A screening procedure for oropharyngeal dysphagia.

The present study was designed to examine the sensitivity and specificity of a 28-item screening test in identifying patients who aspirate, have an oral stage disorder, a pharyngeal delay, or a pharyngeal stage disorder. The screening test includes 28 items divided into 5 categories: (1) 4 medical history variables; (2) 6 behavioral variables; (3) 2 gross motor variables; (4) 9 observations from oromotor testing; and (5) 7 observations during trial swallows. Results identified variables that were able to classify patients correctly as having or not having aspiration 71% of the time, an oral stage disorder 69% of the time, a pharyngeal delay 72% of the time, and a pharyngeal stage swallowing problem 70% of the time.

Incidence and patient characteristics associated with silent aspiration in the acute care setting.

Coughing is a physiologic response to aspiration in normal healthy individuals. However, there are published records that report no cough in response to aspiration (i.e.

Congenital retinoblastoma: appearance of calcifications during short-term follow-up.

An echographic follow-up of a case of congenital retinoblastoma was performed by monitoring variations in the tumoral echostructure concomitant with the appearance of microcalcifications. A previously unreported echo-graphic aspect regarding the first phase of observation is described. The calcifications in the tumour were evidenced on the 41st day of the patient's life.

A case of quiescent choroidal melanoma: early echographic signs of reactivation.

A medium-sized choroidal melanoma was studied during a 5-year phase of remission. The tumour presented signs of reactivation with changes in the echographic features without a significant increase in size. The echographic signals in the reactivation phase and the echographic evolution after treatment are described.

Echobiometry of the ocular layers at the posterior pole.

The thickness of the retina, choroid and sclera in relation to macular oedema (ME) can be measured using A scan echography. Ninety diabetic patients (180 eyes) divided into two groups with and without ME, respectively, were studied compared to a third group of 73 healthy controls (146 eyes). Statistical analysis of results showed good specificity (80%) and reasonable sensitivity (70%) of the echographic method in showing the presence of ME confirmed by fluorescein angiography.

Functional results of primary closure vs flaps in oropharyngeal reconstruction: a prospective study of speech and swallowing.

Background: The preservation of speech and swallowing function is the primary goal when reconstructing soft tissue defects in the oral cavity or oropharynx. The type of reconstructive procedure used should be based on outcome data examining speech and swallowing function; yet, there is a paucity of such information.

Objectives: To present the results of a multi-institutional prospective study of speech and swallowing function before and after soft tissue reconstruction of the oral cavity and oropharynx, and to compare 3 methods of reconstruction with respect to speech and swallowing function: primary closure, distal myocutaneous flap, and microvascular free flap.

Surgical variables affecting speech in treated patients with oral and oropharyngeal cancer.

Postoperative speech function may be influenced by a number of treatment variables. The objective of this study was to examine the relationships among various treatment factors to determine the impact of these measures on speech function. Speech function was tested prospectively in 142 patients with surgically treated oral and oropharyngeal cancer 3 months after treatment.

Speech and swallowing in irradiated and nonirradiated postsurgical oral cancer patients.

The effect of radiation on speech and swallowing function was assessed for 18 patients surgically treated for oral and oropharyngeal cancer. Nine patients received surgical intervention and postoperative radiation therapy, and nine received surgery only. Patients were matched regarding percentage of oral tongue resected, percentage of tongue base resected, locus of resection, and method of reconstruction.

Age and volume effects on liquid swallowing function in normal women.

Understanding the nature of swallowing in persons without swallowing problems is a prerequisite to evaluating the nature and extent of dysphagia in persons with compromised swallowing. In order to determine how swallowing varies with age and with liquid bolus volume in women, we assessed 167 normal female swallowers videofluoroscopically and obtained multiple measures of swallowing function. The women in this study demonstrated a change in swallowing function with age, due primarily to an increase in pharyngeal transit and total duration of the motor response.

Light digital occlusion of the tracheostomy tube: a pilot study of effects on aspiration and biomechanics of the swallow.

Background: This study examined the effects of digital occlusion of the tracheostomy tube versus no occlusion on oropharyngeal swallowing in head and neck cancer patients.

Methods: Eight treated head and neck cancer patients were studied, six of whom had undergone surgical treatment for oral or laryngeal cancer and two who had undergone high-dose chemotherapy and radiotherapy for laryngeal cancer. Videofluorographic studies of oropharyngeal swallowing were accomplished on 3-mL boluses of liquid in seven patients and 3-mL boluses of paste in three patients, first with the tracheostomy not occluded and then with it lightly digitally occluded by the patient.

Super-supraglottic swallow in irradiated head and neck cancer patients.

Background: After radiotherapy to the head and neck, many patients experience swallowing difficulties. Preliminary work indicates that these patients benefit from the super-supraglottic swallow maneuver.

Methods: Lateral videofluoroscopic studies examined oropharyngeal swallowing in 9 patients who suffered from dysphagia after radiation to the head and neck.

Speech and swallowing rehabilitation for head and neck cancer patients.

Head and neck cancer and its treatment frequently cause changes in both speech and swallowing, which affect the patient's quality of life and ability to function in society. The exact nature and severity of the post-treatment changes depend on the location of the tumor, the choice of treatment, and the availability and use of speech and swallowing therapy during the first 3 months after treatment. This paper reviews the literature on speech and swallowing problems in various types of treated head and neck cancer patients.

Acute chest syndrome in sickle cell disease: clinical presentation and course. Cooperative Study of Sickle Cell Disease.

Acute chest syndrome (ACS) is an important cause of morbidity and mortality in sickle cell disease (SCD). Previous studies reported conflicting pictures of ACS making therapeutic interventions difficult. The Cooperative Study of Sickle Cell Disease prospectively followed 3,751 patients enrolled from birth to 66 years of age for ACS.

Natural history of blood pressure in sickle cell disease: risks for stroke and death associated with relative hypertension in sickle cell anemia.

Purpose: Blood pressure in individuals who have sickle cell disease has been reported to be lower than published normal values. We determine whether and to what degree this is true, using data obtained as part of a large natural history study.

Patients And Methods: Blood pressure was measured annually for 3,317 subjects with sickle cell disease who were 2 years old or older.

Lipids and lipoproteins in diabetic adolescents and young adults with retinopathy.

Purpose: To compare serum concentrations of lipoproteins and apolipoproteins in insulin-dependent diabetic patients with and without retinopathy.

Methods: A cross-sectional study was performed on 42 diabetic adolescents and young adults with different degrees of retinopathy. The mean +/- SD age of the patient was 21.

Swallowing disorders in head and neck cancer patients treated with radiotherapy and adjuvant chemotherapy.

The nature of swallowing problems was examined in nine patients treated primarily with external-beam radiation and adjuvant chemotherapy for newly diagnosed tumors of the head and neck. All subjects underwent videofluorographic examination of their swallowing. Three analyses were completed, including the following: observations of motility disorders, residue, and aspiration; temporal analyses; and biomechanical analyses.

Management of early-stage Hodgkin's lymphoma. The radiation oncology experience at Northwestern University/Northwestern Memorial Hospital.

Early-stage Hodgkin's lymphoma patients treated with radiotherapy alone or combined modality therapy were retrospectively analyzed for survival, patterns of failure, salvage, and toxicity. Of 75 evaluable patients, 47 were given radiotherapy alone and 28 were given combination radiotherapy and chemotherapy. Of the patients studied, 26 were clinical stage I and 49 were clinical stage II, with nine patients upstaged at laparotomy.

T stage and functional outcome in oral and oropharyngeal cancer patients.

Background: The locus and extent of resection and the type of reconstruction used in surgery are important joint determinants of functional outcome in oral and oropharyngeal cancer patients. However, prediction of functional outcome from broader factors such as clinical T stage and approximate locus of resection is important for the preoperative period when the extent of resection and the exact surgical reconstruction to be used may not be decided and preoperative counseling about potential functional outcomes is needed.

Methods: Oropharyngeal swallow efficiency (OPSE) and conversational speech understandability (CU) were measured preoperatively and 3 months posthealing in 68 patients.

Longitudinal assessment of quality of life in laryngeal cancer patients.

Background: Although quality of life (QL) and performance status are important outcomes in head and neck (HN) cancer, there is little systematic inclusion of these parameters in treatment trials.

Methods: Rate and recovery of function were evaluated over a 6-month period in 21 laryngeal cancer patients, 7 in each of 3 treatment groups: total laryngectomy (group 1), hemilaryngectomy (group 2), and radiotherapy only (group 3). Assessment included Performance Status Scale for Head and Neck Cancer Patients (PSS-HN: Diet, Speech, and Eating in Public subscales) and the FACT-HN, a multidimensional QL measure.

Intraoperative blood loss and prognosis in prostate cancer patients undergoing radical retropubic prostatectomy.

Purpose: To assess more thoroughly the prognostic significance of perioperative transfusions, we examined a previously ignored factor, namely intraoperative blood loss.

Materials And Methods: Univariate and multivariate stepwise regression analysis was performed on results of a 10-year series of 251 consecutive men who underwent radical retropubic prostatectomy for clinically localized carcinoma.

Results: Gleason score, operative blood loss and pathological stage were significantly (p < 0.

Effects of a sour bolus on oropharyngeal swallowing measures in patients with neurogenic dysphagia.

This study examines the effects of a sour bolus (50% lemon juice, 50% barium liquid) on pharyngeal swallow measures in two groups of patients with neurogenic dysphagia. Group 1 consisted of 19 patients who had suffered at least one stroke. Group 2 consisted of 8 patients with dysphagia related to other neurogenic etiologies.

Biomechanical analysis of the pharyngeal swallow in postsurgical patients with anterior tongue and floor of mouth resection and distal flap reconstruction.

The purpose of this study was to examine changes in the biomechanics of pharyngeal swallow after surgery in eight patients (six men and two women) with anterior tongue and floor of mouth resections with distal flap reconstruction. Eight normal age-matched subjects were also studied. Swallowing performance was assessed following a standardized protocol with videofluoroscopy preoperatively and at 1 and 3 months postoperatively for the oral cancer patients.

Topical naphazoline in treatment of myopathic ptosis.

We instilled naphazoline Hcl (0.1%), an imidazole derivative with preferential alpha-2 activity, in 17 eyes of 12 patients with myopathic ptosis due to involvement of the levator palpebrae superioris, in the attempt to selectively stimulate Müller's smooth muscle. Naphazoline significantly widened the palpebral fissure with little change in pupillary diameter and no significant change in ocular pressure, visual acuity and near point determination.

Theoretical analysis of emission spectra of electronic transitions of molecules in dense media.

The purpose of this paper is to investigate the nature of band shapes of emission spectra and their relation to the rate of nonradiative processes. Two cases are discussed, one in which the Franck-Condon principle applies and the other in which the electronic transition is symmetry-forbidden but vibronic-allowed. The moment relations of emission spectra have been derived and their applications demonstrated.