Proyecto combo. criterios y pautas de terapia combinada en la diabetes tipo 2. Documento de consenso (II) / COMBO project. Combined therapy criteria and guidelines for type-2 Diabetes. Consensus document (II)

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Proyecto COMBO. Criterios y pautas de terapia combinada en la diabetes tipo 2. Documento de consenso (I) / COMBO project. Criteria and guidelines for combined therapy to treat type-2 diabetes. Consensus document (I)

No disponible

Recovery of postoperative swallowing in patients undergoing partial laryngectomy.

This study assessed the achievement of postoperative swallowing in patients undergoing partial laryngectomy surgery. Oropharyngeal swallow efficiency was used to predict time to achievement of outcome. Fifty-five patients were followed for up to 1 year in two hemilaryngectomy and four supraglottic laryngectomy groups. Within 10 days of healing, a videofluoroscopic evaluation enabled the measurement of swallowing efficiency. Times to achievement of oral intake, removal of feeding tube, preoperative diet, and normal swallow were analyzed using actuarial curves. Patients with hemilaryngectomies achieved swallowing rehabilitation sooner than patients with nonextended supraglottic laryngectomies (p < .05) who, in turn, achieved swallowing function sooner than did patients undergoing supraglottic laryngectomies with tongue base resection (p < .05). Median time to attainment of preoperative diet in these three groups was 28 days, 91 days, and > 335 days, respectively. Higher early postoperative oropharyngeal swallow efficiency was related to earlier achievement of oral food intake and of preoperative diet (p < .05). Results show that the time course for swallowing rehabilitation covers an extended postoperative period. In some surgical groups, functional swallowing and eating may be achieved within 3 months of surgery while for other types, significant impairment remains up to 9 months postoperatively Early radiographic assessments of swallowing function are useful in predicting the time to swallow recovery. Recovery of swallowing ability may be delayed in patients who have not achieved oral intake before radiotherapy is started.

Speech and swallowing function after anterior tongue and floor of mouth resection with distal flap reconstruction.

The purpose of this study was to assess the postoperative functioning of oral cancer patients with resections of the anterior tongue and floor of mouth, reconstructed with distal flap closure. Speech and swallowing performance was assessed for 11 men and 5 women preoperatively and at 1 and 3 months postoperatively following a standardized protocol. Speech tasks included an audio recording of a brief conversation and of a standard articulation test; swallowing function was examined using videofluoroscopy. Data were also collected on the number and duration of speech/swallowing treatment sessions, as well as the amount and duration of radiation therapy. Statistical analyses revealed that patients demonstrated a significant and severe impairment in speech and swallow functioning after surgery, with no recovery of function by 3 months post-healing. The degree of impairment in these patients may be related to the adynamic character of the distal flap used for reconstruction. Lack of improvement at the 3-month evaluation may be related to either the timing of postoperative radiation therapy or the low rate (44%) and amount of speech/swallowing treatment provided to these patients.

Impact of the diagnostic procedure on outcome measures of swallowing rehabilitation in head and neck cancer patients.

This study was designed to determine whether swallow rehabilitation outcomes were affected by the type of evaluation procedure utilized by the clinician. The two evaluation techniques compared were the bedside examination and videofluoroscopy (the modified barium swallow). Ten institutions participated in this study, enrolling a total of 103 partial laryngectomized patients, 21 in the bedside arm and 82 in the videofluoroscopy arm. Data on recovery of oral intake were collected weekly. All patients received an X-ray study of swallow at 3 months after the operation. Mean time to oral intake of food was significantly lower in patients assessed with bedside examination. Overall swallow measures of transit times and swallow efficiencies after 3 months revealed significantly better function in the videofluoroscopy group. Results are discussed in terms of the visibility of swallow physiology with the two assessment techniques, the accuracy of therapy planning with the bedside examination versus videofluoroscopy and the ability of head and neck cancer patients to tolerate some aspiration without developing aspiration pneumonia.

Essential voice tremor: treatment with propranolol.

We studied chronic oral propranolol therapy and placebo in seven patients with essential voice tremor. Mean scores for voice tremor and voice quality did not differ for placebo or propranolol. Hand tremor amplitude decreased significantly with propranolol. Voice tremor seems to be more resistant to propranolol therapy than hand tremor.

Speech and swallow following Staffieri voice restoration procedure.

The Loyola University and Hines Veterans Administration Surgical Service completed the Staffieri procedure to construct a pharyngoesophageal flap at the time of total laryngectomy in 12 patients. Following surgery, 11 patients produced speech that was highly intelligible. Ultimately, seven continued to rely on this method of speech as their primary means of communication. Voice quality was judged to be rough, strained, wet, and breathy in a majority of patients. Aspiration of liquids was evident in 11 of 12. Four underwent revisions to reduce the size of the fistula and to correct swallowing problems.