Swallowing in Patients with Mental Disability - Analysis of 189 Swallowing Video Endoscopies

Abstract Introduction Feeding, swallowing and breathing are fundamental activities for the survival and well-being of humans; these functions are performed by themost complex neuromuscular unit of the human body, which, when altered, may raise morbidity and mortality rates. Objective To evaluate deglutition in patients with mental disability in order to determine the incidence and the severity of dysphagia. Methods A total of 189 institutionalized adult patients with mental disability were analyzed using a 3.2 mm flexible fiberscope (Machida, Japan 1995). The following food consistencies were tested: pasty, thickened liquid and liquid. Results Among the total of 189 patients, 101 (53.4%) were female aged between 14 and 55 years old. Most of them 120 (63.5%) had profound mental deficiency, 58 (30.7%) had severe mental deficiency, 9 (4.8%) had moderate mental deficiency, and 2 (1.1%) had mild mental deficiency. Gender and the degree of mental deficiency did not influence significantly the degree of dysphagia. Age, degree of disability and interaction between age groups and degrees of disability influenced significantly the degree of dysphagia. Younger patients are more likely to present more severe dysphagia. Stabilization occurs between 31 and 40 years of age, and above this age, a greater chance of less severe dysphagia, because the increase in the degree of mental deficiency decreases the probability of more severe dysphagia. Conclusion The population that mostly presented severe dysphagia was characterized by being mostly female, with profound mental deficiency, with an average age of 36.7 years. There was no relationship between gender and the degree of mental disability concerning the degree of dysphagia. (AU)

Píloro doble. Presentación de un caso y revisión de la literatura / Double pylorus. Case report and literature review

RESUMEN El doble píloro es una comunicación anormal entre el antro gástrico y el bulbo duodenal y representa un raro hallazgo endoscópico. Se presentó un paciente de 80 años de edad, con antecedentes de hipertensión arterial, fumador inveterado, tomador de aspirina, que presentó melena aproximadamente 15 días antes del ingreso. La videoendoscopia reveló la existencia de dos orificios similares en el antro, que se comunicaban con el bulbo duodenal de manera independiente que fueron catalogados como píloros. La comunicación se constató con el paso del endoscopio a su través. Se impuso tratamiento médico con inhibidores de la bomba de protones y la evolución fue favorable. Es el cuarto caso reportado en la literatura en nuestro país y el primero en la provincia de Matanzas.

ABSTRACT Double pylorus is an abnormal communication between the gastric antrum and the duodenal bulb and represents a rare endoscopic finding. It is presented the case of a patient aged 80 years, with a background of arterial hypertension, inveterate smoker, taking aspirin, who presented melena about 15 days before the admission. The video-endoscopy revealed the existence of two similar orifices in the antrum that were independently communicating with the duodenal bulb and they went catalogued like pylori. The communication was proved by passing the endoscope through it. He was treated with IBP (the Spanish acronym for proton bomb inhibitors) and the evolution was favorable. It is the fourth case reported in the literature in Cuba and the first one in Matanzas.

Dynamic Slow Motion Video Endoscopy as an Adjunct to Impedance Audiometry in the Assessment of Eustachian Tube Function

Abstract Introduction Eustachian tube (ET) dysfunction plays an important role not only in the pathophysiology of various middle ear disorders, but also in predicting the outcome of the treatment. As there is no single test that assesses both the anatomic and physiological functions of the ET, a combination of tympanometry and dynamic slow motion video endoscopy may improve the sensitivity of ET function assessment. Objective To find out if there is any correlation between dynamic slow motion nasal video endoscopy and impedance audiometry in assessing ET function in patients with middle ear diseases. Methods Ours was a descriptive study performed with 106 patients attending the Ear, Nose and Throat (ENT) Outpatient Department of a tertiary care center in South India with features suggestive ofmiddle ear disease. All patients underwent impedance audiometry and dynamic slow motion nasal video endoscopy, and were graded based on the severity of the ET pathology. Results A total of 47 out of 97 patients with abnormal endoscopy findings also had abnormal impedance audiometry. The correlation was greater among the patients with higher grades of ET dysfunction. The endoscopy findings of 106 cases, when correlated with middle ear manometry, revealed that 56 cases showed complete agreement, and 50 cases showed disagreement. The nasal endoscopy results, when correlated with middle ear manometry studies by using McNemar's chi-squared (χ2) test, showed a significant association between the 2 tests (p = 0.017). Conclusion There is a significant alteration in middle ear pressure as the severity of the ET tube dysfunction increases. Impedance audiometry and nasal endoscopy provide a better measure of ET function.

Gastrointestinal polyp detection in endoscopic images using an improved feature extraction method

Gastrointestinal polyps are treated as the precursors of cancer development. So, possibility of cancers can be reduced at a great extent by early detection and removal of polyps. The most used diagnostic modality for gastrointestinal polyps is video endoscopy. But, as an operator dependant procedure, several human factors can lead to miss detection of polyps. In this peper, an improved computer aided polyp detection method has been proposed. Proposed improved method can reduce polyp miss detection rate and assists doctors in finding the most important regions to pay attention. Color wavelet features and convolutional neural network features are extracted from endoscopic images, which are used for training a support vector machine. Then a target endoscopic image will be given to the classifier as input in order to find whether it contains any polyp or not. If polyp is found, it will be marked automatically. Experiment shows that, color wavelet features and convolutional neural network features together construct a highly representative of endoscopic polyp images. Evaluations on standard public databases show that, proposed system outperforms state-of-the-art methods, gaining accuracy of 98.34%, sensitivity of 98.67% and specificity of 98.23%. In this paper, the strength of color wavelet features and power of convolutional neural network features are combined. Fusion of these two methodology and use of support vector machine results in an improved method for gastrointestinal polyp detection. An analysis of ROC reveals that, proposed method can be used for polyp detection purposes with greater accuracy than state-of-the-art methods.

Analysis of Eustachian Tube Dysfunction by Dynamic Slow Motion Video Endoscopy and Eustachian Tube Dysfunction Questionnaire in Chronic Otitis Media

OBJECTIVES: Eustachian tube dysfunction has been associated with most cases of middle-ear disease. We aimed to assess the effectiveness of dynamic slow motion video endoscopy (DSVE) as a test of eustachian tube dysfunction. Furthermore, we assessed the correlation of the test with the Valsalva maneuver, the seven-item Eustachian Tube Dysfunction Questionnaire (ETDQ-7), and intraoperative findings of the eustachian tube. METHODS: We retrospectively reviewed medical records from April to September 2014 to identify patients who were diagnosed with chronic otitis media (COM) at Korea University Ansan Hospital. They all underwent surgery because of COM without cholesteatoma and were assessed via the DSVE and ETDQ-7 to determine eustachian tube function. RESULTS: We reviewed 46 COM patients and examined 46 ears with COM and 46 ears on the contralateral side to COM that were thought to be normal. The mean DSVE grade in COM ears was 1.57±0.96, while the mean DSVE grade in contralateral ears was 1.15±0.94. The difference in DSVE between COM ears and normal ears was statistically significant (P=0.006). In the ETDQ-7, a higher score was related to intraoperative obstruction of the eustachian tube (P=0.012). CONCLUSION: DSVE and ETDQ-7 can provide information regarding preoperative status of eustachian tube dysfunction by measuring dynamic structural changes of the eustachian tube in combination with other diagnostic tests.

Prognóstico da videocirurgia da região frontal com técnica modificada de fixação / Prognosis of frontal region video surgery with a modified fixation technique

INTRODUÇÃO: A videoendoscopia tem se estabelecido como procedimento de escolha no tratamento da ptose do supercílio e das rugas da região frontal. O acesso minimamente invasivo produz vantagens em relação à tradicional incisão coronal. Diversos métodos de fixação são relatados na literatura, apresentando resultados semelhantes. Nesta série de casos, descrevemos a fixação direta com agulha. OBJETIVO: Avaliar o prognóstico da videocirurgia, utilizando-se a técnica direta com agulha. MÉTODO: Avaliação fotográfica computadorizada de 37 pacientes submetidos à videoendoscopia da região frontal com a fixação direta com agulha, realizada em dois hospitais privados na cidade de Porto Alegre-RS. Resultados: A elevação média do supercílio foi de 5,7 mm no terço lateral e de 4,4 mm no terço medial. Após um pequeno descenso da elevação, no primeiro mês pós-operatório, o reposicionamento do supercílio permaneceu inalterado nas medidas subsequentes até 24 meses. CONCLUSÃO: A fixação direta com agulha é capaz de produzir resultados duráveis, seguros e reprodutíveis no período em que foram realizadas as medições.

INTRODUCTION: Video endoscopy has become a procedure of choice for the treatment of eyebrow ptosis and forehead wrinkles. This minimally invasive technique has several advantages over traditional coronal incision. Several fixation methods are reported in the literature, with similar results. In this study, we describe direct needle fixation. OBJECTIVE: To evaluate the prognosis of video endoscopic surgery using a direct needle technique. METHOD: Computerized photographic evaluations of 37 patients undergoing video endoscopy of the frontal region with needle direct fixation were conducted in two private hospitals in the city of Porto Alegre in Rio Grande do Sul, Brazil. RESULTS: The mean eyebrow elevations were 5.7 and 4.4 mm in the lateral and middle third measurements. After a small dip in elevation in the first month after surgery, the repositioning of the eyebrow remained unchanged in subsequent measurements up to 24 months later. CONCLUSION: Direct needle fixation produced lasting, reliable, and reproducible results during the period in which measurements were made.

Videoendoscopia digestiva superior en el Centro Médico de Diagnóstico de Alta Tecnología "Las Heroínas de Mérida" del estado venezolano de Mérida / Upper gastrointestinal video endoscopy at the Diagnostic Medical Center of High Technology "Las heroínas de Mérida" of Mérida state in Venezuela

Se efectuó un estudio descriptivo y transversal de los 1 742 pacientes mayores de 18 años en los que se realizó de forma satisfactoria la videoendoscopia del tracto digestivo superior en el Centro Médico de Diagnóstico de Alta Tecnología "Las Heroínas de Mérida" del Estado Mérida (Venezuela), desde el 2008 hasta el 2011, con vistas a describir los hallazgos a través de dicho procedimiento. En la casuística predominaron el sexo femenino (63,3 %) y el grupo etario de 46-61 años, con una edad promedio de 55,8 años; además, 30,6 % de las pruebas resultaron normales. El dolor epigástrico (48,6 %), la dispepsia (43,5 %) y el reflujo gastroesofágico (8,6 %) fueron las principales causas de remisión, en tanto la gastritis (32,4 %) constituyó el diagnóstico endoscópico más frecuente, específicamente sus variedades eritematosa y eritemato-erosiva, con 66,0 y 13,0 %, respectivamente. Del total, 10 pacientes presentaron cáncer gástrico y 9, cáncer esofágico. Se pudo concluir que el procedimiento permitió el diagnóstico preciso de las enfermedades del tracto digestivo superior, así como una atención terapéutica adecuada.

A descriptive and cross-sectional study was conducted in 1 742 patients over 15 years, in whom the video endoscopy of upper gastrointestinal tract was successfully performed at the Diagnostic Medical Center of High Technology "Las Heroínas de Mérida" of Mérida state (Venezuela), from 2008 to 2011, with the purpose of describing the findings through this procedure. Female sex (63.3%) and age group of 46-61 years with a mean age of 55.8 years predominated in the case material, and 30.6% of the tests were normal. Epigastric pain (48.6%), dyspepsia (43.5%) and gastroesophageal reflux (8.6%) were the main reasons for referrals, while gastritis (32.4%) constituted the most frequent endoscopic diagnosis, specifically its erythematous and erythematous-erosive varieties, with 66.0 and 13.0%, respectively. Of the total, 10 patients had gastric cancer and 9, esophageal cancer. It was concluded that the procedure allowed accurate diagnosis of upper gastrointestinal tract diseases as well as an appropriate therapeutic care.

Avaliação da resistência nasal total e do espaço livre bucofaringeano e nasofaringeano em pacientes com má oclusão de classe II divisão 1a. de Angle, submetidos ao tratamento ortopédico com bionator de Balters / Evaluation of the total nasal resistance, the bucopharynx and nasalpharynx free space in patient class II division 1 of Angle submitted of treatment orthopedic with bionator of Balters

O propósito desta pesquisa foi avaliar, neste grupo de indivíduos, se ocorreram mudanças no padrão respiratório e na porcentagem do espaço aéreo llivre bucofaringeano e nasofaringeano, bem como, se existia alguma relação entre a resistência nasal total e o espaço livre da bucofaringe e da nasofaringe, e entre os dados obtidos pela visão endoscópica clínica e o programa de análise de imagem da via aérea superior, após o tratamento ortopédico com o aparelho bionator de Balters. A amostra constou de 13 pacientes leucodermas, do sexo feminino e masculino, na faixa etária de 8 a 12 anos, com dentadura mista e má oclusão de Classe II divisão 1ª Angle, do Departamento de Clínica Infantil da Faculdade de Odontologia de Araraquara (UNESP) e que não tinham sido submetido a tratamento ortodôntico. A resistência nasal foi avaliada, por meio da rinomanometria anterior ativa, já a bucofaringe e a nasofaringe foram avaliadas, por meio da nasofibroscopia. Para calcular o espaço aéreo total e livre bucofaringeano e nasofaringeano foi utilizada o programa UTSHCSA desenvolvido pelo "Department of Dental Diagnostic Science at The University of Texas Health Science Center". As médias e o desvio padrão de cada variável estudada foi obtida utilizando o teste t de Student ou de Wilcoxon. Desta forma, conclui-se após o tratamento com o bionator de Balters, que: a) houve uma diminuição em torno de 15% da resistência nasal total após a aplicação da solução vasoconstritora tópica; b) houve uma diminuição em torno de 5% da resistência nasal unilateral e total; c) 8 pacientes (57,14%) apresentaram valores de resistência nasal total acima da variação da normalidade; d) não houve uma diferença estatisticamente significante da resistência nasal unilateral e total; e) houve um aumento estatisticamente significante, em torno de 12%, nos espaços aéreos da bucofaringe e da nasofaringe; f) o exame de nasofibroscopia, permitiu o diagnóstico dos fatores etiológicos que ocasionaram a obstrução e a diminuição da função naso-respiratória de todos os pacientes; g) houve uma forte correlação (r > 0,90) estatisticamente significante entre as variáveis obtidas de forma visual e por meio do programa de análise de imagem; h) os diagnósticos obtidos pelo médico otorrinolaringologista, em comparação com os resultados obtidos pelo programa de análise de imagem, tiveram uma concordância maior do que 90%

The aim of this work wasa to evaluate the occurrence of changes in the respiratory pattern: in the free buccopharyngeal and nasopharyngeal airspace, if there was any relation between the total nasal resistance and the free buccopharyngeal and nasopharyngeal airspace, and if there was any relation between the data obtained by the clinical endoscopic view and the image analysis software of the upper airway after orthopedic treatment with Balters' bionator in this group of individuals. The sample was composed of 13 patients caucasian descendents, both male and female between 8 and 12 years old, with mixed denture and Angle Class II Division 1 malocclusion, from the Infant Clinic Department of Araraquara School of Dentistry (UNESP), and that had not been submitted to orthodontic treatment. The nasal resistance was measured by active anterior rhinomanometry, and the bucopharynx and nasopharynx were measured by nasopharyngeal airspace, it was analised the nasofibroscopy image using the software Image Tools, developed by the Department of Dental Diagnostic Science at The University of Texas Health Science Center. The averages and standard deviation of each variable studied were obtained using the Student-t test or the Wilcoxon test. So, it was concluded that after treatment with Balters' bionator: a) was observed that after applying the topic vasoconstrictor solution, there was a 15% reduction in the total nasal resistance; b) there was about 5% reduction in the unilateral and total nasal resistance; c) 8 patients (57,14%) presented total nasal resistance values above the variations of the normality, d) there was no statistically significant difference between the unilateral and total nasal resistance; e) the etiologic factors that were responsible for the obstruction and the reduction of the nasorespiratory function in all the patients were diagnosed by the nasofibroscopy, f) there was a statistically significant increase, around 12%, in all the buccopharyngeal and nasopharyngeal airspace, g) the relation between the variables obtained visually and through the image analysis software was statistically significant, a strong correlation (r > 0,90), h) the diagnoses obtained by the otolaryngologist had a higher conformity than the 90% in relation to the results obtained by the image analysis software