Using ultrasound to investigate intrapersonal variability in durational aspects of tongue movement during swallowing

The purpose of this study was to determine the extent of intrapersonal variability in durational aspects of tongue movement during swallowing. Using ultrasound, the entire duration of tongue movement and the duration of the oral transport stage during swallowing was measured in a group of patients with neurogenic swallowing disorder and a group of matched healthy control subjects. The results indicate considerable intrapersonal variability in both groups. The patient group performed significantly more variably in terms of the duration of the transport stage. However, when looking at individual results, this finding can not be generalized, in that some patients showed rather decreased variability. Other differences between patient the group and control subjects were not statistically significant. Ultrasound was found to be a highly suitable technique for the purpose of this study.     

Acute coronary closure complicating intravascular ultrasound examination

A patient with an excellent angiographic result after directionalatherectomy suffered an acute coronary closure during an intravascularultrasound study performed after the intervention, Intravascularultrasound revealed a large medial dissection which could besuccessfully managed only with intracoronary stenting. The pathogenesisand implications of this rare major complication are discussed.     

经纤维支气管镜行气道内超声检查的临床应用

目的　初步探讨气道内超声检查的临床应用价值。方法　对 15例X线胸片或CT发现肺部占位性病变或怀疑阻塞性肺炎、肺不张患者采用微探头通过纤支镜的工作通道做气道内超声检查。在气道轴的垂直平面得到一个 3 60°环形超声图象。结果　支气管壁回声增强并分层。肺实质呈致密斑点状强回声。血管影为搏动性的无回声影 ,内见漂浮点状回声。 10例患者超声扫描显示肿瘤破坏管壁 ,病理诊断均为恶性肿瘤 ;1例右肺尖段结节患者超声扫描见管壁完整 ,手术证实为结核。 1例右侧胸积液并肺不张患者纤支镜下见右下叶支气管通畅 ,用超声微探头探查远端支气管未见异常回声 ,提示肺不张为胸水压迫所致 ,排除阻塞性因素。 3例疑阻塞性肺炎患者 ,1例超声扫描见腔外肿大淋巴结压迫致管腔轻度狭窄 ,但管壁完整 ,余 2例未见肿瘤样回声 ,管壁完整 ,排除阻塞性因素。气道内超声检查仅少数患者有轻度不适 ,无明显并发症。结论　气道内超声能清晰显示气道壁和腔外的结构 ,是一项安全有效的纤支镜检查辅助手段     

An electronic device measuring the frequency of spontaneous swallowing: Digital Phagometer

A new and protable electronic device called the Digital Phagometer is described for the time-based counting of spontaneous swallowing. This device is composed of a piezoelectric sensor and a digital event counter/recorder which can be downloaded to any IBM-compatible PC. The sensor of Digital Phagometer is placed and fixed on the coniotomy region between the cricoid and thyroid cartilage. In this way, it is capable of sensing each upward and downward movement of the larynx produced by spontaneous movement as a function of time. Spontaneous swallowing was measured 1–4 h after lunch in 21 normal subjects and 21 patients with Parkinson's disease (PD). The mean frequency of spontaneous swallowing was 0.8 counts/min in PD patients and 1.18 counts/min in normal subjects (p<0.05). During the intake of 200 ml water, the mean frequency of voluntary swallowing did not differ significantly between the two groups (24.6 counts/min in normals vs. 22.3 counts/min in PD patients), but the time necessary to swallow the same volume of water was longer in the PD group.     

Dynamic aspects of lingual propulsive activity in swallowing

This investigation concerned the effect of different bolus volumes on the characteristics of lingual propulsive activity in swallowing. Young normal subjects were asked to perform dry swallows and swallows of 5, 10, and 15 ml of water. Tongue activity was recorded by tracking multiple gold pellets affixed to the tongue, utilizing the specialized research capabilities of the X-ray Microbeam facility at the University of Wisconsin. The major differences were between dry and liquid swallows, with dry swallows showing smaller range of movement, higher tongue position at the initiation of lingual propulsive activity, a slightly different direction of motion, a humped or flat rather than grooved cross-sectional contour of the tongue, lower peak velocity of motion, and slower progression of activity from tongue blade to dorsum. Within the 5–15 ml range of liquid bolus volumes, fewer consistent differences were found as a function of bolus size, and some marked individual differences in swallowing patterns were seen. Data are presented on normal within-subject variability in swallowing, with discussion of the possible contribution of sensory assessment of bolus size to the modification of oral and pharyngeal characteristics of swallowing.     

Pancreatic hyperechogenicity on endoscopic ultrasound examination

There is an ongoing discussion on how to diagnose a hyperechogenic pancreas and what is the clinical significance of diffusely hyperechogenic pancreas. Computerized tomography and magnetic resonance imaging are the more appropriate methods to diagnose pancreatic hyperechogenicity when compared with transcutaneous or endoscopic ultrasound examination. More importantly, pancreatic hyperechogenicity may not be a certain indicator of pancreatic fat infiltration. Even if it is true, we do not know the clinical s...     

卒中后吞咽障碍荧光透视与临床吞咽功能的相关性

目的探讨吞咽障碍患者的临床表现与吞咽荧光透视检查(VFSS)所示结构和功能的相关性。方法连续收集2012年6月—2014年5月浙江中医药大学附属温州市中医院收治的56例卒中后吞咽障碍患者,选择性应用4种不同质地的食物进行测试,分别完成临床吞咽功能评估和VFSS检查,并用SPSS 20.0统计软件对该两种方法的各项观察指标进行单因素分析和多因素Logistic回归分析。结果临床表现与VFSS检查的点对应关系在口腔期有口内食物残留与口唇闭合异常(95%CI:1.430~101.468,P=0.022);软腭上抬差与口腔食物残留(95%CI:1.476~102.033,P=0.020);分次吞咽与口通过时间延长(95%CI:2.616~182.897,P=0.004);舌运动障碍及软腭上抬差与食团形成障碍(95%CI分别为1.468~50.795、1.220~13.825,P值分别为0.017、0.023);食物口角漏出、咽下困难与食团从舌根掉落会厌或气管(95%CI分别为1.146~125.459、1.657~174.400,P值分别为0.038、0.017)。在咽期主要有咽反射减弱与喉上抬程度弱(95%CI:1.150~92.815,P=0.037);咽下困难、吞咽延迟与吞咽反射启动触发时间长(95%CI分别为2.123~37.770、1.233~114.176,P值分别为0.003、0.032);分次吞咽、用力吞咽、哽噎感以及喉上抬差与咽期通过时间长(95%CI分别为1.619~223.316、1.061~31.445、2.834~132.707,P值分别为0.019、0.042、0.003);咽下困难与环咽肌开放不全(95%CI:1.037~24.115,P=0.045);喉上抬程度弱、咽部异物感、吞咽后呛咳与会厌谷或梨状窝滞留或残留(95%CI分别为1.046~13.685、1.116~87.741,P值分别为0.043、0.040);吞咽过程中咳嗽、进食呛咳与误吸(95%CI分别为0.010~0.921、0.037~0.826,P值分别为0.042、0.028)等,均存在明显相关性。结论某些临床症状表现与VFSS检查发现的吞咽功能异常密切相关,借助该规律可更简捷、安全地判断患者吞咽障碍程度及类型,为不能接受VFSS检查的卒中后吞咽障碍患者进行康复治疗作指导。     

Acute coronary artery closure following intracoronary ultrasound examination

Two patients undergoing intracoronary ultrasound examination were complicated by acute coronary artery closure. One of the complications was thought to be caused by intimal dissection and thrombus formation and the other was thought to be caused by intimal dissection and subsequent embolization. The complications were successfully managed conservatively in both cases. © 1995 Wiley-Liss, Inc.     

Pressure-flow dynamics of the oral phase of swallowing

In 5 healthy volunteers, we studied the pressure-flow kinetics of the oral phase of swallowing. The regional profile within the oral cavity during swallowing was recorded, at the tongue tip (T₁), dorsum of the tongue (T₂), 3 cm from the tongue tip, oral floor, buccal cavity, and between the lips during swallows of water (0–20 ml) and 5 ml of mashed potato. Two strain gauge (SG) probes, each with two transducer recording sites 3 cm apart, were used for recording pressure. Supralingual and sublingual pressure were recorded concurrently. The relationship between transit of a barium bolus and deglutitive oral pressure phenomena was determined by concurrent videoradiography and manometry. Lingual pressure with the SG facing the tongue showed the most consistent recording and highest pressure: 193±16 (SE) mmHg at T₁ and 214±18 mmHg at T₂ for dry swallows. Pressures were similar for water swallows. However, mashed potato swallows produced a pressure of 383±30 mmHg at T₁ and 485±52 mmHg at T₂ that were greater than for water swallows (p<0.01). Pressure recorded with the transducers facing the hard palate and, to a lesser extent, laterally, was low and inconsistent. Oral-floor pressure was greatest with the transducers oriented upwards and averaged 64±2.9 mmHg proximally and 173±36 mmHg distally. At all sites the pressure waves propagated sequentially, toward the pharynx. Minimal pressure increases occurred in the buccal cavity. Lip squeeze varied from 0 to 90 mmHg. We can draw the following conclusions. The oral phase of swallowing includes contraction of the oral floor, which provides a platform for tongue movement. Oral pressure waves propagate toward the pharynx so that a swallowed bolus is propelled ahead of the point of lingual-palatal closure. Lingual peristalsis exhibits a wide range of pressures, with lower pressure for dry and liquid boluses than for a semisolid bolus. Buccal and lip contractions act as stabilizing forces, but do not contribute to bolus propulsion. Significant differences exist in the radial pressure profile of lingual peristalsis, with maximal pressure oriented toward the tongue.     

Stethoscope acoustics and cervical auscultation of swallowing

Frequency response characteristics of six popular stethoscopes are reported for the higher frequency range (to 3000 Hz) to supplement equivalent measurements for the lower frequencies (35–1000 Hz) published previously. Spectra of the sounds of swallowing from the throat, transduced with an accelerometer, demonstrate important frequency composition in this higher range. Two stethoscope models were found to have superior transmission characteristics for use in cervical auscultation of swallowing sounds.     

气道内超声检测气道壁结构的参数设置探索

目的 探讨气道内超声(EBUS)在检测气道壁厚度及分层结构时,超声主机不同参数对图像清晰度的影响.方法 2011年9月1日至2012年4月1日期间,广东省人民医院纤维支气管镜室予EBUS检测气道壁结构的68例患者纳入研究,其中男41例,女27例,平均年龄(51.2±13.7)岁.在常规纤维支气管镜检查后,选择左、右主支气管作为目标支气管进行EBUS检测.在超声主机分别设置两组不同参数,一组参数设置为超声主机的默认值(各参数的中位值),一组设置为我科在检查实践中摸索出来的经验值.对比在设置2套不同参数时,分别可获得清晰图像的数值.结果 默认参数组获得清晰图像的总阳性率为14.6％,经验参数组获得清晰图像的总阳性率为96.5％.结论 本研究总结出一组EBUS检测气道壁结构的参数设置:调节增益至15～17,对比度4～6,显示范围为3～4 cm,配合其他操作要点即可获得清晰的气管壁分层图像.     

Effects of tongue pressing effortful swallow in older healthy individuals

IntroductionThe risk of swallowing disorders is increased for older individuals due to weak tongue and pharyngeal muscle strength. This study was appraised the value of a preventative approach by developing the tongue pressing effortful swallow (TPES) applied using a home-based and self-administered procedure. The TPES was developed by combining two swallowing exercises: tongue strengthening exercise and the effortful swallow. The purpose of this study was to examine the effects of the TPES on maximum tongue pressure and peak amplitude of submental muscle activity in older individuals.Material and methods27 older individuals (mean 73 years) performed a 4-week TPES. The exercise program was adapted to a home-based and self-administered procedure. The maximum tongue pressure was measured by the Iowa Oral Performance Instrument and peak amplitude of submental muscle activity by surface electromyography (sEMG). Statistical comparisons were made by a matched pairs t-test (p < 0.05).ResultsThe results of this study showed that the TPES had statistically significant and positive effects on increasing maximum tongue pressure, but the peak amplitude of the submental sEMG did not differ between before and after exercises.ConclusionsThe TPES had a positive impact in older individuals. The TPES, a combining exercise, was possible because two exercises had common physiological events. The TPES was a more innovative and efficient approach than the tongue strengthening exercise alone. In addition, older individuals were able to perform the swallowing exercise at home and by themselves with little assistance. Future research needs to refine the TPES and apply it to patients with dysphagia.     

肺脏超声在新生儿肺不张疾病检查中的应用价值

目的 探讨肺脏超声在新生儿肺不张疾病检查中的应用价值.方法 选择德宏州人民医院新生儿科2018-03～2020-08收住院治疗的新生儿肺不张患儿286例,其中新生儿呼吸窘迫综合征(NRDS)121例,新生儿肺炎(PN)92例,胎粪吸入综合征(MAS)73例,均行X线胸片检查和肺脏超声检查.采用Kappa一致性检验分析两...     

胃腺癌患者舌苔变化及其血清sE-cad水平和临床检验指标的相关性

目的:探讨胃腺癌患者和正常人的舌苔形成与血清sE-cad水平的相关性.方法:采用临床病例-对照法,应用ELISA测定266例胃腺癌患者和252例对照人群的血清sE-cad水平,非参数检验分析血清sE-cad水平、临床检验指标和舌苔类型的相关性.结果:胃腺癌组血清sE-cad水平显著高于对照组(P<0.01),术前者血清sE-cad水平显著高于术后者(P<0.05),胃腺癌未转移者血清sE-cad水平显著高于转移者(P<0.05).胃腺癌组血清sE-cad水平表现为白厚苔>白薄苔>黄厚苔>黄薄苔>剥苔,有统计学意义(P<0.05),对照组血清sE-cad水平表现为黄薄苔>黄厚苔>白薄苔>白厚苔>剥苔,但无统计学意义(P>0.05).胃腺癌组临床检验指标异常者比例均高于对照组(P<0.05),特别是总蛋白异常的厚苔、薄苔胃腺癌患者的血清sE-cad水平均高于总蛋白异常的厚苔、薄苔对照组(P<0.05).结论:胃腺癌患者苔质厚薄变化、血清总蛋白和sE-cad水平检测对临床胃腺癌防治可能有重要的临床价值.     

A randomized trial of olfactory stimulation using black pepper oil in older people with swallowing dysfunction

OBJECTIVES: To determine the effect of olfactory stimulation with volatile black pepper oil (BPO) on risk factors for pneumonia. DESIGN: A 1-month randomized, controlled study. SETTING: Nursing homes in Japan that serve as long-term care facilities for older residents who are physically handicapped, mainly because of cerebrovascular disease. PARTICIPANTS: One hundred five poststroke residents. MEASUREMENTS: Latency of the swallowing reflex (LTSR), the number of swallowing movements, serum substance P (SP), and regional cerebral blood flow (rCBF). RESULTS: Nasal inhalation of BPO for 1 minute shortened LTSR, compared with that of lavender oil and distilled water (P < .03). Compared with the period before the study, the 1-month intervention using BPO improved LTSR with an increase of serum SP (P < .01). The number of swallowing movements for 1 minute during the nasal inhalation of BPO increased (P < .001). Multiple comparisons showed a poststudy increase in rCBF within the insular cortex (P < .001). Compared with the prestudy rCBF, BPO intervention increased rCBF in the right orbitofrontal and left insular cortex (P < .001). CONCLUSION: Inhalation of BPO, which can activate the insular or orbitofrontal cortex, resulting in improvement of the reflexive swallowing movement, might benefit older poststroke patients with dysphagia regardless of their level of consciousness or physical and mental status.     

Acute occlusion of the left main coronary artery following intracoronary ultrasound examination

Intracoronary ultrasound (ICUS) is generally considered as safe procedure, with a low complication rate. We describe a nearly fatal complication of a diagnostic ICUS study that was treated succesfully with stent implantation in the left main coronary artery and discuss the indications and remaining risks of this procedure. Cathet. Cardiovasc. Intervent. 47:181–184, 1999. © 1999 Wiley-Liss, Inc.