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 main objective of this study was to investigate whether patients with chronic myeloid leukemia (CML) in treatment with long-term therapy imatinib have a different health-related quality-of-life (HRQOL) profile compared with the general population. In total, 448 CML patients were enrolled, and the SF-36 Health Survey was used to compare generic HRQOL profiles. Symptoms were also assessed. HRQOL comparisons were adjusted for key possible confounders. The median age of patients was 57 years and the median time of imatinib treatment was 5 years (range 3-9 years). The largest HRQOL differences were found in younger patients. In particular, patients aged between 18 and 39 years had marked impairments in role limitations because of physical and emotional problems, respectively: ؊22.6 (P < .001), ؊22.3 (P < .001). Patients with CML age 60 or older had a HRQOL profile very similar to that reported by the general population. Women had a worse profile than men when each were compared with their peers in the general population. Fatigue was the most frequently reported symptom. The HRQOL of CML patients is comparable with that of population norms in many areas, however, younger and female patients seem to report the major limitations. (Blood. 2011;118(17):4554-4560)
The main objective of this study was to compare health-related quality of life (HRQOL) of primary immune thrombocytopenia (pITP) patients with that of general population, overall, and by patient group (i.e., newly diagnosed, persistent, and chronic patients). Fatigue was also investigated as a secondary objective. Overall, 424 adult patients were enrolled in a multicenter observational study and the control group consisted of a representative sample from the general population. Propensity score matching plus further multivariate linear regression adjustment was used to compare HRQOL outcomes between pITP patients and general population. Mean age of patients was 54 years. Of those with HRQOL assessment, 99 patients (23.6%) were newly diagnosed, 53 (12.6%) were persistent, and 268 (63.8%) were chronic pITP patients. Comparison by patient group versus their respective peers in the general population revealed greater impairments in persistent pITP patients. Persistent pITP patients reported clinically meaningful impairments in physical functioning (-15; 95% CI -24.1 to -5.8; P = 0.002), social functioning (-15.3; 95% CI -25.5 to -5.1; P = 0.004), role physical (-28.4; 95% CI -43.1 to -13.7; P < 0.001), role emotional (-23.9; 95% CI -40.1 to -7.7; P = 0.004), and mental health scales (-11.3; 95% CI -21.2 to -1.4; P = 0.026) of the SF-36 questionnaire. Higher fatigue severity was associated with lower physical and mental HRQOL outcomes. Our findings suggest that the burden of the disease and treatment might depend on the disease phase and that persistent pITP patients are the most vulnerable subgroup. Am. J. Hematol. 91:995-1001, 2016. © 2016 Wiley Periodicals, Inc.
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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