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1.
J Oral Sci ; 62(2): 156-159, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32224568

RESUMO

Swallowing has a vital function in airway protection and is the next step after mastication. Swallowing impairment, which is known as dysphagia, is frequently accompanied by pain. Previous clinical studies have shown that orofacial pain affects swallowing function. Thus, it was hypothesized that orofacial noxious inputs may modulate swallowing function. Previous studies using anesthetized animals has proposed that the facial skin-nucleus tractus solitarii (NTS), masseter muscle-NTS, lingual muscle-NTS, and lingual muscle-paratrigeminal nucleus-NTS pathways may be involved in the inhibition of swallowing caused by facial, masseter, and lingual pain. Moreover, the activation of gamma-aminobutyric acidergic NTS neurons is involved in the inhibition of the swallowing reflex following trigeminal noxious inputs. This review focused on the recent management of dysphagia, neural mechanisms of swallowing, and relationship between orofacial pain and swallowing function. This and other future studies in this field can provide a better understanding of both normal and impaired swallowing and can help develop a new approach to treat patients with dysphagia and orofacial pain.


Assuntos
Transtornos de Deglutição , Animais , Deglutição , Dor Facial , Humanos , Músculo Masseter , Núcleo Solitário
2.
J Oral Sci ; 62(2): 239-241, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32224575

RESUMO

Polypharmacy in elderly persons living at home or in a nursing home is an issue. In the field of dentistry, strategies to reduce polypharmacy must be promoted; however, there is insufficient basic data on medications received by elderly persons with dysphagia living at home or in a nursing home. The subjects were 106 elderly persons with dysphagia living at home or in a nursing home. Based on their medical records, the presence of disease and number/type of drugs being administered were investigated. Stroke, dementia, and hypertension were common. The mean number of drugs per person was 6.3 (minimum: 0, maximum: 15). Drugs for digestive ulcers were the most frequently prescribed medication, followed by hypotensive drugs, anti-parkinsonism drugs, and other central nervous drugs. Fifty-nine patients (52.8%) had taken drugs that may cause dysphagia, and 19 (17.9%) had taken drugs that may cause aspiration. Of the subjects, 68.9% had taken ≥5 drugs, demonstrating polypharmacy in elderly persons with dysphagia living at home or in a nursing home. Many drugs that may cause dysphagia or aspiration had been prescribed, suggesting the importance of dentists' reducing polypharmacy from the viewpoint of swallowing.


Assuntos
Transtornos de Deglutição , Idoso , Humanos , Casas de Saúde , Polimedicação , Fatores de Risco , Inquéritos e Questionários
4.
Medicine (Baltimore) ; 99(10): e19337, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32150072

RESUMO

OBJECTIVE: To examine the efficacy of combined inspiratory and expiratory respiratory muscle training (RMT) with respect to the swallowing function, pulmonary function, functional performance, and dysarthria in patients with stroke. DESIGN: Prospective, randomized controlled trial. SETTING: Tertiary hospital. PARTICIPANTS: The trial included 21 subjects (12 men, 9 women) aged 35 to 80 years presenting with 6 months history of unilateral stroke, respiratory muscle weakness (≥70% predicted maximal inspiratory pressure (MIP) and/or ≤70% maximal expiratory pressure (MEP)), dysphagia, or dysarthria. These subjects were randomly assigned to the control (n = 10, rehabilitation) and experimental (n = 11, rehabilitation with RMT) groups. INTERVENTION: Inspiratory RMT starting from 30% to 60% of MIP and expiratory RMT starting from 15% to 75% of MEP for 5 days/week for 6 weeks. MAIN OUTCOME MEASURES: MIP, MEP, pulmonary function, peak cough flow, perception of dyspnea, Fatigue Assessment Scale, Modified Rankin Scale, Brunnstrom stage, Barthel index, Functional Oral Intake Scale (FOIS), and parameters of voice analysis. RESULTS: Significant differences were observed between both groups in terms of MIP, forced vital capacity (FVC), and forced expiratory volume per second (FEV1) of the percentage predicted. Significant difference was found with respect to the change in fatigue, shimmer percent, amplitude perturbation quotient, and voice turbulence index (VTI) according to the acoustic analysis in the RMT group. The FEV1/FVC ratio was negatively correlated with jitter percent, relative average perturbation, pitch perturbation quotient, and VTI; the maximum mid-expiratory flow (MMEF) and MMEF% were also negatively correlated with VTI. Significant differences among participants of the same group were observed while comparing the Brunnstrom stage before and after training of the affected limbs and the Barthel scale and FOIS scores in both the groups. CONCLUSIONS: Altogether, 6-week combined inspiratory and expiratory RMT is feasible as adjuvant therapy for stroke patients to improve fatigue level, respiratory muscle strength, lung volume, respiratory flow, and dysarthria.Clinical trial registration number (Clinical Trial Identifier): NCT03491111.


Assuntos
Exercícios Respiratórios/métodos , Transtornos de Deglutição/terapia , Disartria/terapia , Debilidade Muscular/terapia , Acidente Vascular Cerebral/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Exercícios Respiratórios/normas , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/fisiopatologia , Disartria/etiologia , Disartria/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Debilidade Muscular/etiologia , Debilidade Muscular/fisiopatologia , Estudos Prospectivos , Músculos Respiratórios/fisiopatologia , Estatísticas não Paramétricas , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/terapia
5.
Medicine (Baltimore) ; 99(10): e19121, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32150052

RESUMO

About 11% to 13% of patients with acute dysphagia induced by stroke remain chronic dysphagia 6 months after stroke which usually leads to many severe complications and poor quality of life.To investigate the effect of transcranial direct current stimulation (tDCS) on swallowing function in the patients with chronic dysphagia after stroke.26 post-stroke patients with chronic dysphagia who received tDCS were identified by electronic medical records between July 2016 and April 2018. Of which, 13 were treated by unilateral hemispheric anodal tDCS at affected pharyngeal motor cortex. 13 eligible patients only treated by conventional therapies but without tDCS were randomly selected by matching on date of admission (±2 weeks) of the patients receiving unilateral tDCS. The swallowing function and quality of life were evaluated before and 2 weeks after treatment.The patients in three groups were comparable. The swallowing function and quality of life of the patients in all the 3 groups had been improved over time. Comparing to the group without tDCS, both the groups with unilateral or bilateral tDCS had shorter oral transit time (1.69 ±â€Š0.95, 0.97 ±â€Š0.71 seconds, respectively) and higher scores of quality of life (159.76 ±â€Š12.59, 179.69 ±â€Š11.81, respectively) after treatment.Both unilateral and bilateral hemispheric anodal tDCS combined with conventional therapies are helpful for recovery of swallowing function in patients with chronic dysphagia induced by stroke, but bilateral anodal tDCS substantially improve more.


Assuntos
Transtornos de Deglutição/terapia , Córtex Motor/fisiopatologia , Reabilitação do Acidente Vascular Cerebral , Estimulação Transcraniana por Corrente Contínua , Estudos de Coortes , Transtornos de Deglutição/fisiopatologia , Transtornos de Deglutição/psicologia , Feminino , Humanos , Masculino , Registros Médicos , Pessoa de Meia-Idade , Qualidade de Vida , Estudos Retrospectivos , Resultado do Tratamento
6.
Medicine (Baltimore) ; 99(9): e19115, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32118714

RESUMO

BACKGROUND: Dysphagia is one of the major post-stroke complications that can severely damage a patient's quality of life. An increasing number of studies have demonstrated that many kinds of nonpharmacological treatments can be used for post-stroke dysphagia. However, there is not enough evidence evaluating the effectiveness and safety of these interventions. This study will conduct a systematic review, and Bayesian network meta-analysis, of nonpharmacological treatments in order to provide evidence for a future study investigating more options for post-stroke dysphagia. METHODS: Randomized controlled trials (RCTs) of adult patients aged >18 years old who meet the criteria for a diagnosis of post-stroke dysphagia will be included, regardless of gender, nationality, or education level. Four Chinese databases (CNKI, SinoMed, Wanfang Database, and the Chinese Scientific Journal Database) and four English databases (Web of Science, MEDLINE, Embase, and the Cochrane Library) will be searched. Two independent reviewers will evaluate the title summary for each RCT. Disagreements will be discussed with a third commentator. Standard pairwise meta-analysis, including heterogeneity analysis, subgroup analysis, and sensitivity analysis, will be performed using the RevMan 5.3 software, and the risk of bias assessment will be conducted based on the methodological quality of the included trials recommended by the Cochrane Handbook 5.1. The Bayesian network meta-analysis will be performed using R-3.3.2 software. The quality evaluation of this study will be completed using the World Health Organization's Grading of Recommendations, Assessment, Development, and Evaluation. RESULTS: This study will summarize all the selected trials aimed at estimating the effectiveness, as well as safety, of applying nonpharmacological treatments to post-stroke dysphagia. CONCLUSION: This systematic review will provide evidence to assess the validity and safety of applying different types of nonpharmacological treatments for post-stroke dysphagia, which may provide clinicians with more choices in the treatment of this disease. PROSPERO REGISTRATION NUMBER: CRD42019119368.


Assuntos
Transtornos de Deglutição/terapia , Modalidades de Fisioterapia , Acidente Vascular Cerebral/complicações , Transtornos de Deglutição/etiologia , Humanos , Revisão Sistemática como Assunto
7.
Medicine (Baltimore) ; 99(11): e19503, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32176093

RESUMO

INTRODUCTION: Post-extubation dysphagia is commonly observed in ICU patients and associated with increased aspiration rates, delayed resumption of oral intake/ malnutrition, prolonged ICU and hospital length of stay, decreased quality of life, and increased mortality. Conventional therapeutic approaches are limited. Pharyngeal electrical stimulation (PES) was previously shown to improve swallowing function and airway safety in severely dysphagic tracheostomised stroke patients. METHODS: In a multi-center, single-blind, 1:1 randomized controlled study, up to 400 (360 evaluable) mixed emergency adult ICU patients with recent extubation following mechanical ventilation and confirmed oropharyngeal dysphagia will be enrolled at investigational academic ICUs. Primary objective is to evaluate the effectiveness of PES in reducing the severity of unsafe swallows. Patients will be randomized to receive PES (or sham) treatment on 3 consecutive days in addition to best supportive care. Primary endpoint is a composite of 2 endpoints with hierarchy based on clinical priorities: DISCUSSION:: This study will evaluate the effects of PES on swallowing safety in critically ill ICU patients post mechanical ventilation with oropharyngeal dysphagia.


Assuntos
Transtornos de Deglutição/terapia , Terapia por Estimulação Elétrica , Transtornos de Deglutição/psicologia , Europa (Continente) , Humanos , Unidades de Terapia Intensiva , Estudos Prospectivos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Método Simples-Cego , Estados Unidos
8.
Zhongguo Zhen Jiu ; 40(2): 119-22, 2020 Feb 12.
Artigo em Chinês | MEDLINE | ID: mdl-32100494

RESUMO

OBJECTIVE: To observe the clinical effect of electronic moxibustion on dysphagia in patients with achalasia of cricopharyngeus muscle after stroke. METHODS: Sixty patients with dysphagia of achalasia of cricopharyngeus muscle were randomly divided into an observation group and a control group, 30 cases in each group. One patient in the observation group and 2 cases in the control group dropped off. The patients in the control group were treated with routine medical treatment, acupuncture treatment and swallowing rehabilitation training; the patients in the observation group were additionally treated with electronic moxibustion at Lianquan (CV 23), Tiantu (CV 22), Tianding (LI 17) and Futu (LI 18), 30 min each treatment. Both groups were treated 5 times a week for 4 weeks. The musculoskeletal ultrasound (MSUS) was applied to test the activity of parapharyngeal wall and the dysphagia score of Ichiro Fujishima was compared before and after 4-week treatment. RESULTS: After treatment, the activity of the parapharyngeal wall and the dysphagia score of Ichiro Fujishima were increased in both groups (P<0.01, P<0.05). The changes of activity of parapharyngeal wall and dysphagia score of Ichiro Fujishima in the observation group were greater than the control group (P<0.05, P<0.01). CONCLUSION: Electronic moxibustion can improve the impaired swallowing function and reconstruct the normal swallowing process.


Assuntos
Acalasia Esofágica/terapia , Esfíncter Esofágico Superior/fisiopatologia , Moxibustão , Acidente Vascular Cerebral/complicações , Pontos de Acupuntura , Transtornos de Deglutição , Humanos , Resultado do Tratamento
9.
J Biol Regul Homeost Agents ; 34(1 Suppl. 1): 142-150, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32064849

RESUMO

Based on the knowledge supporting the position of the tongue in relation to the palate to be the guiding factor of oro-dental growth and the key factor in long-term orthodontic stability after treatment, 6 different case reports show how the Froggy Mouth device changes treatment strategy in rehabilitation of dysfunctional swallowing by relying on the subcortical process, following the principles established by pioneering studies on memorization mechanisms conducted by Eric Kandel (year 2000 Nobel Prize winner in medical field for his research on memorization process).


Assuntos
Transtornos de Deglutição/reabilitação , Terapia Miofuncional/instrumentação , Língua/fisiopatologia , Humanos , Palato
10.
Medicine (Baltimore) ; 99(6): e19100, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32028436

RESUMO

The aims were to determine the impact of dysphagia and glomerular filtration rate (GFR) in the prediction of myasthenia relapse and analyse whether different number of plasma exchange sessions could prolong the time before future relapse.This was a retrospective, longitudinal follow-up study with 60 enrolled patients. The patients were followed-up for a total of 50 months.Patients without relapses had significantly higher GFR and higher number of plasma exchange sessions when compared to patients with relapses. Mean time before next myasthenia relapse was significantly longer in patients with GFR ≥ 60 mL/min. Time before next and number of following myasthenia relapses were significantly higher in patients with symptoms of dysphagia.Decline in GFR levels is strongly associated with the presence of dysphagia and independently impacts the onset of myasthenia relapses. Timely initiation of plasmapheresis therapy and adequate hydration of patients with prolonged dysphagia should be one of the treatment goals for clinicians treating this disease.


Assuntos
Taxa de Filtração Glomerular , Miastenia Gravis/epidemiologia , Troca Plasmática/estatística & dados numéricos , Creatinina/sangue , Transtornos de Deglutição/etiologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Miastenia Gravis/complicações , Miastenia Gravis/fisiopatologia , Plasmaferese/estatística & dados numéricos , Recidiva , Estudos Retrospectivos
11.
Zhonghua Yi Xue Za Zhi ; 100(5): 378-381, 2020 Feb 11.
Artigo em Chinês | MEDLINE | ID: mdl-32074783

RESUMO

Objective: To compare the safety and efficacy of photodynamic therapy (PDT) and esophageal stent implantation in improving dysphagia caused by malignant obstruction of middle and advanced esophageal cancer. Methods: A total of 45 patients treated in the Affiliated Hospital of Qingdao University and Qingdao Huangdao District Central Hospital from January 2017 to January 2018 were retrospectively analyzed, of which 34 cases were males and 11 cases were females, 29 cases with the age beyond 60 years old, 41 cases were squamous carcinoma, 4 were adenocarcinoma. PDT was applied to 20 patients and 25 patients received esophageal carotid stenting implantation. There was no significant difference in gender, age, pathological type, location and stage between the two groups. Before treatment, 3 days, 1 month and 3 months after treatment, dysphagia was compared according to Stooler grading criteria, and also the time that patients experienced dysphagia again post treatment. Results: There were no statistical differences between the two groups in dysphagia grade change in 3 days, 1 month and 3 months after treatment (all P>0.05), The stent groups showed advantages towards the PDT group 3 days after treatment in patients with Stooler grading 0 (40%(10/25) vs 0(0/20), P<0.05). No significant differences were found between two groups with Stooler grading 0 (P>0.05) in 1 month and 3 months after treatment. Obstruction symptoms occurred earlier in the stent group compared with the PDT group (P<0.05). Conclusion: Esophageal stent can relieve the symptoms of dysphagia immediately after the implantation, while photodynamic therapy can also prolong the time of esophageal re-obstruction in addition to the immediate effect, with proved safety and efficacy in the treatment of middle and advanced esophageal cancer.


Assuntos
Transtornos de Deglutição , Neoplasias Esofágicas , Fotoquimioterapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos , Estudos Retrospectivos , Stents , Resultado do Tratamento
12.
Artigo em Chinês | MEDLINE | ID: mdl-32086923

RESUMO

Objective:The aim of this study is to investigate the effect of fibreoptic endoscopic of sallowing (FEES) in the assessment of pharyngeal dysphagia in post-irradiated patients with nasopharyngeal carcinoma. Method:Fifty-three NPC patients with post-irradiated underwent FEES and video fluoroscopy(VF).The results were analyzed using the Bolus Residue Scale and Rosenbek's penetration aspiration scale. Result:The agreement in the detection of penetration and aspiration between FEES and VF of liquid(κ=0.56, 95%CI 0.38-0.73) and porridge(κ=0.64, 95%CI 0.43-0.81) was "fair". The detection rates of penetration on FEES with liquid and porridge were 60% and 51%, the detection rates of aspiration on VF with liquid and porridge were 70% and 53%. There were no statistical differences. The agreement in the detection of pharyngeal residue between FEES and VF of liquid (κ=0.38, 95%CI0.12-0.62) and porridge (κ=0.66, 95%CI 0.44-0.86) was "fair". The detection rates of pharyngeal residue on FEES and VF with porridge were 43% and 45%, the difference was not statistically significant. The detection rates of pharyngeal residue on FEES and VF with liquid were 44% and 24%, and the difference was statistically significant. Conclusion:FEES is an effective and valuable tool for evaluating pharyngeal dysphagia in post-irradiated patients with nasopharyngeal carcinoma.


Assuntos
Transtornos de Deglutição/diagnóstico por imagem , Endoscópios , Carcinoma Nasofaríngeo/complicações , Neoplasias Nasofaríngeas/complicações , Deglutição , Transtornos de Deglutição/etiologia , Tecnologia de Fibra Óptica , Humanos , Carcinoma Nasofaríngeo/radioterapia , Neoplasias Nasofaríngeas/radioterapia
13.
Artigo em Chinês | MEDLINE | ID: mdl-32086930

RESUMO

Sarcomatoid carcinoma, a malignant tumor containing both epithelial-derived malignant cells and malignant mesenchymal cells. Microscopically, cancer cells and sarcoma cells migrate to each other, and CK and Vimentin are simultaneously expressed. A rare case of tonsillar sarcomatoid carcinoma is discussed in our department with dysphagia as the first symptom.


Assuntos
Carcinoma/diagnóstico , Tonsila Palatina/patologia , Sarcoma/diagnóstico , Neoplasias Tonsilares/diagnóstico , Transtornos de Deglutição/etiologia , Humanos , Vimentina/metabolismo
14.
Br J Radiol ; 93(1107): 20190955, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31971818

RESUMO

Patients with squamous cell carcinoma of the oropharynx are generally treated with (chemo) radiation. Patients with oropharyngeal cancer have better survival than patients with squamous cell carcinoma of other head and neck subsites, especially when related to human papillomavirus. However, radiotherapy results in a substantial percentage of survivors suffering from significant treatment-related side-effects. Late radiation-induced side-effects are mostly irreversible and may even be progressive, and particularly xerostomia and dysphagia affect health-related quality of life. As the risk of radiation-induced side-effects highly depends on dose to healthy normal tissues, prevention of radiation-induced xerostomia and dysphagia and subsequent improvement of health-relatedquality of life can be obtained by applying proton therapy, which offers the opportunity to reduce the dose to both the salivary glands and anatomic structures involved in swallowing.This review describes the results of the first cohort studies demonstrating that proton therapy results in lower dose levels in multiple organs at risk, which translates into reduced acute toxicity (i.e. up to 3 months after radiotherapy), while preserving tumour control. Next to reducing mucositis, tube feeding, xerostomia and distortion of the sense of taste, protons can improve general well-being by decreasing fatigue and nausea. Proton therapy results in decreased rates of tube feeding dependency and severe weight loss up to 1 year after radiotherapy, and may decrease the risk of radionecrosis of the mandible. Also, the model-based approach for selecting patients for proton therapy in the Netherlands is described in this review and future perspectives are discussed.


Assuntos
Carcinoma de Células Escamosas/radioterapia , Transtornos de Deglutição/prevenção & controle , Neoplasias Orofaríngeas/radioterapia , Terapia com Prótons/métodos , Lesões por Radiação/prevenção & controle , Xerostomia/prevenção & controle , Idoso , Transtornos de Deglutição/etiologia , Nutrição Enteral/estatística & dados numéricos , Humanos , Mandíbula/efeitos da radiação , Pessoa de Meia-Idade , Países Baixos , Órgãos em Risco/efeitos da radiação , Qualidade de Vida , Glândulas Salivares/efeitos da radiação , Xerostomia/etiologia
15.
Einstein (Sao Paulo) ; 18: eAO4952, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31939524

RESUMO

OBJECTIVE: To define physician´s behavior in the face of a mentally capable elderly dysphagic patients at risk of pulmonary aspiration, who do not accept oral restriction. METHODS: Observational, cross-sectional study, presenting a clinical case of an independent elderly with clinical complaints of dysphagia and laryngotracheal aspiration by flexible endoscopic evaluation of swallowing who rejected the proposal to restrict oral diet. A questionnaire about the patient's decision-making process was used to assess whether the physician was sympathetic and justify their answer, and if they are aware of hierarchy of ethical principles (recognition of the person´s value, autonomy, beneficence, nonmaleficence and justice), in the decision-making process, and which was the main principle that guided their decision. RESULTS: One hundred participants were classified by time since graduation as Group I (less than 10 years) and Group II (more than 10 years). Of them, 60% agreed with the patient's decision, with no difference between the groups. The main reason was autonomy of patients, in both groups. Among those who were not sympathetic, the main argument was beneficence and nonmaleficence, considering the risk between benefit and harm. As to awareness about the hierarchy of principles, we did not find differences between the groups. Autonomy was the principle that guided those who were sympathetic with the patient's decision, and justice among those who didnot agree. CONCLUSION: Physicians were sympathetic with the patient's decision regarding autonomy, despite the balance between risks of beneficence and nonmaleficence, including death. We propose to formalize a non-compliance term.


Assuntos
Transtornos de Deglutição/complicações , Padrões de Prática Médica/estatística & dados numéricos , Aspiração Respiratória/etiologia , Recusa do Paciente ao Tratamento/estatística & dados numéricos , Idoso de 80 Anos ou mais , Tomada de Decisão Clínica , Estudos Transversais , Transtornos de Deglutição/prevenção & controle , Gastroscopia/métodos , Gastrostomia/métodos , Humanos , Intubação Gastrointestinal/métodos , Masculino , Autonomia Pessoal , Relações Médico-Paciente , Aspiração Respiratória/prevenção & controle , Fatores de Risco , Inquéritos e Questionários , Fatores de Tempo
16.
Mymensingh Med J ; 29(1): 129-135, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31915348

RESUMO

Tetanus is a potentially preventable neurological infectious disorder with paucity of literature in Bangladesh. We aimed to see the demography and symptom profile of tetanus cases managed at the Infectious disease Hospital Sylhet. This hospital based cross-sectional descriptive study was conducted within the time period of January to December 2012 among 50 consecutive admitted patients in the Infectious Disease Hospital, Sylhet, Bangladesh who were diagnosed as a case of tetanus and fulfilling the inclusion criteria and exclusion criteria. Neonatal tetanus was considered as exclusion criteria and clinical diagnosis of tetanus was considered as the tetanus. Data were collected purposively with pretested predesigned questionnaire. Data were processed manually and analyzed with the help of SPSS Version 16.0. The mean±SD age was 33.00±16.8 years, ranging from 10 to 70 years. Among the 50 respondents, 72.0% were male, 50% from lower class, 34% were students and 30.0% had their educational status of primary level, 60.0% from rural social background. Trismus was found in 98.0% of the cases, rigidity in 96.0% cases, body ache in 94.0% cases, dysphagia in 92.0% cases, neck pain in 78.0% cases, dysarthria in 92.0% cases, reflex spasm in 66.0% cases, opisthotonus in 46.0% cases and urinary retention in 26.0% cases. In this study rural male people with lower socioeconomic status individuals were mostly affected with trismus, rigidity, body ache and dysphagia symptoms.


Assuntos
Transtornos de Deglutição/etiologia , Tétano/diagnóstico , Trismo/etiologia , População Urbana/estatística & dados numéricos , Adolescente , Adulto , Idoso , Bangladesh/epidemiologia , Criança , Estudos Transversais , Transtornos de Deglutição/epidemiologia , Demografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , População Rural , Distribuição por Sexo , Fatores Socioeconômicos , Tétano/complicações , Tétano/epidemiologia , Tétano/terapia , Resultado do Tratamento , Trismo/epidemiologia , Adulto Jovem
17.
BMC Surg ; 20(1): 6, 2020 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-31914981

RESUMO

BACKGROUND: Head and neck surgeries can perturb normal structures of neck muscles and nerve innervations, which are supposed to function in harmony to allow complicated process like swallowing. It is still likely that cricopharyngal dysfunction emerges years after the head and neck surgeries. CASE PRESENTATION: We report a case with history of left unilateral vocal cord immobility and development of dysphagia and aspiration 2 years after radical thyroidectomy with neck lymph nodes dissection and medialization thyroplasty. Cricopharyngeal dysfunction was impressed and was confirmed with visualization of cricopharyngeal narrowing segment in radiographic contrast swallow examination. The patient was treated successfully by cricopharyngeal myotomy, achieving long-term relief in our 4 years of follow up. CONCLUSIONS: Our case of delayed cricopharyngal dysfunction after radical thyroidectomy and medialization thyroplasty shows that it is important to follow up swallowing functions after patients with UVCI undergo medialization thyroplasty. In the event of delayed manifestation of cricopharyngeal function, it can still be treated successfully by cricoharyngeal myotomy, achieving long term relief of dysphagia.


Assuntos
Transtornos de Deglutição/cirurgia , Traumatismos do Nervo Laríngeo/complicações , Miotomia/métodos , Esvaziamento Cervical/efeitos adversos , Músculos Faríngeos/cirurgia , Complicações Pós-Operatórias/cirurgia , Tireoidectomia/efeitos adversos , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/fisiopatologia , Feminino , Humanos , Traumatismos do Nervo Laríngeo/fisiopatologia , Traumatismos do Nervo Laríngeo/cirurgia , Pessoa de Meia-Idade , Músculos Faríngeos/inervação , Músculos Faríngeos/fisiopatologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia
18.
Cir. pediátr ; 33(1): 51-54, ene. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-186139

RESUMO

Introducción: El tratamiento de la tiroides lingual es controvertido y debe individualizarse. Las opciones incluyen el reemplazo hormonal, cirugía en presencia de hemorragia y obstrucción de la vía aérea o digestiva, y la terapia con radioisótopos. Caso clínico: Niña de 8 años de edad, con molestias a la deglución. Se observa masa rosada, muy vascularizada, no dolorosa ni ulcerada, que protruye desde la base de la lengua y cierra prácticamente toda la orofaringe. Ecografía informa ausencia de tejido tiroideo en su posición normal. Tomografía axial computarizada cervical comprueba el diagnóstico y la obstrucción faríngea. Se indicó tratamiento sustitutivo de las hormonas tiroideas. Ante la progresión de los síntomas de disfagia, se indicó cirugía. Se describe la exéresis tiroidea por vía cervical, suprahioidea, con reimplante de láminas de tejido tiroideo. Evolucionó sin complicaciones y se mantiene tratamiento sustitutivo, con excelente estado clínico después de cuatro años


Introduction: The treatment of lingual thyroid is controversial and should be individualized. Options include hormonal replacement, surgery in the presence of bleeding and obstruction of the airway and the digestive tract, and radioisotope therapy. Clinical case: 8-year-old girl presenting with discomfort when swallowing. A pink, well-vascularized mass, not painful or ulcerated, protruding from the base of the tongue and virtually closing the whole oropharynx, was observed. Absence of thyroid tissue in its normal posi-tion was reported by the ultrasound department. Cervical computed axial tomography confirmed the diagnosis and the presence of pharyngeal ob-struction. Thyroid hormone replacement was established. As a result of dysphagia symptom progression, surgery was indicated. Thyroid removal was performed by means of a cervicotomy, with re-implantation of thyroid tissue laminas. The postoperative course was uneventful and replacement treatment was maintained, with an excellent clinical status four years later


Assuntos
Humanos , Feminino , Criança , Tireoide Lingual/diagnóstico por imagem , Tireoide Lingual/cirurgia , Obstrução das Vias Respiratórias/complicações , Radioisótopos/uso terapêutico , Tireoide Lingual/tratamento farmacológico , Transtornos de Deglutição/complicações , Tomografia Computadorizada de Emissão , Laringe/diagnóstico por imagem , Laringe/patologia , Cintilografia
19.
Int J Radiat Oncol Biol Phys ; 106(2): 320-328, 2020 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-31669562

RESUMO

PURPOSE: Oral mucositis (OM) is a frequent and painful sequela of concomitant chemoradiation (CRT) used for the treatment of head and neck cancer (HNC) for which there is no effective intervention. This randomized, placebo-controlled study evaluated the efficacy of a novel, mucoadhesive topical tablet formulation of clonidine in mitigating CRT-induced OM in patients with HNC. METHODS AND MATERIALS: Patients with HNC undergoing adjuvant radiation therapy (60-66 Gy; 5 × 1.8-2.2 Gy/wk) with concomitant platinum-based chemotherapy received daily local clonidine at 50 µg (n = 56), 100 µg (n = 65), or placebo (n = 62) via a topical mucobuccal tablet starting 1 to 3 days before and continuing during treatment. The primary endpoint was the incidence of severe OM (severe OM [SOM], World Health Organization grade 3/4). RESULTS: SOM developed in 45% versus 60% (P = .06) of patients treated with clonidine compared with placebo and occurred for the first time at 60 Gy as opposed to 48 Gy (median; hazard ratio, 0.75 [95% confidence interval, 0.484-1.175], P = .21); median time to onset was 45 versus 36 days. Opioid analgesic use, mean patient-reported mouth and throat soreness, and CRT compliance were not significantly different between treatment arms. Adverse events were reported in 90.8% versus 98.4%, nausea in 49.6% versus 71.0%, dysphagia in 32.8% versus 48.4%, and reversible hypotension in 6.7% versus 1.6% of patients on clonidine versus placebo, respectively. CONCLUSIONS: Although the primary endpoint was not met, the positive trends of OM-associated outcomes suggest that the novel mucoadhesive tablet delivery of clonidine might favorably affect the course and severity of CRT-induced SOM and support further evaluation.


Assuntos
Quimiorradioterapia/efeitos adversos , Clonidina/administração & dosagem , Neoplasias de Cabeça e Pescoço/radioterapia , Protetores contra Radiação/administração & dosagem , Carcinoma de Células Escamosas de Cabeça e Pescoço/radioterapia , Estomatite/prevenção & controle , Administração Bucal , Adulto , Idoso , Analgésicos Opioides/administração & dosagem , Clonidina/efeitos adversos , Intervalos de Confiança , Transtornos de Deglutição/etiologia , Método Duplo-Cego , Esquema de Medicação , Feminino , Neoplasias de Cabeça e Pescoço/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Placebos/administração & dosagem , Protetores contra Radiação/efeitos adversos , Dosagem Radioterapêutica , Estomatite/etiologia , Comprimidos , Adulto Jovem
20.
Codas ; 32(1): e20180216, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31721923

RESUMO

PURPOSE: This study aimed to compare the fiberoptic endoscopic findings of oropharyngeal swallowing of distinct food consistencies in Amyotrophic Lateral Sclerosis (ALS). METHODS: This was a retrospective clinical study of a convenience sample of 20 individuals (13 males and seven females aged 34 to 78 years old) with a diagnosis of ALS and oropharyngeal dysphagia confirmed by clinical and objective evaluation of swallowing, regardless of the bulbar or skeletal type and of the time of neurological diagnosis. The fiberoptic endoscopic evaluation of swallowing (FEES) of the liquid (N = 18), thickened liquid (N = 19) and pureed samples (N = 20) in a volume of 5 ml were analyzed. Data related to posterior oral spillage, pharyngeal residues, laryngeal penetration and/or aspiration after swallowing the three food consistencies were analyzed statistically by the Friedman ANOVA test. RESULTS: No impairment of laryngeal sensitivity was found in this population. There was no statistically significant difference in posterior oral spillage, penetration and/or aspiration between food consistencies. There was a statistically significant difference only related to pharyngeal residues of the thickened liquid and pureed consistency. CONCLUSION: Among the fiberoptic endoscopic findings of swallowing in ALS, only pharyngeal residues had a higher frequency depending on the consistency of food.


Assuntos
Esclerose Amiotrófica Lateral/complicações , Transtornos de Deglutição/diagnóstico por imagem , Transtornos de Deglutição/etiologia , Laringoscopia/métodos , Adulto , Idoso , Deglutição , Endoscopia do Sistema Digestório , Feminino , Alimentos/classificação , Humanos , Laringe , Masculino , Pessoa de Meia-Idade , Orofaringe , Estudos Retrospectivos
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