Incidence Of Dysphagia Research Articles

Association between quality of life and patient-reported complications from surgery and radioiodine in early-stage thyroid cancer survivors: A matched-pair analysis

BackgroundRemnant radioiodine ablation is discouraged in low-risk differentiated thyroid cancer because it confers no survival advantage. The impact of remnant radioiodine ablation on health-related quality of life in these patients is not well described. We hypothesized remnant radioiodine ablation is associated with lower health-related quality of life in early-stage differentiated thyroid cancer survivors. MethodsA retrospective matched-pair analysis was conducted in stage I differentiated thyroid cancer survivors recruited from a thyroid cancer support group. Respondents self-reported via online survey. Dysphonia and dysphagia were reported via Likert scale. Health-related quality of life was evaluated using Patient-Reported Outcomes Measurement Information System (PROMIS) 29-item profile. Respondents who received remnant radioiodine ablation were matched for age, sex, race, and years since diagnosis with respondents who did not receive remnant radioiodine ablation. PROMIS t-scores were compared between remnant radioiodine ablation and nonremnant radioiodine ablation groups, and among those with or without surgical complications. ResultsOne hundred and twenty-two pairs were matched. There was no significant difference in incidence of self-reported hypocalcemia, infection, dysphonia, or dysphagia between remnant radioiodine ablation and no remnant radioiodine ablation groups. There was no significant difference in mean PROMIS t-scores. Of respondents reporting normal preoperative voice and swallowing, there were no significant differences in postprocedural outcomes or PROMIS scores. Regardless of remnant radioiodine ablation treatment, those with surgical complications of hypocalcemia, dysphonia, or dysphagia reported worse PROMIS scores across multiple domains. Remnant radioiodine ablation-associated xerostomia was associated with worse PROMIS scores across multiple domains. ConclusionThis is the first study to use PROMIS measures to evaluate the association between remnant radioiodine ablation and health-related quality of life in early-stage differentiated thyroid cancer survivors treated surgically. Surgical and remnant radioiodine ablation-associated complications were associated with significantly worse PROMIS scores across multiple domains.

TYPE OF FUNDOPLICATION FOR LAPAROSCOPICHIATAL HERNIA REPAIR, COMPLICATED BY GASTROESOPHAGEAL REFLUX DISEASE

Purpose. To analyze short-term and long-term outcomes of surgical treatment of the patients with hiatal hernia complicated by gastroesophageal reflux disease, depending on the choice of fundoplication method.Materials and methods. A retrospective analysis of the short and long-term outcomes of the treatment of 171 patients suffering hiatal hernia complicated by gastroesophageal reflux disease was performed. All patients were underwent laparoscopic hiatal hernia repair supplemented by Nissen fundoplication - 109 patients or Toupet fundoplication – 62 patients.Results. In the Nissen fundoplication group the incidence of intraoperative complications was 9.2% (11 patients), postoperative complications – 8.3% (9 patients), dysphagia in the early postoperative period was noted in 24 (22%) patients. In 5 years after surgery, gastroesophageal reflux was observed in 6 (5.5%) patients, anatomical recurrence in 13 (11.9%) patients. Dysphagia in the late postoperative period was noted in 7.3% (8 patients). In the Toupet fun doplication group the incidence of intraoperative complications was 11.3% (7 patients), the incidence of postoperative complications was 6.5% (4 patients), functional dysphagia in the early postoperative period was noted in 8 (12.9%) patients. In 5 years after surgery, gastroesophageal reflux was observed in 8 (12.9%) patients, anatomical relapse in 13 (11.9%) patients. Persistent long-term dysphagia in the late postoperative period was noted in 2(3.2%) patients.Findings. The choice of fundoplication method did not significantly affect on the duration of surgery, the frequency of intraoperative and postoperative complications, duration hospital stay, the incidence of early functional postoperative dysphagia, the number of unsatisfactory results in the long term period, including recurrence and dysphagia.

Comparison of Patient-Reported Postoperative Dysphagia in Patients Undergoing One-Level Versus Two-Level Anterior Cervical Discectomy and Fusion with the Zero-P Implant System.

To investigate whether dysphagia differs between one-level and two-level anterior cervical discectomy and fusion (ACDF) with the Zero Profile (Zero-P) Implant System. A retrospective analysis of 208 patients who underwent ACDF with the Zero-P Implant System and had at least one year of follow-up was performed from January 2013 to December 2018. The patients were divided into two groups based on the number of operated levels (one-level group, N = 86; two-level group, N = 122). Dysphagia was assessed based on the Bazaz grading system. The incidence of dysphagia and the severity of dysphagia at each follow-up were compared between the two groups. The patients were divided into two groups (nondysphagia group, N = 160; dysphagia group, N = 48), and covariates were obtained for multivariate analysis, including demographic parameters, surgical parameters, and radiographic parameters. The results showed that the incidence and severity of postoperative dysphagia in the two-level group were significantly greater at 1week, 1month and 3months postoperatively than those in the one-level group. The results of ordinal logistic regression showed that older age, two-level surgery, greater prevertebral soft tissue swelling (PSTS) and the difference between the postoperative and preoperative C2-7 angle (dC2-7A) were significantly associated with a higher incidence of dysphagia after ACDF with the Zero-P. Two-level ACDF with the Zero-P can result in a significantly greater incidence and severity of transient postoperative dysphagia. Older age, greater PSTS and the dC2-7A were also associated with postoperative dysphagia after ACDF with the Zero-P.

Study on Factors Influencing Dysphagia in Elderly Patients with Chronic Obstructive Pulmonary Disease Based on Structural Equation Modeling

Dysphagia can occur in elderly patients with chronic obstructive pulmonary disease due to poor coordination between breathing and swallowing. Dysphagia can not only lead to aspiration pneumonia and acute exacerbation of chronic obstructive pulmonary disease, but also increase the risk of death. Previous studies only analyzed the influencing factors, but did not explore the interaction and size of the influencing factors, and there is still a lack of epidemiological investigation of dysphagia in chronic obstructive pulmonary disease patients in China. This study investigated the current situation of dysphagia in patients with chronic obstructive pulmonary disease in elderly chronic obstructive pulmonary disease patients in China, and used structural equation model to explore the direct and indirect effects of influencing factors. From April 2019 to April 2020, 1020 elderly chronic obstructive pulmonary disease patients who met the inclusion and exclusion criteria in the department of respiratory Medicine in 9 tertiary hospitals in Ningxia were selected as study subjects. The data were collected through questionnaires, including general information, chronic obstructive pulmonary disease Assessment Test, Activities of Daily Living, Geriatric Depression Scale, The Mini Nutritional Assessment-Short Form, FRAIL assessment scale, and Water Swallowing Test. On the basis of exploratory factor analysis, Amos was used to construct the initial model in combination with literature and professional knowledge, and the overall fitting evaluation and modification of the model were carried out to construct the final model. The incidence of Dysphagia in patients with chronic obstructive pulmonary disease in elderly chronic obstructive pulmonary disease patients was 19.71 %. The modified structural equation model fitted well, and the comprehensive condition of the elderly, smoking condition and comorbidities directly affects the dysphagia (the effect values respectively were 0.372, 0.112 and 0.095).The disease condition not only directly affects dysphagia, but also influences it through the comprehensive condition of the elderly (direct effect 0.109, indirect effect 0.109, total effect 0.218); age factors not only directly affects dysphagia, but also influences it through The disease condition and comprehensive condition of the elderly (direct effect 0.113, indirect effect 0.183 and total effect 0.296). eating condition not only directly affects dysphagia, but also influences it through comprehensive condition of the elderly (direct effect 0.127, indirect effect 0.074, total effect 0.201). The comprehensive condition of the elderly, smoking status and comorbidities directly affects the swallowing function, and the effect value of comprehensive condition of the elderly on swallowing function is 0.372. The disease status, age factors and eating status not only directly affect swallowing function, but also indirectly affect it through other factors.

Various findings in upper gastrointestinal endoscopy in patients presenting with dyspepsia: A clinical study

Background: Incidence of Dysphagia become more prevalent because of the faulty food habits among the people in recent days.Aim: To study incidence of various oesophageal and gastric diseases with respect to age, sex, occupation, socioeconomic status and other factors in our hospital. To find the upper gastrointestinal morphological features among patients presenting with dyspepsia using endoscopy. To find the prevalence of of H-pylori infection in patients presenting with dyspepsia and screening for oesophago-gastric carcinoma among patients presenting with dyspepsia. Materials and Methods: It is a prospective study conducted on patients who presented with dyspepsia in department of general surgery, sree mookabika institute of medical sciences during the period of September 2020 – January 2021.All the patients were evaluated on basis of chief complaints, clinical examination and investigation and They underwent endoscopy and findings were documented, invasive tests like biopsy, rapid urease test and geimsa staining were done findings were tabulated and analysed . Appropriate statistical methods were applied to provide the below mentioned results.Results: Highest prevalence of dyspepsia belong to the age group of 20-40years. Most common presenting complaint was heart burn followed by nausea/vomiting /epigastric discomfort. Dyspepsia were noted more common in male gender comparing to female gender. Most common endoscopic finding among the study population were gastritis followed by esophagitis along with gastritis. H-pylori infection was present in 42.5% of study population. Malignancy was diagnosed in 2.5% patients with dyspepsia. Clinically significant endoscopic findings were observed in 80.8% of patients with non-investigated dyspepsia. Conclusion: Clinically significant endoscopic findings were observed in 80.8% of patients with non-investigated dyspepsia. Prevalence of large number of inflammatory lesions as a result of increased acid production, a remarkable prevalence of H-Pylori infection and low incidence of malignancy in the study group suggests that the non-investigated patients with dyspepsia may be initially managed medically with acid suppressive therapy or H-pylori eradication in cases suspected to be infected. Endoscopy may be undertaken in patients with recurrent symptoms or in whom drug therapy fails.

Rehabilitation strategies and results in patients treated with chemoradiotherapy/radiotherapy for head and neck cancer: Institutional experience

Oncologic treatments, such as Radio- therapy and Chemo-radiation, for head and neck cancer can cause long-term swallowing impairments (dysphagia) that negatively impact the Quality of life. Radiation-induced dysphagia consists of a broad spectrum of structural, mechanical, and neurologic deficits. The goal of this study is to understand the importance of Onco Rehabilitation during Radiation and Chemo-Radiation to minimize the incidence of Dysphagia during the Treatment, which ultimately causes delay in Overall Treatment Time (OTT).

Dysphagia Severity and Management in Patients with COVID-19.

COVID-19 has resulted in unprecedented numbers of patients treated at intensive care units (ICUs). Dysphagia is a key concern in critical illness survivors. We investigated the severity of dysphagia in COVID-19 and the need to adapt practices to provide efficient care. We reviewed the literature on COVID-19, post-critical-illness dysphagia, and dysphagia and tracheostomy guidelines during the pandemic. Critically ill COVID-19 patients present a high incidence of dysphagia, aggravated by respiratory distress, deconditioning, and neurological complications. Mechanical ventilation (MV), delirium, sedation and weakness are worse in COVID-19 than in other etiologies of critical care. In awake patients, respiratory compromise impairs breathing-swallowing-coughing coordination. Tracheostomy reduces laryngopharyngeal trauma, sedation, delirium, ICU stay and improves swallowing rehabilitation. Tracheostomy weaning and swallowing evaluation is complex in COVID-19 due to respiratory instability and a team discussion will guide adaptations. Patients assessed in the ICU were 67% recommended to be nil by mouth (were aspirating). Two months following hospital discharge, 83% of those who had undergone tracheostomy were managing a normal diet. Severely ill COVID-19 patients are expected to regain swallow function. Dysphagia care is based on adaptation of practices to the patients’ multiple impairments.

THE NEW STIMULATING METHOD IN THE SPEECH THERAPY WORKOUT SYSTEM FOR THE RESTORATION OF THE SWALLOWING FUNCTION IN SEVERE BRAIN INJURIES

Background. The significance of this study becomes more relevant due to the higher incidence and complication of dysphagia in patients with severe brain damage as a result of stroke, traumatic brain injury, and other diseases and injuries. Purpose The study aimed to assess the effectiveness of the new stimulating method - "passive-active logopedic cryomassage" for restoring impaired swallowing function (dysphagia) in patients with severe brain injury, used in the system of speech therapy measures at the early stage of rehabilitation in the neurointensive care unit. Methods. The study involved 96 patients with dysphagia caused by severe brain damage, who received speech therapy assistance aimed at restoring the impaired swallowing function in a system of early rehabilitation measures carried out in a neurorehabilitation department. The severity of dysphagia was evaluated using an integrative assessment of swallowing function scale. Results. The practice of using the new method developed in combination with thermal and tactile stimulation: "passive-active logopedic cryomassage" indicated its higher efficiency in comparison with the traditionally used methods of speech therapy stimulation. In the course of this study, there were three categories of patients: patients with a rapid positive effect, patients with a delayed effect, and patients with no apparent positive effects. There was an analysis of all possible causes of different therapeutic effects. Conclusion. This new method of combined thermal and tactile stimulation - "passive-active logopedic cryomassage" can be recommended with all its indications and contraindications for widespread use in the clinical practice assisting speech therapists in the restoration of impaired swallowing function in patients with severe brain injury

Evaluation of the pharynx and upper esophageal sphincter motility using high-resolution pharyngeal manometry for Parkinson’s disease

Parkinson’s disease (PD) is associated with a high incidence of dysphagia. Aspiration pneumonia due to dysphagia is a major cause of death in patients with PD, and therefore accurately evaluating dysphagia should help improve prognosis. It has been reported that the severity of dysphagia does not always correlate with the Hoehn and Yahr (H&Y) stage for classifying PD severity. However, no reports have quantitatively evaluated the relationship between severity of dysphagia and H&Y stage. High-resolution pharyngeal manometry (HRPM) is a quantitative method that can be used to measure swallowing pressure from the velopharynx to the entry of the upper esophageal sphincter (UES). We used HRPM to measure swallowing pressure in 51 patients with PD. As PD progresses, atrophy and degeneration of the pharyngeal muscles become more pronounced, which contributes to dysphagia. However, thus far there is no quantitative clinical evidence for this pathological change. To evaluate the relationship between severity of underlying PD and dysphagia, patients were categorized by H&Y stage, as follows: stage II in four patients, stage III in 23, stage IV in 14, and stage V in 10. In patients with H&Y stages II, III, IV, and V, the respective velopharyngeal pressures were 179.8 ± 32.5, 157.6 ± 62.2, 172.2 ± 48.9, and 107.4 ± 44.0 mmHg, the mesopharyngeal pressures were 126.8 ± 53.2, 121.6.1 ± 50.4, 142.1 ± 57.8, and 61.4 ± 19.6 mmHg, the residual UES pressure were -8.0 ± 10.8, 10.3 ± 16.1, 16.5 ± 37.9, and 11.2 ± 16.2 mmHg, and the resting UES pressure were 49.5 ± 30.0, 15.8 ± 25.7, 1.85 ± 14.1, and -1.2 ± 12.2 mmHg. Patients with severe PD demonstrated significantly decreased velopharyngeal and oropharyngeal pressures, along with incomplete UES opening and contraction. HRPM can detect subtle abnormalities by quantifying swallowing pressure in patients with PD. Evaluating swallowing pressure with HRPM provides insights into neuromuscular dysfunction that causes abnormal pressure generation during pharyngeal swallowing in patients with PD.

A Prospective Cohort Study of Dysphagia After Subaxial Cervical Spine Surgery.

Prospective observational cohort study. To prospectively examine dysphagia after subaxial cervical spine surgery. Although dysphagia after anterior cervical spine surgery is common and well-studied, it has rarely been examined in posterior subaxial cervical spine surgery. This study analyzed 191 consecutive patients (132 male, 59 female; mean age, 64.9 yrs) who underwent subaxial cervical spine surgery for degenerative disease and completed 1 year of follow-up. Anterior decompression with fusion (ADF) was performed in 87 patients, posterior decompression with fusion (PDF) in 21, and laminoplasty (LAMP) in 83. Dysphagia was evaluated by a self-administered questionnaire using the Bazaz dysphagia scale before, 6 months, and 1 year after surgery. Diagnosis, levels and number of operative segments, C2-7 lordotic angle (CL), O-C2 angle (OC2A), C2-7 range of motion (ROM), Japanese Orthopedic Association for cervical myelopathy (C-JOA) score, and neck pain visual analog scale (VAS) were examined. Thirty-two patients (16.8%) reported dysphagia before surgery. New dysphagia after surgery, defined as more than or equal to 1 grade worsening of the Bazaz score after surgery compared with the preoperative status, was observed in 38 patients (19.9%) at 6 months and 32 patients (16.8%) at 1 year. The incidence of new dysphagia at 1 year was 25.3% in the ADF group, 23.8% in the PDF group, and 6.0% in the LAMP group. Fusion surgery (ACDF or PDF) and increased CL after surgery were found as risk factors at 1 year in multivariate analysis; receiver operating characteristic analysis determined a postsurgical change in CL cutoff of 5°. Fusion surgery and increased CL after surgery were risk factors for development of dysphagia after subaxial cervical spine surgery. Cervical alignment change due to anterior and posterior fusion surgery can cause postoperative dysphagia.Level of Evidence: 3.

Selective Esophagogastric Devascularization in the Modified Sugiura Procedure for Patients with Cirrhotic Hemorrhagic Portal Hypertension: A Randomized Controlled Trial.

Aim Portal hypertension is a series of syndrome commonly seen with advanced cirrhosis, which seriously affects patient's quality of life and survival. This study was designed to access the efficacy and safety of selective esophagogastric devascularization in the modified Sugiura procedure for patients with cirrhotic hemorrhagic portal hypertension. Methods Sixty patients with hepatitis B cirrhotic hemorrhagic portal hypertension and meeting the inclusion criteria were selected and randomly divided by using computer into the selective modified Sugiura group (sMSP group, n = 30) and the modified Sugiura group (MSP group, n = 30). The primary endpoint measurement is the postoperative rebleeding rate. Secondary endpoint measurements included free portal venous pressure, liver Child–Pugh score, liver volume, portal vein width and blood flow velocity, survival rate, quality of life, and dysphagia as well as other complications one year postoperatively. This trial is registered with ChiCTR, number ChiCTR2000033468. Results There was no statistically significant difference in rebleeding rates within one year after surgery between patients in the sMSP and MSP groups (χ = 0.11, p=0.73). In comparison with the MSP group, the Child–Pugh score of liver function in the sMSP group significantly increased (χ = 6.4, p=0.04) and the incidence of dysphagia was significantly reduced (χ = 6.23, p=0.01) one year after surgery. There was a statistically significant difference in the quality of life between the two groups. However, there were no statistically significant differences in free portal venous pressure (MD = −3.44, 95% CI: −7.87 to 0.98, p=0.12), postoperative liver volume (3 months: MD = -258.81, 95% CI: −723.21 to 205.57, p=0.24; 1 year: MD = −320.12, 95% CI: −438.43 to 102.78, p=0.16), postoperative portal vein width (3 months: MD = −0.06, p=0.50; 1 year: MD = 0.17, p=0.21), portal vein flow velocity (3 months: MD = 1.64, p=0.21; 1 year: MD = −1.19, p=0.57), 1-year survival rate (χ = 1.01, p=0.31), and other complications between the two groups. Conclusions Selective esophagogastric devascularization in the modified Sugiura procedure may not lower the incidence of rebleeding in the short term based on our findings. However, it may significantly improve quality of life of patients with cirrhotic hemorrhagic portal hypertension, improve liver function, and reduce postoperative dysphagia.

INCIDENCE OF DYSPHAGIA IN PATIENTS WITH UNILATERAL VOCAL CORD PARALYSIS

Background: It is essential and evaluates dysphagia among patients with UVCP to help the management, improves the quality of life, and prevents secondary complications. Aim of the work: This research aims to find the incidence of dysphagia in patients with unilateral vocal cord paralysis [UVCP]. Patients and Methods: This study was performed in 245 patients with UVCP; 98 males and 147 females. There were two groups of patients: the non-dysphagia group [130 patients] and the dysphagia group [115 patients]. Assessment of patients was performed by the verified 10-item Eating Assessment Tool [EAT-10] and Dysphagia Handicap Index [DHI]. Results: Performing EAT-10 questionnaire revealed average values of 18.5 ± 9.56 and 34.3 ± 11.3 in the non-dysphagia group and dysphagia groups, respectively. DHI showed mean values of 45.7 ± 18.12 and 85.42 ± 21.7 in the non-dysphagia group and dysphagia groups, respectively. All of them demonstrated a highly significant variation [P = 0.001]. Regarding the etiology of UVCP, iatrogenic was the first cause of UVCP; it was the cause of 36.9% and 36.52%, followed by idiopathic; 23.1% and 24.34 %, intubation injury; 12.6% and 11.3%, tumor; 10% and 9.56%, trauma; 8.46% and 8.69%, thyroid surgery; 4.62% and 5.22%, and neurodegenerative disease; 4.62% and 4.35% of non-dysphagia and dysphagia groups, respectively. Conclusion: The incidence of dysphagia in unilateral vocal cord paralysis depends mainly on the cause; however, vocal cord paralysis itself increases the incidence of dysphagia whatever the cause.

More beads, more peristaltic reserve, better outcomes: factors predicting postoperative dysphagia after magnetic sphincter augmentation.

Magnetic sphincter augmentation (MSA) offers a minimally invasive anti-reflux alternative to fundoplication for gastroesophageal reflux disease. The most common side effect of MSA is dysphagia, which may require dilation or even device removal. The incidence of dysphagia may be reduced by MSA sizing and preoperative motility studies. Multiple rapid swallows (MRS) is a provocative maneuver during high-resolution esophageal manometry (HRM) that assesses peristaltic reserve. We evaluated factors predicting development of dysphagia following MSA. A retrospective review of a prospectively maintained database identified patients undergoing MSA. Preoperative work-up included barium swallow, esophagogastroduodenoscopy, and esophageal manometry. Peristaltic augmentation was defined as a ratio > 1 of the distal contractile integral (DCI) following MRS and the mean DCI of the 10 baseline wet swallows during manometry. Demographics, MSA implant size, and postoperative symptom data were gathered on all patients. Sixty-eight patients underwent MSA. Mean age was 51.7 years, average BMI was 25.8 kg/m2. 15 (22.1%) of patients had severe dysphagia requiring endoscopic dilation. Peristaltic augmentation with MRS was significantly higher in patients without dysphagia (46.1% vs 6.3% p = 0.026). 33.3% of patients requiring dilatation exhibited complete absence of smooth muscle contraction following MRS (DCI = 0). The ratio of the DCI of MRS/wet swallows predicting dysphagia following MSA was 0.56. Patients with a small (12-14 beads) versus a larger MSA implant (15-17 beads) had a significantly higher rate of postoperative dysphagia (58.5% vs 30.0% p = 0.026). Adequate peristaltic reserve and larger device size correlate with decreased incidence of dysphagia following MSA implantation without compromising the anti-reflux barrier. Routine assessment of peristaltic reserve during preoperative HRM should be considered prior to MSA placement.

Analysis Of Follow-Up Results Of Chronotherapy And Conventional Chemotherapy Combined With IMRT For Locally Advanced Nasopharyngeal Carcinoma

To compare the long-term side effects and survival rates of Intensity modulated radiation therapy combined with chemotherapy in the treatment of advanced Nasopharyngeal carcinoma, and It is expected to reduce the long-term toxic response without reducing the survival, to find a more reasonable treatment for locally advanced Nasopharyngeal carcinoma. 160 patients with locally advanced nasopharyngeal carcinoma were randomly divided into a Time group and conventional group using a professional statistical randomized list (1:1) for treatment. Time group induced chronotherapy with TPF regimen, docetaxel 75 mg/m2 ivgtt, execution in d1 03:30-04:30. Cisplatin 75mg/m2 civ, completed in 5 days, every day from 10:00 to 22:00.5-FU 750mg/m2/d civ, completed in 5 days, every day from 22:00 to 10:00, 2 cycles/21 day. IMRT combined with cisplatin chemotherapy after 3 weeks of induction chemotherapy 100mg/m2 civ, completed at 10:00-22:00,3cycles/21day.In the conventional group, the conventional TPF regimen chemotherapy docetaxel 75mg/m2 ivgtt starts at 10:00.Cisplatin 75mg/m2 civ, begins after the end of docetaxel.5-FU 750mg/m2/d civ, completed in 5 days, executed 24 hours a day, 2cycles/21day.IMRT combined with cisplatin chemotherapy after 3 weeks of induction chemotherapy 100mg/m2 ivgtt starts at 10:00,3cycles/21day.Observation of long-term toxic and 1,3 years of survival situation. The incidence of hearing loss in the time group and the conventional group was 22.7% vs 39.1%, the incidence of dysphagia was 0% vs 8.6%, and the incidence of neck fibrosis was 4.5% vs 15%. The difference was statistically significant (P<0.05). Results of 1,3-year survival of patients in the two groups: The overall survival of time group and conventional group is 97.0% vs 92.8%、80.3% vs 81.2%,not statistically significant (P>0.05), the progression-free survival of time group and conventional group is 95.50% vs 87.0%、71.2% vs 73.9%,not statistically significant(P>0.05),the local recurrence-free survival of time group and conventional group is 97.0% vs 95.7%、92.4% vs 92.8%, not statistically significant(P>0.05) and the distant metastasis-free survival of time group and conventional group is 97.0% vs 98.6%、90.9% vs 91.3%, not statistically significant(P>0.05) When chronotherapy and intensity modulated radiation therapy were combined, the toxicity and side effects of patients were decreased without decreasing survival. Chronotherapy combined with intensity modulation radiotherapy is a recommended mode in the treatment of locally advanced nasopharyngeal carcinoma.

Does the Number of Attempts of Endotracheal Intubation Influence the Incidence of Post-Extubation Dysphagia in Patients Undergoing Maxillofacial Surgical Procedures? - A Prospective Analysis

Does the Number of Attempts of Endotracheal Intubation Influence the Incidence of Post-Extubation Dysphagia in Patients Undergoing Maxillofacial Surgical Procedures? - A Prospective Analysis

The effect of the difference in C2\u20137 angle on the occurrence of dysphagia after anterior cervical discectomy and fusion with the zero-P implant system

ObjectivesTo investigate the effect of the difference in C2–7 angle on dysphagia after anterior cervical discectomy and fusion (ACDF) with the Zero-P Implant System.MethodsA retrospective analysis of 181 patients who underwent ACDF with the Zero-P Implant System and had at least one year of follow-up from January 2011 to November 2018 was performed. All patients were divided into a non-dysphagia group and a dysphagia group to explore the effect of the difference between postoperative and preoperative C2–7 angle (dC2–7A) on postoperative dysphagia. At the same time, other possible related factors including the difference between postoperative and preoperative O-C2 angle (dO-C2A), sex, age, body mass index (BMI), intraoperative time, estimated blood loss, diabetes mellitus, hypertension, smoking, alcohol consumption, prevertebral soft-tissue swelling (PSTS), the highest segment involved in the surgery and the levels of surgery segments were analyzed.ResultsIn total, the non-dysphagia group comprised 139 patients and the dysphagia group comprised 42 patients. The single-factor analysis showed that smoking, PSTS and dC2–7A were significantly different between the two groups (P < 0.05). Spearman’s correlation coefficient showed no significant correlation between the degree of dysphagia and dC2–7A (P > 0.05). The results of the multiple-factor analysis with an ordinal logistic regression model showed that smoking, PSTS and dC2–7A were significantly associated with the incidence of dysphagia (P < 0.05).ConclusionsThe postoperative C2–7 angle has an important effect on the occurrence of dysphagia in patients undergoing Zero-P implant system interbody fusion surgery.

Fiberoptic Endoscopic Examination of Swallowing (FEES) Evaluation in Post Stroke Patients

Introduction. Complications caused by post-stroke dysphagia increase the morbidity and mortality of patients. Although it has a significant effect on the functional abilities and worsening of the patient's prognosis, post-stroke dysphagia is still under-noticed and often undiagnosed. The importance of knowing the incidence of post-stroke dysphagia, not only to determine its relationship to the pathology of the disease but also to determine treatment plans or follow-up interventions. This study aims to determine the incidence of FEES findings in post-stroke dysphagia both hemorrhagic and non-hemorrhagic stroke.&#x0D; Methods. Forty post-stroke patients in the Inpatient and Outpatient Installation of the THTKL Section and the Neurology Section of Dr. Hospital. Mohammad Hoesin Palembang conducted a FEES examination to see leakage, residue, penetration, and aspiration after being given six different types of food boluses ranging from filter porridge, rice porridge, oatmeal, water, milk, and biscuits. The results of the assessment are recorded and analyzed descriptively.&#x0D; Results. From 40 research subjects found 25 people experiencing dysphagia, where subjects with non-hemorrhagic stroke types were 21 people (52.5%), while hemorrhagic stroke types were four people (10%). The occurrence of leakage of filter porridge was 5 findings, leakage of rice porridge was eight findings, oatmeal leakage, water, and milk were seven findings each, and biscuit leakage was two findings. The incidence of filtered pulp residues was 12 findings, rice porridge residues were 14 findings, oatmeal residues were 15 findings, water and milk residues were five findings each, and biscuit residues were eight findings. The incidence of penetration of filter porridge, rice porridge, and biscuits was one finding each, oatmeal penetration was not found, while water and milk penetration were six events each. The aspirations of filter porridge, rice porridge, oatmeal, and biscuits were not found, while water and milk aspirations were seven findings.&#x0D; Conclusion. The incidence of dysphagia in post-stroke patients both hemorrhagic and non-hemorrhagic in the Inpatient and Outpatient Installation of the THTKL Section and the Neurology Section of the Mohammad Hoesin Hospital Palembang Palembang is quite high at 62.5%. The occurrence of food residues is the most FEES findings. While aspirations are the fewest findings.

Quantitative assessment of crural closure for laparoscopic anti-reflux surgeries: A novel technique to reduce post-operative dysphagia.

Background:Long-term dysphagia is a known complication of laparoscopic anti-reflux surgery (LARS). Of the several factors, inadequate hiatal closure is one of the major reasons for its occurrence. The aim of this study is to develop a technique for the quantitative assessment of crural closure during LARS to reduce dysphagia.Materials and Methods:It is an analysis of prospectively collected data of 109 patients who underwent LARS at a tertiary healthcare centre in India. To identify the adequacy of hiatal closure intraoperatively, a 7 French Fogarty catheter was used, and its balloon was inflated with 1 cc air at the repaired hiatus. This inflated balloon in the repaired hiatus following cruroplasty gives an accurate quantitative assessment of the adequate closure and adequate space for food bolus to pass without causing mechanical obstruction after hiatus repair. Pre- and post-operative 12 months’ DeMeester scores and lower oesophageal sphincter (LES) pressures were calculated.Results:The patients had a significant reduction in DeMeester scores postoperatively from a mean of 68.5–12.3 (P < 0.0001). None of the patients had long-term dysphagia or the need for long-term proton-pump inhibitors. The mean LES pressures on post-operative manometry showed increase to 15.1 mmHg from a mean of 6.4 mmHg, which was statistically significant (P = 0.0001). None of the patients had a recurrence of hiatus hernia.Conclusion:Quantitative assessment of adequacy for crural closure during LARS using a 7 French Fogarty catheter balloon is a novel technique which may decrease the incidence of post-operative dysphagia or intrathoracic wrap migration or recurrence of hiatus hernia.

The evolution and expectation of surgical options for gastroesophageal reflux disease

It has been nearly 70 years since the first attempt of surgical treatment for gastroesophageal reflux disease in Western countries, while in China, it is still in initial stage. Allison first attempted to control gastroesophageal reflux through surgical approach in 1951, but single hiatal hernia repair was inadequate to control reflux. Nissen developed fundoplication in 1955, and Rossetti modified it for reduction of the mobilized extent and related damage. The anti-reflux effect has been greatly improved but with high incidence of dysphagia and gas related complications. In order to solve these troublesome symptoms, Toupet and Dor came up with partial fundoplication, DeMeester and Donahue came up with "short floppy" Nissen fundoplication, they all successfully reduced the incidence of dysphagia and gas related complications but with preservation of anti-reflux effect.Thereafter, the three main stream fundoplication was formed (short floppy Nissen, Toupet and Dor procedures). In addition, other attempts for surgical control of gastroesophageal reflux were made, such as Belsey Mark Ⅳ, Hill and Collis procedures, but they are not as popular as fundoplication for a variety of reasons. In the meantime, the operative approach was converted from traditional laparotomy and thoracotomy to laparoscopic or robot-assisted laparoscopic era, and the anti-reflux effect was preserved with reduction in the duration of hospital stay and incidence of complications. Although plenty of anti-reflux procedures exists, they all with their own advantages and disadvantages, the concern for inadequate long-term anti-reflux effect and post-operative complications remains the main obstacle to the widespread of anti-reflux surgery. Better and more minimally invasive anti-reflux treatments should be explored.

IMPACT OF AGE ON ORAL TOXICITIES INDUCED BY RADIOTHERAPY IN YOUNG PATIENTS WITH HEAD AND NECK CANCER

Objective: To evaluate treatment-related toxicities in young head and neck cancer (HNC) patients. Study Design: This was a retrospective observational study designed to access oral toxicities of cancer treatment in young ( 58 years of age, group II) HNC patients with similar tumor stage and treatment protocols. Oral mucositis (OM), xerostomia, dysphagia, dysgeusia, trismus, and radiodermatitis were assessed during days 7, 21, and 35 of head and neck radiotherapy (RT). Results: Patients from both groups showed high incidence and severity of oral toxicities by the end of the RT with OM (81.9% and 63.6%, respectively) and xerostomia (72.6% and 77.2%, respectively) as the most prevalent toxicities for this period of assessment. No differences regarding xerostomia, dysphagia, dysgeusia, and radiodermatitis incidence or severity could be observed between groups. However, higher incidences and severity of OM and trismus were observed throughout the treatment in young patients compared with older patients (P