objective variable and the items with significant differences between the two groups as explanatory variables. Additionally, the receiver operating characteristic curve was used to identify patients who could take food orally at discharge. RESULTS: The odds ratios for the Hyodo-Komagane score and the pharyngeal clearance score were 1.485 and 3.379, respectively. When the cut-off values of the Hyodo-Komagane score and the pharyngeal clearance score were 6 and 1, the sensitivity was 0.88 and 0.91, and the specificity was 0.64 and 0.70, respectively. CONCLUSION: The Hyodo-Komagane score and especially the pharyngeal clearance score are useful indices to predict oral intake recovery for inpatients with aspiration pneumonia.


Assuntos
Transtornos de Deglutição , Pneumonia Aspirativa , Deglutição , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/etiologia , Humanos , Pacientes Internados , Japão
2.
Support Care Cancer ; 29(1): 263-269, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32350670

RESUMO

BACKGROUND: Wax microsphere bound oxycodone was developed as an abuse-deterrent opioid and maintains a similar pharmacokinetic profile whether administered with or without an intact capsule. We hypothesized that microsphere oxycodone could be utilized for extended release analgesia in patients undergoing radiation (RT) for head-and-neck cancer (HNC) and would not need to be discontinued due to dysphagia or gastrostomy tube dependence. METHODS AND MATERIALS: We performed a prospective trial that enrolled participants > 18 years with histologically confirmed HNC who were scheduled to receive RT. Analgesia was prescribed in accordance with the WHO pain ladder. Microsphere oxycodone was initiated when total daily opioid dose exceeded 30 mg of morphine sulfate equivalent and was titrated weekly during RT. Pain level and effect on quality of life were assessed using the Brief Pain Inventory. The primary feasibility endpoint was frequency of microsphere oxycodone discontinuation within 3 months of RT for reasons other than pain resolution. RESULTS: Twenty-six eligible patients were enrolled. Microsphere oxycodone was initiated in 16 (61.5%) patients. Six (23.1%) patients utilized a gastrostomy tube to administer microsphere oxycodone during all or part of RT. Microsphere oxycodone was discontinued in 1 (7.6%) patient due to perceived inefficacy. No patients were discontinued due to toxicity or difficulty with administration. Ratings for average pain was 3.1 (± 3.4) at enrollment, 4.0 (± 2.4) at week 6 of RT, and 1.8 (± 2.2) at 3-month follow-up. CONCLUSIONS: These results support the feasibility and safety of microsphere oxycodone for extended release analgesia among patients with HNC undergoing RT.


Assuntos
Analgésicos Opioides/uso terapêutico , Neoplasias de Cabeça e Pescoço/radioterapia , Morfina/uso terapêutico , Oxicodona/uso terapêutico , Manejo da Dor/métodos , Dor/tratamento farmacológico , Analgesia , Transtornos de Deglutição , Preparações de Ação Retardada/uso terapêutico , Feminino , Gastrostomia , Humanos , Masculino , Microesferas , Pessoa de Meia-Idade , Mucosite/prevenção & controle , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Oxicodona/administração & dosagem , Estudos Prospectivos , Qualidade de Vida/psicologia
3.
Int J Pediatr Otorhinolaryngol ; 140: 110306, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32829932

RESUMO

BACKGROUND: SLPs have a crucial need to depend on comprehensive clinical swallowing assessments to determine the presence of dysphagia in neonates. A comprehensive clinical swallowing assessment that is ethnoculturally sensitive may help to identify the presence and severity of swallowing problems in neonates. OBJECTIVE: The study aimed to construct and validate the contents of a test for oropharyngeal dysphagia in Indian neonates (TOD-IN). METHOD: The test for oropharyngeal dysphagia in Indian neonates (TOD-IN) was developed using the Delphi process. Five expert panelists served as participants; two rounds of electronic questionnaire-based survey was carried out to develop and validate the contents of TOD-IN. RESULTS: Round one rendered descriptive data that was analyzed quantitatively and qualitatively. At the end of round one, panelists unequivocally agreed on the need for research to develop a validated assessment tool for dysphagia in Indian neonates. The second round dealt with establishing the face and content validity of the final version of TOD-IN. A unanimous consensus was obtained regarding the format, scoring system, and the construct of the final version of the tool. CONCLUSION: Practicing clinicians in India are met with several challenges such as resource constraints, limited infrastructure, increasing caseload, and a lack of trained workforce. We believe that inexperienced clinicians will benefit from the structured guidance provided by TOD-IN in a restrained resource context where prioritization of patients is the key. Further studies investigating the psychometric properties of TOD-IN are in progress.


Assuntos
Transtornos de Deglutição , Deglutição , Feminino , Humanos , Índia , Recém-Nascido , Masculino , Reprodutibilidade dos Testes , Inquéritos e Questionários
6.
Acta Gastroenterol Belg ; 83(4): 663-665, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33321027

RESUMO

Covered oesophageal stents are often used to treat dysphagia in patients with inoperable oesophageal cancer. Stent migration is a well-known but usually benign complication. We report the case of a patient whose esophageal stent migrated into the distal ileum with perforation hereof. A laparoscopic stent extraction and intestinal repair was necessary to treat the perforation.


Assuntos
Transtornos de Deglutição , Neoplasias Esofágicas , Estenose Esofágica , Migração de Corpo Estranho , Perfuração Intestinal , Migração de Corpo Estranho/complicações , Migração de Corpo Estranho/diagnóstico por imagem , Humanos , Perfuração Intestinal/diagnóstico por imagem , Perfuração Intestinal/etiologia , Perfuração Intestinal/cirurgia , Stents/efeitos adversos
7.
J Oral Sci ; 63(1): 79-82, 2020 Dec 23.
Artigo em Inglês | MEDLINE | ID: mdl-33281145

RESUMO

PURPOSE: To examine the relationship between oral intake function and oral health status in convalescent inpatients. METHODS: Subjects were 222 patients admitted to a convalescent hospital between 1 January and 30 June 2018. Investigation items were age, sex, causative disease, body mass index, functional oral intake scale (FOIS), functional independence measure, occlusal contact, assistance with oral cleaning, and oral health assessment tool (OHAT) scores. Multiple regression analysis was performed with FOIS as the dependent variable, and investigation items were related to FOIS as independent variables. RESULTS: Results of multiple regression analysis for all patients suggested that saliva and denture scores were significantly associated with FOIS. However, analysis excluding non-oral feeding patients did not show a significant association between FOIS and OHAT scores. CONCLUSION: The results of this study suggest that oral health status is associated with oral intake function. In addition, the oral health status of inpatients may be strongly related to whether or not they are eating orally. Therefore, it is necessary to take good care of oral health in non-oral feeding patients in the convalescent ward.


Assuntos
Transtornos de Deglutição , Saúde Bucal , Humanos , Pacientes Internados , Saliva
8.
J Stroke Cerebrovasc Dis ; 29(12): 105405, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33254381

RESUMO

OBJECTIVE: The aim of our study was to evaluate the associations between baseline hemoglobin (Hb) levels and sarcopenia and outcomes in patients undergoing rehabilitation after stroke. METHODS: This retrospective cohort study included consecutive hospitalized post-stroke patients. Data on serum Hb level were extracted from medical records on tests performed within 24 h of admission. Primary outcome was the presence of sarcopenia at admission, diagnosed based on both low skeletal muscle mass and strength criteria per recently updated Asian Working Group for Sarcopenia 2019 guidelines. Other outcomes included the Functional Independence Measure-motor (FIM-motor) score at discharge and its change from baseline, and the Food Intake Level Scale (FILS) score (measure of dysphagia, FILS score < 7) at discharge. Multivariate analyses were used to determine the association between Hb levels at admission and outcomes of interest, adjusted for potential confounders. RESULTS: Data from 598 patients (mean age 72.1 years; 52.7% men) were included in the analysis. The mean Hb level at admission was 13.2 g/dL, and 86 (27.3%) men and 102 (36.0%) women had low Hb levels, i.e., 13.0 g/dL and 12.0 g/dL, respectively. In multivariate analyses, the baseline Hb level was independently associated with sarcopenia (odds ratio [OR]: 0.794, 95% confidence interval [CI]: 0.677-0.930, p = 0.004), FIM-motor score (ß = 0.096, p = 0.045) at discharge and its change from baseline (ß = 0.191, p = 0.018), and dysphagia (OR: 0.762, 95% CI: 0.595-0.961, p = 0.041) at discharge. CONCLUSION: Baseline low Hb levels were associated with sarcopenia, poorer recovery of physical function, and dysphagia in patients undergoing rehabilitation after stroke.


Assuntos
Anemia/sangue , Composição Corporal , Transtornos de Deglutição/reabilitação , Deglutição , Hemoglobinas/metabolismo , Sarcopenia/fisiopatologia , Reabilitação do Acidente Vascular Cerebral/efeitos adversos , Acidente Vascular Cerebral/terapia , Idoso , Idoso de 80 Anos ou mais , Anemia/diagnóstico , Biomarcadores/sangue , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/fisiopatologia , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Sarcopenia/diagnóstico , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
9.
Einstein (Sao Paulo) ; 18: eRC5478, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33263677

RESUMO

A 33-year-old male with house dust mite allergic rhinitis and asthma reported an episode of facial and lip angioedema, dyspnea, cough and dysphagia at the age of 25, minutes after eating a mushroom ( Agaricus bisporus ) pizza. He denied any drug intake, hymenoptera stings or other possible triggers, and no identifiable cofactors were present. Since then he avoided all types of mushrooms, however an accidental contact occurred with mushroom sauce that resulted in angioedema of the lip within minutes. The allergy workup included measurements of total IgE and specific IgE to mushroom, and skin prick test to aeroallergens sources, possible food allergen sources and mushroom extract, a prick to prick test with raw and cooked A. bisporus , in addition to a SDS-PAGE and immunoblotting assay. The study revealed a specific IgE to mushroom of 0.76kUA/L positive skin prick test to mushroom extract, and prick to prick test positive to white and brown A. bisporus (raw and cooked). The immunoblotting identified two IgE binding proteins with 10kDa and 27kDa. We report a case of A. bisporus anaphylaxis probably due to primary mushroom sensitization. We detected two IgE-reactive proteins with 10kDa and 27kDa as possible culprit allergens.


Assuntos
Agaricus , Anafilaxia/etiologia , Angioedema/etiologia , Tosse/etiologia , Transtornos de Deglutição/etiologia , Dispneia/etiologia , Hipersensibilidade Alimentar/imunologia , Adulto , Alérgenos , Alternaria , Anafilaxia/induzido quimicamente , Animais , Gatos , Farinha , Humanos , Imunoglobulina E/sangue , Masculino , Testes Cutâneos
12.
Artigo em Chinês | MEDLINE | ID: mdl-33254330

RESUMO

The clinical manifestations of this patient with hypopharyngeal liposarcoma are dyspnea, dysphagia and aspiration. Fiberlaryngoscopic examination showed a grayish-yellow mass with a smooth surface and a broad base in the left hypopharynx, piriform fossa, and laryngeal entrance. CT examination revealed a solid mass with clear borders in the hypopharynx and a fibrous septum. Pathology revealed a highly differentiated liposarcoma of the hypopharynx.


Assuntos
Transtornos de Deglutição , Neoplasias Hipofaríngeas , Lipossarcoma , Dispneia , Humanos , Hipofaringe
13.
Artigo em Chinês | MEDLINE | ID: mdl-33254347

RESUMO

Objective:To summarize and analyze the clinical diagnosis and surgical treatment of patients with tumors involving the root of neck. Method:We retrospectively analyzed the clinical data of 73 patients with tumors involving the root of neck in Peking University First Hospital Otorhinolaryngology Head and Neck Surgery department. Data collected included clinical manifestations, preoperative imaging evaluation, surgical approach selection, postoperative pathological types, postoperative complications and prognosis. Result:The most frequent symptom was a painless cervical mass(36 cases) and dysphagia(16 cases). All patients underwent preoperative enhanced CT scan or MRI, which would be helpful to evaluate the tumor size, shape, location, relationship with surrounding structures, especially important blood vessels, and secondary changes. The postoperative pathological diagnosis included 37 cases of benign and 36 cases of malignant. The most common benign tumor was retrosternal goiter in 17 cases, and the most common malignant tumor was cervical esophageal cancer in 15 cases. Nonsurgical treatment was performed in 3 cases ,while surgical treatment was performed in 70 cases, including 61 cases (87.1%) with cervical approach , 9 cases (12.9%) with combined cervicothoracic approach , 67 cases of complete tumor resection and 3 cases of palliative resection. Sixteen cases cooperated with thoracic surgerons, and 1 case with orthopedic surgerons. Surgical complications occurred in 16 cases (22.9%). Seven patients were lost to follow-up, and 66 patients were followed up for 3 months to 15 years. None of the 35 patients with benign tumors had recurrence, and among the 31 patients with malignant tumors, the 3-year survival rate was 48.4% and the 5-year survival rate was 32.3%. Conclusion:Tumors involving the root of neck are challenging to diagnose and treat due to the complex regional anatomy and a variety of pathological types, with comparable proportion of benign and malignant tumors. Surgery is the first choice, but it requires careful preoperative assessment. Surgical approaches include cervical approach and combined cervicothoracic approach, which should be determined according to the pathology, size and surrounding structure of the tumor, as well as the habits of the surgeon. Most benign tumors can be excised by the cervical approach. The combined cervicothoracic approach is suitable for malignant tumors with unclear boundaries and close adhesion of important blood vessels and nerves. Proper treatment of large vessels is the key to complete resection of tumors. There are many complications in the operation of this site, so it is necessary to fully communicate with the patient before operation, and sometimes multidisciplinary cooperation is needed.


Assuntos
Transtornos de Deglutição , Neoplasias Esofágicas , Humanos , Pescoço , Recidiva Local de Neoplasia , Estudos Retrospectivos
14.
Am J Gastroenterol ; 115(11): 1915-1917, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33156112

RESUMO

INTRODUCTION: We aim to discuss the utility of self-expandable esophageal metal stent (SEMS) in variceal bleeding in challenging cases. METHODS: Case description, discussion on patient management and decision-making process in an uncommon situation, from a multidisciplinary point of view. RESULTS: We report a case of a cirrhotic patient with refractory variceal bleeding who underwent a SEMS placement, which remained in situ for 9 months. This decision was based on the initial poor status and short life expectancy, limiting the consideration of other options for lowering portal hypertension, along with an underlying prothrombotic predisposition. However, the patient's general and hepatic improvement and the development of dysphagia led to the SEMS removal, exposing a large esophageal-tracheal fistula. DISCUSSION: Early patient evaluation, risks of long-term SEMS, and life expectancy should be taken in consideration before SEMS placement.


Assuntos
Transtornos de Deglutição , Estenose Esofágica , Varizes Esofágicas e Gástricas/terapia , Hemorragia Gastrointestinal/terapia , Hepatite B Crônica/complicações , Cirrose Hepática Alcoólica/complicações , Complicações Pós-Operatórias , Stents Metálicos Autoexpansíveis , Fístula Traqueoesofágica , Idoso , Anticoagulantes/uso terapêutico , Carcinoma Hepatocelular/etiologia , Doenças do Esôfago/etiologia , Doenças do Esôfago/terapia , Varizes Esofágicas e Gástricas/etiologia , Artéria Femoral , Hemorragia Gastrointestinal/etiologia , Hemostase Endoscópica , Humanos , Expectativa de Vida , Cirrose Hepática/complicações , Neoplasias Hepáticas/etiologia , Masculino , Nutrição Parenteral , Doença Arterial Periférica/complicações , Doença Arterial Periférica/tratamento farmacológico , Inibidores da Agregação de Plaquetas/uso terapêutico , Artéria Poplítea , Fatores de Tempo
15.
Cochrane Database Syst Rev ; 11: CD003633, 2020 11 12.
Artigo em Inglês | MEDLINE | ID: mdl-33180963

RESUMO

BACKGROUND: This is an update of a Cochrane Review first published in 2005. Cervical dystonia is the most common form of focal dystonia, and is a highly disabling movement disorder, characterised by involuntary, usually painful, head posturing. Currently, botulinum toxin type A (BtA) is considered the first line therapy for this condition. OBJECTIVES: To compare the efficacy, safety, and tolerability of BtA versus placebo, in people with cervical dystonia. SEARCH METHODS: We searched Cochrane Movement Disorders' Trials Register, CENTRAL, MEDLINE, Embase, reference lists of articles, and conference proceedings in July 2020. All elements of the search, with no language restrictions, were last run in July 2020. SELECTION CRITERIA: Double-blind, parallel, randomised, placebo-controlled trials (RCTs) of BtA versus placebo in adults with cervical dystonia. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed records, selected included studies, extracted data using a paper pro forma, and evaluated the risk of bias. We resolved disagreements by consensus or by consulting a third review author. We performed meta-analyses using a random-effects model, for the comparison of BtA versus placebo, to estimate pooled effects and corresponding 95% confidence intervals (95% CI). We performed preplanned subgroup analyses according to BtA dose used, the BtA formulation used, and the use (or not) of guidance for BtA injections. The primary efficacy outcome was improvement in cervical dystonia-specific impairment. The primary safety outcome was the proportion of participants with any adverse event. MAIN RESULTS: We included nine RCTs, with moderate, overall risk of bias, that included 1144 participants with cervical dystonia. Seven studies excluded participants with poorer responses to BtA treatment, therefore, including an enriched population with a higher probability of benefiting from this therapy. Only one trial was independently funded. All RCTs evaluated the effect of a single BtA treatment session, using doses from 150 U to 500 U of onabotulinumtoxinA (Botox), 120 U to 240 U of incobotulinumtoxinA (Xeomin), and 250 U to 1000 U of abobotulinumtoxinA (Dysport). BtA resulted in a moderate to large improvement from the participant's baseline clinical status, assessed by the investigators, with a mean reduction of 8.09 points in the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS total score) at week four after injection (95% CI 6.22 to 9.96; I² = 0%) compared to placebo. This corresponded, on average, to a 18.4% improvement from baseline. The mean difference (MD) in TWSTRS pain subscore at week four was 2.11 (95% CI 1.38 to 2.83; I² = 0%) compared to placebo. Overall, both participants and clinicians reported an improvement of subjective clinical status. It was unclear if dropouts due to adverse events differed (risk ratio (RR) 2.51; 95% CI 0.42 to 14.94; I² = 0%) However, BtA treatment increased the risk of experiencing an adverse event (R) 1.23; 95% CI 1.05 to 1.43; I² = 28%). Neck weakness (14%; RR 3.40; 95% CI 1.19 to 9.71; I² = 15%), dysphagia (11%; RR 3.19; 95% CI 1.79 to 5.70; I² = 0%), and diffuse weakness or tiredness (8%; RR 1.80; 95% CI 1.10 to 2.95; I² = 0%) were the most common treatment-related adverse events. Treatment with BtA resulted in a decreased risk of dropouts. We have moderate certainty in the evidence across all of the aforementioned outcomes, with the exception of subjective assessment and tolerability, in which we have high confidence in the evidence. We found no evidence supporting the existence of a clear dose-response relationship between BtA and improvement in cervical dystonia-specific impairment, a destinction between BtA formulations, or a variation with use of EMG-guided injection for efficacy outcomes. Due to clinical heterogeneity, we did not pool health-related quality of life data, duration of clinical effect, or the development of secondary non-responsiveness. AUTHORS' CONCLUSIONS: We are moderately certain in the evidence that a single BtA treatment session resulted in a clinically relevant reduction of cervical dystonia-specific impairment, and pain, and highly certain that it is well tolerated, compared with placebo. There is moderate-certainty evidence that people treated with BtA are at an increased risk of developing adverse events, most notably, dysphagia, neckweakness and diffuse weakness or tiredness. There are no data from RCTs evaluating the effectiveness and safety of repeated BtA injection cycles. There is no evidence from RCTs to allow us to draw definitive conclusions on the optimal treatment intervals and doses, the usefulness of guidance techniques for injection, the impact on quality of life, or the duration of treatment effect.


Assuntos
Toxinas Botulínicas Tipo A/uso terapêutico , Fármacos Neuromusculares/uso terapêutico , Torcicolo/tratamento farmacológico , Viés , Toxinas Botulínicas Tipo A/efeitos adversos , Transtornos de Deglutição/etiologia , Humanos , Debilidade Muscular/etiologia , Fármacos Neuromusculares/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto
17.
Z Gastroenterol ; 58(12): 1201-1207, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33152792

RESUMO

BACKGROUND: Intramural pseudodiverticulosis of the esophagus (EIPD) is a rare disease leading to dysphagia, chest pain, and weight loss. The diagnosis is difficult, and the disease can be confounded with eosinophilic esophagitis (EoE). We present a patient with esophageal intramural pseudodiverticulosis and a literature review. CASE REPORT: The 45-year-old white caucasian woman with a history of nicotine and alcohol abuse had progressive hoarseness and severe dysphagia for solid food. Esophagogastroduodenoscopy (EGD) showed proximal esophageal stenosis, thrush esophagitis, and mucosal alteration with trachealization suspicious of EoE. However, repeated bouginage EGD and barium swallow revealed typical signs of esophageal intramural pseudodiverticulosis (EIPD). The patient was treated successfully by bougingage, acid suppression, and antifungal therapy. The literature analysis revealed the characteristics of EIPD according to age, sex, risk factors, and therapy modalities. CONCLUSION: The case report and the literature overview suggest that EIPD can be confounded with EoE.


Assuntos
Transtornos de Deglutição/etiologia , Divertículo Esofágico/complicações , Endoscopia do Sistema Digestório/métodos , Estenose Esofágica/diagnóstico por imagem , Esôfago/diagnóstico por imagem , Dilatação , Divertículo Esofágico/diagnóstico por imagem , Esofagite Eosinofílica/diagnóstico , Esofagite Eosinofílica/terapia , Estenose Esofágica/complicações , Estenose Esofágica/terapia , Feminino , Humanos , Pessoa de Meia-Idade
18.
Medicine (Baltimore) ; 99(46): e22617, 2020 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-33181646

RESUMO

INTRODUCTION: Esophageal window defect in patients with esophageal resection could be challenging to repair. In this case report, a free posterior tibial artery perforator flap (FPTAPF) was used for semi-circumference patch esophagoplasty. PATIENT CONCERNS: For this 47-year-old male patient with recurrent laryngeal nerve schwannoma invading cervical and upper thoracic esophagus, cervical and upper thoracic esophageal reconstruction following tumor resection was needed DIAGNOSIS:: Pathologic result demonstrated recurrent laryngeal nerve schwannoma. Ultrasound examination detected a tumor (7 cm × 6 cm × 3 cm) located behind the right thyroid lobe, and contrast-enhanced computed tomography scan revealed that tumor was located between the cervical esophagus and trachea, and compressed these structures. INTERVENTIONS: The tumor had a size of 7 cm × 6 cm × 3 cm, and the semi-circumference defect of the cervical and upper thoracic esophagus was about 7 cm in length after complete tumor resection. A 7 cm × 4 cm FPTAPF was designed and harvested for esophageal reconstruction. OUTCOMES: The posterior tibial flap survived well and satisfactory recovery of esophageal function was obtained with no significant complications. No local tumor relapse was indicated by computed tomography during the 2-year postoperative follow-up. CONCLUSION: This case highlights the stable performance of FPTAPF when used for the reconstruction of large esophageal window defect.


Assuntos
Esôfago/cirurgia , Neurilemoma/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Retalhos Cirúrgicos/cirurgia , Artérias da Tíbia/transplante , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/cirurgia , Esôfago/transplante , Humanos , Masculino , Pessoa de Meia-Idade , Neurilemoma/complicações , Retalhos Cirúrgicos/transplante , Artérias da Tíbia/cirurgia
19.
Medicine (Baltimore) ; 99(46): e23177, 2020 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-33181693

RESUMO

Prediction of aspiration pneumonia development in at-risk patients is vital for implementation of appropriate interventions to reduce morbidity and mortality. Unfortunately, studies utilizing a comprehensive approach to risk assessment are still lacking. The objective of this study was to analyze the clinical features and videofluoroscopic swallowing study (VFSS) findings that predict aspiration pneumonia in patients with suspected dysphagia.Medical records of 916 patients who underwent VFSS between September 2014 and June 2018 were retrospectively analyzed. Patients were divided into either a pneumonia group or a non-pneumonia group based on diagnosis of aspiration pneumonia. Clinical information and VFSS findings were evaluated.One hundred seven patients (11.7%) were classified as having pneumonia. Multivariate analysis indicated that aspiration during the 2- cubic centimeter thick-liquid trial of VFSS (odds ratio [OR] = 3.23, 95% confidence interval [CI]: 1.93-5.41), smoking history (OR = 2.63, 95% CI: 1.53-4.53), underweight status (OR = 2.27, 95% CI: 1.31-3.94), abnormal pharyngeal delay time (OR = 1.60, 95% CI: 1.01-2.53), and a Penetration-Aspiration Scale level of 8 (OR = 3.73, 95% CI: 2.11-6.59) were significantly associated with aspiration pneumonia development. Integrated together, these factors were used to develop a predictive model for development of aspiration pneumonia (DAP), with a sensitivity of 82%, specificity of 56%, and an area under the receiver operating characteristic curve of 0.73.The best predictors for DAP included videofluoroscopic findings of aspiration during a 2-cubic centimeter thick-liquid trial, prolonged pharyngeal delay time, a Penetration-Aspiration Scale level of 8, history of smoking, and underweight status. These 5 proposed determinants and the associated DAP score are relatively simple to assess and may constitute a clinical screening tool that can readily identify and improve the management of patients at risk for aspiration pneumonia.


Assuntos
Transtornos de Deglutição/diagnóstico por imagem , Deglutição/fisiologia , Fluoroscopia/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Transtornos de Deglutição/complicações , Feminino , Fluoroscopia/métodos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Pneumonia Aspirativa/etiologia , Pneumonia Aspirativa/fisiopatologia , Curva ROC , Estudos Retrospectivos , Fatores de Risco , Reino Unido , Gravação em Vídeo/instrumentação
20.
Pan Afr Med J ; 36: 360, 2020.
Artigo em Francês | MEDLINE | ID: mdl-33224426

RESUMO

The purpose of this study was to perform correlation of 5 cases and literature review. The study involved both children and adults. The major cause of retropharyngeal abscess was fish bone foreign body. Dysphagia associated with pain, fever and torticollis were the most common symptoms. Retropharyngeal abscess mainly occurred in the oropharyngeal and hypopharyngeal regions. Imaging tests, in particular CT scan, allowed for accurate information in 3 cases. Aerodigestive tract obstruction was found in most of our patients. Only 4 patients underwent incision and drainage. All patients received medical treatment. A 2-year-old died 5 days after surgery due to septic shock. This study highlights the rarity of this condition in our context as well as the importance of early diagnosis and treatment to prevent life-threatening complications.


Assuntos
Transtornos de Deglutição/etiologia , Corpos Estranhos/complicações , Abscesso Retrofaríngeo/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Drenagem/métodos , Feminino , Humanos , Masculino , Abscesso Retrofaríngeo/etiologia , Abscesso Retrofaríngeo/terapia , Choque Séptico/etiologia , Tomografia Computadorizada por Raios X , Torcicolo/etiologia
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