What Happens to Swallowing Muscles after Stroke?: A Prospective Randomized Controlled Electrophysiological Study

Background

Stroke is the most frequent reason of neurological dysphagia Electrophysiological studies can be used to evaluate oral, pharyngeal and initial phase of esophageal phase.

Aims

This study aims to noninvasively evaluate mastication, mimic, and tongue muscles of stroke patients, which play an important role in the oral phase of swallowing process and compare them with healthy individuals.

Setting and Design

This study was conducted at the Physical Medicine and Rehabilitation Clinic of our hospital between January 2014 and December 2016.

Materials and Methods

Fifty-one patients who were admitted to our clinic with stroke and 51 healthy individuals were evaluated for the study. Demographic features of individuals were recorded. The swallowing intervals and motor action potentials (MAPs) of trigeminal, facial and hypoglossal nerves were measured. After four weeks of treatment schedule, patients were re-evaluated.

Statistical Analysis

The Wilcoxon Signed Rank test, the Mann-Whitney U test and Fisher exact test were used in this study.

Results

The all swallowing intervals were found prolonged compared to the healthy controls (P < 0.05). The MAPs of the masseter, orbicularis oculi, and intrinsic tongue muscles were significantly lower in patient group (P < 0.05). After treatment, we found significant improvement for all parameters in patient group, but the swallowing intervals were still significantly prolonged, and MAPs of these muscles were still lower (P < 0.05).

Conclusion

Although swallowing is examined as different phases, the process is complicated and should be evaluated totally. In post-stroke dysphagia, oral phase of swallowing process is as important as phayngeal phase and perioral, mastication, and tongue muscles are influenced even in an early period as a month.

Do CO2 and oxidative stress induce cancer?: a brief study about the evaluation of PON 1, CAT, CA and XO enzyme levels on head and neck cancer patients

Head and neck cancer (HNC) is one of the most common malignancies in the world. HNC is a group of cancers that starts in the mouth, nose, throat, larynx, sinuses, or salivary glands. According to this section of the body parts; induction of cancer can be associated with CO₂ and oxidative stress. The aim of this study is to assess the activities of carbonic anhydrase (CA), catalase (CAT), paraoxonase1 (PON1), and xanthine oxidase (XO) activities in 89 HNC patients and 115 healthy volunteers. Paraoxonase1 activity was found lower in HNC cancer patients. There is no statistically significant difference between patients and controls for catalase, carbonic anhydrase, and xanthine oxidase enzyme levels. According to this results, paraoxonase1 levels could be a candidate as an oxidative marker in HNC patients, but further studies are needed to investigate the other type of cancer related PON1 and the other enzyme levels.

Laryngeal electromyographic changes in postthyroidectomy patients with normal vocal cord mobility

Thyroidectomy has been used for the treatment of thyroid disease for more than 100 years. In spite of the advancement of surgical techniques, there is still a risk of laryngeal nerve injury. The risk of partial or complete injury still depends on some surgical and disease-related factors. The aim of this study is to show the partial injury and to establish these risk factors via laryngeal electromyographic analysis (LEMG) in postthyroidectomy patients with normal vocal cord motion and mucosal anatomy. Patients who had undergone thyroid surgery were enrolled in this prospective study. LEMG analysis was performed to all patients with normal vocal cord mobility preoperatively and was repeated after the first and the third months of surgery. Thyroarytenoid (TA) and cricothyroid (CT) muscles were used to evaluate recurrent and external branch of superior laryngeal nerves, respectively. Four of the 32 patients had mild-to-moderate degrees of partial LEMG changes during preoperative LEMG analysis of TA and CT muscles on each side. After 3 months of surgery, there was a statistically significant worsening of LEMG findings in the right and left external branches of superior and left recurrent laryngeal nerves. Disease and surgery-related risk factors were analyzed. However, there was no significant relationship on the progression of LEMG findings according to these parameters. This is the first prospective study which supports the risk of progression of LEMG changes in patients with normal laryngoscopic examination after thyroid surgery. No reliable significant risk factor was found influencing the LEMG progression.

Detection of XRCC1 gene polymorphisms in Turkish head and neck squamous cell carcinoma patients: a comparative analysis with different populations

PURPOSE

X-ray repair cross-complementing (XRCC1) is one of the most important genes for the maintenance of genomic integrity and protection of cells from DNA damage. Although tobacco and alcohol consumption are the major risk factors for the development of head and neck squamous cell carcinoma (HNSCC), sequence variation in XRCC1 gene may alter HNSCC susceptibility. Reports on the relationship between HNSCC and polymorphisms in XRCC1 gene have been inconsistent so far. The aim of this study was to investigate the association of XRCC1 Arg194Trp and Arg399Gln single nucleotide polymorphisms (SNP), smoking and alcohol consumption with the risk of HNSCC in Turkish population and also to compare to these results with the ones from both Turkish and different populations in the literature. The frequencies of Arg194Trp and Arg399Gln SNPs were studied in 55 HNSCC and 69 healthy individuals.

METHODS

Genomic DNA was isolated from peripheral blood and SNP was genotyped by PCR-RFLP method.

RESULTS

The genotype and allele frequencies of both polymorphisms were not statistically different between the HNSCC and control groups. On the other hand, smoking and chronic alcohol consumption were associated with risk of HNSCC, but there was no association between Arg194Trp, Arg399Gln polymorphisms, smoking and alcohol consumption in HNSCC cases.

CONCLUSION

These results indicate that both Arg194Trp and Arg399Gln polymorphisms were not associated with the development of HNSCC in Turkish population. In addition, the allele frequencies of polymorphisms were in line with other Turkish population results that were studied previously. However, compared to different populations, there were marked differences in allele frequencies.

Interscapular pharyngocutaneous fistula: an extreme complication of cervical stabilization surgery

Pharyngeal and esophageal perforations are rare during cervical spine surgery but can cause significant morbidity. Pharyngeal or eosephageal perforations can occur by several mechanisms and the management of pharyngeal or eosephageal perforation's treatment may become difficult. We report a 41-year-old paraplegic man with an interscapular pharyngocutaneous fistula secondary to cervical vertebral surgery. The diagnosis of posterior fistula was delayed for several months as it was an extremely rare complication. We explored the anterior neck and repaired the perforation on the right pyriform sinus primarily. The fistula tract on the back of the patient was completely healed and the patient started oral feeding in the second week after surgery.

Complete nasopharyngeal stenosis: presentation of a rare case

A sixty-eight years old female patient with complete nasopharyngeal stenosis without any determined etiology is presented. She had complete nasal obstruction as well as obstructive sleep apnea syndrome. She was operated and dense, thick, avascular fibrotic tissues were excised and reconstructed with local flaps and skin graft. Only partial opening was achieved in the long term follow-up.

Spindle cell carcinoma of the tongue: a rare tumor in an unusual location

Spindle cell carcinoma is a rare biphasic tumor consisting of epithelial and mesenchymal components. Presence of this tumor type in the tongue has rarely been reported. Herein, a case of 55-year-old woman who presented with a polypoid lesion at her tongue has been reported. Surgery was performed and pathologic examination revealed a spindle cell carcinoma. We present this rare tumor with an unusual location to contribute in part to the better understanding and awareness of this rare malignancy.

Do palatal implants really reduce snoring in long-term follow-up?

OBJECTIVES/HYPOTHESIS

To evaluate the efficacy of palatal implants in primary snoring patients and to determine the long-term results.

STUDY DESIGN

Retrospective clinical trial.

METHODS

Twenty-one adult primary snorers treated with palatal implants were reviewed. Apnea-hypopnea indexes of all the patients were <5. Patients and their partners were evaluated together at 0, 30, and 90 days and at 6, 12, and 18 months. The partners' visual analog scale (VAS) for snoring intensity and the patients' overall satisfaction, along with the Epworth sleepiness scale, were used for assessments.

RESULTS

The mean VAS score was reduced from 9.1 +/- 1.1 to 5.4 +/- 2.7 at the 3rd month, and to 5.1 +/- 3.15 at the 1st year (P < .05). At the 6th month, VAS scores of snoring intensity were reduced >50% in 13 of the patients (61.9%) and 52.3% (n = 11) at the 12th month. Eleven successfully treated patients and their partners were revisited at the 18th month, and both recommended the implant to others. The patient satisfaction rate was over 80% in 14 of the patients after 1 year. The mean ESS scores decreased from 7.8 to 5.5 after 180 days (P < .05). There was a strong correlation between low oxygen desaturation index and treatment success (coefficient, 0.779; P < .001). There were no postprocedure complications, such as bleeding, infection, and extrusion.

CONCLUSIONS

In primary snoring patients, pillar implant is a safe and easy single procedure. At the 18th-month follow-up, partners' VAS score improvement was 53%, along with 80% patient satisfaction.

Comparison of head rotation versus head elevation methods for vestibular evoked myogenic potentials by using logon stimulus

OBJECTIVES

To compare vestibular evoked myogenic potentials (VEMP) between two different methods, head rotation (HR) with unilateral recording and head elevation (HE) with bilateral simultaneous recording.

SUBJECTS AND METHODS

Twenty-eight healthy children (56 ears) were involved in the study. The subjects were tested in two different positions: head rotation (HR) method and head elevation (HE) method. Right- and left-side recordings were made separately in HR method and simultaneously in HE method. Logon type stimulus with 120dB Hl intensity was used to trigger VEMPs in both methods.

RESULTS

The response rate was 80.4% for HR method and 89.3% for HE method (p>0.05). There was no significant difference between the two groups with respect to P1 latency, N1 latency, and P1-N1 interval. The mean P1-N1 amplitude of HE method was higher than HR method (p<0.05). There were very strong positive correlations between two methods regarding N1 latency and P1-N1 interval (r: 0.849 and 0.841, respectively).

CONCLUSION

Bilateral simultaneous VEMP recording in head elevation position by using logon stimulus is a practical way to evaluate vestibulocollic reflex in children and it gives superior results than unilateral recording with head rotation position.

Iatrogenic carotid artery pseudoaneurysm presenting with conductive hearing loss

Pseudoaneurysms of the intracranial internal carotid artery may occur in the setting of carotid artery dehiscence, due to trauma, invasive tumors, or as a complication of surgery. The rare surgical complication of carotid artery laceration in the petrous segment may occur during myringotomy procedures, middle ear operations, or petrous temporal bone surgery. We report a 28-year-old female patient, a case of internal carotid artery pseudoaneurysm as a complication of middle ear surgery. On her follow-up, computed tomography of the temporal bone demonstrated a dehiscent carotid artery, and a pseudoaneurysm involving the left petrous internal carotid artery was found in the cerebral angiography. She was managed by endovascular means.

From a branchial fistula to a branchiootorenal syndrome: a case report and review of the literature

Branchial abnormalities constitute 32% to 45% of all neck pathologies in children. They may be a part of branchiootorenal (BOR) syndrome, which is characterized by branchial arch anomalies, preauricular pits, hearing impairment, and renal malformations. Typically, the management of a branchial fistula does not necessarily require an extensive diagnostic workup. However, in patients with a branchial fistula associated with external ear anomalies on physical examination and/or a history of hearing loss and a similar history and findings in other family members, an additional workup should be performed to eliminate the possibility of BOR syndrome. The aim of this report is to make pediatric surgeons aware of the BOR syndrome in patients presenting with branchial arch anomalies.

A mass at fat density in the parotid gland: dermoid cyst or lipoma

A mass at fat density in the parotid gland: dermoid cyst or lipoma. Dermoid cysts (DC) of the head and neck are uncommon and account for only 7% of all dermoid cysts in the body. DCs of the parotid gland are even rarer. In this article, a 42-year-old female patient with DC of the parotid gland is presented and discussed with a brief review of the literature. Radiologic findings suggested that the mass was a lipoma, but observation of a hair in the cyst during surgery changed the clinical diagnosis to DC; this suspicion was confirmed by pathological analysis. Although DCs are rare among the parotid masses, they should be kept in mind during the differential diagnosis.

Dilated cardiomyopathy as the first early complication in a 14 year-old girl with diabetes mellitus type 1

Diabetic cardiomyopathy (DC) has been reported in type 2 diabetics with short duration of clinically overt diabetes. Impaired left ventricular function has been reported in young patients with diabetes mellitus type 1 (IDDM), but severe cardiomyopathy as the first early major complication of IDDM is very rare. We report a 14 year-old girl with a 5-year history of IDDM and very poor compliance with treatment and follow-up. She was referred to our clinic upon the development of congestive heart failure and dilated cardiomyopathy was diagnosed based on clinical findings, electrocardiogram, chest X-ray and echocardiography. She had no evidence of other major complications of IDDM such as retinopathy, nephropathy or neuropathy.

Chronic hypoxemia leads to reduced serum IGF-I levels in cyanotic congenital heart disease

Cyanotic congenital heart disease in children commonly causes more pronounced growth retardation in comparison with acyanotic congenital heart disease. Chronic hypoxemia has been suggested as the cause of poor growth in these patients, but the relationship between serum IGF-I levels and chronic hypoxemia is unclear. Serum IGF-I concentrations, oxygen saturation and nutritional status were evaluated in 29 patients with cyanotic congenital heart disease, and serum IGF-I levels were compared with a group of 20 well-nourished, age-matched control children to assess the relationship between IGF-I levels and chronic hypoxemia. The nutritional status of each patient was determined by using anthropometric parameters and calorie and protein intake ratios. The patients were divided into malnourished and well-nourished groups (21 and 8 patients, respectively) according to their nutritional status. Serum IGF-I concentrations were measured in the two patient groups and the controls. The malnourished group had the lowest IGF-I levels (48.14 +/- 21.8 ng/ml, p<0.05). However, the well-nourished group's IGF-I levels were significantly lower than the control subjects' despite improved nutritional status (85.5 +/- 30.2 and 107 +/- 19.7 ng/ml, respectively, p<0.05). In addition, we found a positive correlation between serum IGF-I levels and oxygen saturation of the patients (r=0.402, p<0.05). These findings indicate that chronic hypoxemia has a direct or indirect effect to reduce serum IGF-I concentrations and this may be a cause of the increased growth failure in patients with cyanotic congenital heart disease.