Effects of the Chin-Tuck Maneuver on Anatomical Changes and Angles during Swallowing:A Systematic Review / 대한연하장애학회지

Objective@#This study aimed at providing a critical review of the overall benefits of the chin-tuck maneuver through a systematic review of its effects when used in the treatment of dysphagia, as well as to provide basic data for a comparative analysis in future studies. @*Methods@#To identify academic papers on the chin-tuck maneuver published from January 2000 to January 2021, a literature search on three databases was performed using keywords, including chin-tuck, dysphagia, and head flexion. Out of the 712 related papers identified, the methodological characteristics and results of 12 selected studies were reviewed. @*Results@#Nine of the 12 studies found that the chin-tuck position not only helped in the opening of the upper esophageal sphincter (UES) but also reduced pharyngeal residues and prevented aspiration and penetration. In addition, three studies analyzed the position of the neck flexion angle and the changing angle when performing the chin-tuck maneuver. @*Conclusion@#This shows that the chin-tuck maneuver is an effective strategy in the treatment of dysphagia. In future studies, further investigation of the posture, angles, and effects of the chin-tuck maneuver, could help identify additional benefits of this treatment.

A Securing Suture Technique of Autologous Cartilage for the Prevention of Septal Perforation during Septal Surgery

BACKGROUND AND OBJECTIVES: Septoplasty is a commonly performed operation in otolaryngological practice. In cases of septal mucosal tearing, septal perforation can easily occur. The aim of this study was to investigate patients who underwent an autologous cartilage securing suture technique to prevent nasal septal perforation. SUBJECTS AND METHODS: A total of 403 patients who underwent septoplasty alone or with endoscopic sinus surgery for the past three years were enrolled in this study. Septal mucosal tearing occurred in 27 patients. In group 1 (15 patients), autologous cartilage was inserted between the injured mucosa. In group 2 (12 patients), autologous cartilage was inserted between the injured mucosa with a securing suture technique. We investigated the septal perforation rate between the two groups. RESULTS: In group 1, septal perforation occurred in 7 of 15 patients (46.6%) and in group 2 there were no perforations. The occurrence rate of perforation in group 2 was significantly lower than that in group 1 (p<0.01). CONCLUSION: The securing suture technique of autologous cartilage can be an effective method for prevention of septal perforation during septal surgery.

A Case of Dual Ectopic Thyroid / 대한이비인후과학회지

Ectopic thyroid is an uncommon status characterized by the presence of thyroid tissue in a site other than in its usual region. It is rare for dual ectopic thyroid to have two ectopic foci simultaneously. Three cases of dual ectopic thyroid have been reported in the Korean literature. Clinically, most cases in ectopic thyroid were noted at adolescence or postpartum due to increased physiologic hormonal demands. Clinical manifestation, thyroid function test, and radiologic imaging should be employed to make a diagnosis and therapeutic plan of this disease. We present a patient with dual ectopic thyroid tissue in the suprahyoid and infrahyoid area without thyroid tissue in its normal thyroid bed.

Effect of Hand-free “Chin Tuck against Resistance (CTAR)” Exercise on Hyoid Bone Movement and the Degree of Aspiration in Stroke Patients with Dysphagia: A Report of 2 Cases / 대한연하장애학회지

This study recruited two men with dysphagia after stroke, aged 57 and 62 years. They had difficulty using both hands properly due to paralysis of the left upper extremity and rheumatoid arthritis of the right hand in patient 1 and paralysis of both upper extremities in patient 2. This study examined the effects of 4 weeks of hand-free chin-tuck-resistance exercise on the hyoid movement and aspiration. The exercises involved isotonic and isometric parts. In isometric CTAR, the patients were asked to chin tuck against the device 3 times for 60 s each with no repetition. In isotonic CTAR, the patient performed 30 consecutive repetitions by strongly pressing against the resistance device and then releasing it. Based on a video fluoroscopic swallowing study, the degree of aspiration was measured using the Penetration-Aspiration Scale (PAS) and two-dimensional motion analysis of the hyoid bone. Post-intervention, the hyoid movements in both patients improved by 0.16 and 0.22 cm (anterior movement), and 0.26 and 0.28 cm (superior movement), and the PAS scores decreased by 2 and 2 points, respectively. This study confirms that hands-free chin-tuck resistance exercise is applicable and helpful for improving the hyoid movement and reducing aspiration in patients with dysphagia after stroke. Therefore, this exercise can be introduced as an intervention for improving the swallowing function in patients with dysphagia who have difficulty using both hands.

Therapeutic Exercises for Strengthening Suprahyoid Muscles / 대한연하장애학회지

Suprahyoid muscles play an important role in normal swallowing by providing muscle contractions involved in airway protection and upper esophageal sphincter opening. However, these muscles can be weakened by neurological disease or aging, which can result in pharyngeal dysphagia. Therefore, strengthening of the suprahyoid muscles is a clinically important treatment. In addition, it is important to know exactly how and which method is optimal. Many therapeutic exercise methods have been reported to strengthen the suprahyoid muscles, and new methods related to this have recently been reported. Therefore, this study will briefly summarize the representative traditional methods and the recently reported, relatively new methods for strengthening the suprahyoid muscles.

Analysis of Isolated Proteinuria on School Urinary Mass Screening Test in Busan and Kyungsangnam-do Province

PURPOSE: The urinary mass screening program for the detection of urinary abnormalities in school aged population has been performed in Seoul since 1981. Nation-wide urinary mass screening program was also performed since 1998. The aim of this study was to analyze the cause and nature of isolated proteinuria detected by chance on the urinary mass screening test in Busan and Kyungsangnam-do Province. METHODS: The medical records of 44 cases of isolated proteinuria detected by chance on the urinary mass screening test in Busan and Kyungsangnam-do Province, and evaluated for urinary abnormalities at the pediatrics outpatients renal clinics of Busan Paik Hospital from April 2002 to August 2003 were reviewed prospectively. RESULTS: The cause and incidence of isolated proteinuria were as follows; transient proteinuria 4 cases(9.1%), orthostatic proteinuria 36 cases(81.8%) and persistent proteinuria 4 cases (9.1%). The total protein amount of the 24 hour urine were 121.0+/-136.4 mg in transient proteinuria, 179.1+/-130.0 mg in orthostatic proteinuria and 1532.8+/-982.5 mg in persistent proteinuria. In the orthostatic proteinuria group, the total protein amount of the 24 hour urine was in the range of 40-616 mg. Spot urine protein/creatinine ratio(PCR) were 0.10+/-0.01 in transient proteinuria, 0.61+/-0.61 in orthostatic proteinuria and 4.35+/-4.04 in persistent proteinuria. In the orthostatic proteinuria group, spot urine PCR was in the range of 0.09-2.32. Renal biopsy was performed in 4 children of the persisitent proteinuria group. They showed minimal change in 1 case, membranoproliferative glomerulonephritis in 2 cases and secondary renal amyloidosis in 1 case. CONCLUSION: The majority of isolated proteinuria which was detected by chance on school urinary mass screening were transient or orthostatic proteinuria. Even though the incidence of persistent proteinuria was much lower, it is necessary to take care of these children regularly and continuously, because persistent proteinuria itself is a useful marker of the progressive renal problems.

Analysis of Isolated Proteinuria on School Urinary Mass Screening Test in Busan and Kyungsangnam-do Province

PURPOSE: The urinary mass screening program for the detection of urinary abnormalities in school aged population has been performed in Seoul since 1981. Nation-wide urinary mass screening program was also performed since 1998. The aim of this study was to analyze the cause and nature of isolated proteinuria detected by chance on the urinary mass screening test in Busan and Kyungsangnam-do Province. METHODS: The medical records of 44 cases of isolated proteinuria detected by chance on the urinary mass screening test in Busan and Kyungsangnam-do Province, and evaluated for urinary abnormalities at the pediatrics outpatients renal clinics of Busan Paik Hospital from April 2002 to August 2003 were reviewed prospectively. RESULTS: The cause and incidence of isolated proteinuria were as follows; transient proteinuria 4 cases(9.1%), orthostatic proteinuria 36 cases(81.8%) and persistent proteinuria 4 cases (9.1%). The total protein amount of the 24 hour urine were 121.0+/-136.4 mg in transient proteinuria, 179.1+/-130.0 mg in orthostatic proteinuria and 1532.8+/-982.5 mg in persistent proteinuria. In the orthostatic proteinuria group, the total protein amount of the 24 hour urine was in the range of 40-616 mg. Spot urine protein/creatinine ratio(PCR) were 0.10+/-0.01 in transient proteinuria, 0.61+/-0.61 in orthostatic proteinuria and 4.35+/-4.04 in persistent proteinuria. In the orthostatic proteinuria group, spot urine PCR was in the range of 0.09-2.32. Renal biopsy was performed in 4 children of the persisitent proteinuria group. They showed minimal change in 1 case, membranoproliferative glomerulonephritis in 2 cases and secondary renal amyloidosis in 1 case. CONCLUSION: The majority of isolated proteinuria which was detected by chance on school urinary mass screening were transient or orthostatic proteinuria. Even though the incidence of persistent proteinuria was much lower, it is necessary to take care of these children regularly and continuously, because persistent proteinuria itself is a useful marker of the progressive renal problems.

A Case of Type II Ehlers-Danlos Syndrome

Ehlers-Danlos syndrome represents a group of inherited connective tissue disorders characterized by varying degrees of joint laxity, skin fragility and hyperextensibility, and a bleeding tendency. The essential defect is a quantitative deficiency of collagen. At present, 10 clinical forms have been recognized on the basis of extent and severity of the principal features, in combination with other abnormalities and the likely mode of inheritance. Type II Ehlers-Danlos syndrome is characterized by mild skin and joint manifestations, the latter limited to hands and feet, and inherited as an autosomal dominant pattern. We experienced a case of type II Ehlers-Danlos syndrome in 9-year-old girl with easy bruisability, skin hyperelasticity, thin, atrophic and a shiny scar, the so-called cigarette-paper scar on anterior side of lower extremities, and joint hypermobility limited to hand and feet. The diagnosis was made by characteristic clinical features and skin biopsy findings. A brief review of related literature was made.

A Case of Congenital Lobar Emphysema

Congenital lobar emphysema has the clinical features of an air block' syndrome with- out the evidence of pulmonary infection or intrabronchial foreign body. The hyperinflated lung causes a compression of uninvolved lobes creating respiratory distress, cyanosis within the first weeks of life. We experienced a case of congenital lobar emphysema diagnosed incidentally by chest reontgenogram in an infant with frequent upper respiratory infection within a few weeks of life. Chest X-ray revealed extensive emphysematous changes in the left upper lobe, shifting of heart and medistinum to the right and compression of the right lung. Respiratory distress, cyanosis and chest wall retraction ensued and left upper lobe Lobectomy was performed successfully.

Computerized Quantitative Analysis of Left Ventricular Wall Motion by 2-Dimensional Echocardiography

We present the methods of analysis of left ventricular wall motion by 2-dimensional echocardiography using computerized system. Quantiative analysis of left ventricular wall motion abnormalities depents on the used reference method, because the heart shifts and rotates within thorax during the cardiac cycle. To access left ventricular wall motion abnormalities, we studied 60 subjects(normal; 30 subjects, abnormal; 30 subjects)with 5 different floating reference methods correcting for traslation and/or rotation in two echocardiographic views. (apical 4-chamber view and apical 2-chamber view) In the first the endocardial tracings of enddiastole and endsystole in 30 normal subjects were stored in VAX-11-780 main computer and the data of these 30 normal subjects were plotted to obtain a 95% confidence interval for measured normal fractional change every five degree according to 5 reference methods. In the second, 30 patients with abnormal left ventricular wall motion analyzed and the results were compared with a 95% confidence interval. We assessed that left ventricular wall motion by visual and computerized quantitative anlysis were in close relationship according to optimal reference method. We suggested that computerized quantitative analysis of left ventricular wall motion by 2-dimensional echocardiography was clinically useful method and translation of the midpoint of mitral anulus with rotation according to center of mass was the most specific and sensitive new method of evaluating left ventricular wall motion abnormalities.