脑卒中后吞咽障碍的异常模式

目的：初步探讨脑卒中后吞咽器官在X线透视下是否存在不同的异常运动模式。方法：对80例脑卒中后吞咽困难患者进行电视透视检查，吞咽60％W／V液体钡剂5ml，对吞咽器官的异常运动进行定性和定量测量，区分不同模式。结果：脑卒中后吞咽困难的患者表现出三种不同的吞咽模式，分别为以舌肌无力为主的口腔期吞咽困难、以舌骨及喉结构复合体运动保留的咽期运动损伤模式、以舌骨及喉结构运动分离为主的吞咽异常。结论：脑卒中后吞咽困难有多种模式，可能与病变部位有关。明确不同的模式有助于采用不同的康复方法。     

Tenosynovial giant cell tumor of the posterior pharyngeal space

A 55‐year‐old man presented with dysphagia and a sore throat. Oral examination revealed a firm nodular mass in the midline of the pharyngeal wall. The tumor was en‐bloc excised. Histopathology and immunohistochemistry confirmed the diagnosis of a tenosynovial giant cell tumor.     

Airway management in a child with penetrating pharyngeal wall foreign body injury: a case report

Penetrating foreign bodies of the oropharynx are encountered in children of all ages, although more frequently between the ages of 3 to 5 years. A thorough preanesthetic evaluation of these patients, including type and extent of injury, must be performed if time allows. As a result of the often emergent nature of these cases, poor patient cooperation, and great potential for airway compromise, special considerations are given to management of the airway. The use of nontraditional equipment may greatly facilitate laryngoscopy and intubation.     

Desmoid fibromatosis in the pharyngeal wall: A case report and literature review

Desmoid fibromatosis (DF) is one of the rarest locally aggressive growing benign tumor entities. We present an overview of the literature and a rare clinical case of a 22‐year‐old female patient, who was diagnosed with aggressive DF in the left pharyngeal wall at the age of 4 years old.     

Effects of respiratory motion on coronary wall MR imaging: a quantitative study of older adults

The aim of the present study is to assess the effects of respiratory motion on the image quality of two-dimensional (2D), free-breathing, black-blood coronary wall magnetic resonance (MR) imaging. This study was compliance with the HIPPA. With the approval of the institution review board, 230 asymptomatic participants, including 164 male patients (72.9 ± 4.4 years) and 66 female patients (72.4 ± 5.1 years), were recruited. Written informed consent was obtained. A 2D navigator (NAV)-gated, black-blood coronary wall MR imaging sequence was run on the left main artery, the left anterior descending artery and the right coronary artery. The drift of the location of the NAV and scan efficiency were compared between good (scored 2 or 3) and poor images (scored 1). Age, body weight, body weight index, heart rate, length of the rest period of cardiac motion, diaphragm excursion and breathing frequency were compared using a t test between the “successful” (having 2 or 3 good images) and “unsuccessful” cases (having 1 or 0 good images). A logistic regression model was applied to identify the contributors to good image quality. The drift of the NAV location and the scan efficiency were higher in the 411 good images compared with the 279 poor images. Minimal drift of the NAV location and low body weight were identified as independent predictors of good images after using a logistic regression model to adjust for multiple physiological and technical factors. The stability of respiratory motion significantly influences the image quality of 2D, free-breathing, black-blood coronary wall MR imaging.     

Dysphagia following stroke: quantitative evaluation of pharyngeal transit times.

Forty stroke subjects referred for dysphagia and studied by videofluoroscopy were compared with 16 individuals with no known pharyngeal swallowing difficulty. Kinematic pharyngeal transit time was defined as the time from the first movement of the bolus posteriorly resulting in a complete swallow to the return of the epiglottis to its original position. The mean transit time was 1.00 second for the comparative group and 6.15 seconds for the stroke group (p less than 0.001). Other component transit times are described and were all significantly prolonged for the stroke group. There was no significant difference in transit times between right-sided and left-sided lesions except for the segmental interval from onset of bolus movement to arrival at the valleculae, which was significant at p = 0.05. Measurement of transit times using the method described in this study requires equipment available in most hospitals. These measurements may be used in the evaluation of dysphagia in various pathologic disorders, in following the progress of patients with dysphagia, and in evaluating the effects of remedial therapies.     

中国正常成人咽期吞咽的表面肌电图研究：建立肌电活动持续时间标准数据库

目的:利用表面肌电图技术研究不同年龄正常人咽期吞咽相关肌群肌电活动的持续时间,建立正常人咽期吞咽肌电活动持续时间的标准数据库.方法:187例正常受试者,按年龄分为4组:18-30岁组、31-50岁组、51-70岁组、＞70岁组.应用表面肌电图技术与分析系统,测量受试者咽期吞咽时相关肌群肌电活动的持续时间,得到不同年龄咽期吞咽时相关肌群肌电活动的持续时间后进行分析.结果:建立中国正常成人咽期吞咽相关肌群肌电活动持续时间的标准数据库.本数据库显示肌电活动的持续时间与年龄有关,随着年龄的增加呈递增趋势,18-30岁、31-50岁、51-70岁年龄段肌电活动的持续时间无显著性差异(P＞0.05),＞70岁年龄段肌电活动的持续时间明显延长,且具有显著性差异(P＜0.05).此外,肌电活动的持续时间还与吞咽模式有关,“干”吞咽组和“湿”吞咽组持续时间相差不明显,但都明显低于过量(20ml)吞咽组,且具有显著性差异(P＜0.05).结论:应用表面肌电技术与分析系统,首次建立中国正常成人咽期吞咽时相关肌群肌电活动持续时间的标准数据库,初步揭示中国正常成人咽期吞咽相关肌群的表面肌电特征,为临床筛查和评估吞咽障碍提供科学参考依据.     

脑卒中吞咽障碍患者表面肌电信号与咽期活动的量化关系研究

目的：通过观察吞咽过程中的表面肌电（sEMG）信号和吞咽造影（VFSS）时吞咽器官的结构性位移,探讨脑卒中吞咽障碍患者吞咽器官形态学变化与电生理指标的相关性。方法：选取经床旁筛查证实存在吞咽障碍的脑卒中恢复期患者21例,设为病例组,另选取健康受试者9例设为正常对照组。对所有患者进行VFSS检查,同时在同一次吞咽动作中采集颏下肌群、舌骨下肌群的sEMG信号。使用吞咽功能影像数字化采集与分析系统记录吞咽过程,对吞咽时吞咽器官活动进行量化分析。对两组受试者的肌电活动持续时间、平均振幅、激活顺序、肌电活动潜伏期以及舌骨运动潜伏期进行比较,并对病例组患者sEMG信号与舌骨喉复合体位移、食管上括约肌（UES）开放幅度进行相关性分析。结果：病例组颏下肌群及舌骨下肌群的吞咽时程大于对照组,平均振幅小于对照组（P<0.05）;病例组患者sEMG颏下肌群平均振幅与舌骨位移以及UES开放幅度均未见明显相关。病例组患者中有14例表现为反向激活序列模式,有7例表现为正向激活序列模式。反向激活序列模式的患者与正向激活序列模式的患者相比,舌骨位移以及UES开放幅度均显著下降（P<0.05）。病例组患者肌...     

磁共振血管成像定量研究脑后循环缺血患者的功能性后交通动脉的血流动力学特征

目的 研究脑后循环缺血(PCI)患者功能性后交通动脉(F-PCoA)定量分析中磁共振血管成像(MRA)的应用价值.方法 采用回顾性分析方法,研究对象为2019年1月至2020年1月沧州中西医结合医院收治入院的63例行MRA检查者,根据是否存在PCI分为PCI组(n=32)和非PCI组(n=31),且非PCI组根据是否存...     

Placenta flow index in posterior wall placentas measured with 99mtechnetium-labelled human serum albumin

Summary. Measurement of the perfusion of posterior wall placentas with the isotope technique may pose a problem owing to attenuation of the gamma radiation. The present investigation compares the placenta flow index (PFI) in 34 pregnant women with anterior wall placenta and 13 with posterior wall placenta. We found no difference in the shortest skin-to-placenta distance on ultrasound scanning and no difference in PFI between the anterior and the posterior wall placentas.     

Videofluoroscopy study of swallowing in neurogenic dysphagia

Videofluoroscopy (VFS) was for the first time used for examining swallowing in 49 patients with nervous diseases. Disturbances in each phase of swallowing act are analyzed with evaluation of the time parameters and defects, causes of aspiration in neurogenic dysphagia are discussed, and cricopharyngeal insufficiency is described. Neurogenic dysphagia is characterized by a combination of disorders which determine the degree of dysphagia. The most severe swallowing disorders were observed in patients with multiple foci in the brain stem and in diphtheritic polyneuropathies. The authors conclude that VFS is the optimal method for the diagnosis of neurogenic dysphagia.     

不同时间咽部冰刺激对脑卒中后吞咽功能障碍的影响

[目的]探讨不同时间咽部冰刺激干预对重建脑卒中病人的吞咽功能及吸入性肺炎发生率的影响.[方法]将74例脑卒中后出现吞咽功能障碍的病人随机分为两组,均给予常规治疗和康复护理,实验组于3餐前20 min进行咽部冰刺激干预,对照组于3餐后2 h进行咽部冰刺激干预,每日3次,每次15 min.干预30 d后,比较两组病人吞咽功能和吸入性肺炎发生情况.[结果]治疗后两组病人的吞咽能力都较治疗前有所改善,两组疗效及吸入性肺炎发生率比较差异均有统计学意义(P<0.05).[结论]餐前20 min咽部冰刺激比餐后2 h冰刺激更能改善脑卒中病人吞咽功能,预防吸入性肺炎的发生.     

The effect of effortful swallow on pharyngeal manometric measurements during saliva and water swallowing in healthy participants

Witte U, Huckabee M-L, Doeltgen SH, Gumbley F, Robb M. The effect of effortful swallow on pharyngeal manometric measurements during saliva and water swallowing in healthy participants.

Objective

To evaluate the effect of effortful swallow on pharyngeal manometric pressure measurements during saliva and water swallowing.

Design

Comparative analysis of pharyngeal pressure generation under 2 bolus and 2 task conditions.

Setting

Swallowing rehabilitation research laboratory.

Participants

Healthy participants (N=40), sex equally represented, with a mean age of 25.8 years.

Interventions

Not applicable.

Main Outcome Measures

Manometric peak and nadir amplitude and duration measures at 3 locations in the pharynx.

Results

Significantly higher peak pressures were measured for saliva swallows compared with water swallows under both swallowing conditions at the proximal pharyngeal sensor only (P=.011). No significant differences were observed between the effortful versus noneffortful conditions at the proximal and midpharyngeal sensors; however, upper esophageal sphincter (UES) nadir pressures were significantly lower for effortful than noneffortful swallows (P=.034) with significantly lower pressure measurements in saliva effortful swallows (P=.008) compared with water effortful swallows. Saliva swallows resulted in significantly longer pressure durations than water swallows at the proximal (P=.003) and middle (P=.048) sensors. Pressure-generation duration was significantly longer in effortful versus noneffortful swallows for the middle sensor (P=.036) only.

Conclusions

The results indicate that the effect of effortful swallow on pharyngeal peak pressure measurement is not altered by bolus type (saliva vs water). However, this is not the case for nadir pressure measurements in the UES, which were significantly lower in effortful saliva swallows than in effortful water swallows.     

Prenatal sonographic diagnosis of posterior urethral valves: Identification of valves and thickening of the posterior urethral wall

This report describes 2 heretofore unreported sonographic findings that may aid in the antenatal diagnosis of posterior urethral valves. Each of 2 fetuses showed a prominent or thickened posterior urethra and one or more bright echogenic lines representing valve tissue within a dilated and/or thickened posterior urethra. These findings helped solidify the antenatally suspected diagnosis of posterior urethral valves. The diagnosis was confirmed clinically and surgically during neonatal life. These 2 imaging findings may help in providing a more definitive antenatal diagnosis of posterior urethral valves and allow more expeditious therapy. © 1998 John Wiley & Sons, Inc. J Clin Ultrasound 26:366–370, 1998.     

Accuracy of quantitative MR vessel wall imaging applying a semi-automated gradient detection algorithm--a validation study.

Magnetic resonance imaging (MRI) is uniquely suited to study the pathophysiology of arteriosclerosis. So far, magnetic resonance (MR) measurements of vessel dimensions have mainly been done by manual tracing of vessel wall contours. However, such data postprocessing is very time-consuming and has limited accuracy due to difficulties in precise tracing of the thin vessel wall. PURPOSE: To assess the accuracy and reproducibility of quantitative vascular MR imaging applying a data analysis method based on (1) vessel wall unwrapping, followed by (2) a gradient detection algorithm for MR data postprocessing. Vascular MR imaging studies were done both in vessel phantoms and in healthy volunteers (n=29) on a clinical 1.5 T MR scanner. A dark blood double-inversion turbo spin echo sequence with fat suppression was applied, with proton-density-weighted and breath-hold acquisition for aortic imaging and T2-weighted acquisition for carotid imaging. Intraobserver and interobserver variability were systematically evaluated by two independent observers. A repeat study within 10 days of the first MRI was performed in 10 of these subjects for assessment of interstudy reproducibility. RESULTS: The semiautomated edge detection software revealed a clear view of the inner and outer vessel wall boundaries both in the phantoms and in the volunteers studied. There was close agreement between MR-derived measurements and phantom dimensions (mean difference of 1.1+/-16.9 mm2, 8.0+/-19.9 mm2, 9.0+/-12.1 mm2 for vessel wall cross-sectional area, inner vessel area, and total vessel area, respectively). Quantification of vessel dimensions was feasible in all 29 healthy volunteers studied. Semiautomated quantification of cross-sectional vessel wall area (mean+/-SD, 253.6+/-208.4 mm2) revealed close correlation for repeated measurements by one or two observers (r=0.99 each). Both intraobserver and interobserver variability of vessel wall area MR measurements were low (mean difference 7.5+/-16.7 mm2 and 14.4+/-24.6 mm2 , respectively). In the repeat study of 10 volunteers, MRI with semiautomated postprocessing quantitation revealed a high correlation and agreement of vessel dimensions between the two scans (r=0.994, mean difference 2.6+/-25.1 mm2). CONCLUSION: Semiautomated analysis methods can provide approaches that benefit from the human understanding of the image and the computer's ability to measure precisely and rapidly. Thus, by combining the latest MRI methods and semiautomated image analysis methods, we are now able to reproducibly determine the geometric parameters of blood vessels.     

CT研究蝶窦后壁可开窗范围及相关因素

目的:采用多层螺旋CT技术研究蝶窦后壁的可开窗范围,并分析其相关的限制因素。方法:对110例头部增强薄层CT扫描的原始资料行多平面重建,测量双侧颈内动脉外侧襻间距和内侧襻间距、蝶窦后壁面积、蝶窦后壁骨质厚度等数据,观察并记录蝶窦的位置和气化、蝶窦分隔、颈内动脉有无突入窦腔情况及斜坡处静脉窦强化等表现。结果:结合蝶窦气化情况,将蝶窦后壁按厚度分为厚壁型(35．6%)、薄壁型(55．9%)及菲薄型(8．5%)。两侧颈内动脉的外侧襻间距(19．2±2．9)mm、内侧襻间距(15．8±2．3)mm限定了蝶窦后壁可开窗的边界。蝶窦后壁的可开窗面积平均为(251．0±53．1)mm~2。结论:蝶窦后壁整体上可形成类梯形窗口。开放窗口的主要限制因素有双侧颈内动脉间距、蝶窦后壁骨质厚度及斜坡处静脉窦。CT重建和测量可显示蝶窦腔内、外的关键结构,对经蝶手术的术前评价和计划具重要意义。