[Ventral cervical spondylophytes as differential diagnosis of neurogenic dysphagia]. / Ventrale zervikale Spondylophyten als Differenzialdiagnose neurogener Dysphagien.

BACKGROUND: Ventral cervical spondylophytes can lead to severe dysphagia if they are of sufficient extent and height localization and represent an important differential diagnosis of neurogenic dysphagia, especially in older patients. OBJECTIVE: Presentation of various etiologies of ventral cervical spondylophytes, specific symptoms and abnormalities of the swallowing function caused by spondylophytes, their manifestation in the instrumental swallowing diagnostics and an outlook on treatment options. MATERIAL AND METHODS: Summary of the current literature on spondylophyte-related dysphagia and an overview of research results regarding differential diagnostic aspects of neurogenic dysphagia. RESULTS: The manifestation forms of ventral cervical spondylophytes can be very diverse. With respect to dysphagia, disorders of pharyngeal bolus transfer and an increased tendency to aspiration have been observed. The occurrence and severity of the symptoms depend primarily on the extent of the bony attachments and their height localization. CONCLUSION: In some cases, symptomatic ventral cervical spondylophytes can be a relevant differential diagnosis of neurogenic dysphagia. For a more precise evaluation of the dysphagic symptoms and their association with the spondylophytic outgrowths, a video fluoroscopy of swallowing (VFS) should be added to the fiber endoscopic evaluation (FEES). In most cases, a resection of the bone spurs leads to a significant improvement or even to a complete restitution of the swallowing disorders.

Flexible endoscopic evaluation of swallowing (FEES) for neurogenic dysphagia: training curriculum of the German Society of Neurology and the German stroke society.

BACKGROUND: Neurogenic dysphagia is one of the most frequent and prognostically relevant neurological deficits in a variety of disorders, such as stroke, parkinsonism and advanced neuromuscular diseases. Flexible endoscopic evaluation of swallowing (FEES) is now probably the most frequently used tool for objective dysphagia assessment in Germany. It allows evaluation of the efficacy and safety of swallowing, determination of appropriate feeding strategies and assessment of the efficacy of different swallowing manoeuvres. The literature furthermore indicates that FEES is a safe and well-tolerated procedure. In spite of the huge demand for qualified dysphagia diagnostics in neurology, a systematic FEES education has not yet been established. RESULTS: The structured training curriculum presented in this article aims to close this gap and intends to enforce a robust and qualified FEES service. As management of neurogenic dysphagia is not confined to neurologists, this educational programme is applicable to other clinicians and speech-language therapists with expertise in dysphagia as well. CONCLUSION: The systematic education in carrying out FEES across a variety of different professions proposed by this curriculum will help to spread this instrumental approach and to improve dysphagia management.

Assaults in the elderly--a population-based study with victim and perpetrator characteristics.

The aim of the present epidemiological study was to investigate characteristics of assaults in the elderly aged 65 years and above from the perspective of the victim and perpetrator. This population-based study included 23,142 assaults (according to §§ 224/226 StGB of German criminal law) that were recorded in Bavaria, Germany, from 1999 to 2005. The population-based ratio of serious crimes of battery for the elderly in comparison with the reference population was markedly lower (0.10; 95% CI: 0.09-0.11) in suspects aged more than 65 years and 0.08 (95% CI: 0.07-0.09) for the injured above 65 years. Elderly perpetrators differed significantly concerning the manner of the assault (p < 0.001). They committed less crimes in urban areas (56.1% vs. 68.8%) and were victimized significantly more in rural areas (p < 0.001; 41.2% vs. 30.2%). Violence in the elderly differs from that of the younger population. Further research is warranted to establish prevention measures.

Relationship between lunar phases and serious crimes of battery: a population-based study.

OBJECTIVE: The hypothesis of a lunar influence on human abnormal behavior is still widespread, although research has led to conflicting findings. Therefore, a population-based study to assess the influence of lunar phases on violent crimes was conducted. METHODS: The study included all serious crimes of battery (aggravated assaults) committed in Middle Franconia (Bavaria, Germany) between 1999 and 2005 (n = 23 142). Data were analyzed regarding lunar phase, sex, and place of crime scene (outdoor vs indoor). RESULTS: No significant associations between full, absent, and the moon's interphases and serious crimes of battery could be detected. Furthermore, a Fourier analysis was conducted that failed to produce an association between violence and the moon's phases. DISCUSSION: Several possible explanations for the presented results are discussed including biological and social mechanisms. CONCLUSIONS: The present study fails to find a significant association between lunar phases and crimes of battery.