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Biomedical subjects

M J Feinberg

Publications and source records attributed to M J Feinberg.

12 recordsLinked to original sources
PubMed1999

Dystonia, botulinum neurotoxin, and the aviator.

Dystonia is both a symptom and the name for group of illnesses called the dystonias. The physical manifestation consists of sustained, involuntary contractions of the muscles in one or more parts of the body, resulting in twisting or distortion of that part of the body. For focal dystonias including torticollis, blepharospasm and spasmodic dysphonia, botulinum toxin injections have become the treatment of choice because of the ability of this toxin to sufficiently weaken the muscle to reduce the spasm but not so much as to cause paralysis. This paper involves the fate of four airmen all afflicted with a form of dystonia who had been reviewed in the Aeromedical Certification Division of the FAA Civil Aeromedical Institute.

Aerospace Medicine↗
PubMed1997

The effect of anabolic-androgenic steroids on sexual behavior and reproductive tissues in male rats.

This study assessed the effects of high doses of anabolic-androgenic steroids (AAS) and their withdrawal on male reproductive behavior and reproductive tissues during development. Prepubertal, peripubertal, and adult male Long Evans rats were divided into 4 groups: 1) Testosterone propionate for 16 weeks (TP), 2) TP for 3 weeks and withdrawn for 13 weeks (TPWL), 3) TP for 16 weeks and withdrawn for 3 weeks (TPWS), 4) propylene glycol (control vehicle) for 16 weeks (PG). As determined by sexual performance and sexual preference tests, administration of high doses of AAS to the peripubertal animals enhanced sexual performance and sexual motivation. There was no significant effect on sexual behavior of the prepubertal animals. High doses of anabolic-androgenic steroids depleted Leydig cell number in the prepubertal and adult rats, but had no effect on the Leydig cell number of the peripubertal animals. After long-term withdrawal from AAS no significant effects on sexual behavior were found. The depletion of Leydig cells that occurred in the prepubertal animals after withdrawal was reversible, while the depletion of the Leydig cells of the adult animals did not return to the control level suggesting a long lasting alteration.

Anabolic Agents↗
PubMed1996

Prandial aspiration and pneumonia in an elderly population followed over 3 years.

The purpose of our study was to prospectively determine pneumonia frequency and correlate it with prandial liquid aspiration and feeding status in frail elderly nursing home residents. Initially, 152 patients had video swallowing examinations (81 oropharyngeal dysphagia, 19 thoracic dysphagia, 52 without dysphagia). Those diagnosed with oropharyngeal impairment were subsequently managed with swallowing therapy or artificial feeding modalities. Patients were followed for 3 years (unless they expired earlier) and clinical courses were categorized according to the degree of prandial aspiration and feeding (PAF) status. Subjects with new lung infiltrates persisting for at least 5 days with appropriate clinical findings were diagnosed as having pneumonia and were classified according to the PAF status months in which these findings occurred. Fifty-six pneumonias were diagnosed during 4,280 months with the following frequencies: no aspiration months 0.6%; minor aspiration months 0.9%; major aspiration/oral feeding months 1.3%; major aspiration/artificial feeding months 4.4%, p < 0.001. Our results indicate that there is not a simple and obvious relation between prandial liquid aspiration and pneumonia. Artificial feeding does not seem to be a satisfactory solution for preventing pneumonia in elderly prandial aspirators.

Aged↗
PubMed1993

Radiographic techniques and interpretation of abnormal swallowing in adult and elderly patients.

The radiologic evaluation of oropharyngeal dysfunction requires interpretation of observed morphodynamics and bolus movements. This can be facilitated if a simplified biomechanical approach is used to understand basic physiology. Oral stage activity can be described as a lingual delivery pump and pharyngeal stage activity as a glossopharyngeal propulsion pump. Bolus misdirection into the airway is more often due to oral rather than pharyngeal abnormalities and is frequently inconsistent with regard to timing and degree. The video-deglutition examination is still a relatively new diagnostic study and its purpose, indications, and criteria for patient selection should be clearly understood.

Adult↗
PubMed1992

Deglutition in elderly patients with dementia: findings of videofluorographic evaluation and impact on staging and management.

Oral and pharyngeal function in 131 institutionalized elderly patients with advanced dementia was evaluated by means of videofluoroscopic deglutition examination (VDE). Findings were normal in only nine (7%) patients. Oral-stage dysfunction was observed in 93 (71%) patients, pharyngeal dysfunction in 56 (43%), and pharyngoesophageal-segment abnormalities in 43 (33%). Multiple-stage dysfunction was noted in 55 (42%) patients. Major aspiration of contrast medium was present in 31 patients, and minor aspiration in 66. Evaluation of VDE findings prompted a change in clinical staging (degree of impairment) in 40 patients and substantial alteration in treatment planning in 28. At clinical bedside evaluation, the degree of bolus misdirection was overestimated in 19 patients with minor aspiration and underestimated in seven with major aspiration. Dementia is often associated with oral and pharyngeal impairment, and VDE can be important in diagnosis and treatment.

Aged↗
PubMed1991

Videofluoroscopy in elderly patients with aspiration: importance of evaluating both oral and pharyngeal stages of deglutition.

Oropharyngeal functional impairment increases with age so that radiologists frequently are asked to determine the cause of aspiration in elderly patients. Neuromuscular and cognitive impairment often make it difficult to perform and interpret videofluoroscopic deglutition examinations in these patients. We retrospectively reviewed the barium swallow examinations in 50 elderly patients (mean age, 87 years) who were known to aspirate. We looked for specific patterns of oropharyngeal dysfunction that resulted in bolus misdirection. Analysis revealed that aspiration was due to abnormalities of the oral stage in 23, pharyngeal stage in 10, and both stages in 17. Dysfunction in the oral stage was due to ingestion of large volumes or rapid acquisition rates in nine, failure of containment during processing (bolus manipulation) in 18, and dissociation of lingual delivery and swallowing initiation in the transitional phase in 13. Dysfunction in the pharyngeal stage was due to incomplete transport (bolus retention) in 21 and defective closure of the laryngeal vestibule in 11. No significant relationship between conditions known to cause oropharyngeal dysfunction (dementia, stroke, Parkinson disease, disuse deconditioning) and the specific pattern of dysfunction was identified. These results indicate that an accurate and valid assessment of oropharyngeal dysfunction in elderly patients with aspiration is possible if specific patterns of dysfunction are sought. Our study indicates the importance of evaluating the oral and pharyngeal stages of deglutition in elderly patients who aspirate.

Aged↗
PubMed1991

Altered swallowing function in elderly patients without dysphagia: radiologic findings in 56 cases.

Swallowing disorder is an increasing problem in our aging population. A majority of these patients have a functional abnormality of the oral, pharyngeal, and/or esophageal stage of swallowing. However, what constitutes normalcy is not well understood, and baseline swallowing in elderly persons without dysphagia has not been adequately described. We therefore evaluated 56 persons with a mean age of 83 years who had no symptoms of dysphagia or eating difficulty. Videofluoroscopy and radiographs with the subject erect and recumbent were obtained. Normal deglutition, as defined in young persons, was present in only 16%. Oral abnormalities (difficulty ingesting, controlling, and delivering bolus relative to swallowing initiation) were seen in 63%. Pharyngeal dysfunction (bolus retention and lingual propulsion or pharyngeal constrictor paresis) was seen in 25%. Pharyngoesophageal segment abnormalities were observed in 39% (mostly cricopharyngeal muscle dysfunction). Esophageal abnormalities (mostly motor in nature) were observed in 36%. What has been described as swallowing dysfunction in young persons may not be abnormal in very elderly persons. It is difficult to distinguish the effect of normal aging from the effects of specific diseases or gradual degenerative changes.

Aged↗
PubMed1990

Aspiration and the elderly.

Aspiration is prevalent in the elderly but its association with impairment of oral intake and gastroesophageal reflux is often misunderstood. This paper describes the causes, pathophysiology, and consequences of aspiration and their unique features in aged persons. It also explains how videofluoroscopic evaluation can assess current function while limiting factors that result in misinformation. The management of aspiration is discussed, emphasizing the importance and difficulties in maintaining functional well-being and possible complications of therapy.

Aged↗
PubMed1990

Deglutition after near-fatal choking episode: radiologic evaluation.

Acute airway obstruction during oral intake is a relatively common event that may be fetal if not relieved immediately. Deglutition was studied in 75 individuals who had experienced a near-fatal choking episode (NFCE) or sudden inability to breathe during food intake that was promptly relieved by means of a Heimlich maneuver, suctioning, or intubation. Videofluoroscopy supplemented by static imaging revealed abnormal stages of deglutition in 58 individuals: oral, 32; pharyngeal, 19; pharyngoesophageal segment (PES), 28; and esophageal, 23. Forty individuals aspirated a liquid bolus; this was more often due to oral dysfunction (bolus leakage, n = 17; delayed initiation, n = 18) than pharyngeal abnormality (defective closure, n = 13; incomplete transport, n = 9). Oral-stage dysfunction was common in those with neurologic disease, a history of dysphagia, and structural or motor abnormalities of the PES or esophagus. Fourteen patients were able to vocalize during the NFCE, and each demonstrated an abnormality of the PES or esophagus that could obstruct a solid bolus, suggesting that symptoms were not due to airway obstruction. A variety of unsuspected deglutition abnormalities were documented, indicating the usefulness of radiographic evaluation after NFCE.

Adult↗
PubMed1986

Coexistence of primary Crohn's disease and carcinoid tumor isolated to the appendix. A case report.

A patient is described in whom isolated Crohn's disease of the appendix was present simultaneously with isolated carcinoid tumor of the appendix. Appendectomy was the primary therapy and no recurrence of either disease has been discovered after four years of follow-up. We believe this to be the first case of its type to be reported. Crohn's disease of the appendix, carcinoid tumors of the appendix and the occurrence of gastrointestinal tumors in conjunction with Crohn's disease are all briefly discussed.

Adult↗