Dysphagia - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

DYSPHAGIA A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES

J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright ©2004 by ICON Group International, Inc. Copyright ©2004 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1 Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Dysphagia: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-597-84400-3 1. Dysphagia-Popular works. I. Title.

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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International, Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this book.

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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on dysphagia. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.

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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.

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About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes&Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON DYSPHAGIA ............................................................................................... 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Dysphagia ................................................................................... 25 E-Journals: PubMed Central ....................................................................................................... 41 The National Library of Medicine: PubMed ................................................................................ 41 CHAPTER 2. NUTRITION AND DYSPHAGIA ..................................................................................... 75 Overview...................................................................................................................................... 75 Finding Nutrition Studies on Dysphagia .................................................................................... 75 Federal Resources on Nutrition ................................................................................................... 80 Additional Web Resources ........................................................................................................... 81 CHAPTER 3. ALTERNATIVE MEDICINE AND DYSPHAGIA............................................................... 83 Overview...................................................................................................................................... 83 National Center for Complementary and Alternative Medicine.................................................. 83 Additional Web Resources ........................................................................................................... 88 General References ....................................................................................................................... 89 CHAPTER 4. DISSERTATIONS ON DYSPHAGIA................................................................................. 91 Overview...................................................................................................................................... 91 Dissertations on Dysphagia ......................................................................................................... 91 Keeping Current .......................................................................................................................... 92 CHAPTER 5. CLINICAL TRIALS AND DYSPHAGIA ........................................................................... 93 Overview...................................................................................................................................... 93 Recent Trials on Dysphagia ......................................................................................................... 93 Keeping Current on Clinical Trials ............................................................................................. 96 CHAPTER 6. PATENTS ON DYSPHAGIA ........................................................................................... 99 Overview...................................................................................................................................... 99 Patents on Dysphagia .................................................................................................................. 99 Patent Applications on Dysphagia ............................................................................................ 105 Keeping Current ........................................................................................................................ 110 CHAPTER 7. BOOKS ON DYSPHAGIA ............................................................................................. 113 Overview.................................................................................................................................... 113 Book Summaries: Federal Agencies............................................................................................ 113 Book Summaries: Online Booksellers......................................................................................... 116 Chapters on Dysphagia .............................................................................................................. 119 CHAPTER 8. MULTIMEDIA ON DYSPHAGIA .................................................................................. 125 Overview.................................................................................................................................... 125 Video Recordings ....................................................................................................................... 125 Audio Recordings....................................................................................................................... 127 CHAPTER 9. PERIODICALS AND NEWS ON DYSPHAGIA ............................................................... 129 Overview.................................................................................................................................... 129 News Services and Press Releases.............................................................................................. 129 Newsletter Articles .................................................................................................................... 131 Academic Periodicals covering Dysphagia................................................................................. 132 CHAPTER 10. RESEARCHING MEDICATIONS................................................................................. 133 Overview.................................................................................................................................... 133 U.S. Pharmacopeia..................................................................................................................... 133 Commercial Databases ............................................................................................................... 134 Researching Orphan Drugs ....................................................................................................... 135 APPENDIX A. PHYSICIAN RESOURCES .......................................................................................... 139 Overview.................................................................................................................................... 139

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NIH Guidelines.......................................................................................................................... 139 NIH Databases........................................................................................................................... 141 Other Commercial Databases..................................................................................................... 143 The Genome Project and Dysphagia .......................................................................................... 143 APPENDIX B. PATIENT RESOURCES ............................................................................................... 147 Overview.................................................................................................................................... 147 Patient Guideline Sources.......................................................................................................... 147 Finding Associations.................................................................................................................. 154 APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 157 Overview.................................................................................................................................... 157 Preparation................................................................................................................................. 157 Finding a Local Medical Library................................................................................................ 157 Medical Libraries in the U.S. and Canada ................................................................................. 157 ONLINE GLOSSARIES................................................................................................................ 163 Online Dictionary Directories ................................................................................................... 163 DYSPHAGIA DICTIONARY ...................................................................................................... 165 INDEX .............................................................................................................................................. 217

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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with dysphagia is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about dysphagia, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to dysphagia, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on dysphagia. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to dysphagia, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on dysphagia. The Editors

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From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.

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CHAPTER 1. STUDIES ON DYSPHAGIA Overview In this chapter, we will show you how to locate peer-reviewed references and studies on dysphagia.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and dysphagia, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “dysphagia” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: •

When It's Hard to Swallow: What to Look for in Patients With Dysphagia Source: Postgraduate Medicine. 105(7): 131-134, 141-142, 145. June 1999. Summary: A wide variety of causes, from an obstructive foreign body to a cerebrovascular accident (stroke) can disrupt the complicated processes that make up a swallow. In this article, the third in a series of three on esophageal diseases, the authors describe the many symptoms and other factors (e.g., onset, progression, exacerbating conditions) that can provide clues to the cause of dysphagia. The authors also discuss useful diagnostic studies and how to choose among them on the basis of findings during history taking. Dysphagia is classified as oropharyngeal (also called transfer dysphagia) or esophageal. The most common cause of oropharyngeal dysphagia is cerebrovascular accidents (stroke); other causes include oropharyngeal structural lesions, systemic and local muscular disease, and diverse neurologic disorders. Esophageal dysphagia may

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result from neuromuscular disorders, motility abnormalities, and intrinsic or extrinsic obstructive lesions. A thorough patient history helps define the type of dysphagia and can guide diagnostic testing. One sidebar reviews the physiology of swallowing. 3 figures. 1 table. 12 references. •

Development of an Interdisciplinary Dysphagia Team in the Public Schools Source: Language, Speech, and Hearing Services in Schools. 31(1): 62-75. January 2000. Contact: Available from American Speech-Language-Hearing Association (ASHA). Product Sales, 10801 Rockville Pike, Rockville, MD 20852. (888) 498-6699. TTY (301) 8970157. Website: www.asha.org. Summary: As the scope of practice in the field of speech language pathology has expanded to include dysphagia (swallowing disorders), the school based clinician's recognition of students with potential swallowing problems has increased. Dysphagia is common in children with severe cerebral palsy and multiple disabilities; it can also occur in at-risk neonates and children with a variety of neurological deficits and structural abnormalities. This article describes the development of a school based dysphagia team within the St. Tammany Parish school system located in Covington, Louisiana. The team's vision was to ensure safe nutrition and hydration for students at risk for swallowing dysfunction during school hours. The authors discuss how the team was initially formed, the process of identifying students who were exhibiting a swallowing disorder, steps taken for staff development, and problems encountered in seeking administrative approval. The authors also present a brief discussion of the current status of the dysphagia program, along with future plans for further implementation. Numerous appendices offer recordkeeping and other forms used by the program. 1 figure. 1 table. 7 references.

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Esophageal Dysphagia: Is the Cause Benign or Potentially Deadly? A Guide to Key Components of the Work-Up Source: Journal of Critical Illness. 13(4): 236-242, 245-246. April 1998. Contact: Available from Cliggott Publishing Company. 55 Holly Hill Lane, Greenwich, CT 06831-0010. (203) 661-0600. Summary: Dysphagia (difficulty in swallowing) is an important symptom that nearly always signals an organic abnormality. In this article, the authors review the causes of dysphagia and the approach to diagnosis. They focus on the most common esophageal causes of dysphagia and describe available diagnostic methods and management options. They present a diagnostic algorithm to help readers identify the underlying cause of dysphagia. The authors note that clues in the patient history often point to the cause. For example, worsening dysphagia and weight loss in a patient older than 50 may indicate esophageal carcinoma, while chest pain associated with intermittent dysphagia suggests diffuse esophageal spasm. If dysphagia occurs with both solids and liquids or with liquids alone, a motility disorder (such as achalasia), scleroderma, or a spastic motor disorder may be involved. Achalasia is often characterized by bland regurgitation of ingested food and thick saliva; weight loss may be striking. Other, less common causes of dysphagia include esophageal diverticula, foreign bodies, vascular or mediastinal abnormalities, and cervical osteoarthritis. A barium swallow with a solid bolus challenge is the initial test for all patients who have dysphagia. Esophageal manometry or esophagogastroscopy may be required for definitive diagnosis. 6 figures. 2 tables. 15 references. (AA-M).

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Evaluating Dysphagia Source: American Family Physician. 61(12): 3639-3648. June 15, 2000. Contact: Available from American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (800) 274-2237. Website: www.aafp.org. Summary: Dysphagia (difficulty swallowing) is a problem that commonly affects patients cared for by family physicians in the office setting, as hospital inpatients and as nursing home residents. This article reviews the diagnostic strategies that should be used to evaluate these patients. Familiar medical problems, including cerebrovascular accidents (stroke), gastroesophageal reflux disease, and medication related side effects, often lead to complaints of dysphagia. Stroke patients are at particular risk of aspiration because of dysphagia. Classifying dysphagia as oropharyngeal, esophageal and obstructive, or neuromuscular symptom complexes lead to a successful diagnosis in 80 to 85 percent of patients. Based on the patient history and physical examination barium esophagram or gastroesophageal endoscopy can confirm the diagnosis. Special studies and consultation with subspecialists can confirm difficult diagnoses and help guide treatment strategies. 3 figures. 4 tables. 19 references.

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Radiologic Evaluation of the Dysphagic Patient Source: Nutrition and Clinical Practice. 14(5 Supplement): S10-S12. October 1999. Contact: Available from American Society for Parenteral and Enteral Nutrition. 8630 Fenton Street, Suite 412, Silver Spring, MD 20910-3805. (301) 587-6315. Summary: Dysphagia (swallowing difficulty) is a common symptom that uncommonly has no underlying cause. Many diseases and disorders can produce dysphagia, varying from neurologic causes such as cerebrovascular accident (CVA) or Parkinson's disease to infectious causes such as candidiasis. This article on the radiologic evaluation of the patient with dysphagia, is from a medical nutrition and device roundtable on dysphagia. The author stresses that the radiographic evaluation of the patient with dysphagia should be tailored to each individual depending on symptoms and the site of symptoms. The author discusses variations in technique and an approach to the interpretation of the study. Swallowing physiology is analyzed by considering a series of the following consecutive stages: oral transfer phase, tongue to soft palate seal, soft palate to superior constrictor seal, bolus propulsion, laryngeal complex, and cricopharyngeal (CP) opening. 22 references.

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Dysphagia: Populations at Risk and Methods of Diagnosis Source: Nutrition and Clinical Practice. 14(5 Supplement): S2-S9. October 1999. Contact: Available from American Society for Parenteral and Enteral Nutrition. 8630 Fenton Street, Suite 412, Silver Spring, MD 20910-3805. (301) 587-6315. Summary: Dysphagia has been recognized as a variable that increases hospital length of stay and influences patient outcome. Additionally, in young children, it can seriously affect physical and intellectual development. This article on populations at risk and methods of diagnosis of dysphagia (swallowing difficulty), is from a medical nutrition and device roundtable on dysphagia. Issues regarding the safety of swallowing relate to both airway protection and adequate nutritional intake. The author notes that the likelihood of a dysphagic patient regaining the ability to return to oral intake is improved if the underlying variables resulting in the dysphagia are adequately diagnosed and if the patient is able to participate in a program of swallowing

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rehabilitation. Diagnosis of the pathophysiological or anatomical variations that result in swallowing dysfunction generally requires examination beyond that which can be performed with the clinical examination. The author discusses the clinical indicators of dysphagia, frequent etiologies for disordered deglutition (swallowing), and various methods for assessment. 5 tables. 87 references. •

Medications and Dysphagia: How Do They Impact Each Other? Source: Nutrition and Clinical Practice. 14(5 Supplement): S27-S30. October 1999. Contact: Available from American Society for Parenteral and Enteral Nutrition. 8630 Fenton Street, Suite 412, Silver Spring, MD 20910-3805. (301) 587-6315. Summary: Dysphagia is a clinical syndrome that describes the problems or inability to swallow a wet or dry bolus properly and is associated with an impairment in the transportation of the bolus. This article considers how medications can affect any of the three main phases of swallowing: oral, pharyngeal, and esophageal. Medications may cause side effects, such as dry mouth or cognitive impairment, that have a physiologic effect that causes or worsens dysphagia or induces esophagitis. The author emphasizes that understanding the pathophysiology of dysphagia as well as the pharmacology of the medications will heighten the clinicians' awareness to this often misunderstood syndrome. Specific syndromes discussed include transfer dysphagia, cognitive impairment, xerostomia, tardive dyskinesia, neuroleptic malignant syndrome, Parkinson's disease, thyroid disorders, achalasia, esophageal chest pains, gastroesophageal reflux disease (GERD), alcohol use, odynophagia (painful swallowing), and impaired nutritional status associated with dysphagia. The author concludes by recommending a comprehensive medication history of both over the counter and prescription medications that should be done with every patient to rule out medications as a cause of dysphagia. 4 tables. 14 references.

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Esophageal Dysphagia: Is the Cause Benign or Potentially Deadly? Source: Journal of Critical Illness. 13(4): 236-242, 245-246. April 1998. Contact: Available from Cliggott Publishing Company. 55 Holly Hill Lane, Box 4010, Greenwich, CT 06831-0010. Summary: Dysphagia, or difficulty in swallowing, may be a manifestation of a benign process or a symptom of malignant disease. This article reviews the causes of dysphagia and the recommended approach to diagnosis. The authors focus on the most common esophageal causes of dysphagia and describe available diagnostic methods and management options. The authors note that clues in the patient history often point to the cause. For example, worsening dysphagia and weight loss in a patient older than 50 years may indicate esophageal carcinoma, while chest pain associated with intermittent dysphagia suggests diffuse esophageal spasm. If dysphagia occurs with both solids and liquids or with liquids alone, a motility disorder, such as achalasia or scleroderma, or a spastic motor disorder may be the culprit. Achalasia is often characterized by bland regurgitation of ingested food and thick saliva; weight loss may be striking. A barium swallow with a solid bolus challenge is the initial test for all patients who have dysphagia. Esophageal manometry or esophagogastroscopy may be required for definitive diagnosis. The authors present an algorithm to help with the diagnostic strategy. 5 figures. 2 tables. 10 references. (AA-M).

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Textural Property Considerations of Food for Dysphagia Source: Nutrition and Clinical Practice. 14(5 Supplement): S57-S59. October 1999. Contact: Available from American Society for Parenteral and Enteral Nutrition. 8630 Fenton Street, Suite 412, Silver Spring, MD 20910-3805. (301) 587-6315. Summary: Food and liquid textures play very important roles in the care of people with dysphagia (swallowing difficulty). This article reviews the textural property considerations of food for dysphagia. The author notes that a major source of frustration for those involved with the patient is how to determine, describe, and deliver the proper textures of foods and liquids. The science of food rheology (a study of the flow and formation of matter) offers the potential to establish standardized food textures using objective measurement techniques. The author discusses the basic physical forces of chewing and swallowing, standard food texture terminology, textures of interest in dysphagia, selection of physical measurement methods and instruments, and techniques to determine the boundaries between the levels of the dysphagia diet. 2 figures. 14 references.

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Role of the School-Based Speech-Language Pathologist Serving Preschool Children with Dysphagia: A Personal Perspective Source: Language, Speech, and Hearing Services in Schools. 31(1): 42-49. January 2000. Contact: Available from American Speech-Language-Hearing Association (ASHA). Product Sales, 10801 Rockville Pike, Rockville, MD 20852. (888) 498-6699. TTY (301) 8970157. Website: www.asha.org. Summary: Increasing numbers of children with complex medical conditions are being referred to preschool programs managed by the public school system. And although school based speech language pathologists are often expected or required to work with children exhibiting dysphagia (swallowing disorders), they often lack the necessary resources, equipment, or training. This article presents the background for the service delivery model that is used by the speech language pathologists who work with preschoolers with dysphagia in the Montgomery County, Maryland public school system. The author addresses the controversy about whether this more traditional medical intervention belongs in the educational model. In the educational setting, information and techniques must be accurately and safely transmitted to the entire team working with the child. Ongoing communication between the medical community and the school staff is crucial. The increased responsibility of the speech language pathologist brings with it a variety of concerns, including safety, mandatory cardiopulmonary resuscitation (CPR) training, awareness of dangerous mealtime practices, specific education in pediatric dysphagia intervention, liability, and financial support. 8 references.

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Therapy for Children with Swallowing Disorders in the Educational Setting Source: Language, Speech, and Hearing Services in Schools. 31(1): 50-55. January 2000. Contact: Available from American Speech-Language-Hearing Association (ASHA). Product Sales, 10801 Rockville Pike, Rockville, MD 20852. (888) 498-6699. TTY (301) 8970157. Website: www.asha.org. Summary: Many children of all ages with swallowing disorders (dysphagia) now receive at least part of their swallowing therapy in the public schools. This article provides an overview of available treatment procedures for children with dysphagia.

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The author presents the various types of swallowing therapy available, including postural changes, sensory enhancements, changes in feeding processes, and exercise programs. Other therapy issues discussed include the relationship of the feeding process to swallowing therapy, the management of drooling, the schedule of therapy, and maintenance programs as compared to therapy. The author concludes that there are many issues involved in determining the nature of treatment to be delivered to a child with dysphagia. However, if the speech language pathologist obtains information from a careful and detailed (usually instrumental) assessment of the child's oropharyngeal swallowing, as well as other aspects of the child's functioning, treatment for swallow disorders in the public schools can be safe and efficient. The article concludes with a list of references for additional reading on therapy procedures. 45 references. •

Dysphagia Caused by Neurologic Deficits Source: Otolaryngologic Clinics of North America. 31(3): 507-524. June 1998. Contact: Available from W.B. Saunders Company. 6277 Sea Harbor Drive, Orlando, FL 32887-4800. Summary: Normal swallowing is a complex, dynamic neuromuscular activity that depends on a set of physiologic behaviors resulting in liquid and solid material moving efficiently and safely from the mouth to the stomach. Problems with swallowing in the oropharynx (oropharyngeal dysphagia) are often linked to neurologic or muscular diseases. This article reviews the neurologic lesions and conditions that account for the majority of oropharyngeal dysphagia cases. The authors first review the physiology and neurophysiology of both normal and abnormal swallowing, then outline the recommended patient physical examination and laboratory work up. Each neurological disease that may contribute to oropharyngeal dysphagia is then discussed: amyotrophic lateral sclerosis, Parkinson's disease, Huntington's disease, multiple sclerosis, myasthenia gravis, stroke (cerebrovascular accident), and laryngeal nerve injury. Dysphagia secondary to acute neurologic deficits, along with other abnormalities, tends to improve with time. Dysphagia resulting from chronic neurologic conditions, however, often worsens as the disease process evolves. 4 tables. 62 references.

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Management of Pediatric Dysphagia Source: Otolaryngologic Clinics of North America. 31(3): 453-476. June 1998. Contact: Available from W.B. Saunders Company. 6277 Sea Harbor Drive, Orlando, FL 32887-4800. Summary: Optimal management strategies are critical for infants and children with feeding and swallowing problems (pediatric dysphagia). This article outlines management decisions for this population. The author stresses that management decisions are best made through a team approach in which caregivers participate with medical and educational professionals to work toward maximizing each child's nutritional status in the context of safe and efficient feeding. Management decisions may incorporate nutrition recommendations, medical and surgical decisions, position guidelines, oral motor and swallow practice, and behavioral intervention. Goals are determined in light of health issues, with adequate nutrition as the most important goal for long term growth. The author discusses management strategies including: food rules applicable to all children beyond infancy, position and posture changes, alterations in various attributes of food and liquid, oral motor and swallow function, utensil changes, adjustments in feeding schedule and pacing, and behavioral intervention with failure to thrive in the context of global issues for children who are oral and non oral feeders.

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Readers are reminded that optimal management of nutrition regardless of the route for meeting nutrition and hydration needs, as well as airway and gastrointestinal systems, is necessary for all children in order for clinicians to proceed with behavioral based therapeutic approaches. 1 figure. 7 tables. 75 •

Understanding Dysphagia: A Parent's Guide Source: Exceptional Parent: 74-77. October 2002. Contact: Available from Exceptional Parent, 65 East Route 4, River Edge, NJ 07661. (201) 489-4111. Fax: (201) 489-0074. PRICE: $2.95 per online article. Summary: Parents need to be aware of the signs of swallowing problems (dysphagia) and know what to do if they suspect their child has a swallowing problem. This article provides parents with an overview of dysphagia, including types of swallowing problems, common signs of this condition, and the types of tests and procedures that take place when a child is evaluated. Parents are alerted to a list of common signs of dysphagia as well as the various tests that can be performed if further evaluation is necessary. If dysphasia is diagnosed, a plan of support should take the child's health and lifestyle into consideration. Relevant Web site addresses and contact information for supply resources also are provided.

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Evaluation and Management of Postfundoplication Dysphagia Source: American Journal of Gastroenterology. 91(11): 2318-2322. November 1996. Summary: Persistent dysphagia occurs in 3 to 24 percent of patients after fundoplication. This article describes the evaluation and management of postfundoplication dysphagia. There are virtually no data on the success or safety of endoscopic dilation to relieve postfundoplication dysphagia. The authors report on their experience with the endoscopic management of these patients. Thirty-five patients (mean age 49 years; 12 males, 23 females) with dysphagia after fundoplication were referred for endoscopic dilation. Twenty-nine patients had undergone one fundoplication (group A) and six patients had undergone two or more operations (group B). The integrity of the fundoplication was evaluated by barium esophogram and upper endoscopy. In group A, no complications, such as disruption of the fundoplication, resulted from endoscopic dilation, and no one developed new reflux symptoms. Dysphagia resolved in 15 of these 29 patients (52 percent) after dilation. The most important prognostic feature was endoscopic or radiological evidence of a slipped fundoplication. Dilation was successful in relieving dysphagia in only 3 of 11 (27 percent) patients with a slipped fundoplication, compared with 12 of 18 (67 percent) patients with an intact fundoplication. Dysphagia resolved in only one of the six patients in group B. The authors conclude that endoscopic dilation is safe and often effective in patients with postfundoplication dysphagia. However, patients with a slipped fundoplication or who have undergone multiple fundoplications respond poorly to endoscopic dilation. 4 figures. 5 tables. 18 references. (AA-M).

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Dysphonia and Dysphagia Following the Anterior Approach to the Cervical Spine Source: Archives of Otolaryngology-Head and Neck Surgery. 127(1): 51-55. January 2001. Contact: Available from American Medical Association. Subscriber Services, P.O. 10946, Chicago, IL 60610-0946. (800) 262-3250 or (312) 670-7827. Fax (312) 464-5831. E-mail: [email protected]. Website: www.ama-assn.org/oto.

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Summary: Speech dysfunctions (dysphonia) and swallowing dysfunctions (dysphagia) are common following the use of the anterior surgical approach to the cervical spine. Despite functional morbidity and legal implications, the incidence and etiologic factors of these complications have not been adequately established. This article reports on a study in which a questionnaire was mailed to 497 patients who had undergone anterior cervical fusion or anterior cervical discectomy at a university hospital; 150 questionnaires were sent to a control group. The study group response rate was 46 percent; the control group response rate was 51 percent. The incidence of hoarseness in the study group was 51 percent (control group, 19 percent). This difference is statistically significant. Dysphagia was present in 60 percent of the study group patients versus 23 percent of control group patients, also statistically significant. Qualitative questions revealed that constant hoarseness, pain with talking, difficulty eating solid foods, and odynophagia were significantly more common following the anterior approach to the cervical spine. The authors caution that hoarseness and dysphagia may adversely affect recovery and the patient's sense of well being. Preoperative counseling and postoperative evaluation are essential. 1 figure. 4 tables. 10 references. •

Serving Students with Dysphagia in the Schools?: Educational Preparation Is Essential! Source: Language, Speech, and Hearing Services in Schools. 31(1): 76-78. January 2000. Contact: Available from American Speech-Language-Hearing Association (ASHA). Product Sales, 10801 Rockville Pike, Rockville, MD 20852. (888) 498-6699. TTY (301) 8970157. Website: www.asha.org. Summary: Speech language pathologists employed in public schools often serve students with dysphagia (swallowing disorders). This article reviews the delivery of dysphagia interventions to these students. The author emphasizes that students with significant health problems, severe disabilities, or orthopedic impairments may require the services of a school team. This team may be missing a person with adequate training in swallowing evaluation and treatment. The author concludes that speech language pathologists should not provide services to students with dysphagia without pursing continuing education to acquire the necessary knowledge and skills to do so. Providing services without this additional training would compromise the speech language pathologist's ethical standards, jeopardize the student's health, and create undue liability for the school division. 1 table. 6 references.

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Systemic Causes of Dysphagia in Adults Source: Otolaryngologic Clinics of North America. 31(3): 525-535. June 1998. Contact: Available from W.B. Saunders Company. 6277 Sea Harbor Drive, Orlando, FL 32887-4800. Summary: The act of swallowing is the most intricate neuromuscular action carried out in the body and because of this complexity, swallowing is affected by many systemic diseases. This article explores the systemic causes of dysphagia (difficulty swallowing) in adults. After recommending that readers first distinguish between oropharyngeal and esophageal dysphagia, the author discusses the etiology (causes) in categories including congenital, traumatic, neoplastic (including cancer), infection, inflammation, degenerative (due to aging), and psychological disorders. In the inflammatory category, the broadest category of diseases that cause dysphagia, the author summarizes the manner in which each of the following diseases may affect swallowing: systemic sclerosis, systemic lupus erythematosus, dermatomyositis, mixed connective tissue

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disease, benign mucosal pemphigoid and epidermolysis bullosa, Sjogren's syndrome, rheumatoid arthritis, and secondary autoimmune diseases. It is essential that all patients who present with dysphagia have as thorough a work up as necessary to determine the etiology of their dysfunction. If the cause of a patient's dysphagia is not apparent after a complete head and neck examination, barium swallow, and upper gastrointestinal endoscopy, then a complete physical examination, laboratory testing, and special gastrointestinal tests should be performed to determine if a generalized illness is present. 43 references. •

Evolution of the Evaluation and Treatment of Dysphagia Across the Health Care Continuum: A Historical Perspective-Inception to Proliferation Source: Nutrition and Clinical Practice. 14(5 Supplement): S13-S18. October 1999. Contact: Available from American Society for Parenteral and Enteral Nutrition. 8630 Fenton Street, Suite 412, Silver Spring, MD 20910-3805. (301) 587-6315. Summary: The complexity of swallowing has been long appreciated and was described before the development of a sophisticated modality for direct viewing of the swallowing process. This article reviews the history of the discovery of the physiologic principles of swallowing and the development of the evaluation and management of dysphagia. The author describes appropriate diagnostic and treatment tools for various care environments, including acute care hospitals, subacute facilities, rehabilitation hospitals, ambulatory clinics, and home care. Differences in the delivery of dysphagia services in each setting are discussed. The author challenges dysphagia clinicians to provide care on the basis of patient need rather than reimbursement structure. 1 table. 45 references.

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Anatomy and Physiology of Pediatric Swallowing Disorders Source: Otolaryngologic Clinics of North America. 31(3): 397-404. June 1998. Contact: Available from W.B. Saunders Company. 6277 Sea Harbor Drive, Orlando, FL 32887-4800. Summary: The functions of the mouth, pharynx, and esophagus are related primarily to the digestive system and represent the most complex neuromuscular unit in the body. The interface between the digestive system, the respiratory system, and the speech producing mechanism further complicates the physiologic of this region, which is under both voluntary and involuntary (reflex) control. This article outlines the relationships between these structures and the functional anatomic units that are derived from them. The authors also present the physiologic changes that accompany maturation from the newborn period through infancy and childhood. The authors separate their discussion into dysphagia (difficulty with swallowing) and the healthy swallowing process. 2 figures. 14 references.

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Dilatation Therapy for Dysphagia in Patients with Upper Esophageal Sphincter Dysfunction: Manometric and Symptomatic Response Source: Diseases of the Esophagus. 11(4): 254-259. October 1998. Contact: Available from Harcourt Brace and Company, Ltd. Journal Subscription Department. Foots Cray, Sidcup, Kent, DA 14 5HP. Summary: The inability to maintain oral nutrition because of oropharyngeal dysphagia is common in patients with a variety of neurologic and neuromuscular disorders and severely affects quality of life. This article reports on a study that followed 10 patients

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with oropharyngeal dysphagia and either elevated upper esophageal sphincter (UES) resting pressure, or a high residual pressure or attenuated duration of relaxation on swallowing. The authors note that disorders at the level of the UES can lead to mechanical obstruction to solid foods and incoordination resulting in problems with liquids. Dilation therapy was performed with an 18 to 20 mm Savary dilator, and manometry was repeated after an average period of 4 weeks. A total of 9 out of 10 patients saw their dysphagia improve and have maintained oral nutrition for a mean followup of 13 months. UES residual pressure decreased in 9 out of 10 patients, and the group media value decreased significantly. UES resting pressure decreased in 8 out of 10 patients, and the group median value decreased. Duration of relaxation did not change significantly. Videoradiography was normal in 5 out of 9 responders to therapy. The authors conclude that, for selected patients with oropharyngeal dysphagia and manometric signs of UES dysfunction, dilation therapy may give excellent symptomatic relief, apparently by reducing UES resting pressure or increasing the duration and completeness of relaxation. 3 figures. 3 tables. 17 references. (AA-M). •

Legal, Ethical, and Financial Aspects of Providing Services to Children with Swallowing Disorders in the Public Schools Source: Language, Speech, and Hearing Services in Schools. 31(1): 56-61. January 2000. Contact: Available from American Speech-Language-Hearing Association (ASHA). Product Sales, 10801 Rockville Pike, Rockville, MD 20852. (888) 498-6699. TTY (301) 8970157. Website: www.asha.org. Summary: The public schools must follow laws that deal with services for children who meet the legal requirements for having a disability. Children who have swallowing disorders (dysphagia) that require the services of a speech language pathologist typically meet the definition of a child with a disability. This article addresses the importance of the speech language pathologist being aware of legal requirements for the provision of services as well as liability, ethical, and risk management issues related to the provision of such services. The author considers legal aspects as addressed under the Individuals with Disabilities Education Act (IDEA, 1997), Section 504 of the Rehabilitation Act of 1973, and the Family Educational Rights and Privacy Act (FERPA, 1974). Financial considerations relating to service provision are also described; funding of speech language pathologists' services follows the pattern for all special education funding. The author concludes by stressing the importance of all speech language pathologists knowing local school policies regarding such matters as recordkeeping and confidentiality of records. Awareness of funding issues at the local and state level, while important, is less vital than knowing the legal and ethical issues involved in serving children with dysphagia. The speech language pathologist should know what legal resources his or her system has and not be afraid to seek advice. Consideration should also be given to the purchase of liability insurance, because defending oneself in a professional liability action can be expensive. 23 references.

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Nutrition Issues in Dysphagia: Identification, Management, and the Role of the Dietitian Source: Nutrition and Clinical Practice. 14(5 Supplement): S47-S51. October 1999. Contact: Available from American Society for Parenteral and Enteral Nutrition. 8630 Fenton Street, Suite 412, Silver Spring, MD 20910-3805. (301) 587-6315. Summary: The relationship between dysphagia and malnutrition is strong. This article discusses the identification and management of nutrition issues in dysphagia, focusing

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on the role of the dietitian. The author cautions that if dysphagia is undiagnosed or untreated, it can result in progressive malnutrition and its related sequelae. Registered dietitians can play an essential role in early identification of patients at risk for dysphagia and in the development of dysphagia focused nutrition care plans. Dysphagia screening, including mealtime observation, and basic physical examinations can assist in identification and referral to the dysphagia team. The nutrition care plan should be individualized and centered around the primary goal of nutrition therapy for the dysphagic patient, i.e., adequate and safe intake of nutrients. The author concludes that creative and nutritious meal planning as well as continuous monitoring with review of risk factors and diet adjustments are critical to the success of the nutrition plan. 1 figure. 2 tables. 22 references. •

Approaches for Management of Dysphagia: Evidence-Based Practice in the Community Source: Nutrition and Clinical Practice. 14(5 Supplement): S31-S34. October 1999. Contact: Available from American Society for Parenteral and Enteral Nutrition. 8630 Fenton Street, Suite 412, Silver Spring, MD 20910-3805. (301) 587-6315. Summary: The stress and complexity of care associated with dysphagia (swallowing disorders), which is a complex disorder managed best by an interdisciplinary team and client family partnership, tend to be underestimated by health providers, family caregivers, and especially third party payment sources. So contend the authors of this article reviewing approaches for managing patients with dysphagia. The authors stress that health providers who use the approaches described in this article may improve outcomes for more clients who have dysphagia and enable them to return home. The authors outline the epidemiologic approach, the ecological approach, a partnership approach, and a holistic approach. The authors consider the sociocultural implications of dysphagia and the many dimensions of the rituals of eating. 15 references.

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Surgical Management of Oropharyngeal Dysphagia Source: Nutrition and Clinical Practice. 14(5 Supplement): S37-S38. October 1999. Contact: Available from American Society for Parenteral and Enteral Nutrition. 8630 Fenton Street, Suite 412, Silver Spring, MD 20910-3805. (301) 587-6315. Summary: There are several types of oropharyngeal dysphagia that are amenable to surgical correction. This article discusses the surgical management of oropharyngeal dysphagia. The author discusses the role of cricopharyngeal myotomy in various forms of dysphagia, the surgical approaches to Zenker's diverticulum, and various surgical options in the management of chronic aspiration. Cricopharyngeal myotomy (CPM) is a procedure designed to decrease the pharyngoesophageal sphincter (PES) pressure by incising the main muscular component of the PES, the cricopharyngeus muscle. PES dysfunction is always seen in patients with Zenker's diverticulum. The author outlines six procedures that can be used for chronic aspiration: tracheotomy, medialization, laryngeal suspension, CPM, laryngeal closure, and laryngotracheal separation or diversion. The author concludes that there is a need for more prospective studies to guide clinicians in the management of dysphagia, both in deciding whether to perform surgery at all and to choose which procedure will have the highest chance of success in helping the individual patient. 6 references.

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Oropharyngeal Dysphagia in the Elderly Source: Clinics in Geriatric Medicine. 8(3): 569-577. August 1992. Summary: This article describes the effects of normal and pathologic aging on swallowing. The author notes that more elderly persons require institutionalization and dysphagia is more prevalent in older institutionalized persons, specifically males over age 60. Topics covered in the article include the physiology of normal swallowing, aging and associated effects on the oropharyngeal swallow, the causes of dysphagia, specific symptoms of dysphagia in neurologic conditions, and oropharyngeal dysphagia in institutional settings. The author concludes that oropharyngeal dysphagia in the elderly is the specific result of a pathologic condition or illness that may occur more commonly in elderly persons. These conditions are neurologic, neuromuscular, systemic, immunologic, psychiatric, environmental, or societal in nature. 3 tables. 39 references. (AA-M).

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National Dysphagia Diet Project: The Science and Practice Source: Nutrition and Clinical Practice. 14(5 Supplement): S60-S63. October 1999. Contact: Available from American Society for Parenteral and Enteral Nutrition. 8630 Fenton Street, Suite 412, Silver Spring, MD 20910-3805. (301) 587-6315. Summary: This article describes the National Dysphagia Diet project, a program that was conceived by the Dietetics in Physical Medicine and Rehabilitation dietetic practice group in 1996. The group formed a task force, whose goal it was to formulate a new dysphagia diet based on scientific food properties and clinical swallowing problems. Members of the task force include food scientists, clinical and consulting dietitians, speech language pathologists, and food industry representatives, all who have an interest and experience in dysphagia (swallowing disorders). The result of the project is a multilevel dysphagia diet that will be published by the American Dietetic Association in 1999. Another goal of the task force is to standardize all dysphagia diets on a national basis to enhance communication among professionals, institutional food preparers, and food industry leaders to provide better and more consistent care for dysphagic patients. 1 table. 9 references.

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Flexible Endoscopic Evaluation of Swallowing with Sensory Testing (FEESST) to Diagnose and Manage Patients with Pharyngeal Dysphagia Source: Practical Gastroenterology. 24(4): 52, 54, 56, 58-59. April 2000. Contact: Available from Shugar Publishing. 12 Moniebogue Lane, Westhampton Beach, NY 11978. (516) 288-4404. Fax (516) 288-4435. Summary: This article describes the use of flexible endoscopic evaluation of swallowing with sensory testing (FEESST), in the diagnosis and management of patients with pharyngeal dysphagia (swallowing difficulty). The authors stress that the comprehensive evaluation of the patient with dysphagia entails a detailed assessment of bolus transport in conjunction with airway protection. As gastroenterologists continue to diagnose and manage patients with dysphagia, an analysis of the hypopharynx as well as the esophagus is necessary; i.e., with FEESST. Unlike the modified barium swallow (MBS), FEESST does not involve x-ray exposure, barium administration, or the presence of a radiologist or a radiology technician. Instead, FEESST involves endoscopy, and gives direct evidence regarding the handling of secretions. Moreover, this technique provides an objective assessment of hypopharyngeal sensitivity which, in turn, gives the clinician information regarding a patient's ability to protect their airway during the

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ingestion of food. Like MBS, FEESST requires the participation of a speech language pathologist (SLP), and is extremely useful in guiding the dietary and behavioral management of patients with difficulty swallowing. The authors describe the use of the FEESST technique and provide a basic approach to the management of patients with pharyngeal dysphagia (with the goal of guarding against aspiration and the consequences of aspiration pneumonia). 3 figures. 1 table. 14 references. •

Home Care Team Approach to Dysphagia Source: Caring Magazine. 9(10): 66-69. October 1990. Summary: This article discusses a home care team approach to dysphagia. Chronic medical problems and multiple medications can contribute to dysphagia, compromising the patient's nutritional status. The authors stress that the comprehensive management of dysphagia in the home setting includes coordination between the home care team, the hospital's dysphagia team, and the patient and his or her caregiver. Early detection, followed by evaluation, treatment, and education can provide the patient with the best opportunity for a positive outcome. Three sidebars present possible physical complications that can disturb swallowing, a dysphagia evaluation checklist, and a sample pureed diet with thick liquids. 2 references. (AA-M).

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Swallowing Disorders and Nutritional Support Source: Dysphagia. 4(4): 213-219. 1990. Summary: This article discusses swallowing disorders and nutritional support. Evaluation of nutritional needs in patients with swallowing disorders should include a global assessment. The global assessment includes a nutritional assessment, a determination of the metabolic state, and a separation of the causes of nutrient deficits due to the patient's underlying disease(s) from diminished nutrient intake related to the dysphagia. Techniques for intense nutritional support are surveyed and the complications of each technique are discussed. 4 tables. 11 references.

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Differential Diagnosis of Dysphagia in Children Source: Otolaryngologic Clinics of North America. 31(3): 435-451. June 1998. Contact: Available from W.B. Saunders Company. 6277 Sea Harbor Drive, Orlando, FL 32887-4800. Summary: This article explores the differential diagnosis of dysphagia in children. Dysphagia is defined as any process that produces difficulty with active transport of food and liquid from mouth to stomach. The authors divide diagnostic pediatric dysphagia into categories including congenital, infectious or inflammatory, systemic, neoplastic, traumatic, and miscellaneous causes. In the first section, the authors discuss choanal atresia (complete nasal obstruction), congenital nasal masses, and cleft lip or cleft palate, laryngomalacia, vocal cord paralysis, laryngeal clefts, tracheoesophageal fistula or esophageal atresia, foregut malformations, and vascular rings. Infectious causes considered include acute pharyngitis, tonsillitis, peritonsillar abscess, retropharyngeal abscess, other deep neck abscesses, epiglottis, and esophagitis. Other causes covered are neurologic causes of dysphagia, central nervous system diseases, diseases of the neuromuscular junction, neoplastic causes of dysphagia (hemangioma, lymphangioma, papilloma, leiomyoma, neurofibroma), oral cavity and posterior pharyngeal injury, surgically related dysphagia, external trauma, caustic ingestion, gastroesophageal reflux, and foreign bodies of the upper aerodigestive tract. The

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authors caution that the diagnostic work up can be extremely difficult and exhaustive in many cases. Typical of any diagnostic dilemma, emphasis on history and physical examination remains paramount. Imaging studies can be extremely valuable in certain cases. Once a diagnosis has been established, treatment options are often less problematic. 4 figures. 1 table. 43 references. •

AGA Technical Review on Management of Oropharyngeal Dysphagia Source: Gastroenterology. 116(2): 455-478. February 1999. Contact: Available from W.B. Saunders Company. 6277 Sea Harbor Drive, Orlando, FL 19106-3399. (800) 654-2452 or (407) 345-4000. Summary: This article offers a technical literature review on the management of oropharyngeal dysphagia (swallowing difficulty). The authors describe their selective approach to the literature: outlining a systematic clinical approach to the dysphagic patient and then selecting key illustrative references to either highlight the logic of that approach or substantiate advocated interventions. Editorial emphasis was placed on critical analysis of more current and controversial concepts requiring a broader perspective of the literature. The authors first review oropharyngeal dysphagia and normal oropharyngeal swallowing. They then outline the American Gastroenterological Association (AGA) recommendations stemming from the literature. Clinical assessment of patients with suspected oropharyngeal dysphagia should address five fundamental questions that permit the clinician to establish investigational priorities: does the dysphagia compare with globus sensation or hyposalivation; is the origin of the dysphagia oropharyngeal or esophageal; is there any structural or functional disorder; how severe is the dysphagia and are there any complications; and is there an underlying related or causative disease? The authors review the patient history taking, physical examination, laboratory tests, diagnostic investigations (videofluoroscopic swallowing evaluation, nasoendoscopy, manometry, manofluorography), selection among management options. Management options include surgery and dilation, and swallowing therapy. The authors note the importance of establishing whether or not the patient will be able to sustain adequate nutrition safely via the oral route. The natural history and prognosis of the underlying cause of dysphagia, as well as the patient's cognitive ability, will also influence the choice between oral and nonoral feeding. Introduction of dietary modification and specific swallowing therapy is appropriate at this point. 3 figures. 7 tables. 197 references.

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Increasing Liquid Consumption in Patients with Dysphagia Source: Advance for Speech-Language Pathologists and Audiologists. 10(45): 4, 12. November 13, 2000. Contact: Available from Merion Publications, Inc. 2900 Horizon Drive, P.O. Box 61556, King of Prussia, PA 19406-0956. Summary: This article offers strategies for increasing liquid consumption in patients with dysphagia (swallowing difficulties), focusing on the avoidance of three potential health complications: aspiration pneumonia, malnutrition, and dehydration. The author notes that these conditions are all interrelated and that dysphagia leaves patients at great risk for all three. The author reports on a study that showed that using prethickened, prepackaged, ready to serve beverages, as opposed to those that are manually thickened, helps hospital patients and long term care residents with dysphagia to receive more balanced diets with appropriate fluid. In addition, the incidence of error is greatly reduced, and there are benefits in the area of staff

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utilization. The author also considers the impact of aging on these risk factors. The author notes that the study not only supported the use of these prethickened beverages, but also incorporated staff education about the importance of using beverages with the correct viscosity for patients and residents with dysphagia. Utilizing these beverages also helped the patients take their medications more successfully. •

Current Research Trends in Dysphagia and Dysphagia Management Source: Nutrition and Clinical Practice. 14(5 Supplement): S66-S69. October 1999. Contact: Available from American Society for Parenteral and Enteral Nutrition. 8630 Fenton Street, Suite 412, Silver Spring, MD 20910-3805. (301) 587-6315. Summary: This article on current research trends in dysphagia and dysphagia management is from a special issue of Nutrition and Clinical Practice that reprints presentations from a conference on dysphagia (swallowing disorders). The author notes that dysphagia is a relatively new area in the scheme of research. However, research studies in dysphagia have been emerging rapidly over the past two decades. The author briefly reviews general research methodology, then describes how dysphagia research follows the general research pattern. The author describes her literature searches that support these contentions. Topics include the history of dysphagia research, funded research in dysphagia, evidence based analysis of dysphagia research, the current status of dysphagia research, and the challenges for the future in this research area. 10 references.

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Old Swallowing and Dysphagia: Thoughts on Intervention and Prevention Source: Nutrition and Clinical Practice. 14(5 Supplement): S21-S26. October 1999. Contact: Available from American Society for Parenteral and Enteral Nutrition. 8630 Fenton Street, Suite 412, Silver Spring, MD 20910-3805. (301) 587-6315. Summary: This article on swallowing and dysphagia (swallowing difficulties) in older adults is from a medical nutrition and device roundtable on dysphagia. In this article, the author considers the role of intervention and prevention. Topics include the incidence of swallowing problems in aging adults; the levels of outcomes assessment in healthy swallowing; swallowing outcomes related to age related disease; and clinical dysphagia related outcomes, including mortality, health status, aspiration pneumonia, nutrition and hydration, and intervention and prevention paradigms. The author concludes that the increasing geriatric population demands practitioners move beyond a 'feel good' perspective about growing old gracefully, to the science of positive aging. Knowledge of specific age related changes permits clinicians and scientists to distinguish healthy old swallowing from dysphagia. It appears the possibility of delaying the onset of dysphagia by proactive exercise regimens for aging adults is the most promising strategy for preserving health and quality of life in this area. 1 figure. 37 references.

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American Gastroenterological Association Medical Position Statement on Management of Oropharyngeal Dysphagia Source: Gastroenterology. 116(2): 452-454. February 1999. Contact: Available from W.B. Saunders Company. 6277 Sea Harbor Drive, Orlando, FL 19106-3399. (800) 654-2452 or (407) 345-4000.

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Summary: This article presents the official recommendations of the American Gastroenterological Association (AGA) on the management of oropharyngeal dysphagia (swallowing disorders). The article encourages clinicians to prioritize clinical objectives; each objective is summarized with a brief outline of how to approach each step. These recommendations are developed from a critical review of the medical literature. The recommendations are: ascertain whether oropharyngeal dysphagia is likely and identify the likely etiology (cause); identify structural etiologies of oropharyngeal dysfunction; ascertain the functional integrity of the oropharyngeal swallow (which part of the swallow function is not working); evaluate the risk of aspiration pneumonitis; and determine if the pattern of dysphagia is amenable to therapy. Once structural lesions have been excluded, data supporting surgical intervention are weak. Current strategies of swallowing therapy are modification of diet, swallowing posture, or swallowing technique. The strongest recommendation that can be made pertains to diet modification, with efficacy studies showing reduced risk of airway penetration and of aspiration pneumonia. The article includes a patient care algorithm that summarizes the implementation of these recommendations. 1 figure. 1 reference. •

Unusual Case of Dysphagia Source: Archives of Otolaryngology, Head and Neck Surgery. 121(10): 159-160. October 1995. Summary: This article reports a case of myasthenia gravis in a patient who presented with dysphagia. The patient had been seen by several specialists who had performed a multitude of tests without reaching the correct diagnosis. Symptoms of dysphagia differ according to the cause. The authors stress that both neuromuscular and esophageal causes must be considered in the evaluation of dysphagia. 10 references. (AA-M).

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Swallowing Disorders Following Acute Stroke: Prevalence and Diagnostic Accuracy Source: Cerebrovascular Diseases. 10(5): 380-386. September-October 2000. Contact: Available from Karger. Customer Service, P.O. Box, CH-4009, Basel, Switzerland. Fax 41 61 306 12 34. Website: www.karger.com. Summary: This article reports on a study of 128 patients with acute, first ever, stroke (cerebrovascular accident). The study was undertaken to determine the prevalence of swallowing disorders, the diagnostic accuracy of the clinical assessment of swallowing function compared with videofluoroscopy, and interobserver agreement for the clinical and videofluoroscopic diagnosis of swallowing disorders and aspiration. The authors found clinical and videofluoroscopic evidence of a swallowing disorder in 51 percent and 64 percent of patients, respectively, and aspiration in 49 percent and 22 percent of patients, respectively. The interobserver agreement between two speech pathologists for the clinical diagnosis of a swallowing disorder and aspiration was food. Between a speech pathologist and radiologist for the videofluoroscopic, diagnosis of a swallowing disorder and aspiration was good' and fair' respectively. Although clinical bedside examination underestimates the frequency of swallowing abnormalities and overestimates the frequency of aspiration compared with videofluoroscopy, bedside examination may still offer valuable information for the diagnosis of swallowing impairment. Long term follow up studies are necessary to determine the use of these types of examinations in predicting the occurrence of important outcome events such as aspiration pneumonia. 2 appendices. 1 figure. 4 tables. 31 references.

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Moving Toward Specialized Education and Training in Dysphagia Source: Advance for Speech-Language Pathologists and Audiologists. 4(24): 14-15,40. October 17, 1994. Contact: Available from Merion Publications, Inc. 650 Park Avenue West, King of Prussia, PA 19406. (800) 355-1088. Summary: This article reports on recent increases in the instances of feeding and swallowing disorders in the caseloads of speech-language pathologists and discusses the need for increased education and training in dysphagia for these professionals. Topics covered include changes in regulations that establish quality of care levels for people with dysphagia; the assessment and treatment of dysphagia as a specialty within the speech language pathology field; the impact of changes in health care, such as shortened hospital stays; the incidence of dysphagia, particularly among geriatric and pediatric populations; the importance of accurate assessment to adequate treatment design; courses in place in medical care and training facilities around the country; and the dysphagia special interest group of the American Speech-Language-Hearing Association (ASHA). The article concludes with a brief discussion of certification in this specialty.

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Recent Advances in the Assessment and Treatment of Dysphagia Source: Current Opinion in Otolaryngology and Head and Neck Surgery. 7(3): 107-111. June 1999. Contact: Available from Lippincott Williams and Wilkins. 12017 Insurance Way, Hagerstown, MD 21740. (800) 638-3030 or (301) 714-2300. Fax (301) 824-7390. Website: www.lww.com. Summary: This article reviews developments in dysphagia (swallowing disorders) research of importance to head and neck specialists. The authors emphasize swallowing function after head and neck surgery, in patients with compromised airways, and in association with normal aging. The authors also discuss analysis techniques that permit insights into the effects of specific residual impairments on swallowing physiology, have predictive capabilities, or are of value in directing treatment. Dysphagia is an important risk for aspiration pneumonia, but generally not sufficient to cause pneumonia unless other risk factors are present as well. The authors conclude that advances in dysphagia emulation techniques has led to a closer understanding of normal and abnormal swallowing. 26 references. (AA-M).

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Esophageal Dysphagia: Differentiating Benign from Life-Threatening Causes Source: Consultant. 37(10): 2626-2628, 2633, 2636-2640. October 1997. Contact: Available from Cliggott Publishing Company. 55 Holly Hill Lane, Box 4010, Greenwich, CT 06831-0010. Summary: This article reviews the causes of dysphagia (swallowing disorders) and the approach to diagnosis. The authors focus on the most common esophageal causes of dysphagia and describe available diagnostic methods and management options. Worsening dysphagia and weight loss in a patient older than 50 years may indicate esophageal carcinoma, while chest pain associated with intermittent dysphagia suggests diffuse esophageal spasm. Progressive symptoms in a patient with chronic heartburn may be caused by peptic stricture. If dysphagia occurs with both solids and liquids or with liquids alone, a motility disorder, such as achalasia, scleroderma, or a spastic motor

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disorder, may be involved. Achalasia is often characterized by bland regurgitation of ingested food and thick saliva; weight loss may be striking. A barium swallow with a solid bolus challenge is the initial test for all patients who have dysphagia. Esophageal manometry and or esophagogastroscopy may be required for definitive diagnosis. The authors also present an algorithm that demonstrates how clues in the patient's history can help identify the underlying cause of dysphagia. 5 figures. 2 tables. 15 references. (AA-M). •

Dysphagia: Going Down and Staying Down Source: AJN. American Journal of Nursing. 101(1): 37-43. January 2001. Contact: Available from Lippincott, Williams, and Wilkins. 12107 Insurance Way, Hagerstown, MD 21740. (800) 638-3030 or (301) 714-2300. Fax (301) 824-7390. Website: www.lww.com. Summary: This article reviews the causes, complications, and nursing strategies for patients with swallowing difficulties (dysphagia). Often responsible for monitoring patients during meals, nurses can be the first to detect signs and symptoms of this condition. Appropriate nursing interventions can prevent life threatening complications such as aspiration, which often results in pneumonia. The author discusses the patients who are most at risk of dysphagia, the complications of swallowing problems, patient care strategies (concentration during meals, positioning), food considerations (temperature, presentation, consistency), medication concerns, and additional management techniques. One sidebar offers a summary of normal and dysfunctional swallowing (deglutition). The article concludes with a post-test with which readers can qualify for continuing education credits. 3 tables. 12 references.

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Contemporary Diagnosis of the Dysphagic Patient Source: Otolaryngologic Clinics of North America. 31(3): 489-506. June 1998. Contact: Available from W.B. Saunders Company. 6277 Sea Harbor Drive, Orlando, FL 32887-4800. Summary: This article reviews the contemporary approach to diagnosis of the patient with dysphagia (difficulty in swallowing). The diagnostic sequence used when working with a new patient with symptoms of dysphagia begins with a general medical history, followed by a focused history of the swallowing problem. After the history taking comes a thorough examination of the head and neck. At this point, many experienced clinicians may be able to accurately predict the nature and severity of the swallowing disorder. However, some sort of swallowing study is appropriate to complete the work up by revealing details of the patient's actual swallowing physiology. The author guides readers through the use of the barium swallow and the videofluoroscopic swallowing study, manometry, manofluorography (a combination of manometry and videofluoroscopic), bolus scintigraphy, ultrasonography, and a new methodology, the videoendoscopic swallowing study (VESS). 10 figures. 2 tables. 27 references.

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Evaluation of Swallowing Disorders in Children Source: Otolaryngologic Clinics of North America. 31(3): 405-418. June 1998. Contact: Available from W.B. Saunders Company. 6277 Sea Harbor Drive, Orlando, FL 32887-4800.

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Summary: This article reviews the evaluation of disorders of feeding and swallowing in children (pediatric dysphagia), serious and potentially fatal problems. Among infants, particularly those born prematurely, aspiration due to dysphagia may lead to severe pulmonary compromise, and impaired oral and pharyngeal function may rapidly result in failure to thrive. In other children, avoidance behaviors and inadequate intake may lead to chronic malnutrition. Topics include the expected stages of swallow development for each age group, classifying disorders of feeding and swallowing in children, medical history in children with disordered feeding and swallowing, the assessment of swallowing in children (including clinical or bedside evaluations), the use of imaging (radiography, ultrasound, and fiberoptic endoscopy), and otolaryngologic assessment. The authors conclude that disorders of feeding and swallowing in children are most common among children with congenital anomalies of the head and neck, and in those with congenital or acquired neuromuscular impairment. Bedside clinical assessment is often sufficient to make a diagnosis or preliminary feeding recommendations. However, videofluoroscopy is the study of choice for complete evaluation of the feeding and swallowing process. 5 figures. 8 references. •

Advances in Dysphagia Research: FEESST and the Finer Points of Endoscopic Analysis Source: ADVANCE for Speech-Language Pathologists and Audiologists. 8(41): 6-9. October 12, 1998. Contact: Available from Merion Publications, Inc. 650 Park Avenue, Box 61556, King of Prussia, PA 19406-0956. (800) 355-5627, ext. 279. E-mail: [email protected]. Website: www.advanceweb.com. Summary: This article, from a professional newsletter for speech language pathologists and audiologists, outlines current advances in dysphagia research, notably the development of a diagnostic test called flexible endoscopic evaluation of swallowing with sensory testing (FEESST). The FEESST method offers assessment of both the motor and sensory components of swallowing, thus providing an advance in specialized dysphagia management. FEESST allows clinicians to visualize the laryngopharynx during deglutition (swallowing) and to identify patients who are at risk for developing aspiration pneumonia. The article describes the indications for this evaluation method, the equipment and supplies used, risk factors associated with the examination, the types of patients that may benefit from FEESST, cost considerations, and the problem of aspiration pneumonia. The article concludes with the contact information for the primary clinician interviewed in the article.

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Cricomyotomy for Pharyngeal Swallowing Disorders Source: Practical Gastroenterology. 20(3): 22, 24, 29-30, 33-34, 36, 38. March 1996. Contact: Available from Shugar Publishing, Inc. 99B Main Street, Westhampton Beach, NY 11978. (631) 288-4404. Fax (631) 288-4435. E-Mail: [email protected]. Summary: This article, the third in a series on surgery of the gastrointestinal (GI) tract, describes cricomyotomy for pharyngeal swallowing disorders. Cricopharyngeal dysphagia may be due to muscular, neurologic, or anatomic abnormalities. The condition also increases in incidence with advancing age and may be due to a fibrotic cricopharyngeal muscle that will not open sufficiently to allow the easy passage of a swallowed bolus. A normal muscle may also cause relative obstruction to a food bolus in the presence of weak or uncoordinated pharyngeal muscle action after strokes. Failure of the food bolus to pass the cricopharyngeal sphincter often results in

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aspiration. Cricopharyngeal myotomy has low morbidity and mortality and entails only a short hospital stay. It may offer complete relief or allow satisfactory swallowing without aspiration in many selected patients. Patients are selected carefully for myotomy after radiologic and manometric evaluation of the cricopharyngeal swallowing mechanism. The results of myotomy in patients with an isolated cricopharyngeal muscle abnormality are uniformly good. In patients with swallowing disorders after strokes, swallowing may improve with time and swallowing therapy. The results of cricopharyngeal myotomy are not as predictably good in these patients as in those with muscle disease, but improvement will be obtained in up to 60 percent of patients who have not responded to conservative therapy. 5 figures. 7 tables. 12 references. (AA-M). •

New Diets for People With Dysphagia: Caregivers' Attitudes and Presentation of Food Can Make a Program Succeed or Fail Source: Provider. 53-55. April 1999. Summary: This journal article addresses the problem of serving enjoyable, appetizing, and nutritious food to long-term care residents who have difficulty swallowing. Dysphagia, a swallowing disorder, may result from stroke or neurological disorders such as Parkinson's disease, multiple sclerosis, or Alzheimer's disease. Traditionally, physicians have recommended mechanically altered food to dysphagia patients, which lack eye appeal and may reduce appetite. The authors discuss how providers can design alternative diets that are appealing and diverse and that fulfill clinical mandates. They show how a culinary team consisting of a professional chef and a registered dietician works together to create a new menu. Staff education and recognition, culinary training manuals or seminars, and a commitment to excellent food contribute to the success of a new food program. Photograph.

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Assessment of Oral, Pharyngeal and Esophageal Dysphagia in Elderly Persons Source: Physical and Occupational Therapy in Geriatrics. 14(4): 1-25. 1996. Summary: This journal article describes methods used to assess swallowing disorders in older people. It describes three phases of swallowing (oral preparatory, pharyngeal, esophageal) and the methodologies commonly used in the clinical setting to assess difficulties in each phase. The purpose, procedures, limitations, and drawbacks of each methodology are discussed, with particular attention to possible complications caused by age-related changes and disorders such as dementia. The methods available for assessment of the oral preparatory phase are limited to two feeding skill profiles that were designed for use with children and have not been validated for older people. The methods used for assessment of the pharyngeal phase include videofluoroscopy, fiberoptic endoscopy, pharyngeal manometry, the Exeter Dysphagia Assessment Technique, cervical auscultation, scintigraphy, and timed drinking tests. Those used for assessment of the esophageal phase include esophageal manometry and a bedside, questionnaire-based assessment. 1 table, 93 references.

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Dysphagia and Dementia Can Be a Dangerous Duo Source: Journal. 10: 10-12. 2000-2001. Summary: This journal article discusses problems associated with dysphagia (difficulty, pain, or inability to swallow) in people with dementia. Dysphagia makes it difficult to ingest enough calories and fluids to maintain body weight and stay healthy. This article describes the normal physiology of swallowing, how people with dementia are at risk

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when they have dysphagia, how to detect swallowing problems, how to evaluate the problem, and strategies for managing dysphagia. The article recommends an interdisciplinary approach to address the situation on many fronts. •

Dysphagia, Headache, and Dizziness as Symptoms of Cervical Spine Disorders Source: Revue du Rhumatisme (English Edition). 65(5): 346-351. May 1998. Summary: This journal article provides health professionals with information on recognizing dysphagia, headache, and dizziness as symptoms of cervical spine disorders. Much evidence points to the causal relationship between dysphagia and lesions of the cervical spine. In many cases, dysphagia is caused by a lesion or bony excrescence arising from the anterior aspect of the cervical spine. Sometimes, dysphagia is caused by anterior cervical disk herniation. Other causes include spondylolisthesis, discal calcification, and trauma-related hyperlordosis of the cervical spine. Conservative treatment is usually recommended. Corticosteroids, nonsteroidal anti-inflammatory drugs, spasm-relieving agents, and precautions during meals are helpful. Evidence that lesions of the cervical spine cause headaches is unclear, although lesions of the atlantooccipital, atlantoaxoidal, and C2-C3 joints resulting from osteoarthritis have been shown to cause headaches. Occipital neuralgia has been reported in patients who have septic or rheumatoid arthritis and ankylosing spondylitis. Cervicogenic headache refers to unilateral pain originating in the neck and radiating to the oculofrontotemporal area. There is no evidence that this type of headache originates in the cervical spine. Dizziness not attributable to vertebrobasilar insufficiency may be caused by cervical spine lesions in some patients; however, an extensive search for other causes is needed. 54 references.

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Evaluation and Management of Adult Dysphagia and Aspiration Source: Current Opinion in Otolaryngology and Head and Neck Surgery. 8(6): 489-496. December 2000. Contact: Available from Lippincott Williams and Wilkins. 12107 Insurance Way, Hagerstown, MD 21740. (800) 637-3030. Fax (301) 824-7390. Website: www.lww.com. Summary: This review article discusses the current state of dysphagia management, including evaluation and treatment of swallowing disorders arising from neurologic disorders and surgical interventions. The modified barium swallow and the flexible endoscopic assessment of swallowing are the two most common instrumental evaluations of swallowing. Other useful tests include scintigraphy, ultrasonography and pulse oximetry. Although current evaluative methods rely on instrumental tests, the efficacy of dysphagia testing remains controversial. New treatments, or modifications of previous techniques, for swallowing disorders include the use of botulinum toxin, pharmacologic approaches, modification of bolus consistencies, and surgeries to improve vocal fold closure. Other behavioral techniques include thermal stimulation, maneuvers to increase bolus propulsion, and postural techniques. Although most reports indicate the positive effects of treatment, controlled prospective studies to suggest the amount of treatment and the best time to initiate treatments are sparse. The discipline of dysphagia continues to evolve; however, definitive diagnostic and treatment protocols remain to be determined for many swallowing disorders. 4 tables. 62 references.

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Disease State Management: Dysphagia Source: Nutrition and Clinical Practice. 14(5 Supplement): S1-S73. October 1999.

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Contact: Available from American Society for Parenteral and Enteral Nutrition. 8630 Fenton Street, Suite 412, Silver Spring, MD 20910-3805. (301) 587-6315. Summary: This special supplement of Nutrition and Clinical Practice reports the proceedings of the Fourth Annual Ross Medical Nutrition and Device Roundtable, which focused on dysphagia (swallowing disorders). The conference describes patient populations who are at risk for dysphagia, various clinical and instrumental diagnostic procedures, the health care continuum, aging, medications, surgical procedures and other medical treatments, aspiration and pneumonia, nursing, nutritional issues, viscosity and texture of diet, and the present status of research in dysphagia. One of the basic yet essential components in improving the health of patients with dysphagia is nutritional care and management. In the introduction, the editor notes that nutrition treatment implies more than the diet; it includes many other factors, such as how the food is presented, the ingredients and nutritive value of the diet, and matching individuals with specific needs to an appropriate diet. The supplement emphasizes the importance of a multidisciplinary approach to dysphagia and patient care management. Each article concludes with a list of references, and, in some case, a reprint of the associated panel discussion from the conference. •

Prospective, Randomized Outcome Study of Endoscopy Versus Modified Barium Swallow in Patients with Dysphagia Source: Laryngoscope. The American Laryngological, Rhinological and Otological Society, Inc. 110: 563-574. April 2000. Contact: Available from Lippincott, Williams, and Wilkins. 530 Walnut Street, Philadelphia, PA 19106. Tel: (215) 521-8300. Web site: http://www.laryngoscope.com. Available online on a pay-per- view basis. Summary: This study compared the effectiveness of the modified barium swallow (MBS) test and the flexible endoscopic evaluation of swallowing with sensory testing (FEESST) in diagnosing dysphagia, which has been associated with susceptibility to aspiration pneumonia. A total of 126 patients were tested using one of the two methods as part of a program to control dysphagia through dietary and behavior management. The incidence of pneumonia and pneumonia-free intervals were tracked for 76 patients receiving BMS and 50 patients receiving FEESST examinations. Eighteen percent of the BMS patients and 12 percent of the FEESST patients contracted pneumonia. Patients in the MBS sample were pneumonia-free for an average of 47 days, and patients in the FEESST group were pneumonia-free for 39 days. The differences between the groups were not statistically significant. The author concludes that neither test is more effective than the other.

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Managing Dysphagia: Special Problems in Patients with Neurologic Disease Source: Postgraduate Medicine. 89(5): 203-213. April 1991. Summary: When the process of swallowing is interrupted, as in patients with neurologic disorders, problems such as aspiration and risk of malnutrition can occur. The authors of this article discuss an individualized approach to evaluation and management of neurogenic oropharyngeal dysphagia. Three cases illustrate the diversity of causes, signs and symptoms, and clinical course. 6 tables. 24 references. (AA-M).

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Federally Funded Research on Dysphagia The U.S. Government supports a variety of research studies relating to dysphagia. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to dysphagia. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore dysphagia. The following is typical of the type of information found when searching the CRISP database for dysphagia: •

Project Title: AGING OF THE INTRINSIC LARYNGEAL MUSCLES Principal Investigator & Institution: Andrade, Francisco H.; Assistant Professor; Neurology; Case Western Reserve University 10900 Euclid Ave Cleveland, Oh 44106 Timing: Fiscal Year 2004; Project Start 01-JAN-2004; Project End 31-DEC-2005 Summary: (provided by applicant): As the population of the United States grows older, age-induced dysfunction of the different motor systems becomes a more important cause of diminishing quality of life, increasing health costs, and even institutionalization. The larynx is part of a complex motor system that separates the airways from the digestive tract. It protects the airway during swallowing and ventilation, serves as a pressure valve for straining and airway protective reflexes, and is a resonance box for phonation. In the elderly, atrophy and dysfunction of the larynx and its intrinsic musculature compromise voice quality and impair the ability to communicate and remain socially engaged. Laryngeal dysfunction may also cause dysphagia and increase the risk of aspiration. Our preliminary findings indicate that the intrinsic laryngeal muscles are significantly altered by age; unfortunately, the biology of these small muscles has not been systematically studied, and the effects of aging on their function remain largely unknown. Because of their strategic role for ventilation, swallowing and airway protection, it is likely that even small age-related functional deficits in the intrinsic laryngeal muscles may translate to higher morbidity and mortality. In consequence, the objective of this project is to understand the cellular mechanisms that explain the effects of aging on the function of the laryngeal muscles. Combining well-established functional and biochemical assays with the Fischer 344Brown Norway hybrid rat model of aging, we will determine (1) how age changes the functional characteristics of the intrinsic laryngeal muscles; (2) how aging alters the cytosolic calcium kinetics of these muscles; and (3) the changes in mitochondrial capacity induced by aging in the intrinsic laryngeal muscles and that may render the muscles more fatigable. We expect that this project will obtain significant new information on the effects of age on laryngeal muscle function, and define the most likely cellular targets for interventions designed to retard, prevent, and even reverse the

2 Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

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detrimental effects of the aging process on this hitherto neglected muscle group, of vital importance for a normal and healthy life. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: BIOMECHANICS OF ESOPHAGEAL WALL AND VISCERAL SENSATION Principal Investigator & Institution: Mittal, Ravinder K.; Professor of Medicine; Veterans Medical Research Fdn/San Diego Foundation of San Diego San Diego, Ca 92161 Timing: Fiscal Year 2002; Project Start 01-SEP-2002; Project End 30-JUN-2005 Summary: (provided by applicant): The biomechanical properties of the esophagus have relevance to its motor and sensory function. These properties have been studied in the animals and humans by several investigators using various techniques. However, there are limitations with each of these techniques. We have developed a novel system of balloon ultrasonography that measures esophageal pressure, radius and wall thickness simultaneously, in vivo, in humans. Our technique, therefore, allows accurate measurement of the wall stress, strain and elastic modulus (wall rigidity) on a continuous time basis. Our preliminary data show that in normal subjects there is a close temporal correlation between increase in intraluminal pressure and esophageal wall thickness, which allows the esophagus to maintain a low wall stress. Patients with motility disorders of the esophagus have a thicker esophageal muscularis propria compared to normal subjects. We hypothesize that difference in the biomechanical properties of the esophageal wall between normal subjects and patients is the reason for impaired esophageal transport and dysphagia in patients with motility disorders of the esophagus. The current understanding is that hypersensitivity of the esophagus is the cause of esophageal pain. Patients with presumed esophageal pain respond to distension of the esophagus at lower balloon volumes than normal subjects. The site of esophageal hypersensitivity may be at either the peripheral (esophageal wall) or at the central level (CNS). The latter is currently the favored site. The differences in the biomechanical properties of the esophageal wall in patients and normal subjects may result in different wall stress and strain in response to the same volume of distension. We hypothesize that differences in the biomechanical properties of the esophagus may be the reason for a hypersensitive esophagus. The specific aims of our studies are: 1: In vitro validation of the novel technique of balloon-ultrasonography. 2: To determine biomechanical properties of the esophagus in normal human subjects using balloon ultrasonography and to determine the relationship between esophageal pain and its biomechanical properties. 3: To define the abnormalities of muscularis propria thickness in patients with primary motility disorders of the esophagus. 4: To determine the biomechanical properties of the esophageal wall in patients with a normal and thick muscularis propria and its relationship to esophageal hypersensitivity. 5: To study biomechanics of the esophageal wall in patients with esophageal dysphagia. We believe that our observations have important implications in understanding the mechanisms of esophageal motor and sensory function in healthy and diseased states. Furthermore, the principles discussed in the esophagus may be applicable to the understanding of visceral hypersensitivity seen in irritable bowel syndrome and other functional disorders of the GI tract. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: COMPARISON OF TWO THERAPIES FOR UES DYSPHAGIA Principal Investigator & Institution: Shaker, Reza; Professor and Chief; Medicine; Medical College of Wisconsin Po Box26509 Milwaukee, Wi 532264801

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Timing: Fiscal Year 2002; Project Start 01-SEP-2002; Project End 31-AUG-2007 Summary: (provided by applicant): Pharyngeal phase dysphagia can be a severe and costly side effect of stroke and chemoradiation therapy for head and neck cancer, causing the patient to regularly aspirate and be unable to eat by mouth. A major subset of pharyngeal phase dysphagia is caused by inability to move the bolus completely through the upper esophageal sphincter (UES) during swallowing. Available therapy for this condition is limited and yields a degree of success, but a new therapy procedure, the Shaker exercise, offers an exciting new opportunity to rehabilitate these patients perhaps more effectively and efficiently than the usual therapy program. The 5 year project we are proposing is a randomized clinical trial of these two therapies in patients with severe pharyngeal phase dysphagia with inability to move the bolus completely through the UES. The patients must be non-oral for at least three months because of aspiration of residue from either or both the valleculae and pyriform sinuses. The primary objective of this project is to identify which of two therapy programs, the Shaker exercise versus traditional therapy, results in the largest number of stable, nonoral dysphagic patients who can swallow safely and return to full oral feeding after 6 weeks of intervention. The study is powered adequately so that this aim can be tested separately for post chemoradiation therapy, head and neck cancer, and stroke patients. Our outcome measure is return to oral feeding, i.e., 100-percent of nutrition and hydration by mouth. Our secondary objectives are to: 1) determine in a descriptive manner whether patients with residue in the pyriform sinuses who aspirate the residue after the swallow respond better, i.e., a higher percentage of them can return to 100percent oral intake, than patients with residue in the valleculae or patients with residue in both locations who aspirate after the swallow and thus to define the spectrum of indications for the proposed exercise programs in the two studied groups of dysphagic patients, and 2) define the pathophysiological elements which change as a result of each therapy program including changes in a. anteroposterior and lateral diameter of maximum deglutitive UES opening, and b. maximum deglutitive laryngeal anterior and superior excursions. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: COORDINATION OF RESPIRATION AND DEGLUTITION Principal Investigator & Institution: Perlman, Adrienne L.; Professor; Speech and Hearing Science; University of Illinois Urbana-Champaign Henry Administration Bldg Champaign, Il 61820 Timing: Fiscal Year 2002; Project Start 15-JAN-2000; Project End 31-DEC-2003 Summary: The close proximity of the larynx to the entrance of the esophagus, and the common pathway through the pharynx that both air and a swallowed bolus must traverse, require that swallowing and respiration be well coordinated. Discoordination can result in the aspiration of food, liquid, or oral secretions consequent risk of severe respiratory complications. Despite its critical function, the coordination of respiration with swallowing is not well-understood either in healthy individuals or in persons, such as stroke patients, who are known to be at high risk for developing aspiration pneumonia. Using respirodeglutometry, this research will characterize the joint timing of respiration with the swallow and simultaneously record respiratory airflow, submental surface electromyography, and swallow-associated acoustic signals. Two hundred forty normal subjects (120 male, 120 female) in five groups ranging from 3 to 85 years-of-age, and sixty medically stable stroke patients, will be studied. Respirodeglutometric (RDT) output will be digitized at 1000 samples/sec/channel while subjects swallow pre-measured 5, 10, and 15 ml volumes of water and pudding.

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For all subjects and for each swallow, the direction of respiration preceding and following the swallow, the duration of deglutition apnea, and five additional RDT temporal measures will be obtained. All stroke patients will also be seen for videofluoroscopic assessment within 24 hours of the RDT evaluation in order to directly assess the oral and pharyngeal stages of their swallow and to identify various indicators of dysphagia, including the presence/absence of laryngeal penetration and aspiration. Analysis will address i) effects of size and viscosity of swallowed material on timing of RDT measured events within the swallow, ii) changes in the coordination of respiration with swallowing in healthy subjects across the lifespan, iii) age and gender adjusted effects of stroke on such coordination, iv) adaptations of coordination by healthy subjects and stroke patients to feeding by a caregiver relative to self-feeding, and v) the relationship in stroke patients of videofluoroscopically- observed oropharyngeal dysphasia and aspiration to aberrant respiratory-swallowing patterns. Findings from this research can have a profound effect on patient evaluation procedures as well as on behavioral management techniques, clinical outcome goals, and medical costs for stroke patients. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DEPRESSION AND END OF LIFE CARE IN ALS Principal Investigator & Institution: Albert, Steven M.; Gertrude H Sergievsky Center; Columbia University Health Sciences New York, Ny 10032 Timing: Fiscal Year 2002; Project Start 20-AUG-2000; Project End 31-JUL-2004 Summary: (Adapted from investigator's abstract) Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease that results in death, usually from respiratory insufficiency or aspiration, within 3 to 5 years of diagnosis. The disease affects all voluntary motor function except eye movement and sphincter control. In the final 6-9 months of life, patients must choose (either explicitly or by default) palliation or tracheostomy and long-term mechanical ventilation (LTMV). In this 4 year project, we will follow 140 patients diagnosed with definite or probable ALS who face a high likelihood of death within 6-9 months, as defined by poor pulmonary function, dysphagia and weight loss, or hospice certification or eligibility. These patients will be followed with bimonthly in-home assessments, and with an additional assessment in the last weeks of life. We will also interview the primary family caregiver on the same schedule and once after the patient's death, as well as conduct a survey of medical providers' influence on end-of-life decisions. In this observational cohort study, we propose (1) to assess the prevalence and course of depressive disorders and symptoms in ALS patients in the final months of life and its relevance for decision-making at the end of life; (2) to identify predictors of tracheostomy/LTMV use; (3) to examine the degree to which patients and families take steps to control the timing of death by adopting a strict palliative care regime; and (4) to examine associations between patient and caregiver distress in the final months of life. Key questions include the following: Do levels of distress and depressive symptoms increase as patients approach death, and does this relationship differ according to choice of palliative care or LTMV? What maintains hope in these patients, who are, in a medical sense, hopelessly ill? Of patients who receive LTMV, in what proportion is LTMV consciously planning for, as opposed to an unplanned emergency procedure? Is patient mental health or caregiver burden associated with decisions to forego or undergo LTMV? To what degree does use of noninvasive, temporary nasal ventilation (Bi-Pap) prevent use of LTMV? These questions have not been investigated in a prospective study. We will be able to address them through repeated, detailed assessments of patients and caregivers. This information will

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be critical for understanding the experience of patients with terminal disease as they and their families face end-of-life care decisions. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DIFFERENCES IN SWALLOW MECHANICS IN INFANTS Principal Investigator & Institution: German, Rebecca Z.; Professor; Biological Sciences; University of Cincinnati 2624 Clifton Ave Cincinnati, Oh 45221 Timing: Fiscal Year 2002; Project Start 01-JUL-1998; Project End 31-JUL-2006 Summary: (provided by applicant): Swallowing requires the coordination of a large number of muscles; this complexity arises partly from the need for airway protection. In the previous funding period, we added to the understanding of muscle activity and oropharyngeal kinematics in infant deglutition. However, the role of the majority of muscles during emptying of the valleculae and in the transport of the bolus past the laryngeal opening or the natural stimuli that initiate the emptying of the valleculae over maturation is not well understood. Our preliminary data suggest that two distinct pathways of bolus movement exist, either around the epiglottis/laryngeal opening (in the newborn) or over it (by the age of weaning). However the timing of the transition, from one path to the other and the associated changes in the kinematics or motor patterns, are unknown. The decerebrate pig is an excellent model for studying vallecular emptying because this phase of the swallow can be isolated experimentally. We propose to apply our existing techniques both to this model and to intact animals, in order to answer the following questions. What natural stimuli initiate vallecular emptying, and do they change during maturation? What is the pattern of muscle activity during vallecular emptying in terms of the order and amplitude of muscle activation? Does change in the consistency of the bolus alter the motor pattern during vallecular emptying, and does this change over developmental time? Does epiglottal movement result from: (i) direct muscle contraction; (ii) indirect movement of the rest of the larynx, (iii) the mechanical action of food on the epiglottis, or a combination of all three? Current studies of human dysphagia and rehabilitation rely heavily on several older studies of oral function in adult man and animal; these studies did not have the means to examine the ontogeny of vallecular function in detail. The proposed study of the maturation of motor patterns will provide an important baseline for treatment strategies aimed at human infant dysphagia. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: EFFECTS OF LSVT ON DYSPHAGIA IN PARKINSON'S DISEASE Principal Investigator & Institution: Logemann, Jerilyn A.; Professor; Communication Scis & Disorders; Northwestern University 633 Clark Street Evanston, Il 60208 Timing: Fiscal Year 2002; Project Start 01-APR-2002; Project End 31-MAR-2004 Summary: (provided by applicant): Lee Silverman Voice Treatment (LSVT) has shown promise in improving swallow, as well as voice and speech. This project is designed to define the effects of LSVT on swallow in patients who exhibit VFG verified aspiration on any food volume or viscosity. Thirty patients with idiopathic Parkinson's disease, who aspirate (with or without cough response) on any food consistency, will serve as subjects in this study. When identified clinically as at-risk for aspiration, patients will receive a modified barium swallow on a standard protocol, followed by randomization to immediate LSVT treatment for 1-month (4 sessions per-week for 4-weeks) or delayed LSVT beginning 1-month after the first group's therapy is completed. Thus, the comparison of critical interest is therapy vs. no therapy. The delayed group will serve as

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the no therapy arm. Patients in both arms will receive instructions on diet and posture modification, as necessary, based on the results of VFG. Patients will receive no other swallowing therapy or voice or speech therapy during this 2-month period when both groups receive treatment. After completion of one-month of therapy, patients will receive a modified barium swallow assessment to document change. Medication schedules will remain unchanged throughout the study, and patients will receive their modified barium swallow studies at the same time of day relative to medication both pre- and post-LSVT treatment. The outcome measure will be the elimination of aspiration. We will also define, as secondary measures, the changes in bolus transit times, the observation of percentage residue in the mouth and pharynx, the frequency of swallowing motility disorders and the temporal measures of swallow. These will all serve as explanatory variables for changes in frequency of occurrence of aspiration. This application proposes to generate pilot data on the effects of LSVT on aspiration, a potentially dangerous and costly side effect of dysphagia in Parkinson's disease. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: FEEDING BEHAVIORS & ENERGY COST IN INFANTS WITH CHD Principal Investigator & Institution: Medoff-Cooper, Barbara S.; Helen M Shearer Professor in Nutrition; None; University of Pennsylvania 3451 Walnut Street Philadelphia, Pa 19104 Timing: Fiscal Year 2002; Project Start 01-JUN-1994; Project End 31-MAY-2007 Summary: (provided by applicant) This proposal requests continued support for a NINR funded study that had been entitled: Nutritive sucking: Physiological and Behavioral correlates. In the present proposal, we (1) deepen our analysis of feeding organization by integrating measures of sucking, swallowing and breathing over the course of full meals and (2) characterize the feeding patterns of another at-risk population - infants with congenital heart disease (CHD), and (3) relate feeding performance and energy expenditure to problems in growth and development over the first year of life in CHD infants. These infants are often difficult to feel, even when their surgery has improved their cardiac function. Indeed, the success of the surgery often unmasks their severe nutritional syndrome, failure to thrive (FTT). To address this important clinical problem, we propose to measure feeding performance and energy expenditures over the first hear of life in 120 infants who have undergone surgery during the first month of life to correct or palliate sever cardiac abnormalities and 60 healthy newborn controls. The specific aims of our proposed study are as follows: 1) to establish which aspects of feeding performance (e.g. suck/swallow/breathe coordination, temporal patterning of sucking with meals, suck pressure generation, adaptation to variation in flow rate) are most subject to disruption in CHD infant after corrective or palliative surgery; 2) to determine infants' pattern of oropharyngeal adaptation to variations in the flow rate through an artificial nipple, and whether flow rate adjustment represents a viable strategy for improving meal size outcomes; and 3) to determine the relative contributions of disrupted feeding organization and (potentially elevated) energy expenditure to unfavorable growth outcomes, i.e. (i) relate disrupted feeding to growth, (ii) relate energy expenditure to growth, and (iii) integrate energetic and feeding-performance characteristics in a predictive model of failure to thrive in infants with CHD. This study addresses what we believe is the central role of feeding organization in the nutritional status of this patient population; as such, it represents an approach toward early identification, based on feeding performance and energetic profiles, of infants most at risk for developing FTT by the age of one. The present work

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may offer prospects for targeted behavioral interventions involving modification of flow rates and paced feeds. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: GASTRIC FEEDING TUBES: PATIENT/FAMILY/PROVIDER VIEWS Principal Investigator & Institution: Carey, Timothy S.; Professor of Medicine; Medicine; University of North Carolina Chapel Hill Aob 104 Airport Drive Cb#1350 Chapel Hill, Nc 27599 Timing: Fiscal Year 2002; Project Start 01-SEP-2000; Project End 28-FEB-2004 Summary: We propose a two and a half year prospective study of predominantly older individuals with neurologic diseases, head and neck cancer, and severe medical illness who receive gastric feeding tubes. We wish to define the outcomes of this treatment from a patient and caregiver perspectives. The number of gastrostomy feeding tubes used for the Medicare population has grown rapidly, more than doubling during the past decade. The diseases that cause dysphagia also shorten life expectancy, and cause other deficits in cognitive, physical and social functioning. Nutrition, hydration, and the social context of eating are fundamental elements of comfort care for these patients near the end of life. Feeding is a primary act of care giving and nurture, yet tube feedings have become a form of life- sustaining treatment fraught with ethical implications for patients and caregivers. Previous studies have emphasized medical outcomes of this procedure. No prior study has examined outcomes of this treatment from the patient and caregiver perspective. Our overall aims are: 1. Describe the expectations of patient, family, health care providers regarding the benefits of gastric feeding tubes on: patient longevity, patient functioning, likelihood of hospitalization for pneumonia. 2. Compare perceived benefits of gastric feeding tubes at the time of placement to perceived benefits such as outcomes of survival, functional status and pneumonia at 3 and 6 month followup, from the perspectives of patient, family and health care providers, including physicians and nurses. 3. Describe the true outcomes of patient survival, pneumonia incidence and functional status among those who survive for 3 and 6 months after insertion of the feeding tube. We will recruit 200 patients receiving gastrostomy from two North Carolina hospitals: a university tertiary care center, and a large community hospital. Interviews will be conducted with physicians, nurses, family caregivers and patients shortly following the procedure with follow-up interviews at 3 and 6 months. The interview will include assessment of functional status, perceived benefit, and expectations regarding longevity and future function. These multiple perspectives on the use of gastrostomy tubes will allow a much more complete portrait of the benefits and limitations of this increasingly utilized supportive therapy at the end of life. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: INVESTIGATING ALGORITHMS

SPEECH

DISORDERS

WITH

EMERGING

Principal Investigator & Institution: Salvatore, Anthony P.; University of Texas El Paso El Paso, Tx 79968 Timing: Fiscal Year 2003; Project Start 01-JUN-2003; Project End 31-MAY-2007 Summary: (provided by applicant): This project proposes to investigate various speech disorders with emerging computational algorithms. Specifically, it is in our plan to develop an expert system based upon the use of recent advances in neural networks, fuzzy logic and other computational algorithms. Although several researchers in communication disorders have already claimed some initial success with these recently

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emerging tools, a thorough investigation is warranted to tap the full potential of these algorithms. It is anticipated that the proposed system will be capable of objectively analyzing communication disorders based on multi-dimensional measures of speech fluency, acoustic variables, and some selected physiologic assessments. Specifically, the proposed system will be applied to differentiate between the set of data from normal and speech-language disordered individuals so that the burden of perceptual judgment by the clinician is objectively resolved by the expert system. There is significant evidence from clinical experience that this corpus of measures contain the information necessary to make the differential diagnosis. However, this information has not been mined successfully through objective means because of the multitude of simultaneous variables present in these tasks, and lack of sufficient technical thrust in this province. It is expected that this project will include a wide variety of communication disorders such as: stuttering, spasmodic dysphonia, aphasia, apraxia and dysarthria. This technology is expected to benefit clinicians in objective decision-making. Currently individual clinicians perform this task. It is subjective and time consuming. The clinical decisions on treatment methods depend upon the nature and extent of the training and any biases inherent in that training of individual clinicians. This limitation may be overcome by the unlimited learning potential of the computer. Another aim of this project is to develop a model of communication disorders based upon the underlying mechanisms of the expert system. It is anticipated that such a model will provide helpful insights into the pathophysiology of communication disorders. Furthermore, the results of this research is expected to improve the current knowledge of the comparative strengths and weaknesses of existing algorithms and develop means to combine the advantages of several computational methods within one operating system. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: LINGUAL MECHANICAL FUNCTION DURING SWALLOWING Principal Investigator & Institution: Gilbert, Richard J.; Mechanical Engineering; Massachusetts Institute of Technology Room E19-750 Cambridge, Ma 02139 Timing: Fiscal Year 2003; Project Start 12-SEP-2003; Project End 31-AUG-2006 Summary: (provided by applicant): The human tongue is an intricately configured muscular organ that plays a vital role during the physiological act of swallowing. During normal deglutition, the tongue first configures, then propels the ingested bolus from the oral cavity retrograde to the pharynx. From a clinical perspective, disorders of lingual function are exceedingly common in the elderly, in association with common neurological diseases, such as stroke, Parkinson's disease, and dementia, and are responsible for impaired nutrition and increased risk of aspiration pneumonia in these patient populations. Notwithstanding, there is minimal understanding of the way in which lingual muscular structure contributes to physiological function. The study of lingual mechanics has long been hampered by the complex myoarchitecture of the tissue and its material properties. As a result, mechanical function cannot be determined solely from global changes of shape, but necessitates the study of intramural dynamics. Our overall hypothesis is that the tongue functions as a muscular hydrostat, a unique structure in the human body, with the ability to both create motion and to provide the skeletal support for that motion. In order to test this hypothesis in the setting of human swallowing, we have considered the tongue from the perspective of a material continuum, and have thus depicted the tissue in terms of local fiber organization and strain. This project will study the quantitative relationship between three-dimensional myoarchitecture and regional mechanics during human swallowing. Our experimental approach uses non-invasive nuclear magnetic resonance imaging techniques to discern

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patterns of myoarchitecture and regional mechanics in vivo. In Specific Aim 1, the threedimensional myoarchitecture of the tongue will be studied through the depiction of the local second order diffusion tensor derived from magnetic resonance imaging. In Specific Aim 2, the quantitative relationship between muscle fiber architecture and regional strain in association with swallowing will be determined by linkage of the structural measures with tagged magnetization. In Specific Aim 3, the regional mechanical adaptation to varying bolus volume and viscosity will be studied through combined diffusion tensor and tagged magnetization imaging under varying load conditions. This project should result in an improved understanding of structurefunction relationships for the human tongue, and related human muscular hydrostats. It is anticipated that this understanding will result in novel hypotheses of pathological lingual function for patients with oropharyngeal dysphagia. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: NATURAL HISTORY, SEARCH FOR A MARKER AND THERAPY Principal Investigator & Institution: Sakkubai, Naidu; Kennedy Krieger Research Institute, Inc. Baltimore, Md 21205 Timing: Fiscal Year 2002 Summary: The goal of this project is to define the natural history, identify a diagnostic marker, understand the mechanism of neuronal dysfunction, and apply specific therapies early in the evolution of the disease to improve neurological status in Rett syndrome (RS). Based on the postulate that RS is a disorder of early brain growth, AIM 1 focuses on the identification of younger patients and delineation of early clinical features. Familial cases and their pedigrees will be documented in search of a genetic abnormality. Cases identified in Aim 1 will be a vital resource for all projects. In Aim 2 gene(s) defective in RS will be sought by classical cytogenetic approaches, and by representational difference analysis (RDA). Aim 2 will also search for proteins, and expressed genes that have up- or down regulated in RS, which may serve as a molecular fingerprint for the disease. Aim 3 is designed to study olfactory receptor neurons (ORNs) obtained from biopsies of olfactory neuroepithelium in RS girls, and compared to ORNs from normal and disease controls. A cell culture approach will provide direct access to RS neurons early in the course of the disease, and permit study of the evolution of neuronal defects in this disorder. In Aim 4 therapeutic interventions will attempt to prevent the devastating consequences of increased glutamate NMDA, and AMPA receptor induced neuronal injury by specific treatments with receptor antagonists, dextromethorphan and topiramate. To compensate for the significant reductions in choline acetyltransferase levels, treatment with an acetylcholine esterase inhibitordonepezil hydrochloride- to improve cognition will be tested. Efficacy of treatment will be monitored by clinical and neuroimaging techniques. Careful study of the nutritional status, and the role of dysphagia in growth failure will be examined in the light of therapeutic interventions. Use of growth factors or gene therapy will be considered when efficacy is established in the animal model. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: NEURAL HIERARCHY IN THE MODULATION OF INGESTIVE BEHAVIOR Principal Investigator & Institution: Grill, Harvey J.; Professor; Psychology; University of Pennsylvania 3451 Walnut Street Philadelphia, Pa 19104 Timing: Fiscal Year 2002; Project Start 01-JUL-1983; Project End 29-FEB-2004

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Summary: Understanding the role of the nervous system in feeding control is an important goal for basic and clinical science. In humans, the excessive feeding associated with some obesities increases the probability of diabetes, hypertension, and heart disease. Other feeding-related problems (failure to thrive, early satiety, dyspepsia, gastroesophageal reflux, dysphagia, cachexia, anorexia, bulimia) account for a significant portion of health-care expenditures in the U.S. Clearly, basic research into the location and operating characteristics of the neural substrates that control feeding behavior is essential for: an understanding of the basic physiology of intake control, an appreciation of the CNS underpinnings of various feeding pathologies, and the development of effective pharmacological treatments. We believe, as did Sherrington that the most fruitful approach to analyzing a complex distributed neural control system, such as that controlling feeding behavior, begins at the anatomical level(s) of the relevant sensory inputs and motor outputs. It is a given that many of the relevant sensory inputs (taste, visceral) enter, and all of the consummatory motor outputs (somatic and autonomic) emerge, at the level of the caudal brainstem (CBS). To address the issue of integration, we developed a chronic decerebrate rat (CD) model and have provided data that call attention to a CBS contribution to intake control. When the CD and intact rat respond similarly to selective treatments we can infer that the CBS-neurally disconnected from the hypothalamus long held to be the seat of intake control-is sufficient for all elements of the integrated response. In addition, with 4th icv infusion of orexigenic agents we will explore the relevance of CBS receptor systems to the integrated behavioral response of the neurologically intact rat. Finally, we approach a more anatomically resolved analysis of the intake-relevance of specific CBS structures through intraparenchymal infusion, cFos immunohistochemical, and NPY mRNA expression studies. The proposed experiments address the following specific aims evaluate: (1) the sufficiency of the CBS for response to signals that underlie short-term intake control; (2) the role of CBS structures in long-term intake control and (3) the relevance of CBS receptors to the feeding response evoked by selected orexigenic agents. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DYSPHAGIA

OLFACTORY

CONDITIONING

THERAPY

FOR

INFANT

Principal Investigator & Institution: Bingham, Peter M.; Children's Hospital of Philadelphia 34Th St and Civic Ctr Blvd Philadelphia, Pa 19104 Timing: Fiscal Year 2002 Summary: This abstract is not available. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ORAL MUCOSITIS - FORMULATIONS FOR PALLIATION AND THERAPY Principal Investigator & Institution: Squier, Christopher A.; Dows Inst for Dental Research; University of Iowa Iowa City, Ia 52242 Timing: Fiscal Year 2002; Project Start 01-SEP-2000; Project End 31-AUG-2004 Summary: As the end-of-life approaches, the frequency of cancer increases markedly and it has been estimated that approximately 400,000 persons each year suffer oral side effects as a consequence of being treated for cancer therapy. Oral mucositis, an inflammatory condition of the oral mucosa leading to atrophy and ulceration, is one of the conditions frequently seen in those patients undergoing anti-cancer therapy. The lesions first appear in the mucosa of the soft palate, tongue and cheeks and as they

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enlarge lead to extreme pain and dysphagia. As a consequence, there may be dehydration, a compromised nutritional status and a decreased quality of life. Palliation represents the standard clinical management so as to relieve symptoms and to check infections by means of anesthetic and antibiotic rinses. The hypothesis underlying the proposed research is that an appropriate occlusive muco-adhesive will not only reduce the symptoms of mucositis but could provide a means for effective adjunctive therapy of the condition. This application as an R21 exploratory and developmental grant seeks to develop an occlusive muco-adhesive in both gel and film form for the treatment of oral mucositis based on the biocompatible polymer, chitosan. The investigators intend to explore the effectiveness of the muco-adhesive in-vitro for delivering the antimicrobial and anti-inflammatory compounds necessary for palliative therapy of mucositis as well as for delivering bioactive peptides that may be able to provide protection or promote healing of the oral mucosa. Finally, they will investigate the acceptability, substantivity and durability of the muco-adhesive in vivo using normal mucosa and examine its effects on ulcerated mucosa in human volunteers. The study will involve collaborative studies between investigators with expertise in pharmaceutical technology, oral mucosal biology and oral medicine so as to develop palliative and therapeutic approaches to mucositis that would be of great benefit in improving the quality of life of those who are frequently at the end-of-life. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PHYSIOLOGY OF SWALLOWING AND AIRWAY PROTECTION Principal Investigator & Institution: Paydarfar, David; Neurology; Univ Massachusetts Med Sch Worcester Office of Research Funding Worcester, Ma 01655

of

Timing: Fiscal Year 2003; Project Start 17-JUL-2003; Project End 30-JUN-2007 Summary: (provided by applicant): The long-term objective of our research is to better understand the neural control of swallowing and airway protection, to analyze the mechanisms of neurogenic dysphagia and aspiration in a controlled and systematic way, and to develop novel therapies based on pathogenesis. Our specific thesis is that laryngeal afferent feedback during swallowing facilitates the swallowing pattern generator's output to laryngeal and pharyngeal muscles. The internal branch of the superior laryngeal nerve (ISLN) is the principal sensory nerve of the larynx in humans. We propose to study how the ISLN regulates swallowing using nerve blocking and stimulating techniques in healthy subjects. Then, we plan to use what we learn about the ISLN to devise a method for improving glottic closure and pharyngeal contraction during swallowing in patients with dysphagia and aspiration due to cerebral lesions. Specific aims are: 1) To determine the physiological mechanism of aspiration in healthy subjects with ISLN blockade. Our preliminary studies show that the bolus usually penetrates the laryngeal inlet during the pharyngeal phase of swallowing. We will use electromygraphic, fluoroscopic and manometric techniques to analyze whether laryngeal penetration is due to reduced activation of laryngeal adductors, excessive intrapharyngeal pressure, or excessive inspiratory effort. 2) To test for extrafusal motor fibers in the ISLN. We will test the widely held view that the ISLN functions purely as an afferent by applying supramaximal current pulses to the isolated ISLN in patients undergoing laryngeal surgery. The presence of efferent fibers would be supported by a short latency (<5msec) laryngeal or pharyngeal motor response that is abolished following ISLN transection. 3) To optimize the activation of laryngeal adductors and pharyngeal constrictors evoked by ISLN stimulation. In awake healthy subjects with blocked ISLNs, we will attempt to reverse dysphagia and aspiration by electrically stimulating the ISLN central to the block, and the optimum stimuli that potentiate

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Dysphagia

swallowing without causing discomfort will be determined. 4) To test the feasibility of ISLN stimulation for treatment of neurogenic dysphagia and aspiration in patients with cerebral lesions. We will stimulate the ISLN (using optimum parameters from Aim 3) in patients with neurogenic dysphagia caused by focal cerebral damage, and we will test for improvement in swallowing and decrease in aspiration. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: RADIOACTIVE OBSTRUCTIONS

STENTING

OF

MALIGNANT

BILIARY

Principal Investigator & Institution: Bunker, Stephen N.; Implant Sciences Corporation 107 Audubon Rd, #5 Wakefield, Ma 01880 Timing: Fiscal Year 2003; Project Start 10-APR-2003; Project End 31-MAR-2004 Summary: (provided by applicant): Luminal obstructive symptoms such as dysphagia, vomitus, jaundice, or ileus are often the first symptoms noticed by patients or physicians and unfortunately, usually indicate an advanced stage of gastrointestinal disease associated with high mortality. Stenting of malignant biliary obstructions, performed on patients who are not candidates for curative surgery, is currently performed as palliative treatment with limited success. These stents fail one third of the time due to tumor growth through the struts of the stent. Our efforts will be focused on optimizing an iridium-192 radiation source for low dose rate permanent brachytherapy. This medical device would reduce costs and improve quality of life for the patient, because it requires only one intervention compared to other methods of palliative radiotherapy (HDR, EBRT), which require daily treatment regimens, often for weeks at a time. In addition, unlike EBRT, the dose to radiosensitive nontargeted tissue is greatly reduced. The proposed iridium-192 stent also has greatly improved radioopacity for enhancing accurate placement. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: RETT SYNDROME: NATURAL HISTORY AND TREATMENT Principal Investigator & Institution: Naidu, Sakkubai R.; Professor of Neurology and Pediatrics; Kennedy Krieger Research Institute, Inc. Baltimore, Md 21205 Timing: Fiscal Year 2003; Project Start 29-SEP-2003; Project End 30-JUN-2008 Summary: Patients with (70-80%) and those without mutations in MeCP2 gene are recognized to have the clinical features of Rett Syndrome. Although location of mutations can in part be correlated with the phenotype, they do not provide essential prognostic guidelines. We will attempt to delineate the molecular profiles of the various mutations that contribute to phenotypic variability. We will therefore correlate the clinical, gastrointestinal status, and neuroimaging changes (MRI, MRS) to levels of MeCP2, other methyl-binding domain proteins, and histone acetylation in Project 10, and with changes in olfactory receptor neurons in Project 9. We will also compare these changes to those with the phenotype but without mutations in MeCP2 to determine commonality in factors that may contribute to phenotypic similarities. In collaboration with Dr. Shemer (Israel), we will attempt to identify mutations in the promoter region of the MeCP2 gene in this latter group. The increased expression of the glutamatergic system in younger RS subjects leads us to treat patients below 15 years of age with dextromethorphan to block NMDA/glutamate receptors so as to prevent excitotoxicity and provide neuroprotection. To gain additional insight into the neurobiology of RS, we will conduct SPECT and PET studies in conjunction with Project 8 to delineate abnormalities in the cholinergic and glutamatergic systems that would provide future

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therapeutic strategies in conjunction with studies in murine models in Project 5. Data from interaction between this and other projects will support our hypothesis that the phenotype of RS is the result of the unique effects of different MeCP2 mutations on specific neuronal populations and their interconnections during the dynamic phase of activity-dependant synaptic plasticity. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: STADARDIZED ASSESMENT OF SWALLOWING IMPAIRMENT Principal Investigator & Institution: Martin-Harris, Bonnie J.; Program Director; Otolaryngology-Head & Neck Surgery; Medical University of South Carolina 171 Ashley Ave Charleston, Sc 29425 Timing: Fiscal Year 2003; Project Start 01-JUL-2003; Project End 30-APR-2008 Summary: (provided by applicant): The origin of the candidate's interest in this award mechanism stems from her career pathway that has included the integration of meaningful patient-oriented research into the clinical practice of evaluating and treating patients with swallowing disorders. The ultimate career goal of the candidate is to independently study and define functional swallowing impairment in adult patients with chronic pulmonary disease; however, there exists no validated or reliable measurement tool that permits the detection and quantification of swallowing impairment. A preliminary step toward the future pathway of independent swallowing research of patients with chronic pulmonary disease will require the development of a swallowing impairment measurement tool to be used during the modified barium swallowing evaluation. This tool (the MBSImP) will be clinically meaningful, practically implemented, reliably scored and sensitive to the presence of observed aspiration and to external indicators of health and quality of life. The structure of this award provides a vehicle to facilitate achievement of these short-term and long-term goals, and to the candidate's successful progression from clinical excellence and early stage clinical scientist to an independent clinical researcher. A complex reduction and aggregation strategy is proposed in the research plan that requires knowledge of applied multivariate statistical analyses, measurement theory and scale development, factor analysis and latent variable modeling. The candidate has included a mentor and external advisor to oversee a comprehensive curriculum in her Career Plan that includes didactic coursework and independent studies in the areas of statistical design, measurement, and factor analysis. Achievement of the candidate's stated career goals will require comprehensive understanding of the gross anatomy, physiology and pathophysiology of the upper aerodigestive tract in its entirety. Advanced competency as a clinical scientist in the area of swallowing and swallowing disorders will require understanding and application of overlapping swallowing physiology. While Dr. Martin-Harris demonstrates strong clinical proficiency in the clinical study of oropharyngeal swallowing dynamics and pulmonary function, she has insufficient knowledge of cervical, thoracic and distal esophageal structure and function. Patients with pulmonary disease and the prospective patients to be studied in the research plan often present with coexisting oropharyngeal and esophageal swallowing disorders. Therefore, the Candidate has included didactic coursework in advanced head, neck and chest anatomy, head and neck surgical rotations, and independent studies with her primary mentor, a world renowned clinician and researcher of esophageal swallowing disorders. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Dysphagia

Project Title: COORDINATION

SWALLOWING--BUCCOPHARYNGEAL/ESOPHAGEAL

Principal Investigator & Institution: Altschuler, Steven M.; President & C.E.O.; Children's Hospital of Philadelphia 34Th St and Civic Ctr Blvd Philadelphia, Pa 19104 Timing: Fiscal Year 2002; Project Start 01-APR-1999; Project End 31-MAR-2004 Summary: Swallowing, one of the more complex motor behaviors is programmed centrally by a medullary central pattern generator located in and around the nucleus of the solitary tract. The generation and modulation of neuronal patterned motor activity by the central pattern generator is dependent upon endogenous excitatory and inhibitory mechanisms and requisite central and peripheral afferent contacts. A significant imbalance in the relative contribution of excitation via NMDA and inhibition via GABA receptors may form the basis of dysfunctional swallowing present in neurological disease. Utilizing the rat as animal model, the anatomic basis of the excitatory and inhibitory processes critical to the coordination of the buccupharyngeal and esophageal phases of swallowing will be studied. Transsynaptic tracing with Pseudorabies Virus in conjunction with: (1) Fluorescent retrograde tracing will be utilized to study the anatomical connections between the buccopharyngeal and esophageal central pattern generator networks at the premotor neuron level; (2) In situ hybridization with oligonucleotide probes for the different N-Methyl-D-aspartate (NMDA) receptor subunits (R1, R2A- D) and GABAA receptor subunits (alpha1-6, beta1-3, gamma1-3, delta) will be utilized to determine the NMDA and GABAA receptor subunits expressed by our premotor neurons; (4) Immunocytochemistry for glutamate and GABA will be utilized to determined location and organization of glutaminergic and GABAergic neurons constituting and projecting to the central pattern generator; (5) Immunocytochemistry for NMDAR1 and GABAA alpha1 receptor subunit proteins will be utilized to investigate colocalization of the receptors on buccopharyngeal and esophageal premotor neurons (triple labeling method). Since alterations in excitatory and inhibitory synaptic function could contribute to the pathogenesis of swallowing disorders, these studies may have a direct bearing on the future clinical management of patients with dysphagia. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: THE ANATOMICAL BASIS OF HUMAN TONGUE BIOMECHANICS Principal Investigator & Institution: Sanders, Ira; Associate Professor; Otolaryngology; Mount Sinai School of Medicine of Nyu of New York University New York, Ny 10029 Timing: Fiscal Year 2002; Project Start 01-FEB-2001; Project End 31-JUL-2004 Summary: (provided by applicant): What is special about the human tongue that allows it to perform the movements that are unique to human speech and swallowing? The biomechanics of the tongue are dependent on its anatomy, and some of the most basic facts of human tongue anatomy are unknown. It is hypothesized that the human tongue contains specialized anatomy related to the movements of human speech and swallowing. Studying this anatomy will increase our understanding of tongue movements; provide a normative baseline from which to compare pathological conditions, and provide the detail required for progress in surgical procedures on the tongue, including transplantation. The human tongue presents formidable challenges for the anatomist: the small muscle groups that interweave in complex ways are technically difficult to trace; it is often difficult to identify specific muscles in histological sections; and many techniques routinely used in animal studies cannot be used on human post mortem tissue. However, based on experience studying the human larynx,

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a systematic approach is proposed with a variety of techniques that have all been successfully tested in the preliminary work. Tongue anatomy will simultaneously be studied on the gross anatomical, microscopic and molecular level using the following methods: 1) high-resolution magnetic resonance microscopy of tongue tissue to study 3D structural detail; 2) Sihler's stain, a process that renders whole tongue specimens translucent while counterstalning the nerve supply and outlines of muscle groups; 3) serial sectioning of whole tongues followed by staining to show details of muscle structure and insertion into connective tissue; 4) micro dissection of muscle fibers followed by silver and acetylcholinesterase staining to study details of muscle fiber size and shape, motor endplate types, and terminal axon branching; 5) myofibrillar ATPase, to type the muscle fibers of each muscle; 6) immunohistochemistry, to identify the myosin heavy chain (MHC) within tongue muscles; and 7) immunoelectrophoresis and immunoblotting, to confirm the immunohistochemistry. Preliminary work has supported the presence of specialized anatomy in the human tongue. Certaln muscles are significantly different in size and position when compared to other mammalian tongues. The genioglossus muscle, for example, is greatly enlarged while the inferior longitudinal is comparatively smaller. In addition, human tongue muscles have unusual internal structure: some appear to be compartmentalized into smaller groups of muscle fibers arranged in series. In the superior longitudinal muscle preliminary work suggests that these muscle compartments are surprisingly short and that the muscle fibers are interconnected in complex webs. Overall, the human tongue has the highest proportion of slow twitch muscle fibers yet reported in any mammalian tongue, and these are arranged in a gradient with the higher proportions found medially and in the tongue base. Among these slow muscle fibers are large numbers of slow tonic muscle fibers, an extremely rare type of muscle fiber with unique contractile properties. In summary, the dearth of information about the human tongue appears to offer an opportunity to increase our understanding of the special nature of speech and swallowing as well as the pathophysiology of dysphagia and dysarthria. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: THE ESOPHAGOGASTRIC JUNCTION IN HEALTH AND DISEASE Principal Investigator & Institution: Kahrilas, Peter J.; Professor of Medicine; Medicine; Northwestern University Office of Sponsored Research Chicago, Il 60611 Timing: Fiscal Year 2002; Project Start 01-APR-2001; Project End 31-MAR-2006 Summary: (Verbatim from Applicant's Abstract): Gastroesophageal reflux disease (GERD) is a common disorder, affecting millions of Americans and caused by anatomical and physiological perturbations of the esophagogastric junction (EGJ). The economic impact of GERD in the US is evident by the annual expenditure of >$4 billion for pharmaceutical treatments. Although effective, medical therapy is by nature compensatory, as opposed to potentially curative surgery. However, a problem with antireflux surgery has been unpredictable postoperative dysphagia and bloating related to a diminished ability to belch. Thus, this revised RO1 application represents a collaborative effort by a gastroenterologist (Dr Kahrilas), a surgeon (Dr Joehl), and a mechanical engineer (Dr Brasseur) to study perturbations of the EGJ imposed by GERD and by surgical treatments of GERD (Nissen fundoplication). Specific aim #1 addresses antegrade EGJ function while specific aim #2 investigates mechanisms of reflux. Antegrade EGJ function will be quantified with an "esophageal stress test" using manometry with concurrent fluoroscopy while swallowing boluses of defined viscoelastic properties. These data will be complimented by a dysphagia questionnaire. Data from controls will be compared to that of GERD patients and patients after

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Dysphagia

antireflux surgery. The underlying hypothesis of specific aim #1 is that a mathematical model of the EGJ, embedded within a "computer laboratory" and based on the best anatomical and physiological data obtainable will improve understanding and prevention of post-surgical dysphagia. Specific aim #2 is focused aboutextending our investigations into the interplay between anatomical and physiological factors in the pathophysiology of GERD. Investigational methodologies include using a barostat to create measured degrees of gastric distension and to ascertain EGJ compliance during fluoroscopy of the EGJ, using intragastric air insufflation to study the physiology of transient LES relaxations and high resolution manometry to map the geometry and mobility of the EGJ. An underlying hypothesis is that the optimal surgical management of a patient with tLESR induced reflux is different than of the patient with a patulous sphincter. The ultimate goal is to tailor the surgical management of GERD for the individual patient based on physiological studies of that patient with the hope that this will improve the efficacy and reduce the complications of antireflux surgery. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: TREATMENT OF DYSPHAGIA USING THE MENDELSOHN MANEUVER Principal Investigator & Institution: Mccullough, Gary H.; Audiology and Speech Pathology; University of Arkansas Med Scis Ltl Rock Little Rock, Ar 72205 Timing: Fiscal Year 2002; Project Start 01-SEP-2002; Project End 31-AUG-2005 Summary: (provided by applicant): The primary goal of the proposed investigation is to determine the effects of the Mendelsohn maneuver (voluntary prolongation of laryngeal excursion at the midpoint of the swallow) on the physiology of the swallow in individuals who have suffered a stroke and exhibit signs of pharyngeal dysphagia. The proposed study is a phase 1 investigation designed to determine whether the treatment can be safely administered to individuals post-stroke and whether the biomechanical measures of choice are reflective of treatment outcomes. This type of phase 1 study aims to provide data which is essential for the development of phase 2 and phase 3 (efficacy) studies, including the treatment dose necessary to produce physiological change. Participants who have suffered a stroke and have pharyngeal dysphagia will be divided randomly into one of two groups. Group 1 participants will receive two weeks of treatment using the Mendelsohn maneuver in conjunction with surface electromyography (SEMG) biofeedback [followed by two weeks of no treatment (BBAA)]. Group 2 participants will be placed in a no-treatment period for two weeks and will then receive two weeks of treatment using the Mendelsohn maneuver in conjunction with SEMG biofeedback (AABB). Participants will be assessed with videofluoroscopy at the initiation of the study and after each week of the study. [After the 4 weeks of participation (AABB or BBAA) are complete, all participants will be discharged from treatment and will be brought back to the clinic for a final VFS evaluation after 2 additional weeks of no-treatment.] Specific Aim 1: To determine the effect of the Mendelsohn maneuver on the biomechanics of the pharyngeal swallow (i.e., measures of swallowing extent and duration). Specific Aim 2: To determine the effect of the Mendelsohn maneuver on measures of bolus flow (i.e., pharyngeal residue and penetration/aspiration). Specific Aim 3: To determine the effect of the Mendelsohn Maneuver on an overall dysphagia severity scale (Dysphagia Oral Severity Scale DOSS). Specific Aim 4: To determine the most appropriate dose of treatment. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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E-Journals: PubMed Central3 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).4 Access to this growing archive of e-journals is free and unrestricted.5 To search, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Pmc, and type “dysphagia” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for dysphagia in the PubMed Central database: •

A distinctive case of dysphagia. by Greenwald E, Rawlinson JD, Marshall JK.; 2004 Jan 6; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=305311

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Dysphagia and Chronic Mental Illness: Looking Beyond Hysteria and Broadening the Psychiatric Differential Diagnosis. by Stovall JG, Gussak LS.; 2001 Jun; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=181177

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Rehabilitation medicine: 2. Diagnosis of dysphagia and its nutritional management for stroke patients. by Finestone HM, Greene-Finestone LS.; 2003 Nov 11; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=236230

The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.6 The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with dysphagia, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “dysphagia” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for dysphagia (hyperlinks lead to article summaries):

3 4

Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html.

With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 5 The value of PubMed Central, in addition to its role as an archive, lies in the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print. 6 PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

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A 54-year-old man with a history of heartburn and progressive dysphagia. Author(s): Katzka DA. Source: Medgenmed [electronic Resource] : Medscape General Medicine. 2003 April 7; 5(2): 15. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14603114&dopt=Abstract

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A case of cough and dysphagia. Author(s): Smyth CM, Evans CC. Source: Postgraduate Medical Journal. 2002 February; 78(916): 104-5, 111. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11807200&dopt=Abstract

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A comment on “Aspiration risk after stroke: comparison of clinical examination and fiberoptic endoscopic evaluation of swallowing” (Dysphagia 17:214-218, 2002). Author(s): Kalf JG. Source: Dysphagia. 2003 Fall; 18(4): 305-6; Author Reply 306. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14584480&dopt=Abstract

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A comment on “Pneumonia in stroke patients: a retrospective study” (Dysphagia 15:51-57, 2000). Author(s): Wiles CM. Source: Dysphagia. 2001 Fall; 16(4): 317-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11720407&dopt=Abstract

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A comparison of 3 types of covered metal stents for the palliation of patients with dysphagia caused by esophagogastric carcinoma: a prospective, randomized study. Author(s): Siersema PD, Hop WC, van Blankenstein M, van Tilburg AJ, Bac DJ, Homs MY, Kuipers EJ. Source: Gastrointestinal Endoscopy. 2001 August; 54(2): 145-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11474382&dopt=Abstract

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A diabetic haemodialysis patient with dysphagia and weight loss. Author(s): Ahmed W, Rylance PB, Jackson MA, Nicholas JC, Odum J. Source: Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association. 2003 May; 18(5): 1018-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12686683&dopt=Abstract

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A distinctive case of dysphagia. Author(s): Greenwald E, Rawlinson JD, Marshall JK. Source: Cmaj : Canadian Medical Association Journal = Journal De L'association Medicale Canadienne. 2004 January 6; 170(1): 42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14707217&dopt=Abstract

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A leiomyosarcoma of the oesophagus presenting incidentally without dysphagia. Author(s): Jutley RS, Gray RD, MacKenzie JM, Cockburn JS. Source: European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery. 2002 January; 21(1): 127-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11788282&dopt=Abstract

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A new complication of hypothyroid coma: neurogenic dysphagia: presentation, diagnosis, and treatment. Author(s): Urquhart AD, Rea IM, Lawson LT, Skipper M. Source: Thyroid : Official Journal of the American Thyroid Association. 2001 June; 11(6): 595-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11442008&dopt=Abstract

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A new mutation in the mitochondrial tRNA(Ala) gene in a patient with ophthalmoplegia and dysphagia. Author(s): Spagnolo M, Tomelleri G, Vattemi G, Filosto M, Rizzuto N, Tonin P. Source: Neuromuscular Disorders : Nmd. 2001 July; 11(5): 481-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11404121&dopt=Abstract

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A prospective assessment of the characteristics of dysphagia in myasthenia gravis. Author(s): Colton-Hudson A, Koopman WJ, Moosa T, Smith D, Bach D, Nicolle M. Source: Dysphagia. 2002 Spring; 17(2): 147-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11956840&dopt=Abstract

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A randomised prospective comparison of the Flamingo Wallstent and Ultraflex stent for palliation of dysphagia associated with lower third oesophageal carcinoma. Author(s): Sabharwal T, Hamady MS, Chui S, Atkinson S, Mason R, Adam A. Source: Gut. 2003 July; 52(7): 922-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12801944&dopt=Abstract

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A rare case of dysphagia: hypopharyngeal amyloidosis masquerading as a postcricoid tumour. Author(s): Chadwick MA, Buckland JR, Mason P, Randall CJ, Theaker J. Source: The Journal of Laryngology and Otology. 2002 January; 116(1): 54-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11860656&dopt=Abstract

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A study of the early stage of Dysphagia in amyotrophic lateral sclerosis. Author(s): Kawai S, Tsukuda M, Mochimatsu I, Enomoto H, Kagesato Y, Hirose H, Kuroiwa Y, Suzuki Y. Source: Dysphagia. 2003 Winter; 18(1): 1-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12497190&dopt=Abstract

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A woman with dysphagia and Raynaud's phenomenon. Author(s): Gaya DR, Mactier R. Source: Postgraduate Medical Journal. 2002 February; 78(916): 102-3, 109. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11807198&dopt=Abstract

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ABC of the upper gastrointestinal tract. Dysphagia. Author(s): Owen W. Source: Bmj (Clinical Research Ed.). 2001 October 13; 323(7317): 850-3. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11597971&dopt=Abstract

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Aberrant right subclavian artery (arteria lusoria) as a rare cause of dysphagia and dyspnea in a 79-year old women with right mediastinal and retrotracheal mass, and co-existing coronary artery disease. Author(s): Stork T, Gareis R, Krumholz K, Eichstadt H. Source: Vasa. Zeitschrift Fur Gefasskrankheiten. Journal for Vascular Diseases. 2001 July; 30(3): 225-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11582955&dopt=Abstract

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Aberrant right subclavian artery and dysphagia lusoria. Author(s): O'Dwyer H, Ryan S, Saidlear C. Source: The New England Journal of Medicine. 2002 November 7; 347(19): 1532. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12422895&dopt=Abstract

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Aberrant right subclavian artery and dysphagia lusoria. Author(s): Morgan-Hughes GJ, Owens PE, Roobottom CA. Source: The New England Journal of Medicine. 2002 November 7; 347(19): 1532. Erratum In: N Engl J Med 2002 December 19; 347(25): 2090. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12421902&dopt=Abstract

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Actinomycosis of the post-cricoid space: an unusual cause of dysphagia. Author(s): Syed MA, Ayshford CA, Uppal HS, Cullen RJ. Source: The Journal of Laryngology and Otology. 2001 May; 115(5): 428-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11410143&dopt=Abstract

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Acute characteristics of pediatric Dysphagia subsequent to traumatic brain injury: videofluoroscopic assessment. Author(s): Morgan A, Ward E, Murdoch B, Bilbie K. Source: The Journal of Head Trauma Rehabilitation. 2002 June; 17(3): 220-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12086576&dopt=Abstract

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Acute onset dysphagia associated with an intramural oesophageal haematoma in acquired haemophilia. Author(s): Horan P, Drake M, Patterson RN, Cuthbert RJ, Carey D, Johnston SD. Source: European Journal of Gastroenterology & Hepatology. 2003 February; 15(2): 2057. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12560769&dopt=Abstract

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Adherence to eating and drinking guidelines for adults with intellectual disabilities and dysphagia. Author(s): Chadwick DD, Jolliffe J, Goldbart J. Source: Am J Ment Retard. 2003 May; 108(3): 202-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12691599&dopt=Abstract

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An 82-year-old woman with oropharyngeal dysphagia. Author(s): LeVert E. Source: Medgenmed [electronic Resource] : Medscape General Medicine. 2002 November 5; 4(4): 7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12817203&dopt=Abstract

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An interdisciplinary approach to the management of dysphagia. Author(s): Davies S. Source: Prof Nurse. 2002 September; 18(1): 22-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12238717&dopt=Abstract

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An interdisciplinary team approach to providing dysphagia treatment in the schools. Author(s): Homer EM. Source: Seminars in Speech and Language. 2003 August; 24(3): 215-34. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14533054&dopt=Abstract

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An unusual case of dysphagia: ectopic salivary gland pleomorphic adenoma of the parapharyngeal space. Author(s): Kesse KW, Howlett DC, Manjaly G. Source: The Journal of Otolaryngology. 2002 June; 31(3): 193-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12121031&dopt=Abstract

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An unusual case of dysphagia: retained Groningen valve. Author(s): Basha SI, Durham LH. Source: The Journal of Laryngology and Otology. 2002 May; 116(5): 392-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12081003&dopt=Abstract

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An update in the palliative management of malignant dysphagia. Author(s): Blazeby JM, Alderson D, Farndon JR. Source: European Journal of Surgical Oncology : the Journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology. 2001 April; 27(3): 332-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11373117&dopt=Abstract

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Anterior cervical osteophytes: a rare cause of dysphagia and upper airway obstruction in older patients. Author(s): Stancampiano FF, Zavaleta EG, Astor F. Source: Journal of the American Geriatrics Society. 2002 November; 50(11): 1910-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12410920&dopt=Abstract

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Anxiety disorder after laparoscopic refundoplication as a cause of dysphagia. Author(s): Kamolz T, Bammer T, Pointner R. Source: Surgical Endoscopy. 2002 February; 16(2): 360-1. Epub 2001 November 16. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11967703&dopt=Abstract

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Are metal stents effective for palliation of malignant dysphagia and fistulas? Author(s): Kostopoulos PP, Zissis MI, Polydorou AA, Premchand PP, Hendrickse MT, Shorrock CJ, Isaacs PE. Source: Dig Liver Dis. 2003 April; 35(4): 275-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12801040&dopt=Abstract

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Aspiration pneumonia and dysphagia in the elderly. Author(s): Marik PE, Kaplan D. Source: Chest. 2003 July; 124(1): 328-36. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12853541&dopt=Abstract

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Aspiration with dysphagia: the interaction between oropharyngeal and respiratory impairments. Author(s): Morton R, Minford J, Ellis R, Pinnington L. Source: Dysphagia. 2002 Summer; 17(3): 192-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12140644&dopt=Abstract

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Assessment of oesophageal motor function in patients with dysphagia or chest pain the Clinical Outcomes Research Initiative experience. Author(s): Dekel R, Pearson T, Wendel C, De Garmo P, Fennerty MB, Fass R. Source: Alimentary Pharmacology & Therapeutics. 2003 December; 18(11-12): 1083-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14653827&dopt=Abstract

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Biomechanics of failed deglutitive upper esophageal sphincter relaxation in neurogenic dysphagia. Author(s): Williams RB, Wallace KL, Ali GN, Cook IJ. Source: American Journal of Physiology. Gastrointestinal and Liver Physiology. 2002 July; 283(1): G16-26. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12065287&dopt=Abstract

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Biomechanics, diagnosis, and treatment outcome in inflammatory myopathy presenting as oropharyngeal dysphagia. Author(s): Williams RB, Grehan MJ, Hersch M, Andre J, Cook IJ. Source: Gut. 2003 April; 52(4): 471-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12631653&dopt=Abstract

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Botulinum toxin for dysphagia due to cricopharyngeal dysfunction. Author(s): Moerman M, Callier Y, Dick C, Vermeersch H. Source: European Archives of Oto-Rhino-Laryngology : Official Journal of the European Federation of Oto-Rhino-Laryngological Societies (Eufos) : Affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery. 2002 January; 259(1): 1-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11954918&dopt=Abstract

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Botulinum toxin in the treatment of cricopharyngeal dysphagia. Author(s): Haapaniemi JJ, Laurikainen EA, Pulkkinen J, Marttila RJ. Source: Dysphagia. 2001 Summer; 16(3): 171-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11453562&dopt=Abstract

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Cardiovascular effects of the supraglottic and super-supraglottic swallowing maneuvers in stroke patients with dysphagia. Author(s): Chaudhuri G, Hildner CD, Brady S, Hutchins B, Aliga N, Abadilla E. Source: Dysphagia. 2002 Winter; 17(1): 19-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11820383&dopt=Abstract

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Carer knowledge of dysphagia management strategies. Author(s): Chadwick DD, Jolliffe J, Goldbart J. Source: International Journal of Language & Communication Disorders / Royal College of Speech & Language Therapists. 2002 July-September; 37(3): 345-57. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12201982&dopt=Abstract

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Causes of long-term dysphagia after laparoscopic Nissen fundoplication. Author(s): Sato K, Awad ZT, Filipi CJ, Selima MA, Cummings JE, Fenton SJ, Hinder RA. Source: Jsls. 2002 January-March; 6(1): 35-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12002294&dopt=Abstract

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Cervical osteophyte induced dysphagia. Author(s): Chattopadhyay A, Singh S, Sood A, Wanchu A, Bambery P. Source: J Assoc Physicians India. 2001 October; 49: 1043-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11848321&dopt=Abstract

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Cervical osteophytes presenting as unilateral vocal fold paralysis and dysphagia. Author(s): Yoskovitch A, Kantor S. Source: The Journal of Laryngology and Otology. 2001 May; 115(5): 422-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11410141&dopt=Abstract

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Chronic dysphagia following laparoscopic fundoplication (Br J Surg 2000; 87: 1341-5). Author(s): Ackroyd R, Watson DI. Source: The British Journal of Surgery. 2001 June; 88(6): 887. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11412265&dopt=Abstract

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Clinical assessment of dysphagia in early phases of Parkinson's disease. Author(s): Volonte MA, Porta M, Comi G. Source: Neurological Sciences : Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology. 2002 September; 23 Suppl 2: S121-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12548373&dopt=Abstract

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Comments on selected recent dysphagia literature. Author(s): Sasaki CT, Leder SB. Source: Dysphagia. 2002 Fall; 17(4): 316-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12355147&dopt=Abstract

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Construction and validation of the mealtime and dysphagia questionnaire: an instrument designed to assess nursing staff reasons for noncompliance with SLP dysphagia and feeding recommendations. Author(s): Colodny N. Source: Dysphagia. 2001 Fall; 16(4): 263-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11720402&dopt=Abstract

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Cost-effectiveness of two types of dysphagia care in head and neck cancer: a preliminary report. Author(s): Aviv JE, Sataloff RT, Cohen M, Spitzer J, Ma G, Bhayani R, Close LG. Source: Ear, Nose, & Throat Journal. 2001 August; 80(8): 553-6, 558. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11523474&dopt=Abstract

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Craniocervical tetanus presenting with dysphagia: diagnostic value of electrophysiological studies. Author(s): Mastaglia FL, Thickbroom GW, Day T, Bond R. Source: Journal of Neurology. 2001 October; 248(10): 903-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11697530&dopt=Abstract

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Cricopharyngeal achalasia is a common cause of dysphagia in patients with mtDNA deletions. Author(s): Kornblum C, Broicher R, Walther E, Seibel P, Reichmann H, Klockgether T, Herberhold C, Schroder R. Source: Neurology. 2001 May 22; 56(10): 1409-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11376201&dopt=Abstract

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Dementia with oropharyngeal dysphagia and myopathy. Author(s): Jerrard-Dunne P, Farrell Z, O'Neill D. Source: Dysphagia. 2001 Summer; 16(3): 196-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11453567&dopt=Abstract

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Differential diagnosis of “dysphagia” in an elderly woman. Author(s): Wedekind H, Bisping G, Attaie T, Wessling J, Tombach B, Breithardt G, Domschke W. Source: Clin Cardiol. 2002 March; 25(3): 132. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11890372&dopt=Abstract

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Diffuse idiopathic skeletal hyperostosis resulting in dysphagia and aspiration pneumonia. Author(s): Giddings CE, Caulfield HM, Dorward NL. Source: British Journal of Neurosurgery. 2003 October; 17(5): 467-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14635756&dopt=Abstract

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Diffuse idiopathic skeletal hyperostosis: a case of dysphagia. Author(s): Foshang TH, Mestan MA, Riggs LJ. Source: Journal of Manipulative and Physiological Therapeutics. 2002 January; 25(1): 716. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11898021&dopt=Abstract

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Dismissing dysphagia. Author(s): Godden D. Source: British Dental Journal. 2001 October 13; 191(7): 355-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11697594&dopt=Abstract

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Drug-induced esophageal injuries and dysphagia. Author(s): O'Neill JL, Remington TL. Source: The Annals of Pharmacotherapy. 2003 November; 37(11): 1675-84. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14565800&dopt=Abstract

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Dysphagia after Heimlich maneuver. Author(s): Olenchock SA Jr, Rowlands DM, Reed JF 3rd, Garzia FM, Zasik JM. Source: Chest. 2004 January; 125(1): 302-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14718456&dopt=Abstract

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Dysphagia and advancing age: are manometric abnormalities more common in older patients? Author(s): Robson KM, Glick ME. Source: Digestive Diseases and Sciences. 2003 September; 48(9): 1709-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14560988&dopt=Abstract

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Dysphagia and aspiration pneumonia in patients with Alzheimer's disease. Author(s): Kalia M. Source: Metabolism: Clinical and Experimental. 2003 October; 52(10 Suppl 2): 36-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14577062&dopt=Abstract

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Dysphagia and aspiration secondary to polymyositis. Author(s): Belafsky PC, Mims JW, Postma GN, Koufman JA. Source: Ear, Nose, & Throat Journal. 2002 May; 81(5): 316. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12025001&dopt=Abstract

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Dysphagia and aspiration with unilateral vocal cord immobility: incidence, characterization, and response to surgical treatment. Author(s): Bhattacharyya N, Kotz T, Shapiro J. Source: The Annals of Otology, Rhinology, and Laryngology. 2002 August; 111(8): 672-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12184586&dopt=Abstract

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Dysphagia and clinical outcome after laparoscopic Nissen or Rossetti fundoplication: sequential prospective study. Author(s): Contini S, Zinicola R, Bertele A, Nervi G, Rubini P, Scarpignato C. Source: World Journal of Surgery. 2002 September; 26(9): 1106-11. Epub 2002 June 06. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12045866&dopt=Abstract

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Dysphagia and dyspnea due to an anterior cervical osteophyte. Author(s): Maiuri F, Stella L, Sardo L, Buonamassa S. Source: Archives of Orthopaedic and Trauma Surgery. 2002 May; 122(4): 245-7. Epub 2002 January 08. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12029517&dopt=Abstract

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Dysphagia and Maloney dilations. Author(s): Langdon DE. Source: The American Journal of Gastroenterology. 2001 October; 96(10): 3045-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11693358&dopt=Abstract

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Dysphagia and oesophageal clearance after laparoscopic versus open Nissen fundoplication. A randomized, prospective trial. Author(s): Luostarinen M, Virtanen J, Koskinen M, Matikainen M, Isolauri J. Source: Scandinavian Journal of Gastroenterology. 2001 June; 36(6): 565-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11424313&dopt=Abstract

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Dysphagia and oral feeding problems in the premature infant. Author(s): Jones MW, Morgan E, Shelton JE. Source: Neonatal Netw. 2002 March; 21(2): 51-7. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11924001&dopt=Abstract

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Dysphagia and quality of life after laparoscopic Nissen fundoplication in patients with and without prosthetic reinforcement of the hiatal crura. Author(s): Kamolz T, Granderath FA, Bammer T, Pasiut M, Pointner R. Source: Surgical Endoscopy. 2002 April; 16(4): 572-7. Epub 2002 January 09. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11972190&dopt=Abstract

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Dysphagia and stridor caused by laryngeal rheumatoid arthritis. Author(s): Erb N, Pace AV, Delamere JP, Kitas GD. Source: Rheumatology (Oxford, England). 2001 August; 40(8): 952-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11511774&dopt=Abstract

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Dysphagia aortica: harbinger of aortoesophageal fistula? Author(s): Lau H. Source: Surgery. 2001 June; 129(6): 763-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11391378&dopt=Abstract

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Dysphagia associated with lower thoracic spondylosis. Author(s): Cai FZ, Rischmueller M, Pile K, Brady SJ. Source: Rheumatology (Oxford, England). 2003 December; 42(12): 1575-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14645871&dopt=Abstract

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Dysphagia associated with risperidone therapy. Author(s): Stewart JT. Source: Dysphagia. 2003 Fall; 18(4): 274-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14571332&dopt=Abstract

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Dysphagia caused by a foreign body. Author(s): Hiorns MP, Patwardhan N, Spitz L. Source: Archives of Disease in Childhood. 2003 November; 88(11): 1017-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14612373&dopt=Abstract

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Dysphagia caused by an embryonic triple epithelial duplication cyst. Author(s): Hoem D, Odegaard S, Morild I, Viste A. Source: The European Journal of Surgery = Acta Chirurgica. 2001 July; 167(7): 546-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11560393&dopt=Abstract

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Dysphagia caused by anterior cervical osteophytes: a case report. Author(s): Humphreys SC, Hodges SD, Eck JC, Griffin J. Source: Am J Orthop. 2002 July; 31(7): 417-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12180629&dopt=Abstract

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Dysphagia caused by Plummer-Vinson syndrome. Author(s): Sanai FM, Mohamed AE, Al Karawi MA. Source: Endoscopy. 2001 May; 33(5): 470. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11396773&dopt=Abstract

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Dysphagia caused by transluminal erosion of a titanium rod into the esophagus. Author(s): Barranco B, Gregory SA, Sanford Y, Monkemuller KE. Source: Gastrointestinal Endoscopy. 2003 February; 57(2): 274-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12556806&dopt=Abstract

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Dysphagia caused by ventricular pseudoaneurysm. Author(s): Noukoua CT, Nchimi A, Biquet JF, Markov M, Sakalihassan N, Magotteaux P. Source: Jbr-Btr. 2003 May-June; 86(3): 168-9. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12880168&dopt=Abstract

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Dysphagia due to a large schwannoma of the oropharynx: case report and review of the literature. Author(s): Thurnher D, Quint C, Pammer J, Schima W, Knerer B, Denk DM. Source: Archives of Otolaryngology--Head & Neck Surgery. 2002 July; 128(7): 850-2. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12117350&dopt=Abstract

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Dysphagia due to an aberrant left subclavian artery in a right-sided aortic arch. Author(s): McKenna E, Kelly BE, Khan M. Source: Ulster Med J. 2001 May; 70(1): 64-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11428331&dopt=Abstract

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Dysphagia due to cervical osteophytes. Author(s): Yutan E, Daras M, Koppel BS. Source: Clinical Imaging. 2001 July-August; 25(4): 262-4. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11566087&dopt=Abstract

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Dysphagia due to Chiari I malformation mimicking ALS. Author(s): Gamez J, Santamarina E, Codina A. Source: Journal of Neurology, Neurosurgery, and Psychiatry. 2003 April; 74(4): 549-50; Author Reply 550. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12640093&dopt=Abstract

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Dysphagia evaluation practices: inconsistencies in clinical assessment and instrumental examination decision-making. Author(s): Mathers-Schmidt BA, Kurlinski M. Source: Dysphagia. 2003 Spring; 18(2): 114-25. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12825905&dopt=Abstract

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Dysphagia in a patient with a history of large B-cell lymphoma: esophageal disease with negative biopsy findings. Author(s): Crook TW, Robinson RA. Source: Diagnostic Cytopathology. 2002 March; 26(3): 167-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11892022&dopt=Abstract

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Dysphagia in a patient with lateral medullary syndrome: insight into the central control of swallowing. Author(s): Martino R, Terrault N, Ezerzer F, Mikulis D, Diamant NE. Source: Gastroenterology. 2001 August; 121(2): 420-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11487551&dopt=Abstract

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Dysphagia in a patient with lupus and review of the literature. Author(s): Chua S, Dodd H, Saeed IT, Chakravarty K. Source: Lupus. 2002; 11(5): 322-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12090569&dopt=Abstract

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Dysphagia in a patient with palmoplantar keratoderma. Author(s): Morgan R. Source: Postgraduate Medical Journal. 2001 October; 77(912): 667, 678-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11571384&dopt=Abstract

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Dysphagia in a patient with rheumatoid arthritis and iron deficiency anemia. Author(s): Medrano M. Source: Medgenmed [electronic Resource] : Medscape General Medicine. 2002 August 28; 4(3): 10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12466753&dopt=Abstract

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Dysphagia in Crohn's disease: a diagnostic challenge. Author(s): Knoblauch C, Netzer P, Scheurer U, Seibold F. Source: Dig Liver Dis. 2002 September; 34(9): 660-4. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12405254&dopt=Abstract

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Dysphagia in lateral medullary infarction (Wallenberg's syndrome): an acute disconnection syndrome in premotor neurons related to swallowing activity? Author(s): Aydogdu I, Ertekin C, Tarlaci S, Turman B, Kiylioglu N, Secil Y. Source: Stroke; a Journal of Cerebral Circulation. 2001 September; 32(9): 2081-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11546900&dopt=Abstract

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Dysphagia in lung cancer. Author(s): Amin R. Source: Journal of the Royal Society of Medicine. 2002 January; 95(1): 55-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11773359&dopt=Abstract

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Dysphagia in multiple sclerosis - prevalence and prognostic factors. Author(s): Calcagno P, Ruoppolo G, Grasso MG, De Vincentiis M, Paolucci S. Source: Acta Neurologica Scandinavica. 2002 January; 105(1): 40-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11903107&dopt=Abstract

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Dysphagia in multiple sclerosis. Author(s): De Pauw A, Dejaeger E, D'hooghe B, Carton H. Source: Clinical Neurology and Neurosurgery. 2002 September; 104(4): 345-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12140103&dopt=Abstract

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Dysphagia in patients with acute cervical spinal cord injury. Author(s): Wolf C, Meiners TH. Source: Spinal Cord : the Official Journal of the International Medical Society of Paraplegia. 2003 June; 41(6): 347-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12746741&dopt=Abstract

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Dysphagia in patients with nasopharyngeal cancer after radiation therapy: a videofluoroscopic swallowing study. Author(s): Chang YC, Chen SY, Lui LT, Wang TG, Wang TC, Hsiao TY, Li YW, Lien IN. Source: Dysphagia. 2003 Spring; 18(2): 135-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12825907&dopt=Abstract

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Dysphagia in patients with systemic lupus erythematosus. Author(s): Jimenez-Alonso J, Estev D, Vera C, Sabio JM; Grupo Lupus Virgen de las Nieves. Source: Lupus. 2003; 12(6): 493. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12873055&dopt=Abstract

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Dysphagia lusoria--a tale to tell and what to do. Author(s): Govind C, Thomson SR. Source: South African Medical Journal. Suid-Afrikaanse Tydskrif Vir Geneeskunde. 2003 April; 93(4): 269-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12806714&dopt=Abstract

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Dysphagia lusorum. Author(s): Praveen V, Anbarasu M, Sreenivas VG, Neelakandhan KS. Source: Asian Cardiovascular & Thoracic Annals. 2003 December; 11(4): 376. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14681108&dopt=Abstract

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Dysphagia outcomes in patients with brain tumors undergoing inpatient rehabilitation. Author(s): Wesling M, Brady S, Jensen M, Nickell M, Statkus D, Escobar N. Source: Dysphagia. 2003 Summer; 18(3): 203-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14506986&dopt=Abstract

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Dysphagia with bilateral lesions of the insular cortex. Author(s): Stickler D, Gilmore R, Rosenbek JC, Donovan NJ. Source: Dysphagia. 2003 Summer; 18(3): 179-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14506983&dopt=Abstract

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Dysphagia, hoarseness, and unilateral true vocal fold motion impairment following anterior cervical diskectomy and fusion. Author(s): Baron EM, Soliman AM, Gaughan JP, Simpson L, Young WF. Source: The Annals of Otology, Rhinology, and Laryngology. 2003 November; 112(11): 921-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14653359&dopt=Abstract

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Dysphagia. Causes of high dysphagia should be assessed by ENT surgeons. Author(s): Haddow K, MacDougall GM, Buchanan MA. Source: Bmj (Clinical Research Ed.). 2002 March 9; 324(7337): 613. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11884338&dopt=Abstract

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Dysphagia. With endoscopic pouch stapling, pouch excision is no longer necessary. Author(s): Bates G. Source: Bmj (Clinical Research Ed.). 2002 March 9; 324(7337): 613. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11887887&dopt=Abstract

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Dysphagia: a cost analysis of the diagnostic approach. Author(s): Esfandyari T, Potter JW, Vaezi MF. Source: The American Journal of Gastroenterology. 2002 November; 97(11): 2733-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12425540&dopt=Abstract

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Dysphagia: evaluation and treatment. Author(s): Lind CD. Source: Gastroenterology Clinics of North America. 2003 June; 32(2): 553-75. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12858606&dopt=Abstract

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Dysphagia: the management and detection of a disabling problem. Author(s): Perry L. Source: British Journal of Nursing (Mark Allen Publishing). 2001 July 12-25; 10(13): 83744. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11927883&dopt=Abstract

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Dysphonia and dysphagia as primary manifestations of invasive aspergillosis. Author(s): Florent M, Ajchenbaum-Cymbalista F, Amy C, Rio B, Molina T, Audouin J, Marie JP, Bouvet A, Cornet M. Source: European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology. 2001 June; 20(6): 441-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11476454&dopt=Abstract

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Early assessments of dysphagia and aspiration risk in acute stroke patients. Author(s): Ramsey DJ, Smithard DG, Kalra L. Source: Stroke; a Journal of Cerebral Circulation. 2003 May; 34(5): 1252-7. Epub 2003 April 03. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12677020&dopt=Abstract

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Early reoperation for acute dysphagia following laparoscopic fundoplication. Author(s): Bessell JR, Adair WD, Smithers BM, Martin I, Menzies B, Gotley DC. Source: The British Journal of Surgery. 2002 June; 89(6): 783-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12027992&dopt=Abstract

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Ectopic lingual thyroid as unusual cause of severe dysphagia. Author(s): Gallo A, Leonetti F, Torri E, Manciocco V, Simonelli M, DeVincentiis M. Source: Dysphagia. 2001 Summer; 16(3): 220-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11453571&dopt=Abstract

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Effect of citric acid and citric acid-sucrose mixtures on swallowing in neurogenic oropharyngeal dysphagia. Author(s): Pelletier CA, Lawless HT. Source: Dysphagia. 2003 Fall; 18(4): 231-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14571326&dopt=Abstract

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Endoluminal palliation for dysphagia secondary to esophageal carcinoma. Author(s): Weigel TL, Frumiento C, Gaumintz E. Source: The Surgical Clinics of North America. 2002 August; 82(4): 747-61. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12472128&dopt=Abstract

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Endoscopic botulinum toxin injection for cricopharyngeal dysphagia. Author(s): Parameswaran MS, Soliman AM. Source: The Annals of Otology, Rhinology, and Laryngology. 2002 October; 111(10): 8714. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12389853&dopt=Abstract

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Endoscopic palliation of malignant dysphagia. Author(s): Adler DG, Baron TH. Source: Mayo Clinic Proceedings. 2001 July; 76(7): 731-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11444406&dopt=Abstract

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Eosinophilic esophagitis: strictures, impactions, dysphagia. Author(s): Khan S, Orenstein SR, Di Lorenzo C, Kocoshis SA, Putnam PE, Sigurdsson L, Shalaby TM. Source: Digestive Diseases and Sciences. 2003 January; 48(1): 22-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12645786&dopt=Abstract

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EsophaCoil for palliation of dysphagia in unresectable oesophageal carcinoma: shortand long-term results. Author(s): Naso P, Bonanno G, Aprile G, Trama G, Favara C, Greco S, Russo A. Source: Dig Liver Dis. 2001 November; 33(8): 653-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11785709&dopt=Abstract

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Esophageal pneumatic dilation for postfundoplication dysphagia: safety, efficacy, and predictors of outcome. Author(s): Hui JM, Hunt DR, de Carle DJ, Williams R, Cook IJ. Source: The American Journal of Gastroenterology. 2002 December; 97(12): 2986-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12492180&dopt=Abstract

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Esophageal tuberculosis abscess: an unusual cause of dysphagia. Author(s): Eroglu A, Kurkcuoglu C, Karaoglanoglu N, Yilmaz O, Gursan N. Source: Diseases of the Esophagus : Official Journal of the International Society for Diseases of the Esophagus / I.S.D.E. 2002; 15(1): 93-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12060051&dopt=Abstract

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Evaluation and management of oropharyngeal Dysphagia in head and neck cancer. Author(s): Gaziano JE. Source: Cancer Control : Journal of the Moffitt Cancer Center. 2002 September-October; 9(5): 400-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12410179&dopt=Abstract

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Expandable metal stents in the palliation of malignant dysphagia and oesophagealrespiratory fistulae. Author(s): McGrath JP, Browne M, Riordan C, Ravi N, Reynolds JV. Source: Ir Med J. 2001 October; 94(9): 270-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11820518&dopt=Abstract

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Familial gastrointestinal stromal tumors associated with dysphagia and novel type germline mutation of KIT gene. Author(s): Hirota S, Nishida T, Isozaki K, Taniguchi M, Nishikawa K, Ohashi A, Takabayashi A, Obayashi T, Okuno T, Kinoshita K, Chen H, Shinomura Y, Kitamura Y. Source: Gastroenterology. 2002 May; 122(5): 1493-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11984533&dopt=Abstract

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Food refusal and dysphagia in older people with dementia: ethical and practical issues. Author(s): Wasson K, Tate H, Hayes C. Source: International Journal of Palliative Nursing. 2001 October; 7(10): 465-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11923745&dopt=Abstract

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Guidelines for the pathoanatomical examination of the lower brain stem in ingestive and swallowing disorders and its application to a dysphagic spinocerebellar ataxia type 3 patient. Author(s): Rub U, Brunt ER, Del Turco D, de Vos RA, Gierga K, Paulson H, Braak H. Source: Neuropathology and Applied Neurobiology. 2003 February; 29(1): 1-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12581335&dopt=Abstract

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Heterotopic pancreas presenting as dysphagia. Author(s): Shalaby M, Kochman ML, Lichtenstein GR. Source: The American Journal of Gastroenterology. 2002 April; 97(4): 1046-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12003387&dopt=Abstract

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Homocysteine blood level in long-term care residents with oropharyngeal dysphagia: comparison of hand-oral and tube-enteral-fed patients. Author(s): Leibovitz A, Sela BA, Habot B, Gavendo S, Lansky R, Avni Y, Segal R. Source: Jpen. Journal of Parenteral and Enteral Nutrition. 2002 March-April; 26(2): 94-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11871741&dopt=Abstract

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Hyoid movement during swallowing in older patients with dysphagia. Author(s): Kendall KA, Leonard RJ. Source: Archives of Otolaryngology--Head & Neck Surgery. 2001 October; 127(10): 12249. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11587603&dopt=Abstract

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Images in clinical medicine. Aberrant right subclavian artery and dysphagia lusoria. Author(s): Kent PD, Poterucha TH. Source: The New England Journal of Medicine. 2002 May 23; 346(21): 1637. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12023996&dopt=Abstract

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Images in medicine. Dysphagia lusoria. Author(s): Dalal L, Stipho S, Diaz J. Source: Medicine and Health, Rhode Island. 2003 September; 86(9): 282. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14556412&dopt=Abstract

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Incidence of dysphagia after anterior cervical spine surgery: a prospective study. Author(s): Bazaz R, Lee MJ, Yoo JU. Source: Spine. 2002 November 15; 27(22): 2453-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12435974&dopt=Abstract

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Incidence, characteristics, and predictive factors for Dysphagia after pediatric traumatic brain injury. Author(s): Morgan A, Ward E, Murdoch B, Kennedy B, Murison R. Source: The Journal of Head Trauma Rehabilitation. 2003 May-June; 18(3): 239-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12802166&dopt=Abstract

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Insertion of self-expanding metal stents for malignant dysphagia: assessment of a simple endoscopic method. Author(s): Shenfine J, Hayes N, Griffiths SM. Source: Annals of the Royal College of Surgeons of England. 2001 May; 83(3): 219-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11432145&dopt=Abstract

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Inter- and intra-rater reliability of cervical auscultation to detect aspiration in patients with dysphagia. Author(s): Stroud AE, Lawrie BW, Wiles CM. Source: Clinical Rehabilitation. 2002 September; 16(6): 640-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12392339&dopt=Abstract

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Intravenous immunoglobulin for dysphagia of inclusion body myositis. Author(s): Cherin P, Pelletier S, Teixeira A, Laforet P, Simon A, Herson S, Eymard B. Source: Neurology. 2002 January 22; 58(2): 326. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11805271&dopt=Abstract

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Investigating and managing chronic dysphagia: dysphagia should prompt urgent gastroenterological referral. Author(s): Spencer HL, Riley S. Source: Bmj (Clinical Research Ed.). 2003 May 24; 326(7399): 1147-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12764007&dopt=Abstract

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Investigating and managing chronic dysphagia: gastroenterological input should have been included. Author(s): Lewis CJ, Attwood SE. Source: Bmj (Clinical Research Ed.). 2003 May 24; 326(7399): 1148. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12764012&dopt=Abstract

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Investigation and management of chronic dysphagia. Author(s): Leslie P, Carding PN, Wilson JA. Source: Bmj (Clinical Research Ed.). 2003 February 22; 326(7386): 433-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12595385&dopt=Abstract

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Is endovascular stent grafting for descending thoracic aortic disease recommendable in patients with dysphagia? Author(s): Chocron S, Stoica L, Koch S, Bonneville JF, Kaili D, Heyd B, Etievent JP. Source: The Journal of Thoracic and Cardiovascular Surgery. 2002 December; 124(6): 1239-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12447196&dopt=Abstract

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It's tough to swallow: a practical approach to nutritional care of dysphagia. Author(s): Dorner B. Source: Director. 2002 Summer; 10(3): 107-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12116752&dopt=Abstract

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Laparoscopic Heller myotomy relieves dysphagia in patients with achalasia and low LES pressure following pneumatic dilatation. Author(s): Diener U, Patti MG, Molena D, Tamburini A, Fisichella PM, Whang K, Way LW. Source: Surgical Endoscopy. 2001 July; 15(7): 687-90. Epub 2001 May 11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11591969&dopt=Abstract

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Lateral medullary infarct presenting as acute dysphagia. Author(s): Chiti-Batelli S, Delap T. Source: Acta Oto-Laryngologica. 2001 April; 121(3): 419-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11425212&dopt=Abstract

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Less is more: treatment of aggravating behaviour in myasthenia gravis patients with dysphagia. Author(s): de Swart BJ, Padberg GW, van Engelen BG. Source: European Journal of Neurology : the Official Journal of the European Federation of Neurological Societies. 2002 November; 9(6): 688-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12453089&dopt=Abstract

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Localized brainstem infarction presenting as acute onset dysphagia. Author(s): Lim RP, Brown CL, Berkowitz RG. Source: Anz Journal of Surgery. 2002 August; 72(8): 606-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12190741&dopt=Abstract

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Long-term follow-up study of Lennox-Gastaut syndrome in patients with severe motor and intellectual disabilities: with special reference to the problem of dysphagia. Author(s): Ogawa K, Kanemoto K, Ishii Y, Koyama M, Shirasaka Y, Kawasaki J, Yamasaki S. Source: Seizure : the Journal of the British Epilepsy Association. 2001 April; 10(3): 197202. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11437619&dopt=Abstract

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Management of neurogenic dysphagia. Author(s): Bakheit AM. Source: Postgraduate Medical Journal. 2001 November; 77(913): 694-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11677277&dopt=Abstract

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Mediastinal mass with Dysphagia in an elderly patient. Author(s): Kotanidou A, Andrianakis I, Mavrommatis A, Politis P, Roussos C, Bellenis I. Source: Infection. 2003 June; 31(3): 178-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12789477&dopt=Abstract

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Meeting the nutritional needs of patients with severe dysphagia following a stroke: an interdisciplinary approach. Author(s): Rodrigue N, Cote R, Kirsch C, Germain C, Couturier C, Fraser R. Source: Axone. 2002 March; 23(3): 31-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14621495&dopt=Abstract

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Misdiagnosis of amyotrophic lateral sclerosis in a patient with dysphagia due to Chiari I malformation. Author(s): Paulig M, Prosiegel M. Source: Journal of Neurology, Neurosurgery, and Psychiatry. 2002 February; 72(2): 270. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11796783&dopt=Abstract

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Mysterious dysphagia. Author(s): Biggs MJ, Quick CA. Source: Journal of the Royal Society of Medicine. 2003 November; 96(11): 549-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14594963&dopt=Abstract

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Nasogastric tubes in patients with dysphagia. Author(s): Inoue K, Takano H, Yamada T, Tsuchida Y, Yoshikawa T, Horohisa T. Source: Lancet. 2002 January 5; 359(9300): 81. Erratum In: Lancet 2002 July 27; 360(9329): 344. Horohisa Takano [corrected to Takano Hirohisa]. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11809224&dopt=Abstract

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Nasogastric tubes in patients with dysphagia. Author(s): Sekizawa K. Source: Lancet. 2002 January 5; 359(9300): 80-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11809223&dopt=Abstract

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Nasogastric tubes in patients with dysphagia. Author(s): Zeeh J. Source: Lancet. 2002 January 5; 359(9300): 80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11809222&dopt=Abstract

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Non-invasive technique for assessment and management planning of oral-pharyngeal dysphagia in children with cerebral palsy. Author(s): Cockerill H, Carroll-Few L. Source: Developmental Medicine and Child Neurology. 2001 June; 43(6): 429-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11409835&dopt=Abstract

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Nonobstructive dysphagia and recovery of motor disorder after antireflux surgery. Author(s): Diaz de Liano A, Oteiza F, Ciga MA, Aizcorbe M, Trujillo R, Cobo F. Source: American Journal of Surgery. 2003 February; 185(2): 103-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12559437&dopt=Abstract

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Nursing assessment of dysphagia among patients with stroke. Author(s): Westergren A, Hallberg IR, Ohlsson O. Source: Scandinavian Journal of Caring Sciences. 1999; 13(4): 274-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12032925&dopt=Abstract

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Objective measures of dysphagia complexity in children related to suckle feeding histories, gestational ages, and classification of their cerebral palsy. Author(s): Selley WG, Parrott LC, Lethbridge PC, Flack FC, Ellis RE, Johnston KJ, Foumeny MA, Tripp JH. Source: Dysphagia. 2001 Summer; 16(3): 200-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11453568&dopt=Abstract

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Oesophageal motor and sensitivity abnormalities in non-obstructive dysphagia. Author(s): Bohn B, Bonaz B, Gueddah N, Rolachon A, Papillon E, Bost R, Fournet J. Source: European Journal of Gastroenterology & Hepatology. 2002 March; 14(3): 271-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11953692&dopt=Abstract

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Oesophageal scintigraphy for the investigation of dysphagia: in ans out of favour underused when available. Author(s): Stacey B, Patel P. Source: European Journal of Nuclear Medicine and Molecular Imaging. 2002 September; 29(9): 1216-20. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12418460&dopt=Abstract

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Oropharyngeal dysphagia after cardiac operations. Author(s): Ferraris VA, Ferraris SP, Moritz DM, Welch S. Source: The Annals of Thoracic Surgery. 2001 June; 71(6): 1792-5; Discussion 1796. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11426749&dopt=Abstract

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Oropharyngeal dysphagia in the elderly. Identifying and managing patients at risk. Author(s): Blackington E, McCormick T, Willson B, Lowenstein A, Gilbert R. Source: Adv Nurse Pract. 2001 July; 9(7): 42-9; Quiz 49-50. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12420453&dopt=Abstract

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Oropharyngeal tuberculosis causing severe odynophagia and dysphagia. Author(s): Caylan R, Aydin K, Caylan R. Source: European Archives of Oto-Rhino-Laryngology : Official Journal of the European Federation of Oto-Rhino-Laryngological Societies (Eufos) : Affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery. 2002 May; 259(5): 229-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12107522&dopt=Abstract

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Osteophyte-induced dysphagia: report of three cases. Author(s): Ozgocmen S, Kiris A, Kocakoc E, Ardicoglu O. Source: Joint, Bone, Spine : Revue Du Rhumatisme. 2002 March; 69(2): 226-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12027318&dopt=Abstract

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Palliation of malignant dysphagia. Author(s): Fotheringham T, Haslam P, Teoh CG, McGrath F, Lee MJ. Source: Ir J Med Sci. 2001 October-December; 170(4): 264. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11918337&dopt=Abstract

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Palliation of patients with dysphagia due to advanced esophageal cancer by endoscopic injection of cisplatin/epinephrine injectable gel. Author(s): Harbord M, Dawes RF, Barr H, Giovannini M, Viens P, Eysselein V, Mishra L, Orenberg EK, Bown SG. Source: Gastrointestinal Endoscopy. 2002 November; 56(5): 644-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12397270&dopt=Abstract

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Pathologic quiz case: a woman with dysphagia and unusual histologic findings in the esophagus. Residual tracheobronchial remnants, consistent with the history of TEF. Tracheoesophageal fistula. Author(s): Moatamed NA, Kiyabu MT. Source: Archives of Pathology & Laboratory Medicine. 2003 November; 127(11): 1523-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14567747&dopt=Abstract

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Patient outcomes and dysphagia after laparoscopic antireflux surgery performed without use of intraoperative esophageal dilators. Author(s): Walsh JD, Landercasper J, Boyd WC, Lambert PJ, Havlik PJ. Source: The American Surgeon. 2003 March; 69(3): 219-23; Discussion 223-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12678478&dopt=Abstract

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Pharyngeal and upper esophageal sphincter manometry in the evaluation of dysphagia. Author(s): Hila A, Castell JA, Castell DO. Source: Journal of Clinical Gastroenterology. 2001 November-December; 33(5): 355-61. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11606849&dopt=Abstract

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Pharyngoesophageal manometry with an original balloon sensor probe for the study of oropharyngeal dysphagia. Author(s): Mattioli S, Lugaresi M, Zannoli R, Brusori S, d'Ovidio F, Braccaioli L. Source: Dysphagia. 2003 Fall; 18(4): 242-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14571327&dopt=Abstract

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Physiologic mechanism and preoperative prediction of new-onset dysphagia after laparoscopic Nissen fundoplication. Author(s): Blom D, Peters JH, DeMeester TR, Crookes PF, Hagan JA, DeMeester SR, Bremner C. Source: Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract. 2002 January-February; 6(1): 22-7; Discussion 27-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11986014&dopt=Abstract

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Placing nasogastric tubes in stroke patients with dysphagia: efficiency and tolerability of the reflex placement. Author(s): Dziewas R, Schilling M, Konrad C, Stogbauer F, Ludemann P. Source: Journal of Neurology, Neurosurgery, and Psychiatry. 2003 October; 74(10): 142931. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14570839&dopt=Abstract

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Postmyotomy dysphagia after laparoscopic surgery for achalasia. Author(s): Shiino Y, Awad ZT, Haynatzki GR, Davis RE, Hinder RA, Filipi CJ. Source: World Journal of Gastroenterology : Wjg. 2003 May; 9(5): 1129-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12717873&dopt=Abstract

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Postoperative dysphagia versus neurogenic dysphagia: scintigraphic assessment. Author(s): Galli J, Valenza V, D'Alatri L, Reale F, Gajate AS, Di Girolamo S, Paludetti G. Source: The Annals of Otology, Rhinology, and Laryngology. 2003 January; 112(1): 20-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12537054&dopt=Abstract

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Precipitation of dysphagia due to achalasia cardia by hemorrhagic stroke. Author(s): Mukharia GK, Garg PK, Tandon RK. Source: The American Journal of Gastroenterology. 2002 June; 97(6): 1569-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12094894&dopt=Abstract

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Preoperative oesophageal motor activity does not predict postoperative dysphagia. Author(s): Hakanson BS, Thor KB, Pope CE 2nd. Source: The European Journal of Surgery = Acta Chirurgica. 2001 June; 167(6): 433-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11471667&dopt=Abstract

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Prevention of pneumonia in elderly stroke patients by systematic diagnosis and treatment of dysphagia: an evidence-based comprehensive analysis of the literature. Author(s): Doggett DL, Tappe KA, Mitchell MD, Chapell R, Coates V, Turkelson CM. Source: Dysphagia. 2001 Fall; 16(4): 279-95. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11720404&dopt=Abstract

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Prospective, randomized outcome study of endoscopy versus modified barium swallow in patients with dysphagia. Author(s): Finkelstein Y. Source: The Laryngoscope. 2002 February; 112(2): 409-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11892607&dopt=Abstract

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Radiological and manometric diagnosis of cricopharyngeal dysphagia in a Japanese encephalitis survivor. Author(s): Chuang YM, Kwan SY, Lirng JF, Tiu CM, Pan PJ. Source: European Journal of Neurology : the Official Journal of the European Federation of Neurological Societies. 2002 July; 9(4): 407-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12099926&dopt=Abstract

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RE: endoscopic diverticulotomy of Zenker's diverticulum: management and complications (Dysphagia 17:34-39). Author(s): Postma GN. Source: Dysphagia. 2003 Summer; 18(3): 227; Author Reply 227-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14506989&dopt=Abstract

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Re: Scolapio et al.--Normal endoscopy, dysphagia, and esophageal dilation. Author(s): Qasim A, Seery J, O'Morain CA. Source: The American Journal of Gastroenterology. 2001 October; 96(10): 3036. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11693349&dopt=Abstract

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Real-time remote telefluoroscopic assessment of patients with dysphagia. Author(s): Perlman AL, Witthawaskul W. Source: Dysphagia. 2002 Spring; 17(2): 162-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11956842&dopt=Abstract

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Recent developments in diagnosis and intervention for aspiration and dysphagia in stroke and other neuromuscular disorders. Author(s): Doggett DL, Turkelson CM, Coates V. Source: Current Atherosclerosis Reports. 2002 July; 4(4): 311-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12052283&dopt=Abstract

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Reconsidering dysphagia. Author(s): Stevens ME. Source: The American Journal of Nursing. 2001 May; 101(5): 13-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11355490&dopt=Abstract

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Recurrent respiratory tract infections and dysphagia in a child with an aortic vascular ring. Author(s): Pumberger W, Voitl P, Gopfrich H. Source: Southern Medical Journal. 2002 February; 95(2): 265-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11846259&dopt=Abstract

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Rehabilitation medicine: 2. Diagnosis of dysphagia and its nutritional management for stroke patients. Author(s): Finestone HM, Greene-Finestone LS. Source: Cmaj : Canadian Medical Association Journal = Journal De L'association Medicale Canadienne. 2003 November 11; 169(10): 1041-4. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14609974&dopt=Abstract

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Rehabilitation of swallowing by exercise in tube-fed patients with pharyngeal dysphagia secondary to abnormal UES opening. Author(s): Shaker R, Easterling C, Kern M, Nitschke T, Massey B, Daniels S, Grande B, Kazandjian M, Dikeman K. Source: Gastroenterology. 2002 May; 122(5): 1314-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11984518&dopt=Abstract

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Restoring pleasure: nutritional management of dysphagia. Author(s): Kemp S. Source: British Journal of Community Nursing. 2001 June; 6(6): 284-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11873203&dopt=Abstract

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Retropharyngeal lipoma causing dysphagia. Author(s): Akhtar J, Shaykhon M, Crocker J, D'Souza AR. Source: European Archives of Oto-Rhino-Laryngology : Official Journal of the European Federation of Oto-Rhino-Laryngological Societies (Eufos) : Affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery. 2001 November; 258(9): 458-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11769991&dopt=Abstract

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Reversible dysphagia associated with neuroleptic treatment. Author(s): Stewart JT. Source: Journal of the American Geriatrics Society. 2001 September; 49(9): 1260-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11559393&dopt=Abstract

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Review of reports on relative prevalence of swallowing disorders after acute stroke (Dysphagia 16:141-142, 2001). Author(s): Mann G. Source: Dysphagia. 2002 Winter; 17(1): 81-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11820390&dopt=Abstract

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Schatzki's ring: a benign cause of dysphagia in adults. Author(s): Jalil S, Castell DO. Source: Journal of Clinical Gastroenterology. 2002 October; 35(4): 295-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12352291&dopt=Abstract

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Self-expanding metal stents or conventional prostheses for palliation of dysphagia? Author(s): Homs MY, Siersema PD. Source: Endoscopy. 2001 May; 33(5): 466-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11396770&dopt=Abstract

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Severe dysphagia after botulinum toxin injection for cervical dystonia in multiple system atrophy. Author(s): Thobois S, Broussolle E, Toureille L, Vial C. Source: Movement Disorders : Official Journal of the Movement Disorder Society. 2001 July; 16(4): 764-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11481708&dopt=Abstract

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Sideropenic dysphagia in an adolescent. Author(s): Lopez Rodriguez MJ, Robledo Andres P, Amarilla Jimenez A, Roncero Maillo M, Lopez Lafuente A, Arroyo Carrera I. Source: Journal of Pediatric Gastroenterology and Nutrition. 2002 January; 34(1): 87-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11753173&dopt=Abstract

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Sideropenic Dysphagia. Author(s): Dantas RO, Miranda AL. Source: Journal of Pediatric Gastroenterology and Nutrition. 2002 September; 35(3): 399; Author Reply 399. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12352537&dopt=Abstract

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Simple method for placing nasogastric tubes in patients with dysphagia. Author(s): Dziewas R, Ludemann P, Konrad C, Stogbauer F. Source: Lancet. 2001 September 1; 358(9283): 725-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11551581&dopt=Abstract

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Social and psychological burden of dysphagia: its impact on diagnosis and treatment. Author(s): Ekberg O, Hamdy S, Woisard V, Wuttge-Hannig A, Ortega P. Source: Dysphagia. 2002 Spring; 17(2): 139-46. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11956839&dopt=Abstract

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Sore throat, dysphagia, stiffness in back of neck, and dyspnea following tricyclic antidepressant overdose. Author(s): Irwin RS. Source: Chest. 2003 October; 124(4): 1533-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14555590&dopt=Abstract

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Successful botulinum toxin treatment of dysphagia in a young child with nemaline myopathy. Author(s): Restivo DA, Giuffrida S, Marchese Ragona R, Falsaperla R. Source: Dysphagia. 2001 Summer; 16(3): 228-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11453573&dopt=Abstract

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Successful treatment of dysphagia in Paget's disease of the bone. Author(s): Varadarajulu S, Reddy S, Noone T, Payne KM. Source: Digestive Diseases and Sciences. 2002 September; 47(9): 2112-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12353865&dopt=Abstract

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Sudden dysphagia with uvular enlargement following the initiation of risperidone which responded to benztropine: was this an extrapyramidal side effect? Author(s): Nair S, Saeed O, Shahab H, Sedky K, Garver D, Lippmann S. Source: General Hospital Psychiatry. 2001 July-August; 23(4): 231-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11569473&dopt=Abstract

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Suture-induced dysphagia: the role of endoscopy in diagnosis and therapy. Author(s): Kattih M, Brady PG, Mamel JJ. Source: Gastrointestinal Endoscopy. 2003 October; 58(4): 636-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14520308&dopt=Abstract

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Swallow function and perception of dysphagia in patients with head and neck cancer. Author(s): Pauloski BR, Rademaker AW, Logemann JA, Lazarus CL, Newman L, Hamner A, MacCracken E, Gaziano J, Stachowiak L. Source: Head & Neck. 2002 June; 24(6): 555-65. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12112553&dopt=Abstract

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Swallowing function and medical diagnoses in infants suspected of Dysphagia. Author(s): Newman LA, Keckley C, Petersen MC, Hamner A. Source: Pediatrics. 2001 December; 108(6): E106. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11731633&dopt=Abstract

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Synchronized electrical stimulation in treating pharyngeal dysphagia. Author(s): Leelamanit V, Limsakul C, Geater A. Source: The Laryngoscope. 2002 December; 112(12): 2204-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12461342&dopt=Abstract

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The causes of dysphagia in carcinoma of the lung. Author(s): Camidge DR. Source: Journal of the Royal Society of Medicine. 2001 November; 94(11): 567-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11691893&dopt=Abstract

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The congenital duplication cyst: a rare differential diagnosis of retrosternal pain and dysphagia in a young patient. Author(s): Overhaus M, Decker P, Zhou H, Textor HJ, Hirner A, Scheurlen C. Source: Scandinavian Journal of Gastroenterology. 2003 March; 38(3): 337-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12737453&dopt=Abstract

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The current practices, training and concerns of a group of hospital-based speech therapists working in the area of dysphagia. Author(s): Modi N, Ross E. Source: S Afr J Commun Disord. 2000; 47: 3-14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11455821&dopt=Abstract

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The development and implementation of a standardized policy for the management of dysphagia in motor neurone disease. Author(s): Kirker FJ, Oliver DJ. Source: Palliative Medicine. 2003 June; 17(4): 322-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12822848&dopt=Abstract

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The development and validation of a dysphagia-specific quality-of-life questionnaire for patients with head and neck cancer: the M. D. Anderson dysphagia inventory. Author(s): Chen AY, Frankowski R, Bishop-Leone J, Hebert T, Leyk S, Lewin J, Goepfert H. Source: Archives of Otolaryngology--Head & Neck Surgery. 2001 July; 127(7): 870-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11448365&dopt=Abstract

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The effect of bolus consistency on dysphagia in unilateral vocal cord paralysis. Author(s): Bhattacharyya N, Kotz T, Shapiro J. Source: Otolaryngology and Head and Neck Surgery. 2003 December; 129(6): 632-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14663428&dopt=Abstract

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The evaluation of dysphagia after anterior cervical spine surgery: a case report. Author(s): Vanderveldt HS, Young MF. Source: Dysphagia. 2003 Fall; 18(4): 301-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14571336&dopt=Abstract

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The evaluation of dysphagia following radical surgery for oral and pharyngeal carcinomas by cine-magnetic resonance imaging (Cine-MRI). Author(s): Kitano H, Asada Y, Hayashi K, Inoue H, Kitajima K. Source: Dysphagia. 2002 Summer; 17(3): 187-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12140643&dopt=Abstract

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The experience of dysphagia and its effect on the quality of life of patients with oesophageal cancer. Author(s): Watt E, Whyte F. Source: European Journal of Cancer Care. 2003 June; 12(2): 183-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12787017&dopt=Abstract

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The incidence of dysphagia in pediatric patients after open heart procedures with transesophageal echocardiography. Author(s): Kohr LM, Dargan M, Hague A, Nelson SP, Duffy E, Backer CL, Mavroudis C. Source: The Annals of Thoracic Surgery. 2003 November; 76(5): 1450-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14602266&dopt=Abstract

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The incidence, management, and complications of dysphagia in patients with medullary strokes admitted to a rehabilitation unit. Author(s): Teasell R, Foley N, Fisher J, Finestone H. Source: Dysphagia. 2002 Spring; 17(2): 115-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11956836&dopt=Abstract

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The National Dysphagia Diet: implementation at a regional rehabilitation center and hospital system. Author(s): McCallum SL. Source: Journal of the American Dietetic Association. 2003 March; 103(3): 381-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12616266&dopt=Abstract

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The pivotal role of nursing in dysphagia management. Author(s): Platt J. Source: Perspectives. 2002 Spring; 26(1): 3-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11998133&dopt=Abstract

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The sinister significance of dysphagia. Author(s): Grannell MS, Kelly S, Shannon S, Chong AL, Walsh TN. Source: Ir J Med Sci. 2001 October-December; 170(4): 244-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11918330&dopt=Abstract

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The small-caliber esophagus: an unappreciated cause of dysphagia for solids in patients with eosinophilic esophagitis. Author(s): Vasilopoulos S, Murphy P, Auerbach A, Massey BT, Shaker R, Stewart E, Komorowski RA, Hogan WJ. Source: Gastrointestinal Endoscopy. 2002 January; 55(1): 99-106. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11756928&dopt=Abstract

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The SWAL-QOL and SWAL-CARE outcomes tool for oropharyngeal dysphagia in adults: III. Documentation of reliability and validity. Author(s): McHorney CA, Robbins J, Lomax K, Rosenbek JC, Chignell K, Kramer AE, Bricker DE. Source: Dysphagia. 2002 Spring; 17(2): 97-114. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11956835&dopt=Abstract

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Tolerance of early diet textures as indicators of recovery from dysphagia after stroke. Author(s): Wilkinson TJ, Thomas K, MacGregor S, Tillard G, Wyles C, Sainsbury R. Source: Dysphagia. 2002 Summer; 17(3): 227-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12140651&dopt=Abstract

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Topical corticosteroid treatment of dysphagia due to eosinophilic esophagitis in adults. Author(s): Arora AS, Perrault J, Smyrk TC. Source: Mayo Clinic Proceedings. 2003 July; 78(7): 830-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12839078&dopt=Abstract

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Use of a nitinol stent to treat dysphagia post-laryngopharyngectomy. Author(s): Sheahan P, Walsh MA. Source: The Journal of Laryngology and Otology. 2003 January; 117(1): 78-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12590864&dopt=Abstract

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Use of laser in the relief of malignant dysphagia: a district hospital experience. Author(s): Aly EA, Burgess P. Source: Digestive Surgery. 2002; 19(1): 3-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11961348&dopt=Abstract

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Videofluoroscopic assessment of patients with dysphagia: pharyngeal retention is a predictive factor for aspiration. Author(s): Eisenhuber E, Schima W, Schober E, Pokieser P, Stadler A, Scharitzer M, Oschatz E. Source: Ajr. American Journal of Roentgenology. 2002 February; 178(2): 393-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11804901&dopt=Abstract

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Wernicke's encephalopathy presenting with severe dysphagia: a case report. Author(s): Truedsson M, Ohlsson B, Sjoberg K. Source: Alcohol and Alcoholism (Oxford, Oxfordshire). 2002 May-June; 37(3): 295-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12003921&dopt=Abstract

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CHAPTER 2. NUTRITION AND DYSPHAGIA Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and dysphagia.

Finding Nutrition Studies on Dysphagia The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail: [email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.7 The IBIDS includes references and citations to both human and animal research studies. As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. Now that you have selected a database, click on the “Advanced” tab. An advanced search allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “dysphagia” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.

7 Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.

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The following information is typical of that found when using the “Full IBIDS Database” to search for “dysphagia” (or a synonym): •

Dysphagia: the new frontier. Author(s): Community Rehabilitation Services, Wichita Falls, TX Source: Williams, M. Nutrition-today (USA). (June 1992). volume 27(3) page 26-31.

Additional physician-oriented references include: •

A review of dysphagia in four cases of motor neurone disease. Author(s): Speech Pathology Department, Bethlehem Hospital, South Caulfield, Victoria, Australia. Source: Scott, A Heughan, A Palliat-Med. 1993; 7(4 Suppl): 41-7 0269-2163

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A team approach to the treatment of dysphagia. Source: Herbert, S Nurs-Times. 1996 December 11-17; 92(50): 26-9 0954-7762

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An integrated team approach to the management of patients with oropharyngeal dysphagia. Author(s): Department of Diagnostic Radiology and Nuclear Medicine, University Hospital, University of Western Ontario, London. Source: Bach, D B Pouget, S Belle, K Kilfoil, M Alfieri, M McEvoy, J Jackson, G J-AlliedHealth. 1989 Fall; 18(5): 459-68 0090-7421

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Behavioral management for oropharyngeal dysphagia. Author(s): Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL 60208, USA. Source: Logemann, J A Folia-Phoniatr-Logopage 1999 Jul-October; 51(4-5): 199-212 10217762

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Can protein-calorie malnutrition cause dysphagia? Author(s): University of Washington Medical Center, Food and Nutrition Services, Seattle 98195. Source: Veldee, M S Peth, L D Dysphagia. 1992; 7(2): 86-101 0179-051X

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Developing a dysphagia program in an acute care hospital: a needs assessment. Author(s): Department of Audiology and Speech Pathology, University of Rochester Medical Center, Strong Memorial Hospital, New York 14642. Source: Young, E C Durant Jones, L Dysphagia. 1990; 5(3): 159-65 0179-051X

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Diagnosis and treatment of swallowing disorders (dysphagia) in acute-care stroke patients. Source: Anonymous Evid-Rep-Technol-Assess-(Summ). 1999 March; (8): 1-6 1530-440x

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Dietary adjustments and nutritional therapy during treatment for oral-pharyngeal dysphagia. Author(s): North Chicago VA Medical Center, IL 60064. Source: O'Gara, J A Dysphagia. 1990; 4(4): 209-12 0179-051X

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Dietary management of swallowing disorders. Author(s): Speech-Language Pathology Department, Chelsea Community Hospital, Michigan 48118. Source: Martin, A W Dysphagia. 1991; 6(3): 129-34 0179-051X

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Drug-induced Parkinsonism associated with dysphagia and aspiration: a brief report. Author(s): Department of Rehabilitation & Geriatrics, Illawarra Regional Hospital, Warrawong NSW, Australia.

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Source: Bashford, G Bradd, P J-Geriatr-Psychiatry-Neurol. 1996 July; 9(3): 133-5 08919887 •

Dysphagia and dementia in subjects with Parkinson's disease. Author(s): Department of Speech-Language Pathology and Audiology, University of South Carolina, Columbia 29208, USA. Source: Bine, J E Frank, E M McDade, H L Dysphagia. 1995 Summer; 10(3): 160-4 0179051X

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Dysphagia associated with neurological disorders. Author(s): Johns Hopkins University School of Medicine, Baltimore. Source: Buchholz, D W Acta-Otorhinolaryngol-Belg. 1994; 48(2): 143-55 0001-6497

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Dysphagia diet update. Author(s): Cardiovascular Disease and Nutrition Services, Local and Family Health Administration, Maryland Department of Health and Mental Hygiene, Baltimore, USA. Source: Yen, P K Geriatr-Nurs. 1998 Jul-August; 19(4): 243-4 0197-4572

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Dysphagia diets: the state of the art. Author(s): Arden Hill Life Care Center, Goshen, NY, USA. Source: Hopkins, M Hosp-Food-Nutr-Focus. 1996 March; 12(7): 3, 8 0747-7376

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Dysphagia due to cervical osteophytosis. Author(s): Divisione di Ortopedia e Traumatologia Polichlinico S. Orsola-Malpighi, Bologna. Source: Laus, M Malaguti, M C Alfonso, C Ferrari, D Zappoli, F A Giunti, A ChirOrgani-Movolume 1995 Jul-August; 80(3): 263-71 0009-4749

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Dysphagia following strokes: clinical observations of swallowing rehabilitation employing palatal training appliances. Author(s): Department of Physics, University of Exeter, U.K. Source: Selley, W G Roche, M T Pearce, V R Ellis, R E Flack, F C Dysphagia. 1995 Winter; 10(1): 32-5 0179-051X

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Dysphagia in Alzheimer disease: a review. Author(s): Complex Continuing Care Program, SCO Health Service, 43 Bruyere St., Ottawa, ON K1N 5C8, Canada. [email protected] Source: Chouinard, J J-Nutr-Health-Aging. 2000; 4(4): 214-7 1279-7707

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Dysphagia, dysphasia, dys-what-ia?! Source: Anonymous Hosp-Food-Nutr-Focus. 1993 January; 9(5): 7-8 0747-7376

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Dysphagia--the new frontier. Source: Grivetti, L.E. Nutr-Today. Baltimore, Md. : Williams & Wilkins. June 1992. volume 27 (3) page 26-31. 0029-666X

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Feeding strategies for the dysphagic patient: a nursing perspective. Author(s): Nursing Service, VA Medical Center, St. Cloud, MN 56303. Source: Layne, K A Dysphagia. 1990; 5(2): 84-8 0179-051X

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Gag reflex and dysphagia. Author(s): Department of Surgery, Yale University School of Medicine, New Haven, Connecticut 06504, USA. Source: Leder, S B Head-Neck. 1996 Mar-April; 18(2): 138-41 1043-3074

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Identifying & managing dysphagia. Source: Cole Arvin, C Notich, L Underhill, A Nursing. 1994 January; 24(1): 48-9 03604039

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Issues in the management of dysphagia. Author(s): VA Medical Center, Ann Arbor, MI 48105, USA. Source: Langmore, S E Folia-Phoniatr-Logopage 1999 Jul-October; 51(4-5): 220-30 10217762

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It's tough to swallow: a practical approach to nutritional care of dysphagia. Source: Dorner, B Director. 2002 Summer; 10(3): 107-10

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Management of pediatric dysphagia. Author(s): Speech-Language-Hearing Department, Children's Hospital of Buffalo, Buffalo, New York, USA. Source: Arvedson, J C Otolaryngol-Clin-North-Am. 1998 June; 31(3): 453-76 0030-6665

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Managing dysphagia in a chronic care setting: an introduction. Author(s): Veterans Administration Medical Center, New York, New York. Source: Groher, M E Dysphagia. 1990; 5(2): 59-60 0179-051X

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Mealtime difficulties in a home for the aged: not just dysphagia. Author(s): Baycrest Centre for Geriatric Care, North York, Ontario, Canada. Source: Steele, C M Greenwood, C Ens, I Robertson, C Seidman Carlson, R Dysphagia. 1997 Winter; 12(1): 43-50; discussion 51 0179-051X

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New diets for people with dysphagia. Source: Chappetta, B Darlington, D Deering, C Provider. 1999 April; 25(4): 53, 55-6 08880352

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Nutrition assessment and management in pediatric dysphagia. Author(s): Office of the Maryland WIC Program, Baltimore 21201, USA. Source: Kovar, A J Semin-Speech-Lang. 1997 February; 18(1): 39-49 0734-0478

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Nutritional aspects of dysphagia. Author(s): Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, Free University Brussels, Belgium. Source: Vreugde, S Acta-Otorhinolaryngol-Belg. 1994; 48(2): 229-34 0001-6497

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Nutritional considerations for the pureed diet texture in dysphagic elderly. Author(s): United Helpers Management Company, Inc., Ogdensburg, New York 13669. Source: Hotaling, D L Dysphagia. 1992; 7(2): 81-5 0179-051X

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On the true definition of dysphagia. Source: MacKay, R.J. Compend-contin-educ-pract-vet. Trenton, N.J. : Veterinary Learning Systems. November 2001. volume 23 (11) page 1024-1027. 0193-1903

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Osteophyte-induced dysphagia: report of three cases. Author(s): Department of Physical Medicine and Rehabilitation, Firat University, Faculty of Medicine, Elazig, Turkey. [email protected] Source: Ozgocmen, S Kiris, A Kocakoc, E Ardicoglu, O Joint-Bone-Spine. 2002 March; 69(2): 226-9 1297-319X

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Outcomes of swallowing rehabilitation in chronic brainstem dysphagia: A retrospective evaluation. Author(s): School of Audiology and Speech Language Pathology, The University of Memphis, Memphis, Tennessee, USA. Source: Huckabee, M L Cannito, M P Dysphagia. 1999 Spring; 14(2): 93-109 0179-051X

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Predictors of tube feeding in acute stroke patients with dysphagia. Author(s): School of Nursing, (Department of Neurology), University of Texas at Houston, Houston, Texas, USA. [email protected]

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Source: Wojner, A W Alexandrov, A V AACN-Clin-Issues. 2000 November; 11(4): 531-40 1079-0713 •

Prospective, randomized outcome study of endoscopy versus modified barium swallow in patients with dysphagia. Author(s): Department of Otolaryngology--Head and Neck Surgery, ColumbiaPresbyterian Center, New York Presbyterian Hospital, New York, USA. Source: Aviv, J E Laryngoscope. 2000 April; 110(4): 563-74 0023-852X

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Referral criteria for speech and language therapy assessment of dysphagia caused by idiopathic Parkinson's disease. Author(s): Department of Neurology, Hull Royal Infirmary, UK. Source: Clarke, C E Gullaksen, E Macdonald, S Lowe, F Acta-Neurol-Scand. 1998 January; 97(1): 27-35 0001-6314

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Rehabilitation of neurogenic dysphagia with percutaneous endoscopic gastrostomy. Author(s): Hines Veterans Affairs Hospital, Hines, Illinois 60141, USA. Source: Klor, B M Milianti, F J Dysphagia. 1999 Summer; 14(3): 162-4 0179-051X

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Restoring pleasure: nutritional management of dysphagia. Source: Kemp, S Br-J-Community-Nurs. 2001 June; 6(6): 284-9 1462-4753

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Successful treatment of dysphagia in Paget's disease of the bone. Author(s): Digestive Disease Center, Medical University of South Carolina, Charleston 29425, USA. Source: Varadarajulu, S Reddy, S Noone, T Payne, K M Dig-Dis-Sci. 2002 September; 47(9): 2112-5 0163-2116

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Swallow function and perception of dysphagia in patients with head and neck cancer. Author(s): Communication Sciences and Disorders, Northwestern University, 2299 N. Campus Drive, Evanston, Illinois 60208-3540, USA. [email protected] Source: Pauloski, Barbara Roa Rademaker, Alfred W Logemann, Jerilyn A Lazarus, Cathy L Newman, Lisa Hamner, Annette MacCracken, Ellen Gaziano, Joy Stachowiak, Linda Head-Neck. 2002 June; 24(6): 555-65 1043-3074

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The current practices, training and concerns of a group of hospital-based speech therapists working in the area of dysphagia. Author(s): Department of Speech Pathology and Audiology, University of the Witwatersrand. Source: Modi, N Ross, E S-Afr-J-Commun-Disord. 2000; 47: 3-14 0379-8046

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The dysphagia diagnostic procedure as a treatment efficacy trial. Author(s): Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL. Source: Logemann, J A Clin-Commun-Disord. 1993 Fall; 3(4): 1-10 1054-8505

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The Dysphagia Outcome and Severity Scale. Author(s): Hartford Hospital, Hartford, Connecticut 06102, USA. Source: O'Neil, K H Purdy, M Falk, J Gallo, L Dysphagia. 1999 Summer; 14(3): 139-45 0179-051X

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The incidence, management, and complications of dysphagia in patients with medullary strokes admitted to a rehabilitation unit. Author(s): Department of Physical Medicine and Rehabilitation, London Health Sciences Centre, Ontario, Canada. [email protected] Source: Teasell, R Foley, N Fisher, J Finestone, H Dysphagia. 2002 Spring; 17(2): 115-20 0179-051X

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The role of speech language pathologists in the management of dysphagia, 1989. Source: Erlichman, M Health-Technol-Assess-Repage 1989; (1): 1-10 8755-9765

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The use of ethanol injection under endoscopic control to palliate dysphagia caused by esophagogastric cancer. Author(s): Dept. of Gastroenterology, Hospital da Previdencia dos Servidores do Estado de Minas Gerais, Belo Horizonte, Brazil. Source: Moreira, L S Coelho, R C Sadala, R U Dani, R Endoscopy. 1994 March; 26(3): 3114 0013-726X

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Thickener viscosity in dysphagia management: variability among speech-language pathologists. Author(s): Division of Communication Disorders, University of Kentucky, Lexington, Kentucky, USA. Source: Glassburn, D L Deem, J F Dysphagia. 1998 Fall; 13(4): 218-22 0179-051X

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Tolerance of early diet textures as indicators of recovery from dysphagia after stroke. Author(s): Christchurch School of Medicine and Health Sciences, New Zealand. [email protected] Source: Wilkinson, T J Thomas, K MacGregor, S Tillard, G Wyles, C Sainsbury, R Dysphagia. 2002 Summer; 17(3): 227-32 0179-051X

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Treatment of dysphagia improves nutritional conditions in stroke patients. Author(s): Department of Community Medicine, Malmo University Hospital, Lund University, Malmo, Sweden. Source: Elmstahl, S Bulow, M Ekberg, O Petersson, M Tegner, H Dysphagia. 1999 Spring; 14(2): 61-6 0179-051X

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Using cervical auscultation in the clinical dysphagia examination in long-term care. Author(s): Audiology and Speech Pathology Service, VA Medical Center, St. Cloud, Minnesota 56303. Source: Zenner, P M Losinski, D S Mills, R H Dysphagia. 1995 Winter; 10(1): 27-31 0179051X

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Validation of the 50 ml3 drinking test for evaluation of post-stroke dysphagia. Author(s): Beit Rivka Hospital, Petach Tiqva, Israel. Source: Gottlieb, D Kipnis, M Sister, E Vardi, Y Brill, S Disabil-Rehabil. 1996 October; 18(10): 529-32 0963-8288

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Vincristine-induced dysphagia suggesting esophageal motor dysfunction: a case report. Author(s): Department of Medicine, Veterans General Hospital-Taipei and National Yang-Ming University School of Medicine, Taiwan. Source: Wang, W S Chiou, T J Liu, J H Fan, F S Yen, C C Chen, P M Jpn-J-Clin-Oncol. 2000 November; 30(11): 515-8 0368-2811

Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: •

healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0

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•

The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov

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The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov

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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/

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The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/

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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/

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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/

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Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/

Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats

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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html

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Google: http://directory.google.com/Top/Health/Nutrition/

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Healthnotes: http://www.healthnotes.com/

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Open Directory Project: http://dmoz.org/Health/Nutrition/

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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/

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WebMD®Health: http://my.webmd.com/nutrition

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

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CHAPTER 3. ALTERNATIVE MEDICINE AND DYSPHAGIA Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to dysphagia. At the conclusion of this chapter, we will provide additional sources.

National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to dysphagia and complementary medicine. To search the database, go to the following Web site: http://www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “dysphagia” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine that are related to dysphagia: •

A collaborative approach to the assessment and management of dysphagia. Author(s): Heritage M. Source: International Journal of Language & Communication Disorders / Royal College of Speech & Language Therapists. 2001; 36 Suppl: 369-74. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11340814&dopt=Abstract

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A direct intervention program for chronic neurogenic dysphagia secondary to brainstem stroke. Author(s): Crary MA. Source: Dysphagia. 1995 Winter; 10(1): 6-18. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7859537&dopt=Abstract

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A multimodal approach to functional dysphagia. Author(s): Atkins DL, Lundy MS, Pumariega AJ.

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Source: Journal of the American Academy of Child and Adolescent Psychiatry. 1994 September; 33(7): 1012-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7961340&dopt=Abstract •

A psychosomatic approach to the problem of dysphagia post-poliomyelitic patient. Author(s): ODENHEIMER KJ. Source: Psychiatr Neurol (Basel). 1965; 149: 164-70. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14317143&dopt=Abstract

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A tongue force measurement system for the assessment of oral-phase swallowing disorders. Author(s): Robinovitch SN, Hershler C, Romilly DP. Source: Archives of Physical Medicine and Rehabilitation. 1991 January; 72(1): 38-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1985622&dopt=Abstract

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Advances in the management of dysphagia caused by stroke. Author(s): Miller RM, Chang MW. Source: Phys Med Rehabil Clin N Am. 1999 November; 10(4): 925-41, X. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10573716&dopt=Abstract

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Biofeedback in the treatment of a selected dysphagic patient. Author(s): Bryant M. Source: Dysphagia. 1991; 6(3): 140-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1914542&dopt=Abstract

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Biofeedback therapy using accelerometry for treating dysphagic patients with poor laryngeal elevation: case studies. Author(s): Reddy NP, Simcox DL, Gupta V, Motta GE, Coppenger J, Das A, Buch O. Source: Journal of Rehabilitation Research and Development. 2000 May-June; 37(3): 36172. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10917268&dopt=Abstract

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Bolus transit assessed by an esophageal stress test in postfundoplication dysphagia. Author(s): Tatum RP, Shi G, Manka MA, Brasseur JG, Joehl RJ, Kahrilas PJ. Source: The Journal of Surgical Research. 2000 June 1; 91(1): 56-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10816350&dopt=Abstract

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Comparison of endoscopy and barium swallow with marshmallow in dysphagia. Author(s): Somers S, Stevenson GW, Thompson G.

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Source: Canadian Association of Radiologists Journal = Journal L'association Canadienne Des Radiologistes. 1986 June; 37(2): 73-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2941435&dopt=Abstract •

Design and development of portable biofeedback systems for use in oral dysphagia rehabilitation. Author(s): Sukthankar SM, Reddy NP, Canilang EP, Stephenson L, Thomas R. Source: Medical Engineering & Physics. 1994 September; 16(5): 430-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7952683&dopt=Abstract

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Diffuse idiopathic skeletal hyperostosis: a case of dysphagia. Author(s): Foshang TH, Mestan MA, Riggs LJ. Source: Journal of Manipulative and Physiological Therapeutics. 2002 January; 25(1): 716. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11898021&dopt=Abstract

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Dysphagia after pharyngolaryngeal cancer surgery. Part II: Implications for reconstructive procedures. Author(s): Herberhold C, Walther EK. Source: Dysphagia. 1995 Fall; 10(4): 279-81. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7493511&dopt=Abstract

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Dysphagia among nursing home residents. Author(s): Kayser-Jones J, Pengilly K. Source: Geriatric Nursing (New York, N.Y.). 1999 March-April; 20(2): 77-82; Quiz 84. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10382421&dopt=Abstract

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Dysphagia of pseudobulbar palsy successfully treated by hypnosis. Author(s): Black S. Source: N Z Med J. 1980 March 26; 91(656): 212-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6929999&dopt=Abstract

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Electromyographic biofeedback treatment of a woman with chronic dysphagia. Author(s): Haynes SN. Source: Biofeedback Self Regul. 1976 March; 1(1): 121-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=990340&dopt=Abstract

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Evaluation and management of oropharyngeal Dysphagia in head and neck cancer. Author(s): Gaziano JE.

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Source: Cancer Control : Journal of the Moffitt Cancer Center. 2002 September-October; 9(5): 400-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12410179&dopt=Abstract •

Evaluation of the esophagus with a marshmallow bolus: clarifying the cause of dysphagia. Author(s): Ott DJ, Kelley TF, Chen MY, Gelfand DW. Source: Gastrointest Radiol. 1991 Winter; 16(1): 1-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1991597&dopt=Abstract

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Hypnobehavioral approaches for school-age children with dysphagia and food aversion: a case series. Author(s): Culbert TP, Kajander RL, Kohen DP, Reaney JB. Source: Journal of Developmental and Behavioral Pediatrics : Jdbp. 1996 October; 17(5): 335-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8897222&dopt=Abstract

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Hypnosis in dysphagia. Author(s): MAGONET AP. Source: Int J Clin Exp Hypn. 1961 October; 9: 291-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14468370&dopt=Abstract

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Hypnosis in the treatment of dysphagia. Author(s): Gurian B. Source: J Oral Med. 1981 October-December; 36(4): 99-101. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6948937&dopt=Abstract

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Hypnotherapy treatment for dysphagia. Author(s): Kopel KF, Quinn M. Source: Int J Clin Exp Hypn. 1996 April; 44(2): 101-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8871337&dopt=Abstract

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Incidence and nature of dysphagia in polio survivors. Author(s): Coelho CA, Ferranti R. Source: Archives of Physical Medicine and Rehabilitation. 1991 December; 72(13): 10715. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1741659&dopt=Abstract

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Optimal patterns of care for dysphagic stroke patients. Author(s): Daniels SK.

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Source: Seminars in Speech and Language. 2000; 21(4): 323-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11085256&dopt=Abstract •

Outcomes of swallowing rehabilitation in chronic brainstem dysphagia: A retrospective evaluation. Author(s): Huckabee ML, Cannito MP. Source: Dysphagia. 1999 Spring; 14(2): 93-109. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10028039&dopt=Abstract

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Phagophobia: a form of psychogenic dysphagia. A new entity. Author(s): Shapiro J, Franko DL, Gagne A. Source: The Annals of Otology, Rhinology, and Laryngology. 1997 April; 106(4): 286-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9109717&dopt=Abstract

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Remission of dysphagia in a 9-year-old treated in a family practice office setting. Author(s): Elinoff V. Source: Am J Clin Hypn. 1993 January; 35(3): 205-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8434567&dopt=Abstract

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Restoring pleasure: nutritional management of dysphagia. Author(s): Kemp S. Source: British Journal of Community Nursing. 2001 June; 6(6): 284-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11873203&dopt=Abstract

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Solid swallowing versus water swallowing: manometric study of dysphagia. Author(s): Keren S, Argaman E, Golan M. Source: Digestive Diseases and Sciences. 1992 April; 37(4): 603-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1551353&dopt=Abstract

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Surface electromyographic biofeedback and the patient with dysphagia: clinical opportunities and research questions. Author(s): Barofsky I. Source: Dysphagia. 1995 Winter; 10(1): 19-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7859527&dopt=Abstract

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Systemic sclerosis: successful treatment of ulcerations, pain, Raynaud's phenomenon, calcinosis, and dysphagia by transcutaneous nerve stimulation. A case report. Author(s): Kaada B. Source: Acupuncture & Electro-Therapeutics Research. 1984; 9(1): 31-44. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6145309&dopt=Abstract

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The small-caliber esophagus: an unappreciated cause of dysphagia for solids in patients with eosinophilic esophagitis. Author(s): Vasilopoulos S, Murphy P, Auerbach A, Massey BT, Shaker R, Stewart E, Komorowski RA, Hogan WJ. Source: Gastrointestinal Endoscopy. 2002 January; 55(1): 99-106. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11756928&dopt=Abstract

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Unexplained dysphagia: viscous swallow-induced esophageal dysmotility. Author(s): Meshkinpour H, Eckerling G. Source: Dysphagia. 1996 Spring; 11(2): 125-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8721071&dopt=Abstract

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Vincristine-induced dysphagia suggesting esophageal motor dysfunction: a case report. Author(s): Wang WS, Chiou TJ, Liu JH, Fan FS, Yen CC, Chen PM. Source: Japanese Journal of Clinical Oncology. 2000 November; 30(11): 515-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11155923&dopt=Abstract

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Vincristine-induced dysphagia. Author(s): Chisholm RC, Curry SB. Source: Southern Medical Journal. 1978 November; 71(11): 1364-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=715485&dopt=Abstract

Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: •

Alternative Medicine Foundation, Inc.: http://www.herbmed.org/

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AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats

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Chinese Medicine: http://www.newcenturynutrition.com/

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drkoop.com®: http://www.drkoop.com/InteractiveMedicine/IndexC.html

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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm

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Google: http://directory.google.com/Top/Health/Alternative/

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Healthnotes: http://www.healthnotes.com/

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MedWebPlus: http://medwebplus.com/subject/Alternative_and_Complementary_Medicine

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Open Directory Project: http://dmoz.org/Health/Alternative/

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HealthGate: http://www.tnp.com/

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WebMD®Health: http://my.webmd.com/drugs_and_herbs

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/

The following is a specific Web list relating to dysphagia; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

General Overview Choking Source: Integrative Medicine Communications; www.drkoop.com Cough Source: Integrative Medicine Communications; www.drkoop.com Dysphagia Source: Integrative Medicine Communications; www.drkoop.com Regurgitation Source: Integrative Medicine Communications; www.drkoop.com Weight Loss Source: Integrative Medicine Communications; www.drkoop.com

General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at http://www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources.

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CHAPTER 4. DISSERTATIONS ON DYSPHAGIA Overview In this chapter, we will give you a bibliography on recent dissertations relating to dysphagia. We will also provide you with information on how to use the Internet to stay current on dissertations. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical dissertations that use the generic term “dysphagia” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on dysphagia, we have not necessarily excluded nonmedical dissertations in this bibliography.

Dissertations on Dysphagia ProQuest Digital Dissertations, the largest archive of academic dissertations available, is located at the following Web address: http://wwwlib.umi.com/dissertations. From this archive, we have compiled the following list covering dissertations devoted to dysphagia. You will see that the information provided includes the dissertation’s title, its author, and the institution with which the author is associated. The following covers recent dissertations found when using this search procedure: •

Induction and Maintenance of the Swallow Response in Infants and Young Children with Dysphagia and Isolation of Components of the Treatment Package by Brosi, Nyla Lamm, EDD from Columbia University Teachers College, 1988, 122 pages http://wwwlib.umi.com/dissertations/fullcit/8906445

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Problematic Eating of Children with Dysphagia: Parents Learn to Feed Their Children in the Home Using Behavioral Procedures by Wallingford, Priscilla, PhD from University of Kansas, 1998, 122 pages http://wwwlib.umi.com/dissertations/fullcit/9920377

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Rheological and Structural Properties of Foods Thickened with Different Starches and Their Pharyngeal Transport: a Computer-aided Study in Dysphagia by Meng, Yizhi; PhD from Cornell University, 2003, 278 pages http://wwwlib.umi.com/dissertations/fullcit/3104463

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The Effect of a Dysphagia Teaching Module on Knowledge, Application, and Attitudes of Registered Nurses Working in a Nursing Home (Nurse Training) by Mullaney, Nancy S., EDD from Columbia University Teachers College, 1992, 134 pages http://wwwlib.umi.com/dissertations/fullcit/9218699

Keeping Current Ask the medical librarian at your library if it has full and unlimited access to the ProQuest Digital Dissertations database. From the library, you should be able to do more complete searches via http://wwwlib.umi.com/dissertations.

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CHAPTER 5. CLINICAL TRIALS AND DYSPHAGIA Overview In this chapter, we will show you how to keep informed of the latest clinical trials concerning dysphagia.

Recent Trials on Dysphagia The following is a list of recent trials dedicated to dysphagia.8 Further information on a trial is available at the Web site indicated. •

Effects of Age and Age-Related Diseases on Swallowing Condition(s): Dysphagia Study Status: This study is currently recruiting patients. Sponsor(s): Department of Veterans Affairs Rehabilitation Research and Development Service Purpose - Excerpt: The long-term goal of this research program is to advance the treatment of swallowing disorders in elderly adults. This study will identify the impact of an 8-week progressive resistance exercise program for oral muscles on swallowing physiology, anatomy, dietary intake, and Quality of Life (QOL) in frail dysphagic adults. Findings from the exercise program may indicate new directions for treatments and techniques designed to influence the biological underpinnings of dysphagia in elderly persons. Translation of these findings into clinical practice will have far-reaching significance in the fields of gerontology, speech language pathology, and long-term care. Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00038350

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These are listed at www.ClinicalTrials.gov.

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Electrical Muscle Stimulation to Aid Swallowing in Dysphagia Condition(s): Deglutition Disorder; Healthy Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Neurological Disorders and Stroke (NINDS) Purpose - Excerpt: The purpose of this study is to determine the feasibility of using extrinsic laryngeal muscle stimulation to elevate the larynx in a manner similar to that which occurs during normal swallowing. This research will also determine whether laryngeal elevation will open the upper esophageal sphincter to assist with entry of the bolus into the esophagus. This protocol includes studies in normal volunteers and patients with swallowing disorders. The outcome of this study will be relevant to future use of neuromuscular stimulation for laryngeal elevation in patients with pharyngeal dysphagia. Study Type: Observational Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00001936

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Ultrasound and Videofluoroscopy for Diagnosing Swallowing Disorders Condition(s): Deglutition Disorder; Motor Neuron Disease Study Status: This study is currently recruiting patients. Sponsor(s): Warren G Magnuson Clinical Center (CC) Purpose - Excerpt: This study will identify clinical signs and symptoms critical for diagnosing swallowing disorders and will characterize swallowing problems in various patient populations, such as patients with Parkinson's disease, stroke, post-polio syndrome, multiple sclerosis and other conditions that cause swallowing abnormalities. Patients with swallowing difficulties who are enrolled in NIH neurology or speech pathology protocols may be eligible for this study. Participants will undergo the following procedures: 1. Oral examination-A neurologist and speech pathologist examine the patient's swallowing function. The patient is interviewed about difficulties with food intake, chewing and swallowing during meals. 2. Ultrasound examinationUltrasound creates image of areas inside the body using sound waves. With the patient in a sitting position, a 3/4-inch transducer (device for transmitting and receiving sound waves) is placed under the chin to visualize tongue movements during swallowing. 3. Modified barium swallow-While standing or sitting, the patient swallows 1/2 teaspoon of flavored barium (a radioactive substance) six times (a total of 3 teaspoons), while the tongue and pharynx (tube leading from the mouth to the esophagus) are scanned and videotaped. The barium is given in three consistencies-thin, medium and thick (pudding-like). 4. Electromyography-A small plastic strip with wires attached is placed under the patient's chin. The patient then swallows 1/2 ounce of barium three times in a row, and the movement of the chin muscles during swallowing is displayed. Patients may also be asked to swallow 5/8 cup of barium twice; once with the head tilted upward and once with the head untilted. Depending on the test results, patients may be asked to return for follow-up study and monitoring. Study Type: Observational Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00001220

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Comparison of Two Therapies for UES Dysphagia Condition(s): Deglutition Disorders Study Status: This study is not yet open for patient recruitment. Sponsor(s): National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Purpose - Excerpt: The aim of this research study is to determine the effectiveness of: 1) a traditional therapy regimen focusing on individual exercises for pharyngeal (throat) and laryngeal (voice box) musculature and 2) a new therapeutic exercise, the Shaker exercise. The primary objective of this 5-year project is to identify which of two therapy programs, the Shaker exercise versus traditional therapy, results in the largest number of stable, non-oral dysphagic patients who can swallow safely and return to full oral feeding after 6 weeks of intervention. The study is powered adequately so that this aim can be tested separately for head and neck cancer and stroke patients. Our primary outcome measure is return to oral feeding, i.e., 100% of nutrition and hydration by mouth. Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00059670

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Facilitation of Oral Bolus Propulsion Using Electropalatography in Patients with Dysphagia Condition(s): Deglutition Disorders; dysphagia Study Status: This study is completed. Sponsor(s): Warren G Magnuson Clinical Center (CC) Purpose - Excerpt: Electropalatography (EPG), a noninvasive device that provides specific visual output on tongue-palate contact, has well-established usefulness as a biofeedback tool in speech therapy. While EPG has also been shown to be capable of revealing the details of linguopalatal interactions during swallowing, its applicability in swallowing therapy has not been evaluated to date. This study will determine if EPG can facilitate bolus propulsion in patients presenting with swallowing problems of the oral phase. Seven patients with oral dysphagia will be selected to serve as subjects based on specific inclusion and exclusion criteria, and each will be custom-fitted with a pseudo-palate. Each patient will undergo four 45-minute sessions of biofeedback training with emphasis on developing systematic front-to-back anchoring of the tongue against the palate during propulsion of liquid and semisolid boluses. Ultrasound imaging will be used to determine swallow durations and identify oral deficits of swallowing before the EPG biofeedback training, and to identify any changes that may result from the training. Quantitative measurements will also be made of the swallowrelated EPG contact timing and pattern before and after training and compared for each individual subject as a function of training and bolus volume. Appropriate statistical analyses will be conducted. Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00001718

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Keeping Current on Clinical Trials The U.S. National Institutes of Health, through the National Library of Medicine, has developed ClinicalTrials.gov to provide current information about clinical research across the broadest number of diseases and conditions. The site was launched in February 2000 and currently contains approximately 5,700 clinical studies in over 59,000 locations worldwide, with most studies being conducted in the United States. ClinicalTrials.gov receives about 2 million hits per month and hosts approximately 5,400 visitors daily. To access this database, simply go to the Web site at http://www.clinicaltrials.gov/ and search by “dysphagia” (or synonyms). While ClinicalTrials.gov is the most comprehensive listing of NIH-supported clinical trials available, not all trials are in the database. The database is updated regularly, so clinical trials are continually being added. The following is a list of specialty databases affiliated with the National Institutes of Health that offer additional information on trials: •

For clinical studies at the Warren Grant Magnuson Clinical Center located in Bethesda, Maryland, visit their Web site: http://clinicalstudies.info.nih.gov/

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For clinical studies conducted at the Bayview Campus in Baltimore, Maryland, visit their Web site: http://www.jhbmc.jhu.edu/studies/index.html

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For cancer trials, visit the National Cancer Institute: http://cancertrials.nci.nih.gov/

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For eye-related trials, visit and search the Web page of the National Eye Institute: http://www.nei.nih.gov/neitrials/index.htm

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For heart, lung and blood trials, visit the Web page of the National Heart, Lung and Blood Institute: http://www.nhlbi.nih.gov/studies/index.htm

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For trials on aging, visit and search the Web site of the National Institute on Aging: http://www.grc.nia.nih.gov/studies/index.htm

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For rare diseases, visit and search the Web site sponsored by the Office of Rare Diseases: http://ord.aspensys.com/asp/resources/rsch_trials.asp

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For alcoholism, visit the National Institute on Alcohol Abuse and Alcoholism: http://www.niaaa.nih.gov/intramural/Web_dicbr_hp/particip.htm

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For trials on infectious, immune, and allergic diseases, visit the site of the National Institute of Allergy and Infectious Diseases: http://www.niaid.nih.gov/clintrials/

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For trials on arthritis, musculoskeletal and skin diseases, visit newly revised site of the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health: http://www.niams.nih.gov/hi/studies/index.htm

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For hearing-related trials, visit the National Institute on Deafness and Other Communication Disorders: http://www.nidcd.nih.gov/health/clinical/index.htm

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For trials on diseases of the digestive system and kidneys, and diabetes, visit the National Institute of Diabetes and Digestive and Kidney Diseases: http://www.niddk.nih.gov/patient/patient.htm

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For drug abuse trials, visit and search the Web site sponsored by the National Institute on Drug Abuse: http://www.nida.nih.gov/CTN/Index.htm

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For trials on mental disorders, visit and search the Web site of the National Institute of Mental Health: http://www.nimh.nih.gov/studies/index.cfm

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For trials on neurological disorders and stroke, visit and search the Web site sponsored by the National Institute of Neurological Disorders and Stroke of the NIH: http://www.ninds.nih.gov/funding/funding_opportunities.htm#Clinical_Trials

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CHAPTER 6. PATENTS ON DYSPHAGIA Overview Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.9 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical patents that use the generic term “dysphagia” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on dysphagia, we have not necessarily excluded nonmedical patents in this bibliography.

Patents on Dysphagia By performing a patent search focusing on dysphagia, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. The following is an 9Adapted

from the United States Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.

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example of the type of information that you can expect to obtain from a patent search on dysphagia: •

Dysphagia cup Inventor(s): Stevens; Barry A. (1039 Madison Ave. North, Bainbridge Island, WA 98110) Assignee(s): None Reported Patent Number: 5,323,928 Date filed: September 16, 1992 Abstract: A drinking cup 10 for assisting swallowing has a hollow container portion 12 including a base 18 and an upwardly extending, elliptically-shaped sidewall 20. The sidewall defines an elliptical aperture 32 at its apex. The inner surface 26 of the sidewall defines an ellipse from a cross-sectional perspective at substantially all elevations between the aperture and a point proximate to the base, each cross section being taken along a plane disposed parallel to a plane defined by the aperture. The elliptical aperture is sized to accommodate a person's nasal bridge during drinking such that substantial backwards angulation of the head is not required. The cup includes a handle 16 disposed 90.degree. out from the major axis of the elliptical aperture. People with dysphagia and/or arthritis are expected to benefit especially from the features of the present invention. Excerpt(s): The present invention relates to drinking cups, and more particularly, to drinking cups for people suffering from dysphagia or who have problems holding the handle of a conventional cup. Drinking cups are generally comprised of a container portion for holding the desired liquid and a handle for the person using the cup to hold on to. Generally, in order to be able to use a conventional drinking cup, a person must angulate his or her head backwards to avoid spilling of the fluid contents of the cup. This spilling occurs partly because conventional cups, in almost all cases, have a cylindrically-shaped container which does not provide sufficient clearance for the user's nose. In order to tip the cup to a degree sufficient to allow fluid, particularly thick, viscous fluids, to flow toward the mouth, the user is required to angulate his or her head while drinking. People suffering from dysphagia, a condition associated with difficulty in swallowing, often have trouble swallowing when the head is tilted due to a tendency to aspirate fluid into the lungs. This is sometimes a condition associated with having a stroke, head injury, or other neurological disorders and aging. Additionally, people so afflicted often encounter problems with liquid spillage when drinking from conventional cups due to the large radius of the rim. It is known that swallowing in people suffering from dysphagia may be enhanced if the head is not angulated rearwardly while drinking. In an attempt to take advantage of this, conventional "nosecups" have been designed which include a container part whose inner wall is circular in shape, but which is provided with a cut-out on the rim to accommodate the nose of the user, so that drinking can be accomplished while the user's head remains substantially vertical. However, such cups have an unusual appearance, which some users may find undesirable and thus avoid using. Additionally, such conventional "nose-cups" have cylindrical inner walls which do not facilitate controlled fluid flow, tending to lead to fluid spillage or the inability to empty cup of thicker fluids. Web site: http://www.delphion.com/details?pn=US05323928__

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Gelatinous food product and process for preparing the same Inventor(s): Emoto; Mitsuo (Otsu, JP) Assignee(s): Otsuka Foods Co., Ltd. (osaka, Jp) Patent Number: 6,458,395 Date filed: July 7, 2000 Abstract: The present invention provide a gelatinous food product for supplying balanced nutrition, which is a gel of an emulsified mixture comprising 10 to 50 wt. % of total solid content on a dry weight basis and 50 to 90 wt. % of water, the solid content contains 30 to 90 wt. % of saccharide, 5 to 40 wt. % of lipid, 2 to 60 wt. % of protein, 0.2 to 5 wt. % of organic acid, 0.2 to 5 wt. % of organic acid salt, 0.2 to 5 wt. % of emulsifying agent and 0.2 to 5 wt. % of gelling agent, the food product having a pH of 3.3 to 4 and being a composite of an isoelectric gel of the protein and a heat-soluble gel formed with the gelling agent. The invention also provides a process for preparing the food product. The gelatinous food product of the invention is particularly suitable for nutrition of patients with dysphagia, since it comprises various nutrients in suitable proportions and has good eating qualities, for instance, ease of swallowing even by patients with dysphagia, owing to the soft jelly form. Excerpt(s): The present invention relates to gelatinous food products for supplying balanced nutrition, particularly the gelatinous food products which contain all the essential nutrients, and which have a refreshing taste because of their pH of 3.3 to 4, and which is a composite of a gel formed with a gelling agent and an isoelectric gel of the protein, the composite producing good eating qualities, for instance, ease of swallowing owing to the soft gel form. Conventionally, jellies made by setting beverages with agars or gelatins and gelatinous foods such as puddings, yogurts and aspics are known as foods for supplying water and nutrients to patients suffering from dysphagia (swallowing difficulty), typically elderly patients and patients with cerebrovascular diseases. If a substantially nonviscous liquid such as water or tea is carelessly given to patients with dysphagia, the liquid cannot be swallowed properly and may enter the trachea, increasing the risk of pneumonia, or threatening the life in extreme cases. The jellies or gelatinous foods are provided to the patients in order to avoid such risks. Foods for patients with dysphagia are required to have the following properties. First, they should contain all the essential nutrients in suitable proportions for giving the patients sufficient nutrition. Further, they should have appropriate firmness and consistency that enable easy swallowing or easy chewing; should be cohesive in the mouth without separation; and should pass through the throat smoothly when swallowed. Web site: http://www.delphion.com/details?pn=US06458395__

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Method and apparatus for treating dysphagia with electrical stimulation Inventor(s): Asmar; Marie (Richmond Heights, OH), Beytas; Erol M. (Beachwood, OH), Christian; Michael O. (Beachwood, OH), Freed; Leonard A. (Kailua, HI), Freed; Marcy L. (Pepper Pike, OH), Kotton; Bernard (Beachwood, OH), Tucker; Howard (Cleveland Heights, OH) Assignee(s): Esd Limited Liability Company (beachwood, Oh) Patent Number: 5,725,564 Date filed: October 27, 1995

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Abstract: This invention is directed to a simple, non-invasive method and device for treating dysphagia and artificially promoting swallowing by electrical stimulus. In the present invention, a plurality of electrodes are selectively placed in electrical contact with tissue of a pharyngeal region of patient and a series of electrical pulses in electrical contact with each of the plurality of electrodes with a generator. The generator includes a pulse rate modulator for generating each of the electrical pulses having a frequency generally fixed at 80 hertz, a pulse width modulator for generating each pulse of the series of electrical pulses at a duration generally fixed at 300 microseconds, and a governor for regulating the electrical pulses such that at least one of current so as not to exceed 4.4 milliamps RMS or power so as not to exceed 9.6 MW RMS. The electrical pulses selectively stimulate muscles located proximate to the selectively placed electrodes to initiate swallowing. Excerpt(s): This invention relates to a method and device for effectively treating dysphagia. In particular, the present invention relates to a method and device for treating dysphagia by providing electrical stimulation to the pharyngeal region of an associated animal. Dysphagia is the inability to swallow or difficulty in swallowing and may be caused by stroke, neurodegenerative diseases, or respiratory disorders. Swallowing is a complicated action which is usually initiated voluntarily but always completed reflexively, whereby food is moved from the mouth through the pharynx and esophagus to the stomach. The act of swallowing occurs in three stages and requires the integrated action of the respiratory center and motor functions of multiple cranial nerves, and the coordination of the autonomic system within the esophagus. In the first stage, food is placed on the surface of the tongue. The tip of the tongue is placed against the hard palate. Elevation of the larynx and backward movement of the tongue forces the food through the isthmus of the fauces in the pharynx. In the second stage, the food passes through the pharynx. This involves constriction of the walls of the pharynx, backward bending of the epiglottis, and an upward and forward movement of the larynx and trachea. Food is kept from entering the nasal cavity by elevation of the soft palate and from entering the larynx by closure of the glottis and backward inclination of the epiglottis. During this stage, respiratory movements are inhibited by reflex. In the third stage, food moves down the esophagus and into the stomach. This movement is accomplished by momentum from the second stage, peristaltic contractions, and gravity. Although the main function of swallowing is the propulsion of food from the mouth into the stomach, swallowing also serves as a protective reflex for the upper respiratory tract by removing particles trapped in the nasopharynx and oropharynx, returning materials refluxed from the stomach into the pharynx, or removing particles propelled from the upper respiratory tract into the pharynx. Therefore, the absence of adequate swallowing reflex greatly increases the chance of pulmonary aspiration. Web site: http://www.delphion.com/details?pn=US05725564__

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Method and apparatus for treating oropharyngeal disorders with electrical stimulation Inventor(s): Asmar; Marie (Richmond Heights, OH), Beytas; Erol M. (Beachwood, OH), Christian; Michael O. (Beachwood, OH), Freed; Leonard A. (Kailua, HI), Freed; Marcy L. (Pepper Pike, OH), Kotton; Bernard (Beachwood, OH), Tucker; Howard (Cleveland Heights, OH) Assignee(s): Esd Limited Liability Company (beachwood, Oh) Patent Number: 5,891,185 Date filed: November 10, 1997 Abstract: A simple, non-invasive device and method for treating oropharyngeal disorders provides electrical stimulation to the pharyngeal region of a patient. Oropharyngeal disorders may cause an inability to swallow or difficulty in swallowing. The method and device provide an effective and non-invasive treatment for these disorders which is substantially more effective than traditional treatment methods, such as thermal stimulation. The method and device also effectively treat worst-case dysphagia (the inability to swallow) resulting from neurodegeneration and strokes. The device, an electrical pharyngeal neuromuscular stimulator, includes one or more pulse generators for generating a series of electrical pulses and a processor coupled to the pulse generators for controlling their operation. A switching network is also coupled to the pulse generators. The switching network directs series of electrical pulses respectively generated by the pulse generators to an electrode array positioned on the tissue of a patient's pharyngeal region. The processor controls the switching operation of the switching network by determining which electrode in the electrode array receives the series of pulses generated by the respective pulse generators. The electrode array also generates electrical feedback signals in response to the neuromuscular stimulation of the patient. The electrical feedback signals are provided to the processor via the switching network. The processor generates and stores test data and modifies the operation control signals and switching control signals in response to the electrical feedback signals. Excerpt(s): This invention relates to a method and apparatus for effectively treating oropharyngeal disorders. In particular, the present invention relates to a method and apparatus for treating oropharyngeal disorders by providing electrical stimulation to the pharyngeal region of an associated animal. A symptomatic and symptomatic oropharyngeal disorders can lead to an inability to swallow or difficulty in swallowing. These disorders may be caused, for example, by stroke, neurodegenerative diseases, brain tumors or respiratory disorders. Swallowing is a complicated action whereby food is moved from the mouth through the pharynx and esophagus to the stomach. The act of swallowing may be initiated voluntarily or reflexively but is always completed reflexively. Web site: http://www.delphion.com/details?pn=US05891185__

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Standardized test for dysphagia Inventor(s): Tymchuck; Donald L. (Minnetonka, MN) Assignee(s): Regents of the University of Minnesota (minneapolis, Mn) Patent Number: 5,976,084 Date filed: October 24, 1997

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Abstract: Dysphagia, or difficulty in swallowing, can cause choking, aspiration of food or liquid into the lungs, incomplete administration of medication, and discomfort to the victims. A method is provided for evaluating the severity of Dysphagia. The method comprises providing at least two sets of orally ingestible materials, each set of orally ingestible material comprising at least two compositions of like materials differing significantly in one property selected from the group consisting of viscosity, adhesiveness, cohesiveness and yield force. A patient ingests a first one of the at least two compositions from a first set of the at least two sets, examining the patients for a dysphagic response to the ingestion of the first one of the at least two compositions, and noting any dysphagic responses. Steps b), c) and d) are repeated for another set of orally ingestible materials which another set of the at least two sets of orally ingestible materials characterizes a property that is different from a property selected from the group consisting of viscosity, adhesiveness, cohesiveness and yield force characterized by the first one of the at least two compositions from a first set of the at least two sets of orally ingestible material. Excerpt(s): Dysphagia is a condition or symptom defined as a difficulty in swallowing. The present invention relates to a method for the standardized measurement of the quality or degree of dysphagia and a kit used for that method. Dysphagia, or difficulty in swallowing, is a condition or symptom which can be caused by many different conditions, injuries or diseases. Dysphagia can cause choking, aspiration of food or liquid into the lungs, incomplete administration of medication, and discomfort to the victims. These factors can at least discomfort a patient, but may also interfere with or complicate conventional treatment of patients. Among the many contributions to or causes of dysphagia are head injuries, Parkinsonism, Alzheimer's disease, muscular dystrophy, cerebral palsy, cancer, medication side effects, advanced HIV infections, gastrointestinal disorders, and brain tumors. It has been estimated that more than 10,000 patients a year choke to death as a result of dysphagia. Dysphagia is a well-recognized condition and has been studied and addressed by doctors and nutritionists (Robertson, Helen M. And Pattillo, Margaret S., Journal of the Canadian Dietetic Association, Vol. 54, No. 4, Winter 1993). Such studies have noted that the condition is affected by the temperature, pH, viscosity, volume, size and shape of particulate matter in the ingested sample, and that these conditions can affect the likelihood of a bolus passing safely through the swallowing process. Web site: http://www.delphion.com/details?pn=US05976084__ •

Thickened hydrolyte isotonic beverage Inventor(s): Sheldon; Kathie L. (Austin, MN) Assignee(s): Hormel Foods Corporation (de) Patent Number: 6,033,713 Date filed: March 13, 1998 Abstract: A prethickened hydrolytic beverage useful in rehydrating and regaining electrolytic balance with those suffering from dysphagia. Said beverage contains water, a carbohydrate source, a modified food starch, various electrolytes and other minor ingredients. Excerpt(s): The invention relates to electrolytic beverages useful in restoring lost water and regaining electrolytic balance and further relates to prethickened electrolytic beverages useful in restoring lost water and regaining electrolytic balance for those

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suffering from dysphagia. Several beverages currently exist which aid in replacing fluids lost to exertion or illness. For example, GATORADE.RTM. is a well known beverage which serves to replace fluids and necessary minerals in athletes. PEDIALYTE.RTM. is a well known beverage which serves essentially the same purpose for infants and small children. None of the isotonic beverages currently on the market address the problem of dysphagia, which is a difficulty in swallowing. Although dysphagia can have many different possible medical-causes, a difficulty in swallowing is common to them all. People who have this difficulty also have a need for replenishing fluids and electrolytes. It has been found that people with this affliction can more easily swallow liquids which have been thickened. Unfortunately, no prethickened isotonic beverage is currently available. Consequently, a need still exists for such a prethickened, isotonic beverage. Web site: http://www.delphion.com/details?pn=US06033713__

Patent Applications on Dysphagia As of December 2000, U.S. patent applications are open to public viewing.10 Applications are patent requests which have yet to be granted. (The process to achieve a patent can take several years.) The following patent applications have been filed since December 2000 relating to dysphagia: •

Aspiration screening process for assessing need for modified barium swallow study Inventor(s): Addington, W. Robert; (Indialantic, FL), Miller, Stuart P.; (Melbourne Beach, FL), Ockey, Roben R.; (San Antonio, TX), Stephens, Robert E.; (Parkville, MO) Correspondence: Charles E. Wands, Esq; Allen, Dyer, Doppelt, Milbrath, Gilchrist, P.A.; P.O. Box 3791; Orlando; FL; 32802-3791; US Patent Application Number: 20010003143 Date filed: December 12, 2000 Abstract: Whether a (stroke) patient is at risk for oral or pharyngeal dysphagia is determined by conducting a cough-based screening process for clinically evaluating the patient's swallow. The cough-based screening methodology is able to identify those patients who require a modified barium swallow test in order to rule out aspiration, and which patients do not need a modified barium swallow test. In accordance with the process the patient attempts to cough voluntarily. If the patient is unable to cough voluntarily, the patient is required to inhale an aerosol that stimulates a sensory innervation of the patient's larynx, thereby causing the patient to cough. The resulting cough is graded to determine whether the patient is at risk to a prescribed physiological condition, in particular pneumonia. The cough tests are supplemented by monitoring the ability of the patient to hold water in the patient's mouth for a prescribed period of time. If the patient is able to hold a prescribed volume of water in the patient's mouth for the prescribed period of time, the patient is permitted to be given a modified barium swallow test. If the patient is unable to hold a prescribed volume of water in the patient's mouth for the prescribed period of time, the patient is not permitted to be given a modified barium swallow test.

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This has been a common practice outside the United States prior to December 2000.

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Excerpt(s): The present invention relates in general to the field of speech pathology, and is particularly directed to a process for determining whether a patient is at risk for oral or pharyngeal dysphagia, by means of a cough-based screening process for clinically evaluating the patient's swallow. In order to clinically detect those patients who are at risk for aspiration, speech pathologists currently employ a standard procedure for evaluating a patient's swallow. A normal human swallow can be separated into four phases: 1)-oral preparation, 2)-the oral phase, 3)-the pharyngeal phase, and 4)-the esophageal phase. Patients who have suffered a stroke, traumatic brain injury or neuromuscular disorder (such as MS or ALS) have an increased risk of aspiration, and may have difficulty with either the oral phase, the pharyngeal phase or both, secondary to neurologic deficits. Poor tongue movement in chewing or in the swallow can cause food to fall into the pharynx and into the open airway before the completion of the oral phase. A delay in triggering the pharyngeal swallowing reflex can result in food falling into the airway during the delay when the airway is open. Reduced peristalsis in the pharynx, whether unilateral or bilateral, will cause residue in the pharynx after the swallow that can fall or be inhaled into the airway. Laryngeal or cricopharyngeal dysfunction can lead to aspiration because of decreased airway protection during the swallow. An abnormal human swallow is termed dysphagia. The oropharyngeal physiology involved in a normal swallow is very complicated, and many different neurological disturbances can disrupt normal swallowing and can cause aspiration of food material, liquid or solid, into the lungs, leading to increased morbidity in hospitalized patients and possible pneumonia. See, for example, the article by Jeri Logemann, entitled: "Swallowing Physiology and Pathophysiology," Otolaryngologic Clinics of North America, Vol. 21, No. 4, November, 1988, and the article by L. Kaha et. al., entitled: "Medical Complications During Stroke Rehabilitation, Stroke Vol. 26, No. 6, June 1995. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Bread equivalents and methods of making the same Inventor(s): Meister, Jeff; (Plymouth, MN) Correspondence: Thomas Hoxie; Novartis, Corporate Intellectual Property; One Health Plaza 430/2; East Hanover; NJ; 07936-1080; US Patent Application Number: 20030228408 Date filed: June 2, 2003 Abstract: A bread equivalent suitable for patients suffering from difficult in chewing or swallowing includes a starch-base and a gelling agent blended to form a dry mix and mixed with a liquid vehicle, such as water. The bread equivalent has properties that are similar to real bread. For example, the bread can be sliced and topped with spreadable foods like butter, margarine and the like. The bread equivalent lacks the glutenous nature of bread making it amenable for ingestion by patients having dysphagia. Excerpt(s): The present invention relates to food compositions that have attributes similar to bread yet suitable for ingestion by patients who have difficulty swallowing or chewing. Bread has been a staple in the diet of man for centuries providing essential nutrients such as protein, carbohydrates as well as vitamins and minerals. For most people, bread is a major component of at least one meal a day. However, for some individuals, bread can be rarely enjoyed because they have dysphagia, or difficulty in chewing and/or swallowing. This is because the gluten in bread makes the bread too elastic. While elasticity is good for rising and making bread higher, it makes bread

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nearly impossible for dysphagic patients to chew the bread. Because of bread's nutritional value, healthcare providers have recognized the importance of bread in a patient's diet. In order to make bread accessible to dysphagic patients, bread is typically soaked in water or milk and pureed resulting in a mushy consistency that resembles mashed potatoes. Instead of eating the bread in discrete pieces, the mashed bread is spoon-fed to the patient. Not only is this method of eating bread not appetizing but also ineffective in rehabilitating the patients to regain muscle tone in their jaws. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Gelled nutritional composition and process Inventor(s): DeWille, Normanella T.; (Columbus, OH), Liebrecht, Jeffery W.; (Columbus, OH), Mazer, Terrence B.; (Reynoldsburg, OH) Correspondence: Ross Products Division OF Abbott Laboratories; Department 108140ds/1; 625 Cleveland Avenue; Columbus; OH; 43215-1724; US Patent Application Number: 20030091613 Date filed: November 8, 2001 Abstract: A nutritional supplement in the form of a gelled nutritional composition. The composition contains gelled whey protein, a carbohydrate source, minerals, and vitamins. The composition may have a viscosity greater than about 2000 cp, more typically greater than about 5000 cp and an energy density greater than about 600 kcal/liter. The composition is suitable for dysphagia patients, children, and athletes. Excerpt(s): This invention relates to a gelled nutritional composition which may provide a nutritional supplement; for example for dysphagia patients and children. The invention also relates to a process for producing the gelled nutritional composition and to a method for providing nutrition to a dysphagic patient or post operatively to a patient recovering from surgery. Many people do not take in sufficient nutrients for a nutritionally complete diet. In order to assist these people, nutritional supplements have been developed. Nutritional supplements are not intended to provide all the nutrients necessary for a nutritionally complete diet; instead they are intended to supplement the diet such that it becomes more nutritionally complete. There are many targets for nutritional supplements; for example children, the elderly and patients suffering from dysphagia. Dysphagia, refers to difficulty in swallowing and occurs in all age groups. It is especially prevalent amongst the elderly. Typical symptoms include drooling, a feeling that food is sticking in the throat, discomfort in the chest and throat, a feeling of a lump in the throat, and coughing or choking caused by food not passing easily to the stomach and being sucked into the lungs. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Method and apparatus for treating poor laryngeal-elevation disorder with sequentialhigh voltage electrical stimulation Inventor(s): Geater, Alan; (Hatyai, TH), Leelamanit, Vitoon; (Hatyai, TH), Limsakul, Chusak; (Hatyai, TH) Correspondence: Reed Smith Hazel & Thomas Llp; Suite 1400; 3110 Fairview Park Drive; Falls Church; VA; 22042; US Patent Application Number: 20020133194 Date filed: January 29, 2001 Abstract: The sequential stimulator for the treatment of dysphagic patients incorporates a unit which is capable of detecting a swallowing signal from the glossal or temporalis surface electromyography (SEMG). When a swallowing signal is recognized, a trigger signal is sent to the stimulation generation unit to release high voltage stimuli sequentially to the suprahyoid muscles or the masseter muscles and the pharyngeal muscles in order to assist in the elevation of the larynx. This enables the pharyngeal lumen to open more widely so that food can pass through the patient's pharynx and into the oesophagus more easily during swallowing. Thus the sequential stimulator is a device for assisting swallowing in patients with dysphagia due to a variety of causes, for instance, brain injury, cerebrovascular accident, injury of the cervical nerves, muscles weakness, or old age. The stimulator is operative only when the patient attempts to swallow and provides a physiologic stimulus and provides a means of immediate relief of the swallowing difficulty. The device is also useful for physical therapy whereby the muscles under the chin, the masseter muscles and the pharyngeal muscles can be reeducated to contract in the normal coordinated sequence. Excerpt(s): The present invention relates generally to a method and an apparatus for treating poor laryngeal-elevation disorder with sequential-high voltage electrical stimulation. Phase 1: is the oral phase, during which food in the oral cavity is masticated and mixed. Phase 2: is the pharyngeal phase, during which the masticated and mixed food bolus is propelled from the oral cavity into the pharyngeal lumen and thence into the upper oesophagus. The second phase of swallowing involves the use of the glossal muscles and the pharyngeal muscles (suprahyoid and thyrohyoid) and a lowering of the base of the tongue. The tongue muscles then propel food bolus from the oral cavity into the pharyngeal lumen. At this stage, the muscles of the pharynx contract in sequence, raising elevating the larynx and moving it forward in order to open the pharyngeal lumen and the upper oesophageal sphincter so that the bolus can pass readily into the upper oesophagus. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Sildenafil citrate chewing gum formulations and methods of using the same Inventor(s): Gmunder, Charlean B.; (Branchburg, NJ), Li, Weisheng; (Bridgewater, NJ), Ream, Ronald L.; (Plano, IL) Correspondence: Bell, Boyd, & Lloyd, Llc; P.O. Box 1135; Chicago; IL; 60690-1135; US Patent Application Number: 20020012633 Date filed: September 19, 2001 Abstract: Methods and chewing gum formulations for delivering a medicament, namely sildenafil citrate, to an individual are provided. Further, an improved dosage form and

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method of treating erectile dysfunction are provided. Methods of treating esophageal spasms, dysphagia, and gastroparesis utilizing chewing gum formulations containing sildenafil citrate are also provided. Excerpt(s): This application is a divisional of U.S. patent application Ser. No. 09/714,571, filed on Nov. 16, 2000, which is a continuation-in-part patent application of U.S. patent application Ser. No. 09/286,818, filed on Apr. 6, 1999 and U.S. patent application Ser. No. 09/621,780 filed on Jul. 21, 2000 which claims priority from PCT patent application WO 00/35298. The present invention generally relates to medicaments and other agents. More specifically, the present invention relates to the delivery of medicaments or other agents. It is of course known to provide agents to individuals for various purposes. There are a great variety of such agents. These agents can be used to treat diseases and as such are typically referred to as drugs or medicaments. Likewise, the drugs or medicaments can be used for prophylactic purposes. In addition, some agents are taken on an as needed basis while others must be taken at regular intervals by the individual being treated. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Standardized compositions which facilitate swallowing in dysphagic subjects Inventor(s): Robbins, Jo Anne; (Madison, WI) Correspondence: Dewitt Ross & Stevens S.C.; 8000 Excelsior DR; Suite 401; Madison; WI; 53717-1914; US Patent Application Number: 20030044351 Date filed: August 26, 2002 Abstract: Disclosed are kits containing two or more viscosity-standardized, edible solutions for evaluating human subjects for dysphagia. Also disclosed are corresponding methods of using the kits for diagnosing dysphagia and for radiographic imaging of the oropharynx. Excerpt(s): This is a continuation-in-part of co-pending application Ser. No. 09/442,704, filed Nov. 18, 1999, which claims priority to provisional application Serial No. 60/151,213, filed Aug. 27, 1999, the contents of both of which are incorporated herein by reference. The invention is directed to standardized, viscosity-modified, edible formulations for use with dysphagic patients and methods to gauge the viscosity of modified foods using the standardized formulations. The formulations described herein can also be combined with a radio-opaque agent to facilitate improved dynamic fluoroscopic imaging of the oropharynx, hypopharynx, etc. The oropharyngeal physiology involved in a normal swallow is an exceedingly complex series of coordinated actions. A host of very different medical conditions, both physical and neurological in nature, can alter normal swallowing. For example, patients suffering stroke, Alzheimer's disease, amyotrophic lateral sclerosis, or traumatic brain injury can exhibit abnormal swallowing. In many instances, the abnormal swallow can and does cause aspiration of food material, both liquids and solids, into the lungs. This is especially prevalent (and life-threatening) in bed-ridden patients. Aspiration of foreign material into the airways leads to increased morbidity in hospitalized patients and can lead to pneumonia. Abnormalities in the human swallow, whether or not the condition results in aspiration of foods, is called dysphagia. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Stimulation of nociceptor (irritant) and c-fibre receptors in patient's throat by nebulized application of chemostimulant and contrast material that allows fluoroscopy observation of larynx response for identifying patient's risk to dysphagia Inventor(s): Addington, W. Robert; (Melbourne Beach, FL), Miller, Stuart P.; (Melbourne Beach, FL), Stephens, Robert E.; (Kansas City, MO) Correspondence: Christopher F. Regan; Allen, Dyer, Doppelt, Milbrath & Gilchrist, P.A.; P.O Box 3791; Orlando; FL; 32802-3791; US Patent Application Number: 20010023698 Date filed: March 1, 2001 Abstract: The injection of an aerosol containing a chemostimulant into a patient's throat to stimulate nociceptor (irritant) and c-fiber receptors is augmented by the inclusion of a medically safe and accepted contrast substance, such as barium. The addition of a contrast substance to the aerosol allows fluoroscopic observation of the patient's (larynx) response, to facilitate a medical practitioner's identification of whether the patient is at risk to one or more abnormal physiological conditions, such as oral or pharyngeal dysphagia, and pneumonia. Excerpt(s): The present application is a continuation-in-part of co-pending U.S. patent application, Ser. No. 09/734,404 (hereinafter referred to as the '404 application), filed Dec. 11, 2000, entitled: "Aspiration Screening Process for Assessing Need for Modified Barium Swallow Study," by W. Robert Addington et al, which is a continuation of U.S. patent application, Ser. No. 09/224,431, filed Dec. 31, 1998, which is a continuation of U.S. patent application, Ser. No. 08/885,360, filed Jun., 30, 1997, now U.S. Pat. No. 5,904,656, which is a continuation of U.S. patent application, Ser. No. 08/559,562, filed Nov. 16, 1995, now U.S. Pat. No. 5,678,563, the disclosures of which are incorporated herein. In addition, the present application claims the benefit of co-pending U.S. Provisional patent application, Ser. No. 60/186,826, filed Mar. 3, 2000, by W. Robert Addington et al, entitled: "Stimulation of Nociceptor (Irritant) and C-Fibre Receptors in Patient's Throat by Nebulized Application of Chemostimulant and Contrast Material That Allows Fluoroscopy Observation of Larynx Response for Identifying Patient's Risk to Dysphagia," and the disclosure of which is incorporated herein. The present invention relates in general to the field of speech pathology, and is directed to determining whether a patient is at risk for one or more abnormal physiological conditions, including but not limited to oral or pharyngeal dysphagia, and pneumonia. In particular, the present invention is directed to an enhancement to the invention disclosed in the above-referenced '404 application, that involves the addition of a contrast substance to the aerosol chemostimulant, so as to allow fluoroscopic observation of the patient's (larynx) response, and facilitate a medical practitioner's visual monitoring of the patient's airway during the aerosol application of the chemostimulant. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

Keeping Current In order to stay informed about patents and patent applications dealing with dysphagia, you can access the U.S. Patent Office archive via the Internet at the following Web address: http://www.uspto.gov/patft/index.html. You will see two broad options: (1) Issued Patent,

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and (2) Published Applications. To see a list of issued patents, perform the following steps: Under “Issued Patents,” click “Quick Search.” Then, type “dysphagia” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on dysphagia. You can also use this procedure to view pending patent applications concerning dysphagia. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.

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CHAPTER 7. BOOKS ON DYSPHAGIA Overview This chapter provides bibliographic book references relating to dysphagia. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on dysphagia include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.

Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “dysphagia” (or synonyms) into the “For these words:” box. You should check back periodically with this database which is updated every three months. The following is a typical result when searching for books on dysphagia: •

Scoop It, Mold It, Pipe It!: Dysphagia Textures With Thickeners to Include HACCP Guidelines Source: Bellevue, WA: Challenge Books. 1996. 90 p. Contact: Available from Pam Womack. 13320 SE. 43rd Place, Bellevue, WA 98006. (206) 641-4540. PRICE: $15.00 plus $5.00 shipping and handling; bulk discounts available. Summary: This book presents recipes using thickeners to obtain a variety of dysphagia textures. Each recipe includes HACCP guidelines, plating techniques, heating in volume, or one plate at a time with recommendation as to which method works best. The recipes use the least amount of thickener to achieve the optimum product. Recipes are printed in 5, 10, 15, 20, 25, and 30 portions. Information on mixing, storing, and serving thickened products is also given. Recipes are presented in categories: breakfast items, fruits, salads, vegetables, entrees, and sandwiches.

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Clinical Management of Dysphagia in Adults and Children. 2nd ed Source: Gaithersburg, MD: Aspen Publishers, Inc. 1994. 246 p. Contact: Available from Aspen Publishers, Inc. Attn: Orders, 7210 McKinney Circle, Frederick, MD 21704. (301) 417-7500. Fax (301) 695-7931. Website: www.aspenpublishing.com. PRICE: $79.00 plus shipping and handling. ISBN: 0834203766. Summary: This clinical management guide offers a practical text on dysphagia (swallowing dysfunction). In addition to chapters on dysphagia in adults and in children, the evaluation section includes a chapter on instrumental procedures. The text includes eight chapters, each written by specialists in this field. In chapter 1, the author presents a summary of the neurophysiology of swallowing in adults and the changes in swallowing associated with aging and with a variety of common neurologic disorders. In chapter 2, the author discusses the development of oral motor and swallowing skills in the infant and child. The author also summarizes the feeding and swallowing problems that may accompany specific neurologic disorders in the pediatric population. Chapter 3 provides guidelines for the clinical examination in adults, while Chapter 4 discusses the clinical examination of dysphagia in infants and children. Both chapters present a series of forms for documenting the results of the clinical examination. These forms were developed primarily to evaluate dysphagia in the neurologically impaired population, but they also may be used effectively to evaluate dysphagia associated with other etiologies. The forms may be reproduced for clinical use. Chapter 3 also includes handouts for patient, family, and team education, and an oral intake severity rating scale. Chapter 5 presents a model for selecting appropriate instrumental techniques such as videofluoroscopy and ultrasonography for further differential diagnosis of dysphagia. In chapter 6, the author relates dysphagia diagnosis to management in a discussion of indirect and direct approaches to treatment of adults. Chapter 7 presents an overview of treatment approaches for children with dysphagia, and Chapter 8 discusses the development of quality assurance monitors for dysphagia. The text is written primarily for the feeding specialist, typically a speech language pathologist who has been specifically trained in the evaluation and treatment of oropharyngeal dysphagia. Each chapter concludes with references and the text concludes with a subject index.

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Dysphagia: A Continuum of Care Source: Gaithersburg, MD: Aspen Publishers, Inc. 1997. 202 p. Contact: Available from Aspen Publishers, Inc. 7201 McKinney Circle, Frederick, MD 21704. (800) 234-1660 or (301) 698-7155. PRICE: $49.00 each. ISBN: 0834207850. Summary: This medical textbook on dysphagia presents the diagnosis and treatment of patients with dysphagia in a wider context of health care services. The authors emphasize the importance of team approaches to the ethical management of patients with dysphagia. Collaboration across settings is particularly important, as patients move from acute, to subacute, to outpatient or residential rehabilitation programs. The authors provide case history examples and vignettes which bring to life problems likely to be encountered in clinical care. Detailed information is provided regarding the assessment of oral, laryngeal, and pharyngeal swallowing function, including the alternative techniques that can be applied. Alternative techniques covered are videofluoroscopy, flexible fiberoptic endoscopy, ultrasound, electromyography, electroglottography, and measurement of the association between respiration and swallowing. Nine chapters are included in the text: critical decisions regarding service delivery across the health care

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continuum; a team approach to the ethical management of an elderly patient with dysphagia; pediatric dysphagia and related medical, behavioral, and developmental issues; legal implications in dysphagia practice; secular and sacred ethical considerations in dysphagia treatment and research; the effects of medications on swallowing; professional education and training in this field; the application of instrumental procedures to the evaluation and treatment of dysphagia; and instrumental imaging technologies and procedures. A subject index concludes the text. •

Pediatric Dysphagia Resource Guide Source: San Diego, CA: Singular Publishing Group. 2001. 231 p. Contact: Available from Thomson Learning Group. P.O. Box 6904, Florence, KY 41022. (800) 842-3636. Fax (606) 647-5963. Website: www.singpub.com. PRICE: $49.95 plus shipping and handling. ISBN: 0769300634. Summary: This text brings together information on the assessment and treatment of pediatric feeding and swallowing disorders (dysphagia) in an easy to use, clinical format. The guide begins with the normal aspects of neurodevelopment, oral motor feeding skills, and the anatomy and physiology of swallowing. The book guides readers in all aspects of working in a neonatal intensive care unit (NICU) environment, including how to monitor the equipment, the effects of medications on feeding and swallowing, and etiologies (causes) of swallowing disorders. Additional sections review procedures and diagnostic tests, and therapy for feeding and swallowing problems. One section of case studies profiles infants and children with common feeding or swallowing problems and provides guidelines for assessment, intervention, and goal writing. The text includes a glossary of terms and definitions, a list of resources (including Internet web sites), and a bibliography relevant to pediatric dysphagia. The book includes case studies, charts, graphs, indexes, and reproducible forms. A subject index concludes the book. 27 figures. 20 tables. 153 references.

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Dysphagia and the Child with Developmental Disabilities: Medical, Clinical and Family Interventions Source: San Diego, CA: Singular Publishing Group, Inc. 1994. 430 p. Contact: Available from Singular Publishing Group, Inc. 401 West 'A' Street, Suite 325, San Diego, CA 92101-7904. (800) 521-8545 or (619) 238-6777. Fax (800) 774-8398 or (619) 238-6789. E-mail: [email protected]. Website: www.singpub.com. PRICE: $65.00 plus shipping and handling. ISBN: 1565930894. Summary: This text covers the medical, clinical, and family interventions utilized in children who have developmental disabilities and dysphagia. Eighteen chapters cover the symptomatology and etiology of dysphagia; the comprehensive team evaluation; clinical evaluation and treatment; nutritional support; nutritional support for the child with AIDS; dysphagia in children with AIDS; the behavioral aspects of feeding disorders; the influence of posture and positioning on oral motor development and dysphagia; the radiologic assessment of pediatric swallowing; otolaryngology considerations; respiratory conditions and care; gastrointestinal problems; the surgical management of gastroesophageal reflux in children; dental treatment; dental care; nursing assessment and management; the family perspective on raising a child with developmental disability; ethical issues in treatment; and pharmacology. Each chapter includes numerous references and a subject index concludes the text.

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Dysphagia Assessment and Treatment Planning: A Team Approach Source: San Diego, CA: Singular Publishing Group. 1997. 308 p. Contact: Available from Singular Publishing Group, Inc. 401 West A Street, Suite 325, San Diego, CA 92101-7904. (619) 238-6777. Fax (619) 238-6789. E-mail: [email protected]. PRICE: $56.95. ISBN: 156593749X. Summary: This textbook focuses on the principles of assessment and treatment planning for patients with dysphagia (swallowing dysfunction). The first chapter covers normative aspects of swallowing and head and neck examination for a patient with dysphagia. Chapter 2 follows with a description of dysphagia impairment, particularly in patients recovering from oral, oropharyngeal, or laryngeal cancer. This is followed by a chapter on the implications of various neurogenic disorders for swallow function, and with recommendations for the timing of swallow studies in these patient populations. Chapters 4 through 10 deal with dysphagia assessment. Four chapters are devoted to radiographic assessment of swallowing, which reflects the importance of the dynamic swallow study as a diagnostic tool. Chapter 11 focuses on the treatment plan, illustrating how assessment information is formulated into a treatment plan, and how such a plan relates to a team approach. This chapter also briefly covers the major categories of treatment which may result. Since a nutritional consultation is frequently recommended following the dysphagia team evaluation, a chapter is devoted to dietary assessment. Chapter 13 is devoted to pediatric assessment, and helps readers adapt the standard assessment protocol to infants and young children. The book is accompanied by a CD-ROM disk, which provides examples of fluoroscopic studies of dynamic swallows. The CD-ROM includes studies from 10 normal adults and 9 dysphagic adults. For most of the normal subjects, 1 cc, 3 cc, paste, and self-select boluses are presented. In addition, three of the normal studies include subjects producing the vowels A, I, and U. Each normal study includes the authors' measurements for each swallow, so that any measures users make can be compared to the authors'. Each chapter includes black and white photographs or radiographs, charts, and extensive references; a subject index concludes the volume.

Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes&Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in Print®). IMPORTANT NOTE: Online booksellers typically produce search results for medical and non-medical books. When searching for “dysphagia” at online booksellers’ Web sites, you may discover non-medical books that use the generic term “dysphagia” (or a synonym) in their titles. The following is indicative of the results you might find when searching for “dysphagia” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): •

Clinical Evaluation of Dysphagia (Rehabilitation Institute of Chicago Procedure Manual) by Leora Reiff Cherney; ISBN: 0871892707; http://www.amazon.com/exec/obidos/ASIN/0871892707/icongroupinterna

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Clinical Management of Dysphagia in Adults and Children by Leora Reiff Cherney (Editor); ISBN: 0944480152; http://www.amazon.com/exec/obidos/ASIN/0944480152/icongroupinterna

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Drugs and Dysphagia: How Medications Can Affect Eating and Swallowing by Lynnete L. Carl, Peter R. Johnson; ISBN: 0890799822; http://www.amazon.com/exec/obidos/ASIN/0890799822/icongroupinterna

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Dysphagia and the Child with Developmental Disabilities: Medical, Clinical, and Family Interventions by Mary M.S., R.N. Lotze, et al; ISBN: 1565930894; http://www.amazon.com/exec/obidos/ASIN/1565930894/icongroupinterna

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Dysphagia Assessment and Treatment Planning: A Team Approach (Dysphagia Series) by Rebecca, Phd Leonard (Editor), Katherine, MD Kendall (Editor); ISBN: 156593749X; http://www.amazon.com/exec/obidos/ASIN/156593749X/icongroupinterna

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Dysphagia Care by Nadine O'Sullivan, Hubert M. Gulak (Designer); ISBN: 0963323407; http://www.amazon.com/exec/obidos/ASIN/0963323407/icongroupinterna

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Dysphagia Care for Adults: Aota Self-Paced Clinical Course by Aota; ISBN: 1569001839; http://www.amazon.com/exec/obidos/ASIN/1569001839/icongroupinterna

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Dysphagia Care: Team Approach (Team Approach With Acute and Long Term Patients) by Nadine O'Sullivan; ISBN: 0963323415; http://www.amazon.com/exec/obidos/ASIN/0963323415/icongroupinterna

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Dysphagia Challenge, Techniques for the Individual by Pam Womack, et al; ISBN: 0967133807; http://www.amazon.com/exec/obidos/ASIN/0967133807/icongroupinterna

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Dysphagia Evaluation Protocol - Pocket Manual by Wendy Avery-Smith, et al; ISBN: 076164413X; http://www.amazon.com/exec/obidos/ASIN/076164413X/icongroupinterna

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Dysphagia in the Elderly by Musson; ISBN: 1565938585; http://www.amazon.com/exec/obidos/ASIN/1565938585/icongroupinterna

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Dysphagia Management: A Clinical Guide (Clinical Competence Series) by Joanne Robbins; ISBN: 1879105772; http://www.amazon.com/exec/obidos/ASIN/1879105772/icongroupinterna

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Dysphagia Rehabilitation for Neurologically Impaired Adults by Jill S. Steefel; ISBN: 0398045569; http://www.amazon.com/exec/obidos/ASIN/0398045569/icongroupinterna

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Dysphagia resource manual : training for caregivers of patients with swallowing problems by Trudy E. Posner; ISBN: 091031764X; http://www.amazon.com/exec/obidos/ASIN/091031764X/icongroupinterna

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Dysphagia Screening: A Training Resource Pack by Lucy Rodriguez, Merida Borrelli; ISBN: 1861563299; http://www.amazon.com/exec/obidos/ASIN/1861563299/icongroupinterna

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Dysphagia Theranotes (Theranotes Series) by Dawn Scott Knauss; ISBN: 0761612165; http://www.amazon.com/exec/obidos/ASIN/0761612165/icongroupinterna

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Dysphagia: A Continuum of Care by Barbara C. Sonies (Editor); ISBN: 0944480292; http://www.amazon.com/exec/obidos/ASIN/0944480292/icongroupinterna

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Dysphagia: An Assessment and Management Program for the Adult (46P) (Sister Kenny Institute. Rehabilitation Publication, 706) by James R Roueche; ISBN:

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0884400352; http://www.amazon.com/exec/obidos/ASIN/0884400352/icongroupinterna •

Dysphagia: Diagnosis and Management by Michael E. Groher; ISBN: 075069730X; http://www.amazon.com/exec/obidos/ASIN/075069730X/icongroupinterna

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Dysphagia: Diagnosis and Treatment by David W. Gelfand, Joel E. Richter (Editor); ISBN: 0896401588; http://www.amazon.com/exec/obidos/ASIN/0896401588/icongroupinterna

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Dysphagia: Update on Assessment and Treatment of Swallowing Disorders by Jeri Logemann (Editor); ISBN: 3805569440; http://www.amazon.com/exec/obidos/ASIN/3805569440/icongroupinterna

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Evaluation of Dysphagia in Adults: Expanding the Diagnostic Options: For Clinicians by Clinicians (For Clinicians by Clinicians) by Russell H. Mills (Editor); ISBN: 0890798362; http://www.amazon.com/exec/obidos/ASIN/0890798362/icongroupinterna

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FELT : ANDERSON NUTRITIONAL MGMT OF DYSPHAGIA; ISBN: 0761647635; http://www.amazon.com/exec/obidos/ASIN/0761647635/icongroupinterna

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Management of Adult Neurogenic Dysphagia by Maggie Lee Huckabee, et al; ISBN: 1565937317; http://www.amazon.com/exec/obidos/ASIN/1565937317/icongroupinterna

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Manual of Dysphagia Assessment in Adults by Joseph Murray; ISBN: 1565938712; http://www.amazon.com/exec/obidos/ASIN/1565938712/icongroupinterna

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Oral Health and Dysphagia: Assessment and Implementation of Care by Richard White; ISBN: 1856422267; http://www.amazon.com/exec/obidos/ASIN/1856422267/icongroupinterna

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Pediatric Dysphagia Resource Guide (Singular Resource Guide Series) by Kelly Dailey Hall; ISBN: 0769300634; http://www.amazon.com/exec/obidos/ASIN/0769300634/icongroupinterna

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Pediatric Dysphagia: Management Challenges for the School-Based Speech-Language Pathologist by Joan C. Arvedson, Brian T. Rogers; ISBN: 1580410189; http://www.amazon.com/exec/obidos/ASIN/1580410189/icongroupinterna

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The Dysphagia Cookbook: Great Tasting and Nutritious Recipes for People With Swallowing Difficulties by Elayne Achilles, Todd Levine (Introduction); ISBN: 1581823487; http://www.amazon.com/exec/obidos/ASIN/1581823487/icongroupinterna

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The National Dysphagia Diet (Ndd: Standardization for Optimal Care by National Dysphagia Diet Task Force; ISBN: 0880913150; http://www.amazon.com/exec/obidos/ASIN/0880913150/icongroupinterna

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The Neuroscientific Principles of Swallowing and Dysphagia (Dysphagia Series) by Arthur J. Miller; ISBN: 1565938593; http://www.amazon.com/exec/obidos/ASIN/1565938593/icongroupinterna

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The Official Patient's Sourcebook on Dysphagia: A Revised and Updated Directory for the Internet Age by Icon Health Publications; ISBN: 0597833702; http://www.amazon.com/exec/obidos/ASIN/0597833702/icongroupinterna

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The role of speech language pathologists in the management of dysphagia (SuDoc HE 20.6512/7:989/1) by Martin Erlichman; ISBN: B00010B9JA; http://www.amazon.com/exec/obidos/ASIN/B00010B9JA/icongroupinterna

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The Source for Dysphagia by Nancy B. Swigert; ISBN: 0760603634; http://www.amazon.com/exec/obidos/ASIN/0760603634/icongroupinterna

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Working with Dysphagia by Lizzie Marks, Deirdre Rainbow; ISBN: 0863882498; http://www.amazon.com/exec/obidos/ASIN/0863882498/icongroupinterna

Chapters on Dysphagia In order to find chapters that specifically relate to dysphagia, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and dysphagia using the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” Type “dysphagia” (or synonyms) into the “For these words:” box. The following is a typical result when searching for book chapters on dysphagia: •

Recognition and Management of Pediatric Swallowing Disorders Source: in Kleinmann, R.E., ed. Pediatric Nutrition Handbook. 4th ed. Elk Grove Village, IL: American Academy of Pediatrics. 1998. p. 107-122. Contact: Available from American Academy of Pediatrics. P.O. Box 927, 141 Northwest Point Boulevard, Elk Grove Village, IL 60009-0927. (800) 433-9016. PRICE: $47.95 (members) plus $6.25 shipping and handling; $52.95 for nonmembers; plus $8.95 shipping and handling. ISBN: 1581100051. Summary: Assessment of nutritional status and providing dietary advice and nutritional support are important and increasingly prominent components of the practice of those who provide health care for infants, children, and adolescents. This chapter on the recognition and management of pediatric swallowing disorders is from a handbook that serves as a ready desk reference on the nutritional requirements and impact of nutritional status on the health of infants, children, and adolescents. Topics include common conditions associated with dysphagia (swallowing disorders), the consequences of dysphagia, recognition of pediatric dysphagia, clinical evaluation, the instrumental and radiographic (x ray) evaluation of dysphagia (pharyngeal manometry, electromyography), treatment options, feeding infants with cleft lip or cleft palate, and the efficacy of rehabilitative dysphagia management. The authors stress that because pediatric swallowing dysfunction may result in substantial morbidity, timely recognition and treatment is essential. Anatomic defects of the oropharynx, larynx, or esophagus, as well as disease processes that alter motor or sensory function, may lead to swallowing abnormalities. Pediatric dysphagia may result in unsuccessful feeding leading to malnutrition; behavioral feeding problems, including refusal of food, expulsion of food, and disruptive mealtime behaviors; drooling; and respiratory compromise. Treatment options can include positioning, oral sensory normalization, modification of food consistency, adaptive feeding devices, and oral feeding exercises. 2 tables. 47 references.

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Approach to the Patient with Dysphagia Source: in Danzi, J.T.; Scopelliti, J.A., eds. Office Management of Digestive Diseases. Malvern, PA: Lea and Febiger. 1992. p. 11-17. Contact: Available from Lea and Febiger. Box 3024, Malvern, PA 19355-9725. (215) 2512230. PRICE: $39.50. ISBN: 0812114361. Summary: Dysphagia, or difficulty in swallowing, is a manifestation of various medical problems. This chapter, from a medical textbook about the office management of common gastrointestinal diseases, discusses the approach to the patient with dysphagia. Topics include oropharyngeal dysphagia; disorders of the esophageal body, including diagnostic testing and evaluation; mechanical disorders, including esophageal cancer, peptic esophageal strictures, and esophageal webs; and motor disorders, including achalasia, diffuse esophageal spasm, and connective tissue disorders. 1 table. 7 references.

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Dysphagia, Odynophagia, Heartburn, and Other Esophageal Symptoms Source: in Feldman, M.; Friedman, L.S.; Sleisenger, M.H. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 7th ed. [2-volume set]. St. Louis, MO: Saunders. 2002. p. 93-101. Contact: Available from Elsevier. 11830 Westline Industrial Drive, St. Louis, MO 63146. (800) 545-2522. Fax (800) 568-5136. Website: www.us.elsevierhealth.com. PRICE: $229.00 plus shipping and handling. ISBN: 0721689736. Summary: Occasional esophageal complaints are common and usually are not harbingers of disease. However, frequent or persistent dysphagia (swallowing difficulty), odynophagia (painful swallowing), or heartburn immediately suggests an esophageal problem that necessitates investigation and treatment. This chapter on dysphagia, odynophagia, heartburn, and other esophageal symptoms is from a comprehensive and authoritative textbook that covers disorders of the gastrointestinal tract, biliary tree, pancreas, and liver, as well as the related topics of nutrition and peritoneal disorders. Topics include the mechanisms and classification of dysphagia, odynophagia, the symptoms and mechanisms of heartburn, globus sensation, chest pain, and respiratory, ear, nose and throat, and cardiac symptoms of esophageal problems. The author stresses that in particular, gastroesophageal reflux disease (GERD) may manifest with atypical complaints and should not be missed, because it is readily treatable. The chapter includes a mini-outline with page citations, full-color illustrations, and extensive references. 1 figure. 5 tables. 73 references.

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Oropharyngeal Dysphagia and Associated Disorders Source: in Brandt, L.J., et al., eds. Clinical Practice of Gastroenterology. Volume 1. Philadelphia, PA: Current Medicine. 1999. p. 66-74. Contact: Available from W.B. Saunders Company. Order Fulfillment, 6277 Sea Harbor Drive, Orlando, FL 32887. (800) 545-2522. Fax (800) 874-6418 or (407) 352-3445. Website: www.wbsaunders.com. PRICE: $235.00 plus shipping and handling. ISBN: 0443065209 (two volume set); 0443065217 (volume 1); 0443065225 (volume 2). Summary: Swallowing requires the voluntary and involuntary coordination of a large number of structures of the oral cavity, pharynx, larynx, and esophagus. The term oropharyngeal dysphagia (OPD) refers to difficulty in swallowing because of abnormalities in either the delivery of oral content to the proximal esophagus or

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misdirection of the bolus to the airway or nasopharynx. This chapter on OPD and associated disorders is from a lengthy textbook that brings practitioners up to date on the complexities of gastroenterology practice, focusing on the essentials of patient care. Topics include anatomy, the physiology of swallowing, the pathophysiology of OPD, clinical features of OPD, diagnostic evaluation of the condition, and treatment options, including rehabilitation and retraining, cricopharyngeal dilation and myotomy, and the correction of anatomic abnormalities. The authors stress that the evaluation and treatment of OPD requires a multidisciplinary approach. The initial goals in the treatment of OPD are palliation of dysphagia and prevention of aspiration; these are most successful only after a correct diagnosis is made. 6 figures. 5 tables. 37 references. •

Dysphagia in Head and Neck Surgery Patients Source: in Leonard, R.; Kendall, K. Dysphagia Assessment and Treatment Planning: A Team Approach. San Diego, CA: Singular Publishing Group, Inc. 1997. p. 19-27. Contact: Available from Singular Publishing Group, Inc. 401 West 'A' Street, Suite 325, San Diego, CA 92101-7904. (800) 521-8545 or (619) 238-6777. Fax (800) 774-8398 or (619) 238-6789. E-mail: [email protected]. Website: www.singpub.com. PRICE: $56.95 plus shipping and handling. ISBN: 156593749X. Summary: This chapter is from a textbook that focuses on the principles of assessment and treatment planning for patients with dysphagia (swallowing dysfunction). The chapter provides a description of dysphagia impairment, particularly in patients recovering from oral, oropharyngeal, or laryngeal cancer. These patients are the most common head and neck population to experience dysphagia, but the concepts involved in understanding the etiology of dysphagia in this group can be generalized to other patient populations. In patients with head and neck cancer, interference with normal swallowing can result from the growth of the tumor that invades structures and impairs functioning or from the obstructive effects of the tumor itself. Surgery to excise the tumor with a margin of normal tissue results in a defect and loss of structures, which typically also produces dysphagia. When radiation therapy is added to the regimen postoperatively, dysphagia may worsen secondary to xerostomia (dry mouth) and fibrosis of soft tissues in the field of radiation exposure. The author stresses that all patients undergoing surgery for head and neck cancers involving the oral cavity, pharynx, and larynx should be considered at risk for dysphagia in the postoperative period. Specific structures discussed include the oral sphincter, anterior floor of the mouth, tongue, mandible, palate, pharynx, larynx, and base of skull. The author concludes that the defects described in the chapter are often combined or only partial. Other factors, including the overall medical condition, social situation, and support system, will also likely impact the patient's ability to achieve adequate safe oral intake to maintain nutritional requirements. 12 references.

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Dysphagia in Adults Source: in Vinson, B.P. Essentials for Speech-Language Pathologists. San Diego, CA: Singular Publishing Group. 2001. p. 229-252. Contact: Available from Thomson Learning Group. P.O. Box 6904, Florence, KY 41022. (800) 842-3636. Fax (606) 647-5963. Website: www.singpub.com. PRICE: $49.95 plus shipping and handling. ISBN: 0769300715. Summary: This chapter on dysphagia in adults is from a textbook that is designed to help new professionals with a transition to clinical practice in speech language pathology. Sometimes dysphagia (difficult swallowing) occurs at the same time as a

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communication disorder, and sometimes it does not. Regardless, assessment and treatment falls within the practice of speech language pathologists. The author emphasizes that the speech language pathologist functions as part of a dysphagia patient care team, which typically includes a radiologist, a pulmonary physician, a gastroenterologist, a nutritionist, otolaryngologists, and a nurse. The author reviews the different types of dysphagia, then considers assessment issues; the evaluation of neurogenic dysphagia, including Guillain Barre syndrome, multiple sclerosis, amyotrophic lateral sclerosis or ALS, Parkinson disease, and stroke; the evaluation of mechanical dysphagia, including that due to acute inflammations, macroglossia (large tongue), pharyngeal diverticulum, cancer, and tracheostoma tube; and assessment tests, including ultrasound, the Blue Dye Test, fiberoptic endoscopic examination of swallowing (FEES), videofluoroscopy, cervical auscultation, electromyography (EMG), electroglottography (EGG), pharyngeal manometry, esophageal stage studies, and protocols for dysphagia assessment. The latter section of the chapter covers therapy, including diet, oral and non-oral feedings, and specific treatment procedures such as postural techniques, sensory awareness, effortful swallow, the Mendelsohn maneuver, the supraglottic swallow, and the super supraglottic swallow. 10 tables. •

Approach to the Patient with Dysphagia or Odynophagia Source: in Textbook of Gastroenterology. 4th ed. [2-volume set]. Hagerstown, MD: Lippincott Williams and Wilkins. 2003. p. 678-691. Contact: Available from Lippincott Williams and Wilkins. P.O. Box 1600, Hagerstown, MD 21741. (800) 638-6423. Fax: (301) 223-2400. Website: www.lww.com. PRICE: $289.00. ISBN: 781728614. Summary: This chapter on the approach to patients with dysphagia (swallowing difficulty) or odynophagia (painful swallowing) is from a lengthy, two-volume textbook that integrates the various demands of science, technology, expanding information, good judgment, and common sense into the diagnosis and management of gastrointestinal patients. Topics include symptom definitions, mechanisms responsible for symptom production, differential diagnoses, and recommended approaches to patients with dysphagia and to those with odynophagia. Patients with oropharyngeal dysphagia typically describe food lodging or sticking in the back of the throat or cervical esophageal region. Hesitation with swallowing, frequent and repeated attempts at swallowing, and throat clearing may accompany the dysphagia. Pain during the oropharyngeal phase of swallowing has been attributed to a variety of processes, particularly malignancies, foreign body ingestion, and mucosal inflammation and ulceration. 4 figures. 4 tables. 162 references.

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Dysphagia and Dysarthria: The Role of the Speech-Language Pathologist Source: in Mitsumoto, H.; Norris, F.H., Jr. Amyotrophic Lateral Sclerosis: A Comprehensive Guide to Management. New York, NY: Demos Vermande. 1994. p. 6375. Contact: Available from Demos Vermade. 386 Park Avenue South, Suite 201, New York, NY 10016. (800) 532-8663 or (212) 683-0072; Fax (212) 683-0118. PRICE: $39.95 plus shipping and handling. ISBN: 0939957582. Summary: This chapter, from a guide to the management of patients with amyotrophic lateral sclerosis (ALS), describes the role of the speech-language pathologist, particularly in treating the dysphagia and dysarthria common to ALS. Concerns specific to the speech-language pathologists (SLP) are the effects of the disease on the patient's oral

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mechanism, communicative abilities, and deglutition. Furthermore, the SLP address the familial and psychosocial issues surrounding speech and swallowing compromise. The author presents a model for the diagnosis and treatment of the ALS patient, dealing with the issues within the scope of practice of the SLP, based on the author's clinical experience. The author notes that the manifestations of ALS (oral mechanism compromise, communicative disorder, dysphagia, and family issues) are more dramatic in clinical presentation and become more crucial when confronted with a patient presenting with bulbar symptomatology either initially or progressively. Paradoxically, it is the progressively bulbar nature of ALS that has fostered innovative and adaptive diagnostic and therapeutic methods, resulting in improved quality of life throughout the remaining life span. The author emphasizes the need for therapy to adapt to the progressive nature of the disease, in order to achieve the best possible quality of life for the patient. 9 references. (AA-M). •

Pediatric Dysphagia and Related Medical, Behavioral, and Developmental Issues Source: in Sonies, B.C., ed. Dysphagia: A Continuum of Care. Gaithersburg, MD: Aspen Publishers, Inc. 1997. p. 55-73. Contact: Available from Aspen Publishers. 7201 McKinney Circle, Frederick, MD 217013129. (800) 234-1660. PRICE: $49.00. ISBN: 0834207850. Summary: This chapter, from a medical textbook on dysphagia, describes medical, behavioral and development issues related to pediatric dysphagia. Topics include ontogeny; pathology, including the developmental manifestations of dysphagia disability, and the causes and consequences of feeding disorders; the pediatric clinical evaluation, including the use of imaging techniques such as videofluoroscopy and ultrasonography; and clinical management of the child with dysphagia, including procedures for improving feeding skills and swallowing. The author focuses on the relationship between feeding behaviors and parent-child interactions, psychosocial development, acquisition of developing oral motor skills, nutrition, and respiratory health. Early and comprehensive management of dysphagia is important to minimize the wide-ranging primary and secondary medical and developmental consequences that may occur. These consequences can include failure to thrive, pulmonary disorders, increased risk for choking, prolonged and uncomfortable mealtime experiences, stressors in the parent-child relationship, failure to advance eating skills, and drooling. The chapter concludes with three illustrative case studies. 4 tables. 45 references.

•

Oral Care of the Dysphagic, Dependent and Terminally Ill Source: in Griffiths, J. and Boyle, S. Colour Guide to Holistic Oral Care: A Practical Approach. Mosby-Year Book Europe. 1993. p. 217-224. Contact: Available from Mosby-Year Book Europe. Lynton House, 7-12 Tavistock Square, London WC1H 9LB, England. Telephone 0171-391 4471. Fax 0171-391 6598. ISBN: 0723417792. Summary: This chapter, from a textbook that outlines the role of the nurse in oral health care, discusses the principles of oral care for people who are largely dependent on others for oral hygiene. Topics covered include normal swallowing; dysphagia; oral care for dependent or dysphagic patients; oral hygiene equipment and materials; and oral care in terminal illness. The authors stress that conversing, eating and drinking comfortably are basic human needs that are even more important for the person with a debilitating or terminal condition. 6 tables. 24 references.

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CHAPTER 8. MULTIMEDIA ON DYSPHAGIA Overview In this chapter, we show you how to keep current on multimedia sources of information on dysphagia. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine.

Video Recordings An excellent source of multimedia information on dysphagia is the Combined Health Information Database. You will need to limit your search to “Videorecording” and “dysphagia” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Videorecording (videotape, videocassette, etc.).” Type “dysphagia” (or synonyms) into the “For these words:” box. The following is a typical result when searching for video recordings on dysphagia: •

Dysphagia: The Latest in Instrumental Diagnostic Procedures and Service Delivery Issues Source: Rockville, MD: American Speech-Language-Hearing Association (ASHA). 1995. (videocassette, audiotape, manual). Contact: Available from American Speech-Language-Hearing Association (ASHA). Product Sales, 10801 Rockville Pike, Rockville, MD 20852. (888) 498-6699. TTY (301) 8970157. Website: www.asha.org. PRICE: $65.00 each. Item Number 0112019. Summary: This continuing education program describes the instrumental diagnostic procedures and service delivery issues for dysphagia (swallowing disorders). The program includes a manual, videotape, and audiotapes created in preparation for, and from a teleseminar held in July 1995. The three-hour seminar included a teleconference session on the anatomy and physiology of swallowing, an introduction of the diagnostic techniques that will be covered, a viewing of the videotape, a discussion of the techniques and procedures covered in the video, a presentation on the application of

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techniques to special populations and age groups, and two question-and-answer periods. Topics include the events in the pharyngeal stage of swallowing, oropharyngeal swallow physiology, the bedside examination, the use of the modified barium swallow in videofluoroscopy, purchasing sources for equipment for positioning patients during the radiographic procedure, simultaneous fluoroscopy and manometry, endoscopy, surface electromyography, ultrasound, and scintigraphy. The manual includes illustrations of some of the procedures, reprints of related medical journal articles, and the posttest with which participants can obtain continuing medical education credits. The program comes packaged in a plastic case that holds the audios, video, and manual. •

Pediatric Dysphagia: Management Challenges for the School-Based Speech-Language Pathologist Source: Rockville, MD: American Speech-Language-Hearing Association (ASHA). 1997. (videocassette, manual). Contact: Available from American Speech-Language-Hearing Association (ASHA). Product Sales, 10801 Rockville Pike, Rockville, MD 20852. (888) 498-6699. TTY (301) 8970157. Website: www.asha.org. PRICE: $110.00 plus shipping and handling. Order number 0112094. Summary: This video conference covers the special challenges faced by professionals working with infants and children who demonstrate feeding and swallowing problems. The emphasis is on children with complex management issues and how speech language pathologists can interface with parents and professional teams in educational and medical settings. The program emphasizes that school-based service providers in educational settings are well placed to identify needs for medical team referral, as well as for ongoing monitoring and therapeutic intervention. Topics include the physiology of multiple systems that affect or are affected by dysphagia (swallowing disorders); oral motor function and swallowing in the context of health, medical, and developmental issues; neural control of deglutition (chewing and swallowing); the etiologies of swallowing and feeding problems in pediatrics; management issues that encompass risk benefit considerations, liability, and ethical factors; and components for pediatric dysphagia team function. The accompanying manual includes references, a glossary of terms, and an appendix offering an evaluation form for clinic feedings and swallowing. 107 references.

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Audio Recordings The Combined Health Information Database contains abstracts on audio productions. To search CHID, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find audio productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Sound Recordings.” Type “dysphagia” (or synonyms) into the “For these words:” box. The following is a typical result when searching for sound recordings on dysphagia: •

Pediatric Dysphagia: Assessment and Intervention Considerations for Children and Young Adults Source: Rockville, MD: American Speech-Hearing-Language Association (ASHA). 1997. (audiocassette and study guide). Contact: Available from American Speech-Language-Hearing Association (ASHA). Product Sales, 10801 Rockville Pike, Rockville, MD 20852. (888) 498-6699. TTY (301) 8970157. Website: www.asha.org. PRICE: $80.00 for ASHA members; $90.00 for nonmembers; plus shipping and handling. ISBN: 1580410219. Summary: This multimedia study kit features the materials offered in two teleseminars sponsored by the American Speech Language Hearing Association, held in May and October 1997, on Pediatric Dysphagia: Assessment and Intervention Considerations. The teleseminars (and audiocassettes) feature Dr. Joan C. Arvedson, Dr. Maureen LeftonGreif, and Dr. Justine J. Sheppard. Topics include the physiologic basis for safe swallowing with implications of airway, gastrointestinal (GI), neurologic, and nutrition factors in infants and children with dysphagia; the assessment of feeding and swallowing disorders in the context of an interdisciplinary team focus; the use of management decisions that reflect the 'total child' approach; the medical and neurological conditions associated with dysphagia in older children and young adults; assessment and management strategies for older children with dysphagia; how to specify appropriate functional outcome goals for children with dysphagia; and the etiologies and prognoses for older children with dysphagia. The Study Guide includes an outline of the material covered in the presentations, a glossary of terms, a list of selected references, reprints of various articles on pediatric swallowing and feeding disorders, information about joining the Dysphagia division of ASHA, and materials with which to qualify for continuing education credits (test and answer form). 8 figures. 19 tables. 93 references.

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CHAPTER 9. PERIODICALS AND NEWS ON DYSPHAGIA Overview In this chapter, we suggest a number of news sources and present various periodicals that cover dysphagia.

News Services and Press Releases One of the simplest ways of tracking press releases on dysphagia is to search the news wires. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing. PR Newswire To access the PR Newswire archive, simply go to http://www.prnewswire.com/. Select your country. Type “dysphagia” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. The search results are shown by order of relevance. Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to dysphagia. While some of the listed articles are free to view, others are available for purchase for a nominal fee. To access this archive, go to http://www.reutershealth.com/en/index.html and search by “dysphagia” (or synonyms). The following was recently listed in this archive for dysphagia: •

Encore Medical to market VitalStim dysphagia device Source: Reuters Industry Breifing Date: November 04, 2002

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Dysphagic patients on thickened-fluid diets at risk of dehydration Source: Reuters Medical News Date: January 11, 2002

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High dysphagia rate seen with laparoscopic Nissen fundoplication Source: Reuters Medical News Date: January 18, 2000

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Dysphagia in elderly not recognized often enough Source: Reuters Medical News Date: September 08, 1999

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Stroke management programs neglect dysphagia Source: Reuters Medical News Date: April 01, 1999

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Management of oropharyngeal dysphagia "an inexact science" Source: Reuters Medical News Date: February 15, 1999

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Sensory Stimulation May Help To Correct Dysphagia After Stroke Source: Reuters Medical News Date: April 15, 1998

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Resistant Asthma May Involve Dysphagia Or GERD Source: Reuters Medical News Date: September 24, 1997

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Esophageal Stricture Associated With Dysphagia In AIDS Patient Source: Reuters Medical News Date: February 05, 1997

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Dysphagia: Independent Predictor Of Mortality After Acute Stroke Source: Reuters Medical News Date: July 16, 1996 The NIH

Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name. Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to

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Market Wire’s home page at http://www.marketwire.com/mw/home, type “dysphagia” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests. Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “dysphagia” (or synonyms). If you know the name of a company that is relevant to dysphagia, you can go to any stock trading Web site (such as http://www.etrade.com/) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/. BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “dysphagia” (or synonyms).

Newsletter Articles Use the Combined Health Information Database, and limit your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” Type “dysphagia” (or synonyms) into the “For these words:” box. You should check back periodically with this database as it is updated every three months. The following is a typical result when searching for newsletter articles on dysphagia: •

Pediatric Dysphagia: Practice and Challenges Source: ASHA Leader. 6(11): 4-7. June 12, 2001. Contact: Available from American Speech-Language-Hearing Association (ASHA). Product Sales, 10801 Rockville Pike, Rockville, MD 20852. (888) 498-6699. TTY (301) 8970157. Website: www.asha.org. Summary: This article reviews the challenges inherent in caring for children with dysphagia (swallowing disorders). The author notes that speech language pathologists (SLPs) are being asked to diagnose and treat an increasing number of swallowing disorders. The incidence of children with dysphagia is increasing because of improved technology, which has saved the lives of many children with life threatening conditions. The inclusive practice model and the Individuals with Disabilities Education Act (IDEA) have resulted in the increasing involvement of SLPs providing services to individuals with feeding and swallowing disorders in the educational setting. The author discusses the identification of the infant or child with dysphagia, the diagnosis of swallowing disorders, the management of feeding and swallowing disorders, and the role of the SLP

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in a multidisciplinary team approach to these children. Treatment of swallowing disorders usually involves the use of compensatory techniques to help the child swallow safely and habilitative techniques (such as oral motor exercises) that are designed to change swallowing physiology. Other considerations must be made for habilitative or rehabilitative techniques in children, including level of alertness and interactiveness, age and cognitive ability, receptive language skills, and capacity for compliance. 22 references. •

Dysphagia: When Swallowing Becomes Difficult, See Your Doctor Source: Mayo Clinic Health Letter. 16(8): 4-5. August 1998. Contact: Available from Mayo Clinic Health Letter. Subscription Services, P.O. Box 53889, Boulder, CO 80322-3889. (800) 333-9037 or (303) 604-1465. Summary: This newsletter article describes dysphagia, or swallowing difficulties. The article outlines the mechanics of swallowing and describes two categories of swallowing disorders: oropharyngeal dysphasia, when a stroke or neuromuscular disorder leaves throat muscles weakened; and esophageal dysphagia, which refers to the sensation of food sticking or getting hung up in the base of the throat or chest. Esophageal dysphagia can be caused by peptic stricture (narrowing of the lower esophagus), tumors, certain muscle problems, diverticulum, and complications of radiation therapy for cancer treatment. The article notes the diagnostic tests that may be used to confirm swallowing problems, including barium x-ray, endoscopy, and manometry. The author reminds readers that treatment options for dysphagia depend on the cause of the disorder, but can include diet therapy, physical therapy, esophageal dilatation, drug therapy, and surgery. One sidebar summarizes the questions that patients should think about before going to see their physician; the answers to these questions will help the physician come to an accurate diagnosis. 1 figure.

Academic Periodicals covering Dysphagia Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to dysphagia. In addition to these sources, you can search for articles covering dysphagia that have been published by any of the periodicals listed in previous chapters. To find the latest studies published, go to http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.” If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/, you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”

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CHAPTER 10. RESEARCHING MEDICATIONS Overview While a number of hard copy or CD-ROM resources are available for researching medications, a more flexible method is to use Internet-based databases. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.

U.S. Pharmacopeia Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications recommended for dysphagia. One such source is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the U.S. Pharmacopeia (USP). Today, the USP is a nonprofit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at http://www.usp.org/. The USP currently provides standards for over 3,700 medications. The resulting USP DI® Advice for the Patient® can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database, located at http://www.fda.gov/cder/da/da.htm. While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopeia (USP). Below, we have compiled a list of medications associated with dysphagia. If you would like more information on a particular medication, the provided hyperlinks will direct you to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.). The

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following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to dysphagia: Antacids •

Oral - U.S. Brands: Advanced Formula Di-Gel; Alamag; Alamag Plus; Alenic Alka; Alenic Alka Extra Strength; Alka-Mints; Alkets; Alkets Extra Strength; Almacone; Almacone II; AlternaGEL; Alu-Cap; Aludrox; Alu-Tab; Amitone; Amphojel; Antacid Gelcaps; Antacid Liquid http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202047.html

Lansoprazole •

Systemic - U.S. Brands: Prevacid http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202787.html

Nitrates Lingual Aerosol •

Systemic - U.S. Brands: Nitrolingual http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202410.html

Nitrates Oral •

Systemic - U.S. Brands: Dilatrate-SR; IMDUR; ISDN; ISMO; Isordil Tembids; Isordil Titradose; Monoket; Nitrocot; Nitroglyn E-R; Nitrong; Nitro-par; Nitrotime; Sorbitrate http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202411.html

Nitrates Sublingual, Chewable, or Buccal •

Systemic - U.S. Brands: Isordil; Nitrogard; Nitrostat; Sorbitrate http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202412.html

Nitrates Topical •

Systemic - U.S. Brands: Deponit; Minitran; Nitro-Bid; Nitrodisc; Nitro-Dur; Nitrol http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202413.html

Rabeprazole •

Systemic - U.S. Brands: AcipHex http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/500054.html

Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. Or, you may be able to access these sources from your local medical library.

Mosby’s Drug Consult™ Mosby’s Drug Consult™ database (also available on CD-ROM and book format) covers 45,000 drug products including generics and international brands. It provides prescribing

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information, drug interactions, and patient information. Subscription information is available at the following hyperlink: http://www.mosbysdrugconsult.com/. PDRhealth The PDRhealth database is a free-to-use, drug information search engine that has been written for the public in layman’s terms. It contains FDA-approved drug information adapted from the Physicians’ Desk Reference (PDR) database. PDRhealth can be searched by brand name, generic name, or indication. It features multiple drug interactions reports. Search PDRhealth at http://www.pdrhealth.com/drug_info/index.html. Other Web Sites Drugs.com (www.drugs.com) reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. (http://www.medletter.com/) which allows users to download articles on various drugs and therapeutics for a nominal fee.

Researching Orphan Drugs Although the list of orphan drugs is revised on a daily basis, you can quickly research orphan drugs that might be applicable to dysphagia by using the database managed by the National Organization for Rare Disorders, Inc. (NORD), at http://www.rarediseases.org/. Scroll down the page, and on the left toolbar, click on “Orphan Drug Designation Database.” On this page (http://www.rarediseases.org/search/noddsearch.html), type “dysphagia” (or synonyms) into the search box, and click “Submit Query.” When you receive your results, note that not all of the drugs may be relevant, as some may have been withdrawn from orphan status. Write down or print out the name of each drug and the relevant contact information. From there, visit the Pharmacopeia Web site and type the name of each orphan drug into the search box at http://www.nlm.nih.gov/medlineplus/druginformation.html. You may need to contact the sponsor or NORD for further information. NORD conducts “early access programs for investigational new drugs (IND) under the Food and Drug Administration’s (FDA’s) approval ‘Treatment INDs’ programs which allow for a limited number of individuals to receive investigational drugs before FDA marketing approval.” If the orphan product about which you are seeking information is approved for marketing, information on side effects can be found on the product’s label. If the product is not approved, you may need to contact the sponsor. The following is a list of orphan drugs currently listed in the NORD Orphan Drug Designation Database for dysphagia: •

Sucralfate suspension http://www.rarediseases.org/nord/search/nodd_full?code=187

If you have any questions about a medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA

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through its toll-free number, 1-888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.

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APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.

NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute11: •

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

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National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/

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National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html

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National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25

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National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm

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National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm

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National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375

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National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/

11

These publications are typically written by one or more of the various NIH Institutes.

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•

National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm

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National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/

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National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm

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National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm

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National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/

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National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/

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National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm

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National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html

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National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm

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National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm

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National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm

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National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html

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National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm

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Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp

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National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/

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National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp

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Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html

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Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm

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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.12 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:13 •

Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html

•

HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html

•

NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html

•

Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/

•

Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html

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Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html

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Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/

•

Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html

•

Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html

•

Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html

•

MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html

12

Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 13 See http://www.nlm.nih.gov/databases/databases.html.

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•

Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html

•

Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html

The NLM Gateway14 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.15 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “dysphagia” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total

Items Found 13323 179 869 64 452 14887

HSTAT16 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.17 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.18 Simply search by “dysphagia” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

14

Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.

15

The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 16 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 17 18

The HSTAT URL is http://hstat.nlm.nih.gov/.

Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations.

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Coffee Break: Tutorials for Biologists19 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.20 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.21 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.

Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: •

CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.

•

Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.

The Genome Project and Dysphagia In the following section, we will discuss databases and references which relate to the Genome Project and dysphagia. Online Mendelian Inheritance in Man (OMIM) The Online Mendelian Inheritance in Man (OMIM) database is a catalog of human genes and genetic disorders authored and edited by Dr. Victor A. McKusick and his colleagues at Johns Hopkins and elsewhere. OMIM was developed for the World Wide Web by the National Center for Biotechnology Information (NCBI).22 The database contains textual information, pictures, and reference information. It also contains copious links to NCBI’s Entrez database of MEDLINE articles and sequence information. 19 Adapted 20

from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html.

The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 21 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process. 22 Adapted from http://www.ncbi.nlm.nih.gov/. Established in 1988 as a national resource for molecular biology information, NCBI creates public databases, conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information--all for the better understanding of molecular processes affecting human health and disease.

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To search the database, go to http://www.ncbi.nlm.nih.gov/Omim/searchomim.html. Type “dysphagia” (or synonyms) into the search box, and click “Submit Search.” If too many results appear, you can narrow the search by adding the word “clinical.” Each report will have additional links to related research and databases. In particular, the option “Database Links” will search across technical databases that offer an abundance of information. The following is an example of the results you can obtain from the OMIM for dysphagia: •

Odontoma-dysphagia Syndrome Web site: http://www.ncbi.nlm.nih.gov/entrez/dispomim.cgi?id=164330 Genes and Disease (NCBI - Map)

The Genes and Disease database is produced by the National Center for Biotechnology Information of the National Library of Medicine at the National Institutes of Health. This Web site categorizes each disorder by system of the body. Go to http://www.ncbi.nlm.nih.gov/disease/, and browse the system pages to have a full view of important conditions linked to human genes. Since this site is regularly updated, you may wish to revisit it from time to time. The following systems and associated disorders are addressed: •

Cancer: Uncontrolled cell division. Examples: Breast and ovarian cancer, Burkitt lymphoma, chronic myeloid leukemia, colon cancer, lung cancer, malignant melanoma, multiple endocrine neoplasia, neurofibromatosis, p53 tumor suppressor, pancreatic cancer, prostate cancer, Ras oncogene, RB: retinoblastoma, von Hippel-Lindau syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Cancer.html

•

Immune System: Fights invaders. Examples: Asthma, autoimmune polyglandular syndrome, Crohn’s disease, DiGeorge syndrome, familial Mediterranean fever, immunodeficiency with Hyper-IgM, severe combined immunodeficiency. Web site: http://www.ncbi.nlm.nih.gov/disease/Immune.html

•

Metabolism: Food and energy. Examples: Adreno-leukodystrophy, atherosclerosis, Best disease, Gaucher disease, glucose galactose malabsorption, gyrate atrophy, juvenile-onset diabetes, obesity, paroxysmal nocturnal hemoglobinuria, phenylketonuria, Refsum disease, Tangier disease, Tay-Sachs disease. Web site: http://www.ncbi.nlm.nih.gov/disease/Metabolism.html

•

Muscle and Bone: Movement and growth. Examples: Duchenne muscular dystrophy, Ellis-van Creveld syndrome, Marfan syndrome, myotonic dystrophy, spinal muscular atrophy. Web site: http://www.ncbi.nlm.nih.gov/disease/Muscle.html

•

Nervous System: Mind and body. Examples: Alzheimer disease, amyotrophic lateral sclerosis, Angelman syndrome, Charcot-Marie-Tooth disease, epilepsy, essential tremor, fragile X syndrome, Friedreich’s ataxia, Huntington disease, Niemann-Pick disease, Parkinson disease, Prader-Willi syndrome, Rett syndrome, spinocerebellar atrophy, Williams syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Brain.html

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•

Signals: Cellular messages. Examples: Ataxia telangiectasia, Cockayne syndrome, glaucoma, male-patterned baldness, SRY: sex determination, tuberous sclerosis, Waardenburg syndrome, Werner syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Signals.html

•

Transporters: Pumps and channels. Examples: Cystic fibrosis, deafness, diastrophic dysplasia, Hemophilia A, long-QT syndrome, Menkes syndrome, Pendred syndrome, polycystic kidney disease, sickle cell anemia, Wilson’s disease, Zellweger syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Transporters.html Entrez

Entrez is a search and retrieval system that integrates several linked databases at the National Center for Biotechnology Information (NCBI). These databases include nucleotide sequences, protein sequences, macromolecular structures, whole genomes, and MEDLINE through PubMed. Entrez provides access to the following databases: •

3D Domains: Domains from Entrez Structure, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo

•

Books: Online books, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=books

•

Genome: Complete genome assemblies, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Genome

•

NCBI’s Protein Sequence Information Survey Results: Web site: http://www.ncbi.nlm.nih.gov/About/proteinsurvey/

•

Nucleotide Sequence Database (Genbank): Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Nucleotide

•

OMIM: Online Mendelian Inheritance in Man, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=OMIM

•

PopSet: Population study data sets, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Popset

•

ProbeSet: Gene Expression Omnibus (GEO), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo

•

Protein Sequence Database: Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Protein

•

PubMed: Biomedical literature (PubMed), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed

•

Structure: Three-dimensional macromolecular structures, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Structure

•

Taxonomy: Organisms in GenBank, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Taxonomy

To access the Entrez system at the National Center for Biotechnology Information, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=genome, and then

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select the database that you would like to search. The databases available are listed in the drop box next to “Search.” Enter “dysphagia” (or synonyms) into the search box and click “Go.” Jablonski’s Multiple Congenital Anomaly/Mental Retardation (MCA/MR) Syndromes Database23 This online resource has been developed to facilitate the identification and differentiation of syndromic entities. Special attention is given to the type of information that is usually limited or completely omitted in existing reference sources due to space limitations of the printed form. At http://www.nlm.nih.gov/mesh/jablonski/syndrome_toc/toc_a.html, you can search across syndromes using an alphabetical index. Search by keywords at http://www.nlm.nih.gov/mesh/jablonski/syndrome_db.html.

The Genome Database24 Established at Johns Hopkins University in Baltimore, Maryland in 1990, the Genome Database (GDB) is the official central repository for genomic mapping data resulting from the Human Genome Initiative. In the spring of 1999, the Bioinformatics Supercomputing Centre (BiSC) at the Hospital for Sick Children in Toronto, Ontario assumed the management of GDB. The Human Genome Initiative is a worldwide research effort focusing on structural analysis of human DNA to determine the location and sequence of the estimated 100,000 human genes. In support of this project, GDB stores and curates data generated by researchers worldwide who are engaged in the mapping effort of the Human Genome Project (HGP). GDB’s mission is to provide scientists with an encyclopedia of the human genome which is continually revised and updated to reflect the current state of scientific knowledge. Although GDB has historically focused on gene mapping, its focus will broaden as the Genome Project moves from mapping to sequence, and finally, to functional analysis. To access the GDB, simply go to the following hyperlink: http://www.gdb.org/. Search “All Biological Data” by “Keyword.” Type “dysphagia” (or synonyms) into the search box, and review the results. If more than one word is used in the search box, then separate each one with the word “and” or “or” (using “or” might be useful when using synonyms).

23

Adapted from the National Library of Medicine: http://www.nlm.nih.gov/mesh/jablonski/about_syndrome.html. 24 Adapted from the Genome Database: http://gdbwww.gdb.org/gdb/aboutGDB.html - mission.

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APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on dysphagia can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.

Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to dysphagia. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. The National Institutes of Health The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below. Topic Pages: MEDLINEplus The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to dysphagia. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “dysphagia”:

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Other guides Degenerative Nerve Diseases http://www.nlm.nih.gov/medlineplus/degenerativenervediseases.html Esophageal Cancer http://www.nlm.nih.gov/medlineplus/esophagealcancer.html Esophagus Disorders http://www.nlm.nih.gov/medlineplus/esophagusdisorders.html Movement Disorders http://www.nlm.nih.gov/medlineplus/movementdisorders.html Multiple Sclerosis http://www.nlm.nih.gov/medlineplus/multiplesclerosis.html Myositis http://www.nlm.nih.gov/medlineplus/myositis.html Speech and Communication Disorders http://www.nlm.nih.gov/medlineplus/speechandcommunicationdisorders.html Voice Disorders http://www.nlm.nih.gov/medlineplus/voicedisorders.html

Within the health topic page dedicated to dysphagia, the following was listed: •

General/Overviews Difficulty Swallowing (Dysphagia) Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=DS00523

•

Diagnosis/Symptoms Esophageal Muscle Test (Manometry) Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com//invoke.cfm?id=AN00340 What Is Upper GI Endoscopy? Source: American Gastroenterological Association http://www.gastro.org/clinicalRes/brochures/uppergi.html

•

Specific Conditions/Aspects Signs and Symptoms of Parkinson's Dysphagia Source: National Parkinson Foundation, Inc. http://www.parkinson.org/sw6.htm Swallowing Problems after Head and Neck Cancer Source: American Speech-Language-Hearing Association http://www.asha.org/public/speech/disorders/swallowing_probs.htm Wallenberg's Syndrome Source: National Institute of Neurological Disorders and Stroke http://www.ninds.nih.gov/health_and_medical/disorders/wallenbergs.htm

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•

149

Children Swallowing Disorders in Children Source: American Speech-Language-Hearing Association http://www.asha.org/public/speech/swallowing/Swallowing-Disorders-inChildren.htm

•

From the National Institutes of Health Swallowing Disorders Source: National Institute of Neurological Disorders and Stroke http://www.ninds.nih.gov/health_and_medical/disorders/swallowing_disorders. htm

•

Organizations American Academy of Otolaryngology--Head and Neck Surgery http://www.entnet.org/ American Speech-Language-Hearing Association http://www.asha.org/ National Institute on Deafness and Other Communication Disorders http://www.nidcd.nih.gov/

You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on dysphagia. CHID offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: •

Speech-Language Pathology: Helping Your Patients with Speech, Language or Swallowing Disorders Source: Rockville, MD: American Speech-Language-Hearing Association (ASHA). 199x. [2 p.]. Contact: Available from American Speech-Language-Hearing Association (ASHA). Action Center, 10801 Rockville Pike, Rockville, MD 20852. (800) 638-8255. E-mail: [email protected]. Website: www.asha.org. PRICE: Single copy free for members.

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Summary: A speech language pathologist is the health care professional educated and trained to evaluate and treat children and adults with speech, language, and swallowing problems. This brochure, from the American Speech Language Hearing Association (ASHA), reviews the services that speech language pathologists provide, and reminds physicians and other health care providers of the situations where referral to a speech language pathologist can be helpful for their patients. The brochure reviews common types of speech language disorders, including articulation disorders, language disorders, aphasia (loss of the ability to comprehend words), stuttering, voice disorders, cognitive communication disorders, and dysphagia (swallowing difficulty), with a focus on the services that speech language pathologists can provide to patients with each type of disorder. Speech language pathologists are also trained to offer new possibilities for people with communication disorders through augmentative and alternative communication, including voice synthesizing computers and communication boards. The brochure concludes with the contact information for ASHA and a description of the certification process for speech language pathologists. The brochure is illustrated with black and white photographs of speech language pathologists at work. 3 figures. •

Swallowing Problems (Dysphagia) Source: Oakville, Ontario: Halton Region Health Department. 2001. 2 p. Contact: Available from Halton Regional Health Department. The Region Municipality of Halton, 1151 Bronte Road, Oakville, Ontario, Canada, L6M 3L1. (905) 825-6000. Fax (905) 825-8839. Website: www.region.halton.on.ca/health. Email: [email protected]. PRICE: Contact organization for print copies. Summary: Dysphagia is a series of symptoms that may cause many types of swallowing problems, making it difficult to eat safely. If food is not swallowed properly, it can stay in the mouth, throat, or even enter the lungs. This bookmark-type brochure details the problems that may occur with dysphagia. The document lists the causes of dysphagia, then offers recommendations to treat and manage dysphagia and its related oral problems. The document also offers specific strategies for appropriate denture care for people with dysphagia. Readers are encouraged to contact the Halton Region (Ontario, Canada) Health Department for more information (www.region.halton.on.ca/health).

•

Dysphagia: A Review for Health Professionals Source: Melrose Park, IL: Milani Foods. 1992. [16 p.]. Contact: Available from Milani Foods. Alberto-Culver USA, Inc. 2525 Armitage Avenue, Melrose Park, IL 60160. (800) 333-0003. PRICE: Single copy free. Summary: This booklet updates health care professionals on swallowing disorders. Topics include the causes of dysphagia, the clinical consequences of dysphagia, the anatomy and physiology of swallowing, diagnosing dysphagia, the team approach to patient management, the use of videofluoroscopy as part of the patient evaluation, treatment goals, the nutritional assessment, and swallowing liquids and solids. The booklet concludes with a description of the Diafoods Thick-It product, a food thickener to help people with swallowing disorders achieve the appropriate food consistencies for their fluid intake. 4 figures. 11 references.

•

Dysphagia Source: Rockville, MD: American Speech-Language-Hearing Association (ASHA). 199x. [28 p.].

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Contact: Available from American Speech-Language-Hearing Association (ASHA). Product Sales, 10801 Rockville Pike, Rockville, MD 20852. (888) 498-6699. TTY (301) 8970157. Website: www.asha.org. PRICE: $5.00 plus shipping and handling. Order number 0111656. Summary: This dysphagia (swallowing disorders) information packet was compiled by the American-Speech-Language-Hearing Association (ASHA). Included are four items originally published in the ASHA journal: knowledge and skills needed by speech language pathologists providing services to dysphagic patients or clients (1990); instrumental diagnostic procedures for swallowing (1992); the Ad Hoc Committee on Dysphagia report (1987); and the scope of practice for speech language pathology and audiology (1990). Readers who are speech language pathologists are also invited to join ASHA's special interest division on swallowing and swallowing disorders. 21 references. •

Understanding Pediatric Dysphagia Source: in DeFeo, A.B., ed. Parent Articles 2. San Antonio, TX: Communication Skill Builders. 1995. p. 69-70. Contact: Available from Communication Skill Builders. Customer Service, 555 Academic Court, San Antonio, TX 78204-2498. (800) 866-4446; Fax (800) 232-1223. PRICE: $49.00 plus shipping and handling. Order Number 076-163-0732. Summary: This fact sheet, from a communication skills book for parents, discusses pediatric dysphagia. The author defines dysphagia and its symptoms, describes the use of a videofluoroscopic swallowing examination for diagnosis, provides pre-testing recommendations, makes suggestions for parental behavior during the test itself, and explains what parents can expect from the test results. The author encourages parents to become an active part of their child's health care team. 1 figure.

•

Special Populations: Dysphagia Source: Rockville, MD: American Speech-Language-Hearing Association (ASHA). 1999. [3 p.]. Contact: Available from American Speech-Language-Hearing Association (ASHA). Product Sales, 10801 Rockville Pike, Rockville, MD 20852. (888) 498-6699. TTY (301) 8970157. Website: www.asha.org. PRICE: Single copy free. Summary: This fact sheet, one in a series on special populations, discusses dysphagia (swallowing problems). Swallowing problems are related to neuromotor speech disorders in that they frequently, though not necessarily, accompany disturbances of speech movement. Dysphagia itself is not considered a disease, but rather a symptom of one or more underlying pathologies. The fact sheet considers the possible etiologies of dysphagia, including stroke, neuromuscular disorders, Parkinson's disease, polio, and cerebral palsy. The fact sheet also discusses age factors (dysphagia in the elderly and in children), the setting (where it is likely to occur), and treatment options, including swallowing therapy and the use of compensatory strategies. 1 figure. 20 references.

•

Swallowing Disorders Source: Alexandria, VA: American Academy of Otolaryngology-Head and Neck Surgery Foundation, Inc. (AAO-HNS). 1992. 4 p.

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Contact: American Academy of Otolaryngology-Head and Neck Surgery Foundation, Inc. (AAO-HNS). One Prince Street, Alexandria, VA 22314. (703) 836-4444. Fax (703) 6835100. PRICE: Single copy free (send self-addressed, stamped envelope); $20.00 for members; $25.00 for non-members per 100. Item Number 4763080. Summary: This pamphlet for the general public provides an overview of swallowing disorders. An explanation of how one swallows is followed by a discussion of what causes swallowing disorders, its symptoms, an evaluation of these disorders, and possible treatments. A diagram of the parts of the swallowing process is included. •

Dysphagia Diet: 5 Levels. Difficulty in Swallowing Diet Source: Camp Hill, PA: Chek-Med Systems, Inc. 1995. 8 p. Contact: Available from Chek-Med Systems, Inc. 200 Grandview Avenue, Camp Hill, PA 17011. (800) 451-5797. Fax (717) 761-0216. PRICE: $1.45 each, plus shipping (as of 1995). Order no. D-7. Summary: This patient education brochure, one of a series of 17 brochures, provides dietary recommendations for patients with dysphagia or difficulty in swallowing. The brochure explains the purpose of the special diet; defines esophageal dysphagia and oropharyngeal dysphagia; summarizes relevant nutrition facts related to liquids and calories; and lists special considerations for patients with dysphagia, including tips on how to thin or thicken liquids and foods. The brochure includes examples of medium and thick liquids and foods, as well as some basic recipes. The brochure concludes with descriptions of five levels of swallowing difficulties, with sample menus for breakfast, lunch, and dinner in each level. The brochure is printed in two colors and contains graphics.

•

Nutrition Practice Guidelines for Dysphagia Source: Chicago, IL: American Dietetic Association. 1996. 19 p. Contact: Available from American Dietetic Association. 216 West Jackson Boulevard, Chicago, IL 60606. (800) 877-1600 or (312) 899-0040. Fax (312) 899-4899. PRICE: $9.95 for members, $11.50 for nonmembers. Summary: This publication provides Nutrition Guidelines for Practice for Dysphagia developed by the Dietetics in Physical Medicine and Rehabilitation dietetic practice group. The group recognized the importance of aggressive nutrition intervention to maximize positive outcomes for patients with dysphagia, then developed and field tested the Guidelines for Practice outlined in the publication. The authors emphasize that the team approach, including the coordinated efforts of the dysphagia therapist, registered dietitian (RD), nurse, and physician, is particularly important in managing dysphagia. The ability of a patient with dysphagia to safely meet nutrient needs lies on a continuum between nothing by mouth (NPO) and total oral feedings. The guidelines address the challenges of oral and enteral feedings, and the critical transition between these two modalities. Nutrition assessment and planning, dysphagia diets, discharge planning, and patient and caregiver education are also addressed. The authors provide a field test synopsis that includes the field test objects, field test sites and design, and results. 2 tables. 10 references. (AA-M).

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The National Guideline Clearinghouse™ The National Guideline Clearinghouse™ offers hundreds of evidence-based clinical practice guidelines published in the United States and other countries. You can search this site located at http://www.guideline.gov/ by using the keyword “dysphagia” (or synonyms). The following was recently posted: •

ACR Appropriateness Criteria for imaging recommendations for patients with dysphagia Source: American College of Radiology - Medical Specialty Society; 1998 (revised 2001); 6 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3259&nbr=2485&a mp;string=dysphagia

•

American Gastroenterological Association management of oropharyngeal dysphagia

medical

position

statement

on

Source: American Gastroenterological Association - Medical Specialty Society; 1998 July 24 (reviewed 2001); 3 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3067&nbr=2293&a mp;string=dysphagia •

American Gastroenterological Association medical position statement on treatment of patients with dysphagia caused by benign disorders of the distal esophagus Source: American Gastroenterological Association - Medical Specialty Society; 1998 November 8 (reviewed 2001); 4 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3064&nbr=2290&a mp;string=dysphagia Healthfinder™

Healthfinder™ is sponsored by the U.S. Department of Health and Human Services and offers links to hundreds of other sites that contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database: •

Dysphagia Summary: This fact sheet describes what causes dysphagia, problems that occur with dysphagia, and treatment options. Source: National Institute on Deafness and Other Communication Disorders Information Clearinghouse http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6665

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The NIH Search Utility The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to dysphagia. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats

•

Family Village: http://www.familyvillage.wisc.edu/specific.htm

•

Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/

•

Med Help International: http://www.medhelp.org/HealthTopics/A.html

•

Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/

•

Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/

•

WebMD®Health: http://my.webmd.com/health_topics

Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to dysphagia. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with dysphagia. The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about dysphagia. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at

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http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “dysphagia” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “dysphagia”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “dysphagia” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “dysphagia” (or a synonym) into the search box, and click “Submit Query.”

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APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.

Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.25

Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.

Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of

25

Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.

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libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)26: •

Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/

•

Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)

•

Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm

•

California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html

•

California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html

•

California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html

•

California: Gateway Health Library (Sutter Gould Medical Foundation)

•

California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/

•

California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp

•

California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html

•

California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/

•

California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/

•

California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/

•

California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html

•

California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/

•

Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/

•

Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/

•

Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/

26

Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.

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•

Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml

•

Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm

•

Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html

•

Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm

•

Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp

•

Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/

•

Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm

•

Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html

•

Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/

•

Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm

•

Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/

•

Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/

•

Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/

•

Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm

•

Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html

•

Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm

•

Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/

•

Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/

•

Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10

•

Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/

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•

Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html

•

Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp

•

Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp

•

Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/

•

Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html

•

Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm

•

Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp

•

Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/

•

Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html

•

Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/

•

Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm

•

Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/

•

Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html

•

Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm

•

Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330

•

Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)

•

National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html

•

National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/

•

National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/

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•

Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm

•

New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/

•

New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm

•

New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm

•

New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/

•

New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html

•

New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/

•

New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html

•

New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/

•

Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm

•

Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp

•

Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/

•

Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/

•

Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml

•

Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html

•

Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html

•

Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml

•

Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp

•

Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm

•

Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/

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•

South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp

•

Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/

•

Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/

•

Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72

163

ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •

ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html

•

MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp

•

Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/

•

Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html

•

On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/

•

Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp

•

Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm

Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a).

Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •

Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical

•

MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html

•

Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/

•

Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine

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DYSPHAGIA DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Aberrant: Wandering or deviating from the usual or normal course. [EU] Abscess: A localized, circumscribed collection of pus. [NIH] Acetylcholine: A neurotransmitter. Acetylcholine in vertebrates is the major transmitter at neuromuscular junctions, autonomic ganglia, parasympathetic effector junctions, a subset of sympathetic effector junctions, and at many sites in the central nervous system. It is generally not used as an administered drug because it is broken down very rapidly by cholinesterases, but it is useful in some ophthalmological applications. [NIH] Acetylcholinesterase: An enzyme that catalyzes the hydrolysis of acetylcholine to choline and acetate. In the CNS, this enzyme plays a role in the function of peripheral neuromuscular junctions. EC 3.1.1.7. [NIH] Acoustic: Having to do with sound or hearing. [NIH] Actin: Essential component of the cell skeleton. [NIH] Adaptation: 1. The adjustment of an organism to its environment, or the process by which it enhances such fitness. 2. The normal ability of the eye to adjust itself to variations in the intensity of light; the adjustment to such variations. 3. The decline in the frequency of firing of a neuron, particularly of a receptor, under conditions of constant stimulation. 4. In dentistry, (a) the proper fitting of a denture, (b) the degree of proximity and interlocking of restorative material to a tooth preparation, (c) the exact adjustment of bands to teeth. 5. In microbiology, the adjustment of bacterial physiology to a new environment. [EU] Adenoma: A benign epithelial tumor with a glandular organization. [NIH] Adjunctive Therapy: Another treatment used together with the primary treatment. Its purpose is to assist the primary treatment. [NIH] Adjustment: The dynamic process wherein the thoughts, feelings, behavior, and biophysiological mechanisms of the individual continually change to adjust to the environment. [NIH] Adolescence: The period of life beginning with the appearance of secondary sex characteristics and terminating with the cessation of somatic growth. The years usually referred to as adolescence lie between 13 and 18 years of age. [NIH] Adrenal Cortex: The outer layer of the adrenal gland. It secretes mineralocorticoids, androgens, and glucocorticoids. [NIH] Adrenal Glands: Paired glands situated in the retroperitoneal tissues at the superior pole of each kidney. [NIH] Adrenal Medulla: The inner part of the adrenal gland; it synthesizes, stores and releases catecholamines. [NIH] Adrenergic: Activated by, characteristic of, or secreting epinephrine or substances with similar activity; the term is applied to those nerve fibres that liberate norepinephrine at a synapse when a nerve impulse passes, i.e., the sympathetic fibres. [EU]

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Adverse Effect: An unwanted side effect of treatment. [NIH] Aerosol: A solution of a drug which can be atomized into a fine mist for inhalation therapy. [EU]

Afferent: Concerned with the transmission of neural impulse toward the central part of the nervous system. [NIH] Affinity: 1. Inherent likeness or relationship. 2. A special attraction for a specific element, organ, or structure. 3. Chemical affinity; the force that binds atoms in molecules; the tendency of substances to combine by chemical reaction. 4. The strength of noncovalent chemical binding between two substances as measured by the dissociation constant of the complex. 5. In immunology, a thermodynamic expression of the strength of interaction between a single antigen-binding site and a single antigenic determinant (and thus of the stereochemical compatibility between them), most accurately applied to interactions among simple, uniform antigenic determinants such as haptens. Expressed as the association constant (K litres mole -1), which, owing to the heterogeneity of affinities in a population of antibody molecules of a given specificity, actually represents an average value (mean intrinsic association constant). 6. The reciprocal of the dissociation constant. [EU] Agarose: A polysaccharide complex, free of nitrogen and prepared from agar-agar which is produced by certain seaweeds (red algae). It dissolves in warm water to form a viscid solution. [NIH] Age Factors: Age as a constituent element or influence contributing to the production of a result. It may be applicable to the cause or the effect of a circumstance. It is used with human or animal concepts but should be differentiated from aging, a physiological process, and time factors which refers only to the passage of time. [NIH] Age Groups: Persons classified by age from birth (infant, newborn) to octogenarians and older (aged, 80 and over). [NIH] Aged, 80 and Over: A person 80 years of age and older. [NIH] Airway: A device for securing unobstructed passage of air into and out of the lungs during general anesthesia. [NIH] Alertness: A state of readiness to detect and respond to certain specified small changes occurring at random intervals in the environment. [NIH] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alkaline: Having the reactions of an alkali. [EU] Alpha Particles: Positively charged particles composed of two protons and two neutrons, i.e., helium nuclei, emitted during disintegration of very heavy isotopes; a beam of alpha particles or an alpha ray has very strong ionizing power, but weak penetrability. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Alveoli: Tiny air sacs at the end of the bronchioles in the lungs. [NIH] Amino acid: Any organic compound containing an amino (-NH2 and a carboxyl (- COOH) group. The 20 a-amino acids listed in the accompanying table are the amino acids from which proteins are synthesized by formation of peptide bonds during ribosomal translation of messenger RNA; all except glycine, which is not optically active, have the L configuration. Other amino acids occurring in proteins, such as hydroxyproline in collagen, are formed by

Dictionary 167

posttranslational enzymatic modification of amino acids residues in polypeptide chains. There are also several important amino acids, such as the neurotransmitter y-aminobutyric acid, that have no relation to proteins. Abbreviated AA. [EU] Amniotic Fluid: Amniotic cavity fluid which is produced by the amnion and fetal lungs and kidneys. [NIH] Ampulla: A sac-like enlargement of a canal or duct. [NIH] Amyloidosis: A group of diseases in which protein is deposited in specific organs (localized amyloidosis) or throughout the body (systemic amyloidosis). Amyloidosis may be either primary (with no known cause) or secondary (caused by another disease, including some types of cancer). Generally, primary amyloidosis affects the nerves, skin, tongue, joints, heart, and liver; secondary amyloidosis often affects the spleen, kidneys, liver, and adrenal glands. [NIH] Analog: In chemistry, a substance that is similar, but not identical, to another. [NIH] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Androgens: A class of sex hormones associated with the development and maintenance of the secondary male sex characteristics, sperm induction, and sexual differentiation. In addition to increasing virility and libido, they also increase nitrogen and water retention and stimulate skeletal growth. [NIH] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH] Anesthetics: Agents that are capable of inducing a total or partial loss of sensation, especially tactile sensation and pain. They may act to induce general anesthesia, in which an unconscious state is achieved, or may act locally to induce numbness or lack of sensation at a targeted site. [NIH] Angulation: Deviation from the normal long axis, as in a fractured bone healed out of line. [NIH]

Animal model: An animal with a disease either the same as or like a disease in humans. Animal models are used to study the development and progression of diseases and to test new treatments before they are given to humans. Animals with transplanted human cancers or other tissues are called xenograft models. [NIH] Anomalies: Birth defects; abnormalities. [NIH] Anorexia: Lack or loss of appetite for food. Appetite is psychologic, dependent on memory and associations. Anorexia can be brought about by unattractive food, surroundings, or company. [NIH] Antibacterial: A substance that destroys bacteria or suppresses their growth or reproduction. [EU] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH]

Antibodies: Immunoglobulin molecules having a specific amino acid sequence by virtue of which they interact only with the antigen that induced their synthesis in cells of the lymphoid series (especially plasma cells), or with an antigen closely related to it. [NIH] Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on

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the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Anticoagulants: Agents that prevent blood clotting. Naturally occurring agents in the blood are included only when they are used as drugs. [NIH] Antidepressant: A drug used to treat depression. [NIH] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Anti-Inflammatory Agents: Substances that reduce or suppress inflammation. [NIH] Antimicrobial: Killing microorganisms, or suppressing their multiplication or growth. [EU] Antineoplastic: Inhibiting or preventing the development of neoplasms, checking the maturation and proliferation of malignant cells. [EU] Antipsychotic: Effective in the treatment of psychosis. Antipsychotic drugs (called also neuroleptic drugs and major tranquilizers) are a chemically diverse (including phenothiazines, thioxanthenes, butyrophenones, dibenzoxazepines, dibenzodiazepines, and diphenylbutylpiperidines) but pharmacologically similar class of drugs used to treat schizophrenic, paranoid, schizoaffective, and other psychotic disorders; acute delirium and dementia, and manic episodes (during induction of lithium therapy); to control the movement disorders associated with Huntington's chorea, Gilles de la Tourette's syndrome, and ballismus; and to treat intractable hiccups and severe nausea and vomiting. Antipsychotic agents bind to dopamine, histamine, muscarinic cholinergic, a-adrenergic, and serotonin receptors. Blockade of dopaminergic transmission in various areas is thought to be responsible for their major effects : antipsychotic action by blockade in the mesolimbic and mesocortical areas; extrapyramidal side effects (dystonia, akathisia, parkinsonism, and tardive dyskinesia) by blockade in the basal ganglia; and antiemetic effects by blockade in the chemoreceptor trigger zone of the medulla. Sedation and autonomic side effects (orthostatic hypotension, blurred vision, dry mouth, nasal congestion and constipation) are caused by blockade of histamine, cholinergic, and adrenergic receptors. [EU] Antitussive: An agent that relieves or prevents cough. [EU] Anus: The opening of the rectum to the outside of the body. [NIH] Aorta: The main trunk of the systemic arteries. [NIH] Apathy: Lack of feeling or emotion; indifference. [EU] Aperture: A natural hole of perforation, especially one in a bone. [NIH] Aphasia: A cognitive disorder marked by an impaired ability to comprehend or express language in its written or spoken form. This condition is caused by diseases which affect the language areas of the dominant hemisphere. Clinical features are used to classify the various subtypes of this condition. General categories include receptive, expressive, and mixed forms of aphasia. [NIH] Apnea: A transient absence of spontaneous respiration. [NIH] Applicability: A list of the commodities to which the candidate method can be applied as presented or with minor modifications. [NIH]

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Apraxia: Loss of ability to perform purposeful movements, in the absence of paralysis or sensory disturbance, caused by lesions in the cortex. [NIH] Aqueous: Having to do with water. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Artery: Vessel-carrying blood from the heart to various parts of the body. [NIH] Articular: Of or pertaining to a joint. [EU] Articulation: The relationship of two bodies by means of a moveable joint. [NIH] Articulation Disorders: Disorders of the quality of speech characterized by the substitution, omission, distortion, and addition of phonemes. [NIH] Aspartate: A synthetic amino acid. [NIH] Aspergillosis: Infections with fungi of the genus Aspergillus. [NIH] Aspirate: Fluid withdrawn from a lump, often a cyst, or a nipple. [NIH] Aspiration: The act of inhaling. [NIH] Ataxia: Impairment of the ability to perform smoothly coordinated voluntary movements. This condition may affect the limbs, trunk, eyes, pharnyx, larnyx, and other structures. Ataxia may result from impaired sensory or motor function. Sensory ataxia may result from posterior column injury or peripheral nerve diseases. Motor ataxia may be associated with cerebellar diseases; cerebral cortex diseases; thalamic diseases; basal ganglia diseases; injury to the red nucleus; and other conditions. [NIH] Atresia: Lack of a normal opening from the esophagus, intestines, or anus. [NIH] Atrophy: Decrease in the size of a cell, tissue, organ, or multiple organs, associated with a variety of pathological conditions such as abnormal cellular changes, ischemia, malnutrition, or hormonal changes. [NIH] Atypical: Irregular; not conformable to the type; in microbiology, applied specifically to strains of unusual type. [EU] Audiology: The study of hearing and hearing impairment. [NIH] Auscultation: Act of listening for sounds within the body. [NIH] Autoimmune disease: A condition in which the body recognizes its own tissues as foreign and directs an immune response against them. [NIH] Autonomic: Self-controlling; functionally independent. [EU] Axillary: Pertaining to the armpit area, including the lymph nodes that are located there. [NIH]

Axillary Vein: The venous trunk of the upper limb; a continuation of the basilar and brachial veins running from the lower border of the teres major muscle to the outer border of the first rib where it becomes the subclavian vein. [NIH] Axons: Nerve fibers that are capable of rapidly conducting impulses away from the neuron cell body. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bacterial Physiology: Physiological processes and activities of bacteria. [NIH] Bactericidal: Substance lethal to bacteria; substance capable of killing bacteria. [NIH]

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Bacterium: Microscopic organism which may have a spherical, rod-like, or spiral unicellular or non-cellular body. Bacteria usually reproduce through asexual processes. [NIH] Barium: An element of the alkaline earth group of metals. It has an atomic symbol Ba, atomic number 56, and atomic weight 138. All of its acid-soluble salts are poisonous. [NIH] Barium swallow: A series of x-rays of the esophagus. The x-ray pictures are taken after the person drinks a solution that contains barium. The barium coats and outlines the esophagus on the x-ray. Also called an esophagram. [NIH] Basal Ganglia: Large subcortical nuclear masses derived from the telencephalon and located in the basal regions of the cerebral hemispheres. [NIH] Basal Ganglia Diseases: Diseases of the basal ganglia including the putamen; globus pallidus; claustrum; amygdala; and caudate nucleus. Dyskinesias (most notably involuntary movements and alterations of the rate of movement) represent the primary clinical manifestations of these disorders. Common etiologies include cerebrovascular disease; neurodegenerative diseases; and craniocerebral trauma. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]

Benztropine: A centrally active muscarinic antagonist that has been used in the symptomatic treatment of Parkinson's disease. Benztropine also inhibits the uptake of dopamine. [NIH] Bilateral: Affecting both the right and left side of body. [NIH] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Bile Acids: Acids made by the liver that work with bile to break down fats. [NIH] Bile duct: A tube through which bile passes in and out of the liver. [NIH] Bile Pigments: Pigments that give a characteristic color to bile including: bilirubin, biliverdine, and bilicyanin. [NIH] Biliary: Having to do with the liver, bile ducts, and/or gallbladder. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biological therapy: Treatment to stimulate or restore the ability of the immune system to fight infection and disease. Also used to lessen side effects that may be caused by some cancer treatments. Also known as immunotherapy, biotherapy, or biological response modifier (BRM) therapy. [NIH] Biomechanics: The study of the application of mechanical laws and the action of forces to living structures. [NIH] Biopsy: Removal and pathologic examination of specimens in the form of small pieces of tissue from the living body. [NIH] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning

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technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Biotin: Hexahydro-2-oxo-1H-thieno(3,4-d)imidazole-4-pentanoic acid. Growth factor present in minute amounts in every living cell. It occurs mainly bound to proteins or polypeptides and is abundant in liver, kidney, pancreas, yeast, and milk.The biotin content of cancerous tissue is higher than that of normal tissue. [NIH] Bladder: The organ that stores urine. [NIH] Bloating: Fullness or swelling in the abdomen that often occurs after meals. [NIH] Blood Coagulation: The process of the interaction of blood coagulation factors that results in an insoluble fibrin clot. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Blot: To transfer DNA, RNA, or proteins to an immobilizing matrix such as nitrocellulose. [NIH]

Body Fluids: Liquid components of living organisms. [NIH] Bolus: A single dose of drug usually injected into a blood vessel over a short period of time. Also called bolus infusion. [NIH] Bolus infusion: A single dose of drug usually injected into a blood vessel over a short period of time. Also called bolus. [NIH] Bone Marrow: The soft tissue filling the cavities of bones. Bone marrow exists in two types, yellow and red. Yellow marrow is found in the large cavities of large bones and consists mostly of fat cells and a few primitive blood cells. Red marrow is a hematopoietic tissue and is the site of production of erythrocytes and granular leukocytes. Bone marrow is made up of a framework of connective tissue containing branching fibers with the frame being filled with marrow cells. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Bowel Movement: Body wastes passed through the rectum and anus. [NIH] Brachytherapy: A collective term for interstitial, intracavity, and surface radiotherapy. It uses small sealed or partly-sealed sources that may be placed on or near the body surface or within a natural body cavity or implanted directly into the tissues. [NIH] Brain Infarction: The formation of an area of necrosis in the brain, including the cerebral hemispheres (cerebral infarction), thalami, basal ganglia, brain stem (brain stem infarctions), or cerebellum secondary to an insufficiency of arterial or venous blood flow. [NIH] Brain Stem: The part of the brain that connects the cerebral hemispheres with the spinal cord. It consists of the mesencephalon, pons, and medulla oblongata. [NIH] Brain Stem Infarctions: Infarctions that occur in the brain stem which is comprised of the midbrain, pons, and medulla. There are several named syndromes characterized by their distinctive clinical manifestations and specific sites of ischemic injury. [NIH] Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]

Bronchi: The larger air passages of the lungs arising from the terminal bifurcation of the

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trachea. [NIH] Buccal: Pertaining to or directed toward the cheek. In dental anatomy, used to refer to the buccal surface of a tooth. [EU] Buccopharyngeal: Pertaining to the mouth and pharynx. [EU] Bulbar: Pertaining to a bulb; pertaining to or involving the medulla oblongata, as bulbar paralysis. [EU] Bulimia: Episodic binge eating. The episodes may be associated with the fear of not being able to stop eating, depressed mood, or self-deprecating thoughts (binge-eating disorder) and may frequently be terminated by self-induced vomiting (bulimia nervosa). [NIH] Cachexia: General ill health, malnutrition, and weight loss, usually associated with chronic disease. [NIH] Calcification: Deposits of calcium in the tissues of the breast. Calcification in the breast can be seen on a mammogram, but cannot be detected by touch. There are two types of breast calcification, macrocalcification and microcalcification. Macrocalcifications are large deposits and are usually not related to cancer. Microcalcifications are specks of calcium that may be found in an area of rapidly dividing cells. Many microcalcifications clustered together may be a sign of cancer. [NIH] Calcinosis: Pathologic deposition of calcium salts in tissues. [NIH] Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] Candidiasis: Infection with a fungus of the genus Candida. It is usually a superficial infection of the moist cutaneous areas of the body, and is generally caused by C. albicans; it most commonly involves the skin (dermatocandidiasis), oral mucous membranes (thrush, def. 1), respiratory tract (bronchocandidiasis), and vagina (vaginitis). Rarely there is a systemic infection or endocarditis. Called also moniliasis, candidosis, oidiomycosis, and formerly blastodendriosis. [EU] Candidosis: An infection caused by an opportunistic yeasts that tends to proliferate and become pathologic when the environment is favorable and the host resistance is weakened. [NIH]

Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, polyand heterosaccharides. [EU] Carbon Dioxide: A colorless, odorless gas that can be formed by the body and is necessary for the respiration cycle of plants and animals. [NIH] Carcinogenic: Producing carcinoma. [EU] Carcinogens: Substances that increase the risk of neoplasms in humans or animals. Both genotoxic chemicals, which affect DNA directly, and nongenotoxic chemicals, which induce neoplasms by other mechanism, are included. [NIH] Carcinoma: Cancer that begins in the skin or in tissues that line or cover internal organs. [NIH]

Cardia: That part of the stomach surrounded by the esophagogastric junction, characterized

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by the lack of acid-forming cells. [NIH] Cardiac: Having to do with the heart. [NIH] Cardiopulmonary: Having to do with the heart and lungs. [NIH] Cardiopulmonary Resuscitation: The artificial substitution of heart and lung action as indicated for heart arrest resulting from electric shock, drowning, respiratory arrest, or other causes. The two major components of cardiopulmonary resuscitation are artificial ventilation and closed-chest cardiac massage. [NIH] Case report: A detailed report of the diagnosis, treatment, and follow-up of an individual patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin). [NIH] Case series: A group or series of case reports involving patients who were given similar treatment. Reports of case series usually contain detailed information about the individual patients. This includes demographic information (for example, age, gender, ethnic origin) and information on diagnosis, treatment, response to treatment, and follow-up after treatment. [NIH] Caudal: Denoting a position more toward the cauda, or tail, than some specified point of reference; same as inferior, in human anatomy. [EU] Causal: Pertaining to a cause; directed against a cause. [EU] Caustic: An escharotic or corrosive agent. Called also cauterant. [EU] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell Division: The fission of a cell. [NIH] Cell membrane: Cell membrane = plasma membrane. The structure enveloping a cell, enclosing the cytoplasm, and forming a selective permeability barrier; it consists of lipids, proteins, and some carbohydrates, the lipids thought to form a bilayer in which integral proteins are embedded to varying degrees. [EU] Cell Respiration: The metabolic process of all living cells (animal and plant) in which oxygen is used to provide a source of energy for the cell. [NIH] Cell Survival: The span of viability of a cell characterized by the capacity to perform certain functions such as metabolism, growth, reproduction, some form of responsiveness, and adaptability. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Central Nervous System Diseases: Diseases of any component of the brain (including the cerebral hemispheres, diencephalon, brain stem, and cerebellum) or the spinal cord. [NIH] Central Nervous System Infections: Pathogenic infections of the brain, spinal cord, and meninges. DNA virus infections; RNA virus infections; bacterial infections; mycoplasma infections; Spirochaetales infections; fungal infections; protozoan infections; helminthiasis; and prion diseases may involve the central nervous system as a primary or secondary process. [NIH] Cerebellar: Pertaining to the cerebellum. [EU] Cerebellum: Part of the metencephalon that lies in the posterior cranial fossa behind the brain stem. It is concerned with the coordination of movement. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebral Cortex: The thin layer of gray matter on the surface of the cerebral hemisphere that

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develops from the telencephalon and folds into gyri. It reaches its highest development in man and is responsible for intellectual faculties and higher mental functions. [NIH] Cerebral hemispheres: The two halves of the cerebrum, the part of the brain that controls muscle functions of the body and also controls speech, emotions, reading, writing, and learning. The right hemisphere controls muscle movement on the left side of the body, and the left hemisphere controls muscle movement on the right side of the body. [NIH] Cerebral Palsy: Refers to a motor disability caused by a brain dysfunction. [NIH] Cerebrovascular: Pertaining to the blood vessels of the cerebrum, or brain. [EU] Cerebrum: The largest part of the brain. It is divided into two hemispheres, or halves, called the cerebral hemispheres. The cerebrum controls muscle functions of the body and also controls speech, emotions, reading, writing, and learning. [NIH] Cervical: Relating to the neck, or to the neck of any organ or structure. Cervical lymph nodes are located in the neck; cervical cancer refers to cancer of the uterine cervix, which is the lower, narrow end (the "neck") of the uterus. [NIH] Cervix: The lower, narrow end of the uterus that forms a canal between the uterus and vagina. [NIH] Character: In current usage, approximately equivalent to personality. The sum of the relatively fixed personality traits and habitual modes of response of an individual. [NIH] Chest Pain: Pressure, burning, or numbness in the chest. [NIH] Chin: The anatomical frontal portion of the mandible, also known as the mentum, that contains the line of fusion of the two separate halves of the mandible (symphysis menti). This line of fusion divides inferiorly to enclose a triangular area called the mental protuberance. On each side, inferior to the second premolar tooth, is the mental foramen for the passage of blood vessels and a nerve. [NIH] Choanal Atresia: Congenital bony or membranous occlusion of one or both choanae, due to failure of the embryonic bucconasal membrane to rupture. [NIH] Choline: A basic constituent of lecithin that is found in many plants and animal organs. It is important as a precursor of acetylcholine, as a methyl donor in various metabolic processes, and in lipid metabolism. [NIH] Cholinergic: Resembling acetylcholine in pharmacological action; stimulated by or releasing acetylcholine or a related compound. [EU] Cholinesterase Inhibitors: Drugs that inhibit cholinesterases. The neurotransmitter acetylcholine is rapidly hydrolyzed, and thereby inactivated, by cholinesterases. When cholinesterases are inhibited, the action of endogenously released acetylcholine at cholinergic synapses is potentiated. Cholinesterase inhibitors are widely used clinically for their potentiation of cholinergic inputs to the gastrointestinal tract and urinary bladder, the eye, and skeletal muscles; they are also used for their effects on the heart and the central nervous system. [NIH] Chromosome: Part of a cell that contains genetic information. Except for sperm and eggs, all human cells contain 46 chromosomes. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Chronic Disease: Disease or ailment of long duration. [NIH] Chronic renal: Slow and progressive loss of kidney function over several years, often resulting in end-stage renal disease. People with end-stage renal disease need dialysis or transplantation to replace the work of the kidneys. [NIH] Cisplatin: An inorganic and water-soluble platinum complex. After undergoing hydrolysis,

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it reacts with DNA to produce both intra and interstrand crosslinks. These crosslinks appear to impair replication and transcription of DNA. The cytotoxicity of cisplatin correlates with cellular arrest in the G2 phase of the cell cycle. [NIH] Citric Acid: A key intermediate in metabolism. It is an acid compound found in citrus fruits. The salts of citric acid (citrates) can be used as anticoagulants due to their calcium chelating ability. [NIH] Citrus: Any tree or shrub of the Rue family or the fruit of these plants. [NIH] Cleft Lip: Congenital defect in the upper lip where the maxillary prominence fails to merge with the merged medial nasal prominences. It is thought to be caused by faulty migration of the mesoderm in the head region. [NIH] Cleft Palate: Congenital fissure of the soft and/or hard palate, due to faulty fusion. [NIH] Clinical Medicine: The study and practice of medicine by direct examination of the patient. [NIH]

Clinical study: A research study in which patients receive treatment in a clinic or other medical facility. Reports of clinical studies can contain results for single patients (case reports) or many patients (case series or clinical trials). [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Coagulation: 1. The process of clot formation. 2. In colloid chemistry, the solidification of a sol into a gelatinous mass; an alteration of a disperse phase or of a dissolved solid which causes the separation of the system into a liquid phase and an insoluble mass called the clot or curd. Coagulation is usually irreversible. 3. In surgery, the disruption of tissue by physical means to form an amorphous residuum, as in electrocoagulation and photocoagulation. [EU] Codeine: An opioid analgesic related to morphine but with less potent analgesic properties and mild sedative effects. It also acts centrally to suppress cough. [NIH] Cofactor: A substance, microorganism or environmental factor that activates or enhances the action of another entity such as a disease-causing agent. [NIH] Cognition: Intellectual or mental process whereby an organism becomes aware of or obtains knowledge. [NIH] Colon: The long, coiled, tubelike organ that removes water from digested food. The remaining material, solid waste called stool, moves through the colon to the rectum and leaves the body through the anus. [NIH] Communication Disorders: Disorders of verbal and nonverbal communication caused by receptive or expressive language disorders, cognitive dysfunction (e.g., mental retardation), psychiatric conditions, and hearing disorders. [NIH] Competency: The capacity of the bacterium to take up DNA from its surroundings. [NIH] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols

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C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Compliance: Distensibility measure of a chamber such as the lungs (lung compliance) or bladder. Compliance is expressed as a change in volume per unit change in pressure. [NIH] Compress: A plug used to occludate an orifice in the control of bleeding, or to mop up secretions; an absorbent pad. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue Cells: A group of cells that includes fibroblasts, cartilage cells, adipocytes, smooth muscle cells, and bone cells. [NIH] Consciousness: Sense of awareness of self and of the environment. [NIH] Constipation: Infrequent or difficult evacuation of feces. [NIH] Constitutional: 1. Affecting the whole constitution of the body; not local. 2. Pertaining to the constitution. [EU] Constriction: The act of constricting. [NIH] Consultation: A deliberation between two or more physicians concerning the diagnosis and

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the proper method of treatment in a case. [NIH] Consumption: Pulmonary tuberculosis. [NIH] Continuum: An area over which the vegetation or animal population is of constantly changing composition so that homogeneous, separate communities cannot be distinguished. [NIH]

Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Control group: In a clinical trial, the group that does not receive the new treatment being studied. This group is compared to the group that receives the new treatment, to see if the new treatment works. [NIH] Conventional therapy: A currently accepted and widely used treatment for a certain type of disease, based on the results of past research. Also called conventional treatment. [NIH] Conventional treatment: A currently accepted and widely used treatment for a certain type of disease, based on the results of past research. Also called conventional therapy. [NIH] Coordination: Muscular or motor regulation or the harmonious cooperation of muscles or groups of muscles, in a complex action or series of actions. [NIH] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Corpus: The body of the uterus. [NIH] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Cortical: Pertaining to or of the nature of a cortex or bark. [EU] Corticosteroid: Any of the steroids elaborated by the adrenal cortex (excluding the sex hormones of adrenal origin) in response to the release of corticotrophin (adrenocorticotropic hormone) by the pituitary gland, to any of the synthetic equivalents of these steroids, or to angiotensin II. They are divided, according to their predominant biological activity, into three major groups: glucocorticoids, chiefly influencing carbohydrate, fat, and protein metabolism; mineralocorticoids, affecting the regulation of electrolyte and water balance; and C19 androgens. Some corticosteroids exhibit both types of activity in varying degrees, and others exert only one type of effect. The corticosteroids are used clinically for hormonal replacement therapy, for suppression of ACTH secretion by the anterior pituitary, as antineoplastic, antiallergic, and anti-inflammatory agents, and to suppress the immune response. Called also adrenocortical hormone and corticoid. [EU] Cranial: Pertaining to the cranium, or to the anterior (in animals) or superior (in humans) end of the body. [EU] Cranial Nerves: Twelve pairs of nerves that carry general afferent, visceral afferent, special afferent, somatic efferent, and autonomic efferent fibers. [NIH] Craniocerebral Trauma: Traumatic injuries involving the cranium and intracranial structures (i.e., brain; cranial nerves; meninges; and other structures). Injuries may be classified by whether or not the skull is penetrated (i.e., penetrating vs. nonpenetrating) or whether there is an associated hemorrhage. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Cutaneous: Having to do with the skin. [NIH]

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Cyst: A sac or capsule filled with fluid. [NIH] Cytotoxic: Cell-killing. [NIH] Cytotoxicity: Quality of being capable of producing a specific toxic action upon cells of special organs. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Deglutition: The process or the act of swallowing. [NIH] Dehydration: The condition that results from excessive loss of body water. [NIH] Dementia: An acquired organic mental disorder with loss of intellectual abilities of sufficient severity to interfere with social or occupational functioning. The dysfunction is multifaceted and involves memory, behavior, personality, judgment, attention, spatial relations, language, abstract thought, and other executive functions. The intellectual decline is usually progressive, and initially spares the level of consciousness. [NIH] Dendrites: Extensions of the nerve cell body. They are short and branched and receive stimuli from other neurons. [NIH] Density: The logarithm to the base 10 of the opacity of an exposed and processed film. [NIH] Dental Care: The total of dental diagnostic, preventive, and restorative services provided to meet the needs of a patient (from Illustrated Dictionary of Dentistry, 1982). [NIH] Depressive Disorder: An affective disorder manifested by either a dysphoric mood or loss of interest or pleasure in usual activities. The mood disturbance is prominent and relatively persistent. [NIH] Dextromethorphan: The d-isomer of the codeine analog of levorphanol. Dextromethorphan shows high affinity binding to several regions of the brain, including the medullary cough center. This compound is a NMDA receptor antagonist (receptors, N-methyl-D-aspartate) and acts as a non-competitive channel blocker. It is used widely as an antitussive agent, and is also used to study the involvement of glutamate receptors in neurotoxicity. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Diastolic: Of or pertaining to the diastole. [EU] Diathesis: A constitution or condition of the body which makes the tissues react in special ways to certain extrinsic stimuli and thus tends to make the person more than usually susceptible to certain diseases. [EU] Diencephalon: The paired caudal parts of the prosencephalon from which the thalamus, hypothalamus, epithalamus, and subthalamus are derived. [NIH] Dietitian: An expert in nutrition who helps people plan what and how much food to eat. [NIH]

Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Digestive system: The organs that take in food and turn it into products that the body can use to stay healthy. Waste products the body cannot use leave the body through bowel movements. The digestive system includes the salivary glands, mouth, esophagus, stomach, liver, pancreas, gallbladder, small and large intestines, and rectum. [NIH] Digestive tract: The organs through which food passes when food is eaten. These organs are the mouth, esophagus, stomach, small and large intestines, and rectum. [NIH] Dilatation: The act of dilating. [NIH] Dilation: A process by which the pupil is temporarily enlarged with special eye drops

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(mydriatic); allows the eye care specialist to better view the inside of the eye. [NIH] Dilator: A device used to stretch or enlarge an opening. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Discrete: Made up of separate parts or characterized by lesions which do not become blended; not running together; separate. [NIH] Disease Progression: The worsening of a disease over time. This concept is most often used for chronic and incurable diseases where the stage of the disease is an important determinant of therapy and prognosis. [NIH] Disinfectant: An agent that disinfects; applied particularly to agents used on inanimate objects. [EU] Diskectomy: Excision, in part or whole, of an intervertebral disk. The most common indication is disk displacement or herniation. In addition to standard surgical removal, it can be performed by percutaneous diskectomy or by laparoscopic diskectomy, the former being the more common. [NIH] Dissection: Cutting up of an organism for study. [NIH] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Diverticula: Plural form of diverticulum. [NIH] Diverticulum: A pathological condition manifested as a pouch or sac opening from a tubular or sacular organ. [NIH] Dizziness: An imprecise term which may refer to a sense of spatial disorientation, motion of the environment, or lightheadedness. [NIH] Donepezil: A drug used in the treatment of Alzheimer's disease. It belongs to the family of drugs called cholinesterase inhibitors. It is being studied as a treatment for side effects caused by radiation therapy to the brain. [NIH] Dopamine: An endogenous catecholamine and prominent neurotransmitter in several systems of the brain. In the synthesis of catecholamines from tyrosine, it is the immediate precursor to norepinephrine and epinephrine. Dopamine is a major transmitter in the extrapyramidal system of the brain, and important in regulating movement. A family of dopaminergic receptor subtypes mediate its action. Dopamine is used pharmacologically for its direct (beta adrenergic agonist) and indirect (adrenergic releasing) sympathomimetic effects including its actions as an inotropic agent and as a renal vasodilator. [NIH] Dorsal: 1. Pertaining to the back or to any dorsum. 2. Denoting a position more toward the back surface than some other object of reference; same as posterior in human anatomy; superior in the anatomy of quadrupeds. [EU] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Duct: A tube through which body fluids pass. [NIH] Duodenum: The first part of the small intestine. [NIH] Dysarthria: Imperfect articulation of speech due to disturbances of muscular control which result from damage to the central or peripheral nervous system. [EU] Dyskinesia: Impairment of the power of voluntary movement, resulting in fragmentary or incomplete movements. [EU] Dyspepsia: Impaired digestion, especially after eating. [NIH]

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Dysphagia: Difficulty in swallowing. [EU] Dysphonia: Difficulty or pain in speaking; impairment of the voice. [NIH] Dysphoric: A feeling of unpleasantness and discomfort. [NIH] Dysplasia: Cells that look abnormal under a microscope but are not cancer. [NIH] Dyspnea: Difficult or labored breathing. [NIH] Dystonia: Disordered tonicity of muscle. [EU] Dystrophic: Pertaining to toxic habitats low in nutrients. [NIH] Dystrophy: Any disorder arising from defective or faulty nutrition, especially the muscular dystrophies. [EU] Echocardiography: Ultrasonic recording of the size, motion, and composition of the heart and surrounding tissues. The standard approach is transthoracic. [NIH] Ectopic: Pertaining to or characterized by ectopia. [EU] Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [NIH] Effector: It is often an enzyme that converts an inactive precursor molecule into an active second messenger. [NIH] Efferent: Nerve fibers which conduct impulses from the central nervous system to muscles and glands. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Elastic: Susceptible of resisting and recovering from stretching, compression or distortion applied by a force. [EU] Elasticity: Resistance and recovery from distortion of shape. [NIH] Electric shock: A dangerous patho-physiological effect resulting from an electric current passing through the body of a human or animal. [NIH] Electrode: Component of the pacing system which is at the distal end of the lead. It is the interface with living cardiac tissue across which the stimulus is transmitted. [NIH] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Electromyography: Recording of the changes in electric potential of muscle by means of surface or needle electrodes. [NIH] Electrophoresis: An electrochemical process in which macromolecules or colloidal particles with a net electric charge migrate in a solution under the influence of an electric current. [NIH]

Electrophysiological: Pertaining to electrophysiology, that is a branch of physiology that is concerned with the electric phenomena associated with living bodies and involved in their functional activity. [EU] Embolus: Bit of foreign matter which enters the blood stream at one point and is carried until it is lodged or impacted in an artery and obstructs it. It may be a blood clot, an air bubble, fat or other tissue, or clumps of bacteria. [NIH] Encephalitis: Inflammation of the brain due to infection, autoimmune processes, toxins, and other conditions. Viral infections (see encephalitis, viral) are a relatively frequent cause of this condition. [NIH]

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Encephalitis, Viral: Inflammation of brain parenchymal tissue as a result of viral infection. Encephalitis may occur as primary or secondary manifestation of Togaviridae infections; Herpesviridae infections; Adenoviridae infections; Flaviviridae infections; Bunyaviridae infections; Picornaviridae infections; Paramyxoviridae infections; Orthomyxoviridae infections; Retroviridae infections; and Arenaviridae infections. [NIH] Encephalopathy: A disorder of the brain that can be caused by disease, injury, drugs, or chemicals. [NIH] Endocarditis: Exudative and proliferative inflammatory alterations of the endocardium, characterized by the presence of vegetations on the surface of the endocardium or in the endocardium itself, and most commonly involving a heart valve, but sometimes affecting the inner lining of the cardiac chambers or the endocardium elsewhere. It may occur as a primary disorder or as a complication of or in association with another disease. [EU] Endogenous: Produced inside an organism or cell. The opposite is external (exogenous) production. [NIH] Endoscope: A thin, lighted tube used to look at tissues inside the body. [NIH] Endoscopic: A technique where a lateral-view endoscope is passed orally to the duodenum for visualization of the ampulla of Vater. [NIH] Endoscopy: Endoscopic examination, therapy or surgery performed on interior parts of the body. [NIH] End-stage renal: Total chronic kidney failure. When the kidneys fail, the body retains fluid and harmful wastes build up. A person with ESRD needs treatment to replace the work of the failed kidneys. [NIH] Energetic: Exhibiting energy : strenuous; operating with force, vigour, or effect. [EU] Environmental Exposure: The exposure to potentially harmful chemical, physical, or biological agents in the environment or to environmental factors that may include ionizing radiation, pathogenic organisms, or toxic chemicals. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]

Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Eosinophilic: A condition found primarily in grinding workers caused by a reaction of the pulmonary tissue, in particular the eosinophilic cells, to dust that has entered the lung. [NIH] Epidermal: Pertaining to or resembling epidermis. Called also epidermic or epidermoid. [EU] Epidermolysis Bullosa: Group of genetically determined disorders characterized by the blistering of skin and mucosae. There are four major forms: acquired, simple, junctional, and dystrophic. Each of the latter three has several varieties. [NIH] Epigastric: Having to do with the upper middle area of the abdomen. [NIH] Epiglottis: Thin leaf-shaped cartilage, covered with mucous membrane, at the root of the tongue, which folds back over the entrance to the larynx, covering it, during the act of swallowing. [NIH] Epinephrine: The active sympathomimetic hormone from the adrenal medulla in most species. It stimulates both the alpha- and beta- adrenergic systems, causes systemic vasoconstriction and gastrointestinal relaxation, stimulates the heart, and dilates bronchi and cerebral vessels. It is used in asthma and cardiac failure and to delay absorption of local anesthetics. [NIH]

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Epithelial: Refers to the cells that line the internal and external surfaces of the body. [NIH] Epithelium: One or more layers of epithelial cells, supported by the basal lamina, which covers the inner or outer surfaces of the body. [NIH] Equipment and Supplies: Expendable and nonexpendable equipment, supplies, apparatus, and instruments that are used in diagnostic, surgical, therapeutic, scientific, and experimental procedures. [NIH] Erectile: The inability to get or maintain an erection for satisfactory sexual intercourse. Also called impotence. [NIH] Erection: The condition of being made rigid and elevated; as erectile tissue when filled with blood. [EU] Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH] Esophageal: Having to do with the esophagus, the muscular tube through which food passes from the throat to the stomach. [NIH] Esophageal Manometry: A test to measure muscle tone inthe esophagus. [NIH] Esophageal Spasms: Muscle cramps in the esophagus that cause pain in the chest. [NIH] Esophageal Stricture: A narrowing of the esophagus often caused by acid flowing back from the stomach. This condition may require surgery. [NIH] Esophagitis: Inflammation, acute or chronic, of the esophagus caused by bacteria, chemicals, or trauma. [NIH] Esophagram: A series of x-rays of the esophagus. The x-ray pictures are taken after the person drinks a solution that contains barium. The barium coats and outlines the esophagus on the x-ray. Also called a barium swallow. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]

Essential Tremor: A rhythmic, involuntary, purposeless, oscillating movement resulting from the alternate contraction and relaxation of opposing groups of muscles. [NIH] Ethanol: A clear, colorless liquid rapidly absorbed from the gastrointestinal tract and distributed throughout the body. It has bactericidal activity and is used often as a topical disinfectant. It is widely used as a solvent and preservative in pharmaceutical preparations as well as serving as the primary ingredient in alcoholic beverages. [NIH] Evoke: The electric response recorded from the cerebral cortex after stimulation of a peripheral sense organ. [NIH] Excitation: An act of irritation or stimulation or of responding to a stimulus; the addition of energy, as the excitation of a molecule by absorption of photons. [EU] Excitatory: When cortical neurons are excited, their output increases and each new input they receive while they are still excited raises their output markedly. [NIH] Excitotoxicity: Excessive exposure to glutamate or related compounds can kill brain neurons, presumably by overstimulating them. [NIH] Exocrine: Secreting outwardly, via a duct. [EU] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Expert Systems: Computer programs based on knowledge developed from consultation with experts on a problem, and the processing and/or formalizing of this knowledge using these programs in such a manner that the problems may be solved. [NIH] Expiration: The act of breathing out, or expelling air from the lungs. [EU]

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Expiratory: The volume of air which leaves the breathing organs in each expiration. [NIH] External-beam radiation: Radiation therapy that uses a machine to aim high-energy rays at the cancer. Also called external radiation. [NIH] Extracellular: Outside a cell or cells. [EU] Extracellular Matrix: A meshwork-like substance found within the extracellular space and in association with the basement membrane of the cell surface. It promotes cellular proliferation and provides a supporting structure to which cells or cell lysates in culture dishes adhere. [NIH] Extrapyramidal: Outside of the pyramidal tracts. [EU] Failure to Thrive: A condition in which an infant or child's weight gain and growth are far below usual levels for age. [NIH] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Family Practice: A medical specialty concerned with the provision of continuing, comprehensive primary health care for the entire family. [NIH] Fat: Total lipids including phospholipids. [NIH] Feeding Behavior: Behavioral responses or sequences associated with eating including modes of feeding, rhythmic patterns of eating, and time intervals. [NIH] Fibroid: A benign smooth muscle tumor, usually in the uterus or gastrointestinal tract. Also called leiomyoma. [NIH] Fibrosis: Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. [NIH] Fissure: Any cleft or groove, normal or otherwise; especially a deep fold in the cerebral cortex which involves the entire thickness of the brain wall. [EU] Fistula: Abnormal communication most commonly seen between two internal organs, or between an internal organ and the surface of the body. [NIH] Fluid Therapy: Therapy whose basic objective is to restore the volume and composition of the body fluids to normal with respect to water-electrolyte balance. Fluids may be administered intravenously, orally, by intermittent gavage, or by hypodermoclysis. [NIH] Fluoroscopy: Production of an image when X-rays strike a fluorescent screen. [NIH] Fold: A plication or doubling of various parts of the body. [NIH] Foramen: A natural hole of perforation, especially one in a bone. [NIH] Forearm: The part between the elbow and the wrist. [NIH] Functional Disorders: Disorders such as irritable bowel syndrome. These conditions result from poor nerve and muscle function. Symptoms such as gas, pain, constipation, and diarrhea come back again and again, but there are no signs of disease or damage. Emotional stress can trigger symptoms. Also called motility disorders. [NIH] Fungi: A kingdom of eukaryotic, heterotrophic organisms that live as saprobes or parasites, including mushrooms, yeasts, smuts, molds, etc. They reproduce either sexually or asexually, and have life cycles that range from simple to complex. Filamentous fungi refer to those that grow as multicelluar colonies (mushrooms and molds). [NIH] Fungus: A general term used to denote a group of eukaryotic protists, including mushrooms, yeasts, rusts, moulds, smuts, etc., which are characterized by the absence of chlorophyll and by the presence of a rigid cell wall composed of chitin, mannans, and sometimes cellulose. They are usually of simple morphological form or show some

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reversible cellular specialization, such as the formation of pseudoparenchymatous tissue in the fruiting body of a mushroom. The dimorphic fungi grow, according to environmental conditions, as moulds or yeasts. [EU] Fuzzy Logic: Approximate, quantitative reasoning that is concerned with the linguistic ambiguity which exists in natural or synthetic language. At its core are variables such as good, bad, and young as well as modifiers such as more, less, and very. These ordinary terms represent fuzzy sets in a particular problem. Fuzzy logic plays a key role in many medical expert systems. [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Gamma Rays: Very powerful and penetrating, high-energy electromagnetic radiation of shorter wavelength than that of x-rays. They are emitted by a decaying nucleus, usually between 0.01 and 10 MeV. They are also called nuclear x-rays. [NIH] Ganglia: Clusters of multipolar neurons surrounded by a capsule of loosely organized connective tissue located outside the central nervous system. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gas exchange: Primary function of the lungs; transfer of oxygen from inhaled air into the blood and of carbon dioxide from the blood into the lungs. [NIH] Gastric: Having to do with the stomach. [NIH] Gastric Emptying: The evacuation of food from the stomach into the duodenum. [NIH] Gastric Juices: Liquids produced in the stomach to help break down food and kill bacteria. [NIH]

Gastroenterologist: A doctor who specializes in diagnosing and treating disorders of the digestive system. [NIH] Gastroenterology: A subspecialty of internal medicine concerned with the study of the physiology and diseases of the digestive system and related structures (esophagus, liver, gallbladder, and pancreas). [NIH] Gastroesophageal Reflux: Reflux of gastric juice and/or duodenal contents (bile acids, pancreatic juice) into the distal esophagus, commonly due to incompetence of the lower esophageal sphincter. Gastric regurgitation is an extension of this process with entry of fluid into the pharynx or mouth. [NIH] Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrointestinal stromal tumor: GIST. A type of tumor that usually begins in cells in the wall of the gastrointestinal tract. It can be benign or malignant. [NIH] Gastrointestinal tract: The stomach and intestines. [NIH] Gastroparesis: Nerve or muscle damage in the stomach. Causes slow digestion and emptying, vomiting, nausea, or bloating. Also called delayed gastric emptying. [NIH] Gastrostomy: Creation of an artificial external opening into the stomach for nutritional support or gastrointestinal compression. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

Gene Expression: The phenotypic manifestation of a gene or genes by the processes of gene action. [NIH] Gene Therapy: The introduction of new genes into cells for the purpose of treating disease

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by restoring or adding gene expression. Techniques include insertion of retroviral vectors, transfection, homologous recombination, and injection of new genes into the nuclei of single cell embryos. The entire gene therapy process may consist of multiple steps. The new genes may be introduced into proliferating cells in vivo (e.g., bone marrow) or in vitro (e.g., fibroblast cultures) and the modified cells transferred to the site where the gene expression is required. Gene therapy may be particularly useful for treating enzyme deficiency diseases, hemoglobinopathies, and leukemias and may also prove useful in restoring drug sensitivity, particularly for leukemia. [NIH] Generator: Any system incorporating a fixed parent radionuclide from which is produced a daughter radionuclide which is to be removed by elution or by any other method and used in a radiopharmaceutical. [NIH] Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Germline mutation: A gene change in the body's reproductive cells (egg or sperm) that becomes incorporated into the DNA of every cell in the body of offspring; germline mutations are passed on from parents to offspring. Also called hereditary mutation. [NIH] Gestational: Psychosis attributable to or occurring during pregnancy. [NIH] Gestational Age: Age of the conceptus. In humans, this may be assessed by medical history, physical examination, early immunologic pregnancy tests, radiography, ultrasonography, and amniotic fluid analysis. [NIH] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Globus Sensation: A constant feeling of a lump in the throat. Usually related to stress. [NIH] Glottis: The vocal apparatus of the larynx, consisting of the true vocal cords (plica vocalis) and the opening between them (rima glottidis). [NIH] Glucocorticoids: A group of corticosteroids that affect carbohydrate metabolism (gluconeogenesis, liver glycogen deposition, elevation of blood sugar), inhibit corticotropin secretion, and possess pronounced anti-inflammatory activity. They also play a role in fat and protein metabolism, maintenance of arterial blood pressure, alteration of the connective tissue response to injury, reduction in the number of circulating lymphocytes, and functioning of the central nervous system. [NIH] Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Glutamate: Excitatory neurotransmitter of the brain. [NIH] Gluten: The protein of wheat and other grains which gives to the dough its tough elastic character. [EU] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Graft: Healthy skin, bone, or other tissue taken from one part of the body and used to replace diseased or injured tissue removed from another part of the body. [NIH] Grafting: The operation of transfer of tissue from one site to another. [NIH] Gravis: Eruption of watery blisters on the skin among those handling animals and animal products. [NIH] Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH]

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Growth factors: Substances made by the body that function to regulate cell division and cell survival. Some growth factors are also produced in the laboratory and used in biological therapy. [NIH] Haematoma: A localized collection of blood, usually clotted, in an organ, space, or tissue, due to a break in the wall of a blood vessel. [EU] Haematuria: Blood in the urine. [EU] Haemodialysis: The removal of certain elements from the blood by virtue of the difference in the rates of their diffusion through a semipermeable membrane, e.g., by means of a haemodialyzer. [EU] Haemophilia: A haemorrhagic diathesis occurring in two main forms: 1. Haemophilia A (classic haemophilia, factor VIII deficiency), an X-linked disorder due to deficiency of coagulation factor VIII; 2. Haemophilia B (factor IX deficiency, Christmas disease), also Xlinked, due to deficiency of coagulation factor IX. Both forms are determined by a mutant gene near the telomere of the long arm of the X chromosome (Xq), but a different loci, and are characterized by subcutaneous and intramuscular haemorrhages; bleeding from the mouth, gums, lips, and tongue; haematuria; and haemarthroses. [EU] Headache: Pain in the cranial region that may occur as an isolated and benign symptom or as a manifestation of a wide variety of conditions including subarachnoid hemorrhage; craniocerebral trauma; central nervous system infections; intracranial hypertension; and other disorders. In general, recurrent headaches that are not associated with a primary disease process are referred to as headache disorders (e.g., migraine). [NIH] Headache Disorders: Common conditions characterized by persistent or recurrent headaches. Headache syndrome classification systems may be based on etiology (e.g., vascular headache, post-traumatic headaches, etc.), temporal pattern (e.g., cluster headache, paroxysmal hemicrania, etc.), and precipitating factors (e.g., cough headache). [NIH] Health Status: The level of health of the individual, group, or population as subjectively assessed by the individual or by more objective measures. [NIH] Hearing Disorders: Conditions that impair the transmission or perception of auditory impulses and information from the level of the ear to the temporal cortices, including the sensorineural pathways. [NIH] Heart Arrest: Sudden and usually momentary cessation of the heart beat. This sudden cessation may, but not usually, lead to death, sudden, cardiac. [NIH] Heartburn: Substernal pain or burning sensation, usually associated with regurgitation of gastric juice into the esophagus. [NIH] Hematoma: An extravasation of blood localized in an organ, space, or tissue. [NIH] Hemoglobin: One of the fractions of glycosylated hemoglobin A1c. Glycosylated hemoglobin is formed when linkages of glucose and related monosaccharides bind to hemoglobin A and its concentration represents the average blood glucose level over the previous several weeks. HbA1c levels are used as a measure of long-term control of plasma glucose (normal, 4 to 6 percent). In controlled diabetes mellitus, the concentration of glycosylated hemoglobin A is within the normal range, but in uncontrolled cases the level may be 3 to 4 times the normal conentration. Generally, complications are substantially lower among patients with Hb levels of 7 percent or less than in patients with HbA1c levels of 9 percent or more. [NIH] Hemoglobinopathies: A group of inherited disorders characterized by structural alterations within the hemoglobin molecule. [NIH] Hemoglobinuria: The presence of free hemoglobin in the urine. [NIH]

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Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hemorrhagic stroke: A disorder involving bleeding within ischemic brain tissue. Hemorrhagic stroke occurs when blood vessels that are damaged or dead from lack of blood supply (infarcted), located within an area of infarcted brain tissue, rupture and transform an "ischemic" stroke into a hemorrhagic stroke. Ischemia is inadequate tissue oxygenation caused by reduced blood flow; infarction is tissue death resulting from ischemia. Bleeding irritates the brain tissues, causing swelling (cerebral edema). Blood collects into a mass (hematoma). Both swelling and hematoma will compress and displace brain tissue. [NIH] Hereditary: Of, relating to, or denoting factors that can be transmitted genetically from one generation to another. [NIH] Hereditary mutation: A gene change in the body's reproductive cells (egg or sperm) that becomes incorporated into the DNA of every cell in the body of offspring; hereditary mutations are passed on from parents to offspring. Also called germline mutation. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Hoarseness: An unnaturally deep or rough quality of voice. [NIH] Homogeneous: Consisting of or composed of similar elements or ingredients; of a uniform quality throughout. [EU] Homologous: Corresponding in structure, position, origin, etc., as (a) the feathers of a bird and the scales of a fish, (b) antigen and its specific antibody, (c) allelic chromosomes. [EU] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Hospice: Institution dedicated to caring for the terminally ill. [NIH] Host: Any animal that receives a transplanted graft. [NIH] Hybrid: Cross fertilization between two varieties or, more usually, two species of vines, see also crossing. [NIH] Hybridization: The genetic process of crossbreeding to produce a hybrid. Hybrid nucleic acids can be formed by nucleic acid hybridization of DNA and RNA molecules. Protein hybridization allows for hybrid proteins to be formed from polypeptide chains. [NIH] Hydration: Combining with water. [NIH] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hydrolysis: The process of cleaving a chemical compound by the addition of a molecule of water. [NIH] Hyperbilirubinemia: Pathologic process consisting of an abnormal increase in the amount of bilirubin in the circulating blood, which may result in jaundice. [NIH] Hyperostosis: Increase in the mass of bone per unit volume. [NIH] Hyperreflexia: Exaggeration of reflexes. [EU] Hypersensitivity: Altered reactivity to an antigen, which can result in pathologic reactions upon subsequent exposure to that particular antigen. [NIH]

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Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hypopharynx: The portion of the pharynx between the inferior portion of the oropharynx and the larynx. [NIH] Hypothalamus: Ventral part of the diencephalon extending from the region of the optic chiasm to the caudal border of the mammillary bodies and forming the inferior and lateral walls of the third ventricle. [NIH] Id: The part of the personality structure which harbors the unconscious instinctive desires and strivings of the individual. [NIH] Idiopathic: Describes a disease of unknown cause. [NIH] Ileus: Obstruction of the intestines. [EU] Immune response: The activity of the immune system against foreign substances (antigens). [NIH]

Immunodeficiency: The decreased ability of the body to fight infection and disease. [NIH] Immunodiffusion: Technique involving the diffusion of antigen or antibody through a semisolid medium, usually agar or agarose gel, with the result being a precipitin reaction. [NIH]

Immunoelectrophoresis: A technique that combines protein electrophoresis and double immunodiffusion. In this procedure proteins are first separated by gel electrophoresis (usually agarose), then made visible by immunodiffusion of specific antibodies. A distinct elliptical precipitin arc results for each protein detectable by the antisera. [NIH] Immunofluorescence: A technique for identifying molecules present on the surfaces of cells or in tissues using a highly fluorescent substance coupled to a specific antibody. [NIH] Immunoglobulin: A protein that acts as an antibody. [NIH] Immunohistochemistry: Histochemical localization of immunoreactive substances using labeled antibodies as reagents. [NIH] Immunologic: The ability of the antibody-forming system to recall a previous experience with an antigen and to respond to a second exposure with the prompt production of large amounts of antibody. [NIH] Impaction: The trapping of an object in a body passage. Examples are stones in the bile duct or hardened stool in the colon. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] Implant radiation: A procedure in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near the tumor. Also called [NIH] Impotence: The inability to perform sexual intercourse. [NIH] In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Incision: A cut made in the body during surgery. [NIH] Incompetence: Physical or mental inadequacy or insufficiency. [EU] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Infancy: The period of complete dependency prior to the acquisition of competence in walking, talking, and self-feeding. [NIH] Infant, Newborn: An infant during the first month after birth. [NIH]

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Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]

Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Infusion: A method of putting fluids, including drugs, into the bloodstream. Also called intravenous infusion. [NIH] Ingestion: Taking into the body by mouth [NIH] Inhalation: The drawing of air or other substances into the lungs. [EU] Initiation: Mutation induced by a chemical reactive substance causing cell changes; being a step in a carcinogenic process. [NIH] Innervation: 1. The distribution or supply of nerves to a part. 2. The supply of nervous energy or of nerve stimulus sent to a part. [EU] Inorganic: Pertaining to substances not of organic origin. [EU] Inpatients: Persons admitted to health facilities which provide board and room, for the purpose of observation, care, diagnosis or treatment. [NIH] Insight: The capacity to understand one's own motives, to be aware of one's own psychodynamics, to appreciate the meaning of symbolic behavior. [NIH] Institutionalization: The caring for individuals in institutions and their adaptation to routines characteristic of the institutional environment, and/or their loss of adaptation to life outside the institution. [NIH] Insufflation: The act of blowing a powder, vapor, or gas into any body cavity for experimental, diagnostic, or therapeutic purposes. [NIH] Insulator: Material covering the metal conductor of the lead. It is usually polyurethane or silicone. [NIH] Intensive Care: Advanced and highly specialized care provided to medical or surgical patients whose conditions are life-threatening and require comprehensive care and constant monitoring. It is usually administered in specially equipped units of a health care facility. [NIH]

Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Internal Medicine: A medical specialty concerned with the diagnosis and treatment of diseases of the internal organ systems of adults. [NIH] Internal radiation: A procedure in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near the tumor. Also called brachytherapy, implant radiation, or interstitial radiation therapy. [NIH] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Intervertebral: Situated between two contiguous vertebrae. [EU]

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Intestinal: Having to do with the intestines. [NIH] Intestine: A long, tube-shaped organ in the abdomen that completes the process of digestion. There is both a large intestine and a small intestine. Also called the bowel. [NIH] Intracellular: Inside a cell. [NIH] Intramuscular: IM. Within or into muscle. [NIH] Intravenous: IV. Into a vein. [NIH] Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU] Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU]

Involuntary: Reaction occurring without intention or volition. [NIH] Ionizing: Radiation comprising charged particles, e. g. electrons, protons, alpha-particles, etc., having sufficient kinetic energy to produce ionization by collision. [NIH] Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH] Iridium: A metallic element with the atomic symbol Ir, atomic number 77, and atomic weight 192.22. [NIH] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Isoelectric: Separation of amphoteric substances, dissolved in water, based on their isoelectric behavior. The amphoteric substances are a mixture of proteins to be separated and of auxiliary "carrier ampholytes". [NIH] Isotonic: A biological term denoting a solution in which body cells can be bathed without a net flow of water across the semipermeable cell membrane. Also, denoting a solution having the same tonicity as some other solution with which it is compared, such as physiologic salt solution and the blood serum. [EU] Jaundice: A clinical manifestation of hyperbilirubinemia, consisting of deposition of bile pigments in the skin, resulting in a yellowish staining of the skin and mucous membranes. [NIH]

Joint: The point of contact between elements of an animal skeleton with the parts that surround and support it. [NIH] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Kidney Disease: Any one of several chronic conditions that are caused by damage to the cells of the kidney. People who have had diabetes for a long time may have kidney damage. Also called nephropathy. [NIH] Kinetics: The study of rate dynamics in chemical or physical systems. [NIH] Laceration: 1. The act of tearing. 2. A torn, ragged, mangled wound. [EU] Language Development: The gradual expansion in complexity and meaning of symbols and sounds as perceived and interpreted by the individual through a maturational and learning process. Stages in development include babbling, cooing, word imitation with cognition, and use of short sentences. [NIH] Language Development Disorders: Conditions characterized by language abilities (comprehension and expression of speech and writing) that are below the expected level for

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a given age, generally in the absence of an intellectual impairment. These conditions may be associated with deafness; brain diseases; mental disorders; or environmental factors. [NIH] Language Disorders: Conditions characterized by deficiencies of comprehension or expression of written and spoken forms of language. These include acquired and developmental disorders. [NIH] Language Therapy: Rehabilitation of persons with language disorders or training of children with language development disorders. [NIH] Large Intestine: The part of the intestine that goes from the cecum to the rectum. The large intestine absorbs water from stool and changes it from a liquid to a solid form. The large intestine is 5 feet long and includes the appendix, cecum, colon, and rectum. Also called colon. [NIH] Laryngeal: Having to do with the larynx. [NIH] Laryngeal Muscles: The intrinsic muscles of the larynx are the aryepiglottic(us), arytenoid(eus), cricoarytenoid(eus), cricothyroid(eus), thyroarytenoid(eus), thyroepiglottic(us), and vocal(is). [NIH] Laryngoscope: A thin, lighted tube used to examine the larynx (voice box). [NIH] Larynx: An irregularly shaped, musculocartilaginous tubular structure, lined with mucous membrane, located at the top of the trachea and below the root of the tongue and the hyoid bone. It is the essential sphincter guarding the entrance into the trachea and functioning secondarily as the organ of voice. [NIH] Latency: The period of apparent inactivity between the time when a stimulus is presented and the moment a response occurs. [NIH] Latent: Phoria which occurs at one distance or another and which usually has no troublesome effect. [NIH] Leiomyoma: A benign tumor derived from smooth muscle tissue, also known as a fibroid tumor. They rarely occur outside of the uterus and the gastrointestinal tract but can occur in the skin and subcutaneous tissues, probably arising from the smooth muscle of small blood vessels in these tissues. [NIH] Leiomyosarcoma: A tumor of the muscles in the uterus, abdomen, or pelvis. [NIH] Length of Stay: The period of confinement of a patient to a hospital or other health facility. [NIH]

Leukemia: Cancer of blood-forming tissue. [NIH] Levorphanol: A narcotic analgesic that may be habit-forming. It is nearly as effective orally as by injection. [NIH] Library Services: Services offered to the library user. They include reference and circulation. [NIH]

Life Expectancy: A figure representing the number of years, based on known statistics, to which any person of a given age may reasonably expect to live. [NIH] Ligament: A band of fibrous tissue that connects bones or cartilages, serving to support and strengthen joints. [EU] Linkage: The tendency of two or more genes in the same chromosome to remain together from one generation to the next more frequently than expected according to the law of independent assortment. [NIH] Lip: Either of the two fleshy, full-blooded margins of the mouth. [NIH] Lipid: Fat. [NIH]

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Lipoma: A benign tumor composed of fat cells. [NIH] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Localization: The process of determining or marking the location or site of a lesion or disease. May also refer to the process of keeping a lesion or disease in a specific location or site. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Long-Term Care: Care over an extended period, usually for a chronic condition or disability, requiring periodic, intermittent, or continuous care. [NIH] Lower Esophageal Sphincter: The muscle between the esophagus and stomach. When a person swallows, this muscle relaxes to let food pass from the esophagus to the stomach. It stays closed at other times to keep stomach contents from flowing back into the esophagus. [NIH]

Lumen: The cavity or channel within a tube or tubular organ. [EU] Lupus: A form of cutaneous tuberculosis. It is seen predominantly in women and typically involves the nasal, buccal, and conjunctival mucosa. [NIH] Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH] Lymph node: A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Also known as a lymph gland. Lymph nodes are spread out along lymphatic vessels and contain many lymphocytes, which filter the lymphatic fluid (lymph). [NIH]

Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Lymphoid: Referring to lymphocytes, a type of white blood cell. Also refers to tissue in which lymphocytes develop. [NIH] Lymphoma: A general term for various neoplastic diseases of the lymphoid tissue. [NIH] Magnetic Resonance Imaging: Non-invasive method of demonstrating internal anatomy based on the principle that atomic nuclei in a strong magnetic field absorb pulses of radiofrequency energy and emit them as radiowaves which can be reconstructed into computerized images. The concept includes proton spin tomographic techniques. [NIH] Malabsorption: Impaired intestinal absorption of nutrients. [EU] Malformation: A morphologic developmental process. [EU]

defect

resulting

from

an

intrinsically

abnormal

Malignant: Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body. [NIH] Malnutrition: A condition caused by not eating enough food or not eating a balanced diet. [NIH]

Mammogram: An x-ray of the breast. [NIH] Mandible: The largest and strongest bone of the face constituting the lower jaw. It supports the lower teeth. [NIH] Manifest: Being the part or aspect of a phenomenon that is directly observable : concretely expressed in behaviour. [EU] Manometry: Tests that measure muscle pressure and movements in the GI tract. [NIH] Masseter Muscle: A masticatory muscle whose action is closing the jaws. [NIH]

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Masticatory: 1. subserving or pertaining to mastication; affecting the muscles of mastication. 2. a remedy to be chewed but not swallowed. [EU] Maxillary: Pertaining to the maxilla : the irregularly shaped bone that with its fellow forms the upper jaw. [EU] Mechanical ventilation: Use of a machine called a ventilator or respirator to improve the exchange of air between the lungs and the atmosphere. [NIH] Medial: Lying near the midsaggital plane of the body; opposed to lateral. [NIH] Medical Records: Recording of pertinent information concerning patient's illness or illnesses. [NIH] Medicament: A medicinal substance or agent. [EU] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Medullary: Pertaining to the marrow or to any medulla; resembling marrow. [EU] Meiosis: A special method of cell division, occurring in maturation of the germ cells, by means of which each daughter nucleus receives half the number of chromosomes characteristic of the somatic cells of the species. [NIH] Melanocytes: Epidermal dendritic pigment cells which control long-term morphological color changes by alteration in their number or in the amount of pigment they produce and store in the pigment containing organelles called melanosomes. Melanophores are larger cells which do not exist in mammals. [NIH] Melanoma: A form of skin cancer that arises in melanocytes, the cells that produce pigment. Melanoma usually begins in a mole. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Memory: Complex mental function having four distinct phases: (1) memorizing or learning, (2) retention, (3) recall, and (4) recognition. Clinically, it is usually subdivided into immediate, recent, and remote memory. [NIH] Meninges: The three membranes that cover and protect the brain and spinal cord. [NIH] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU] Mental Disorders: Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function. [NIH] Mental Health: The state wherein the person is well adjusted. [NIH] Mental Retardation: Refers to sub-average general intellectual functioning which originated during the developmental period and is associated with impairment in adaptive behavior. [NIH]

Mesoderm: The middle germ layer of the embryo. [NIH] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Microcalcifications: Tiny deposits of calcium in the breast that cannot be felt but can be detected on a mammogram. A cluster of these very small specks of calcium may indicate that cancer is present. [NIH] Microorganism: An organism that can be seen only through a microscope. Microorganisms

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include bacteria, protozoa, algae, and fungi. Although viruses are not considered living organisms, they are sometimes classified as microorganisms. [NIH] Microscopy: The application of microscope magnification to the study of materials that cannot be properly seen by the unaided eye. [NIH] Migration: The systematic movement of genes between populations of the same species, geographic race, or variety. [NIH] Mineralocorticoids: A group of corticosteroids primarily associated with the regulation of water and electrolyte balance. This is accomplished through the effect on ion transport in renal tubules, resulting in retention of sodium and loss of potassium. Mineralocorticoid secretion is itself regulated by plasma volume, serum potassium, and angiotensin II. [NIH] Mixed Connective Tissue Disease: A syndrome with overlapping clinical features of systemic lupus erythematosus, scleroderma, polymyositis, and Raynaud's phenomenon. The disease is differentially characterized by high serum titers of antibodies to ribonucleasesensitive extractable (saline soluble) nuclear antigen and a "speckled" epidermal nuclear staining pattern on direct immunofluorescence. [NIH] Mobility: Capability of movement, of being moved, or of flowing freely. [EU] Modeling: A treatment procedure whereby the therapist presents the target behavior which the learner is to imitate and make part of his repertoire. [NIH] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Modulator: A specific inductor that brings out characteristics peculiar to a definite region. [EU]

Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecular Structure: The location of the atoms, groups or ions relative to one another in a molecule, as well as the number, type and location of covalent bonds. [NIH] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH] Monoclonal: An antibody produced by culturing a single type of cell. It therefore consists of a single species of immunoglobulin molecules. [NIH] Motility: The ability to move spontaneously. [EU] Motor Activity: The physical activity of an organism as a behavioral phenomenon. [NIH] Motor Endplate: The specialized postsynaptic region of a muscle cell. The motor endplate is immediately across the synaptic cleft from the presynaptic axon terminal. Among its anatomical specializations are junctional folds which harbor a high density of cholinergic receptors. [NIH] Motor Skills: Performance of complex motor acts. [NIH] Mucins: A secretion containing mucopolysaccharides and protein that is the chief constituent of mucus. [NIH] Mucosa: A mucous membrane, or tunica mucosa. [EU] Mucositis: A complication of some cancer therapies in which the lining of the digestive

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system becomes inflamed. Often seen as sores in the mouth. [NIH] Multiple sclerosis: A disorder of the central nervous system marked by weakness, numbness, a loss of muscle coordination, and problems with vision, speech, and bladder control. Multiple sclerosis is thought to be an autoimmune disease in which the body's immune system destroys myelin. Myelin is a substance that contains both protein and fat (lipid) and serves as a nerve insulator and helps in the transmission of nerve signals. [NIH] Muscle Contraction: A process leading to shortening and/or development of tension in muscle tissue. Muscle contraction occurs by a sliding filament mechanism whereby actin filaments slide inward among the myosin filaments. [NIH] Muscle Fibers: Large single cells, either cylindrical or prismatic in shape, that form the basic unit of muscle tissue. They consist of a soft contractile substance enclosed in a tubular sheath. [NIH] Muscular Atrophy: Derangement in size and number of muscle fibers occurring with aging, reduction in blood supply, or following immobilization, prolonged weightlessness, malnutrition, and particularly in denervation. [NIH] Muscular Diseases: Acquired, familial, and congenital disorders of skeletal muscle and smooth muscle. [NIH] Muscular Dystrophies: A general term for a group of inherited disorders which are characterized by progressive degeneration of skeletal muscles. [NIH] Musculature: The muscular apparatus of the body, or of any part of it. [EU] Myasthenia: Muscular debility; any constitutional anomaly of muscle. [EU] Mydriatic: 1. Dilating the pupil. 2. Any drug that dilates the pupil. [EU] Myelin: The fatty substance that covers and protects nerves. [NIH] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Myopathy: Any disease of a muscle. [EU] Myosin: Chief protein in muscle and the main constituent of the thick filaments of muscle fibers. In conjunction with actin, it is responsible for the contraction and relaxation of muscles. [NIH] Myositis: Inflammation of a voluntary muscle. [EU] Myotonic Dystrophy: A condition presenting muscle weakness and wasting which may be progressive. [NIH] Nasal Cavity: The proximal portion of the respiratory passages on either side of the nasal septum, lined with ciliated mucosa, extending from the nares to the pharynx. [NIH] Nasal Obstruction: Any hindrance to the passage of air into and out of the nose. The obstruction may be in the nasal vestibule, fossae, or other areas of the nasal cavity. [NIH] Nasal Septum: The partition separating the two nasal cavities in the midplane, composed of cartilaginous, membranous and bony parts. [NIH] Nasogastric: The process of passing a small, flexible plastic tube through the nose or mouth into the stomach or small intestine. [NIH] Nasopharynx: The nasal part of the pharynx, lying above the level of the soft palate. [NIH] Nausea: An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. [NIH] NCI: National Cancer Institute. NCI, part of the National Institutes of Health of the United

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States Department of Health and Human Services, is the federal government's principal agency for cancer research. NCI conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the NCI Web site at http://cancer.gov. [NIH] Need: A state of tension or dissatisfaction felt by an individual that impels him to action toward a goal he believes will satisfy the impulse. [NIH] Needs Assessment: Systematic identification of a population's needs or the assessment of individuals to determine the proper level of services needed. [NIH] Neonatal: Pertaining to the first four weeks after birth. [EU] Neoplasia: Abnormal and uncontrolled cell growth. [NIH] Neoplasm: A new growth of benign or malignant tissue. [NIH] Neoplastic: Pertaining to or like a neoplasm (= any new and abnormal growth); pertaining to neoplasia (= the formation of a neoplasm). [EU] Nephropathy: Disease of the kidneys. [EU] Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Networks: Pertaining to a nerve or to the nerves, a meshlike structure of interlocking fibers or strands. [NIH] Neural: 1. Pertaining to a nerve or to the nerves. 2. Situated in the region of the spinal axis, as the neutral arch. [EU] Neuralgia: Intense or aching pain that occurs along the course or distribution of a peripheral or cranial nerve. [NIH] Neurodegenerative Diseases: Hereditary and sporadic conditions which are characterized by progressive nervous system dysfunction. These disorders are often associated with atrophy of the affected central or peripheral nervous system structures. [NIH] Neurofibroma: A fibrous tumor, usually benign, arising from the nerve sheath or the endoneurium. [NIH] Neurogenic: Loss of bladder control caused by damage to the nerves controlling the bladder. [NIH] Neuroleptic: A term coined to refer to the effects on cognition and behaviour of antipsychotic drugs, which produce a state of apathy, lack of initiative, and limited range of emotion and in psychotic patients cause a reduction in confusion and agitation and normalization of psychomotor activity. [EU] Neurologic: Having to do with nerves or the nervous system. [NIH] Neurologist: A doctor who specializes in the diagnosis and treatment of disorders of the nervous system. [NIH] Neurology: A medical specialty concerned with the study of the structures, functions, and diseases of the nervous system. [NIH] Neuromuscular: Pertaining to muscles and nerves. [EU] Neuromuscular Junction: The synapse between a neuron and a muscle. [NIH] Neuronal: Pertaining to a neuron or neurons (= conducting cells of the nervous system). [EU] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon,

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and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neurophysiology: The scientific discipline concerned with the physiology of the nervous system. [NIH] Neurotoxicity: The tendency of some treatments to cause damage to the nervous system. [NIH]

Neurotransmitter: Any of a group of substances that are released on excitation from the axon terminal of a presynaptic neuron of the central or peripheral nervous system and travel across the synaptic cleft to either excite or inhibit the target cell. Among the many substances that have the properties of a neurotransmitter are acetylcholine, norepinephrine, epinephrine, dopamine, glycine, y-aminobutyrate, glutamic acid, substance P, enkephalins, endorphins, and serotonin. [EU] Neutrons: Electrically neutral elementary particles found in all atomic nuclei except light hydrogen; the mass is equal to that of the proton and electron combined and they are unstable when isolated from the nucleus, undergoing beta decay. Slow, thermal, epithermal, and fast neutrons refer to the energy levels with which the neutrons are ejected from heavier nuclei during their decay. [NIH] Nonverbal Communication: Transmission of emotions, ideas, and attitudes between individuals in ways other than the spoken language. [NIH] Nuclear: A test of the structure, blood flow, and function of the kidneys. The doctor injects a mildly radioactive solution into an arm vein and uses x-rays to monitor its progress through the kidneys. [NIH] Nuclear magnetic resonance imaging: NMRI. A procedure in which a magnet linked to a computer is used to create detailed pictures of areas inside the body. Also called magnetic resonance imaging (MRI). [NIH] Nuclei: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nucleic acid: Either of two types of macromolecule (DNA or RNA) formed by polymerization of nucleotides. Nucleic acids are found in all living cells and contain the information (genetic code) for the transfer of genetic information from one generation to the next. [NIH] Nucleic Acid Hybridization: The process whereby two single-stranded polynucleotides form a double-stranded molecule, with hydrogen bonding between the complementary bases in the two strains. [NIH] Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nursing Assessment: Evaluation of the nature and extent of nursing problems presented by a patient for the purpose of patient care planning. [NIH] Nursing Care: Care given to patients by nursing service personnel. [NIH] Nursing Staff: Personnel who provide nursing service to patients in an organized facility, institution, or agency. [NIH] Nutritional Status: State of the body in relation to the consumption and utilization of nutrients. [NIH] Nutritional Support: The administration of nutrients for assimilation and utilization by a patient by means other than normal eating. It does not include fluid therapy which normalizes body fluids to restore water-electrolyte balance. [NIH]

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Nutritive Value: An indication of the contribution of a food to the nutrient content of the diet. This value depends on the quantity of a food which is digested and absorbed and the amounts of the essential nutrients (protein, fat, carbohydrate, minerals, vitamins) which it contains. This value can be affected by soil and growing conditions, handling and storage, and processing. [NIH] Occipital Lobe: Posterior part of the cerebral hemisphere. [NIH] Ocular: 1. Of, pertaining to, or affecting the eye. 2. Eyepiece. [EU] Odynophagia: A painful condition of the esophagus. [NIH] Office Management: Planning, organizing, and administering activities in an office. [NIH] Olfactory Bulb: Ovoid body resting on the cribriform plate of the ethmoid bone where the olfactory nerve terminates. The olfactory bulb contains several types of nerve cells including the mitral cells, on whose dendrites the olfactory nerve synapses, forming the olfactory glomeruli. The accessory olfactory bulb, which receives the projection from the vomeronasal organ via the vomeronasal nerve, is also included here. [NIH] Olfactory Receptor Neurons: Neurons in the olfactory epithelium with proteins (receptors, odorant) that bind, and thus detect, odorants. Olfactory receptor neurons are bipolar. They send to the surface of the epithelium apical dendrites with non-motile cilia from which project odorant receptor molecules. Their unmyelinated axons synapse in the olfactory bulb of the brain. Unlike other neurons, they can be generated from precursor cells in adults. [NIH]

Oligonucleotide Probes: Synthetic or natural oligonucleotides used in hybridization studies in order to identify and study specific nucleic acid fragments, e.g., DNA segments near or within a specific gene locus or gene. The probe hybridizes with a specific mRNA, if present. Conventional techniques used for testing for the hybridization product include dot blot assays, Southern blot assays, and DNA:RNA hybrid-specific antibody tests. Conventional labels for the probe include the radioisotope labels 32P and 125I and the chemical label biotin. [NIH] Oncogene: A gene that normally directs cell growth. If altered, an oncogene can promote or allow the uncontrolled growth of cancer. Alterations can be inherited or caused by an environmental exposure to carcinogens. [NIH] Opacity: Degree of density (area most dense taken for reading). [NIH] Ophthalmoplegia: Paralysis of one or more of the ocular muscles due to disorders of the eye muscles, neuromuscular junction, supporting soft tissue, tendons, or innervation to the muscles. [NIH] Optic Chiasm: The X-shaped structure formed by the meeting of the two optic nerves. At the optic chiasm the fibers from the medial part of each retina cross to project to the other side of the brain while the lateral retinal fibers continue on the same side. As a result each half of the brain receives information about the contralateral visual field from both eyes. [NIH]

Oral Health: The optimal state of the mouth and normal functioning of the organs of the mouth without evidence of disease. [NIH] Oral Hygiene: The practice of personal hygiene of the mouth. It includes the maintenance of oral cleanliness, tissue tone, and general preservation of oral health. [NIH] Oropharynx: Oral part of the pharynx. [NIH] Osteoarthritis: A progressive, degenerative joint disease, the most common form of arthritis, especially in older persons. The disease is thought to result not from the aging process but from biochemical changes and biomechanical stresses affecting articular cartilage. In the

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foreign literature it is often called osteoarthrosis deformans. [NIH] Otolaryngology: A surgical specialty concerned with the study and treatment of disorders of the ear, nose, and throat. [NIH] Outpatient: A patient who is not an inmate of a hospital but receives diagnosis or treatment in a clinic or dispensary connected with the hospital. [NIH] Overdose: An accidental or deliberate dose of a medication or street drug that is in excess of what is normally used. [NIH] Oximetry: The determination of oxygen-hemoglobin saturation of blood either by withdrawing a sample and passing it through a classical photoelectric oximeter or by electrodes attached to some translucent part of the body like finger, earlobe, or skin fold. It includes non-invasive oxygen monitoring by pulse oximetry. [NIH] Oxygen Consumption: The oxygen consumption is determined by calculating the difference between the amount of oxygen inhaled and exhaled. [NIH] Oxygenation: The process of supplying, treating, or mixing with oxygen. No:1245 oxygenation the process of supplying, treating, or mixing with oxygen. [EU] Palate: The structure that forms the roof of the mouth. It consists of the anterior hard palate and the posterior soft palate. [NIH] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Palliative therapy: Treatment given to relieve symptoms caused by advanced cancer. Palliative therapy does not alter the course of a disease but improves the quality of life. [NIH] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Pancreatic: Having to do with the pancreas. [NIH] Pancreatic cancer: Cancer of the pancreas, a salivary gland of the abdomen. [NIH] Pancreatic Juice: The fluid containing digestive enzymes secreted by the pancreas in response to food in the duodenum. [NIH] Papilloma: A benign epithelial neoplasm which may arise from the skin, mucous membranes or glandular ducts. [NIH] Paralysis: Loss of ability to move all or part of the body. [NIH] Parent-Child Relations: The interactions between parent and child. [NIH] Paroxysmal: Recurring in paroxysms (= spasms or seizures). [EU] Pathogenesis: The cellular events and reactions that occur in the development of disease. [NIH]

Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Pathologies: The study of abnormality, especially the study of diseases. [NIH] Pathologist: A doctor who identifies diseases by studying cells and tissues under a microscope. [NIH] Pathophysiology: Altered functions in an individual or an organ due to disease. [NIH] Patient Care Management: Generating, planning, organizing, and administering medical and nursing care and services for patients. [NIH]

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Patient Care Planning: Usually a written medical and nursing care program designed for a particular patient. [NIH] Patient Care Team: Care of patients by a multidisciplinary team usually organized under the leadership of a physician; each member of the team has specific responsibilities and the whole team contributes to the care of the patient. [NIH] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]

Pediatrics: A medical specialty concerned with maintaining health and providing medical care to children from birth to adolescence. [NIH] Pelvic: Pertaining to the pelvis. [EU] Pelvis: The lower part of the abdomen, located between the hip bones. [NIH] Pepsin: An enzyme made in the stomach that breaks down proteins. [NIH] Peptic: Pertaining to pepsin or to digestion; related to the action of gastric juices. [EU] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Perception: The ability quickly and accurately to recognize similarities and differences among presented objects, whether these be pairs of words, pairs of number series, or multiple sets of these or other symbols such as geometric figures. [NIH] Percutaneous: Performed through the skin, as injection of radiopacque material in radiological examination, or the removal of tissue for biopsy accomplished by a needle. [EU] Perforation: 1. The act of boring or piercing through a part. 2. A hole made through a part or substance. [EU] Pericardium: The fibroserous sac surrounding the heart and the roots of the great vessels. [NIH]

Peripheral Nervous System: The nervous system outside of the brain and spinal cord. The peripheral nervous system has autonomic and somatic divisions. The autonomic nervous system includes the enteric, parasympathetic, and sympathetic subdivisions. The somatic nervous system includes the cranial and spinal nerves and their ganglia and the peripheral sensory receptors. [NIH] Peristalsis: The rippling motion of muscles in the intestine or other tubular organs characterized by the alternate contraction and relaxation of the muscles that propel the contents onward. [NIH] Peritoneal: Having to do with the peritoneum (the tissue that lines the abdominal wall and covers most of the organs in the abdomen). [NIH] Peritoneum: Endothelial lining of the abdominal cavity, the parietal peritoneum covering the inside of the abdominal wall and the visceral peritoneum covering the bowel, the mesentery, and certain of the organs. The portion that covers the bowel becomes the serosal layer of the bowel wall. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Pharyngeal Muscles: The muscles of the pharynx are the inferior, middle and superior constrictors, salpingopharyngeus, and stylopharyngeus. [NIH] Pharyngitis: Inflammation of the throat. [NIH] Pharynx: The hollow tube about 5 inches long that starts behind the nose and ends at the top of the trachea (windpipe) and esophagus (the tube that goes to the stomach). [NIH] Phenotype: The outward appearance of the individual. It is the product of interactions

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between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of yeasts. [NIH] Phonation: The process of producing vocal sounds by means of vocal cords vibrating in an expiratory blast of air. [NIH] Phosphorus: A non-metallic element that is found in the blood, muscles, nevers, bones, and teeth, and is a component of adenosine triphosphate (ATP; the primary energy source for the body's cells.) [NIH] Physical Examination: Systematic and thorough inspection of the patient for physical signs of disease or abnormality. [NIH] Physical Therapy: The restoration of function and the prevention of disability following disease or injury with the use of light, heat, cold, water, electricity, ultrasound, and exercise. [NIH]

Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]

Physiology: The science that deals with the life processes and functions of organismus, their cells, tissues, and organs. [NIH] Pitch: The subjective awareness of the frequency or spectral distribution of a sound. [NIH] Pituitary Gland: A small, unpaired gland situated in the sella turcica tissue. It is connected to the hypothalamus by a short stalk. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plasticity: In an individual or a population, the capacity for adaptation: a) through gene changes (genetic plasticity) or b) through internal physiological modifications in response to changes of environment (physiological plasticity). [NIH] Platinum: Platinum. A heavy, soft, whitish metal, resembling tin, atomic number 78, atomic weight 195.09, symbol Pt. (From Dorland, 28th ed) It is used in manufacturing equipment for laboratory and industrial use. It occurs as a black powder (platinum black) and as a spongy substance (spongy platinum) and may have been known in Pliny's time as "alutiae". [NIH]

Pleomorphic: Occurring in various distinct forms. In terms of cells, having variation in the size and shape of cells or their nuclei. [NIH] Pneumonia: Inflammation of the lungs. [NIH] Pneumonitis: A disease caused by inhaling a wide variety of substances such as dusts and molds. Also called "farmer's disease". [NIH] Polycystic: An inherited disorder characterized by many grape-like clusters of fluid-filled cysts that make both kidneys larger over time. These cysts take over and destroy working kidney tissue. PKD may cause chronic renal failure and end-stage renal disease. [NIH] Pons: The part of the central nervous system lying between the medulla oblongata and the mesencephalon, ventral to the cerebellum, and consisting of a pars dorsalis and a pars ventralis. [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU]

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Postoperative: After surgery. [NIH] Postoperative Period: The period following a surgical operation. [NIH] Postsynaptic: Nerve potential generated by an inhibitory hyperpolarizing stimulation. [NIH] Postural: Pertaining to posture or position. [EU] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Potentiate: A degree of synergism which causes the exposure of the organism to a harmful substance to worsen a disease already contracted. [NIH] Practicability: A non-standard characteristic of an analytical procedure. It is dependent on the scope of the method and is determined by requirements such as sample throughout and costs. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Predictive factor: A situation or condition that may increase a person's risk of developing a certain disease or disorder. [NIH] Pregnancy Tests: Tests to determine whether or not an individual is pregnant. [NIH] Preoperative: Preceding an operation. [EU] Presynaptic: Situated proximal to a synapse, or occurring before the synapse is crossed. [EU] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Probe: An instrument used in exploring cavities, or in the detection and dilatation of strictures, or in demonstrating the potency of channels; an elongated instrument for exploring or sounding body cavities. [NIH] Prognostic factor: A situation or condition, or a characteristic of a patient, that can be used to estimate the chance of recovery from a disease, or the chance of the disease recurring (coming back). [NIH] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Promoter: A chemical substance that increases the activity of a carcinogenic process. [NIH] Prophase: The first phase of cell division, in which the chromosomes become visible, the nucleus starts to lose its identity, the spindle appears, and the centrioles migrate toward opposite poles. [NIH] Prospective Studies: Observation of a population for a sufficient number of persons over a sufficient number of years to generate incidence or mortality rates subsequent to the

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selection of the study group. [NIH] Prospective study: An epidemiologic study in which a group of individuals (a cohort), all free of a particular disease and varying in their exposure to a possible risk factor, is followed over a specific amount of time to determine the incidence rates of the disease in the exposed and unexposed groups. [NIH] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Protocol: The detailed plan for a clinical trial that states the trial's rationale, purpose, drug or vaccine dosages, length of study, routes of administration, who may participate, and other aspects of trial design. [NIH] Protons: Stable elementary particles having the smallest known positive charge, found in the nuclei of all elements. The proton mass is less than that of a neutron. A proton is the nucleus of the light hydrogen atom, i.e., the hydrogen ion. [NIH] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Pseudobulbar Palsy: Disease of the peripheral nervous system occurring usually after many years of increased lead absorption. [NIH] Psychiatric: Pertaining to or within the purview of psychiatry. [EU] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychic: Pertaining to the psyche or to the mind; mental. [EU] Psychogenic: Produced or caused by psychic or mental factors rather than organic factors. [EU]

Psychomotor: Pertaining to motor effects of cerebral or psychic activity. [EU] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Pulmonary: Relating to the lungs. [NIH] Pulmonary Ventilation: The total volume of gas per minute inspired or expired measured in liters per minute. [NIH] Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH]

Pupil: The aperture in the iris through which light passes. [NIH] Pyramidal Tracts: Fibers that arise from cells within the cerebral cortex, pass through the medullary pyramid, and descend in the spinal cord. Many authorities say the pyramidal tracts include both the corticospinal and corticobulbar tracts. [NIH] Quality of Life: A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment. [NIH] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the

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waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Radiation therapy: The use of high-energy radiation from x-rays, gamma rays, neutrons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body in the area near cancer cells (internal radiation therapy, implant radiation, or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. Also called radiotherapy. [NIH] Radioactive: Giving off radiation. [NIH] Radiography: Examination of any part of the body for diagnostic purposes by means of roentgen rays, recording the image on a sensitized surface (such as photographic film). [NIH] Radioimmunotherapy: Radiotherapy where cytotoxic radionuclides are linked to antibodies in order to deliver toxins directly to tumor targets. Therapy with targeted radiation rather than antibody-targeted toxins (immunotoxins) has the advantage that adjacent tumor cells, which lack the appropriate antigenic determinants, can be destroyed by radiation cross-fire. Radioimmunotherapy is sometimes called targeted radiotherapy, but this latter term can also refer to radionuclides linked to non-immune molecules (radiotherapy). [NIH] Radioisotope: An unstable element that releases radiation as it breaks down. Radioisotopes can be used in imaging tests or as a treatment for cancer. [NIH] Radiolabeled: Any compound that has been joined with a radioactive substance. [NIH] Radiological: Pertaining to radiodiagnostic and radiotherapeutic procedures, and interventional radiology or other planning and guiding medical radiology. [NIH] Radiologist: A doctor who specializes in creating and interpreting pictures of areas inside the body. The pictures are produced with x-rays, sound waves, or other types of energy. [NIH]

Radiology: A specialty concerned with the use of x-ray and other forms of radiant energy in the diagnosis and treatment of disease. [NIH] Radiopharmaceutical: Any medicinal product which, when ready for use, contains one or more radionuclides (radioactive isotopes) included for a medicinal purpose. [NIH] Radiotherapy: The use of ionizing radiation to treat malignant neoplasms and other benign conditions. The most common forms of ionizing radiation used as therapy are x-rays, gamma rays, and electrons. A special form of radiotherapy, targeted radiotherapy, links a cytotoxic radionuclide to a molecule that targets the tumor. When this molecule is an antibody or other immunologic molecule, the technique is called radioimmunotherapy. [NIH] Radius: The lateral bone of the forearm. [NIH] Random Allocation: A process involving chance used in therapeutic trials or other research endeavor for allocating experimental subjects, human or animal, between treatment and control groups, or among treatment groups. It may also apply to experiments on inanimate objects. [NIH] Randomization: Also called random allocation. Is allocation of individuals to groups, e.g., for experimental and control regimens, by chance. Within the limits of chance variation, random allocation should make the control and experimental groups similar at the start of an investigation and ensure that personal judgment and prejudices of the investigator do not influence allocation. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH]

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Randomized clinical trial: A study in which the participants are assigned by chance to separate groups that compare different treatments; neither the researchers nor the participants can choose which group. Using chance to assign people to groups means that the groups will be similar and that the treatments they receive can be compared objectively. At the time of the trial, it is not known which treatment is best. It is the patient's choice to be in a randomized trial. [NIH] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Receptors, Odorant: Proteins, usually projecting from the cilia of olfactory receptor neurons, that specifically bind odorant molecules and trigger responses in the neurons. The large number of different odorant receptors appears to arise from several gene families or subfamilies rather than from DNA rearrangement. [NIH] Recombination: The formation of new combinations of genes as a result of segregation in crosses between genetically different parents; also the rearrangement of linked genes due to crossing-over. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Red Nucleus: A pinkish-yellow portion of the midbrain situated in the rostral mesencephalic tegmentum. It receives a large projection from the contralateral half of the cerebellum via the superior cerebellar peduncle and a projection from the ipsilateral motor cortex. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Reflective: Capable of throwing back light, images, sound waves : reflecting. [EU] Reflex: An involuntary movement or exercise of function in a part, excited in response to a stimulus applied to the periphery and transmitted to the brain or spinal cord. [NIH] Reflux: The term used when liquid backs up into the esophagus from the stomach. [NIH] Refraction: A test to determine the best eyeglasses or contact lenses to correct a refractive error (myopia, hyperopia, or astigmatism). [NIH] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Regurgitation: A backward flowing, as the casting up of undigested food, or the backward flowing of blood into the heart, or between the chambers of the heart when a valve is incompetent. [EU] Rehabilitative: Instruction of incapacitated individuals or of those affected with some mental disorder, so that some or all of their lost ability may be regained. [NIH] Reliability: Used technically, in a statistical sense, of consistency of a test with itself, i. e. the extent to which we can assume that it will yield the same result if repeated a second time. [NIH]

Reoperation: A repeat operation for the same condition in the same patient. It includes reoperation for reexamination, reoperation for disease progression or recurrence, or reoperation following operative failure. [NIH] Reproductive cells: Egg and sperm cells. Each mature reproductive cell carries a single set of 23 chromosomes. [NIH] Respiration: The act of breathing with the lungs, consisting of inspiration, or the taking into the lungs of the ambient air, and of expiration, or the expelling of the modified air which contains more carbon dioxide than the air taken in (Blakiston's Gould Medical Dictionary,

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4th ed.). This does not include tissue respiration (= oxygen consumption) or cell respiration (= cell respiration). [NIH] Respirator: A mechanical device that helps a patient breathe; a mechanical ventilator. [NIH] Respiratory Physiology: Functions and activities of the respiratory tract as a whole or of any of its parts. [NIH] Respiratory System: The tubular and cavernous organs and structures, by means of which pulmonary ventilation and gas exchange between ambient air and the blood are brought about. [NIH] Response rate: The percentage of patients whose cancer shrinks or disappears after treatment. [NIH] Restoration: Broad term applied to any inlay, crown, bridge or complete denture which restores or replaces loss of teeth or oral tissues. [NIH] Retina: The ten-layered nervous tissue membrane of the eye. It is continuous with the optic nerve and receives images of external objects and transmits visual impulses to the brain. Its outer surface is in contact with the choroid and the inner surface with the vitreous body. The outer-most layer is pigmented, whereas the inner nine layers are transparent. [NIH] Retinoblastoma: An eye cancer that most often occurs in children younger than 5 years. It occurs in hereditary and nonhereditary (sporadic) forms. [NIH] Retrograde: 1. Moving backward or against the usual direction of flow. 2. Degenerating, deteriorating, or catabolic. [EU] Retrospective: Looking back at events that have already taken place. [NIH] Retrospective study: A study that looks backward in time, usually using medical records and interviews with patients who already have or had a disease. [NIH] Retrosternal: Situated or occurring behind the sternum. [EU] Retroviral vector: RNA from a virus that is used to insert genetic material into cells. [NIH] Rheology: The study of the deformation and flow of matter, usually liquids or fluids, and of the plastic flow of solids. The concept covers consistency, dilatancy, liquefaction, resistance to flow, shearing, thixotrophy, and viscosity. [NIH] Rheumatism: A group of disorders marked by inflammation or pain in the connective tissue structures of the body. These structures include bone, cartilage, and fat. [NIH] Rheumatoid: Resembling rheumatism. [EU] Rheumatoid arthritis: A form of arthritis, the cause of which is unknown, although infection, hypersensitivity, hormone imbalance and psychologic stress have been suggested as possible causes. [NIH] Ribonuclease: RNA-digesting enzyme. [NIH] Rigidity: Stiffness or inflexibility, chiefly that which is abnormal or morbid; rigor. [EU] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Risperidone: A selective blocker of dopamine D2 and serotonin-5-HT-2 receptors that acts as an atypical antipsychotic agent. It has been shown to improve both positive and negative symptoms in the treatment of schizophrenia. [NIH] Rod: A reception for vision, located in the retina. [NIH] Saliva: The clear, viscous fluid secreted by the salivary glands and mucous glands of the mouth. It contains mucins, water, organic salts, and ptylin. [NIH]

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Salivary: The duct that convey saliva to the mouth. [NIH] Salivary glands: Glands in the mouth that produce saliva. [NIH] Schizophrenia: A mental disorder characterized by a special type of disintegration of the personality. [NIH] Schwannoma: A tumor of the peripheral nervous system that begins in the nerve sheath (protective covering). It is almost always benign, but rare malignant schwannomas have been reported. [NIH] Scleroderma: A chronic disorder marked by hardening and thickening of the skin. Scleroderma can be localized or it can affect the entire body (systemic). [NIH] Sclerosis: A pathological process consisting of hardening or fibrosis of an anatomical structure, often a vessel or a nerve. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Secretion: 1. The process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU] Seizures: Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as epilepsy or "seizure disorder." [NIH] Semen: The thick, yellowish-white, viscid fluid secretion of male reproductive organs discharged upon ejaculation. In addition to reproductive organ secretions, it contains spermatozoa and their nutrient plasma. [NIH] Sensor: A device designed to respond to physical stimuli such as temperature, light, magnetism or movement and transmit resulting impulses for interpretation, recording, movement, or operating control. [NIH] Septic: Produced by or due to decomposition by microorganisms; putrefactive. [EU] Serotonin: A biochemical messenger and regulator, synthesized from the essential amino acid L-tryptophan. In humans it is found primarily in the central nervous system, gastrointestinal tract, and blood platelets. Serotonin mediates several important physiological functions including neurotransmission, gastrointestinal motility, hemostasis, and cardiovascular integrity. Multiple receptor families (receptors, serotonin) explain the broad physiological actions and distribution of this biochemical mediator. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Sex Determination: The biological characteristics which distinguish human beings as female or male. [NIH] Shock: The general bodily disturbance following a severe injury; an emotional or moral upset occasioned by some disturbing or unexpected experience; disruption of the circulation, which can upset all body functions: sometimes referred to as circulatory shock. [NIH]

Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Signs and Symptoms: Clinical manifestations that can be either objective when observed by a physician, or subjective when perceived by the patient. [NIH] Skeletal: Having to do with the skeleton (boney part of the body). [NIH]

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Skeleton: The framework that supports the soft tissues of vertebrate animals and protects many of their internal organs. The skeletons of vertebrates are made of bone and/or cartilage. [NIH] Skull: The skeleton of the head including the bones of the face and the bones enclosing the brain. [NIH] Small intestine: The part of the digestive tract that is located between the stomach and the large intestine. [NIH] Smooth muscle: Muscle that performs automatic tasks, such as constricting blood vessels. [NIH]

Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH] Sodium: An element that is a member of the alkali group of metals. It has the atomic symbol Na, atomic number 11, and atomic weight 23. With a valence of 1, it has a strong affinity for oxygen and other nonmetallic elements. Sodium provides the chief cation of the extracellular body fluids. Its salts are the most widely used in medicine. (From Dorland, 27th ed) Physiologically the sodium ion plays a major role in blood pressure regulation, maintenance of fluid volume, and electrolyte balance. [NIH] Soft tissue: Refers to muscle, fat, fibrous tissue, blood vessels, or other supporting tissue of the body. [NIH] Solvent: 1. Dissolving; effecting a solution. 2. A liquid that dissolves or that is capable of dissolving; the component of a solution that is present in greater amount. [EU] Soma: The body as distinct from the mind; all the body tissue except the germ cells; all the axial body. [NIH] Somatic: 1. Pertaining to or characteristic of the soma or body. 2. Pertaining to the body wall in contrast to the viscera. [EU] Sound wave: An alteration of properties of an elastic medium, such as pressure, particle displacement, or density, that propagates through the medium, or a superposition of such alterations. [NIH] Spasm: An involuntary contraction of a muscle or group of muscles. Spasms may involve skeletal muscle or smooth muscle. [NIH] Spasmodic: Of the nature of a spasm. [EU] Spastic: 1. Of the nature of or characterized by spasms. 2. Hypertonic, so that the muscles are stiff and the movements awkward. 3. A person exhibiting spasticity, such as occurs in spastic paralysis or in cerebral palsy. [EU] Spasticity: A state of hypertonicity, or increase over the normal tone of a muscle, with heightened deep tendon reflexes. [EU] Spatial disorientation: Loss of orientation in space where person does not know which way is up. [NIH] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of

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bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Speech Disorders: Acquired or developmental conditions marked by an impaired ability to comprehend or generate spoken forms of language. [NIH] Speech pathologist: A specialist who evaluates and treats people with communication and swallowing problems. Also called a speech therapist. [NIH] Sperm: The fecundating fluid of the male. [NIH] Sphincter: A ringlike band of muscle fibres that constricts a passage or closes a natural orifice; called also musculus sphincter. [EU] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Spleen: An organ that is part of the lymphatic system. The spleen produces lymphocytes, filters the blood, stores blood cells, and destroys old blood cells. It is located on the left side of the abdomen near the stomach. [NIH] Spondylitis: Inflammation of the vertebrae. [EU] Spondylolisthesis: Forward displacement of one vertebra over another. [NIH] Sporadic: Neither endemic nor epidemic; occurring occasionally in a random or isolated manner. [EU] Staff Development: The process by which the employer promotes staff performance and efficiency consistent with management goals and objectives. [NIH] Standardize: To compare with or conform to a standard; to establish standards. [EU] Statistically significant: Describes a mathematical measure of difference between groups. The difference is said to be statistically significant if it is greater than what might be expected to happen by chance alone. [NIH] Stenosis: Narrowing or stricture of a duct or canal. [EU] Stent: A device placed in a body structure (such as a blood vessel or the gastrointestinal tract) to provide support and keep the structure open. [NIH] Sternum: Breast bone. [NIH] Steroids: Drugs used to relieve swelling and inflammation. [NIH] Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stool: The waste matter discharged in a bowel movement; feces. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stricture: The abnormal narrowing of a body opening. Also called stenosis. [NIH] Stridor: The loud, harsh, vibrating sound produced by partial obstruction of the larynx or trachea. [NIH] Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH] Stromal: Large, veil-like cell in the bone marrow. [NIH] Subacute: Somewhat acute; between acute and chronic. [EU]

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Subarachnoid: Situated or occurring between the arachnoid and the pia mater. [EU] Subclavian: The direct continuation of the axillary vein at the lateral border of the first rib. It passes medially to join the internal jugular vein and form the brachiocephalic vein on each side. [NIH] Subclavian Artery: Artery arising from the brachiocephalic trunk on the right side and from the arch of the aorta on the left side. It distributes to the neck, thoracic wall, spinal cord, brain, meninges, and upper limb. [NIH] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Subcutaneous: Beneath the skin. [NIH] Suppression: A conscious exclusion of disapproved desire contrary with repression, in which the process of exclusion is not conscious. [NIH] Sympathomimetic: 1. Mimicking the effects of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. 2. An agent that produces effects similar to those of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. Called also adrenergic. [EU] Symphysis: A secondary cartilaginous joint. [NIH] Symptomatic: Having to do with symptoms, which are signs of a condition or disease. [NIH] Symptomatic treatment: Therapy that eases symptoms without addressing the cause of disease. [NIH] Symptomatology: 1. That branch of medicine with treats of symptoms; the systematic discussion of symptoms. 2. The combined symptoms of a disease. [EU] Synapse: The region where the processes of two neurons come into close contiguity, and the nervous impulse passes from one to the other; the fibers of the two are intermeshed, but, according to the general view, there is no direct contiguity. [NIH] Synapsis: The pairing between homologous chromosomes of maternal and paternal origin during the prophase of meiosis, leading to the formation of gametes. [NIH] Synaptic: Pertaining to or affecting a synapse (= site of functional apposition between neurons, at which an impulse is transmitted from one neuron to another by electrical or chemical means); pertaining to synapsis (= pairing off in point-for-point association of homologous chromosomes from the male and female pronuclei during the early prophase of meiosis). [EU] Syncope: A temporary suspension of consciousness due to generalized cerebral schemia, a faint or swoon. [EU] Systemic: Affecting the entire body. [NIH] Systemic disease: Disease that affects the whole body. [NIH] Systemic lupus erythematosus: SLE. A chronic inflammatory connective tissue disease marked by skin rashes, joint pain and swelling, inflammation of the kidneys, inflammation of the fibrous tissue surrounding the heart (i.e., the pericardium), as well as other problems. Not all affected individuals display all of these problems. May be referred to as lupus. [NIH] Systolic: Indicating the maximum arterial pressure during contraction of the left ventricle of the heart. [EU] Tardive: Marked by lateness, late; said of a disease in which the characteristic lesion is late in appearing. [EU]

Dictionary 211

Telangiectasia: The permanent enlargement of blood vessels, causing redness in the skin or mucous membranes. [NIH] Telomere: A terminal section of a chromosome which has a specialized structure and which is involved in chromosomal replication and stability. Its length is believed to be a few hundred base pairs. [NIH] Temporal: One of the two irregular bones forming part of the lateral surfaces and base of the skull, and containing the organs of hearing. [NIH] Temporal Lobe: Lower lateral part of the cerebral hemisphere. [NIH] Terminal disease: Disease that cannot be cured and will cause death. [NIH] Tetani: Causal agent of tetanus. [NIH] Tetanic: Having the characteristics of, or relating to tetanus. [NIH] Tetanus: A disease caused by tetanospasmin, a powerful protein toxin produced by Clostridium tetani. Tetanus usually occurs after an acute injury, such as a puncture wound or laceration. Generalized tetanus, the most common form, is characterized by tetanic muscular contractions and hyperreflexia. Localized tetanus presents itself as a mild condition with manifestations restricted to muscles near the wound. It may progress to the generalized form. [NIH] Thalamic: Cell that reaches the lateral nucleus of amygdala. [NIH] Thalamic Diseases: Disorders of the centrally located thalamus, which integrates a wide range of cortical and subcortical information. Manifestations include sensory loss, movement disorders; ataxia, pain syndromes, visual disorders, a variety of neuropsychological conditions, and coma. Relatively common etiologies include cerebrovascular disorders; craniocerebral trauma; brain neoplasms; brain hypoxia; intracranial hemorrhages; and infectious processes. [NIH] Thalamus: Paired bodies containing mostly gray substance and forming part of the lateral wall of the third ventricle of the brain. The thalamus represents the major portion of the diencephalon and is commonly divided into cellular aggregates known as nuclear groups. [NIH]

Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thermal: Pertaining to or characterized by heat. [EU] Third Ventricle: A narrow cleft inferior to the corpus callosum, within the diencephalon, between the paired thalami. Its floor is formed by the hypothalamus, its anterior wall by the lamina terminalis, and its roof by ependyma. It communicates with the fourth ventricle by the cerebral aqueduct, and with the lateral ventricles by the interventricular foramina. [NIH] Thoracic: Having to do with the chest. [NIH] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thrombus: An aggregation of blood factors, primarily platelets and fibrin with entrapment of cellular elements, frequently causing vascular obstruction at the point of its formation. Some authorities thus differentiate thrombus formation from simple coagulation or clot formation. [EU] Thrush: A disease due to infection with species of fungi of the genus Candida. [NIH] Thyroid: A gland located near the windpipe (trachea) that produces thyroid hormone,

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which helps regulate growth and metabolism. [NIH] Time Factors: Elements of limited time intervals, contributing to particular results or situations. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tone: 1. The normal degree of vigour and tension; in muscle, the resistance to passive elongation or stretch; tonus. 2. A particular quality of sound or of voice. 3. To make permanent, or to change, the colour of silver stain by chemical treatment, usually with a heavy metal. [EU] Tonic: 1. Producing and restoring the normal tone. 2. Characterized by continuous tension. 3. A term formerly used for a class of medicinal preparations believed to have the power of restoring normal tone to tissue. [EU] Tonicity: The normal state of muscular tension. [NIH] Tonsillitis: Inflammation of the tonsils, especially the palatine tonsils. It is often caused by a bacterium. Tonsillitis may be acute, chronic, or recurrent. [NIH] Tonsils: Small masses of lymphoid tissue on either side of the throat. [NIH] Tonus: A state of slight tension usually present in muscles even when they are not undergoing active contraction. [NIH] Tooth Preparation: Procedures carried out with regard to the teeth or tooth structures preparatory to specified dental therapeutic and surgical measures. [NIH] Topical: On the surface of the body. [NIH] Torsion: A twisting or rotation of a bodily part or member on its axis. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxin: A poison; frequently used to refer specifically to a protein produced by some higher plants, certain animals, and pathogenic bacteria, which is highly toxic for other living organisms. Such substances are differentiated from the simple chemical poisons and the vegetable alkaloids by their high molecular weight and antigenicity. [EU] Trachea: The cartilaginous and membranous tube descending from the larynx and branching into the right and left main bronchi. [NIH] Tracheoesophageal Fistula: Abnormal communication between the esophagus and the trachea, acquired or congenital, often associated with esophageal atresia. [NIH] Tracheostomy: Surgical formation of an opening into the trachea through the neck, or the opening so created. [NIH] Tracheotomy: Surgical incision of the trachea. [NIH] Transcutaneous: Transdermal. [EU] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Transmitter: A chemical substance which effects the passage of nerve impulses from one cell to the other at the synapse. [NIH]

Dictionary 213

Transplantation: Transference of a tissue or organ, alive or dead, within an individual, between individuals of the same species, or between individuals of different species. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Treatment Outcome: Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, practicability, etc., of these interventions in individual cases or series. [NIH]

Tricyclic: Containing three fused rings or closed chains in the molecular structure. [EU] Tuberous Sclerosis: A rare congenital disease in which the essential pathology is the appearance of multiple tumors in the cerebrum and in other organs, such as the heart or kidneys. [NIH] Tumour: 1. Swelling, one of the cardinal signs of inflammations; morbid enlargement. 2. A new growth of tissue in which the multiplication of cells is uncontrolled and progressive; called also neoplasm. [EU] Tunica: A rather vague term to denote the lining coat of hollow organs, tubes, or cavities. [NIH]

Ulcer: A localized necrotic lesion of the skin or a mucous surface. [NIH] Ulceration: 1. The formation or development of an ulcer. 2. An ulcer. [EU] Ultrasonography: The visualization of deep structures of the body by recording the reflections of echoes of pulses of ultrasonic waves directed into the tissues. Use of ultrasound for imaging or diagnostic purposes employs frequencies ranging from 1.6 to 10 megahertz. [NIH] Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH] Unresectable: Unable to be surgically removed. [NIH] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]

Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Uterus: The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a fetus develops. Also called the womb. [NIH] Vaccine: A substance or group of substances meant to cause the immune system to respond to a tumor or to microorganisms, such as bacteria or viruses. [NIH] Vagina: The muscular canal extending from the uterus to the exterior of the body. Also called the birth canal. [NIH] Vaginitis: Inflammation of the vagina characterized by pain and a purulent discharge. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vasoconstriction: Narrowing of the blood vessels without anatomic change, for which constriction, pathologic is used. [NIH] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Venous: Of or pertaining to the veins. [EU] Ventilation: 1. In respiratory physiology, the process of exchange of air between the lungs and the ambient air. Pulmonary ventilation (usually measured in litres per minute) refers to the total exchange, whereas alveolar ventilation refers to the effective ventilation of the

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alveoli, in which gas exchange with the blood takes place. 2. In psychiatry, verbalization of one's emotional problems. [EU] Ventilator: A breathing machine that is used to treat respiratory failure by promoting ventilation; also called a respirator. [NIH] Ventricle: One of the two pumping chambers of the heart. The right ventricle receives oxygen-poor blood from the right atrium and pumps it to the lungs through the pulmonary artery. The left ventricle receives oxygen-rich blood from the left atrium and pumps it to the body through the aorta. [NIH] Ventricular: Pertaining to a ventricle. [EU] Vertebrae: A bony unit of the segmented spinal column. [NIH] Vertebrobasilar Insufficiency: Localized or diffuse reduction in blood flow through the vertebrobasilar arterial system, which supplies the brain stem; cerebellum; occipital lobe; medial temporal lobe; and thalamus. Characteristic clinical features include syncope; lightheadedness; visual disturbances; and vertigo. brain stem infarctions or other brain infarction may be associated. [NIH] Vertigo: An illusion of movement; a sensation as if the external world were revolving around the patient (objective vertigo) or as if he himself were revolving in space (subjective vertigo). The term is sometimes erroneously used to mean any form of dizziness. [EU] Vestibule: A small, oval, bony chamber of the labyrinth. The vestibule contains the utricle and saccule, organs which are part of the balancing apparatus of the ear. [NIH] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Visceral: , from viscus a viscus) pertaining to a viscus. [EU] Viscosity: A physical property of fluids that determines the internal resistance to shear forces. [EU] Vitro: Descriptive of an event or enzyme reaction under experimental investigation occurring outside a living organism. Parts of an organism or microorganism are used together with artificial substrates and/or conditions. [NIH] Vivo: Outside of or removed from the body of a living organism. [NIH] Vocal cord: The vocal folds of the larynx. [NIH] Voice Disorders: Disorders of voice pitch, loudness, or quality. Dysphonia refers to impaired utterance of sounds by the vocal folds. [NIH] Voice Quality: Voice quality is that component of speech which gives the primary distinction to a given speaker's voice when pitch and loudness are excluded. It involves both phonatory and resonatory characteristics. Some of the descriptions of voice quality are harshness, breathiness and nasality. [NIH] Volition: Voluntary activity without external compulsion. [NIH] Vomitus: 1. Vomiting. 2. Matter vomited. [EU] Weight Gain: Increase in body weight over existing weight. [NIH] Windpipe: A rigid tube, 10 cm long, extending from the cricoid cartilage to the upper border of the fifth thoracic vertebra. [NIH] Xenograft: The cells of one species transplanted to another species. [NIH] Xerostomia: Decreased salivary flow. [NIH] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH]

Dictionary 215

Yeasts: A general term for single-celled rounded fungi that reproduce by budding. Brewers' and bakers' yeasts are Saccharomyces cerevisiae; therapeutic dried yeast is dried yeast. [NIH]

217

INDEX A Abdominal, 165, 199, 200 Aberrant, 28, 44, 53, 59, 165 Abscess, 15, 58, 165 Acetylcholine, 33, 165, 174, 197 Acetylcholinesterase, 39, 165 Acoustic, 27, 32, 165 Actin, 165, 195 Adaptation, 30, 33, 165, 189, 201 Adenoma, 45, 165 Adjunctive Therapy, 35, 165 Adjustment, 30, 165 Adolescence, 165, 200 Adrenal Cortex, 165, 177 Adrenal Glands, 165, 167 Adrenal Medulla, 165, 181 Adrenergic, 165, 168, 179, 181, 210 Adverse Effect, 166, 207 Aerosol, 105, 110, 134, 166 Afferent, 35, 38, 166, 177 Affinity, 166, 178, 208 Agarose, 166, 188 Age Factors, 151, 166 Age Groups, 107, 126, 166 Aged, 80 and Over, 166 Airway, 5, 9, 14, 18, 25, 29, 35, 46, 106, 110, 121, 127, 166 Alertness, 132, 166 Algorithms, 31, 166, 171 Alkaline, 166, 170, 172 Alpha Particles, 166, 204 Alternative medicine, 130, 166 Alveoli, 166, 214 Amino acid, 166, 167, 169, 200, 203, 207 Amniotic Fluid, 167, 185 Ampulla, 167, 181 Amyloidosis, 43, 167 Analog, 167, 178 Anatomical, 6, 34, 38, 39, 167, 174, 188, 194, 207 Androgens, 165, 167, 177 Anemia, 54, 145, 167 Anesthesia, 166, 167 Anesthetics, 167, 181 Angulation, 100, 167 Animal model, 33, 38, 167 Anomalies, 21, 167 Anorexia, 34, 167

Antibacterial, 167, 209 Antibiotic, 35, 167, 209 Antibodies, 167, 188, 194, 204 Antibody, 166, 167, 168, 175, 187, 188, 189, 194, 198, 204 Anticoagulants, 168, 175 Antidepressant, 69, 168 Antigen, 166, 167, 168, 176, 187, 188, 189, 194 Anti-inflammatory, 23, 35, 168, 177, 185 Anti-Inflammatory Agents, 168, 177 Antimicrobial, 35, 168 Antineoplastic, 168, 177 Antipsychotic, 168, 196, 206 Antitussive, 168, 178 Anus, 168, 169, 171, 175 Aorta, 168, 210, 214 Apathy, 168, 196 Aperture, 100, 168, 203 Aphasia, 32, 150, 168 Apnea, 28, 168 Applicability, 95, 168 Apraxia, 32, 169 Aqueous, 169, 170 Arterial, 169, 171, 185, 188, 203, 210, 214 Arteries, 168, 169, 171, 177, 193 Artery, 44, 169, 171, 177, 180, 203, 210, 214 Articular, 169, 198 Articulation, 150, 169, 179 Articulation Disorders, 150, 169 Aspartate, 38, 169, 178 Aspergillosis, 56, 169 Aspirate, 27, 29, 100, 169 Ataxia, 59, 144, 145, 169, 211 Atresia, 15, 169, 212 Atrophy, 25, 34, 69, 144, 169, 196 Atypical, 120, 169, 206 Audiology, 40, 76, 77, 78, 79, 80, 151, 169 Auscultation, 22, 60, 80, 122, 169 Autoimmune disease, 11, 169, 195 Autonomic, 34, 102, 165, 168, 169, 177, 200 Axillary, 169, 210 Axillary Vein, 169, 210 Axons, 169, 198 B Bacteria, 167, 168, 169, 170, 180, 182, 184, 193, 194, 209, 212, 213 Bacterial Physiology, 165, 169

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Bactericidal, 169, 182 Bacterium, 170, 175, 212 Barium, 4, 5, 6, 9, 11, 14, 20, 23, 24, 29, 37, 66, 79, 84, 94, 105, 110, 126, 132, 170, 182 Barium swallow, 4, 6, 11, 14, 20, 23, 24, 29, 37, 66, 79, 84, 94, 105, 126, 170, 182 Basal Ganglia, 168, 169, 170, 171 Basal Ganglia Diseases, 169, 170 Base, 39, 100, 106, 108, 121, 132, 170, 178, 190, 211 Benign, 4, 6, 11, 19, 68, 153, 165, 170, 183, 184, 186, 191, 192, 196, 199, 204, 207 Benztropine, 70, 170 Bilateral, 55, 106, 170 Bile, 170, 184, 188, 190, 192 Bile Acids, 170, 184 Bile duct, 170, 188 Bile Pigments, 170, 190 Biliary, 36, 120, 170 Biochemical, 25, 170, 198, 207 Biological therapy, 170, 186 Biomechanics, 26, 38, 40, 47, 170 Biopsy, 53, 170, 200 Biotechnology, 41, 130, 141, 143, 144, 145, 170 Biotin, 171, 198 Bladder, 171, 174, 176, 195, 196, 203, 213 Bloating, 39, 171, 184 Blood Coagulation, 171, 172 Blood pressure, 171, 185, 188, 194, 208 Blood vessel, 171, 174, 186, 187, 190, 191, 208, 209, 211, 213 Blot, 171, 198 Body Fluids, 171, 179, 183, 197, 208 Bolus, 4, 5, 6, 14, 20, 21, 23, 27, 29, 30, 32, 35, 40, 71, 84, 86, 94, 95, 104, 108, 121, 171 Bolus infusion, 171 Bone Marrow, 171, 185, 192, 209 Bowel, 26, 171, 178, 183, 190, 200, 209 Bowel Movement, 171, 178, 209 Brachytherapy, 36, 171, 189, 204 Brain Infarction, 171, 214 Brain Stem, 59, 171, 173, 214 Brain Stem Infarctions, 171, 214 Branch, 35, 161, 171, 180, 199, 208, 210, 211 Bronchi, 171, 181, 212 Buccal, 134, 172, 192 Buccopharyngeal, 38, 172 Bulbar, 123, 172 Bulimia, 34, 172

C Cachexia, 34, 172 Calcification, 23, 172 Calcinosis, 87, 172 Calcium, 25, 172, 175, 176, 193 Candidiasis, 5, 172 Candidosis, 172 Carbohydrate, 104, 107, 172, 177, 185, 198 Carbon Dioxide, 172, 184, 205 Carcinogenic, 172, 189, 202 Carcinogens, 172, 198 Carcinoma, 4, 6, 19, 42, 43, 57, 58, 70, 172 Cardia, 66, 172 Cardiac, 30, 64, 120, 173, 180, 181, 186, 195 Cardiopulmonary, 7, 173 Cardiopulmonary Resuscitation, 7, 173 Case report, 52, 71, 73, 80, 87, 88, 173, 175 Case series, 86, 173, 175 Caudal, 34, 173, 178, 188, 201 Causal, 23, 173, 211 Caustic, 15, 173 Cell, 33, 53, 144, 145, 165, 169, 170, 171, 173, 174, 175, 176, 178, 181, 183, 185, 186, 187, 189, 190, 192, 193, 194, 196, 197, 198, 201, 202, 205, 206, 209, 211, 212 Cell Division, 144, 169, 173, 186, 193, 201, 202 Cell membrane, 173, 190 Cell Respiration, 173, 206 Cell Survival, 173, 186 Central Nervous System, 15, 165, 173, 174, 180, 184, 185, 186, 195, 201, 207 Central Nervous System Diseases, 15, 173 Central Nervous System Infections, 173, 186 Cerebellar, 169, 173, 205 Cerebellum, 171, 173, 201, 205, 214 Cerebral Cortex, 169, 173, 182, 183, 203 Cerebral hemispheres, 170, 171, 173, 174 Cerebral Palsy, 4, 63, 104, 151, 174, 208 Cerebrovascular, 3, 5, 8, 18, 101, 108, 170, 174, 211 Cerebrum, 173, 174, 213 Cervical, 4, 9, 10, 22, 23, 37, 46, 48, 51, 52, 53, 54, 55, 59, 60, 69, 71, 77, 80, 108, 122, 174 Cervix, 174 Character, 174, 178, 185 Chest Pain, 4, 6, 19, 46, 120, 174 Chin, 94, 108, 174, 193 Choanal Atresia, 15, 174 Choline, 33, 165, 174

Index

Cholinergic, 36, 168, 174, 194 Cholinesterase Inhibitors, 174, 179 Chromosome, 174, 186, 191, 211 Chronic Disease, 172, 174 Chronic renal, 174, 201 Cisplatin, 64, 174 Citric Acid, 57, 175 Citrus, 175 Cleft Lip, 15, 119, 175 Cleft Palate, 15, 119, 175 Clinical Medicine, 59, 175, 202 Clinical study, 37, 175 Clinical trial, 25, 93, 96, 141, 175, 177, 203, 204 Cloning, 170, 175 Coagulation, 171, 175, 186, 211 Codeine, 175, 178 Cofactor, 175, 203 Cognition, 33, 175, 190, 196 Colon, 144, 175, 188, 191 Communication Disorders, 31, 47, 80, 83, 96, 140, 148, 149, 150, 153, 175 Competency, 37, 175 Complement, 175, 176 Complementary and alternative medicine, 83, 89, 176 Complementary medicine, 83, 176 Compliance, 40, 132, 176 Compress, 176, 187 Computational Biology, 141, 143, 176 Connective Tissue, 39, 120, 171, 176, 183, 184, 185, 192, 206, 210 Connective Tissue Cells, 176 Consciousness, 176, 178, 210 Constipation, 168, 176, 183 Constitutional, 176, 195 Constriction, 102, 176, 190, 213 Consultation, 5, 116, 176, 182 Consumption, 16, 177, 197, 199 Continuum, 11, 24, 32, 114, 115, 117, 123, 152, 177 Contraindications, ii, 177 Control group, 10, 177, 204 Conventional therapy, 177 Conventional treatment, 104, 177 Coordination, 15, 27, 29, 30, 38, 102, 120, 173, 177, 195 Coronary, 44, 177, 193 Coronary Thrombosis, 177, 193 Corpus, 32, 177, 211 Cortex, 55, 169, 177, 205 Cortical, 177, 182, 207, 211

219

Corticosteroid, 73, 177 Cranial, 102, 173, 177, 186, 196, 200 Cranial Nerves, 102, 177 Craniocerebral Trauma, 170, 177, 186, 211 Curative, 36, 39, 177, 211 Cutaneous, 172, 177, 192 Cyst, 52, 70, 169, 178 Cytotoxic, 178, 204 Cytotoxicity, 175, 178 D Degenerative, 10, 148, 178, 198 Deglutition, 6, 20, 21, 28, 29, 32, 94, 95, 123, 126, 178 Dehydration, 16, 35, 129, 178 Dementia, 22, 32, 49, 58, 77, 168, 178 Dendrites, 178, 197, 198 Density, 107, 178, 194, 198, 208 Dental Care, 115, 178 Depressive Disorder, 28, 178 Dextromethorphan, 33, 36, 178 Diagnostic procedure, 24, 79, 99, 125, 131, 151, 178 Diarrhea, 178, 183 Diastolic, 178, 188 Diathesis, 178, 186 Diencephalon, 173, 178, 188, 211 Dietitian, 12, 13, 152, 178 Digestion, 170, 171, 178, 179, 184, 190, 192, 200, 209 Digestive system, 11, 96, 178, 184, 195 Digestive tract, 25, 178, 208 Dilatation, 11, 61, 132, 178, 202 Dilation, 9, 12, 16, 58, 67, 121, 178 Dilator, 12, 179 Direct, iii, 11, 14, 29, 33, 38, 83, 114, 133, 175, 179, 194, 205, 210 Discrete, 107, 179 Disease Progression, 179, 205 Disinfectant, 179, 182 Diskectomy, 55, 179 Dissection, 39, 179 Distal, 37, 153, 179, 180, 184, 203 Diverticula, 4, 179 Diverticulum, 13, 67, 122, 132, 179 Dizziness, 23, 179, 214 Donepezil, 33, 179 Dopamine, 168, 170, 179, 197, 206 Dorsal, 179, 201 Drug Interactions, 135, 179 Duct, 167, 179, 182, 207, 209 Duodenum, 170, 179, 181, 184, 199, 209 Dysarthria, 32, 39, 122, 179

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Dysphagia

Dyskinesia, 6, 168, 179 Dyspepsia, 34, 179 Dysphonia, 9, 10, 32, 56, 180, 214 Dysphoric, 178, 180 Dysplasia, 145, 180 Dyspnea, 44, 51, 69, 180 Dystonia, 69, 168, 180 Dystrophic, 180, 181 Dystrophy, 104, 144, 180 E Echocardiography, 72, 180 Ectopic, 45, 57, 180 Edema, 180, 187 Effector, 165, 175, 180 Efferent, 35, 177, 180 Efficacy, 18, 23, 33, 40, 58, 79, 119, 180, 213 Elastic, 26, 106, 180, 185, 208 Elasticity, 106, 180 Electric shock, 173, 180 Electrode, 103, 180 Electrolyte, 177, 180, 183, 194, 197, 202, 208 Electromyography, 27, 40, 94, 108, 114, 119, 122, 126, 180 Electrophoresis, 180, 188 Electrophysiological, 49, 180 Embolus, 180, 189 Encephalitis, 66, 180, 181 Encephalitis, Viral, 180, 181 Encephalopathy, 73, 181 Endocarditis, 172, 181 Endogenous, 38, 179, 181 Endoscope, 181 Endoscopic, 9, 14, 21, 23, 24, 42, 56, 57, 60, 64, 67, 79, 80, 122, 181 End-stage renal, 174, 181, 201 Energetic, 30, 181 Environmental Exposure, 181, 198 Environmental Health, 140, 142, 181 Enzymatic, 167, 172, 176, 181 Enzyme, 165, 180, 181, 185, 200, 206, 214 Eosinophilic, 57, 72, 73, 88, 181 Epidermal, 181, 193, 194 Epidermolysis Bullosa, 11, 181 Epigastric, 181, 199 Epiglottis, 15, 29, 102, 181 Epinephrine, 64, 165, 179, 181, 197 Epithelial, 52, 165, 182, 199 Epithelium, 182, 198 Equipment and Supplies, 21, 182 Erectile, 109, 182 Erection, 182

Erythrocytes, 167, 171, 182 Esophageal Manometry, 22, 182 Esophageal Spasms, 109, 182 Esophageal Stricture, 120, 130, 182 Esophagitis, 6, 15, 57, 72, 73, 88, 182 Esophagram, 5, 170, 182 Essential Tremor, 144, 182 Ethanol, 80, 182 Evoke, 182, 209 Excitation, 38, 182, 197 Excitatory, 38, 182, 185 Excitotoxicity, 36, 182 Exocrine, 182, 199 Exogenous, 181, 182 Expert Systems, 182, 184 Expiration, 182, 183, 205 Expiratory, 183, 201 External-beam radiation, 183, 204 Extracellular, 176, 183, 208 Extracellular Matrix, 176, 183 Extrapyramidal, 70, 168, 179, 183 F Failure to Thrive, 8, 21, 30, 34, 123, 183 Family Planning, 141, 183 Family Practice, 87, 183 Fat, 171, 177, 180, 183, 185, 191, 192, 195, 198, 206, 208 Feeding Behavior, 34, 123, 183 Fibroid, 183, 191 Fibrosis, 121, 145, 183, 207 Fissure, 175, 183 Fistula, 51, 65, 183 Fluid Therapy, 183, 197 Fluoroscopy, 39, 110, 126, 183 Fold, 23, 48, 55, 183, 199 Foramen, 174, 183 Forearm, 171, 183, 204 Functional Disorders, 26, 183 Fungi, 169, 183, 184, 193, 194, 211, 215 Fungus, 172, 183 Fuzzy Logic, 31, 184 G Gallbladder, 165, 170, 178, 184 Gamma Rays, 184, 204 Ganglia, 165, 170, 184, 196, 200 Gas, 172, 183, 184, 187, 189, 203, 206, 214 Gas exchange, 184, 206, 214 Gastric, 31, 40, 184, 186, 200 Gastric Emptying, 184 Gastric Juices, 184, 200 Gastroenterologist, 39, 122, 184

Index

Gastroesophageal Reflux, 5, 6, 15, 34, 115, 120, 184 Gastrointestinal stromal tumor, 58, 184 Gastrointestinal tract, 44, 120, 174, 182, 183, 184, 191, 207, 209 Gastroparesis, 109, 184 Gastrostomy, 31, 79, 184 Gene, 33, 36, 43, 58, 145, 146, 171, 184, 185, 186, 187, 198, 201, 205 Gene Expression, 145, 184, 185 Gene Therapy, 33, 184 Generator, 35, 38, 102, 185 Genotype, 185, 201 Germline mutation, 58, 185, 187 Gestational, 63, 185 Gestational Age, 63, 185 Gland, 45, 165, 185, 192, 199, 201, 203, 207, 209, 211 Globus Sensation, 16, 120, 185 Glottis, 102, 185 Glucocorticoids, 165, 177, 185 Glucose, 144, 185, 186 Glutamate, 33, 36, 38, 178, 182, 185 Gluten, 106, 185 Governing Board, 185, 202 Graft, 185, 187 Grafting, 61, 185 Gravis, 8, 18, 43, 61, 185 Growth factors, 33, 186 H Haematoma, 45, 186 Haematuria, 186 Haemodialysis, 42, 186 Haemophilia, 45, 186 Headache, 23, 186 Headache Disorders, 186 Health Status, 17, 186 Hearing Disorders, 175, 186 Heart Arrest, 173, 186 Heartburn, 19, 42, 120, 186 Hematoma, 186, 187 Hemoglobin, 167, 182, 186, 199 Hemoglobinopathies, 185, 186 Hemoglobinuria, 144, 186 Hemorrhage, 177, 186, 187, 209 Hemorrhagic stroke, 66, 187 Hereditary, 185, 187, 196, 206 Hereditary mutation, 185, 187 Heredity, 184, 187 Hoarseness, 10, 55, 187 Homogeneous, 177, 187 Homologous, 185, 187, 210

221

Hormonal, 169, 177, 187 Hormone, 177, 181, 187, 206, 211 Hospice, 28, 187 Host, 109, 172, 187 Hybrid, 25, 187, 198 Hybridization, 38, 187, 198 Hydration, 4, 9, 17, 27, 31, 95, 187 Hydrogen, 170, 172, 187, 194, 197, 203 Hydrolysis, 165, 174, 187 Hyperbilirubinemia, 187, 190 Hyperostosis, 49, 85, 187 Hyperreflexia, 187, 211 Hypersensitivity, 26, 187, 206 Hypertension, 34, 186, 188 Hypopharynx, 14, 109, 188 Hypothalamus, 34, 178, 188, 201, 211 I Id, 81, 88, 144, 148, 153, 154, 160, 162, 188 Idiopathic, 29, 49, 79, 85, 188 Ileus, 36, 188 Immune response, 168, 169, 177, 188 Immunodeficiency, 144, 188 Immunodiffusion, 188 Immunoelectrophoresis, 39, 188 Immunofluorescence, 188, 194 Immunoglobulin, 60, 167, 188, 194 Immunohistochemistry, 39, 188 Immunologic, 14, 185, 188, 204 Impaction, 57, 188 Impairment, 6, 18, 21, 37, 55, 116, 121, 169, 179, 180, 188, 191, 193 Implant radiation, 188, 189, 204 Impotence, 182, 188 In vitro, 26, 185, 188 In vivo, 26, 33, 35, 185, 188 Incision, 188, 190, 212 Incompetence, 184, 188 Indicative, 116, 188, 199, 213 Infancy, 8, 11, 188 Infant, Newborn, 166, 188 Infarction, 54, 61, 171, 177, 187, 189, 193 Infection, 10, 62, 170, 172, 180, 181, 188, 189, 192, 206, 210, 211 Inflammation, 10, 122, 168, 180, 181, 182, 183, 189, 195, 200, 201, 206, 209, 210, 212, 213 Infusion, 34, 189 Ingestion, 15, 104, 106, 122, 189 Inhalation, 166, 189 Initiation, 40, 70, 189 Innervation, 105, 189, 198 Inorganic, 174, 189

222

Dysphagia

Inpatients, 5, 189 Insight, 36, 53, 189 Institutionalization, 14, 25, 189 Insufflation, 40, 189 Insulator, 189, 195 Intensive Care, 115, 189 Intermittent, 4, 6, 19, 183, 189, 192 Internal Medicine, 184, 189 Internal radiation, 189, 204 Interstitial, 171, 189 Intervertebral, 179, 189 Intestinal, 190, 192 Intestine, 171, 190, 191, 200 Intracellular, 189, 190, 202 Intramuscular, 186, 190 Intravenous, 60, 189, 190 Intrinsic, 4, 25, 166, 190, 191 Invasive, 28, 32, 56, 63, 102, 103, 190, 192, 199 Involuntary, 11, 120, 170, 182, 190, 195, 205, 208 Ionizing, 166, 181, 190, 204 Ions, 170, 180, 187, 190, 194 Iridium, 36, 190 Ischemia, 169, 187, 190 Isoelectric, 101, 190 Isotonic, 104, 105, 190 J Jaundice, 36, 187, 190 Joint, 27, 64, 78, 169, 190, 198, 210 K Kb, 140, 190 Kidney Disease, 95, 96, 140, 145, 190 Kinetics, 25, 190 L Laceration, 190, 211 Language Development, 190, 191 Language Development Disorders, 190, 191 Language Disorders, 150, 175, 191 Language Therapy, 79, 191 Large Intestine, 178, 190, 191, 205, 208 Laryngeal, 5, 8, 13, 15, 25, 27, 28, 29, 35, 40, 51, 84, 94, 95, 106, 108, 114, 116, 121, 191 Laryngeal Muscles, 25, 191 Laryngoscope, 24, 66, 70, 79, 191 Latency, 35, 191 Latent, 37, 191 Leiomyoma, 15, 183, 191 Leiomyosarcoma, 43, 191 Length of Stay, 5, 191

Leukemia, 144, 185, 191 Levorphanol, 178, 191 Library Services, 160, 191 Life Expectancy, 31, 191 Ligament, 191, 203 Linkage, 33, 191 Lip, 175, 191 Lipid, 101, 174, 191, 195 Lipoma, 68, 192 Liver, 46, 47, 54, 58, 120, 165, 167, 170, 171, 178, 184, 185, 192 Localization, 188, 192 Localized, 61, 165, 167, 186, 189, 192, 201, 207, 211, 213, 214 Long-Term Care, 22, 59, 80, 93, 192 Lower Esophageal Sphincter, 184, 192 Lumen, 108, 192 Lupus, 53, 55, 192, 210 Lymph, 169, 174, 192 Lymph node, 169, 174, 192 Lymphatic, 189, 192, 209 Lymphoid, 167, 192, 212 Lymphoma, 53, 144, 192 M Magnetic Resonance Imaging, 33, 71, 192, 197 Malabsorption, 144, 192 Malformation, 53, 62, 192 Malignant, 6, 36, 46, 57, 58, 60, 64, 73, 144, 168, 184, 192, 196, 204, 207 Malnutrition, 12, 16, 21, 24, 76, 119, 169, 172, 192, 195 Mammogram, 172, 192, 193 Mandible, 121, 174, 192 Manifest, 120, 192 Manometry, 4, 6, 12, 16, 20, 22, 39, 65, 119, 122, 126, 132, 148, 192 Masseter Muscle, 108, 192 Masticatory, 192, 193 Maxillary, 175, 193 Mechanical ventilation, 28, 193 Medial, 175, 193, 198, 214 Medical Records, 193, 206 Medicament, 108, 193 MEDLINE, 141, 143, 145, 193 Medullary, 38, 53, 54, 61, 72, 79, 178, 193, 203 Meiosis, 193, 210 Melanocytes, 193 Melanoma, 144, 193 Membrane, 173, 174, 176, 181, 183, 186, 191, 193, 194, 206

Index

Memory, 167, 178, 193 Meninges, 173, 177, 193, 210 Mental, iv, 25, 28, 41, 77, 97, 140, 142, 146, 174, 175, 178, 188, 191, 193, 203, 205, 207 Mental Disorders, 97, 191, 193, 203 Mental Health, iv, 25, 28, 97, 140, 142, 193 Mental Retardation, 146, 175, 193 Mesoderm, 175, 193 MI, 46, 78, 163, 193 Microbiology, 56, 165, 169, 193 Microcalcifications, 172, 193 Microorganism, 175, 193, 214 Microscopy, 39, 194 Migration, 175, 194 Mineralocorticoids, 165, 177, 194 Mixed Connective Tissue Disease, 11, 194 Mobility, 40, 194 Modeling, 37, 194 Modification, 16, 18, 23, 30, 31, 119, 167, 194, 203 Modulator, 102, 194 Molecular, 33, 36, 39, 64, 141, 143, 170, 176, 194, 212, 213 Molecular Structure, 194, 213 Molecule, 168, 170, 176, 180, 182, 186, 187, 194, 197, 204, 205 Monitor, 115, 194, 197 Monoclonal, 194, 204 Motility, 4, 6, 19, 26, 30, 183, 194, 207 Motor Activity, 38, 66, 194 Motor Endplate, 39, 194 Motor Skills, 123, 194 Mucins, 194, 206 Mucosa, 34, 192, 194, 195 Mucositis, 34, 194 Multiple sclerosis, 8, 22, 54, 94, 122, 195 Muscle Contraction, 29, 195 Muscle Fibers, 39, 195 Muscular Atrophy, 144, 195 Muscular Diseases, 8, 195 Muscular Dystrophies, 180, 195 Musculature, 25, 95, 195 Myasthenia, 8, 18, 43, 61, 195 Mydriatic, 179, 195 Myelin, 195 Myocardium, 193, 195 Myopathy, 47, 49, 69, 195 Myosin, 39, 195 Myositis, 60, 148, 195 Myotonic Dystrophy, 144, 195 N Nasal Cavity, 102, 195

223

Nasal Obstruction, 15, 195 Nasal Septum, 195 Nasogastric, 62, 63, 65, 69, 195 Nasopharynx, 102, 121, 195 Nausea, 168, 184, 195 NCI, 1, 96, 139, 195 Need, 3, 9, 11, 13, 19, 29, 105, 110, 113, 119, 123, 125, 131, 135, 155, 174, 196 Needs Assessment, 76, 196 Neonatal, 51, 115, 196 Neoplasia, 144, 196 Neoplasm, 196, 199, 213 Neoplastic, 10, 15, 192, 196 Nephropathy, 190, 196 Nervous System, 34, 144, 166, 173, 196, 197, 200, 210 Networks, 31, 38, 196 Neural, 31, 34, 35, 126, 166, 196 Neuralgia, 23, 196 Neurodegenerative Diseases, 102, 103, 170, 196 Neurofibroma, 15, 196 Neurogenic, 24, 35, 43, 47, 57, 62, 66, 79, 83, 116, 118, 122, 196 Neuroleptic, 6, 68, 168, 196 Neurologic, 3, 5, 8, 11, 14, 15, 21, 23, 24, 31, 106, 114, 127, 196 Neurologist, 94, 196 Neurology, 25, 35, 36, 49, 53, 54, 60, 61, 62, 63, 65, 66, 78, 79, 94, 196 Neuromuscular, 4, 5, 8, 10, 11, 14, 15, 18, 21, 43, 67, 94, 103, 106, 132, 151, 165, 196, 198 Neuromuscular Junction, 15, 165, 196, 198 Neuronal, 33, 37, 38, 196 Neurons, 33, 38, 54, 178, 182, 184, 196, 198, 205, 210 Neurophysiology, 8, 48, 114, 197 Neurotoxicity, 178, 197 Neurotransmitter, 165, 167, 174, 179, 185, 197 Neutrons, 166, 197, 204 Nonverbal Communication, 175, 197 Nuclear, 32, 64, 76, 170, 184, 194, 197, 211 Nuclear magnetic resonance imaging, 32, 197 Nuclei, 166, 185, 192, 197, 201, 203 Nucleic acid, 187, 197, 198 Nucleic Acid Hybridization, 187, 197 Nucleus, 38, 170, 184, 193, 197, 202, 203, 211 Nursing Assessment, 115, 197

224

Dysphagia

Nursing Care, 197, 199, 200 Nursing Staff, 48, 197 Nutritional Status, 6, 8, 15, 30, 33, 35, 119, 197 Nutritional Support, 15, 115, 119, 184, 197 Nutritive Value, 24, 198 O Occipital Lobe, 198, 214 Ocular, 198 Odynophagia, 6, 10, 64, 120, 122, 198 Office Management, 120, 198 Olfactory Bulb, 198 Olfactory Receptor Neurons, 33, 36, 198, 205 Oligonucleotide Probes, 38, 198 Oncogene, 144, 198 Opacity, 178, 198 Ophthalmoplegia, 43, 198 Optic Chiasm, 188, 198 Oral Health, 118, 123, 198 Oral Hygiene, 123, 198 Oropharynx, 8, 52, 102, 109, 119, 188, 198 Osteoarthritis, 4, 23, 198 Otolaryngology, 9, 18, 19, 23, 37, 38, 45, 52, 59, 71, 79, 115, 149, 151, 152, 199 Outpatient, 114, 199 Overdose, 69, 199 Oximetry, 23, 199 Oxygen Consumption, 199, 206 Oxygenation, 187, 199 P Palate, 5, 34, 95, 102, 121, 175, 195, 199 Palliative, 28, 30, 35, 36, 46, 58, 71, 199, 211 Palliative therapy, 35, 199 Pancreas, 59, 120, 165, 171, 178, 184, 199 Pancreatic, 144, 184, 199 Pancreatic cancer, 144, 199 Pancreatic Juice, 184, 199 Papilloma, 15, 199 Paralysis, 15, 48, 71, 169, 172, 198, 199, 208 Parent-Child Relations, 123, 199 Paroxysmal, 144, 186, 199 Pathogenesis, 35, 38, 199 Pathologic, 14, 65, 170, 172, 177, 187, 199, 213 Pathologies, 34, 151, 199 Pathologist, 7, 8, 10, 12, 15, 18, 114, 118, 122, 126, 150, 199 Pathophysiology, 6, 32, 37, 39, 40, 106, 120, 121, 199 Patient Care Management, 24, 199 Patient Care Planning, 197, 200

Patient Care Team, 122, 200 Patient Education, 149, 152, 158, 160, 163, 200 Pediatrics, 36, 70, 86, 119, 126, 200 Pelvic, 200, 203 Pelvis, 191, 200, 213 Pepsin, 200 Peptic, 19, 120, 132, 200 Peptide, 166, 200, 203 Perception, 70, 79, 186, 200 Percutaneous, 79, 179, 200 Perforation, 168, 183, 200 Pericardium, 200, 210 Peripheral Nervous System, 179, 196, 197, 200, 203, 207 Peristalsis, 106, 200 Peritoneal, 120, 200 Peritoneum, 200 Pharmacologic, 23, 167, 200, 212 Pharyngeal Muscles, 35, 108, 200 Pharyngitis, 15, 200 Pharynx, 11, 27, 30, 32, 94, 102, 103, 106, 108, 120, 121, 172, 184, 188, 195, 198, 200 Phenotype, 36, 200 Phonation, 25, 201 Phosphorus, 172, 201 Physical Examination, 5, 8, 11, 13, 16, 185, 201 Physical Therapy, 108, 132, 201 Physiologic, 6, 8, 11, 32, 65, 108, 127, 190, 201, 205 Pitch, 201, 214 Pituitary Gland, 177, 201 Plants, 172, 174, 175, 185, 201, 212 Plasticity, 37, 201 Platinum, 174, 201 Pleomorphic, 45, 201 Pneumonitis, 18, 201 Polycystic, 145, 201 Pons, 171, 201 Posterior, 15, 169, 173, 179, 198, 199, 201 Postoperative, 10, 39, 66, 121, 202 Postoperative Period, 121, 202 Postsynaptic, 194, 202 Postural, 8, 23, 122, 202 Potassium, 194, 202 Potentiate, 35, 202 Practicability, 202, 213 Practice Guidelines, 142, 152, 153, 202 Precursor, 174, 179, 180, 181, 198, 202 Predictive factor, 60, 73, 202 Pregnancy Tests, 185, 202

Index

Preoperative, 10, 65, 66, 202 Presynaptic, 194, 197, 202 Prevalence, 18, 28, 54, 68, 202 Probe, 65, 198, 202 Prognostic factor, 54, 202 Progression, 3, 37, 167, 202 Progressive, 13, 19, 28, 42, 93, 123, 174, 178, 185, 195, 196, 198, 202, 213 Promoter, 36, 202 Prophase, 202, 210 Prospective Studies, 13, 23, 202 Prospective study, 28, 31, 50, 59, 203 Prostate, 144, 203 Protein S, 145, 171, 203 Proteins, 33, 36, 38, 166, 168, 171, 173, 175, 187, 188, 190, 194, 198, 200, 203, 205, 207 Protocol, 29, 94, 116, 117, 203 Protons, 166, 187, 190, 203, 204 Proximal, 120, 179, 195, 202, 203 Pseudobulbar Palsy, 85, 203 Psychiatric, 14, 41, 175, 193, 203 Psychiatry, 53, 62, 65, 70, 77, 84, 203, 214 Psychic, 193, 203, 207 Psychogenic, 87, 203 Psychomotor, 196, 203 Public Policy, 141, 203 Pulmonary, 21, 28, 37, 102, 122, 123, 171, 177, 181, 203, 206, 213, 214 Pulmonary Ventilation, 203, 206 Pulse, 23, 102, 103, 194, 199, 203 Pupil, 178, 195, 203 Pyramidal Tracts, 183, 203 Q Quality of Life, 11, 17, 25, 35, 36, 37, 51, 71, 93, 123, 199, 203 R Radiation, 36, 55, 121, 132, 179, 181, 183, 184, 189, 190, 203, 204, 214 Radiation therapy, 55, 121, 132, 179, 183, 189, 204 Radioactive, 94, 187, 188, 189, 197, 204 Radiography, 21, 185, 204 Radioimmunotherapy, 204 Radioisotope, 198, 204 Radiolabeled, 204 Radiological, 9, 66, 200, 204 Radiologist, 14, 18, 122, 204 Radiology, 14, 76, 153, 204 Radiopharmaceutical, 185, 204 Radiotherapy, 36, 171, 204 Radius, 26, 100, 204 Random Allocation, 204

225

Randomization, 29, 204 Randomized, 24, 27, 42, 51, 66, 79, 180, 204, 205 Randomized clinical trial, 27, 205 Receptor, 33, 34, 38, 165, 168, 178, 179, 198, 205, 207 Receptors, Odorant, 198, 205 Recombination, 185, 205 Rectum, 168, 171, 175, 178, 184, 191, 203, 205 Recurrence, 205 Red Nucleus, 169, 205 Refer, 1, 172, 175, 179, 183, 192, 196, 197, 204, 205, 212 Reflective, 40, 205 Reflex, 11, 65, 77, 102, 106, 205 Reflux, 9, 39, 184, 205 Refraction, 205, 208 Regimen, 95, 121, 180, 205 Regurgitation, 4, 6, 20, 89, 184, 186, 205 Rehabilitative, 119, 132, 205 Reliability, 60, 72, 205 Reoperation, 57, 205 Reproductive cells, 185, 187, 205 Respiration, 27, 114, 168, 172, 194, 205 Respirator, 193, 206, 214 Respiratory Physiology, 206, 213 Respiratory System, 11, 206 Response rate, 10, 206 Restoration, 201, 206 Retina, 198, 206 Retinoblastoma, 144, 206 Retrograde, 32, 38, 206 Retrospective, 42, 78, 87, 206 Retrospective study, 42, 206 Retrosternal, 70, 206 Retroviral vector, 185, 206 Rheology, 7, 206 Rheumatism, 206 Rheumatoid, 11, 23, 51, 54, 206 Rheumatoid arthritis, 11, 23, 51, 54, 206 Ribonuclease, 194, 206 Rigidity, 26, 201, 206 Risk factor, 13, 17, 19, 21, 203, 206 Risperidone, 52, 70, 206 Rod, 52, 170, 206 S Saliva, 4, 6, 20, 206, 207 Salivary, 45, 178, 199, 206, 207, 214 Salivary glands, 178, 206, 207 Schizophrenia, 206, 207 Schwannoma, 52, 207

226

Dysphagia

Scleroderma, 4, 6, 19, 194, 207 Sclerosis, 8, 10, 28, 43, 62, 87, 109, 122, 144, 148, 195, 207 Screening, 13, 105, 106, 110, 117, 175, 207 Secretion, 177, 185, 194, 207 Seizures, 199, 207 Semen, 203, 207 Sensor, 65, 207 Septic, 23, 207 Serotonin, 168, 197, 206, 207 Serum, 175, 190, 194, 207 Sex Determination, 145, 207 Shock, 207, 213 Side effect, 5, 6, 27, 30, 34, 70, 104, 133, 135, 166, 168, 170, 179, 207, 212 Signs and Symptoms, 20, 24, 94, 148, 207 Skeletal, 32, 49, 85, 167, 174, 195, 207, 208 Skeleton, 165, 190, 207, 208 Skull, 121, 177, 208, 211 Small intestine, 179, 187, 190, 195, 208 Smooth muscle, 176, 183, 191, 195, 208 Social Environment, 203, 208 Sodium, 194, 208 Soft tissue, 121, 171, 198, 208 Solvent, 182, 208 Soma, 208 Somatic, 34, 165, 177, 193, 200, 208 Sound wave, 94, 204, 205, 208 Spasm, 4, 6, 19, 23, 120, 208 Spasmodic, 32, 208 Spastic, 4, 6, 19, 208 Spasticity, 208 Spatial disorientation, 179, 208 Specialist, 114, 154, 179, 208, 209 Species, 181, 187, 193, 194, 208, 211, 213, 214 Spectrum, 27, 208 Speech Disorders, 31, 151, 209 Speech pathologist, 18, 94, 106, 209 Sperm, 167, 174, 185, 187, 205, 209 Sphincter, 11, 12, 13, 21, 27, 28, 40, 47, 65, 94, 108, 121, 191, 209 Spinal cord, 54, 171, 173, 193, 196, 200, 203, 205, 209, 210 Spleen, 167, 192, 209 Spondylitis, 23, 209 Spondylolisthesis, 23, 209 Sporadic, 196, 206, 209 Staff Development, 4, 209 Standardize, 14, 209 Statistically significant, 10, 24, 209 Stenosis, 209

Stent, 36, 43, 61, 73, 209 Sternum, 206, 209 Steroids, 177, 209 Stimulus, 102, 108, 180, 182, 189, 191, 205, 209, 211 Stomach, 8, 15, 102, 103, 107, 165, 172, 178, 182, 184, 187, 192, 195, 200, 205, 208, 209 Stool, 175, 188, 191, 209 Stress, 13, 14, 15, 18, 26, 39, 84, 119, 121, 123, 183, 185, 195, 206, 209 Stricture, 19, 132, 209 Stridor, 51, 209 Stromal, 209 Subacute, 11, 114, 189, 209 Subarachnoid, 186, 210 Subclavian, 44, 53, 59, 169, 210 Subclavian Artery, 44, 53, 59, 210 Subclinical, 189, 207, 210 Subcutaneous, 180, 186, 191, 210 Suppression, 177, 210 Sympathomimetic, 179, 181, 210 Symphysis, 174, 203, 210 Symptomatic, 11, 12, 103, 170, 210 Symptomatic treatment, 170, 210 Symptomatology, 115, 123, 210 Synapse, 165, 196, 198, 202, 210, 212 Synapsis, 210 Synaptic, 37, 38, 194, 197, 210 Syncope, 210, 214 Systemic, 3, 10, 14, 15, 55, 87, 134, 167, 168, 171, 172, 181, 189, 194, 204, 207, 210 Systemic disease, 10, 210 Systemic lupus erythematosus, 10, 55, 194, 210 Systolic, 188, 210 T Tardive, 6, 168, 210 Telangiectasia, 145, 211 Telomere, 186, 211 Temporal, 26, 28, 30, 186, 211, 214 Temporal Lobe, 211, 214 Terminal disease, 29, 211 Tetani, 211 Tetanic, 211 Tetanus, 49, 211 Thalamic, 169, 211 Thalamic Diseases, 169, 211 Thalamus, 178, 211, 214 Therapeutics, 46, 49, 85, 87, 135, 211 Thermal, 23, 103, 197, 211 Third Ventricle, 188, 211

Index

Thoracic, 37, 43, 51, 55, 61, 64, 72, 210, 211, 214 Threshold, 188, 211 Thrombosis, 203, 209, 211 Thrombus, 177, 189, 211 Thrush, 172, 211 Thyroid, 6, 43, 57, 211 Time Factors, 166, 212 Tone, 107, 182, 198, 208, 212 Tonic, 39, 212 Tonicity, 180, 190, 212 Tonsillitis, 15, 212 Tonsils, 212 Tonus, 212 Tooth Preparation, 165, 212 Topical, 73, 134, 182, 212 Torsion, 189, 212 Toxic, iv, 178, 180, 181, 212 Toxicity, 179, 212 Toxicology, 142, 212 Toxin, 23, 47, 57, 69, 211, 212 Trachea, 101, 102, 172, 191, 200, 209, 211, 212 Tracheoesophageal Fistula, 15, 212 Tracheostomy, 28, 212 Tracheotomy, 13, 212 Transcutaneous, 87, 212 Transfection, 170, 185, 212 Transmitter, 165, 179, 212 Transplantation, 38, 42, 174, 213 Trauma, 15, 23, 44, 51, 60, 182, 213 Treatment Outcome, 40, 47, 213 Tricyclic, 69, 213 Tuberous Sclerosis, 145, 213 Tumour, 43, 213 Tunica, 194, 213 U Ulcer, 213 Ulceration, 34, 122, 213 Ultrasonography, 20, 23, 26, 114, 123, 185, 213 Unconscious, 167, 188, 213

227

Unresectable, 58, 213 Urethra, 203, 213 Urine, 171, 186, 213 Uterus, 174, 177, 183, 191, 213 V Vaccine, 203, 213 Vagina, 172, 174, 213 Vaginitis, 172, 213 Vascular, 4, 15, 44, 67, 186, 189, 211, 213 Vasoconstriction, 181, 213 Vein, 169, 190, 197, 210, 213 Venous, 169, 171, 203, 213 Ventilation, 25, 28, 173, 213, 214 Ventilator, 193, 206, 214 Ventricle, 203, 210, 211, 214 Ventricular, 52, 214 Vertebrae, 189, 209, 214 Vertebrobasilar Insufficiency, 23, 214 Vertigo, 214 Vestibule, 195, 214 Veterinary Medicine, 141, 214 Visceral, 26, 34, 177, 200, 214 Viscosity, 17, 24, 28, 29, 33, 80, 104, 107, 109, 206, 214 Vitro, 35, 214 Vivo, 214 Vocal cord, 15, 50, 71, 185, 201, 214 Voice Disorders, 148, 150, 214 Voice Quality, 25, 214 Volition, 190, 214 Vomitus, 36, 214 W Weight Gain, 183, 214 Windpipe, 200, 211, 214 X Xenograft, 167, 214 Xerostomia, 6, 121, 214 X-ray, 14, 132, 170, 182, 183, 184, 192, 197, 204, 214 Y Yeasts, 172, 183, 201, 215

228

Dysphagia