Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0011168 (dysphagia)
 15,644 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We have carried out a prospective study of selective peripheral denervation (SPD) in cervical dystonia (CD) patients with primary or secondary botulinum toxin (BT) treatment failure using independent standardized assessment. Patients referred for surgery had a standardized clinical examination, neck muscle EMG, videofluoroscopic swallow and CT of the cervical spine, and were selected for surgery on the basis of the results of these investigations. CD severity, disability and pain were assessed preoperatively and at 3, 6, 9, 12 and 18 months postoperatively using the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS). Severity of head tremor and dysphagia were scored using established rating scales. Additionally, psychosocial function was assessed in a representative subsample of patients (n = 12) using several established questionnaires. Of the 62 patients who were assessed, 22 (35.5%) were not offered surgery, most commonly because of widespread dystonia. Of the remaining 40 patients, 37 have so far had surgery, 31 of whom have been followed up for at least 1 year, and 15 for 18 months after surgery (mean follow-up duration 16.7 months). Using the TWSTRS global outcome score, 68% of patients derived functionally relevant improvement at 12 months after surgery. In the entire operated group, total TWSTRS scores were reduced by 30% at 6 and 12 months after surgery (P < 0.0001). The subscores for severity, disability and pain were reduced by 20, 30 and 40%, respectively, at 6 months (P < or = 0.01) and 20, 40 and 30%, respectively, at 12 months (P < 0.01). Pain increased over time, which appeared to result from muscle reinnervation. TWSTRS scores were not significantly improved in the six patients with primary BT treatment failure. Head tremor did not change. There was a significant improvement of body concept, perceived disfigurement, stigma, and quality of life in the 12 patients whose psychosocial function was assessed. Preoperative disability and restriction of head movement were negatively correlated and the initial response to BT treatment positively correlated with global outcome score. Spread or deterioration of dystonia elsewhere in the body occurred in three patients, with unpleasant sensory symptoms in denervated posterior cervical segments occurring in 14. Ten patients developed mild to moderate dysphagia, and two developed severe dysphagia. We conclude that SPD is an effective treatment for patients with secondary, but probably not for those with primary, BT treatment failure. Reinnervation is not infrequent and can compromise outcome. Postoperative morbidity is low, but there is a risk of dysphagia.
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PMID:Prospective study of selective peripheral denervation for botulinum-toxin resistant patients with cervical dystonia. 1128 76

Purpose The purpose of this investigation was to (a) identify the relationship between level of acculturation, and quality of life (QOL) and stigma and (b) explore the QOL experiences for Hispanic New Mexicans with dysphagia. Method This study includes 7 New Mexicans who self-identified as Hispanic. This prospective investigation was completed in 2 phases. In the quantitative phase, all participants completed the (a) the SWAL-QOL ( McHorney et al., 2000 ), (b) the Neuro-QoL Stigma subtest ( Gershon et al., 2012 ), and (c) the Acculturation Rating Scale for Mexican Americans-II (ARSMA-II; Cuellar, Arnold, & Maldonado, 1995 ). In the qualitative phase, 3 participants were selected from the quantitative phase to complete the qualitative phase. These participants were selected to allow for distribution across levels of acculturation, and each of them participated in interviews designed to explore QOL experiences. Interviews were analyzed to identify themes. The occurrence of themes is discussed as a function of level of acculturation. Results There is no clear relationship between acculturation and QOL. A strong nonsignificant correlation was observed between acculturation and stigma. QOL experiences, as identified from the interviews, were classified into 2 broad categories: emotional experiences (stigma, distrust, fear, frustration, religion, and impact) and swallow safety (symptoms, treatment, triggers, and compensatory strategies). Conclusions Level of acculturation did not relate to measures of mental health or fatigue. Yet, both quantitative and qualitative analyses support a relationship between level of acculturation, and symptom reporting and religion, as well as patient perception of stigma.
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PMID:The Relationship Between Culture, Quality of Life, and Stigma in Hispanic New Mexicans With Dysphagia: A Preliminary Investigation Using Quantitative and Qualitative Analysis. 3113 41