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Cerebrovascular Diseases Extra 2017Dysphagia is a frequent and dangerous complication of acute stroke. Apart from a well-timed oropharyngeal muscular contraction pattern, sensory feedback is of utmost...
BACKGROUND
Dysphagia is a frequent and dangerous complication of acute stroke. Apart from a well-timed oropharyngeal muscular contraction pattern, sensory feedback is of utmost importance for safe and efficient swallowing. In the present study, we therefore analyzed the relation between pharyngolaryngeal sensory deficits and post-stroke dysphagia (PSD) severity in a cohort of acute stroke patients with middle cerebral artery (MCA) infarction.
METHODS
Eighty-four first-ever MCA stroke patients (41 left, 43 right) were included in this trial. In all patients, fiberoptic endoscopic evaluation of swallowing (FEES) was performed according to a standardized protocol within 96 h after stroke onset. PSD was classified according to the 6-point fiberoptic endoscopic dysphagia severity scale. Pharyngolaryngeal sensation was semi-quantitatively evaluated by a FEES-based touch technique.
RESULTS
PSD severity was closely related to the pharyngolaryngeal sensory deficit. With regards to lateralization of the sensory deficit, there was a slight but significant preponderance of sensory loss contralateral to the side of stroke. Apart from that, right hemispheric stroke patients were found to present with a more severe PSD.
CONCLUSIONS
This study provides evidence that an intact sensory feedback is of utmost importance to perform nonimpaired swallowing and highlights the key role of disturbed pharyngeal and laryngeal afferents in the pathophysiology of PSD.
Topics: Aged; Aged, 80 and over; Deglutition; Deglutition Disorders; Female; Fiber Optic Technology; Humans; Infarction, Middle Cerebral Artery; Laryngeal Nerves; Laryngoscopy; Male; Middle Aged; Pharynx; Physical Stimulation; Sensory Receptor Cells; Sensory Thresholds; Severity of Illness Index; Time Factors; Visceral Afferents
PubMed: 28972945
DOI: 10.1159/000479483 -
BioMed Research International 2016In airway epithelium, mucociliary clearance (MCC) velocity depends on the ciliary beat frequency (CBF), and it is affected by mucus viscoelastic properties. Local...
In airway epithelium, mucociliary clearance (MCC) velocity depends on the ciliary beat frequency (CBF), and it is affected by mucus viscoelastic properties. Local inflammation induces secretion of cytokines (TNF) that can alter mucus viscosity; however airway ciliated cells have an autoregulatory mechanism to prevent the collapse of CBF in response to increase in mucus viscosity, mechanism that is associated with an increment in intracellular Ca level ([Ca]). We studied the effect of TNF on the autoregulatory mechanism that regulates CBF in response to increased viscosity using dextran solutions, in ciliated cells cultured from human pediatric epithelial adenoid tissue. Cultures were treated with TNF, before and after the viscous load was changed. TNF treatment produced a significantly larger decrease in CBF in cultures exposed to dextran. Furthermore, an increment in [Ca] was observed, which was significantly larger after TNF treatment. In conclusion, although TNF has deleterious effects on ciliated cells in response to maintaining CBF after increasing viscous loading, it has a positive effect, since increasing [Ca] may prevent the MCC collapse. These findings suggest that augmented levels of TNF associated with an inflammatory response of the nasopharyngeal epithelium may have dual effects that contribute to maintaining the effectiveness of MCC in the upper airways.
Topics: Adenoids; Calcium Signaling; Child; Child, Preschool; Cilia; Female; Humans; Male; Respiratory Mucosa; Tissue Culture Techniques; Tumor Necrosis Factor-alpha; Viscosity
PubMed: 28025644
DOI: 10.1155/2016/3628501 -
Food & Function Oct 2017Group A streptococci (GAS) cause 20-30% of pediatric pharyngitis episodes, which are a major cause of ambulatory care visits. Therefore, a strategy to prevent GAS...
Group A streptococci (GAS) cause 20-30% of pediatric pharyngitis episodes, which are a major cause of ambulatory care visits. Therefore, a strategy to prevent GAS dissemination in children could significantly benefit public healthcare. Contextually, we assessed the possibility of employing alternative food-grade strategies to be used with the oral probiotic L. helveticus MIMLh5 for the prevention of pharyngeal infections. First, we demonstrated through an antagonism-by-exclusion assay that guaran may potentially prevent S. pyogenes adhesion on pharyngeal cells. Subsequently, we showed that an anthocyanin-rich fraction extracted from wild blueberry (BbE) exerts anti-inflammatory effects on the human macrophage cell line U937. Finally, we showed that BbE reduces interferon-β expression in MIMLh5-stimulated murine dendritic cells, resulting in a reduction in the pro-inflammatory cytokines IL-12 and TNF-α. In conclusion, this proof-of-concept study indicates that different food-grade strategies may be concomitantly adopted to potentially prevent GAS colonization and modulate local immune defences.
Topics: Anthocyanins; Bacterial Adhesion; Blueberry Plants; Carbohydrates; Epithelial Cells; Humans; Interleukin-12; Macrophages; Pharyngitis; Pharynx; Plant Extracts; Probiotics; Streptococcal Infections; Streptococcus pyogenes; Tumor Necrosis Factor-alpha
PubMed: 28891576
DOI: 10.1039/c7fo00829e -
Journal of Stroke and Cerebrovascular... Sep 2020Coronavirus disease 19 (COVID-19) is an emerging infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In this scenario, managing...
Coronavirus disease 19 (COVID-19) is an emerging infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In this scenario, managing acute medical conditions, such as stroke, requires a timely treatment together with proper strategies that minimize the risk of infection spreading to health care workers and other patients. We report the case of a 79-year-old woman, who was admitted for a wake-up stroke due to occlusion of the left middle cerebral artery. She was treated outside the COVID-19-dedicated track of the hospital because she had no concomitant signs or symptoms suggestive of SARS-CoV-2 infection nor recent contact with other infected individuals. Post-mortem nasal and pharyngeal swab was positive for SARS-CoV-2 infection. We propose that hyperacute stroke patients should be tested for SARS-CoV-2 infection at admission and then managed as having COVID-19 until cleared by a negative result. We are aware that such measure results in some delay of the acute treatment of stroke, which could be minimal using well-exercised containment protocols.
Topics: Aged; Betacoronavirus; COVID-19; COVID-19 Testing; Clinical Laboratory Techniques; Coronavirus Infections; Delayed Diagnosis; Fatal Outcome; Female; Humans; Infarction, Middle Cerebral Artery; Infectious Disease Transmission, Patient-to-Professional; Nose; Occupational Exposure; Pandemics; Pharynx; Pneumonia, Viral; Predictive Value of Tests; Risk Factors; SARS-CoV-2; Severity of Illness Index
PubMed: 32807416
DOI: 10.1016/j.jstrokecerebrovasdis.2020.104981 -
Emergencias : Revista de La Sociedad... Oct 2019
Topics: Adult; Carotid Artery, Internal, Dissection; Female; Humans; Infarction, Middle Cerebral Artery; Oropharynx; Wounds, Stab
PubMed: 31625313
DOI: No ID Found -
Medicine Feb 2019posterior pharyngeal wall carcinomas located at the level of the cricoid cartilage is a rare occurrence. Surgical treatment is a dilemma owing to the retention of...
A case report of application of posterior pharyngeal flap in resection and reconstruction of posterior pharyngeal wall carcinomas located at the level of the cricoid cartilage.
RATIONALE
posterior pharyngeal wall carcinomas located at the level of the cricoid cartilage is a rare occurrence. Surgical treatment is a dilemma owing to the retention of laryngeal function PATIENT CONCERNS:: A 56-year-old man underwent a "resection of left cervical tumor" at another hospital. Postoperative pathological report noted a left metastatic squamous cell carcinoma of the neck. Neck-enhanced computed tomography (CT) revealed thickening of the right posterior pharyngeal wall, and an image of soft tissue density was present on the posterior pharyngeal wall with a size of approximately 1.0 × 1.5 cm.
DIAGNOSIS
Hypopharyngeal carcinoma (T1N2M0).
INTERVENTIONS
We performed operation on a patient who suffered from posterior pharyngeal wall carcinomas at the level of the cricoid cartilage. The postoperative defects were repaired with posterior pharyngeal flaps.
OUTCOMES
The patient with posterior pharyngeal flap after operation survived without necrosis, the neck wounds of patient healed in 1 stage, and the phonation, swallowing and respiratory function was good.
LESSONS
The application of posterior pharyngeal flap to repair defects due to posterior pharyngeal wall carcinomas that were located at the level of the cricoid cartilage after resection is an effective reconstruction method that is easy to use and has excellent repair effects.
Topics: Carcinoma, Squamous Cell; Cricoid Cartilage; Humans; Hypopharyngeal Neoplasms; Male; Middle Aged; Neck; Pharynx; Plastic Surgery Procedures; Surgical Flaps
PubMed: 30762745
DOI: 10.1097/MD.0000000000014412 -
PloS One 2015Streptococcus pneumonia (the pneumococcus) is the leading vaccine preventable cause of serious infections in infants under 5 years of age. The major correlate of...
Streptococcus pneumonia (the pneumococcus) is the leading vaccine preventable cause of serious infections in infants under 5 years of age. The major correlate of protection for pneumococcal infections is serotype-specific IgG antibody. More recently, antibody-independent mechanisms of protection have also been identified. Preclinical studies have found that IL-17 secreting CD4+ Th17 cells in reducing pneumococcal colonisation. This study assessed IL-17A levels in children from Fiji with high and low pneumococcal carriage density, as measured by quantitative real-time PCR (qPCR). We studied Th17 responses in 54 children who were designated as high density carriers (N=27, >8.21x10(5) CFU/ml) or low density carriers (N=27, <1.67x10(5) CFU/ml). Blood samples were collected, and isolated peripheral blood mononuclear cells (PBMCs) were stimulated for 6 days. Supernatants were harvested for cytokine analysis by multiplex bead array and/or ELISA. Th17 cytokines assayed included IL-17A, IL-21, IL-22 as well as TNF-α, IL-10, TGF-β, IL-6, IL-23 and IFNγ. Cytokine levels were significantly lower in children with high density pneumococcal carriage compared with children with low density carriage for IL-17A (p=0.002) and IL-23 (p=0.04). There was a trend towards significance for IL-22 (p=0.057) while no difference was observed for the other cytokines. These data provide further support for the role of Th17-mediated protection in humans and suggest that these cytokines may be important in the defence against pneumococcal carriage.
Topics: Bacterial Load; Child; China; Female; Humans; Interferon-gamma; Interleukin-17; Male; Nasopharynx; Streptococcal Infections; Tumor Necrosis Factor-alpha
PubMed: 26069966
DOI: 10.1371/journal.pone.0129199 -
American Journal of Physical Medicine &... Sep 2018Herein, we present a case of a patient with Wallenberg syndrome with severe bulbar dysphagia who discovered a unique swallowing method: creating strong negative pressure...
Herein, we present a case of a patient with Wallenberg syndrome with severe bulbar dysphagia who discovered a unique swallowing method: creating strong negative pressure in the esophagus to improve pharyngeal passage of a bolus. A 47-yr-old man presented with a subarachnoid hemorrhage secondary to a ruptured aneurysm in the right vertebral artery. After coil embolization, he experienced severe dysphagia due to Wallenberg syndrome and required tube feeding. Eighty-one days after the onset of the stroke, a videofluoroscopic swallowing evaluation revealed that the bolus was rapidly sucked into the esophagus. High-resolution manometry showed weak constriction of the pharynx simultaneous with forced, voluntary constriction of the diaphragm before swallowing; this created negative pressure in the esophagus. The authors named this unique swallowing method "vacuum swallowing." Ultimately, the patient was able to eat an ordinary diet via the use of this technique. Vacuum swallowing is a unique method of improving pharyngeal passage of a bolus by creating strong negative pressure in the esophagus. Additional studies are necessary to determine whether vacuum swallowing can be successfully used for other forms of dysphagia.
Topics: Deglutition Disorders; Esophagus; Humans; Lateral Medullary Syndrome; Male; Manometry; Middle Aged; Pharynx; Pressure
PubMed: 29194048
DOI: 10.1097/PHM.0000000000000872 -
BMJ Case Reports Nov 2014
Topics: Diagnosis, Differential; Hepatitis; Humans; Infectious Mononucleosis; Lymphatic Diseases; Lymphocyte Count; Lymphocytes; Male; Necrosis; Pharyngitis; Pharynx; Severity of Illness Index; Young Adult
PubMed: 25414230
DOI: 10.1136/bcr-2014-207434