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At least 973 records · Page 54Linked to original sources
PubMed1989

Management of pediatric patients who have swallowed foreign objects.

The clinical management of children who have swallowed foreign bodies presents a great challenge for both pediatricians and pediatric surgeons. Our 7-year experience of treating 141 patients with a history of foreign body ingestion is reported. In 114 patients, there were 122 foreign bodies present in areas from the esophagus to the rectum, as located by plain chest and abdominal x-ray examination. In two patients, a plastic toy and the plastic cap of a razor were passed with stool a few days later. In the remaining 25 patients, nothing was found. In babies under one year of age, button batteries were the most commonly swallowed foreign bodies, while coins were the most frequently swallowed objects in children over the age of three years. Seventeen foreign bodies in the esophagus were removed: seven by balloon catheter, four endoscopically, and one by a magnet tube. Four were dislodged into the stomach. Twenty nine of the 78 items present in the stomach were button batteries and 23 of the items were removed using a magnet tube. One was removed endoscopically and 5 batteries that had moved beyond the pylorus were excreted within 48 hours. Twenty four coins in the stomach were managed conservatively. Surgical intervention was required in two patients; one patient had a previous history of pyloromyotomy, and a magnet tag measuring 1.5 cm in diameter did not pass through the pylorus for 7 weeks. The other patient had swallowed a sewing needle that moved into the descending colon and abdominal pain ensued.

Child↗
PubMed1988

Swallowing disorders in the elderly: a guide to diagnosis and treatment.

Swallowing disorders are common in the elderly. They are most commonly seen in patients with cognitive-perceptual changes or neurologic deficits. The history and physical exam may be useful to increase your index of suspicion but cannot determine if a patient is at risk for aspiration. The modified barium swallow using videofluoroscopy is the most useful modality we have at this time for diagnosing swallowing disorders and determining appropriate interventions. Frequently, swallowing problems can be addressed with changes in dietary consistencies, by changes in positioning, or by techniques to improve oral control and sensitivity to food in the mouth.

Aged↗
PubMed1986

Oral motor functioning, frequency of swallowing and drooling in normal children and in children with cerebral palsy.

Attempts to eliminate drooling in children with cerebral palsy have ranged from speech therapy to radical surgery. Drooling primarily results from an overflow of saliva from the mouth due to dysfunctional voluntary oral motor activity, improper swallowing, or oral sphincter deficits and rarely from hypersalivation. A study was undertaken to determine typical orofacial electromyographic patterns and swallowing frequencies of normal children and children with cerebral palsy with oral involvement who do, and who do not drool, as well as to determine the correlation between swallowing frequency and drooling rate. Results suggest that drooling in the pediatric cerebral palsy population is caused by both inefficient and infrequent swallowing.

Adolescent↗
PubMed1985

Behavioral attempts to eliminate air-swallowing in two profoundly mentally retarded clients.

Attempts were made to eliminate the aerophagia (pathological air-swallowing) exhibited by two profoundly retarded clients in a state residential institution. In Experiment 1, a positive-practice overcorrection procedure (coactive mouth-covering) tripled the frequency of a female's air-swallowing and subsequent time-out failed to reduce it below free-operant levels. In Experiment 2, further unsuccessful attempts were made to reduce air-swallowing by the same subject using additional time-out procedures. For a second subject (Experiment 3), increased durations of positive-practice overcorrection produced corresponding reductions in air-swallowing. After physical opposition to treatment, overcorrection was withdrawn, resulting in near-baseline responding. Multiple baselines in each experiment showed no transfer effect. Findings were discussed with reference to investigators who reported negative side-effects of overcorrection and overcame them through continued experimental analysis.

Adult↗
PubMed1977

Speech and swallowing evaluation in the differential diagnosis of neurologic disease.

Examination of the speech mechanism (the vocal tract) frequently provides information about certain neurologic lesions. The speech, swallowing and respiratory patterns of patients with cerebellar, upper motor neuron, lower motor neuron and extra-pyramidal lesions (parkinsonism) were studied, 10 of each category. The patient's lingual, labial and velar movement was examined cineradiographically during production of four short speech samples and the oral, through esophageal structures, during chewing and swallowing. Videotape, with simultaneous voice recording, and 16 mm. film were used. Oral, pharyngeal and esophageal transit times during swallowing were determined. These quantified tests reveal distinctive differences in vocal tract physiology between patient groups. The specific physiologic patterns characteristic of each neurological lesion were discussed and illustrated with films. Each patient group in this study exhibited a distinctive profile distinguishing it from every other. The results also indicate that if only a portion of these studies was completed, the disorder might be erroneously classified. The findings emphasize the need for complete and detailed physiologic studies of the speech and swallowing of patients with neurologic lesions, as an aid to accurate diagnosis.

Brain Diseases↗
PubMedDate not supplied

Effects of aspirated and swallowed water in mongrel dogs subjected to fresh-water drowning.

The effects of aspiration or aspiration-cum-swallowing were studied in two groups of anesthetized dogs. Group I animals were subjected to aspiration (20 mlg/kg) whereas that of group II to aspiration (20 ml/kg) cum-swallowing (20 ml/kg) of fresh water. Aspiration produced decrease in plasma sodium and chloride whereas potassium, hemoglobin and haematocrit increased. These changes were transient and the values came back towards preaspiration level in the surviving animals. In animals subjected to aspiration-cum-swallowing, there was no initial increase in hemoglobin and hematocrit and both these values decreased significantly. The pattern of electrolyte changes was essentially similar to the aspiration group. All the animals in the two groups showed an immediate onset of significant asphyxia and acidosis that persisted throughout the period of observation. It is concluded that aspiration of 20 ml of fresh water per kg body weight produces only transient changes in hemoglobin, hematocrit and electrolyte balance, whereas the changes in arterial gas and pH are significant and persistent. It is further concluded that the swallowed water modifies the aspiration induced changes in fresh water drowning.

Animals↗
PubMed1995

Swallowing and esophageal function in Parkinson's disease.

Dysphagia and drooling of saliva are frequent symptoms in Parkinson's disease (PD), occurring in one-half and three-quarters of all patients, respectively. Aspiration related to swallowing is a major cause of morbidity and mortality in PD. Defects in oral, pharyngeal, and esophageal phases of swallowing have been documented in patients with PD, and these defects precede symptoms. This paper reviews the current knowledge concerning swallowing abnormalities in PD. The pathogenesis of dysphagia and drooling of saliva is multifactorial, involving cognitive and psychological changes in addition to abnormalities of the extrapyramidal and autonomic nervous systems. Videofluoroscopic imaging of the upper esophageal sphincter and pharynx during mastication and swallowing has been the basis of our understanding of the mechanical malfunction present in patients with PD. Manometric abnormalities of the esophageal body and lower esophageal sphincter have also been documented. The use of combined manofluoroscopy to examine the upper esophageal sphincter and pharynx in PD offers great promise both in understanding the defects and directing therapy. Voluntary airway protection techniques may reduce aspiration, but they need to be tested in a clinical study. Such maneuvers may reduce the morbidity seen in PD.

Deglutition↗
PubMedDate not supplied

Severe complications following a "barium swallow" investigation for dysphagia.

OBJECTIVE: To highlight the risks of investigation of patients with swallowing disorders by "barium swallow", when the disorders may arise from dysfunction of the upper swallowing tract. CLINICAL FEATURES: An 81-year-old Italian woman presented to her local doctor with a history of dysphagia of five days' duration. A barium swallow resulted in aspiration of a large amount of barium into the right main bronchus, causing severe problems. After a period of intensive respiratory care including intubation and continuous positive airway pressure, she recovered sufficiently to be referred to a rehabilitation unit. She had mild hemiplegia but severe dysphagia, secondary to a brain stem infarct. INTERVENTION AND OUTCOME: Persisting severe dysphagia was confirmed, with extreme risk of aspiration. The patient underwent percutaneous endoscopic gastrostomy and was discharged to live independently, but requiring long-term gastrostomy feeding. CONCLUSION: When a patient presents with dysphagia, great care should be taken to exclude upper tract dysfunction with its attendant risk of aspiration, generally by referral to a centre or consultant with expertise in this area, before ordering or carrying out investigations appropriate to disorders of the lower tract.

Aged↗
PubMed1994

Laryngeal movement, oropharyngeal pressure, and submental muscle contraction during swallowing.

This study examined temporal relationships of laryngeal movement, oropharyngeal pressure and submental muscle contraction during swallowing. Techniques used to obtain the temporal measures were electroglottography (EGG), oropharyngeal manometry, and submental surface electromyography. Liquid bolus swallows were performed by 40 normal subjects evenly divided by young and elderly, men and women. Results of this investigation suggest that the EGG waveform is reflective of the temporal aspects of laryngeal movement during swallowing and that the EGG has potential as a behavioral modification technique in swallowing therapy. A case study is presented to illustrate the use of the electroglottograph for biofeedback.

Adult↗
PubMed1977

Swallowing and the organization of sucking in the human newborn.

The effect of varying amount and concentration of a sucrose solution on swallowing and sucking activity of newborns was studied. Swallowing activity increased relative to the number of sucks, and sucking rate slowed as amount and concentration of sucrose was increased. Sucking interresponse times associated with swallowing were approximately 200 msec longer than interresponse times not associated with swallows. The results are discussed in relation to previous studies of sucking in the newborn.

Deglutition↗
PubMedDate not supplied

[Swallowing defects determined by tracheostomy].

We have studied the interference on swallowing of the skin-tracheal fixation determined by tracheostomy. We have analyzed this interference by videofluoroscopy. One hundred and twelve patients with complain of dysphagia have been studied by videofluoroscopy at the Hospital Universitário "Clementino Fraga Filho", Rio de Janeiro, RJ. Four have undertaken tracheostomy. One (female, 52 years) had already a metal cannula in the trachea, three others (two females and one male/40 to 66 years) exhibited a longitudinal anterior depressed scar, for more than five years. Two patients had also a neurological disease. In the videofluoroscopic observation it was used liquid medium (barium solution) and also solid and soft contrast media made of barium powder mixed with a bread dough. We have found a correlation between skin-tracheal fixation and swallowing defects. The skin-tracheal fixation interference occurs basically by opposition to the hyo-larynx free displacement. This limited displacement determines a small amplification of the laryngo-pharyngeal space, a restrictive opening of the pharingo-esophageal segment and also determines that the laringeous aditus remains near the pharingo-esophageal limit. We have observed swallowing defects in all the four tracheostomized patients. The observed defects relative to tracheostomy was the penetration of contrast medium in the airway. This penetration was cleared by forced expiration. In three patients the swallowing defects was clearly linked to tracheostomy. We can admit that the skin-tracheal fixation, without any other pathology, can determine dysphagia. In association with other diseases this fixation can increase the disturbance: On the other hand it can run unnoticed due to more evident pathology. The consequence of skin-tracheal fixation is better determined by videofluroscopy.

Adult↗
PubMed1997

[Electroglottographic studies in myasthenia gravis patients--swallowing in exacerbation and remission stage].

We quantitatively evaluated the electroglottographic changes in swallowing in patients with generalized myasthenia gravis during exacerbation and remission stages. Five patients with myasthenia gravis (Osserman's stage IIB, 55.3 +/- 3.1 years old) and 6 healthy control subjects (55.3 +/- 1.1 years old) were examined. The instrument delivered a 450 microA. 52 kHz carrier signal to a pair of surface electrodes on each side of the larynx at the level of the thyroid lamina. Tissue impedance across the neck was recorded via electroglottography (EGG) while swallowing 10 ml of water. Four trials were performed for each subject, and the EGG waveform was analyzed. The EGG waveform during the exacerbation stage exhibited a more significantly increased number of phases and longer duration than that during remission. In myasthenia gravis patients, the number of phases and the duration from exacerbation to remission was more significantly reduced than those in controls at an interval of 3 years (p < 0.001, p < 0.02). These findings suggest that changes in the number of phases and duration of the EGG waveform are objective and quantitative parameters for measuring therapeutic effectiveness in treating swallowing disturbance due to myasthenia gravis. EGG is a useful and noninvasive technique for evaluating swallowing change in myasthenia gravis patents.

Deglutition↗
PubMed1998

Swallowing of hydrochloric acid: study of 25 cases.

INTRODUCTION: Ingestion of hydrochloric acid solutions (Salfumant/Salfuman) constitute a relatively frequent emergency in our environment. It is a strong acid, highly corrosive, the swallowing of which causes a very serious necrosis of the gastrointestinal tract. AIM: We review our experience on emergency treatment of inpatients after the swallowing of watery hydrochloric acid solutions, in order to identify the most important prognosis factor. PATIENTS AND METHODS: During the last thirteen years, 25 patients have been attended in our center with the diagnosis of hydrochloric acid swallowing. The clinical and therapeutical characteristics are respectively analyzed, as well as the high morbi-mortality of these kind of emergencies. RESULTS: Global mortality of the series has been 48% (12 patients). The common characteristic of these 12 patients was the esophagogastric massive necrosis, and the duodenopancreatic frame necrosis. Ten patients who did not present duodenal necrosis or were operated on of later complications, survived. Three patients could be managed with medical conservative treatment. CONCLUSIONS: Hydrochloric acid swallowing constitutes an extraordinary severe emergency, with a high mortality, mainly related to necrosis extension to the duodenopancreatic frame.

Adult↗
PubMed1976

Lower oesophageal sphincter resting pressures in achalasia and the response of the sphincter to swallowing and drugs.

Previous reports on the profile of lower oesophageal sphincter (LOS) pressures and swallow responses in achalasia have been conflicting. Both normal and high resting pressures have been reported. Many reports have noted a failure of relaxation of the LOS in response to swallowing. Manometric studies were performed on 17 untreated patients with achalasia, of whom 76% were found to have a resting peak end-inspiratory pressure significantly greater than normal (P = 0,001). Nine patients showed relaxation of the LOS in response to swallowing but this relaxation was usually inadequate and of brief duration. Contractions were premature in 16 patients. One patient showed a manometric pattern closely simulating a Mobitz type 1 atrioventricular block in response to repeated swallows. A common pathophysiological process is postulated. In one patient an injection of secretin reduced the high resting LOS pressure. This supports previous evidence that a hypersensitive sphincter in achalasia is due to a hypersensitivity to gastrin. Hyoscine-N-butylbromide (Buscopan) caused a significant reduction in LOS pressure in all patients in whom it was used.

Adolescent↗
PubMed2006

Contaminant exposure of barn swallows nesting on Bayou d'Inde, Calcasieu Estuary, Louisiana, USA.

Current and historical point source discharges, storm water runoff, and accidental spills have contaminated the water, sediment, and biota within the Calcasieu Estuary in southwestern Louisiana. In 2003, barn swallow (Hirundo rustica) eggs and nestlings were collected beneath two bridges that cross Bayou d'Inde, the most contaminated waterway within the Calcasieu Estuary. Samples were also collected from a bridge over Bayou Teche, a reference site in south central Louisiana. Polychlorinated biphenyl (PCB) concentrations in barn swallow eggs and nestlings were significantly higher at the downstream site on Bayou d'Inde (2.8 micro g/g PCBs in eggs and 1.5 micro g/g PCBs in nestlings) than at the other two sites (< 0.2 micro g/g PCBs in eggs and nestlings at both sites). Ethoxyresorufin-O-dealkylase activity in nestling livers was significantly higher at the downstream site on Bayou d'Inde (50 pmol/min/mg) compared to the other two locations (24 pmol/min/mg, each), probably because of exposure to PCBs. Polychlorinated dibenzo-p-dioxin and polychlorinated dibenzofuran concentrations in eggs and polycyclic aromatic hydrocarbons in nestlings were at background concentrations at all sites. Trace element concentrations in barn swallow eggs and nestling livers were at background levels and did not differ among the three sites. A biomarker of DNA damage did not differ among sites.

Animals↗
PubMed2006

Mercury in tree swallow food, eggs, bodies, and feathers at Acadia National Park, Maine, and an EPA superfund site, Ayer, Massachusetts.

We monitored nest boxes during 1997-1999 at Acadia National Park, Mt. Desert Island, ME and at an old-field site in Orono, ME to determine mercury (Hg) uptake in tree swallow (Tachycineta bicolor) eggs, tissues, and food boluses. Also, in 1998-1999 we monitored nest boxes at Grove Pond and Plow Shop Pond at a U.S. Environmental Protection Agency Superfund site in Ayer, MA. We recorded breeding success at all locations. On average among locations, total mercury (THg) biomagnified 2 to 4-fold from food to eggs and 9 to 18-fold from food to feathers. These are minimum values because the proportion of transferable methyl mercury (MeHg) of the THg in insects varies (i.e., 35%-95% of THg) in food boluses. THg was highest in food boluses at Aunt Betty Pond at Acadia, whereas THg in eggs was highest at the Superfund site. A few eggs from nests at each of these locations exceeded the threshold (i.e., 800-1,000 ng/g, wet wt.) of embryotoxicity established for Hg. Hatching success was 88.9% to 100% among locations, but five eggs failed to hatch from 4 of the 11 clutches in which an egg exceeded this threshold. MeHg in feathers was highest in tree swallows at Aunt Betty Pond and the concentration of THg in bodies was related to the concentration in feathers. Transfer of an average of 80%-92% of the Hg in bodies to feathers may have enhanced nestling survival. Residues of Hg in tissues of tree swallows in the Northeast seem higher than those of the Midwest.

Animals↗
PubMed2005

Polychlorinated biphenyl congener patterns in tree swallows (Tachycineta bicolor) nesting in the Housatonic River watershed, western Massachusetts, USA, using a novel statistical approach.

A novel application of a commonly used statistical approach was used to examine differences in polychlorinated biphenyl (PCB) congener patterns among locations and sample matrices in tree swallows (Tachycineta bicolor) nesting in the Housatonic River watershed in western Massachusetts, USA. The most prevalent PCB congeners in tree swallow tissue samples from the Housatonic River watershed were Ballsmitter Zell numbers 153, 138, 180, 187, 149, 101, and 170. These congeners were seven of the eight most prevalent congeners in Aroclor 1260, the PCB mixture that was the primary source of contamination in the Housatonic River system. Using paired-Euclidean distances and tolerance limits, it was demonstrated that congener patterns in swallow tissues from sites on the main stem of the Housatonic River were more similar to one another than to two sites upstream of the contamination or from a nearby reference area. The congener patterns also differed between the reference area and the two upstream tributaries and between the two tributaries. These pattern differences were the same in both pipper (eggs or just hatched nestlings) and 12-day-old nestling samples. Lower-chlorinated congeners appeared to be metabolized in nestlings and pippers compared to diet, and metabolized more in pippers compared to nestlings. Euclidean distances and tolerance limits provide a simple and statistically valid method to compare PCB congener patterns among groups.

Animals↗
PubMed2005

Phylogeny of swallows (Aves: Hirundinidae) estimated from nuclear and mitochondrial DNA sequences.

The phylogeny of swallows was reconstructed by comparing segments of three genes, nuclear beta-fibrinogen intron 7 (betafib7), mitochondrial cytochrome b (cytb), and mitochondrial ND2, in a variety of combinations using maximum likelihood and Bayesian methods. betafib7 was sequenced for 47 species, cytb for 74 species, and ND2 for 61 species to yield comparisons among 75 of the 84 currently recognized swallow species. The family Hirundinidae was confirmed to consist of two clades, Pseudochelidoninae (river martins) and Hirundininae (typical swallows). The Hirundininae is further divided into mud nesters (Hirundo sensu lato), core martins (Phedina, Riparia, and New World endemic genera), and basal relicts (Psalidoprocne, Cheramoeca, and Pseudhirundo). We did not resolve the hierarchy among these three hirundinine groups, but discovered many relationships within them. Mud-nesting genera have the following relationships: (Hirundo sensu stricto, Ptyonoprogne), (Delichon, (Petrochelidon, Cecropis)). Core martins have the following topology: (Phedina, Riparia cincta), (Riparia sensu stricto, Tachycineta, ((Stelgidopteryx, Progne), (Neotropical endemic genera))). Interspecific relationships among the Neotropical endemics were resolved completely; Atticora and Notiochelidon are paraphyletic, and all Neotropical endemics probably should be lumped into one or two genera. The final group of hirundinines, the basal relicts, consists of a sister pair, the Australian Cheramoeca and African Pseudhirundo. The African saw-wings (Psalidoprocne) are their likely sister group.

Animals↗