scholarly journals Pediatric Medullary Stroke, Severe Dysphagia, and Multimodal Intervention

Dysphagia ◽  
2021 ◽  
Author(s):  
Laura Brooks ◽  
Nikhila Raol ◽  
Steven Goudy ◽  
Caroline Ivie
Keyword(s):  
Severe Dysphagia ◽  
Multimodal Intervention

Effect of Transcutaneous Vagus Nerve Stimulation in Dysphagia After Lateral Medullary Infarction: A Case Report

2019 ◽  
Vol 28 (4) ◽  
pp. 1381-1387
Author(s):  
Ying Yuan ◽  
Jie Wang ◽  
Dongyu Wu ◽  
Dahua Zhang ◽  
Weiqun Song
Keyword(s):  
Vagus Nerve ◽  
Nerve Stimulation ◽  
Vagus Nerve Stimulation ◽  
Rating Scale ◽  
Tube Feeding ◽  
Nasogastric Feeding ◽  
Lateral Medullary Infarction ◽  
Severe Dysphagia ◽  
Transcutaneous Vagus Nerve Stimulation ◽  
Medullary Infarction

Purpose Severe dysphagia with weak pharyngeal peristalsis after dorsal lateral medullary infarction (LMI) requires long-term tube feeding. However, no study is currently available on therapeutic effectiveness in severe dysphagia caused by nuclear damage of vagus nerve after dorsal LMI. The purpose of the present investigation was to explore the potential of transcutaneous vagus nerve stimulation (tVNS) to improve severe dysphagia with weak pharyngeal peristalsis after dorsal LMI. Method We assessed the efficacy of 6-week tVNS in a 28-year-old woman presented with persisting severe dysphagia after dorsal LMI who had been on nasogastric feeding for 6 months. tVNS was applied for 20 min twice a day, 5 days a week, for 6 weeks. The outcome measures included saliva spitted, Swallow Function Scoring System, Functional Oral Intake Scale, Clinical Assessment of Dysphagia With Wallenberg Syndrome, Yale Pharyngeal Residue Severity Rating Scale, and upper esophagus X-ray examination. Results After tVNS, the patient was advanced to a full oral diet without head rotation or spitting. No saliva residue was found in the valleculae and pyriform sinuses. Contrast medium freely passed through the upper esophageal sphincter. Conclusion Our findings suggest that tVNS might provide a useful means for recovery of severe dysphagia with weak pharyngeal peristalsis after dorsal LMI. Supplemental Material https://doi.org/10.23641/asha.9755438

Premalignant and Malignant Lesions of the Heterotopic Pancreas in the Esophagus: a Case Report and Review of the Literature

2015 ◽  
Vol 24 (2) ◽  
pp. 235-239 ◽  
Author(s):  
Jan Ulrych ◽  
Vladimir Fryba ◽  
Helena Skalova ◽  
Zdenek Krska ◽  
Tomas Krechler ◽  
...  
Keyword(s):  
Case Report ◽  
Gastrointestinal Tract ◽  
Unusual Case ◽  
Accurate Diagnosis ◽  
Heterotopic Pancreas ◽  
Premalignant Lesions ◽  
Resected Specimen ◽  
Review Of The Literature ◽  
Severe Dysphagia ◽  
Malignant Lesions

Heterotopic pancreas is a congenital pathology of the gastrointestinal tract, particularly rare in the esophagus. Both symptomatology and findings during preoperative examinations are non-specific and therefore do not often lead to an accurate diagnosis, which is usually revealed only by histopathological assessment of a resected specimen. We report an unusual case of a patient suffering from severe dysphagia caused by heterotopic pancreas in the distal esophagus with chronic inflammation and foci of premalignant changes. This article also reviews 14 adult cases of heterotopic pancreas in the esophagus previously reported in the literature, with the aim of determining the clinical features of this disease and possible complications including rare premalignant lesions and malignant transformation. Especially with regard to those complications, we suggest that both symptomatic and incidentally found asymptomatic lesions should be resected.

An Autopsy Case of Dermatomyositis with Severe Dysphagia

2004 ◽  
Vol 66 (3) ◽  
pp. 232-235
Author(s):  
Sakae KANEKO ◽  
Naoki MADOKORO ◽  
Kikuo NAKANO ◽  
Kyouka MURAKAMI ◽  
Junya FUJIMOTO ◽  
...  
Keyword(s):  
Autopsy Case ◽  
Severe Dysphagia

scholarly journals Isolated Dysphagia in a Patient with Medial Medullary Infarction – Effects of Evidence-Based Dysphagia Therapy: A Case Report

2021 ◽  
pp. 190-199
Author(s):  
Samra Hamzic ◽  
Patrick Schramm ◽  
Hassan Khilan ◽  
Tibo Gerriets ◽  
Martin Juenemann
Keyword(s):  
Case Report ◽  
Vascular Occlusion ◽  
Evidence Based ◽  
Severe Dysphagia ◽  
First Case ◽  
Jaw Opening ◽  
Medial Medullary Infarction ◽  
Dysphagia Therapy ◽  
Evidence Based Therapy ◽  
Medullary Infarction

Medial medullary infarction (MMI) is a vascular occlusion in the medulla oblongata leading to certain constellations of neurological symptoms and seriously affecting the patient. Effective evidence-based treatment of severe dysphagia as sole symptom of MMI has not yet been reported. This case study aims to report successful effects of evidence-based therapy based on findings of dysphagia symptoms and pathophysiology of swallowing by flexible endoscopic evaluation of swallowing (FEES) in severe isolated dysphagia after MMI. FEES was performed to evaluate swallowing pathophysiology and dysphagia symptoms in a 57-year-old male with severe dysphagia after MMI. On the basis of FEES findings, simple and high-frequent evidence-based exercises for improvement of swallowing were implemented: thermal stimulation of faucial arches, Jaw Opening Exercise, and Jaw Opening Against Resistance. After 7 weeks of high-frequent evidence-based therapy and regular FEES evaluation the patient was set on full oral diet with no evidence of aspiration risk. In a first case report of isolated dysphagia in MMI our case illustrates that high-frequent evidence-based dysphagia therapy in combination with FEES as the method to evaluate and monitor swallowing pathophysiology can lead to successful and quick rehabilitation of severely affected dysphagic patients.

scholarly journals Increasing Facemask Compliance among Healthcare Personnel during the COVID-19 Pandemic

2021 ◽  
pp. 1-22
Author(s):  
Rupak Datta ◽  
Keith Glenn ◽  
Anthony Pellegrino ◽  
Jessica Tuan ◽  
Brian Linde ◽  
...  
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Baseline Period ◽  
Healthcare Personnel ◽  
Structured Interviews ◽  
Time Series Regression ◽  
Multimodal Intervention ◽  
Direct Observations ◽  
Chi Squared ◽  
Ancillary Staff

Abstract Objective: Prior studies of universal masking have not measured facemask compliance. We performed a quality improvement study to monitor and improve facemask compliance among healthcare personnel (HCP) during the coronavirus disease 2019 (COVID-19) pandemic. Design: Mixed-methods study Setting: Tertiary care center in West Haven, Connecticut Patients: HCP including physicians, nurses, and ancillary staff Methods: Facemask compliance was measured through direct observations during a 4-week baseline period after universal masking was mandated. Frontline and management HCP completed semi-structured interviews from which a multimodal intervention was developed. Direct observations were repeated during a 14-week period following implementation of the multimodal intervention. Differences between units were evaluated with chi-squared testing using the Bonferroni correction. Facemask compliance between baseline and intervention periods was compared using time series regression. Results: Among 1,561 observations during the baseline period, median weekly facemask compliance was 82.2% (range, 80.8%-84.4%). Semi-structured interviews were performed with 16 HCP. Qualitative analysis informed the development of a multimodal intervention consisting of audit and passive feedback, active discussion, and increased communication from leadership. Among 2,651 observations during the intervention period, median weekly facemask compliance was 92.6% (range, 84.6%-97.9%). There was no difference in weekly facemask compliance between COVID-19 and non-COVID-19 units. The multimodal intervention was associated with an increase in facemask compliance (β=0.023, p=0.002) Conclusions: Facemask compliance remained suboptimal among HCP despite a facility-wide mandate for universal masking. A multimodal intervention consisting of audit and passive feedback, active discussion, and increased communication from leadership was effective in increasing facemask compliance among HCP.

scholarly journals AB0442 CLINICAL FEATURES OF POLYMYOSITIS AND DERMATOMYOSITIS PATIENTS WITH SEVERE DYSPHAGIA

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1249.1-1249
Author(s):  
Y. Hayashi ◽  
K. Izumi ◽  
S. Hama ◽  
M. Higashida-Konishi ◽  
M. Ushikubo ◽  
...  
Keyword(s):  
Interstitial Pneumonia ◽  
Clinical Features ◽  
Clinical Characteristics ◽  
Age Of Onset ◽  
Inflammatory Diseases ◽  
Medical Center ◽  
Hospital Organization ◽  
Initial Examination ◽  
Severe Dysphagia ◽  
Frequent Complication

Background:Polymyositis (PM) and dermatomyositis (DM) are autoimmune inflammatory diseases characterized by proximal myositis. Dysphagia has been reported to develop in 35 to 62% of PM/DM patients and known as poor prognosis factor.Objectives:The purpose of this study is to determine the clinical characteristics of PM/DM patients who present with deglutition disorder.Methods:Consecutive patients with PM/DM who visited National Hospital Organization Tokyo Medical Center between April 2010 and January 2021 are included in this study. We compared clinical features between the patients with and without dysphagia. The diagnosis of dysphagia was based on videofluorography swallow study, and dysphagia requiring gastrostomy was defined as severe dysphagia. The clinical characteristics compared in this study were following: age of onset, levels of serum creatine kinase (CK) and lactate dehydrogenase(LDH), sense of dysphagia, manual muscle test (MMT) score, and complication of malignancy or interstitial pneumonia.Results:A total of 73 patients with PM/DM were identified. Among them, 12 patients were diagnosed with dysphagia, and 5 patients developed severe dysphagia. Patients with dysphagia had the following characteristics compared to patients without dysphagia: higher levels of serum LDH (833.7 ± 500.1 U/L vs 471.9 ± 321.0 U/L, p = 0.0088), higher levels of serum CK at initial examination (6070.3 ± 7184.8 IU/L vs 1534.7 ± 2978.8 IU/L, p = 0.0086) and more frequent sense of dysphagia (90.9% vs 10.6%, p< 0.0001), lower MMT score(3.18 ± 1.07 vs 4.31 ± 0.75, p = 0.0017). In addition to those, patients with severe dysphagia presented older age of onset (mean age 69.4 ± 12.0 vs 51.7 ± 14.8, p = 0.014), more frequent complication of malignancy (80.0% vs 14.8%, p= 0.0048) and less frequent complication of interstitial pneumonia (0.0% vs 55.5%, p= 0.023).Conclusion:These results indicate that dysphagia develops frequently in PM/DM patients with higher levels of serum LDH or CK, sense of dysphagia and low MMT score. Among them, patients with elderly onset or malignancy are at risk for sever dysphagia, and should be treated carefully.Disclosure of Interests:None declared.

scholarly journals Unilateral Dorsolateral Medullary Hemorrhage Presenting with Severe Dysphagia

2020 ◽  
Vol 12 (3) ◽  
pp. 460-465
Author(s):  
Fumihito Yoshii ◽  
Reiko Matsushita ◽  
Wakoh Takahashi
Keyword(s):  
Severe Dysphagia ◽  
Main Symptom ◽  
Wallenberg Syndrome

We report an 87-year-old woman with right dorsolateral medullary hemorrhage. She did not show all of the usual symptoms of Wallenberg syndrome and her main symptom was severe dysphagia. Dorsolateral medullary hemorrhage may be overlooked, because it is rare and does not exhibit the typical Wallenberg syndrome presentation usually seen in patients with infarction at the dorsolateral medulla.

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