The influence of aging on oral-pharyngeal swallowing was assessed by simultaneous manometry and videoradiography in 14 nondysphagic elderly individuals (mean age 76 yr) and 11 healthy, young controls (mean age 21 yr). Sphincter opening was diminished significantly in the elderly (P = 0.0001), but trans-sphincteric bolus flow rates were preserved. The increased impedance to trans-sphincteric bolus flow from reduced sphincter opening in the aged was reflected in a significant increase in hypopharyngeal intrabolus pressure (P = 0.003). Oral transit time was significantly prolonged in the aged (P = 0.01). The timing of upper esophageal sphincter (UES) manometric relaxation and of opening was significantly delayed in the aged (P = 0.0001), and this delay was comparable in magnitude to the prolongation in oral transit. Coordination of UES relaxation and opening with midpharyngeal contraction was not significantly affected by age. Deglutitive hyolaryngeal motion was not affected by age but was delayed by a duration equivalent to the prolongation in oral transit. We conclude that normal aging prolongs the oral-pharyngeal swallow that impairs UES opening but does not influence pharyngo-sphincteric coordination.
The aim of the study was to determine the influence of normal aging on regional transit and the efficiency of bolus clearance during the oral and pharyngeal phases of swallowing. We compared scintigraphically derived oral-pharyngeal transit times and isotope clearance during swallowing in 21 healthy aged volunteers (mean age 68 +/- 8 yr) and 9 young controls (mean age 28 +/- 7.5 yr). Subjects swallowed 5- and 10-ml water boluses mixed with 30 MBq 99mtechnetium tin colloid. Oral and pharyngeal transit times, pharyngeal clearance time, and postswallow residual counts in each region were derived from time-activity curves. Pharyngeal residual counts were significantly greater in the aged than in controls (P = 0.0008), but age did not influence oral residual. Aging significantly prolonged oral transit time (P = 0.02), pharyngeal transit time (P = 0.0004), and pharyngeal clearance time (P = 0.0001). We conclude that normal impairs the efficiency of pharyngeal clearance during swallowing, prolongs scintigraphic measures of oral-pharyngeal transit, and increases the exposure time of the glottis to the swallowed bolus.
Corpora lutea (CL) of mature, nonlactating Holstein cows (n = 12) each received surgical implants of a microdialysis system between Days 12 and 16 of an estrous cycle (estrus = Day 0). Fractions from dialyzed CL were collected every 30 min for 12 h each day for 7-9 days after surgery. Concurrent sampling of jugular venous blood allowed comparison between luteal dialysate and peripheral serum hormone concentrations. Six cows received no treatment, while 4 cows received prostaglandin F2 alpha (PGF; 25 mg, i.m.) and 2 cows received hCG (5000 IU, i.m.) within 48 h after surgery. Serum progesterone (P4) declined to < 1 ng/ml by Day 20 +/- 0.5 in 4 of 6 nontreated cows and by Day 15 +/- 0.6 in all 4 PGF-treated cows. Both of the hCG-treated cows had increased serum and dialysate P4 after treatment and did not show evidence of luteolysis by the end of their sampling period (Days 22 and 18), and 2 of 6 nontreated cows did not show evidence of luteolysis by the end of their sampling period (Days 22 and 24). All 8 cows undergoing spontaneous or induced luteolysis showed a significant rise (p < 0.01) in dialysate (but not serum) tumor necrosis factor alpha (TNF) after P4 began to decline. From the start of the decline in dialysate P4, intervals to first detectable TNF and to peak TNF, and duration of TNF in the dialysate were 25.8 +/- 8 h, 38.3 +/- 8 h, and 42.3 +/- 7 h, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
In this study we examined the hypothesis that intrabolus pressure is a valid indicator of poor UOS compliance. Specifically we hypothesised that cricopharyngeal myotomy in Zenker's diverticulum would normalise UOS opening; normalise hypopharyngeal intrabolus pressure, and the relation between these two variables; and increase trans-sphincteric bolus flow rates. MethodsPatients and controls We studied eight consecutive patients requiring surgery for a pharyngeal pouch causing dysphagia (5 M:3 F; mean age 62 years; range 48-85). They were studied before and eight weeks after surgery. Seven patients underwent complete cricopharyngeal myotomy by one surgeon (GGJ) of whom five had concurrent diverticulectomy, one diverticulopexy, and one the pouch was left in situ. The eighth patient was excluded from the group data analysis as he underwent only 'partial myotomy' by a different surgeon at another institution. The findings from this particular case are of some interest and are briefly discussed. Radiographic and manometric measures during swallowing in patients were compared with nine healthy controls without dysphagia of comparable age (mean age 76 years; range 52-85). Ethical approval for the study was granted by the Royal Adelaide Hospital Ethics Review Committee and all patients gave written informed consent. VideoradiographyPatients were studied before and after surgery using simultaneous videoradiography and manometry as previously described.4 5 Patients and controls were studied in the upright seated position. Images of barium swallows were recorded in the lateral and anteroposterior projections using a 9" Phillips image intensifier (Phillips, Eindhoven, Holland). Fluoroscopic images of swallows in anteroposterior and lateral projections were recorded on video tape at 25 frames per second by a VHS video recorder (Panasonic, AG6500, Osaka, Japan) for later analysis. Magnification correction was Departments of Medicine
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