| 1. |
- Ekberg, Olle, et al.
(författare)
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The clinical importance of a thick-walled, tender gall-bladder without stones on ultrasonography
- 1991
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Ingår i: Clinical Radiology. - 1365-229X. ; 44:1, s. 38-41
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Tidskriftsartikel (refereegranskat)abstract
- Ultrasound examinations of 563 patients with right upper quadrant pain and a clinical suspicion of acute cholecystitis were reviewed. In 31 patients, a tender, dilated gall-bladder with a thick (more than 4 mm) partly hypoechoic wall without any detectable calculi was found on the emergency examination. This was interpreted as due to acute acalculous cholecystitis. None of the patients was critically ill. Twenty-one of the patients had follow-up studies with either oral cholecystography, cholangiography, or ultrasound. Fourteen of the 21 had gall-bladder calculi while seven did not. These seven patients presumably represent the true frequency (1.2%) of acute acalculous cholecystitis in this clinical setting. In five other patients with an initial diagnosis of acute acalculous cholecystitis the gall-bladder wall thickening probably was secondary to concomitant pancreatitis, appendicitis, hepatitis or peptic ulcer disease. A meticulous and careful search for gall-bladder calculi should be performed in the presence of a dilated, tender thick-walled gall-bladder.
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| 2. |
- Malmberg, Lars, et al.
(författare)
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Effects of drugs and electrical field stimulation on isolated muscle strips from rabbit pharyngoesophageal segment
- 1991
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Ingår i: Dysphagia. - 1432-0460. ; 6:4, s. 203-208
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Tidskriftsartikel (refereegranskat)abstract
- 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.
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| 3. |
- Bengtsson, Henrik, et al.
(författare)
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A population based screening of abdominal aortic aneurysms (AAA)
- 1991
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Ingår i: European Journal of Vascular Surgery. - 0950-821X. ; 5:1, s. 53-57
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Tidskriftsartikel (refereegranskat)abstract
- The prevalence of abdominal aortic aneurysm (AAA) in a defined population of elderly men and its correlation to some risk factors were studied in the population cohort "men born in 1914 from Malmo". A total of 499 were invited to attend and 375 (75%) did so. The aorta could be visualised with ultrasound in 364 patients, 39 (10.7%) of whom had aneurysmal changes. The presence of an AAA was related to the findings at a general health examination undertaken 5 years previously. Tobacco and alcohol consumption, impaired lung function and a history of angina pectoris were related to the presence of an AAA. No relationship was found between an AAA and hypertension, hyperlipidaemia or hyperglycaemia. A decreased tissue elasticity as a common denominator for the lung function impairment and development of AAA is discussed.
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| 4. |
- Ekberg, Olle, et al.
(författare)
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Altered swallowing function in elderly patients without dysphagia: radiologic findings in 56 cases
- 1991
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Ingår i: American Journal of Roentgenology: diagnostic imaging and related sciences. - 1546-3141. ; 156:6, s. 1181-1184
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Tidskriftsartikel (refereegranskat)abstract
- Swallowing disorder is an increasing problem in our aging population. A majority of these patients have a functional abnormality of the oral, pharyngeal, and/or esophageal stage of swallowing. However, what constitutes normalcy is not well understood, and baseline swallowing in elderly persons without dysphagia has not been adequately described. We therefore evaluated 56 persons with a mean age of 83 years who had no symptoms of dysphagia or eating difficulty. Videofluoroscopy and radiographs with the subject erect and recumbent were obtained. Normal deglutition, as defined in young persons, was present in only 16%. Oral abnormalities (difficulty ingesting, controlling, and delivering bolus relative to swallowing initiation) were seen in 63%. Pharyngeal dysfunction (bolus retention and lingual propulsion or pharyngeal constrictor paresis) was seen in 25%. Pharyngoesophageal segment abnormalities were observed in 39% (mostly cricopharyngeal muscle dysfunction). Esophageal abnormalities (mostly motor in nature) were observed in 36%. What has been described as swallowing dysfunction in young persons may not be abnormal in very elderly persons. It is difficult to distinguish the effect of normal aging from the effects of specific diseases or gradual degenerative changes.
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| 5. |
- Feinberg, Michael J, et al.
(författare)
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Videofluoroscopy in elderly patients with aspiration: importance of evaluating both oral and pharyngeal stages of deglutition
- 1991
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Ingår i: American Journal of Roentgenology: diagnostic imaging and related sciences. - 1546-3141. ; 156:2, s. 293-296
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Tidskriftsartikel (refereegranskat)abstract
- Oropharyngeal functional impairment increases with age so that radiologists frequently are asked to determine the cause of aspiration in elderly patients. Neuromuscular and cognitive impairment often make it difficult to perform and interpret videofluoroscopic deglutition examinations in these patients. We retrospectively reviewed the barium swallow examinations in 50 elderly patients (mean age, 87 years) who were known to aspirate. We looked for specific patterns of oropharyngeal dysfunction that resulted in bolus misdirection. Analysis revealed that aspiration was due to abnormalities of the oral stage in 23, pharyngeal stage in 10, and both stages in 17. Dysfunction in the oral stage was due to ingestion of large volumes or rapid acquisition rates in nine, failure of containment during processing (bolus manipulation) in 18, and dissociation of lingual delivery and swallowing initiation in the transitional phase in 13. Dysfunction in the pharyngeal stage was due to incomplete transport (bolus retention) in 21 and defective closure of the laryngeal vestibule in 11. No significant relationship between conditions known to cause oropharyngeal dysfunction (dementia, stroke, Parkinson disease, disuse deconditioning) and the specific pattern of dysfunction was identified. These results indicate that an accurate and valid assessment of oropharyngeal dysfunction in elderly patients with aspiration is possible if specific patterns of dysfunction are sought. Our study indicates the importance of evaluating the oral and pharyngeal stages of deglutition in elderly patients who aspirate.
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| 6. |
- Levine, M S, et al.
(författare)
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Duodenitis: a reliable radiologic diagnosis?
- 1991
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Ingår i: Gastrointestinal Radiology. - 0364-2356. ; 16:2, s. 99-103
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Tidskriftsartikel (refereegranskat)abstract
- 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.
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| 7. |
- Liedberg, Birgitta, et al.
(författare)
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Chewing and the dimension of the pharyngoesophageal segment
- 1991
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Ingår i: Dysphagia. - 1432-0460. ; 6:4, s. 214-218
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Tidskriftsartikel (refereegranskat)abstract
- Masticatory efficiency was evaluated in 21 adults for four chewing parameters: mixing of a color-patterned chewing gum mass, shaping of a chewing gum mass, particle reduction of a silicone tablet, and number of chewing strokes before the first swallow of an almond. The results of these tests were correlated with the dimension of the pharyngoesophageal (PE) segment during swallow of liquid barium and solid meat. The transverse width of the PE segment during swallow of liquid barium correlated significantly with the chewing parameters. The sagittal width of the PE segment during swallow of liquid barium correlated only weakly with the chewing parameters. The PE segment dimension during swallow of a solid meat bolus did not correlate with the chewing parameters. The results suggest that there is feedback during chewing and swallowing between the PE segment and the oral cavity.
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