Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0011168 (dysphagia)
 15,644 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Fifty-five patients were reoperated on for an unsatisfactory outcome after antireflux surgery. Presenting symptoms were heartburn alone (27), heartburn and dysphagia (10), dysphagia alone (9), chest pain (4), left shoulder pain (1), left shoulder pain and fever (1), and signs of anemia (3). The symptom of dysphagia was usually of immediate onset whereas heartburn reoccurred after a symptom-free period (p = 0.014). The most common failed antireflux procedure was a Nissen fundoplication (37). The incompleteness of the residual wrap, its location around the stomach and the irreducibility of the gastro-oesophageal junction below the diaphragm were accurately predicted by barium swallow study in 70, 83 and 92% of the patients, respectively. Abnormal oesophageal body motility was related to oesophagitis, herniation of the residual repair into the chest or both (16/20), and it normalized in 6 of the 11 patients evaluated at follow-up. Oesophageal acid exposure and prevalence of oesophagitis were higher in patients with heartburn than in those with other symptoms (p < 0.02). Intraoperative findings were breakdown of the repair, its location around the stomach, its herniation into the chest, its too excessive tightness, a gastric fistula, or any combination. Remedial surgery consisted of a new antireflux procedure (42), a new antireflux procedure combined with closure of a gastric fistula (3), a closure of a gastric fistula alone (1), a closure of the crura (4), an oesophageal resection (3), a total gastrectomy (1), and a duodenal diversion (1).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Clinical, radiological and functional results of remedial antireflux operations. 817 56

We report a 78-year-old man with progressive gait disturbance, dementia, and dysphagia. He was apparently well until 75 years of age in 1989 when he had an insidious onset of gait disturbance. In October of 1991, he was treated with levodopa and amantadine HCl in another hospital, but he developed visual hallucination right after these medications, and the drugs were discontinued. He also developed difficulty in swallowing with frequent aspiration pneumonia. He was admitted to our hospital on January 13, 1992. On admission, the patient was chronically ill Japanese man; his blood pressure was 118/70 mmHg, body temperature 35.4 degrees C, and heart rate 72 and regular. No anemia or jaundice was noted; lungs were clear and no heart murmur was audible. The abdomen was flat but rigid to palpation without tenderness; no organomegaly was noted. On neurologic examination, he was alert but disoriented to all spheres; he was apparently demented and the score of the mini-mental test was 11. He did not appear to have aphasia or apraxia. Cranial nerves appeared intact, but he had a mask-like face and a slight limitation in the upward gaze; his voice was small. He was unable to stand or walk; he showed marked akinesia and moderate rigidity in his neck and the trunk. Deep reflexes were generally elicited normally or slightly weakly. Plantar response was extensor on the left and flexor on the right. No grasp reflex was present. Sensory examination showed questionable loss of touch in the glove- and -stocking distribution.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[A 78-year-old man with progressive gait disturbance, dysphagia, and dementia]. 819 46

We report a 62-year-old man with a pelvic mass, who developed multiple cranial nerve palsies on the right side. He was well until the summer of 1977 when he developed a numb sensation in the sacral region. In the next year, a huge tumor was found in the sacral area in another hospital. Most of the tumor was resected at that time. Post-operative course was uneventful. In July 1988, there was an onset of weakness in his legs, gait disturbance, and dysuria. Myelography at the above hospital revealed a complete block at the seventh thoracic level. He was treated by laminectomy and post-operative radiation. In June 1990, he developed a neuralgic pan in his right leg. Two months later, he noted diplopia, deafness in his right ear, and swallowing difficulty. He was admitted to our hospital for further work up on January 14th of 1991. On admission, he was afebrile. General physical examination revealed a 4 cm had mass in his right anterior chest attaching the rib. Gynecomastia was noted bilaterally. Liver was felt by 5 cms under the right hypochondrium. The edge of the liver was firm. On neurologic examination he was an alert and mentally sound man. His higher cerebral functions were intact. In the cranial nerves, complete palsy of the abducens nerve, mild nerve deafness, paresis of the soft palate, atrophy and weakness of the sternocleidomastoid and upper trapezium muscles, all on the right side, deviation of the tongue to the right, slurred speech, and dysphagia were observed. The neck was supple. He was able to walk with a support. Mild weakness was present in his right lower extremity. Both legs were spastic. No ataxia or involuntary movements were noted. Deep reflexes were symmetric and normally active. No sensory loss was observed. No meningeal signs were present. Pertinent laboratory findings included moderate anemia (Hb 8.8 g/dl), LDH 2,631 U/l, CRP 7.4 mg/dl. The CSF was under an increased pressure (OP 260 mmH2O) containing 2 lymphocytes/ml, 43 mg/dl of protein, and 49 mg/dl of glucose. Radiologic examinations revealed a destructive change in the sacrum, lytic lesions in the seventh thoracic spine and in the clivus.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[A 62-year-old man with multiple cranial nerve palsies on the right side and a pelvic mass]. 821 5

Between January 1, 1980, and December 31, 1990, 147 patients (93 female and 54 male) were found to have an intrathoracic stomach. Median age was 69 years (range 34 to 89). Signs and symptoms occurred in 140 patients (95.2%) and were primarily obstructive. They included postprandial pain in 87 (59.2%), vomiting in 46 (31.3%), and dysphagia in 44 (29.9%); only 23 patients (15.7%) had symptoms of gastroesophageal reflux. Anemia was present in 31 patients (21.1%) and melena in 3. Elective repair was done in 119 patients and included an uncut Collis-Nissen repair in 81 patients (68.1%), a Belsey Mark IV repair in 19 (16.0%), a Nissen repair in 17 (14.3%), and a Harrington (anatomic) repair in 2 (1.7%). Thirty-two patients had complications (26.9%). There were no operative deaths. Median follow-up was 42 months. Results were excellent in 69 patients (60.0%), good in 38 (33.0%), fair in 6 (5.2%), and poor in 2 (1.7%). Five patients had emergency operations for suspected strangulation; three had gastric necrosis, and one died. Two of the four operative survivors had excellent results. Twenty-three other patients were followed up with medical management for a median of 78 months (range 12 to 268 months). In four patients progressive symptoms developed, and one patient died from aspiration. We conclude that patients with an intrathoracic upside-down stomach who have obstructive symptoms at initial presentation should undergo repair and that elective operation is safe and effective. Gastric strangulation, however, is rare.
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PMID:Intrathoracic stomach. Presentation and results of operation. 842 52

From 1985 to 1993, 49 patients (35 women and 14 men) with diaphragmatic hernia and associated anemia underwent surgical repair. The median age was 64.5 years (range 24 to 84 years). Hematologic and gastroenterologic evaluations revealed no other potential cause of bleeding. Each patient had a diaphragmatic hernia. The median time between the diagnosis of anemia and surgical repair was 36 months (range 1 to 334 months). Forty-five patients (91.8%) had received replacement therapy, including iron for 43 and blood transfusions for 32 (median 6 units; range 2 to 70 units). Forty-six patients (93.9%) had symptoms: heartburn in 28, early satiety with bloating in 19, regurgitation in 11, dysphagia in 7, and aspiration in 4. Preoperative upper gastrointestinal endoscopic evaluation demonstrated gastric erosions at the level of the hiatus in 22 patients (44.9%), esophagitis in 7, stenosis in 1, and Barrett's disease in 1. An uncut Collis-Nissen fundoplication was performed in 44 patients, Belsey fundoplication in 2, a cut Collis-Nissen fundoplication, Nissen fundoplication, and Hill repair in 1 each. There was one operative death (2% mortality). Complications occurred in 18 patients (36.7%). Follow-up was complete and ranged from 4 to 103 months (median 63 months). Forty-five patients (91.8%) had resolution of their anemia. Functional results were excellent in 40 patients (81.6%), good in 2 (4.1%), fair in 4 (8.2%), and poor in 3 (6.1%). In most patients with diaphragmatic hernia and associated anemia refractory to medical treatment, surgical repair can result in successful resolution of the anemia.
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PMID:Diaphragmatic hernia and associated anemia: response to surgical treatment. 945 Oct 84

A 40-year-old woman was admitted to the hospital because of dysphagia and severe anemia (Hb 4.5 g/dl). She was diagnosed as having an advanced gastric cancer, which was unresectable because of liver metastasis, esophageal invasion and paraaortic lymph node metastasis. Combination chemotherapy with CDDP/5'-DFUR was started. CDDP of 80 mg/m2 was administered twice every 4 weeks by a 24-hour drip infusion method, and oral 5'-DFUR of 1,400 mg/m2 was administered for 4 days prior to the first administration of CDDP. Then, 5'-DFUR of 500 mg/m2 was given every day except for 7 days after the first administration of CDDP. Her performance status before the chemotherapy was 3, and improved to 1 a month after the first administration of CDDP. The patient was discharged very much improved on the 45th day after the first administration of CDDP. The side effect was nausea but tolerable. Six months after the first administration, her cancer disappeared on X-ray films, endoscopic and CT examinations. Her PS improved to 0, and she has remained alive with a good QOL for 10 months after the second administration of CDDP.
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PMID:[Unresectable gastric cancer followed by remarkably effective tumor disappearance and good quality of life for 10 months after CDDP/5'-DFUR combination chemotherapy--a case report]. 893 96

This report describes four patients with NSAID-induced esophageal ulcers documented by endoscopy. The cause of injury was ibuprofen alone in two patients, aspirin in one patient, and a combination of aspirin and ibuprofen in one patient. The most common findings were anemia, retrosternal pain, and dysphagia. Three patients had bleeding esophageal ulcers requiring blood transfusions. One patient had massive bleeding which was controlled by endoscopic hemostasis. Three patients were followed up by endoscopy, which showed healing in 3-4 weeks. These NSAID-induced ulcers had characteristic endoscopic features, namely, a large, shallow, discrete ulcer in the midesophagus near the aortic arch with normal surrounding mucosa. These findings suggest that the injury resulted from mucosal contact with NSAIDs. A precise history and immediate endoscopic examination were most important in establishing the diagnosis of esophageal ulcer. Healing occurs if drug-induced injury is recognized early and treatment is appropriately started with antacids and H2 blockade. Offending medication should be discontinued and patients should be counseled to take pills in an upright posture with liberal amounts of fluids well before retiring for the night.
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PMID:Bleeding esophageal ulcers caused by NSAIDs. 906 46

The authors determined the clinical yield, endoscopic time, and patient tolerance of routine upper endoscopy beyond the duodenal bulb. From May through October 1994, all patients undergoing routine esophagogastroduodenoscopy (EGD) were recruited for study. Each procedure was timed from start to finish by the endoscopy nurse, and, in addition, the time of the postbulbar examination was recorded. The endoscopy nurse assessed the patient's comfort level when the endoscope was advanced into the duodenal bulb and again at the postbulbar region. A total of 250 EGDs were performed. There were 152 males and 98 females, with a mean age of 57.1 (range, 23-91) years. Indications for the procedure were as follows: gastroesophageal reflux disease symptoms 82, epigastric pain 64, dysphagia 46, Barrett's surveillance 25, anemia 23, other research study 16, and other 61. The mean time for the procedure was 11 min and 54 s, whereas the mean time for the postbulbar examination was 46.6 s. Patients tolerated endoscope insertion well both before and during examination of the postbulbar duodenum. The only postbulbar finding that affected clinical management was a postbulbar ulcer in a patient without other ulcers who was positive for Helicobacter pylori. Although routine endoscopic examination beyond the duodenal bulb involves minimal time and is well tolerated by patients, the yield of pathologic findings is low (3.6%) and the yield of findings that alter clinical management even lower (0.4%). In patients without prior GI surgery undergoing routine EGD for indications other than suspected small bowel pathology or active upper GI bleeding, examination of the postbulbar duodenum can be considered an elective part of the procedure.
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PMID:Yield of routine endoscopy beyond the duodenal bulb. 917 32

This article presents basic information on the clinical features of HIV infection, most of which are related to the profound immune deficiency associated with HIV/AIDS. Primary HIV infection is associated with clinical symptoms, primarily a mononucleosis syndrome, in about 50% of cases. In the ensuing 10 years, more than 50% of HIV-infected individuals develop the opportunistic infections (OIs) indicative of the onset of AIDS. Common presentations of AIDS include pneumonia, dysphagia, diarrhea, neurologic symptoms, fever, wasting, anemia, and vision loss. Monitoring of peripheral blood CD4 T-lymphocytes provides a measure of the current risk of OIs and a guide for antiretroviral therapy. Protease inhibitors, used in combination with other antiretrovirals, allow long-term control of HIV disease, but the substantial cost of these drugs has prohibited their widespread use in developing countries. Treatment of HIV-related infections must be followed by a maintenance regimen intended to prevent relapse.
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PMID:HIV infection and AIDS. 979 58

Gastro-oesophageal reflux disease is the most common cause of indigestion in the community, and is usually chronic. Typical symptoms are recurrent retrosternal burning (heartburn) and regurgitation of sour or bitter fluid. In patients with typical symptoms and no alarm symptoms (pain on swallowing, dysphagia, weight loss or anaemia), treatment may be instituted without investigation. Patients with alarm symptoms and those who respond poorly or relapse after initial treatment require investigation (endoscopy and possibly pH monitoring). About 60% of reflux sufferers have no evidence of mucosal injury; their management aims to relieve symptoms. About 40% of reflux sufferers have oesophagitis and/or complications such as Barrett's oesophagus or oesophageal stricture at endoscopy. Drug therapy consists of H2-receptor antagonists, cisapride or proton-pump inhibitors.
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PMID:Gastro-oesophageal reflux disease. 986 14


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