针刺配合冰棒刺激治疗中风后吞咽困难的临床研究

目的：观察针刺配合冰棒刺激治疗脑卒中后吞咽障碍的疗效。方法：将 60 例吞咽障碍患者随机分为治疗组和对照组,每组各 30 例。对照组采用神经内科常规治疗,根据病情选用药物和鼻饲饮食支持治疗。治疗组在此基础上针刺阿呛穴,使用自制小冰棒对软腭、舌根及咽后壁等与吞咽有关的黏膜肌肉进行冷刺激治疗。结果：对照组有效率 23.3% ,治疗组有效率96.7% ,两组有效率比较,差异有统计学意义（P 〈 0.01）。结论：针刺配合冰棒刺激治疗治疗中风后吞咽困难有显著疗效。     

益气为主中药结合康复训练对缺血性中风后气虚疲劳患者生活质量的影响

目的观察益气为主中药结合康复训练对缺血性中风后气虚疲劳患者生活质量的影响。方法将90例缺血性中风后气虚疲劳患者随机分为3组,每组30例。中药治疗组给予益气为主中药汤剂加康复治疗,西药治疗组给予中药安慰剂加西药加康复治疗,对照组给予中药安慰剂加康复治疗,共治疗4周。治疗前及治疗4周后采用疲劳严重程度量表(FSS)及脑卒中专用生活质量量表(SS-QOL)进行评估。结果 3组治疗后两个量表的积分均较治疗前增加,尤以中药治疗组最明显,差异有统计学意义(P<0.05)。治疗后中药治疗组与西药治疗组及对照组比较,差异亦有统计学意义(P<0.05),西药治疗组与对照组比较,差异无统计学意义(P>0.05)。结论益气为主中药结合康复训练可以改善缺血性中风后气虚疲劳患者的生活质量。     

CASE REPORT: Lichen Planus Involving the Esophagus

Lichen planus is a common mucocutaneus disorder that rarely involves the esophagus. We report two challenging cases presenting with recurrent dysphagia originally suspected due to gastroesophageal reflux. Subsequent evaluation revealed peculiar endoscopic findings of desquamative esophagitis leading to the diagnosis of lichen planus of the esophagus. This disorder should be considered in middle age or elderly women presenting with unexplained dysphagia or odynophagia. In this paper we review the available literature on the subject and summarize every case reported to date.     

Relationship between ease of swallowing and deglutition‐related muscle activity in various postures

Summary The purpose of this study was to investigate the relationship between the ease of swallowing and the deglutition‐related muscle activity in various body and head postures by surface electromyography (EMG). Bipolar surface electrodes were placed on the right suprahyoid and infrahyoid muscles of nine healthy adults (19–28 years) while swallowing jelly. Ten postures per subject were examined: five body angulations (0° [supine], 30°, 60°, 90° [upright] and 120° from the horizontal) and two head positions (chin‐up and chin‐down). The duration and amplitude of suprahyoid and infrahyoid muscle activity were measured by an electromyograph, and the ease of swallowing was subjectively determined by using a rating scale (0 = difficult to swallow, 10 = easy to swallow). The group‐average duration and amplitude of muscle activity and the group‐average rating scales mostly showed insignificant changes with the body angulations independent of the head positions. Interestingly, the duration and amplitude of muscle activity during swallowing were negatively correlated with the rating scales, indicating that a shorter duration and smaller activity of muscle activity corresponds to easier swallowing. Consequently, the duration and amplitude of suprahyoid and infrahyoid muscle activity measured by surface EMG would be a useful indicator of the easy‐to‐swallow performance.     

Myotomy: Follow-up study of 50 patients

Laparoscopic myotomy has become the standard treatment for definitive management of achalasia. This study was undertaken to assess the long-term results of the procedure. Perioperative data, including a symptom score questionnaire, were collected prospectively on all patients undergoing laparoscopic myotomy. The same questionnaire was readministered by phone to patients with follow-up greater than 3.75 years. The long-term success of myotomy was defined as a 50% or greater decrease in the dysphagia score and absence of further therapy (responders). Fifty of 95 patients (age = 57 years, 23 females) were successfully contacted. Average follow-up was 6.2 years. The overall long-term success rate was 64% (responders). Forty-two patients (84%) were able to gain or maintain their weight after the procedure. Five patients (10%) required one or more endoscopic dilations after the myotomy. The mean change in dysphagia score was higher in the responder group (7.8 ±1.9 vs. 1.9 ±2.1; P = 0.001). The two groups were similar in terms of age, gender distribution, and follow-up interval (P > .05). Dor fundoplication was performed in six patients (12%), and the outcome comparisons of these patients showed no significant differences from those patients undergoing Heller alone. Overall satisfaction was achieved in 94% of contacted patients. These results confirm that laparoscopic myotomy is an effective procedure with excellent long-term symptom resolution and overall satisfaction in patients with achalasia. Presented at the Forty-Sixth Annual Meeting of The Society for Surgery of the Alimentary Tract, Chicago, Illinois, May 14–18, 2005 (poster presentation).     

Chemoradiation therapy is effective for the palliative treatment of malignant dysphagia

Between 1993 and 2001, 106 patients with esophageal cancer were reviewed at a multidisciplinary clinic and treated with palliative intent by chemoradiation therapy. This study assesses the palliative benefit on dysphagia and documents the toxicity of this treatment. The study population comprised 72 men and 34 women with a median age of 69 years. Patients were treated with a median radiation dose of 35 Gy in 15 fractions with a concurrent single course of 5 FU-based chemotherapy. Dysphagia was measured at the beginning and completion of treatment and at monthly intervals until death, using a modified DeMeester (4-point) score. Treatment was well tolerated, with only 5% of patients failing to complete therapy. The treatment-related mortality was 6%. The median survival for the study population was 7 months. The median baseline score at presentation was 2 (difficulty with soft food). Following treatment, 49% of patients were assessed as having a dysphagia score of 0 (no dysphagia). Seventy-eight per cent had an improvement of at least one grade in their dysphagia score after treatment. Only 14% of patients showed no improvement with treatment. Fifty-one per cent maintained improved swallowing until the time of last follow-up or death. This single-institution study shows that chemoradiation therapy administered for the palliation of malignant dysphagia is well tolerated and produces a sustainable normalization in swallowing for almost half of all patients.     

Diffuse idiopathic skeletal hyperostosis‐induced dysphagia or DISHphagia

Dysphagia related to osteophyte compression in diffuse idiopathic skeletal hyperostosis (DISH) or Forestier's disease and in cervical spondylosis has been identified as a cause of dysphagia. We report an elderly man who had dysphagia due to DISH or namely DISHphagia. Clinical findings, barium esophagogram, and magnetic resonance imaging findings have been presented. Good response to medical treatment with liquid forms of NSAIDs and soft diet has been achieved.