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Biomedical subjects

O Ekberg

Publications and source records attributed to O Ekberg.

At least 55 records · Page 3Linked to original sources
PubMed1997

Assessment of respiration during video fluoroscopy of dysphagic patients.

RATIONALE AND OBJECTIVES: The authors evaluated the coordination of swallowing and respiration in dysphagic patients. MATERIALS AND METHODS: Video fluoroscopy and respirometry were performed simultaneously during 98 swallows in 33 patients (18 women, 15 men) with a median age of 70 years (interquartile range, 52-78 years). Pharyngeal transit time, deglutition apnea, and the ratio between the two (swallowing safety index) were calculated. Presence of a misdirected swallow (aspiration or penetration) was indicated. RESULTS: Pharyngeal transit time was not associated with deglutition apnea. Misdirected swallow was associated with a slightly prolonged pharyngeal transit time, a slightly shorter deglutition apnea, and a significantly lower swallowing safety index (1.8 [1.0-4.2] vs 4.5 [2.4-6.7]; P < .001) compared with normally directed swallow. The association between misdirected swallow and lower swallowing safety index was independent of pharyngeal transit time. CONCLUSION: Assessment of respiration is important in the evaluation of dysphagia. Aspiration, especially in elderly dysphagic patients, may be a consequence of primarily disturbed respiration. A low swallowing safety index may indicate risk of misdirected swallow.

Aged↗
PubMed1997

Dynamic radiology of swallowing disorders.

Dysphagia is a common symptom from the oral cavity, pharynx and esophagus, and its causes may be morphological or functional. A biphasic barium swallow is the best way of evaluating these patients. Using a careful clinical history, and by tailoring the examination to the individual case, the radiologist is usually able to pinpoint the cause of the patient's complaints and suggest further diagnostic procedures and treatment.

Adult↗
PubMed1997

Addition of methyl cellulose enema to double-contrast barium imaging of sigmoid diverticulosis.

UNLABELLED: Double-contrast barium enema has a reduced sensitivity in patients with severe sigmoid diverticulosis. Therefore a carboxy methyl cellulose enema was employed after the conventional double-contrast examination in 15 patients with sigmoid diverticulosis. A significant increase in lumen diameter and a superior removal of barium residue from the diverticula facilitated the interpretation of the sigmoid loops. CONCLUSION: The addition of methyl cellulose enema to double-contrast barium imaging improves diagnostic imaging in diverticulosis by expanding the lumen and emptying the diverticula.

Aged↗
PubMed1997

Functional assessment of the pharynx at rest and during swallowing in partially paralyzed humans: simultaneous videomanometry and mechanomyography of awake human volunteers.

BACKGROUND: Functional characteristics of the pharynx and upper esophagus, including aspiration episodes, were investigated in 14 awake volunteers during various levels of partial neuromuscular block. Pharyngeal function was evaluated using videoradiography and computerized pharyngeal manometry during contrast bolus swallowing. METHODS: Measurements of pharyngeal constrictor muscle function (contraction amplitude, duration, and slope), upper esophageal sphincter muscle resting tone, muscle coordination, bolus transit time, and aspiration under fluoroscopic control (laryngeal or tracheal penetration) were made before (control measurements) and during a vecuronium-induced partial neuromuscular paralysis, at fixed intervals of mechanical adductor pollicis muscle train-of-four (TOF) fade; that is, at TOF ratios of 0.60, 0.70, 0.80, and after recovery to a TOF ratio > 0.90. RESULTS: Six volunteers aspirated (laryngeal penetration) at a TOF ratio < 0.90. None of them aspirated at a TOF ratio > 0.90 or during control recording. Pharyngeal constrictor muscle function was not affected at any level of paralysis. The upper esophageal sphincter resting tone was significantly reduced at TOF ratios of 0.60, 0.70, and 0.80 (P < 0.05). This was associated with reduced muscle coordination and shortened bolus transit time at a TOF ratio of 0.60. CONCLUSIONS: Vecuronium-induced partial paralysis cause pharyngeal dysfunction and increased risk for aspiration at mechanical adductor pollicis TOF ratios < 0.90. Pharyngeal function is not normalized until an adductor pollicis TOF ratio of > 0.90 is reached. The upper esophageal sphincter muscle is more sensitive to vecuronium than is the pharyngeal constrictor muscle.

Adult↗
PubMed1996

Quantitative aspects of swallowing in an elderly nondysphagic population.

The prevalence of swallowing impairment increases with age and is a major health care problem in the elderly. It has been assumed that age-related changes in nerves and muscles hamper muscle strength and coordination of swallowing. However, it is unclear what impairment is related to primary aging and what is the consequence of diseases prevalent in the elderly (secondary aging). In order to quantify swallowing in nondysphagic elderly we used the noninvasive ROSS (Repetitive Oral Suction Swallow) test. A total of 53 individuals aged 76 +/- 5 years (mean +/- SD) were examined. We found that the nondysphagic elderly demonstrated significant differences compared with young individuals in 10 of 17 measured variables, i.e., decreased peak suction pressure, increased frequency of multiple swallows after one ingestion, increased frequency of polyphasic laryngeal movements, increased frequency of inspiration after swallowing, and increased frequency of coughing during or after swallowing. Therefore, primary aging mainly seems to influence coordination of swallowing, but oral and pharyngeal swallow per se seem to be unaffected.

Adult↗
PubMed1996

Videomanometric aspects of pharyngeal constrictor activity.

Pressure changes were registered with videomanometry (simultaneous manometry and barium swallow) in the pharynx and in the pharyngoesophageal segment (PES) during swallowing. A considerable longitudinal asymmetry was found. Peak pressure was highest in the PES, lower in the inferior constrictor area, and lowest at the level of the tongue base. The rate of pressure rise was highest at the level of the PES. The speed of propagation of the contraction wave was 13 (+/- 2) cm/sec. There was no correlation between the measured variables (i.e., peak pressure, rate of pressure rise, and speed of contracting wave). Our findings can partly be explained by different mechanical constraints at different levels of the pharynx but may also reflect the organization of neural control of swallowing in the brainstem. Knowledge of transducer position and orientation is essential for the evaluation of pharyngeal pressure during swallowing. Such knowledge is best achieved by performing manometry simultaneously with fluoroscopy, i.e., videomanometry.

Adult↗
PubMed1996

Quantitative assessment of swallowing in healthy adults.

Swallowing has hitherto been evaluated during physical examination, radiologic barium studies, manometry, and cervical auscultation. Radiography principally demonstrates qualitative aspects of oral and pharyngeal function, whereas quantitative aspects have primarily been documented by manometry. To evaluate swallowing quantitatively, without using invasive methods or radiation, we have applied a combined test of water drinking, i.e., the Repetitive Oral Suction Swallow test (ROSS). The test provides reliable measurements of suction pressure, bolus volume, timing of important events in oral and pharyngeal swallow, and respiration. The test is described and results from 292 healthy, non-dysphagic subjects are presented. We found a mean bolus volume of 25.6 +/- 8.5 ml during single swallow and 21.1 +/- 8.2 ml during stress (forced, repetitive swallow). During forced, repetitive swallow, the bolus volume was more strongly associated with suction time (r2 = 0.55) than with peak suction pressure (r2 = 0.04), indicating that suction time is more important than suction pressure in determining the bolus volume. The oral-pharyngeal transit time decreased: single swallow 0.56 +/- 0.36 sec, forced repetitive swallow 0.23 +/- 0.11 sec, as did the coefficient of variation (48% and 64%, respectively) indicating a more automatic neural process for pharyngeal function in forced, repetitive swallow. The postswallow respiration started with inspiration in 10% of studied individuals, but did not correlate with deviations in other variables in the test. Thus, postswallow inspiration must be considered as normal. The ROSS test offers a rapid and easy quantitative assessment of swallowing.

Adolescent↗
PubMed1996

Swallowing in hereditary sensory ataxia.

The oral, pharyngeal, and esophageal stages of swallowing were evaluated in 8 patients with recessively or dominantly inherited pure sensory ataxia. Six patients had swallowing difficulties: solid bolus obstruction, coughs during eating, and choking episodes. One patient had chronic bronchitis and another had recurrent pneumonia. The patients underwent a biphasic radiological barium swallow, including videofluoroscopy. No patient had a completely normal swallow. All had normal oral function, whereas pharyngeal function was abnormal in 6 patients. Esophageal function was abnormal in 6 patients. The swallowing dysfunction did not correlate with the severity of motor or sensory dysfunction in the limbs, nor with age or duration of ataxia. Our study shows that swallowing dysfunction is common in hereditary sensory ataxia. This dysfunction is likely to be due to involvement of the nucleus of the solitary tract in the brainstem. Despite some of the patients having suffered from choking episodes and others from bronchopulmonary complications, they did not spontaneously admit dysphagia. Swallowing should be evaluated thoroughly in patients with hereditary sensory ataxia since dysphagia in these patients might bring serious and potentially fatal complications.

Adult↗
PubMed1996

Quantitative assessment of oral and pharyngeal function in Parkinson's disease.

Oral and pharyngeal dysfunction is common in Parkinson's disease. To reveal the frequency of swallowing dysfunction and correlate swallowing dysfunction with locomotor disturbances, we studied 75 patients with Parkinson's disease staged I-IV according to the Hoehn and Yahr score. We assessed oral and pharyngeal swallow during optimal medication by a quantitative test of swallowing (the ROSS test) measuring the suction pressure, bolus volume, swallowing capacity, and time for important events in the swallowing cycle. We found abnormal results in 7/12 patients (58%) in stage 1 of the Hoehn and Yahr score, in 13/14 patients (93%) in stage 2, in 29/32 patients (91%) in stage 3, and in 16/17 patients (94%) in stage 4. Abnormal test results in stages, 1, 2, and 3 were seldom related to swallowing difficulties noticed by the patients. In advanced disease (Hoehn and Yahr stage 4), the abnormal results were often considerable, with swallowing difficulties obvious to the patient. Two of 17 patients coughed during or immediately after the test and 3/ 17 patients were unable to complete the test. The degree of swallowing disturbance increased during stress (forced, repetitive swallow). The Hoehn and Yahr score and the results in the ROSS test did not correlate, indicating that swallowing disturbances are due to nondopaminergic degeneration. Silent swallowing impairment may interfere with the nutrition and quality of life in Parkinson's disease, thus it is of interest to monitor this in clinical practice.

Adult↗
PubMed1996

Sports-related groin pain: evaluation with MR imaging.

Our purpose was to assess the role of MRI in evaluating the musculoskeletal system in athletes with chronic pain laterally in the groin of unknown etiology. Magnetic resonance imaging (MRI) of the pubic ring was performed in 11 young athletes (soccer players) with long-standing groin pain. MR findings were compared with plain films and isotope examination (bone scan Tc 99M). Abnormal MRI findings included a broadened and irregular symphysis with a characteristic pattern of low signal intensity on T1W and high signal intensity on T2W images localized in the superior pubic ramus at a distance from the symphysis. Positive findings were also observed on plain films and on nuclear medicine studies. However, the imaging findings in the superior public ramus of the symphysis was located considerably more laterally on MRI. MRI is a valuable method for evaluating discrete and ambiguous pelvic pain in athletes, particularly for identifying concomitant changes in the superior ramus, which may give rise to long-standing pain localized laterally in the groin.

Adolescent↗
PubMed1996

Phenotype and genotype analysis of debrisoquine hydroxylase (CYP2D6) in a black Zimbabwean population. Reduced enzyme activity and evaluation of metabolic correlation of CYP2D6 probe drugs.

OBJECTIVE: Debrisoquine hydroxylase (CYP2D6) is responsble for the oxidative metabolism of many clinically used drugs. Since this enzyme has been poorly studied in the southern part of Africa, we examined the CYP2D6 phenotypes and genotypes in 103 unrelated black Zimbabweans. METHODS: Phenotyping for CYP2D6 activity was done using debrisoquine and metoprolol as probe drugs by measuring the urinary metabolic ratio (MR) of parent drug to metabolite concentration ratios. Genotyping was done using polymerase chain reaction (PCR), restriction fragment length polymorphism (RFLP), single-strand conformation polymorphism (SSCP) and sequencing analyses with respect to CYP2D6 variants of interest. RESULTS AND CONCLUSION: Phenotyping with debrisoquine revealed two poor metabolisers (PMs), whereas 5 subjects out of 94 were PMs using metoprolol as probe drug. Genotypes predictive of the poor metaboliser status were observed for the two subjects who were PMs with both probe drugs, whereas no mutations could explain the PM phenotype for metoprolol among the three remaining subjects, a fact possibly explained by lack of compliance in metoprolol intake. There was a moderate correlation of 0.67 between the debrisoquine and metoprolol metabolic ratios in the 89 subjects who were extensive metabolisers for both probe drugs. The median values for the metabolic ratios for debrisoquine and metoprolol as probe drugs were 1.00 and 1.35, respectively, which are higher than those observed in Caucasian populations. This is indicative of a decreased capacity for metabolism of CYP2D6 substrates by Zimbabweans compared to Caucasians. Evaluation of the DNA samples for the known allelic variants CYP2D6A, CYP2D6B, CYP2D6C, CYP2D6D or CYP2D6Ch1 yielded no explanation for these results.

Cytochrome P-450 CYP2D6↗
PubMed1996

Prognosis in elderly men with screening-detected abdominal aortic aneurysm.

OBJECTIVES: To study the natural course of screening-detected symptomless abdominal aortic aneurysm (AAA) in elderly men. SETTING: Malmö, a city in southern Sweden with 230,000 inhabitants and a single referral hospital. MATERIALS: 423 seventy-four-year-old men, randomly selected from the population and belonging to the prospective population study "Men born in 1914", were invited. 343 underwent AAA screening, whereas 80 declined or had moved. CHIEF OUTCOME MEASURES: Five year all cause mortality in relation to participation in and findings at ultrasound screening for AAA. MAIN RESULTS: An abdominal aortic aneurysm was present in 38 (11%) out of 340 men who underwent screening and who had a native aorta. During 5 years of follow-up, one third (13/38) of these men died; 7 from myocardial infarction and 3 from stroke. The mortality rate in men with AAA was 80.2/1000 person years; twice as high as it was in men without AAA (39.4/1000 person years; p = 0.018). Six men underwent AAA surgery. None of them died from aneurysm rupture. However, aneurysm surgery did not reduce the total mortality rate in these men. The highest mortality rate, 91.9/1000 person years, was found in the men who did not participate in the screening. CONCLUSIONS: It is our conclusion that screening for early detection and intervention is of questionable value from a public health perspective.

Aged↗
PubMed1995

Simultaneous videoradiography and pharyngeal solid state manometry (videomanometry) in 25 nondysphagic volunteers.

Recent technological advances in manometry, including solid state transducers and computerized analysis, allows for reliable interpretation of intraluminal pharyngeal pressures. Simultaneous videoradiography (barium swallow) provides fluoroscopic control of the manometric sensors (videomanometry), thereby eliminating the uncertainty of sensor dislocation during laryngeal elevation. This is the first study describing normal manometric parameters in videomanometry during barium swallow. Seven manometric parameters and six videoradiographic parameters were analyzed. We included 25 nondysphagic volunteers with normal videoradiographic parameters in the study. The examination was performed in an upright physiologic position during 10-ml barium and dry swallows. Mean resting pressure in the upper esophageal sphincter was 89.6 +/- 32.6 (+/- 2 SD) mmHg. Mean residual pressure during relaxation of the upper esophageal sphincter was 7.2 +/- 8.0 (+/- 2 SD) mmHg during barium swallow and 3.8 +/- 6.2 (+/- 2 SD) mmHg during dry swallow. The mean duration of upper esophageal sphincter relaxation was 601 +/- 248 (+/- 2 SD) msec. The mean peristaltic contraction of the upper esophageal sphincter was 253.8 +/- 142.8 (+/- 2 SD) mmHg. Fourteen (56%) of the 25 had a measurable intrabolus pressure (mean 33.2 +/- 17.3 mmHg) at the level of the inferior pharyngeal constrictor. A specific finding was discovered when the epiglottis tilts down hitting the manometric sensor. This epiglottic tilt was identified in 7 subjects (28%) and caused pressures of around 600 mmHg. A standardized manometric technique is important in videomanometry, and normal values as described in this study are essential in clinical use.

Adult↗
PubMed1995

Autonomic nerve dysfunction in patients with bolus-specific esophageal dysmotility.

The pathogenetic mechanisms causing esophageal dysmotility is not well understood. We examined 13 patients with solid bolus dysphagia in a radiologic barium study including the swallowing of a 14-mm tablet. In all 13 patients the tablet was caught in the proximal or midesophagus. In 8 patients, the entrapment was associated with symptoms (Group 1) whereas in 5 patients (Group 2), no symptoms were reported. All 13 patients together with a control group of 56 healthy, nondysphagic subjects were tested for autonomic nerve function. Autonomic nerve function tests included registration of electrocardiographic R-R interval variation during deep breathing test (E/I ratio), a test of parasympathetic, vagal, nerve function. The results showed that the E/I ratio was significantly lower in patients with symptoms of bolus-specific esophageal dysmotility (-2,19 [1.76]) (median [interquartile range]) compared with patients without symptoms (0.05 [2, 87], p = 0.0192) and controls (-0.25 [1.26], p = 0.0009). In conclusion, symptomatic bolus-specific esophageal dysmotility is associated with vagal nerve dysfunction.

Adolescent↗
PubMed1995

Oral function test for monitoring suction and swallowing in the neurologic patient.

Disturbances in swallowing are common in neurologic disease but difficult to evaluate in the clinical setting. Fundamental variables such as bolus volume, swallow capacity (volume ingested over time), and the relation between ingestion and time for important events in oral and pharyngeal swallowing have not been sufficiently studied. We therefore employed a composite method for monitoring oral and pharyngeal swallowing function: the test of Repetitive Oral Suction Swallow (the ROSS test). The technical details are described as well as preliminary results from a pilot study of 20 healthy subjects and 5 patients with neurologic swallowing impairment. The correlation with respect to time sequences for major events in bolus ingestion and oral processing as monitored by the ROSS test and by videoradiography is explained. With this simple and rapid bedside test, the immediate and long-time result of therapeutic interventions in dysphagic patients may be monitored.

Adult↗
PubMed1995

Salivary clearance of citric acid after an oral rinse.

OBJECTIVES: Citric acid clearance from the oral cavity may be an important factor in the erosion of dental enamel. The aim of the present study was to investigate the clearance pattern of citric acid in normal subjects. METHODS: After determination of the unstimulated salivary flow rate and the residual volume of saliva after normal swallowing, 12 subjects rinsed with 95.2 mmol l-1 citric acid for 5 s. At 1, 2, 5, 10 and 15 min after the rinse a small saliva sample was collected and the concentration of citric acid was determined enzymatically. For each subject three separate experiments on different occasions were performed with a citric acid solution of pH 2.1 and one experiment with a solution of pH 4.5. RESULTS: The salivary citric acid concentration declined biphasically: rapidly during the first 2 min, then more slowly. The elimination rate over the first minute was on average 87.7 mmol l-1 min-1 at pH 2.1 compared with 85.0 mmol l-1 min-1 at pH 4.5. The difference between individuals estimated from the areas under the clearance curve was strongly significant (P < 0.001). No significant relation was found neither between salivary flow rate and clearance, nor between residual volume after swallowing and clearance. CONCLUSION: The clearance pattern of citric acid is an individual property.

Adult↗
PubMed1995

Videomanometry of the pharynx in dysphagic patients with a posterior cricopharyngeal indentation.

RATIONALE AND OBJECTIVES: Patients with a posterior indentation in the pharyngoesophageal segment (PES) are generally considered to have an abnormality of the cricopharyngeal muscle (CPM). In this study we determined the actual width of the PES and the pressure circumstances during swallowing within the pharynx and PES in such patients. METHODS: Simultaneous videofluoroscopy and solid state manometry, radiologic examination of the pharynx, PES, and cervical esophagus were performed in 16 dysphagic patients with a cricopharyngeal (CP) bar. In eight patients the indentation was 25-50%, and in eight it was more than 50% of the adjacent gullet. Sixteen dysphagic patients without a CP bar were used as control subjects. In each patient swallows of 10-ml barium bolus were recorded. RESULTS: Patients with CP bars had a significantly wider PES above (p = .0005) and below (p = .02) the CPM, whereas the diameter at the level of the CPM was smaller only in the patients with more than 50% indentation compared with the patients without a CP bar. The contraction pressure above the CP bar (i.e., at the level of the inferior pharyngeal constrictor) was significantly (p = .002) weaker in patients with a CP bar (131 +/- 16 mm Hg) than in those without a CP bar (222 +/- 20 mm Hg). CONCLUSION: Our findings in patients with a posterior CP bar suggest that the major abnormality is weak constrictors with outpouching of the gullet above and below. Only in patients with more than 50% indentation was there a slight narrowing at the level of the CP bar. The CPM showed no manometric abnormalities in terms of resting pressure, relaxation, and contraction pressure. Therefore, the CPM is likely to relax and distend normally during swallowing in patients with a CP bar.

Deglutition↗