The Association between Laryngopharyngeal Sensory Deficits, Pharyngeal Motor Function, and the Prevalence of Aspiration with Thin Liquids

2003 ◽  
Vol 128 (1) ◽  
pp. 99-102 ◽  
Author(s):  
Michael Setzen ◽  
Manderly A. Cohen ◽  
Philip W. Perlman ◽  
Peter C. Belafsky ◽  
Joel Guss ◽  
...  
Keyword(s):  
Motor Function ◽  
Motor Dysfunction ◽  
Sensory Testing ◽  
Entire Cohort ◽  
Sensory Deficits ◽  
Motor Testing ◽  
The Mean ◽  
A Prospective Study ◽  
Thin Liquids ◽  
The Relationship

OBJECTIVE: The study goal was to evaluate the association among laryngopharyngeal sensory deficits, pharyngeal motor function, and the prevalence of aspiration with thin liquids. STUDY DESIGN AND SETTING: We conducted a prospective study of 204 consecutive patients undergoing flexible endoscopic evaluation of swallowing with sensory testing and an assessment of pharyngeal motor function (pharyngeal squeeze). Patients were divided into 6 groups depending on the results of sensory and motor testing in the laryngopharynx. Subjects were given 5 mL of thin liquid, and the prevalence of aspiration in each group was compared. RESULTS: The mean age of the entire cohort was 65 years (58% female). The prevalence of aspiration in patients with intact laryngopharyngeal sensation was 2% (3 of 137) in persons with intact pharyngeal motor function and 29% (2 of 7) when pharyngeal motor function was impaired ( P < 0.05). The prevalence of aspiration in patients with a moderate decrease in laryngopharyngeal sensation was 0% (0 of 9) in persons with intact pharyngeal motor function and 67% (2 of 3) when pharyngeal motor function was impaired ( P < 0.05). The prevalence of aspiration in patients with severely diminished or absent laryngopharyngeal sensation was 15% (5 of 33) in persons with intact pharyngeal motor function and 100% (15 of 15) when pharyngeal motor function was impaired ( P < 0.05). CONCLUSION: Patients with severely diminished laryngopharyngeal sensation and pharyngeal motor function are at an extremely high risk of aspirating thin liquids (100%). Moderate sensory deficits only appear to influence the prevalence of thin liquid aspiration in the presence of pharyngeal motor dysfunction. Severe laryngopharyngeal sensory deficits are associated with the aspiration of thin liquids regardless of the integrity of pharyngeal motor function. We assume that all persons with an insensate laryngopharynx aspirate thin liquids until proved otherwise. These results emphasize the relationship between laryngopharyngeal sensation and pharyngeal motor function in the evaluation of patients for suspected aspiration.

scholarly journals Invasive and Doppler Transvalvular gradients after transcatheter aortic valve replacement

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
S Fugar ◽  
K Deka ◽  
C Anderson ◽  
C Lama Von Buchwald ◽  
R Geroux ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Valve Replacement ◽  
Pressure Gradients ◽  
Entire Cohort ◽  
Funding Sources ◽  
Transcatheter Aortic Valve ◽  
The Mean ◽  
The Difference ◽  
Transcatheter Valve ◽  
The Relationship

Abstract Background Differences in mean gradients after Transcatheter valve replacement (TAVR) vary depending on the valve type and the modality used to measure the gradients. Currently there is a paucity of data on the relationship between invasive and doppler derived gradients after TAVR. Purpose We sort to assess the difference in doppler, and catheter derived aortic valve gradients after TAVR Methods This is a single center retrospective study using consecutive patients who presented for TAVR on account of native aortic valve stenosis at our institution from May 2012 till December 2020. Patients with both intraoperative invasive and postoperative doppler derived pressure gradients were included in the analysis. Student T-test were used to compare mean gradients. Pearson's correlation test was used to examine the correlation between measured gradients. Results A total of 587 patients were included in our study. Fifty one percent were male and 462 (78.7%) underwent TAVR with a balloon expandable valve. In the entire cohort the mean gradient measured invasively was significantly lower than those measured by echo doppler (4.48±3.25 vs. 5.57±3.11, P&lt;0.001). There, however, was a positive correlation between invasive and doppler measured gradients (figure 1). In those who received balloon expandable valves, the invasive gradient was 4.39±3.30 and the doppler derived gradient was 5.47±3.04 (P&lt;0.001), while in those self-expanding valves, the invasive gradient was 4.81±3.04 and doppler derived gradient was 5.94±3.36 (P&lt;0.001). Conclusion Post TAVR gradients were all significantly lower when measured invasively as compared to those measured using doppler. Self-expanding valves overall had higher residual gradients. Further studies are needed to assess the correlations between invasively measured gradients and clinical outcomes post TAVR. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals The variability and burden of severe sleep apnea and the relationship with atrial fibrillation occurrence: analysis of pacemaker-detected sleep apnea

2021 ◽  
Author(s):  
RuoHan Chen ◽  
KePing Chen ◽  
Yan Dai ◽  
Shu Zhang
Keyword(s):  
Atrial Fibrillation ◽  
Sleep Apnea ◽  
Left Ventricular ◽  
The Mean ◽  
Respiratory Disturbance ◽  
A Prospective Study ◽  
The Relationship ◽  
Severe Sleep Apnea

Abstract Study objectives This was a pilot study to evaluate the long-term variability and burden of respiratory disturbance index (RDI) detected by pacemaker and to investigate the relationship between RDI and atrial fibrillation (AF) event in patients with pacemakers. Methods This was a prospective study enrolling patients implanted with a pacemaker that could calculate the night-to-night RDI. The mean follow-up was 348 ± 34 days. The RDI variability was defined as the standard deviation of RDI (RDI-SD). RDI burden was referred to as the percentage of nights with RDI ≥ 26. The patient with RDI ≥ 26 in more than 75% nights was considered to have a high sleep apnea (SA) burden. An AF event was defined as a daily AF duration > 6 h. Results Among 30 patients, the mean RDI of the whole follow-up period was 24.5 ± 8.6. Nine (30%) patients were diagnosed with high SA burden. Patients with high SA burden had a higher BMI (26.7 ± 4.8 vs 23.2 ± 3.9, p = 0.036), a higher prevalence of hypertension (86% vs 39%, p = 0.031), and a larger left ventricular diastolic diameter (49.2 mm vs 46.7 mm, p = 0.036). The RDI-SD in patients with a higher burden was significantly greater than that in the patients with less burden (10.7 ± 4.9 vs 5.7 ± 1.4, p = 0.036). Linear regression showed that participants with a higher RDI tended to have a higher SD (R = 0.661; p < 0.001). The mean RDI (OR = 1.118, 95%CI 1.008–1.244, p = 0.044) was associated with AF occurrence. Conclusion Using a metric such as burden of severe SA may be more appropriate to demonstrate a patient’s true disease burden.

scholarly journals Significant weight loss and hypernatremia in exclusively breast-fed neonates

2017 ◽  
Vol 5 (1) ◽  
pp. 151
Author(s):  
Daniel Jayaraj ◽  
Poornima Kumar ◽  
Peter Prasanth Kumar Kommu ◽  
Lalitha Krishnan
Keyword(s):  
Weight Loss ◽  
Birth Weight ◽  
Tertiary Care ◽  
Calculated Data ◽  
Care Hospital ◽  
Significant Weight Loss ◽  
Entire Cohort ◽  
The Mean ◽  
The Relationship ◽  
Breast Fed

Background: Weight loss in the early neonatal period is a problem that often goes unrecognized. Weight loss of upto 5-7% of birth weight is normal but losses more that 10% may result in increased morbidity, especially hypernatremia. Methods: Prospective cohort study of 900, exclusive breastfed inborn babies, >34 weeks gestation and >1800g born in a tertiary care hospital in South India. Babies who were discharged before 96 hours of life, admitted to intensive care and received phototherapy for >24hrs were excluded. Maternal and neonatal variables were collected, and daily weight loss percent was calculated. Data was entered in EPI-INFO and analysed. Independent sample t test was used to compare the means of two independent normally distributed sample groups, ANOVA was used to compare means of more than 2 variables, linear logistic regression was used to find out the relationship between significant weight loss and hypernatremia Results: The mean birth weight of the cohort was 2937±438.4 g and the gestational age was 38±5weeks. The mean maximum weight loss for the entire cohort was 178.71g (±82.08 g) and the mean percent weight loss was 6.12% (2.69). The mean weight nadir of the entire cohort was 2758.32±425.67g. Mean serum sodium levels for all babies who lost >10% of their birth weight was 145.95 (±2.34) mmol/LConclusions: Early neonatal weight loss is a universal phenomenon though often unrecognized. Babies losing more than 10% of birth weight are at risk of morbidities like hypernatremia.

Relationship Between Crestal Bone Levels and Crown-to-Implant Ratio of Ultra-Short Implants With a Microrough Surface: A Prospective Study With 48 Months of Follow-Up

2019 ◽  
Vol 45 (1) ◽  
pp. 18-28 ◽  
Author(s):  
Luciano Malchiodi ◽  
Erika Giacomazzi ◽  
Alessandro Cucchi ◽  
Giulia Ricciotti ◽  
Riccardo Caricasulo ◽  
...  
Keyword(s):  
Bone Loss ◽  
Alveolar Bone ◽  
Complication Rates ◽  
Crestal Bone Loss ◽  
Short Implants ◽  
Bone Atrophy ◽  
The Mean ◽  
A Prospective Study ◽  
The Relationship

The aim of this cohort study was to investigate the relationship between crestal bone levels and crown-to-implant ratio of ultra-short implants, after functional loading. Sixty patients with single or partial edentulism and alveolar bone atrophy were enrolled and treated between December 2009 and January 2016. Without using bone-grafting procedures, patients were rehabilitated with ultra-short implants characterized by a microrough surface and a 6-mm length. Clinical and anatomical crown-to-implant (C/I) ratios and crestal bone levels (CBL) were measured after a follow-up period ranging from 12 to 72 months; all peri-implant and prosthetic parameters were recorded. The data collected were statistically analyzed (P = .05). A total of 47 patients with 66 ultra-short implants were completely followed up according to described protocol. The mean follow-up was 48.5 ± 19.1 months. The mean anatomical C/I ratio was 2.2, while the mean clinical C/I ratio was 2.6 ± 0.6 at baseline and 2.8 ± 0.6 at the last follow-up appointment. Mean CBL as calculated at the baseline was 0.7 ± 0.5 mm, while at the last appointment it measured 1.0 ± 0.5 mm. The overall implant-based success rate was 96.9%, and the mean peri-implant bone loss (PBL) was 0.3 ± 0.3 mm. No statistically significant relationship was found between anatomical or clinical C/I ratio and PBL. Ultra-short implants appear to offer a predictable solution for implant-prosthetic rehabilitation in patients with edentulism and bone atrophy. A high percentage of implants were successful, with minimal crestal bone loss. The high C/I ratio did not appear to influence either peri-implant bone loss or prosthetic complication rates.

scholarly journals Comparison of Peripheral and Central Venous Pressures in Critically Ill Patients

2003 ◽  
Vol 31 (1) ◽  
pp. 34-39 ◽  
Author(s):  
C. Charalambous ◽  
T. A. Barker ◽  
C. S. Zipitis ◽  
I. Siddique ◽  
R. Swindell ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Accurate Estimate ◽  
Mean Difference ◽  
A Value ◽  
Actual Change ◽  
The Mean ◽  
A Prospective Study ◽  
The Relationship ◽  
Serial Measurements

We conducted a prospective study to determine the relationship between central (CVP) and peripheral (PVP) venous pressures in critically ill patients. CVP and PVP were measured on five different occasions in 20 critically ill patients in the intensive care unit. Results showed that the mean difference between PVP and CVP was 4.4 mmHg (95% CI= 3.7 to 5.0). However, PVP might be 1.9 mmHg below (95% CI=0.7 to 3.1) or 10.6 mmHg above (95% CI=9.4 to 11.8) the CVP. The mean difference between changes in PVP and corresponding changes in CVP was 0.3 mmHg (95%CI=-0.1 to 0.7). The actual change in PVP could be 3.0 mmHg below (95% CI=2.3 to 3.7) or 3.6 mmHg above (95% CI=2.9 to 4.3) the change in CVP. Overall, the direction of change in PVP (rise or drop) predicted a same direction of change in CVP with an accuracy of 78%. Changes in PVP ≥2 mmHg predicted a change in same direction of CVP with an accuracy of 90%. The direction of changes in CVP ≥2 mmHg were predicted by the direction of change in PVP with an accuracy of 91%. We conclude that PVP measurement does not give an accurate estimate of the absolute value of CVP in individual patients. However, as changes in PVP parallel, in direction, changes in CVP, serial measurements of PVP may have a value in determining volume status and guiding fluid therapy in critically ill patients.

scholarly journals N-terminal brain natriuretic propeptide levels correlate with procalcitonin and C-reactive protein levels in septic patients

2007 ◽  
Vol 12 (2) ◽  
Author(s):  
Mariusz Piechota ◽  
Maciej Banach ◽  
Robert Irzmański ◽  
Małgorzata Misztal ◽  
Jacek Rysz ◽  
...  
Keyword(s):  
Severe Sepsis ◽  
Plasma Concentrations ◽  
University Hospital ◽  
C Reactive Protein ◽  
Protein Levels ◽  
Reactive Protein ◽  
The Mean ◽  
A Prospective Study ◽  
Medical University ◽  
The Relationship

AbstractThe aim of this study was to find the relationship between N-terminal brain natriuretic propeptide (NT-proBNP), procalcitonin (PCT) and C-reactive protein (CRP) plasma concentrations in septic patients. This was a prospective study, performed at Medical University Hospital No. 5 in łódź. Twenty patients with sepsis and severe sepsis were included in the study. N-terminal brain natriuretic propeptide, procalcitonin and C-reactive protein concentrations, and survival were evaluated. In the whole studied group (128 measurements), the mean NT-proBNP, procalcitonin and C-reactive protein concentrations were, respectively: 140.80±84.65 pg/ml, 22.32±97.41 ng/ml, 128.51±79.05 mg/l. The correlations for the NT-proBNP level and procalcitonin and C-reactive protein levels were 0.3273 (p<0.001) and 0.4134 (p<0.001), respectively. NT-proBNP levels correlate with PCT and CRP levels in septic patients. In the survivor subgroup, the mean NT-proBNP plasma concentrations were significantly lower than in the non-survivor subgroup.

scholarly journals Intracervical Lidocaine Block is more Effective for Pain Management of Curettage in Incomplete Abortion

2014 ◽  
pp. 13-17
Author(s):  
Oktovianus Saranga ◽  
Eddy Hartono ◽  
Isharyah Sunarno
Keyword(s):  
Pain Management ◽  
Local Anesthetic ◽  
Anesthetic Technique ◽  
Fisher Exact Test ◽  
Exact Test ◽  
Incomplete Abortion ◽  
The Mean ◽  
A Prospective Study ◽  
The Relationship ◽  
Paracervical Block

Objective: To compare the effects of Intra cervical and paracervical block with 1% lidocaine for pain management in curettage of incomplete abortion. Method: This study is a prospective study with Randomized Control Trial approach. The samples were 52 pregnant women with gestational age of less than 20 weeks, which diagnosed as having an incomplete abortion and a procedure using any local anesthetic technique. T test was used to calculate the mean VAS score and standard deviation for each group. Fisher Exact test was used to assess the relationship between variable characteristics and the local anesthetic technique. Result: The use of local anesthesia using intra cervical block technique for pain management in incomplete abortion with curettage proved to be more effective in lowering degree of pain than paracervical block techniques. Conclusion: Intracervical block technique as a local anesthetic technique is simpler and relatively safer than paracervical block. This technique can be used extensively in Department of Obstetrics and Gynecology Medical Faculty, Hasanuddin University for pain management in curettage. Keywords: pain, Intracervical anesthesia, paracervical anesthesia, Visual Analogue Scale (VAS)

scholarly journals Craniofacial Pain and Motor Function: Pathogenesis, Clinical Correlates, and Implications

1999 ◽  
Vol 10 (4) ◽  
pp. 504-518 ◽  
Author(s):  
C.S. Stohler
Keyword(s):  
Musculoskeletal Pain ◽  
Motor Function ◽  
Motor Dysfunction ◽  
Pharmacological Interventions ◽  
Novel Treatments ◽  
Sequence Of Events ◽  
Craniofacial Pain ◽  
New Literature ◽  
The Relationship ◽  
Symptoms And Signs

Many structural, behavioral, and pharmacological interventions imply that favorable treatment effects in musculoskeletal pain states are mediated through the correction of muscle function. The common theme of these interventions is captured in the popular idea that structural or psychological factors cause muscle hyperactivity, muscle overwork, muscle fatigue, and ultimately pain. Although symptoms and signs of motor dysfunction can sometimes be explained by changes in structure, there is strong evidence that they can also be caused by pain. This new understanding has resulted in a better appreciation of the pathogenesis of symptoms and signs of the musculoskeletal pain conditions, including the sequence of events that leads to the development of motor dysfunction. With the improved understanding of the relationship between pain and motor function, including the inappropriateness of many clinical assumptions, a new literature emerges that opens the door to exciting therapeutic opportunities. Novel treatments are expected to have a profound impact on the care of musculoskeletal pain and its effect on motor function in the not-too-distant future.

Osteotomy for Correction of Premature Growth Plate Closure in 24 Dogs

1994 ◽  
Vol 07 (03) ◽  
pp. 129-135 ◽  
Author(s):  
C.W. Miller ◽  
P.W. Morgan
Keyword(s):  
Corrective Osteotomy ◽  
Functional Results ◽  
Degenerative Joint Disease ◽  
Joint Disease ◽  
Angular Deformity ◽  
Dynamic Correction ◽  
Age At Surgery ◽  
Limb Deformities ◽  
The Mean ◽  
A Prospective Study

SummaryTwenty-four dogs (27 limbs) were evaluated after surgery for correction of forelimb angular limb deformities. Partial ulnar ostectomies or definitive corrective osteotomies were performed depending upon the age of the dog. According to owner assessment nine of fourteen limbs were considered functionally good, or excellent, after partial ulnar ostectomies. Younger dogs appeared to have better functional results after dynamic correction with the mean age at surgery of dogs with good to excellent results being 6.5 months contrasted to the mean age at surgery of dogs with fair to poor results being 9.75 months. Ten of fourteen limbs were considered functionally good or excellent after definitive corrective osteotomy. One dog had definitive osteotomy after partial ulnar ostectomy in order to further correct a residual angular deformity. However, 58% of the limbs with radiographic follow-up had signs of degenerative joint disease (DJD). There were not significant differences between neither degree of angulation remaining after surgery and the functional result nor the degree of angulation remaining after surgery and the development of DJD. A prospective study is warranted to more objectively assess the efficacy of surgical correction of angular limb deformities in dogs.Twenty-four dogs were evaluated after surgery for correction of forelimb angular limb deformities. The results are described.

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