Association between clinical risk factors and severity of dysphagia after extubation based on a videofluoroscopic swallowing study

Background/Aims@#This study aimed to evaluate the correlation between clinical risk factors of post-extubation dysphagia (PED) and the severity of impaired pharyngeal swallowing function assessed via videofluoroscopic swallowing studies (VFSSs). @*Methods@#This study was a retrospective review of medical records. Of 116 patients who were admitted to the intensive care unit and underwent VFSS, 32 who had non-neurologic disorders and experienced prolonged intubation (for more than 48 hours) were diagnosed with PED. The severity of PED was evaluated by using a functional dysphagia scale (FDS) and a penetration aspiration scale (PAS), on the basis of VFSS. @*Results@#The Simplified Acute Physiology Score 3 and total FDS score were positively correlated (r = 0.40, p = 0.02). Intubation duration was positively correlated with total PAS and FDS scores (r = 0.62, p < 0.001; r = 0.65, p < 0.001, respectively). The amounts of residue in the valleculae (RV) and pyriform sinuses (RP) were associated with intubation duration (r = 0.58, p < 0.001; r = 0.57, p < 0.001, respectively). Multivariate regression analysis revealed that intubation duration was significantly associated with the total FDS score, RV and RP subscales of the FDS, and total PAS score. @*Conclusions@#The severity of impaired swallowing function, particularly the amount of residue in the pharyngeal recesses assessed via VFSS, was strongly associated with both severity of medical illness and intubation duration. Intubation duration could be a prognostic factor for assessing impaired swallowing function on the basis of VFSS.

Culture and Polymerase Chain Reaction of Helicobacter pylori from Rectal and Terminal Ileal Fluid after Polyethylene Glycol (Colyte(R)) Ingestion in Healthy Adults with Positive Urea Breath Test / 대한소화기학회지

BACKGROUND/AIMS: Helicobacter pylori (H. pylori) transmission route is not yet clearly understood. Isolating H. pylori from stool, saliva, and vomitus is very difficult. However, H. pylori could be cultured from feces in the setting of rapid gastrointestinal tract transit. The aim of this study was to isolate H. pylori by culture and PCR in the rectum and terminal ileum during colonoscopy. METHODS: Twenty subjects with positive UBT (urea breath test) were included. We performed polymerase chain reaction (PCR) test and culture of H. pylori with the rectal fluid and terminal ileal fluid during colonoscopy. RESULTS: H. pylori was cultured with rectal fluid from 9 (45.0%) of 20 subjects and with ileal fluid from 11 (55.0%) of 20 subjects. H. pylori was a little more frequently cultured from the terminal ileal fluid than the rectal fluid without statistical significance (p>0.05). PCR test detected flaA (16/20, 80.0% and 17/20, 85.0%), 16S rRNA gene (16/20, 80.0% and 17/20, 85.0%), cagA (10/20, 50.0% and 12/20, 60.0%), and ureC (9/20, 45% and 11/20, 54.5%) from the rectal fluid and the terminal ileal fluid, respectively. The specificity and sensitivity of ureC were 100%. CONCLUSIONS: H. pylori could be cultured from the rectal fluid and terminal ileal fluid in the setting of rapid gastrointestinal tract transit. These results suggest of fecal-oral transmission of H. pylori.

Clinical Analysis of Prognostic Factors in Primary Intraventricular Hemorrhage / 대한뇌혈관외과학회지

OBJECTIVE: This study was conducted to evaluate the prognostic factors of primary intraventricular hemorrhage. METHODS: We retrospectively reviewed 26 patients who suffered from primary intraventricular hemorrhage between 2003 and 2007. We analyzed the various factors that might influence the prognosis and these included the patient age, the disease etiology, the initial Glasgow Coma Scale(GCS) score, the pupil reflex, Evan's ratio, Graeb's score, the ventriculocranial ratio (VCR) and dilatation of the fourth ventricle. The clinical outcomes were evaluated for each patient by using the Glasgow Outcome Scale (GOS) three months after the hemorrhage. RESULTS: The overall mortality rate was 38.5%. The factors correlated with a poor clinical outcome are an initial GCS score below 12 (p0.05). Dilatation of the fourth ventricle showed a poor outcome in 10 patients (83.3%), but this was without clinical significance (p>0.05). CONCLUSION: A low initial GCS score, a high Graeb's score, the absence of a pupil reflex, a high VCR and the presence of obstructive hydrocephalus are associated with a poor outcome in patients with primary intraventricular hemorrhage.

Preliminary Radiological Outcomes of Cervical Arthroplasty with Bryan and Prestige LP Cervical Disc Prosthesis

OBJECTIVE: Postoperative motion preservation and prevention of adjacent segment degeneration is well recognized after placing artificial cervical disc prosthesis in patients with degenerative cervical disc disease. The authors investigated postoperative changes in motion dynamics in two different types of artificial cervical disc prosthesis, Bryan and Prestige LP cervical disc prosthesis, and compared them. METHODS: Twenty five patients underwent anterior cervical discectomy and implantation of artificial cervical disc prosthesis: 10 with Bryan and 15 with Prestige LP. Radiological assessments, including overall sagittal alignment angle, range of motion (ROM) of overall sagittal, functional spine unit (FSU) angle, segmental ROM of FSU and ROM of adjacent segment (Upper and Lower level) using static and dynamic lateral radiographs, were performed preoperatively and postoperatively. The mean postoperative follow up period was 18.6 months (range 10.4~28.5) in Bryan and 9.2 months (range 6.5~12.6) in Prestige LP. RESULTS: The overall sagittal alignment angle was decreased 2.9degrees in Bryan group (p=0.033) and increased 5.7degrees in Prestige LP group (p=0.017). The FSU angle at treated level was decreased 0.4degrees in Bryan group (p=0.929) and increased 2.9degrees in Prestige LP group (p=0.008). The ROM of overall sagittal was decreased in both groups (Bryan: 8.6degrees p=0.075, Prestige LP: 2.9degrees p=0.182). The segmental ROM of FSU was increased 1.0degrees in Prestige LP group (p=0.191) but, decreased 0.6degrees in Bryan group (p=0.929). The ROM of adjacent segment was decreased in both groups (Bryan: upper p=0.023 lower p=0.050, Prestige LP: upper p=0.570 lower p=0.132). The postoperative radiological results of comparison between two different artificial disc showed that overall sagittal alignment angle and FSU angle were more increased in Prestige LP (p=0.005, p=0.026, respectively). CONCLUSION: The segmental ROM of FSU was preserved and ROM of adjacent segment was decreased in both groups. This means that postoperative adjacent segment disease may be prevented regardless of types of implants. On comparison study, postoperative cervical curvature was more lordotic in Prestige LP. Therefore, Prestige LP is more suitable to maintain postoperative cervical lordosis. The limitation of our study is small number of case and short and unequal follow up period between two types of implants. Further long term study will be needed.

Chronic Spinal Epidural Hematoma due to Repeated Epidural Block: A Case Report

A case of a patient diagnosed as the chronic spinal epidural hematoma in the lumbar region is reported. There was no history of trauma except the repeated epidural block for controlling the lower back pain at the pain clinic. The symptoms were occurred after epidural block and were exaggerated by repeated injections. Magnetic resonance imaging showed a spinal epidural mass located dorsolaterally at the level of L3-L4. After removal of the hematoma, the symptoms were completely relieved. The diagnosis of a chronic spinal epidural hematoma was confirmed with both operative and histological findings.