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1.
Z Gastroenterol ; 58(10): 971-974, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33036050

RESUMO

BACKGROUND: Verrucous carcinoma of the esophagus is a rare disease leading to dysphagia, chest pain, and weight loss. The diagnosis is difficult because even repeated biopsies are often without tumor evidence. We present a patient with verrucous carcinoma of the esophagus and a literature review. CASE REPORT: A 64-year-old patient with dysphagia and sore throat received esophagogastroduodenoscopy illustrating segmental circumferential verrucous inflammation and Candida esophagitis in the middle part of the esophagus. Repeated mucosal biopsies revealed reactive hyperkeratosis of the squamous epithelium with minimal atypia but without ulcera, eosinophilic esophagitis, or suspicion of cancer. Mucosal infection with adenovirus, herpes simplex virus 1, human papilloma virus types, and cytomegaly virus was ruled out. Veruccous carcinoma was detected finally by endoscopic mucosal resection. The patient was successfully treated by esophageal resection. Tumor stage was G1, pT1b, pN0, L0, V0, Pn0, R0. CONCLUSION: The results suggest that macroscopic suspicion of verrucous esophageal carcinoma should lead to resections of larger tissue specimens by EMR to confirm the diagnosis.


Assuntos
Carcinoma Verrucoso/patologia , Transtornos de Deglutição/etiologia , Neoplasias Esofágicas/patologia , Faringite/etiologia , Biópsia , Carcinoma Verrucoso/cirurgia , Ressecção Endoscópica de Mucosa , Endoscopia do Sistema Digestório , Neoplasias Esofágicas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
2.
Artigo em Chinês | MEDLINE | ID: mdl-33040517

RESUMO

After treatment, patients with head and neckmalignant tumors may suffer from dysphagia, which may lead to aspiration pneumonia, cough and other complications, even threaten life, seriously affecting patients'quality of life. Through comprehensive evaluation of patients' swallowing function, clinicians can make corresponding rehabilitation plans to improve patients' quality of life.This paper summarizes a variety of subjective and objective evaluation methods for evaluating swallowing function of head and neck malignant tumors.


Assuntos
Transtornos de Deglutição , Neoplasias de Cabeça e Pescoço , Pneumonia Aspirativa , Deglutição , Transtornos de Deglutição/etiologia , Humanos , Qualidade de Vida
3.
Wiad Lek ; 73(9 cz. 1): 1848-1852, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33099528

RESUMO

OBJECTIVE: Introduction: Neurogenic dysphagia is a frequent disorder affecting people with neurological diseases. Many experts work together to diagnose and treat dysphagia. The aim: The article focuses on the specificity of neurogenic dysphagia, its symptoms and treatment possibilities. The speech pathologist can be included in the diagnostic process and can evaluate the intake of liquids and foods based on a variety of consistency tests. In clinical conditions, screening tests such as water swallowing test, multiple consistency tests: GUSS (Gugging Swallowing Screen), V-VST (Volume-Viscosity Swallow Test) and EAT-10 questionnaire can be used successfully. If you have limited ability to perform instrumental tests, they can help you to expand your diagnosis. PATIENTS AND METHODS: Review and Discussion:Treatment of swallowing disorders is based on a daily modification of the patient's posture and consistency of the eaten meals. Nursing staff are involved in this adaptation activity, which plays an invaluable role in the diagnosis and treatment of patients in neurological and rehabilitation departments. CONCLUSION: Conclusions: Despite the knowledge of the problem, difficulty swallowing is still unnoticed. The effects of this neglect are felt both for patients and from the perspective of management within treatment units For people suffering from neurological diseases, swallowing disorders should be diagnosed on a compulsory basis and their assessment should be a permanent part of the standard procedures for assessing patients with neurological deficits.


Assuntos
Transtornos de Deglutição , Doenças do Sistema Nervoso , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/etiologia , Humanos , Doenças do Sistema Nervoso/complicações , Doenças do Sistema Nervoso/diagnóstico , Sensibilidade e Especificidade , Inquéritos e Questionários
4.
J Cardiothorac Surg ; 15(1): 292, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33008484

RESUMO

BACKGROUND: Aortoesophageal fistula (AEF) caused by an esophageal foreign body is a life-threatening crisis, with rapid progress and high mortality. The first case of AEF was reported in 1818, but the first successfully managed case was not until 1980. Although there have been some reports on this condition, in most cases, the aorta was invaded and corroded due to its adjacent relationship with the esophagus and subsequent mediastinitis. To date, few reports have described an aortic wall directly penetrated by a sharp foreign body, likely because this type of injury is extremely rare and most patients cannot receive timely treatment. Here, we present a rare case of a fish bone that directly pierced the aorta via the esophagus. CASE PRESENTATION: A 31-year-old female experienced poststernum swallowing pain after eating a meal of fish. Gastroscope showed a fishbone-like foreign body had penetrated the esophagus wall. Computed tomography revealed that the foreign body had directly pierced the aorta to form an AEF. Surgery was successfully performed to repair the aorta and esophagus. The postoperation and follow-up was uneventful. CONCLUSIONS: For the treatment of foreign bodies in the esophagus, we should be alert of the possibility of AEFs. The effective management of AEFs requires early diagnosis and intervention, as well as long-term treatment and follow-up, which still has a long way to go.


Assuntos
Aorta/lesões , Doenças da Aorta/cirurgia , Osso e Ossos , Fístula Esofágica/cirurgia , Corpos Estranhos/cirurgia , Adulto , Animais , Aorta/diagnóstico por imagem , Transtornos de Deglutição/etiologia , Fístula Esofágica/diagnóstico por imagem , Feminino , Corpos Estranhos/diagnóstico por imagem , Humanos , Dor/etiologia , Tomografia Computadorizada por Raios X
5.
Codas ; 32(5): e20180154, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-33053079

RESUMO

PURPOSE: To correlate stroke severity with oral intake level of the studied population and compare the two factors at the time of admission and after swallowing management. METHODS: A total of 137 patients hospitalized in the cerebral vascular accident unit (CVAU) of a teaching hospital participated. During the stay at CVAU, the patients were submitted to daily neurological evaluation and application of National Institutes of Health Stroke Scale (NIHSS), to evaluate the severity of stroke, ranging from zero (without evidence of neurological deficit) to 42 (in coma and unresponsive). Functional Oral Intake Scale (FOIS), which is a marker for evolution of oral intake and ranges from level one (nothing oral) to seven (oral total restrictions). Data from the NIHSS and FOIS scales of admission and discharge were analyzed and compared to verify association between improvement of oropharyngeal dysphagia with functional improvement of individuals. RESULTS: At admission, 63 (46.0%) patients had mild strokes, 38 (27.7%) had severe and very severe stroke; 46 (33.6%) had oral intake and need for special preparation or compensations. At discharge, there was an increase in patients with mild stroke (76 - 55.5%); oral intake without special preparation or compensations, but with food restrictions (18 - 13.1%), and oral intake without restrictions (44 - 32.1%). CONCLUSION: The level of oral intake increased as the severity of stroke decreased. Speech and language therapy contributed to a decrease in stroke severity and improvement in oral intake.


Assuntos
Transtornos de Deglutição , Acidente Vascular Cerebral , Deglutição , Transtornos de Deglutição/etiologia , Humanos , Alta do Paciente , Índice de Gravidade de Doença , Acidente Vascular Cerebral/complicações
6.
Medicine (Baltimore) ; 99(38): e22360, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957409

RESUMO

BACKGROUND: Post-stroke dysphagia (PSD) requires effective treatment as it may cause aspiration pneumonia, dehydration, or malnutritution, which can increase the length of hospital stay as well as mortality. In the field of stroke, electroacupuncture (EA) has been widely used, and a number of clinical research papers have been published regarding its effects. This systematic review aims to evaluate the effectiveness of EA for the treatment of PSD. METHODS: Randomized controlled trials evaluating the use of EA in PSD will be included in this meta-analysis. The following electronic databases will be searched from inception to July 31, 2020, using terms relating to EA and PSD: PubMed, the Cochrane Library, the Excerpta Medica Database, China National Knowledge Infrastructure, the Korean Medical Database, KoreaMed, the National Digital Science Library, and the Oriental Medicine Advanced Searching Integrated System. Two reviewers will independently search these databases, select studies for inclusion, and evaluate the quality of the studies. Methodological quality will be assessed using the Cochrane Handbook for Systematic Reviews of Interventions (version 6.0). The primary outcome will be the total effective rate; secondary outcomes will include results of other assessments of dysphagia such as the water drinking test scale and videofluoroscopic swallowing study. We will also investigate the number and severity of adverse events. The Cochrane Review Manager (RevMan) software (version 5.3.5) will be employed to assess bias risk, data integration risk, and meta-analysis risk. Mean difference and standardized mean difference will be used to represent continuous data, while risk ratios will be used for pooled binary data. RESULTS: This study will provide a comprehensive review and evaluation of the available evidence regarding the efficacy and safety of EA as a treatment for PSD. CONCLUSION: This study will clarify whether EA could be an effective and safe treatment for PSD.


Assuntos
Transtornos de Deglutição/terapia , Eletroacupuntura/métodos , Reabilitação do Acidente Vascular Cerebral/métodos , Transtornos de Deglutição/etiologia , Humanos , Metanálise como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Acidente Vascular Cerebral/complicações , Revisões Sistemáticas como Assunto
7.
Zhonghua Zhong Liu Za Zhi ; 42(8): 670-675, 2020 Aug 23.
Artigo em Chinês | MEDLINE | ID: mdl-32867460

RESUMO

Objective: The study aimed to analyze the clinicopathological features, treatment, and prognosis factors of primary esophageal small-cell carcinoma (PESC). Methods: The clinical records and follow-up data of 100 patients with PESC were collected, and the clinicopathological features and treatments were examined. Log-rank test and Cox regression model were performed to identify the independent prognostic factors. Results: Progressive dysphagia, weight loss, and abdominal pain were the most common initial symptoms in the 100 patients with PESC. The primary tumor site mainly occurred in the middle of the chest (51%, 51/100), and the ulcer type was the most common under gastroscope (31%, 31/100). One or more positive markers of epithelial origin were present in all of the enrolled patients. At the time of diagnosis, 80 cases had limited disease (LD) and 20 cases had extensive disease (ED). The 1-, 3-, and 5-year survival rates of PESC patients were 57.0%, 18.0%, and 11.0%, respectively, with a median survival time (MST) of 13.8 months. In all PESC patients, multivariate Cox regression analysis indicated that the significant prognostic factors included the lesion length (OR=2.661, P<0.001), TNM staging (OR=1.464, P=0.016), and treatment methods (OR=0.333, P<0.001). Besides, in patients with LD, the lesion length (OR=2.638, P=0.001) and treatment methods (OR=0.285, P<0.001) were independent prognostic factors. The MST of patients in surgery + chemotherapy group (21.6 months) was longer than that of the surgery only group (8.3 months, P=0.021), while patients in surgery+ chemotherapy+ radiotherapy group were also associated with a longer MST than the chemotherapy + radiotherapy group (31.0 months, 9.8 months, respectively; P<0.001). Conclusions: PESC is a rare esophageal malignant tumor with poor prognosis. Our findings reveal that the lesion length, TNM staging, and treatment method are independent prognostic factors for PESC patients. Moreover, surgery-based comprehensive treatments may prolong the survival of patients with LD.


Assuntos
Carcinoma de Células Pequenas/cirurgia , Neoplasias Esofágicas/cirurgia , Dor Abdominal/etiologia , Carcinoma de Células Pequenas/mortalidade , Carcinoma de Células Pequenas/patologia , Transtornos de Deglutição/etiologia , Neoplasias Esofágicas/mortalidade , Neoplasias Esofágicas/patologia , Esofagectomia , Humanos , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida , Perda de Peso
8.
J Rehabil Med ; 52(9): jrm00100, 2020 09 16.
Artigo em Inglês | MEDLINE | ID: mdl-32896863

RESUMO

OBJECTIVE: We present a case report that complements the conclusion of Stam et al. in their call to rehabilitation facilities to anticipate and prepare to address post intensive care syndrome in post-Covid-19 patients. METHODS: The case report presented here provides insight into treating mechanically ventilated post-Covid-19 patients. RESULTS: Early intervention with dysphagia therapy and speech therapy and ventilator-compatible speak-ing valves, provided within an interprofessional collaborative team, can mitigate the potentially negative consequences of prolonged intubation, long-term use of cuffed tracheostomy, and post intensive care syndrome resulting from Covid-19. CONCLUSION: Such a treatment approach can be used to address what is important to patients: to be able to speak with family and friends, eat what they want, and breathe spontaneously.


Assuntos
Infecções por Coronavirus/reabilitação , Transtornos de Deglutição/reabilitação , Terapia da Linguagem/métodos , Pneumonia Viral/reabilitação , Pneumologia/métodos , Fonoterapia/métodos , Betacoronavirus , Infecções por Coronavirus/virologia , Cuidados Críticos , Transtornos de Deglutição/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Equipe de Assistência ao Paciente , Pneumonia Viral/virologia , Respiração , Respiração Artificial/efeitos adversos , Fala , Síndrome , Traqueostomia/efeitos adversos , Traqueostomia/métodos
9.
Medicine (Baltimore) ; 99(38): e22136, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957335

RESUMO

The aim of this study was to investigate the effect of the jaw opening exercise (JOE) on the thickness of the suprahyoid muscle and hyoid bone movement compared with the head lift exercise (HLE) in patients with dysphagia after strokeThis study recruited 30 patients with dysphagia after stroke. The JOE group performed a JOE using a resistance bar. The HLE group performed the traditional HLE. The total intervention duration was 6 weeks. We measured the thickness of the digastric and mylohyoid muscles using ultrasound. Two-dimensional motion analysis of the hyoid bone was performed using Image J software. The Borg rating of the perceived exertion scale was used to assess the intensity level of physical activity during the 2 exercises.Both groups showed a significant increase in the thickness of the digastric and mylohyoid muscles (P < .05). Hyoid bone motion was significantly increased in the anterior and superior movement in both groups (P < .05). After the intervention, there was no significant difference between the 2 groups. The Borg rating of perceived exertion scale for the JOE group was significantly lower than that of the HLE group (P < .05).In conclusion, this study demonstrated that the JOE and the HLE had similar effects with respect to increasing suprahyoid muscle thickness and improving hyoid bone movement. However, the JOE required less perceived exertion than the HLE.


Assuntos
Transtornos de Deglutição/etiologia , Transtornos de Deglutição/terapia , Terapia por Exercício/métodos , Acidente Vascular Cerebral/complicações , Transtornos de Deglutição/fisiopatologia , Feminino , Humanos , Osso Hioide/fisiologia , Masculino , Pessoa de Meia-Idade , Músculos do Pescoço/fisiologia , Projetos Piloto , República da Coreia
10.
N Z Med J ; 133(1521): 102-105, 2020 09 04.
Artigo em Inglês | MEDLINE | ID: mdl-32994641

RESUMO

Foreign body ingestion is not uncommon in patients with mental disorders, alcohol intoxication and for purposes of drug trafficking. Small objects pass spontaneously; however, larger ones may get stuck in the oesophagus, stomach or at narrow areas of the bowel. 'Body packers' is a term used to describe persons who swallow or insert drug-filled packets into a body cavity. They are also called 'swallowers', 'internal carriers', 'couriers' or 'mules'. We report a 37-year-old previous drug abuser who presented with dysphagia. Upper GI endoscopy showed an oblong foreign body covered in plastic in the lower oesophagus. This could not be extracted and hence was pushed into the stomach. Three weeks later, he presented with bowel obstruction that was shown on abdominal radiograph and confirmed by CT indicating multiple dilated small bowel loops with a transition point in the terminal ileum where the ingested package was identified. The package was then removed through a longitudinal enterotomy. Ingested foreign bodies causing dysphagia should ideally be extracted endoscopically. If not possible, then a watch-and-wait policy may be justified. While most ingested objects pass spontaneously, unusual and larger ones may require surgical extraction. The contents, nature and reason for ingesting this strange object remain a mystery. With history of drug abuse and the consistent denial of knowingly swallowing that object, we can only conclude that the patient was trying to transport an illicit drug in the packet.


Assuntos
Corpos Estranhos , Obstrução Intestinal , Adulto , Transtornos de Deglutição/etiologia , Corpos Estranhos/complicações , Corpos Estranhos/diagnóstico por imagem , Corpos Estranhos/cirurgia , Humanos , Íleo/diagnóstico por imagem , Íleo/cirurgia , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Laparotomia , Masculino , Tomografia Computadorizada por Raios X
12.
Medicine (Baltimore) ; 99(31): e21526, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756197

RESUMO

RATIONALE: Dysphagia is a common presenting symptom in elderly people. Nevertheless, dysphagia resulting from diffuse idiopathic skeletal hyperostosis (DISH) of patients' cervical spine may be due to several factors. Despite computed tomography scan showing the size and shape of osteophytes, endoscopy may be necessary to exclude other intrinsic causes of dysphagia. Due to the anatomic variation of the pharynx secondary to DISH, patients undergoing endoscopy are at risk of perforation. Once perforation occurs, inappropriate treatments may finally lead to an irretrievable outcome. PATIENT CONCERNS: A 58-year-old male patient with a 20-day history of dysphagia initially visited an ear-nose-throat (ENT) doctor. He had no neck pain and no other history of cervical disease. DIAGNOSIS: This patient with dysphagia due to DISH of the cervical spine underwent laryngoscopy to exclude other causes. Pharyngeal perforation resulted as a complication of the procedure. INTERVENTIONS: The patient underwent laryngoscopy and biopsy by an ENT doctor to exclude intrinsic causes. After the procedure, a perforation was formed on the posterior wall of the pharynx. Conservative management, that is, 1 week of nothing per oral, and 1 month of antibiotics, was adopted. On the 30th day after the examination, the patient was voluntarily discharged from the hospital and recommended to take antibiotics orally. OUTCOMES: On the 56th day, the patient experienced fever and neck pain. Magnetic resonance imaging showed that the cervical vertebral bodies and spinal cord were infected. On the midday of the 60th day, the patient had a failed resuscitation and died. LESSONS: DISH involving the cervical spine is a complicated cause of dysphagia. Due to the anatomic variation of the pharynx secondary to DISH, patients undergoing endoscopy are at risk of perforation. If other intrinsic causes of dysphagia have to be excluded with the aid of endoscopy, plain films and computed tomography images should be read carefully first. To minimize the risk of perforation, it is necessary to perform endoscopy extremely carefully, especially biopsy. Once perforation occurs, operative treatment may be more appropriate and effective.


Assuntos
Transtornos de Deglutição/diagnóstico por imagem , Transtornos de Deglutição/etiologia , Hiperostose Esquelética Difusa Idiopática/complicações , Laringoscopia/efeitos adversos , Faringe/lesões , Humanos , Masculino , Pessoa de Meia-Idade
14.
Medicine (Baltimore) ; 99(34): e21657, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846777

RESUMO

BACKGROUND: Dysphagia is a common complication after stroke, with high disability rate and high fatality rate. Although several clinical studies and evidence-based medicine have demonstrated the efficacy of acupuncture in the treatment of dysphagia after stroke, there are significant differences in study design and intervention methods. The objective of this study is to compare the efficacy and safety of different acupuncture and related therapies in the treatment of dysphagia after stroke, so as to provide a superior clinical program. METHODS: We will search 7 databases for randomized controlled trials of acupuncture-related therapies for dysphagia after stroke, including PubMed, the Cochrane Library, EMbase, China National Knowledge Infrastructure, China Biological Medicine, Chinese Scientific Journals Database, and wan-fang databases, from the date of the establishment of each database to March 31, 2020. The network meta-analysis will be implemented through Aggregate Data Drug Information System 1.16.8 and Stata 13.0 software. Clinical Efficiency, videofluoroscopic swallowing study score and Kubota Drinking Water Test grade will be the primary outcomes, Swallowing disorder specific quality of life score, Standardized Assessment and Adverse effects will be evaluated as secondary outcomes. Mean differences or odds ratios will be used for statistical analysis. We will ensure the reliability of the results through node-split model and heterogeneity analysis. In addition, methodological quality will be evaluated based on the Cochrane Collaboration's tool, and the quality of evidence will be evaluated according to the Grading of Recommendations Assessment, Development and Evaluation system. RESULTS: This study will provide a reliable evidence for the selection of acupuncture and related therapies for dysphagia after stroke. CONCLUSION: The results of this study will provide references for evaluating the influence of acupuncture and related therapies for dysphagia after stroke, and provide decision-making references for clinical research. ETHICS AND DISSEMINATION: This study did not require ethical approval. We will disseminate our findings by publishing results in a peer-reviewed journal. OSF REGISTRATION NUMBER: DOI 10.17605/OSF.IO/TAHND.


Assuntos
Terapia por Acupuntura/métodos , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/terapia , Metanálise como Assunto , Projetos de Pesquisa , Acidente Vascular Cerebral/complicações , Revisões Sistemáticas como Assunto , Humanos
15.
Codas ; 32(4): e20190036, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32756854

RESUMO

PURPOSE: To verify the relationship between the risk of dysphagia and health status in patients with Chronic Obstructive Pulmonary Disease (COPD). METHOD: Cross-sectional study with convenience sample. Twenty-three individuals with a diagnosis of COPD according to GOLD 2019 criteria. The individuals participated in a pulmonary rehabilitation program, clinically stable (without exacerbations of at least 30 days) and in optimized drug treatment were included. The study analyzed anthropometric measures (BMI), peak expiratory flow (PEF), mental status (MEEM), eating assessment tool (EAT-10), and health status (COPD Assessment Test -CAT). The mean age was 60.39 ± 9.90 years, 11 individuals were female and eutrophic. RESULTS: We observed a positive and moderate association (r = 0.57, p = 0.004) between the CAT and EAT-10 scores in the sample studied. CONCLUSION: The results demonstrated relationship between the risk of dysphagia and the health status in individuals with COPD.


Assuntos
Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/etiologia , Doença Pulmonar Obstrutiva Crônica/complicações , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/reabilitação , Testes de Função Respiratória , Inquéritos e Questionários
16.
Medicine (Baltimore) ; 99(34): e21795, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846813

RESUMO

The objective of this study was to investigate the quality of life in stroke patients using a swallowing quality of life (SWAL-QOL) questionnaire. The correlation between SWAL-QOL questionnaire outcome and videofluoroscopic dysphagia scale (VDS) scores in stroke patients was also determined.This cross-sectional study was retrospectively conducted with 75 stroke patients with dysphagia symptoms. Videofluoroscopic swallowing study (VFSS) and SWAL-QOL questionnaires were performed for all patients. These patients were divided into an oral feeding group and a tube feeding group. SWAL-QOL scores were compared between the 2 groups. The severity of dysphagia was estimated by VDS scores according to the videofluoroscopic swallowing study results. The relationships between SWAL-QOL scores and VDS scores were also investigated.The composite score was 48.82 ±â€Š19.51 for the tube feeding group and 53.17 ±â€Š25.42 for the oral feeding group. There were significant differences in burden and sleep subdomains of the SWAL-QOL between the 2 groups (P = .005 and P = .012, respectively). There was a significant negative correlation between the composite score of SWAL-QOL outcome and the total VDS score (r = -0.468, P = .012). The pharyngeal-phase score of the VDS had significant negative correlations with the SWAL-QOL subdomains of burden (r = -0.327, P = .013), mental health (r = -0.348, P = .008), and social functioning (r = -0.365, P = .029).To improve the quality of life of stroke patients, dysphagia rehabilitation should focus on the pharyngeal phase of dysphagia.


Assuntos
Transtornos de Deglutição/diagnóstico por imagem , Transtornos de Deglutição/etiologia , Qualidade de Vida , Índice de Gravidade de Doença , Acidente Vascular Cerebral/complicações , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Deglutição , Transtornos de Deglutição/fisiopatologia , Nutrição Enteral , Feminino , Fluoroscopia , Humanos , Masculino , Pessoa de Meia-Idade , Nutrição Parenteral , Estudos Retrospectivos , Inquéritos e Questionários
17.
Vasc Endovascular Surg ; 54(8): 747-751, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32748705

RESUMO

Dysphagia Lusoria is a condition when aberrant right subclavian artery (ARSA) causes esophageal compression. We report 2 cases of Dysphagia Lusoria treated by hybrid endovascular technique which included subclavian to carotid transposition and embolization of origin of ARSA. By using this technique, we avoided the need for thoracotomy. Both patients had complete symptom relief without any surgery related complication.


Assuntos
Anormalidades Cardiovasculares/cirurgia , Transtornos de Deglutição/etiologia , Embolização Terapêutica , Procedimentos Endovasculares , Estenose Esofágica/etiologia , Artéria Subclávia/anormalidades , Enxerto Vascular , Adulto , Anormalidades Cardiovasculares/complicações , Anormalidades Cardiovasculares/diagnóstico por imagem , Deglutição , Transtornos de Deglutição/diagnóstico por imagem , Transtornos de Deglutição/fisiopatologia , Estenose Esofágica/diagnóstico por imagem , Estenose Esofágica/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Artéria Subclávia/diagnóstico por imagem , Artéria Subclávia/cirurgia , Resultado do Tratamento
18.
PLoS One ; 15(8): e0236804, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32790801

RESUMO

OBJECTIVE: The ALS Functional Rating Scale-Revised (ALSFRS-R) is the most commonly utilized instrument to index bulbar function in both clinical and research settings. We therefore aimed to evaluate the diagnostic utility of the ALSFRS-R bulbar subscale and swallowing item to detect radiographically confirmed impairments in swallowing safety (penetration or aspiration) and global pharyngeal swallowing function in individuals with ALS. METHODS: Two-hundred and one individuals with ALS completed the ALSFRS-R and the gold standard videofluoroscopic swallowing exam (VFSE). Validated outcomes including the Penetration-Aspiration Scale (PAS) and Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) were assessed in duplicate by independent and blinded raters. Receiver operator characteristic curve analyses were performed to assess accuracy of the ALSFRS-R bulbar subscale and swallowing item to detect radiographically confirmed unsafe swallowing (PAS > 3) and global pharyngeal dysphagia (DIGEST >1). RESULTS: Although below acceptable screening tool criterion, a score of ≤ 3 on the ALSFRS-R swallowing item optimized classification accuracy to detect global pharyngeal dysphagia (sensitivity: 68%, specificity: 64%, AUC: 0.68) and penetration/aspiration (sensitivity: 79%, specificity: 60%, AUC: 0.72). Depending on score selection, sensitivity and specificity of the ALSFRS-R bulbar subscale ranged between 34-94%. A score of < 9 optimized classification accuracy to detect global pharyngeal dysphagia (sensitivity: 68%, specificity: 68%, AUC: 0.76) and unsafe swallowing (sensitivity:78%, specificity:62%, AUC: 0.73). CONCLUSIONS: The ALSFRS-R bulbar subscale or swallowing item did not demonstrate adequate diagnostic accuracy to detect radiographically confirmed swallowing impairment. These results suggest the need for alternate screens for dysphagia in ALS.


Assuntos
Esclerose Amiotrófica Lateral/diagnóstico , Transtornos de Deglutição/diagnóstico , Idoso , Esclerose Amiotrófica Lateral/complicações , Esclerose Amiotrófica Lateral/patologia , Área Sob a Curva , Deglutição/fisiologia , Transtornos de Deglutição/etiologia , Feminino , Fluoroscopia , Humanos , Masculino , Pessoa de Meia-Idade , Curva ROC , Sensibilidade e Especificidade , Índice de Gravidade de Doença
19.
Medicine (Baltimore) ; 99(27): e21099, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629742

RESUMO

RATIONALE: Intramural esophageal squamous cell carcinoma (ESCC) without mucosal invasion is extremely rare. Endoscopic mucosal biopsy results are often negative, making diagnosis difficult. In these cases, endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) biopsy is a useful diagnostic method. PATIENT CONCERNS: A 78-year-old female was admitted to hospital due to dysphagia, and gastroscopy showed a concentric narrowing of the esophageal lumen with a smooth and undamaged esophageal mucosa. DIAGNOSES: Endoscopic ultrasound (EUS) revealed that the esophageal mucosa was thickened with a low echo, and the layers of the esophageal wall could not be clearly distinguished. Cytologic and pathologic diagnoses were obtained through EUS-FNA, which suggested ESCC. INTERVENTIONS: According to the pathologic diagnosis obtained by EUS-FNA, surgery or radiotherapy were recommended for this patient. Eventually, this patient elected to seek treatment at another medical institution. OUTCOMES: This type of disease cannot be diagnosed according to gastroscopic biopsy alone, and the diagnosis was eventually confirmed through EUS-FNA. LESSONS: When an imaging examination suggests a possible malignant lesion of the oesophagus, EUS-FNA may be considered if the surface mucosa contains no endoscopic damage. EUS-FNA has high diagnostic value with high sensitivity, minimal invasiveness, and high safety.


Assuntos
Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/métodos , Neoplasias Esofágicas/patologia , Carcinoma de Células Escamosas do Esôfago/diagnóstico por imagem , Carcinoma de Células Escamosas do Esôfago/patologia , Idoso , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/etiologia , Feminino , Gastroscopia/métodos , Hospitalização , Humanos , Membrana Mucosa/patologia , Pacientes Desistentes do Tratamento/psicologia , Radioterapia/normas , Procedimentos Cirúrgicos Operatórios/normas
20.
Brain Nerve ; 72(7): 797-802, 2020 Jul.
Artigo em Japonês | MEDLINE | ID: mdl-32641576

RESUMO

Medical staff frequently face ethically difficult situations when patients with severe dysphagia request oral intake. The most important thing to assist them with better ethical decision-making is a discussion based on medically accurate facts. Although medical staff suffer from ethical dilemmas, clinical ethics conferences based on the four principles of clinical ethics are recommended. The process leading to better ethical clinical decision-making is important.


Assuntos
Transtornos de Deglutição , Ética Clínica , Tomada de Decisão Clínica , Tomada de Decisões , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/terapia , Humanos
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