Esophageal Clearance Patterns in Normal Older Adults as Documented with Videofluoroscopic Esophagram

Normal esophageal bolus transport in asymptomatic healthy older adults has not been well defined, potentially leading to ambiguity in differentiating esophageal swallowing patterns of dysphagic and healthy individuals. This pilot study of 24 young (45–64 years) and old (65+years) men and women was designed to assess radiographic esophageal bolus movement patterns in healthy adults using videofluoroscopic recording. Healthy, asymptomatic adults underwent videofluoroscopic esophagram to evaluate for the presence of ineffective esophageal clearance, namely, intraesophageal stasis and intraesophageal reflux. Intraesophageal stasis and intraesophageal reflux were visualized radiographically in these normal subjects. Intraesophageal stasis occurred significantly more frequently with semisolid (96%) compared with liquid (16%) barium, suggesting that a variety of barium consistencies, as opposed to only the traditional fluids, would better define the spectrum of esophageal transport. Intraesophageal reflux was observed more frequently in older males than in their younger counterparts. The rates of intraesophageal stasis and intraesophageal reflux were potentially high given that successive bolus presentations were spaced 10 seconds apart. These findings suggest a need for a more comprehensive definition regarding the range of normal esophageal bolus transport to (a) prevent misdiagnosis of dysphagia and (b) to enhance generalization to functional eating, which involves solid foods in addition to liquids

Patient perception of pain versus observed pain behavior during a standardized electrodiagnostic test

Introduction: Clinicians often assume that observations of pain behavior are adequate for assessment of patient pain perception during procedures. This has not been tested during a standardized electrodiagnostic experience. Methods: During a prospective trial including extensive, standardized electrodiagnostic testing on persons with lumbar stenosis, vascular claudication, and asymptomatic volunteers, the subjects and an observer rated levels of pain. Results: In 60 subjects, observers significantly under‐rated pain (Visual Analog Scale 3.17 ± 2.23 vs. 4.38 ± 2.01, t = −4.577, df = 59, P < 0.001). Perceived pain during testing related to bodily pain as measured by the visual analog, McGill, Pain Disability, and Quebec scales, but not age, duration of symptoms, Tampa kinesiphobia, Center for Epidemiological Studies Depression scale, or SF‐36 health quality of life. Conclusions: Persons with worse pain syndromes may perceive more pain during testing than others. Clinicians and researchers should understand that patients may have more pain than they recognize. Muscle Nerve 51: 185–191, 2015Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/110539/1/mus24308.pd

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Die Judenschule, oder gründliche Anleitung, in kurzer Zeit ein vollkommener schwarzer oder weißer Jude zu werden

von Hartwig Hundt von Radowsk

Judenspiegel : ein Schand- und Sittengemälde alter und neuer Zeit

von Hartwig von Hundt-Radowsk