Swallowing evaluation with videofluoroscopy in the paediatric population

Paediatric swallowing disorders can have several causes, from prematurity and congenital anomalies to gastro-oesophageal reflux and infective or inflammatory pathologies of the upper digestive tract. In neonates, the swallowing process is reflexive and involuntary. Later in infancy, the oral phase comes under voluntary control, while the pharyngeal phase and oesophageal phases remain involuntary. Swallowing difficulties can severely compromise pulmonary health and nutritional intake of paediatric patients. Videofluoroscopic Swallow Study (VFSS) is a radiographic procedure that provides a dynamic view of the swallowing process and is frequently considered to be definitive evaluation for objective assessment of dysphagia in paediatric patients. This review focuses on the different possible aetiologies of paediatric swallowing disorders and related videofluoroscopic swallowing study procedures and appearances

Swallowing disorders after thyroidectomy: What we know and where we are. A systematic review

Introduction Dysphagia and hoarseness are possible complications that can be observed in patients undergoing thyroidectomy or other neck surgery procedures. These complaints are usually related to superior and inferior laryngeal nerves dysfunction, but these can appear even after uncomplicated surgical procedure. Methods We reviewed the current literature available on MEDLINE database, concerning the swallowing disorders appearing after the thyroidectomy. The articles included in the review reported pathophysiology and diagnostic concerns. Results Twenty articles were selected for inclusion in the review. Depends on the possible causes of the difficulty swallowing (related to nerve damage or appearing after uncomplicated thyroidectomy), different types of diagnostic procedures could be used to study patient discomfort, as well as intraoperative nerve monitoring, fiber optic laryngoscopy, endoscopy, pH monitoring, esophageal manometry and videofluorography. Among all these procedures, videofluorography is considered the gold standard to evaluate the entire swallowing process, since that allows a real-time study of all the three phases of swallowing: oral phase, pharyngeal phase and esophageal phase. Conclusion The diagnostic procedures described can help to identify the mechanisms involved in swallowing disorders, with the aim to choose the best therapeutic option. More studies are needed for understanding the causes of the dysphagia appearing after thyroidectomy

A comparison of Bayesian and non-linear regression methods for robust estimation of pharmacokinetics in DCE-MRI and how it affects cancer diagnosis

The aim of this work is to compare Bayesian Inference for nonlinear models with commonly used traditional non-linear regression (NR) algorithms for estimating tracer kinetics in Dynamic Contrast Enhanced Magnetic Resonance Imaging (DCE-MRI). The algorithms are compared in terms of accuracy, and reproducibility under different initialization settings. Further it is investigated how a more robust estimation of tracer kinetics affects cancer diagnosis. The derived tracer kinetics from the Bayesian algorithm were validated against traditional NR algorithms (i.e. Levenberg-Marquardt, simplex) in terms of accuracy on a digital DCE phantom and in terms of goodness-of-fit (Kolmogorov-Smirnov test) on ROI-based concentration time courses from two different patient cohorts. The first cohort consisted of 76 men, 20 of whom had significant peripheral zone prostate cancer (any cancer-core-length (CCL) with Gleason>3+3 or any-grade with CCL>=4mm) following transperineal template prostate mapping biopsy. The second cohort consisted of 9 healthy volunteers and 24 patients with head and neck squamous cell carcinoma. The diagnostic ability of the derived tracer kinetics was assessed with receiver operating characteristic area under curve (ROC AUC) analysis. The Bayesian algorithm accurately recovered the ground-truth tracer kinetics for the digital DCE phantom consistently improving the Structural Similarity Index (SSIM) across the 50 different initializations compared to NR. For optimized initialization, Bayesian did not improve significantly the fitting accuracy on both patient cohorts, and it only significantly improved the ve ROC AUC on the HN population from ROC AUC=0.56 for the simplex to ROC AUC=0.76. For both cohorts, the values and the diagnostic ability of tracer kinetic parameters estimated with the Bayesian algorithm weren't affected by their initialization. To conclude, the Bayesian algorithm led to a more accurate and reproducible quantification of tracer kinetic parameters in DCE-MRI, improving their ROC-AUC and decreasing their dependence on initialization settings

Usefulness of SonoVue in the identification of sentinel nodes in patients with breast cancer

Purpose Preoperative lymphoscintigraphy, introduced accordingly to sentinel lymph node biopsy (SLNB), is considered the gold standard for accurate axillary lymph node staging for breast cancer [4-9]. The technique, for the low radiation doses used (average absorbed doses of 0.5-1 mGy), is considered the almost devoid of carcinogenic potential. However lymphoscintigraphy has limitations such as the need of specialized medical and technician personnel and having to follow the strict and precise protectionist rules. Lymphatic imaging after intraparenchymal microbubble injection has been reported in animal models, and only few papers report human use. The aim of our study was to investigate the dynamics of intradermal injection of microbubbles as they travel to draining SLNs and to identify and localize SLNs before surgery in patients with breast cancer. Methods and Materials 14 consecutive consenting women (mean age 61 years, range 39-70), with primary breast cancer were subjected to periareolar intradermal injection of of 0.5 ml of SonoVue (Bracco Imaging, Milan, Italy), of the upper outer quadrant for the identification of the sentinel lymph node. A IU 22 scanner (Philips Ultrasound,Bothell,WA,USA), with a 3-9 MHz linear transducer and Pulse-inversion harmonic imaging tool were used to image the progression of CEUS (contrast enhancement ultra sound). After introduction of the contrast agent the patients were monitored ultrasonographically for 120 minutes, performing a dermal massage. Results In all patients were identified lymphatic pathways that were followed only for few centimeters from the injection site of microbubbles. In no patient was identified the sentinel node. Conclusion The echo scintigraphy with SonoVue in our experience does not seem to be a reproducible method for the study of the sentinel lymph node. The few studies in the literature seem to confirm the reduced reliability of the method that needs to be improved