Accommodation to changes in bolus viscosity in normal deglutition: a videofluoroscopic study.

Videofluoroscopic swallow studies were performed on 60 normal adult volunteers. Swallowing variables were measured during swallows of a 3-cm3 paste bolus and a 3-mL liquid bolus and were compared to identify changes in swallow gesture displacement and timing, as well as changes in bolus movement timing. The study revealed that some differences measured by videofluoroscopy appear to be the result of the inherent bolus characteristics, while others likely represent changes in swallow gestures needed to accommodate variations in bolus viscosity. The overall timing of pharyngeal transit did not vary between bolus types. Oropharyngeal transit trended toward being faster for a liquid bolus with a concurrent early elevation of the aryepiglottic folds. The hyoid bone elevated at the same time, at the same rate, and to the same extent irrespective of bolus viscosity. During a liquid bolus swallow, the hyoid bone trended toward a more prolonged elevation, corresponding to prolonged pharyngoesophageal sphincter opening. The pharyngoesophageal sphincter, however, opened to a greater extent with a paste bolus.

Timing of swallowing events after single-modality treatment of head and neck carcinomas with radiotherapy.

This paper reports the results of a preliminary study designed to evaluate swallowing function in 20 patients 1 year after successful treatment of head and neck carcinomas with radiotherapy. The timing of swallowing events was evaluated by videofluoroscopy. The mean values for each measure were compared to the normative data from 60 control subjects. The radiotherapy patients demonstrated prolonged pharyngeal bolus transit and a delay of laryngeal closure. Hyoid bone elevation began late relative to the onset of bolus movement. A strong trend toward a delay in hyoid elevation relative to bolus movement was demonstrated. The time required for the hyoid bone to reach maximal elevation did not differ from that in normals, but the hyoid was held in an elevated position for a longer period of time. As a result of changes in hyoid movement, the upper esophageal sphincter tended to open early relative to the arrival of the bolus. In conclusion, changes in deglutition occur after radiotherapy, presumably as an adaptation to changes in tissue compliance.

Cytokine and cytokine receptor concentrations in bone marrow supernatant from patients with HIV: correlation with hematologic parameters.

BACKGROUND: To determine the concentrations of tumor necrosis factor (TNF) alpha, soluble TNF receptors (sTNFR), interleukin (IL)-1 beta, gamma-interferon (IFN), macrophage inflammatory protein (MIP)-1 alpha, MIP-1 beta, and RANTES to which hematopoietic progenitors are exposed in vivo in HIV patients and the correlation of these concentrations with hematologic parameters, cytokine and cytokine receptor concentrations were measured by ELISA in bone marrow aspirate supernatants from 19 HIV patients undergoing diagnostic evaluation and 14 healthy paid volunteer controls. IL-1 beta and gamma-IFN were rarely detectable. All cytokines/receptors detectable in marrow supernatant, except RANTES, showed mean concentrations 1.6- to 6.2-fold higher in patients with HIV compared to healthy controls. METHODS: Elevated TNF-alpha and MIP-1 beta were associated with marrow involvement by lymphoma, Hodgkin disease, or mycobacterial infection. Concentrations of all cytokines/receptors measured correlated with the severity of anemia. CD8+ lymphocytes were inversely correlated with concentrations of all cytokines measured other than MIP-1 alpha. To identify differences specific to HIV infection, marrow supernatant cytokine concentrations were also evaluated in 9 non-HIV patients undergoing diagnostic marrow examination. Significant differences were observed in TNF alpha, MIP-1 alpha, and IL-1 beta concentrations. RESULTS: These studies demonstrate that concentrations of these cytokines and receptors are elevated in bone marrow supernatant of HIV-infected patients with hematologic abnormalities, and that these concentrations correlate with clinical parameters in these patients. CONCLUSIONS: Evaluation of local concentrations of cytokines may be relevant to understanding tissue-specific pathology in HIV-infected individuals.

Structural mobility in deglutition after single modality treatment of head and neck carcinomas with radiotherapy.

BACKGROUND: The results of a preliminary study designed to evaluate swallowing function in patients 1 year after successful treatment of head and neck carcinomas with radiotherapy are reported. METHODS: Movement of the velum, hyoid, larynx, tongue base, and posterior pharyngeal wall were objectively assessed by dynamic videofluoroscopy. Mean values of each swallowing parameter measured from the study group were compared with normative data from a group of 60 normal control subjects. The radiotherapy patient group was divided based on the location of the primary tumor in an attempt to correlate the effect of tumor location on swallowing. RESULTS: Hyoid displacement was decreased in radiotherapy patients and the hyoid elevated maximally independent of bolus size, unlike control subjects, in whom hyoid displacement increased with increases in bolus size. Patients with tongue base tumors demonstrated decreased pharyngeal constriction compared with patients with larynx and pharynx/nasopharynx tumors. CONCLUSIONS: A generalized decrease in the mobility of pharyngeal structures is demonstrated after radiotherapy.

Serum chemokine levels in patients with non-progressing HIV infection.

OBJECTIVE: To evaluate serum chemokines, macrophage inflammatory protein (MIP)-1 alpha, MIP-1 beta and RANTES, concentrations in non-progressing HIV-infected patients and AIDS patients. SETTING: University Hospital-based AIDS Clinical Trials Unit. DESIGN/METHODS: Serum MIP-1 alpha, MIP-1 beta and RANTES levels were determined by enzyme-linked immunosorbent assay using archived serum specimens obtained on two occasions at least 1.8 years apart. PATIENT SELECTION: Long-term non-progressing HIV-infected adult patients were identified from clinic records. For each non-progressing patient two adult AIDS patients with initial documentation of seropositivity the same year and the same length of follow-up were selected. RESULTS: Four long-term non-progressing patients and eight AIDS patients were studied. Neither the duration of known HIV positivity at the time of specimen collection nor the length of time between specimen collections differed significantly between non-progressing patients and AIDS patients. Serum levels of MIP-1 alpha, MIP-1 beta and RANTES in specimens obtained either early or later in the course of HIV infection did not differ significantly between non-progressing patients and AIDS patients. In the two patient subsets, significant differences in serum chemokine levels over time were not observed. The rate of change of serum chemokine concentration over time also did not differ between non-progressing patients and AIDS patients. Serum MIP-1 alpha and MIP-1 beta levels did not reach levels reported to suppress HIV proliferation in vitro. When expressed as a quantity per peripheral blood CD8+ lymphocyte, AIDS patients exhibited significantly greater levels of MIP-1 alpha, MIP-1 beta and RANTES than non-progressing HIV patients (P < 0.05). These values did not exhibit a significant variation over time. CONCLUSIONS: Serum MIP-1 alpha, MIP-1 beta and RANTES levels do not distinguish patients with AIDS from patients with non-progressing HIV infection. Variations in levels of these chemokines do not explain individual variation in the natural history of HIV infection.

Aspiration pneumonia in stroke.

Aspiration pneumonia developed within 1 year in 29 of 60 stroke patients referred for videofluoroscopic evaluation of poststroke dysphagia and drawn from a total population of 304 acute stroke patients. The presence of vallecular pooling, piriform pooling, or bolus penetration to or through the true vocal cords on videofluoroscopy did not correlate with the development of aspiration pneumonia. Kinematic pharyngeal transit times did show a significant correlation with the development of aspiration pneumonia (time of first movement, p = .038; time of arrival of bolus at valleculae, p = .0008; time of return of epiglottis to resting position, p = .0001). Those patients with total kinematic pharyngeal transit times (Em) of less than 2.00 sec were at little or no risk for aspiration pneumonia (0%), those with 2.01 to 5.00sec at moderate risk (38.5%), and those with more than 5.00sec were at marked risk (90%).

Kinematic pharyngeal transit times in myopathy: evaluation for dysphagia.

Measurement of kinematic pharyngeal transit times, a new videofluoroscopy technique, provides useful quantitative data to supplement the qualitative data previously available from videofluoroscopy swallowing studies. Kinematic pharyngeal transit times have not previously been reported for subjects with myopathy. This study demonstrates the use of quantitative kinematic pharyngeal transit times for dysphagia evaluation in 15 patients with myopathy. The successful treatment of dysphagia by cricopharyngeal myotomy is reported in two patients with limb-girdle syndrome.

Dysphagia following stroke: quantitative evaluation of pharyngeal transit times.

Forty stroke subjects referred for dysphagia and studied by videofluoroscopy were compared with 16 individuals with no known pharyngeal swallowing difficulty. Kinematic pharyngeal transit time was defined as the time from the first movement of the bolus posteriorly resulting in a complete swallow to the return of the epiglottis to its original position. The mean transit time was 1.00 second for the comparative group and 6.15 seconds for the stroke group (p less than 0.001). Other component transit times are described and were all significantly prolonged for the stroke group. There was no significant difference in transit times between right-sided and left-sided lesions except for the segmental interval from onset of bolus movement to arrival at the valleculae, which was significant at p = 0.05. Measurement of transit times using the method described in this study requires equipment available in most hospitals. These measurements may be used in the evaluation of dysphagia in various pathologic disorders, in following the progress of patients with dysphagia, and in evaluating the effects of remedial therapies.