Results are presented for repeated videofluoroscopic and scintigraphic examinations of a supraglottic laryngectomy patient, illustrating the successful use and later changes in a compensatory swallow. Issues in patient management are outlined, stressing the importance of interaction between radiologists and dysphagia therapists in the rehabilitation of such patients.

Carcinoma, Squamous Cell↗

PubMedDate not supplied

Swallowing recovery following anterior tongue and floor of mouth surgery.

Videofluoroscopic and clinical data are presented for postsurgical recovery of tongue and hyoid activity during swallowing. Comparison is made to normal controls. Postsurgery, but prior to radiotherapy, both the lingual propulsive gesture and hyoid velocity were slower than normal. These features of the swallow had returned to the normal range following radiotherapy. The general sequencing of swallowing events, and the relationship of the end of the tongue propulsion to anterior hyoid motion were normal in those patients able to swallow. In this patient group, postsurgical radiotherapy did not prevent continued recovery of swallowing function sufficient for oral nutrition.

Adult↗

PubMedDate not supplied

Swallowing of bolus types by postsurgical head and neck cancer patients.

BACKGROUND: Clinically, head and neck cancer patients with anterior resections have better postoperative outcomes than do patients with posterior resections. METHODS: Videofluoroscopy was used to study the swallowing characteristics in postsurgery head and neck cancer patients and normal controls. Most patients received post-operative radiotherapy and chemotherapy, and no cancer recurrence was noted at the time of study, 4-8 months posttreatment. Bolus types included: 3 mL and 10 mL liquid barium, barium paste, and barium-coated cookie. Temporal measurements and a count of the number of swallows required to ingest each material were made from the videotaped data. Statistical analysis using an unbalanced univariate repeated measures ANOVA was performed. RESULTS: The major differences were found between bolus types, with few differences noted between surgical groups (anterior vs posterior resections) and normal controls. Patients took longer to ingest viscous material, accomplishing this by multiple piecemeal and clearing swallows. Coordination of mastication and swallowing of the cookie was different between normal and patient groups. CONCLUSIONS: Patients who are able to swallow reasonably well postoperatively maintain normal coordination and timing of swallowing activity and do not vary these parameters to compensate for structural inadequacy. Instead, repeated swallows are used.

Adult↗

PubMedDate not supplied

Phase 2 study of mitozantrone in combination with chlorambucil and prednisolone for relapsed and refractory non-Hodgkins lymphoma.

Thirty-six patients with non-Hodgkin's lymphoma (NHL) (comprising patients with refractory or relapsed disease and eight elderly, unfit patients with de novo disease) were treated with mitozantrone, chlorambucil and prednisolone on an out-patient basis. Fifteen patients had low grade (LG) disease, five patients intermediate grade (IG) disease and 16 patients high grade (HG) disease and 31/36 had stage IV disease. All elderly patients had IG or HG disease. The regimen was well-tolerated. After six courses of chemotherapy, there was a 69 per cent response rate with 33 per cent in complete remission. The median duration of remission was 15 months. The overall 3-year projected survival was 38 per cent; 27 per cent for LG disease and 47 per cent for HG and IG disease. Responses did not appear durable for either HG or LG disease unless CR was achieved early on. Three of the eight patients treated de novo (mean age 71 years) have survived disease-free, between 28 and 38 months from entry. This study indicates that mitozantrone-based regimens have promising activity in NHL and require further evaluation. The low toxicity combined with worthwhile remissions make this an attractive first-line option for elderly patients.

Adult↗

PubMedDate not supplied

The critical impact of early cellular environment on neuronal development.

Normal brain development requires the precise interactions of environmental signals with genes that drive cellular differentiation and circuit formation. Experimental studies in animal models reveal that early environmental influences in utero can modulate cell fate choice and neuronal growth. Modification of the determinants can have long-lasting consequences. Studies using transplant and cell culture methods have examined the development of the limbic system, regions of the brain that mediate cognition, emotion, memory, and learning. The results show that growth factors in the environment of progenitor cells control long-term gene expression that characterizes neurons in limbic brain regions. Other studies in which the cellular environment is altered by prenatal cocaine exposure result in modified fetal neurotransmitter function and specific pharmacological and structural alterations in the cerebral cortex that lead to abnormal behavior. The cellular milieu of the developing central nervous system prenatally thus serves functions as critical as environmental stimuli postnatally that promote synaptic development and refinement.

Animals↗

PubMedDate not supplied

Physiological chemoreceptor stimulation decreases enkephalin and substance P in the carotid body.

Neuroactive peptides, including the enkephalins (Met- and Leu-enkephalin; ME, LE) and substance P (SP) are known to be present in the mammalian carotid body, an arterial chemoreceptor organ sensitive to the O2, CO2 and pH levels in blood. The principal parenchymal (type I) cells of the organ, which receive sensory innervation from the carotid sinus nerve (CSN), have been shown to contain both ME and SP; SP is also present in CSN afferent fibers. In the present study, rabbits were exposed in a chamber to a physiological chemoreceptor stimulus (5% O2 in N2) for one hour, then anesthetized during surgical removal of both carotid bodies for later RIA measurement of ME and SP levels in the tissue; control animals were exposed to air in the chamber, but otherwise treated as the hypoxic animals. Both ME and SP levels were significantly reduced (approximately 40%) in the carotid bodies from hypoxic rabbits, compared to their normoxic controls. The results suggest that these neuroactive peptides are released from carotid body elements during physiological stimulation, and consequently may play a role in the transduction of chemosensory information between the type I cells and their apposed afferent terminals.

Anaerobiosis↗

PubMedDate not supplied

Lack of willpower or lack of wherewithal? "Internal" and "external" barriers to changing diet and exercise in a three year follow-up of participants in a health check.

The aims of this paper were to assess whether anticipated barriers to change in diet and exercise which were cited before a health check intervention were related to subsequent behaviour changes. In 1989 a health and lifestyle questionnaire was posted to 17,965 people aged 35-64 who were registered with five general practices in Bedfordshire. Taking account of non-contacts, a response rate of 80.3% was achieved and 11,090 people described their exercise and dietary habits. Those expressing an interest in changing each behaviour were asked to identify reasons why change might be difficult. Two types of barriers--"internal" and "external"--were identified. A total of 2205 respondents were invited to attend a health check in Year One and a recheck three years later and 1660 attended. In this subgroup improvement in exercise and diet was examined in relation to the participants' baseline characteristics, including the type of barriers selected. Internal barriers to change (e.g. lack of willpower, too lazy, too busy) were chosen most frequently. In a logistic regression including a range of baseline variables those who selected only internal barriers were less likely to take more exercise (OR 0.59, 95% CI 0.41, 0.86) than those who cited only external (e.g. no transport, can't afford sports facilities) or mixed barriers to changing. There was a similar but not statistically significant trend for changing diet (OR 0.78, 95% CI 0.48, 1.28). Those who are aware of external limitations may be better placed to circumvent them. Further research is needed to explore this relationship between type of barrier and behaviour change.

Adult↗

PubMedDate not supplied

Accidental human vaccination with vaccinia virus expressing nucleoprotein gene.

Explore the source record for details and available documents.

Animals↗

PubMedDate not supplied

A new system for sternal intraosseous infusion in adults.

BACKGROUND: Intraosseous (IO) infusion provides an alternative route for the administration of fluids and medications when difficulty with peripheral or central lines is encountered during resuscitation of critically ill and injured patients. OBJECTIVE: To report the first 50 uses of a new system for emergency IO infusion into the sternum in adults, the Pyng F.A.S.T.1 IO infusion system. METHODS: Six emergency departments and five prehospital emergency medical services (EMS) sites in Canada and the United States provided clinical and/or research data on their use of the IO system in a pilot study of success rates, insertion times, and complications. Indications for use included adult patient, urgent need for fluids or medications, and unacceptable delay or inability to achieve standard vascular access. A basic data set was standardized for all sites, and some sites collected additional data. RESULTS: The overall success rate for achieving vascular access with the system was 84%. Success rates were 74% for first-time users, and 95% for experienced users. Failure to achieve vascular access occurred most frequently in patients (5 of 9) described subjectively by the user as "very obese," in whom there was a thick layer of tissue overlying the sternum. Mean time to achieve vascular access was 77 seconds. Flow rates of up to 80 mL/min were reported for gravity drip, and more than 150 mL/min by syringe bolus. Pressure cuffs were also used successfully, although fluid rate was controlled by clamping the line. Further research on flow rates is needed. No complications or complaints were reported at two-month follow-up. CONCLUSION: These early data indicate that sternal IO infusion using the new F.A.S.T.1 IO system may provide rapid, safe vascular access and may be a useful technique for reducing unacceptable delays in the provision of emergency treatment.

Adolescent↗