Diagnostic imaging procedures are useful to analyze the complex mechanism of swallowing. They may be employed beneficially to answer specific questions of swallow coordination, and to distinguish between various forms of airway penetration. The pathophysiology of upper and lower airway involvement may be determined and visualized.

Twenty patients with a remote history of poliomyelitis and recent or progressive dysphagia were evaluated with cinefluorography. Radiographic abnormalities were present in the pharynx in varying degrees in all but one of the patients. Findings included atrophy of the prevertebral soft tissues, unilateral or bilateral weakness of the tongue or soft palate, paresis or paralysis of the pharyngeal constrictor muscle, incomplete or absent epiglottic tilt, poor laryngeal elevation, poor laryngeal closure with laryngeal penetration, aspiration (often without a cough), and luminal narrowing at the cricopharyngeal level. Other structural lesions included a Zenker diverticulum in one patient, bilateral pharyngeal pouches in five, and a unilateral pouch in one. Additional structural lesions contributing to dysphagia were found in two other patients, including a focal stricture in the cervical esophagus in one patient and two stenotic rings in the distal esophagus in another. In four patients (one of whom had the Zenker diverticulum), the inferior constrictor muscle contracted forcibly above a prominent cricopharyngeus muscle, perhaps contributing to the formation of the diverticulum. It is important to examine postpolio patients with dysphagia carefully with dynamic imaging to assess the severity of decompensation and to detect other lesions that may be treatable. The information derived can be used to guide management.

Objective: To review the physiologic basis for normal and abnormal vagal reflexes arising from the pharynx, larynx, and esophagus, as well as the relevance of vagal reflexes to the pathogenesis of such clinically common cardiorespiratory responses as bradycardia, tachycardia, dysrhythmia, coronary angiospasm, bronchospasm, laryngospasm, prolonged apnea, and singultus (hiccups). Data Sources: Pertinent articles and reviews were identified through a MEDLINE search (April 1966 to October 1991). Older studies and others not identified in the MEDLINE search were found through a manual search of the bibliographies of the retrieved articles. Study Selection: Experimental studies in both humans and animals, as well as case series and single case reports, were selected for evaluation and citation. In instances where a similar phenomenon was described in multiple independent reports, only studies that provided a novel finding or interpretation were cited. More authoritative book chapters and peerreviewed summaries were also cited in support of commonly accepted principles. Data Extraction and Synthesis: Most of the clinical data are derived from case reports and small case series and are therefore anecdotal; equal weight was given to all such studies. Reports of conflicting observations or interpretations were clearly identified and were cited without exception. Conclusions: Stimulation of the upper aerodigestive tract can lead to clinically significant cardiorespiratory responses. Although the prevalence of and risk factors for such responses have not been established, we suggest that a pharyngeal, a laryngeal, or an esophageal source for abnormal cardiorespiratory responses be sought whenever a detailed clinical evaluation fails to reveal a cause, particularly when there are concurrent symptoms or signs of upper aerodigestive tract disease, such as dysphagia or gastroesophageal reflux.

Swallowing, from bolus gathering and processing in the mouth to transport through the pharynx and esophagus, involves a complex interaction between various anatomical structures and several physiological systems. In light of such complexity, it is therefore not surprising that a wide spectrum of motility or structural abnormalities may involve the swallowing tract. Accordingly, several medical and surgical subspecialties may need to be involved in the evaluation and management of the impaired patient. Often the presenting symptoms may be misleading or nonspecific when the physician attempts to pinpoint the site of the abnormality.

Achalasia is a well-known if uncommon abnormality of the lower esophageal sphincter, first appearing in the medical literature in 1674 [1]. The radiographic findings in this condition are well known [2], with failure of relaxation of the lower esophageal sphincter, poor or absent peristalsis in the body of the esophagus, and an air-fluid level in the erect position.

Contrast pharyngography: the importance of phonationSE Rubesin, B Jones and MW DonnerAudio Available | Share

This superbly illustrated article is an invaluable guide to the interpretation of double contrast pharyngograms.

Difficulties of swallowing occur in a wide variety of disorders and diseases, overlapping classical medical specialities such as gastroenterology, otolaryngology, neurology, rheumatology and orthopedic surgery. Whatever the disorder or disease, the radiologist’s evaluation of a patient’s swallowing process is strategic in determining which of usually several specialists should become involved in further investigations. Radiologists also participate increasingly in patient management decisions, including swallowing rehabilitation, surgical intervention, and application of feeding devices. The radiologist’s role in the care of patients with swallowing disorders, therefore, is considerably greater than the traditional radiological reporting. This pattern compares with the increasing involvement of radiologists in the overall diagnostic process elsewhere in medicine and with their management of patients as exemplified by interventional radiology.

More than twenty different genetic diseases have been described that are caused by mutations in phosphoinositide metabolizing enzymes, mostly in phosphoinositide phosphatases. Although generally ubiquitously expressed, mutations in these enzymes, which are mainly loss-of-function, result in tissue-restricted clinical manifestations through mechanisms that are not completely understood. Here we analyze selected disorders of phosphoinositide metabolism grouped according to the principle tissue affected: the nervous system, muscle, kidney, the osteoskeletal system, the eye, and the immune system. We will highlight what has been learnt so far from the study of these disorders about not only the cellular and molecular pathways that are involved or are governed by phosphoinositides, but also the many gaps that remain to be filled to gain a full understanding of the pathophysiological mechanisms underlying the clinical manifestations of this steadily growing class of diseases, most of which still remain orphan in terms of treatment. This article is part of a Special Issue entitled Phosphoinositides.

Experiments were done to test the hypothesis that emptying the gallbladder prior to intravenous cholangiography (IVC) would result in earler and better opacification of the gallbladder. Five dogs were studied on two separate days in a crossover experiment. Each dog had a standard IVC (15-minute infusion of meglumine iodipamide) 2.5 cc/kg of following a 14-16-hour fasting period. On one of the days, 0.3 mcg/kg of Ceruletide was intramuscularly administered to each dog 30 to 45 minutes prior to the iodipamide infusion. Films obtained at the end of infusion and at 20, 40, 60, and 90 minutes were evaluated independently by three radiologists. The results indicate that pretreatment with Ceruletide produces a significant (p less than 0.05) improvement in the quality of gallbladder opacification during the first 90 minutes following iodipamide infusion. We conclude that earlier and better opacification of the gallbladder during IVC can be obtained by prior emptying of the gallbladder with a cholecystokinetic agent.

A plastic holding device has been devised to allow in vitro computed tomography of term human placentas. Graded dilutions of iodinated contrast medium have been injected into the fetal placental circulation and into the intervillous space of placental lobules perfused with normal saline solution. Computed tomography in different orientations has imaged Borell's "jets" on the maternal side and cotyledonary vascular "puffs" on the fetal side of the placenta. Attenuation coefficients, before and after injection of contrast medium may be used for quantitative investigation of the physiological placental circulation and possibly for diagnosing placental pathology.

Hypertrophic osteoarthropathy in childhood malignancyMR Ameri, M Alebouyeh and MW DonnerAudio Available | Share

International Symposium and Course on Computed Tomography: Miami Beach, Florida April 4–8, 1977: ABSTRACTS: PDF Only