Howard A. Andersen

Disturbances of swallowing and esophageal motility in patients with multiple sclerosis

AMONG the diverse symptoms of multiple sclerosis, disturbances of swallowing have received little attention. Charcot,l in his classic description of multiple sclerosis, observed: “To this symptom [dysarthria] may successively be added, especially in advanced stages of the disease, certain disorders of deglutition, of circulation, and even of respiration.” Subsequently, few authors have commented upon such symptoms. Carter, Sciarra, and Merritt,2 in a study of 46 patients with multiple sclerosis who came to necropsy, remarked that 1 patient had had a disturbance of swallowing and that the muscles innervated by the ninth and tenth cranial nerves had been involved in 15 per cent of their patients who, however, apparently had no complaints referable to their throats. Difficulty in swallowing which developed early in the illness of 2 patients with multiple sclerosis awakened our curiosity and led us to investigate this problem further. We soon discovered that disturbances in swallowing seemed not to be too unusual among patients who have multiple sclerosis. In an attempt to improve our understanding of the nature of these symptoms, we have investigated the esophageal motility of some of these patients.

Lung Biopsy: Transbronchoscopic, Percutaneous, Open

Transbronchoscopic lung biopsy is the method of choice for nonsuppurative parenchymal disease. In diffuse nodular disease, percutaneous aspiration biopsy is elected. Open lung biopsy is reserved for patients in whom the other methods have failed.