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Biomedical subjects

O Ekberg

Publications and source records attributed to O Ekberg.

At least 73 records · Page 4Linked to original sources
PubMed1995

Positioning improves the oral and pharyngeal swallowing function in children with cerebral palsy.

Many children with cerebral palsy have feeding difficulties. The aim of this study was to investigate if trunk and neck positioning influenced oral and pharyngeal swallow. Five children with feeding problem aged 3-10 years with cerebral palsy were examined using videofluoroscopy. All children had tetraplegia with dystonia, i.e. poor head control and poor trunk stability. All children had gross aspiration and posterior oral leak. The pharyngeal phase was delayed in relation to the oral phase. Two children had pharyngeal retention. The children were positioned with both an extended and flexed neck. The flexed neck position was combined with a 30 degrees reclined sitting position. In both positions they were given purée with barium and liquid barium during video recording. In the reclined position with the neck flexed, aspiration decreased in all five children, oral leak diminished in two children and retention improved in one child.

Cerebral Palsy↗
PubMed1995

[The pharyngoesophageal segment].

The pharyngoesophageal segment (PES) is a striated muscular structure separating the relatively wide pharynx from the narrow cervical esophagus. There is a substantial axial and longitudinal asymmetry within the PES, as well as basal resting pressure that is substantially influenced by a variety of stimuli as well as deglutition.

Deglutition↗
PubMed1995

[Simultaneous video radiography and "solid state" intraluminal pharyngeal manometry during barium swallow; video manometry].

Recent advances in technology, including computerized analysis, have renewed interest in pharyngeal manometry. Simultaneous fluoroscopy and videography have been recommended by many authors. This article reviews the history of pharyngeal manometry and highlights some of the technical difficulties involved. We also report the current status of the simultaneous technique and summarize our own results as well as those reported by other research groups.

Barium Sulfate↗
PubMed1995

Videoradiography of free jejunal grafts for rehabilitation of speech in laryngectomized patients.

In laryngectomized patients a tracheo-esophageal artificial fistula can be used to achieve air flow from the trachea to the esophagus during speech. A one-way plastic valve is often used for the fistula. A free jejunal graft between the trachea and the esophagus can also be used. To avoid aspiration the transplant is attached to the submental area giving the graft a siphon-like shape. We performed 23 videoradiographic examinations using high-density barium in 14 such patients. The aim was to evaluate the protective function of these grafts against aspiration. Penetration of the bolus and a small amount of residual contrast material in the ascending limb of the graft was a normal finding. If the standard barium bolus reached the descending limb at any time during the examination, this was a sign of aspiration hazard. To avoid aspiration, the vertex of the speech siphon should be higher than the level of the hypopharyngeal anastomosis.

Anastomosis, Surgical↗
PubMed1994

Pharyngeal solid-state manometry catheter movement during swallowing in dysphagic and nondysphagic participants.

RATIONALE AND OBJECTIVES: The movements of the soft palate and the larynx are crucial in pharyngeal manometry because of the potential risk of manometry sensor dislocation. METHODS: Twenty dysphagic patients and 20 nondysphagic volunteers were examined with simultaneous videoradiography and intraluminal pharyngeal solid-state manometry. The movements of the manometric sensors were analyzed from lateral videorecording. RESULTS: Two different types of catheter movement were found. The sensor in the upper esophageal sphincter (UES) could either be lifted cranially during the closure of the soft palate (type 1) or stay unaltered in the sphincter until the beginning of the laryngeal elevation and then follow the sphincter cranially during laryngeal elevation with no previous response to soft palate closure (type 2). Type 1 movement was found in eight of 20 patients but in only one of the 20 volunteers. The resting pressure of the upper esophageal sphincter was significantly higher in type 2 (P = 0.004). Nineteen of the 20 patients with a high resting pressure of the UES (83+ mm Hg) were found to have the type 2 movement. CONCLUSION: High resting pressure in the UES permitted the sphincter to grasp the manometry catheter and caused the sensor to follow the cranial movement during laryngeal elevation. Sensor movement is important during pharyngeal manometry, and sensor dislocation out of the sphincter can be misinterpreted as sphincter relaxation. Simultaneous videoradiography provides control of sensor positioning and allows for correction.

Adult↗
PubMed1994

An experimental manometric study simulating upper esophageal sphincter narrowing.

RATIONALE AND OBJECTIVES: Elevated intrabolus pressure above a pharyngeal narrowing has been postulated as an important finding in patients with cricopharyngeal bars. To elucidate the significance of intrabolus pressure around lumen narrowings in the pharynx, intraluminal pressure characteristics were evaluated in a laboratory model simulating upper esophageal sphincter narrowing. METHODS: Intraluminal solid-state manometry was performed in an experimental model in which variable narrowing was created in an expandable balloon simulating the pharyngeal walls. RESULTS: Intrabolus pressure was dependent on the position of the manometric sensor, degree of lumen narrowing, bolus volume, flow rate, and fluid viscosity. CONCLUSIONS: Elevated intrabolus pressure is an important finding. Intrabolus pressure is dependent on many parameters, and hence, is difficult to evaluate. If results found with this model hold true in patients, manometric sensor positioning is crucial, and concurrent fluoroscopy is highly recommended to achieve a standardized manometric technique in pharyngeal manometry.

Deglutition↗
PubMed1994

Myotonic dystrophy revealed at videoradiography of deglutition and speech in adult patients with velopharyngeal insufficiency: presentation of four cases.

Patients with velopharyngeal insufficiency (VPI) without cleft palate, who appear for the first time in adulthood for treatment, will probably reveal a high percentage of undiagnosed myotonic dystrophy (MD). Videoradiography of deglutition and speech reveals the diagnosis. Eleven adult noncleft palate patients with VPI were studied with videoradiography of the pharynx and esophagus. Three exhibited functional radiographic manifestations of MD during deglutition and speech. The diagnosis confirmed by neurologic examination was not known or suspected prior to videoradiography. An additional patient with VPI and suspected MD displayed the same constellation of radiographic findings. Follow-up examinations confirmed the diagnosis of MD. Three of the four patients had had symptoms of VPI since childhood, but none had complaints of deglutition problems except for accidental nasal regurgitations.

Adult↗
PubMed1994

Radiology in laparoscopic cholecystectomy. A retrospective study.

Laparoscopic cholecystectomy (LC) is attempted in all our patients scheduled for cholecystectomy. The related standard radiologic procedures are preoperative ultrasonography (US) and preoperative cholangiography (PCA). In a retrospective study of 214 patients scheduled for LC over a 2-year period we have reviewed the radiologic and clinical records. Preoperative US revealed stones in the common bile duct (CBD) in 8 patients, all treated with endoscopic papillotomy before or after operation. PCA was successful in 176 patients (82%) and gave crucial information in 22 patients including 8 with stones in the CBD not preoperatively diagnosed, 6 with anomalous anatomy, and 8 with malpositioned surgical clip on the cystic duct. In 26 patients LC was converted into open surgery, but in only one case due to CBD stone revealed at PCA. Seventeen patients had minor postoperative complications, all managed conservatively. We consider preoperative US and PCA appropriate radiologic investigations in conjunction with LC.

Bile Ducts↗
PubMed1994

Ipsilateral multiple groin hernias.

BACKGROUND: Recurrence rates after surgical repair of groin hernia vary between 3% and 20%. One possible reason for recurrent hernias are ipsilateral multiple hernias, which might have been overlooked at the primary operation. METHODS: In the present series 1010 patients with unclear groin pain underwent herniography. RESULTS: A total of 314 patients had hernias, and seventy-one (23%) of these had multiple hernias. Ipsilateral multiple hernias were found in 18 (6%) patients. Ipsilateral multiple hernias were present in 9 (6%) of 144 patients with an indirect hernia, in 17 (12%) of 144 patients with a direct hernia, in 5 (21%) of 24 patients with a femoral hernia, and in 3 (23%) of 13 patients with an obturator hernia. The hernias were of indirect, direct, femoral, and obturator types. CONCLUSIONS: The frequency of ipsilateral multiple hernias is much higher than the frequency reported during herniorrhaphy. Such overlooked ipsilateral multiple groin hernias may account for some of the so-called recurrences after herniorrhaphy. Therefore a careful exploration of the groin is mandatory. Preoperative herniography may also prove to be useful in patients with recurrent groin symptoms after herniorrhaphy.

Adult↗
PubMed1994

Simultaneous videoradiography and computerized pharyngeal manometry--videomanometry.

To obtain more information about muscle function in patients with dysphagia, simultaneous barium swallow and computerized pharyngeal manometry with solid-state pressure transducers was employed for the evaluation of the pharynx and the pharyngoesophageal segment (PES) in 30 consecutive patients. The manometry catheter was positioned under fluoroscopic control, providing localized measurements of the intraluminal pressures in the pharynx. Sixteen patients had a normal barium swallow. In 5 (31%) of these the manometry disclosed PES dysfunction, i.e. increased resting pressures between swallows in 3 patients (mean 120 +/- 13 mm Hg), and increased contraction pressures during peristalsis in 2 (mean 297 +/- 21 mm Hg). Barium swallow and manometry are complementary: the former reflecting transport through the pharynx and penetration to the airways, the latter the intraluminal pressures created by the pharyngeal wall. The combination of barium swallow and manometry gives information about pressure in relation to bolus transport, which may elucidate pharyngeal dysfunction.

Adult↗
PubMed1993

Pharyngeal constrictor paresis: an indicator of neurologic disease?

Pharyngeal constrictor paresis (PHCP) is sometimes found in videoradiography of the swallowing act in patients complaining of dysphagia. Ten patients with PHCP and 10 dysphagic, age- and sex-matched controls with normal videoradiography were neurologically evaluated and examined with magnetic resonance imaging (MRI) of the brain and brainstem in order to learn the pathogenetic process behind PHCP. The study revealed 8 PHCP patients and 1 dysphagic control with abnormal clinical neurological findings such as myopathy, cerebrovascular disease, or extrapyramidal disease. The neurological examination revealed considerable information of prognostic and therapeutic value in PHCP patients. The MRI was abnormal in 7 PHCP patients and 4 dysphagic controls. However, the findings in MRI were nonspecific but the examination was found to be valuable in selected cases. It is concluded that PHCP is an indicator of neurological disease and accordingly, such patients should be examined by a neurologist to establish the cause of the disease.

Adult↗
PubMed1993

Expansion pattern and risk of rupture of abdominal aortic aneurysms that were not operated on.

OBJECTIVE: To analyse the outcome of selective management of patients with abdominal aortic aneurysms, the expansion patterns of the aneurysms, and the factors that influenced the rate of rupture. DESIGN: Retrospective study. SETTING: Malmö General Hospital, Lund University, Malmö, Sweden. SUBJECTS: 155 patients (96 men and 59 women) with abdominal aortic aneurysms who were not selected for operation for whatever reason were included in the study immediately after their first ultrasound scan. MAIN OUTCOME MEASURES: Mortality, expansion rate (mm/year) measured on ultrasound scan, and rate of rupture of aneurysm. RESULTS: Median aneurysmal diameter was 40 mm (range 20-80), and length (n = 106) 70 (range 28-140). The patients were followed up for a median of 3.4 years (range 0-10.2). A total of 107 patients died and in 21 the aneurysms ruptured (4 were operated on and survived). Thirteen patients were re-evaluated and operated on electively. Ultrasonography was repeated in 98 patients, the median expansion rates (mm/year) were 3.1 (diameter) and 1.9 (length). There was a significant linear relationship between initial size (diameter and length) and rate of expansion of diameter. The risk of rupture was greater in larger aneurysms that were expanding more quickly. The cumulative mortality was not affected by the 21 aneurysms that ruptured. CONCLUSION: Selective management of patients with aortic aneurysms is justified.

Aged↗
PubMed1993

Solid bolus swallowing in the radiologic evaluation of dysphagia.

Patients with dysphagia, heartburn and chest pain are regularly referred for radiologic evaluation of swallowing. The liquid barium swallow has been of great value for the biphasic evaluation of the pharynx and esophagus. Though many patients complain of dysphagia specifically for solids, solid bolus swallow is usually not part of the evaluation. For the present study we therefore included the use of a solid bolus with a diameter of 13 mm and interviewed the patients carefully for any symptoms during this tablet swallow. Of 200 patients examined, the tablet passed through the esophagus without delay in 102. In the 98 patients with delayed passage, the solid bolus arrest occurred in the pharynx in 5 and in the esophagus in 93. Arrest in the esophagus was due to esophageal dysmotility in 48 patients. Twenty of these were symptomatic during the tablet swallow. A narrowing was the cause in 45, of whom 9 had symptoms. In 18 patients (9%) the solid bolus added key information to the radiologic evaluation. We therefore recommend that the solid bolus is included in the routine radiologic work-up of patients with dysphagia. Careful attention to symptoms during the tablet swallow is important.

Adult↗
PubMed1992

Clinical and demographic data in 75 patients with near-fatal choking episodes.

The clinical background and circumstances of 75 patients who had survived a near-fatal choking episode, i.e., had undergone a Heimlich maneuver, oropharyngeal suctioning, or intubation, is reported. Sixty had choked on a solid bolus (often of a complex texture like sandwiches and chicken soup). Four patients had choked on mashed banana. In 30 patients neurologic disease (such as cerebrovascular disease, Parkinson disease, or dementia) was present. Choking occurred during breakfast (16 patients), lunch (21), dinner (26), and snacks (12). Twenty-five choked at home, 18 in nursing homes, 14 in hospitals, nine in restaurants, and nine in drinking establishments. Twelve were being fed at the time of choking. Fifty-eight of the individuals had oral, pharyngeal, or esophageal abnormalities on radiographic examination that could explain the choking episode. Fourteen patients who were able to vocalize during the choking episode had probably suffered from esophageal impaction. Our study indicates that elderly individuals and those with neurogenic dysphagia are at risk for choking. Dysphagia diet (semisolids) may actually contribute to the risk in these patients. Young adults may also be at risk during episodes of consumption of alcohol and snacks.

Adult↗
PubMed1992

Deglutition in elderly patients with dementia: findings of videofluorographic evaluation and impact on staging and management.

Oral and pharyngeal function in 131 institutionalized elderly patients with advanced dementia was evaluated by means of videofluoroscopic deglutition examination (VDE). Findings were normal in only nine (7%) patients. Oral-stage dysfunction was observed in 93 (71%) patients, pharyngeal dysfunction in 56 (43%), and pharyngoesophageal-segment abnormalities in 43 (33%). Multiple-stage dysfunction was noted in 55 (42%) patients. Major aspiration of contrast medium was present in 31 patients, and minor aspiration in 66. Evaluation of VDE findings prompted a change in clinical staging (degree of impairment) in 40 patients and substantial alteration in treatment planning in 28. At clinical bedside evaluation, the degree of bolus misdirection was overestimated in 19 patients with minor aspiration and underestimated in seven with major aspiration. Dementia is often associated with oral and pharyngeal impairment, and VDE can be important in diagnosis and treatment.

Aged↗
PubMed1991

Duodenitis: a reliable radiologic diagnosis?

The authors performed a retrospective study of 50 patients with endoscopically diagnosed duodenitis who had undergone double-contrast upper gastrointestinal (GI) examinations. Duodenitis was diagnosed on the original radiographic reports in six of 37 patients (16%) with mild-to-moderate duodenitis, five of 13 patients (38%) with severe duodenitis, and 11 of 50 patients (22%) with all grades of duodenitis on endoscopy. Subsequent analysis of the films revealed one or more radiologic signs of duodenitis (including folds more than 4 mm in thickness, mucosal nodularity, bulbar deformity, and erosions) in 18 of 37 patients (49%) with mild-to-moderate duodenitis, eight of 13 patients (62%) with severe duodenitis, and 26 of 50 patients (52%) with all grades of duodenitis on endoscopy. In a separate part of the study, the authors identified another 20 patients with radiographically diagnosed duodenitis who had undergone endoscopic examinations. Nine of those 20 patients (45%) had duodenitis on endoscopy. Subsequent analysis of the films revealed one or more signs of duodenitis in 17 patients from this group. Nine of the latter patients (53%) had duodenitis on endoscopy. Using established radiologic criteria for duodenitis, our rate of false-positive and false-negative radiologic diagnoses still was about 50%. Thus, the double-contrast upper GI examination is a relatively unreliable technique for diagnosing duodenitis.

Adult↗
PubMed1991

Effects of drugs and electrical field stimulation on isolated muscle strips from rabbit pharyngoesophageal segment.

Muscle activity of isolated muscle strips from the middle pharyngeal constrictor, the inferior pharyngeal constrictor, the cricopharyngeal muscle, and the cervical esophagus of the rabbit was studied in organ baths in response to drugs and electrical field stimulation. These muscles of the pharyngoesophageal segment seem to lack an autonomic adrenergic and cholinergic innervation, as determined by responses to specific drugs. The nerve-evoked contractile responses of the two lower muscles of the segment were almost completely abolished by the curarelike drug gallamine, suggesting a somatic cholinergic nerve supply. However, in the two upper muscles, the major part of the response was resistant to gallamine, which suggests involvement of non-adrenergic, nonmuscarinic, nonnicotinic receptors in the transmission of nerve impulses in these muscles. These results suggest a differential innervation of the upper and lower pharyngeal muscles.

Animals↗