- Case 261. [Journal Article]
- RRadiology 2018; 288(3):898-900
- History A 29-year-old woman presented with a 6-month history of progressive general fatigue, fluctuating limb weakness, and difficulty climbing stairs. She initially experienced occasional episodes o...
History A 29-year-old woman presented with a 6-month history of progressive general fatigue, fluctuating limb weakness, and difficulty climbing stairs. She initially experienced occasional episodes of transient diplopia that developed while reading in the evening. She subsequently started to experience dry eyes and mouth, difficulty chewing, and mild dysphagia that worsened throughout the day. Her medical history included hypothyroidism from Hashimoto thyroiditis and pneumonia with left pleural effusion. She had no smoking history, and her body mass index was normal (23.8 kg/m2). No medication use was reported at admission. Physical examination revealed mild bilateral ptosis, reduced muscle tone and strength that worsened in proximal leg muscles, and decreased deep tendon reflexes. An edrophonium test revealed improvement in muscle strength and eyelid ptosis. Repetitive nerve stimulation revealed low amplitude of compound muscle action potential at rest (0.21 mV), with a marked increase (700%; normal increase, <60%) at high-rate stimulation (50 Hz). Laboratory work-up was unremarkable except for detection of acetylcholine receptor antibodies in the serum (21.30 nmol/L) and P/Q-type voltage-gated calcium channel antibodies (220 pmol/L). Recent MRI of the brain and spine at an outside hospital showed no abnormal findings. At admission, the patient underwent CT of the chest, abdomen, and pelvis ( Fig 1 ) followed by thoracic MRI ( Figs 2 , 3 ) to further evaluate CT findings. [Figure: see text][Figure: see text][Figure: see text][Figure: see text][Figure: see text][Figure: see text][Figure: see text][Figure: see text].
- Ipsilateral hypoglossal nerve palsy following left hemithyroidectomy: Case report and review of literature. [Journal Article]
- IJInt J Surg Case Rep 2018 Aug 11; 51:5-7
- CONCLUSIONS: Few cases of HNP are reported in the literature following oropharyngeal manipulation. Factors such as the type of surgery, position changes, and intubation characteristics have been linked to the incidence of HNP. Most of the cases recovered spontaneously, indicating a neuro-paxic type of injury. One case of HNP was reported following robotic total thyroidectomy, which was referred to as iatrogenic complication, and resulted in permanent paralysis. We believe that our case is the only reported case of transient ipsilateral HNP following a conventional left hemithyroidectomy.Strap muscles retraction and neck extension during thyroidectomy could predispose to HNP.
- Is Myotomy Plus Diverticulopexy Suitable for Symptomatic Zenker's Diverticula? [Journal Article]
- DDysphagia 2018 Aug 17
- The aim of the study was to prospectively evaluate the outcome of myotomy plus diverticulopexy over short and long-terms. A prospectively collected consecutive series (2007-2017) of 37 patients under...
The aim of the study was to prospectively evaluate the outcome of myotomy plus diverticulopexy over short and long-terms. A prospectively collected consecutive series (2007-2017) of 37 patients undergoing myotomy plus diverticulopexy was analyzed for clinical condition, operative information, peri-operative events, and follow-up by means of interview and physical examination. Diverticulopexy was scheduled regardless of the diverticulum's features and patient condition, other than operability. There was no choice or selection between possible treatment options. Patients were evaluated pre-operatively, at post-operative day 30 and after 1 year. Follow-up aimed at assessing the subjective condition following treatment. During the interview, patients were asked to self-assess their ability to swallow before and after surgery. No patient had peri-operative events, complications associated with the procedure, wound infection or impaired swallowing. All patients could start drinking the day after operation, could return to solid diet on post-operative day 2 and be discharged on post-operative days 3-4. Barium swallowing was not necessary before discharge. Full solid diet was resumed according to patient's compliance from post-operative day 2 (some patients refused solid diet soon after the operation even if asymptomatic). Follow-up ranged between 1 and 8 years. No patient was lost at follow-up. No disease recurrence was observed. Finally, no patient needed or sought for a clinical examination between the follow-up calls. Patients reported at least 50% improvement of symptomatology after 1 year. Diverticulopexy appears to be clinically safe, methodologically reproducible, and an effective procedure; it avoids suturing and offers good outcome results along with high patient satisfaction.
- Automatic hyoid bone detection in fluoroscopic images using deep learning. [Journal Article]
- SRSci Rep 2018 Aug 17; 8(1):12310
- The displacement of the hyoid bone is one of the key components evaluated in the swallow study, as its motion during swallowing is related to overall swallowing integrity. In daily research settings,...
The displacement of the hyoid bone is one of the key components evaluated in the swallow study, as its motion during swallowing is related to overall swallowing integrity. In daily research settings, experts visually detect the hyoid bone in the video frames and manually plot hyoid bone position frame by frame. This study aims to develop an automatic method to localize the location of the hyoid bone in the video sequence. To automatically detect the location of the hyoid bone in a frame, we proposed a single shot multibox detector, a deep convolutional neural network, which is employed to detect and classify the location of the hyoid bone. We also evaluated the performance of two other state-of-art detection methods for comparison. The experimental results clearly showed that the single shot multibox detector can detect the hyoid bone with an average precision of 89.14% and outperform other auto-detection algorithms. We conclude that this automatic hyoid bone tracking system is accurate enough to be widely applied as a pre-processing step for image processing in dysphagia research, as well as a promising development that may be useful in the diagnosis of dysphagia.
- Phenotypic variability of Niemann-Pick disease type C including a case with clinically pure schizophrenia: a case report. [Journal Article]
- BNBMC Neurol 2018 Aug 17; 18(1):117
- CONCLUSIONS: Marked clinical variability was observed in our three cases. NPC could masquerade as a pure neuropsychiatric disorder such as dystonia or schizophrenia. Abdominal ultrasonography, history evaluation, and neurological examination were quite important in the diagnostic process.
- The frequency of dysphagia and its impact on adults with multiple sclerosis based on patient-reported questionnaires. [Review]
- MSMult Scler Relat Disord 2018 Aug 08; 25:227-231
- CONCLUSIONS: Adults with MS-related dysphagia had reduced scores across all domains of swallowing-related quality of life. These findings support referral to speech-language pathologists for management of dysphagia from the early stages of the disease. Further work is required to determine whether early intervention for dysphagia can sustain or improve swallowing function as well as swallowing-related quality of life domains further into the disease course.
- Validation of the German Version of the Yale Pharyngeal Residue Severity Rating Scale. [Journal Article]
- DDysphagia 2018 Aug 16
- The aim of this study was to validate the German Version of the Yale Pharyngeal Residue Severity Rating Scale and to investigate the impact of rater experience and training. The English original scal...
The aim of this study was to validate the German Version of the Yale Pharyngeal Residue Severity Rating Scale and to investigate the impact of rater experience and training. The English original scale was translated into German language using a forward-backward method. For the validation, 30 images of different pharyngeal residue amounts have been selected and assigned to the scales' severity levels by two experts. 28 raters rated the images in randomized order in two passes. To investigate the impact of experience and training, raters were grouped into subgroups. Statistical analysis was carried out using kappa statistics. The results demonstrate excellent residue ratings for construct validity, inter-rater reliability and intra-rater reliability regarding overall group and all subgroups (Kappa > 0.90). No significant differences were found between groups by experience and inconstant differences were found between groups by training. The German version of the Yale Pharyngeal Residue Severity Rating Scale is a valid, reliable instrument for scoring location and severity of pharyngeal residue in the context of flexible endoscopic evaluations of swallowing.
- Retropharyngeal Hematoma as an Unusual Presentation of Myelodysplastic Syndrome: A Case Report. [Journal Article]
- AJAm J Case Rep 2018 Aug 17; 19:969-972
- CONCLUSIONS: This case adds to the growing body of literature on spontaneous retropharyngeal hematomas. High clinical suspicion is warranted in patients who present with acute dysphagia, odynophagia, and dysphonia. Prompt imaging and airway management are vital in managing patients with this condition.
- Prospective evaluation of patient reported swallow function with the Functional Assessment of Cancer Therapy (FACT), MD Anderson Dysphagia Inventory (MDADI) and the Sydney Swallow Questionnaire (SSQ) in head and neck cancer patients. [Journal Article]
- OOOral Oncol 2018; 84:25-30
- CONCLUSIONS: FACT HNC-subscale and FACT-HNSI may be preferable over other FACT measures for use in clinical trials where patient-reported swallow function is evaluated. MDADI and FACT provide similar insights into HNC patient QoL while SSQ provides additional, complementary information which could serve to better stratify patients into groups with high, medium, and low QoL outcomes.
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- Ten Questions About Barium Esophagography and Dysphagia. [Review]
- GCGastroenterol Clin North Am 2018; 47(3):449-473
- The barium esophagogram is a global test for patients with dysphagia that can simultaneously detect morphologic abnormalities in the pharynx and esophagus, pharyngeal swallowing dysfunction, esophage...
The barium esophagogram is a global test for patients with dysphagia that can simultaneously detect morphologic abnormalities in the pharynx and esophagus, pharyngeal swallowing dysfunction, esophageal dysmotility, and gastroesophageal reflux. The barium esophagram is an inexpensive, noninvasive, and widely available procedure that can serve as the initial diagnostic test for dysphagia and facilitate selection of other diagnostic studies such as endoscopy. This article addresses 10 questions about barium esophagography and dysphagia that should help gastroenterologists gain a better perspective about the utility of barium studies in this clinical setting.