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Query: UMLS:C0011168 (dysphagia)
 15,644 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Thirty-nine patients with longstanding oesophageal dysphagia took part in an interview and a questionnaire study to investigate whether they considered themselves met with interest, respect, understanding and knowledge (felt confirmed) when consulting their physician for the first time (mostly general practitioner), whether non-confirmed patients have any distinguishing attributes, and whether confirmation affects the patient's impression of being helped. Twenty-five of these considered themselves as non-confirmed. There was no difference between the groups as regards sex, age, education, degree of swallowing difficulties and incidence of chest symptoms other than dysphagia. There was a greater fear of cancer (P less than 0.05) and a stronger indirect aggression (P less than 0.05) among the non-confirmed patients. Patients who felt confirmed reported more often that a correct oesophageal diagnosis had been given (P less than 0.05), felt they had received adequate help (P less than 0.001) and experienced improvement in swallowing difficulties (P less than 0.05). It is concluded that patient attributes seem to slightly influence the patients' possibilities of being confirmed, and that confirmation is of great importance for the patient's feeling of being helped and improved.
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PMID:Do physicians care about patients with dysphagia? A study on confirming communication. 150 11

Acute epiglottitis in the child is an emergency, well known to pediatricians, that requires rapid diagnosis and treatment. Aggressive treatment in recent years has markedly decreased mortality (17). Acute epiglottitis in adults has been thought to be rare, but lately numerous studies have shown an increase in the disease. We present 19 older patients, aged 13-72 (mean 44.7 years), with acute epiglottitis. A most important finding was the relatively long time from onset of symptoms until diagnosis, averaging 2.5 days. All the blood and throat cultures were negative, except for a single throat culture which yielded Pseudomonas aeruginosa. The most common presenting symptoms were severe sore-throat and dysphagia; half presented with some respiratory distress. Diagnosis was usually made on indirect laryngoscopy, but lateral X-ray of the soft tissues of the neck was found to be highly reliable. Treatment was usually conservative, including antibiotics, rehydration and steroids to alleviate edema. All patients were under strict observation for the first 48 hours, but only 1 required intubation. There were no deaths.
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PMID:[Epiglottitis in adults]. 222 84

Scleroderma (systemic sclerosis) is a connective tissue disorder characterized by thickening and fibrosis of the skin and visceral involvement that may include the heart, lungs, kidneys, and gastrointestinal tract. At least 40-50% of patients with scleroderma experience esophageal symptoms such as heartburn and dysphagia, while up to 90% of patients have esophageal dysfunction on objective testing at some point in their disease. The disease results in smooth muscle dysfunction that causes esophageal aperistalsis and reduced lower esophageal sphincter pressures. Gastroesophageal reflux with poor acid clearance results with an increased incidence of complications such as peptic stricture and Barrett's esophagus. Aggressive medical therapy is necessary to prevent these and other complications of gastroesophageal reflux.
Dysphagia 1990
PMID:Scleroderma esophagus. 227 19

In a series of 230 patients with carcinoma of the hypopharynx, esophagus and cardia, 114 patients with squamous cell tumors and 86 patients with adenocarcinomas were resected (rate of restability, 87 per cent). Mortality at 30 days was 17.5 per cent. Over-all hospital mortality was 22.0 per cent. The one year survival rate was 40.0 per cent and the five year survival rate was 19.5 per cent. Reflux esophagitis occurred in 26 per cent of survivors, benign stricture in 9 per cent and local recurrence in 7 per cent. Eighty-two per cent of patients were permanently free of dysphagia postoperatively. Aggressive surgical procedures provide effective palliation and a worthwhile proportion of long term survivors.
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PMID:Carcinoma of the hypopharynx, esophagus and cardia. 242 18

Anorexia, dysphagia, and dysgeusia are the most prevalent symptoms in head and neck cancer patients during radiation therapy. The patients, who were in poor general condition, suffered marked loss of body weight and consequently were unable to tolerate further anti-cancer treatments. Aggressive nutritional support to the head and neck cancer patients was started in April, 1986 to improve the general condition of these patients in our hospital. The physiological condition of 152 patients who underwent nutritional support were evaluated as a study group (Group I) between August 1986 and May 1987. Group II, 165 patients without nutritional care were evaluated as a control group between August 1985 and May 1986. In Group I, oral supplementary diets or enteral feedings were provided as nutritional support to all of the anorectic patients. Anthropometric measurement and laboratory data were collected in both groups at the several time points. An average of 1.1 kilogram (Kg) and 3.5Kg body weight loss was observed in Group I and Group II, respectively (P less than 0.005). In patients diagnosed with nasopharyngeal carcinoma, the average duration of radiation treatment was 11 days shorter in Group I than that in Group II (42 vs 53 days). In conclusion, aggressive nutritional care performed by a group of clinical staff, which included doctors (radiation oncologist), dietitians and oncologic nurses, was sufficient to improve the general condition of the head and neck cancer patients during radiation therapy and to therefore increase the recovery rate of these patients after radiation treatments.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Clinical evaluation of aggressive nutritional care to head and neck cancer patients during radiation therapy]. 250 13

Gastro-oesophageal reflux occurs when the pressure barrier of the lower oesophageal sphincter (LOS) fails due to a low basal pressure (less than or equal to 6 mm Hg), sphincteric relaxations or a noncompensated increase in intragastric pressure. This reflux becomes pathological when it leads to symptoms severe enough for the patient to seek medical help or results in reflux oesophagitis or its complications. Damage to the oesophageal mucosa develops when the balance between aggressive and defensive factors is no longer in equilibrium. The main aggressive factor is acid-pepsin or alkaline bile secretion. Defence against this aggression is based on rapid removal of the refluxate from the oesophagus (oesophageal clearance) and on poorly understood mucosal resistance. The length of time acid is in contact with the oesophageal mucosa is shortened by adoption of an upright position, by swallow-induced oesophageal peristalsis and saliva. Treatment of pathological reflux aims (1) to decrease acid aggression by means of H2-receptor antagonists or proton pump inhibitors; (2) to strengthen the anti-reflux barrier and improve oesophageal clearance by prokinetic drugs that increase the LOS pressure and enhance peristaltic contractions; and (3) to boost mucosal resistance by sucralfate or prostaglandin analogues. Initial treatment of gastro-oesophageal reflux disease may be symptomatic provided that there are no alarming symptoms, such as dysphagia, anaemia or weight loss. Usually either H2-receptor blockers or prokinetic drugs are used. Endoscopy is indicated whenever alarming symptoms are present and when there is insufficient symptomatic improvement after a 4-6-week therapeutic trial. Moderate oesophagitis may be treated in the same way.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Pathophysiology and treatment of gastro-oesophageal reflux disease. 257 7

During the acute period of caustic esophagitis, important alterations in esophageal motor function appear. However, it is not known if these alterations persist later. To determine whether motor disorders persist (after the aggression) in the esophagus that has suffered caustic aggression, a manometric study was made in two groups of patients classified as mild (9 cases) or severe esophagitis (8 cases), and results were compared with those of a control group. Patients who had developed stenosis or suffered the caustic aggression less than a year earlier were excluded. The probable existence of motor anomalies could determine the appearance of dysphagia or reduce the effectiveness of motor clearance of the esophageal body, thus conditioning a situation of esophageal defenselessness against physiological or eventual abnormal episodes of gastroesophageal reflux (RGE). Our results indicate that in a variable percentage of cases some peristaltic dysfunctions can persist in the esophageal body in relation to the severity of the initial lesion.
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PMID:[Does the ingestion of caustics produce irreversible motor changes in the esophagus? Manometric study of 17 cases]. 276 35

Odontogenic infections rarely lead to involvement of the lateral and retropharyngeal spaces. When this does occur, the microbiology of the infection is similar to the typical odontogenic infection, ie, Streptococcus and oral anaerobes including Peptostreptococcus, Bacteroides, and Fusobacterium. There is an increased incidence of Fusobacterium seen in the more severe infections, as well as a higher incidence of Streptococcus milleri. Many patients who have deep cervical infections also have some compromise in their host defense mechanism, such as diabetes. The signs and symptoms of deep cervical space infections are similar to those of the severe submandibular space infection, but also includes sialorrhea, respiratory distress, odynophagia, and dysphagia. Lateral soft-tissue radiographs of the neck are useful in assisting with the diagnosis of retropharyngeal infections, and CT scans can provide definitive information regarding lateral pharyngeal space involvement. Treatment includes the use of high-dose intravenous bacteriocidal antibiotics. The recommended antibiotics are penicillin-metronidazole, ampicillin-sulbactam, or clindamycin. Certain cephalosporins may also be useful in selected patients. Early surgical intervention is also indicated. Aggressive incision and drainage of all of the involved spaces is necessary to assure early resolution of the infection. Continual airway monitoring and the establishment of surgical airways is the final portion of the treatment triad.
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PMID:Contemporary management of deep infections of the neck. 844 62

Dysphagia is a problem commonly treated and frequently diagnosed on the rehabilitation unit. It can be caused by trauma, injury, or diseases of the nervous system and can result in potentially serious and life threatening complications. The disruption of normal swallowing has also been reported to occur in psychiatric patients treated with psychotropic medication. Relatively unappreciated by physicians, and unreported by the rehabilitation patient, drug-induced dysphagia can likewise result in serious complications. This report describes a case of drug-induced dysphagia and aspiration pneumonia during the rehabilitation of a traumatically brain injured male who received psychotropic medication to control aggressive behavior. The course of his dysphagia was followed and documented both clinically and with videofluoroscopic studies.
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PMID:Drug-induced dysphagia. 846 30

The newly emerging Australian bat lyssavirus causes rabieslike disease in bats and humans. A captive juvenile black flying fox exhibited progressive neurologic signs, including sudden aggression, vocalization, dysphagia, and paresis over 9 days and then died. At necropsy, lyssavirus infection was diagnosed by fluorescent antibody test, immunoperoxidase staining, polymerase chain reaction, and virus isolation. Eight human contacts received postexposure vaccination.
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PMID:Australian bat lyssavirus infection in a captive juvenile black flying fox. 1034 Nov 82


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