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

A 44-year-old man, a heavy smoker over many years, complained of hoarseness for 8 weeks with weight loss and dysphagia. Malignant tumour of the pharynx was suspected. Examination revealed a swelling of the right upper lip, tumorous changes in the right buccal mucosa, about 6 x 6 cm in size, as well as enlargement of the cervical lymph-nodes. Microlaryngoscopy revealed a three-level tumour of the entire side of the right larynx. Histological examination of biopsies of the right false and true vocal cords as well as the buccal mucosa demonstrated numerous, partly caseous epithelioid granulomas with Langhans giant cells. Ziehl-Neelsen staining showed acid-fast rods. Combined tuberculostatic treatment with isoniazid, rifampicin, ethambutol and pyrazinamide achieved regression of all signs and symptoms within two months. This case emphasizes the need for including laryngeal tuberculosis in the differential diagnosis of seemingly malignant laryngeal tumours.
 ...
PMID:[Tuberculosis of the larynx, oral cavity and pharynx]. 191 28

The modified barium swallow is currently the most comprehensive, widely available, and easily interpreted technique for the evaluation of patients with dysphagia by the head and neck surgeon. However, it requires the facilities, personnel, and use of a radiology suite, a trained speech pathologist, and exposure of the patient to radiation. It would therefore be helpful to have an adjunctive, physician based, nonradiographic method of examination that could provide information similar to and possibly even more complete than that supplied by the modified barium swallow. Such an adjunctive method could help otolaryngologist-head and neck surgeons confronted by a new patient with swallowing difficulties to orient themselves to the nature and severity of the problem while waiting for the modified barium swallow to be scheduled, performed, and reviewed. It could also be a helpful tool for management of patients with cancer of the head and neck, whose swallowing function may change rapidly in the early postoperative period. In such cases, intervals between modified barium swallow examinations (dictated by concern over radiation exposure) may be too far apart to allow up-to-the-minute decisions on case management. Finally, some patients who may be too ill to travel to the radiology suite might benefit from a bedside procedure that would yield information about swallowing function similar to that provided by the modified barium swallow. Videoendoscopic evaluation of dysphagia (VEED) is a protocol I developed and have used regularly since 1984. Experience with this method of dysphagia evaluation has shown that it answers the needs outlined above. Its usefulness also goes beyond that of the modified barium swallow by providing a more detailed understanding of the component anatomic and functional deficits that comprise a given patient's swallowing problem, information about upper aerodigestive tract sensory deficits, and a means for visual feedback training of pharyngeal and laryngeal musculature. The protocol is reviewed here. Case reports illustrating the clinical usefulness of VEED as an adjunct to the modified barium swallow are also presented, and the relative strengths and weaknesses of VEED and the modified barium swallow are compared.
 ...
PMID:Videoendoscopic evaluation of patients with dysphagia: an adjunct to the modified barium swallow. 190 35

A study was conducted of all primary oesophageal cancer cases hospitalized from 1970 to 1975 in Oklahoma City hospitals. During this 6 year period, 181 cases were identified. The average annual incidence in Oklahoma county was lowest in white females (2 per 100,000 population), and highest in black males (19 per 100,000 population). Some of the descriptive features of oesophageal carcinoma by age, sex and race distribution were largely compatible to those reported in the literature. Cases with carcinoma in which pain was the first symptom to appear, sought medical advice latest compared to cases with dysphagia as the first symptom, the latter group seeking medical advice earliest. Blacks and whites presented dissimilar distribution of tumours by site. Whereas in blacks 58% of carcinomas were located in the middle thoracic and none in the oesophagogastric junction, in whites tumours were more or less equally distributed in various anatomical sites. Black males exhibited higher mean ages at diagnosis in all sites than black females. The whites showed the opposite trend except in the oesophagogastric junction. Squamous cell carcinoma was the most frequent cell type (80%). The absence of adenocarcinoma cell types in blacks except only two male cases was a noteworthy observation. The clinical stage distribution by anatomical site was unusual for middle thoracic and gastric cardia carcinomas with 54% and 46% of tumours localized and in regional stages at diagnosis respectively.
 ...
PMID:Epidemiological and clinical aspects of oesophageal carcinoma in the USA. 191 79

A retrospective survey identified 96 patients (58 males) with Barrett's esophagus, diagnosed at the Royal Melbourne Hospital between 1978 and 1986. The age at presentation varied from 20 to 93 years, and 43% were greater than 70 years. Heartburn was a presenting symptom in 71%, regurgitation into the pharynx in 54%, dysphagia in 31% and hematemesis or melena in 29%. At endoscopy, the length of Barrett's epithelium ranged from 3 cm to 15 cm. Macroscopic esophagitis was observed in 69%, benign esophageal strictures in 14% and a co-existent adenocarcinoma of the lower esophagus in 10% of patients. Only 30% of the patients were cigarette smokers at the time of diagnosis, but 64% drank alcohol (9% greater than 80 g alcohol daily). Patients with esophageal cancer at presentation were more likely to be male and cigarette smokers (Fisher's exact probability test). It has been suggested that patients with Barrett's esophagus should be screened to detect the early development of esophageal cancer. If patients who already have cancer, the elderly (age greater than 70 years) and those with a chronic alcohol problem (greater than 80 g intake daily) are excluded from endoscopic cancer surveillance, only 42% of the patients described in this survey would be eligible for enrollment in such a program. This represents a recruitment of only 5 new patients yearly in a large teaching hospital endoscopy unit.
 ...
PMID:Clinical profile in Barrett's esophagus: who should be screened for cancer? 193 80

We report four cases of malignant melanoma of the esophagus treated at the National Cancer Center Hospital in Tokyo over a period of 28 years. There were three men and one woman. One patient had been diagnosed as having Werner's syndrome. The three male patients smoked and were alcohol drinkers. The chief complaint was dysphagia--three patients--and pain on swallowing--one patient. All the tumors were polypoid, and three were large at the time of initial diagnosis. Histological diagnoses were made by examining endoscopic biopsy specimens, and confirmed with resected specimens in three cases. Esophagectomy was performed in three patients, the other receiving radiotherapy. Three patients died of recurrent disease in a rather short period of time, as in many reported cases. The mean survival for the three patients was eight months. The fourth, who had a superficial polypoid lesion and received esophagectomy and adjuvant chemotherapy, lived for 29 months. The combination of early detection and extended radical surgery followed by adjuvant chemotherapy may offer a better prognosis than in the past.
 ...
PMID:Primary malignant melanoma of the esophagus: report of four cases. 194 60

Two cases of granular-cell tumors of the esophagus, occurring in two heavy drinkers and smokers, are reported. One of them had increased in volume, while the other caused dysphagia. Both were treated by local exeresis followed by an immediate histological study. The postoperative period was quite uncomplicated. The authors discuss the merits of ultrasound in the preoperative diagnosis, the problems of the relationships with cancer and the choice of treatment.
 ...
PMID:[Abrikossoff's granular cell tumors of the esophagus. Apropos of 2 cases]. 196 10

A 62-year-old male who complained of dysphagia, body weight loss and hoarseness was admitted to our hospital. Chest x-ray film disclosed right superior mediastinal mass compressing membranous portion of trachea. Esophageal fiberscope revealed carcinoma of cervical esophagus. Bronchofiberscope revealed the paralysis of right recurrent laryngeal nerve and the invasion of esophageal cancer to tracheal membranous portion from the 5th tracheal ring to the 12th. The cancer also invaded the right lobe of thyroid which was shown by echogram. Operation was performed. On dissecting the cervical region, it was found that the tumor invaded both sides of the trachea so that tracheal reconstruction could not be done without injuring left recurrent laryngeal nerve. Sternotomy was added. Anterior mediastinal tracheostomy was done after laryngeal resection with total thoracic esophagectomy and tracheal resection leaving 5 rings long cartilage from carina. The trachea was wrapped with pedicled omentum. Post-operative course was uneventful. This procedure helps to increase blood supply to the tracheal anastomosis and turns to advantage in preventing infectious extension around trachea to mediastinum as well as tracheal compression to major vessels.
 ...
PMID:[A case of carcinoma of the esophagus involving the trachea undergoing anterior mediastinal tracheostomy with pedicled omental wrapping]. 207 83

Oesophagectomy for squamous cell carcinoma of the oesophagus was performed in 25 consecutive patients over a 3.5 years period, for an overall resection rate of 11 pc. It was an Ivor-Lewis in 19 and a left thoracotomy in six. The stage of the disease was II in two, III in six and IV in 17 cases. Seventeen patients had uneventful postoperative evolution. Complications occurred in eight patients: heart failure in three, anastomotic leak in three, massive chest wall infection in two and four of these patients died: a mortality rate of 16 pc. All the 21 patients who left the hospital were able to take normal diet. The mortality of oesophagectomy for cancer can be as high as 30 pc but decreases with better selection of patients and surgical experience. Cure is rarely achieved. Resective surgery, when successful, offers the best palliation for dysphagia. Resectability rate in all African series is very low. There is a need for a more aggressive surgery therapeutic attitude. Our series shows that it is possible in our environment to achieve an acceptable operative morbidity and mortality. With increasing experience, results can only improve.
 ...
PMID:Oesophagectomy for carcinoma of the oesophagus--early results. 209 87

Tube feedings are utilized in elderly patients with acute and chronic problems. Inadequate oral intake with malnutrition, comatose state, neurologic disorders with severe dysphagia, extensive burns, massive gastrointestinal resection, and oropharyngeal and upper gastrointestinal malignancies are the commonly encountered conditions requiring tube alimentation. Dysphagia with frequent aspiration is the most common indication for use of tube feedings in the elderly. Nasogastric tube is preferred for short-term feeding, while gastrostomy or jejunostomy is indicated for long-term or permanent nutritional support. Nutritional assessment should be done initially and on a regular basis. Specific formulas are available to calculate height, weight, and caloric needs of bedbound elderly patients. Various enteral feeding formulas are available for a specific clinical condition and are preferably administered by continuous drip using a pump. Parenteral nutrition is also indicated for certain situations in which enteral feeding cannot meet the patient's nutritional requirement, and in particular situations where enteral feeding is contraindicated and not feasible. Optimal patient care is dependent on adequate nutritional support.
Dysphagia 1990
PMID:Indications for tube feedings in elderly patients. 211 23

Sixteen cases of nontraumatic left atrial-esophageal fistulas have been reported previously. These fistulas usually result from chronic peptic esophagitis or cancer. The diagnosis is suggested by the triad of chronic dysphagia, hematemesis, and acute neurologic signs. There may be cardiac manifestations such as pericarditis, atrial fibrillation, or shock. An unusual feature of these fistulas is systemic embolization of food, air, or septic necrotic debris which may result in sudden central nervous system symptoms. All reported cases resulted in death due to hemorrhage, although there was often a variable time interval between the onset of hematemesis and the patient's death. The authors report two additional cases in which an episode of pericarditis preceded fistula development. Based on these 18 cases, the spectrum of esophagoatrial fistulas is reviewed, as well as the signs which may herald fistula development.
 ...
PMID:Esophagoatrial fistula with previous pericarditis complicating esophageal ulceration. Report of two cases and a review of the literature. 220 19


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>