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)

It is pertinent to ask what clinical conditions would geriatricians most want gastroenterologists to solve. I believe that the three most important are transfer dysphagia, constipation and diarrhea, and fecal incontinence. With transfer dysphagia, the older patient with central nervous system disease simply has forgotten how to swallow. Is it possible, with sensory retraining techniques, to make an impact upon this disabling problem? Although the healthy elderly appear to perceive constipation more often than they actually suffer from it, evacuation clearly is disturbed in hospitalized and nursing-home residents. Can we develop better prokinetic agents to alleviate this problem? Incontinence, more than any other gastrointestinal condition, leads to the transfer of patients from a protected home environment to a chronic-nursing facility. Can we study the pathophysiology of incontinence intensively, as Dr. Nicholas Read's group in Sheffield, England, has done, and develop approaches to managing this important problem? The presentations in this issue of Clinics in Geriatric Medicine may not provide all of the solutions for clinical problems in the elderly that we seek, but it should be a step in the right direction by making salient new information readily available.
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PMID:General perspectives on the aged gut. 185 54

A 32-year-old woman with histiocytic lymphoma was in complete clinical remission after two courses of chemotherapy, when peripheral neuropathy developed fulminantly. Abnormalities included facial nerve paralysis, dysphagia, quadriparesis, myalgia, and incontinence. She died 10 days after onset of these symptoms. Postmortem examination revealed infiltration of peripheral nerves by lymphomatous cells with no involvement of meninges, brain, lymph nodes, or other organs. Differences in the blood-brain barrier of peripheral and central nervous system are suggested: The peripheral barrier may be more penetrable by malignant histiocytes or less permeable to cytotoxic drugs. Intrathecal chemotherapeutic drug instillation and irradiation may be beneficial.
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PMID:Fatal peripheral neurolymphomatosis after remission of histiocytic lymphoma. 629 28

A 26-year-old housewife, born of consanguineous parentage, began to have gait and speech disturbance. Her brother had died from suffocation because of dysphagia. At thirty-two, she developed difficulty in swallowing, clumsiness and incontinence. When she was thirty-six she had pseudobulbar palsy, vertical gaze paresis, hyperreflexia and muscular atrophy of the upper half of the body. CT scan showed cerebral atrophy. Her mental function progressively deteriorated and amyotrophic lateral sclerosis associated with dementia was suspected. She died at the age of thirty-seven. Diagnosis was made only by autopsy. There was no particular general pathologic finding excepting aspiration pneumonia. Microscopical examination revealed numerous distended neurons with accumulation of light brown pigments by Luxol fast blue/H & E stains, especially in hypothalamus, substantia nigra and nuclei of oculomotor nerves. To a lesser extent such neurons were noted ubiquitously. The stored material was mainly composed of lipofuscin and ceroid. Ultrastructurally they presented the various structures which have previously been reported, except for finger print profiles. The pigmentary deposits were shown to be immunoreactive with polyclonal antibody directed against amyloid beta-protein.
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PMID:[Dementia and amyotrophy in Kufs disease. The adult type of neuronal ceroid lipofuscinosis]. 774 8

We report a 65-year-old woman with progressive dysarthria, dysphagia, weakness, and gait disturbance. The patient was well until 59 years of age (January of 1986) when she noted bilateral ptosis. One year later, she noted a gradual onset of difficulty in speech (articulation). Her speech slowly deteriorated and she noted weakness in chewing power and difficulty in swallowing in addition. In October 1987, she developed emotional incontinence. In January of 1988, she started to drag her left foot. She was admitted to our hospital on June 13 of 1988. On admission, she was alert and general physical examination was unremarkable. Neurologic examination revealed no dementia; her higher cerebral functions appeared intact. Ptosis was present bilaterally more on the right. She showed difficulty in opening her eyes on command; no contraction of the frontal muscles was seen upon attempted eye opening. There was a moderate limitation in the vertical gaze. Forced laughing and crying were seen. Facial muscles were moderately weak without apparent atrophy. The movement of the soft palate was very weak, and swallowing disturbance was more prominent for liquid staff. The tongue appeared somewhat small, however, no fasciculation was noted. Her step was small and the posture was stooped. Retropulsion was present, however, Romberg's sign was absent. No muscle atrophy was apparent, however, diffuse mile to moderate muscle weakness was noted in all four limbs. Cerebellar sign was absent. Deep tendon reflexes were exaggerated bilaterally, and Babinski sign was present on the left side. Sensation was intact. Routine blood tests were unremarkable as was a cranial CT scan. Her ptosis did not improve after 10 mg of edrophonium injection. CSF was also normal. She was transferred to another hospital but her neurological disabilities further progressed. In 1989, she was totally unable to move her limbs; she could only move her eyes; still consciousness was clear without dementia. She developed respiratory difficulty and expired on July 25, 1992. She was discussed in a neurological CPC, and the opinions were divided into ALS and primary lateral sclerosis (PLS). The chief discussant arrived at the conclusion that the patient might have had the pyramidal form of ALS. Postmorten examination revealed marked myelin pallor in the anterior as well as lateral corticospinal tracts. Pyramidal tract degeneration was prominent starting at the level of the cerebral peduncle and was continued to be seen until the level of lumbar cord. The number of anterior horn cells showed only slight decrease in the cervical level, however, it was normal in the lumbar cord.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[A 65-year-old woman with dysarthria, dysphagia, weakness, and gait disturbance]. 777 10

Our objective was to obtain national data of the estimated prevalence, sociodemographic relationships, and health impact of persons with functional gastrointestinal disorders. We surveyed a stratified probability random sample of U.S. householders selected from a data base of a national market firm (National Family Opinion, Inc.). Questions were asked about bowel symptoms, sociodemographic associations, work absenteeism, and physician visits. The sampling frame was constructed to be demographically similar to the U.S. householder population based on geographic region, age of householder, population density, household income, and household size. Of 8250 mailings, 5430 were returned suitable for analysis (66% response). The survey assessed the prevalence of 20 functional gastrointestinal syndromes based on fulfillment of multinational diagnostic (Rome) criteria. Additional variables studied included: demographic status, work absenteeism, health care use, employment status, family income, geographic area of residence, population density, and number of persons in household. For this sample, 69% reported having at least one of 20 functional gastrointestinal syndromes in the previous three months. The symptoms were attributed to four major anatomic regions: esophageal (42%), gastroduodenal (26%), bowel (44%), and anorectal (26%), with considerable overlap. Females reported greater frequencies of globus, functional dysphagia, irritable bowel syndrome, functional constipation, functional abdominal pain, functional biliary pain and dyschezia; males reported greater frequencies of aerophagia and functional bloating. Symptom reporting, except for incontinence, declines with age, and low income is associated with greater symptom reporting. The rate of work/school absenteeism and physician visits is increased for those having a functional gastrointestinal disorder. Furthermore, the greatest rates are associated with those having gross fecal incontinence and certain more painful functional gastrointestinal disorders such as chronic abdominal pain, biliary pain, functional dyspepsia and IBS. Preliminary information on the prevalence, socio-demographic features and health impact is provided for persons who fulfill diagnostic criteria for functional gastrointestinal disorders.
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PMID:U.S. householder survey of functional gastrointestinal disorders. Prevalence, sociodemography, and health impact. 835 66

OBJECTIVE--To analyse the natural history of progressive supranuclear palsy (PSP or Steele-Richardson-Olszewski syndrome) and clinical predictors of survival in 24 patients with PSP confirmed by necropsy, who fulfilled the NINDS criteria for a neuropathological diagnosis of typical PSP. METHODS--Patients were selected from the research and clinical files of seven medical centres involving tertiary centres of Austria, England, France, and the United States. Clinical features were analysed in detail. The patients' mean age at onset of PSP was 63 (range 45-73) years. RESULTS--The most frequent clinical features (occurring in at least 75% of the patients) were early postural instability and falls, vertical supranuclear palsy, akinetic-rigid predominant parkinsonian disorder characterised by symmetric bradykinesia and axial rigidity unrelieved by levodopa, pseudobulbar palsy, and frontal release signs. Occasionally, segmental dystonia or myoclonus were described, but neither aphasia nor alien limb syndrome was reported. Fractures occurred in 25% of the patients but were unrelated to the severity of the gait or to the presence of falls. Median survival time was 5.6 (range 2-16.6) years. Onset of falls during the first year, early dysphagia, and incontinence predicted a shorter survival time. Age at onset, sex, early onset of dementia, vertical supranuclear palsy, or axial rigidity had no effect on prognosis of survival. Pneumonia was the most common immediate cause of death. PSP was most often clinically misdiagnosed as Parkinson's disease. Errors in diagnosis suggest that PSP is underdiagnosed. CONCLUSION--Progressive onset of early postural instability with falls or supranuclear vertical palsy in the fifth decade, should suggest the diagnosis of PSP. Onset of falls during the first year are emphasised, as they could lead to an early diagnosis and influence the prognosis of patients with PSP. Whether appropriate treatment of the dysphagia could prolong the survival of PSP patients needs to be explored.
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PMID:Natural history of progressive supranuclear palsy (Steele-Richardson-Olszewski syndrome) and clinical predictors of survival: a clinicopathological study. 864 26

Patients with idiopathic Parkinson's disease (IPD) often show signs and symptoms of autonomic involvement, related to the disease itself or to its progression. The more frequently disturbances reported are connected with loss of extrapyramidal motor control, i.e. dysphagia, gastric emptying and the most common constipation. They concern about 73% of the patients. A high frequency of urinary symptoms, ranging from 37% to 71%, is also reported in IPD, in particular detrusor hyperreflexia causing urgency, frequency of micturing or urgency incontinence. Another autonomic groups of symptoms are related to the failure of cardiopressor adaptability which involve 15% of the subjects and are more typical of late onset cases or forms bordering with the Multiple System Atrophy, finally resulting in orthostatic hypotension (OH).
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PMID:Autonomic disorders in Parkinson's disease. 874 4

Myotonic dystrophy is an autosomal dominant inherited disease of the skeletal and cardiac musculature that involves the pharyngeal and gastrointestinal smooth and striated muscles, resulting in velopharyngeal insufficiency, Swallowing difficulties, gastrointestinal motility disorders and anal incontinence. Gastrointestinal symptoms are found in a large proportion of patients suffering from this disease and may herald the onset of muscular disorders, in rare cases they are even the predominant feature of the disorder. We report on a 31-years-old patient with formerly undiagnosed myotonic dystrophy in combination with a non-rotation of the intestinal tract, an association of disorders that to our knowledge never has been reported before. Our patient was admitted as an emergency with signs of an acute abdomen with ileus, associated with acute aspiration pneumonia. Surgical intervention was avoided once the diagnosis of myotonic dystrophy had been confirmed and the patient was treated successfully by conservative therapy. A review of the literature indicates that conservative treatment of motility disorders of the bowel in patients with myotonic dystrophy is to be recommended.
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PMID:Intestinal non-rotation and pseudoobstruction in myotonic dystrophy: case report and review of the literature. 891 34

A 24-year-old pregnant woman started to have hyperemesis gravidarum 6 weeks before admission. Four weeks later she had vertigo, diplopia, staggering gait, mild dyspnea, dysphagia, and incontinence of urine. On admission she presented with ophthalmoplegia, ptosis, ataxia, decreased tendon reflex, and memory disturbance. Brain magnetic resonance imaging revealed abnormal intensities in medial thalamic-hypothalamic regions and the periaqueductal area, and she was diagnosed with Wernicke's encephalopathy. Urodynamic studies revealed decreased bladder volume and detrusor hyperreflexia. Six weeks after the administration of 100 mg/day of thiamine, urge incontinence gradually recovered, together with neurological signs. Lesions of the medial thalamic-hypothalamic area and the periaqueductal gray matter seemed to be mainly responsible for micturitional disturbance in our patient with Wernicke's encephalopathy.
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PMID:Micturitional disturbance in Wernicke's encephalopathy. 904 73

Gastrointestinal motor dysfunctions result when extrinsic autonomic nerves are diseased and are unable to modulate the motor functions of the digestive tract, which depend on the enteric nervous system and the automaticity of the smooth muscles. Gut motor dysfunction may result from disorders at all anatomic levels of the extrinsic neural control and degenerations of gut smooth muscle. It illustrates the important modulation of gut motor function by the nervous system. Although much emphasis has been placed on dysphagia and constipation in neurologic disorders, more recent studies have highlighted incontinence, vomiting, and abdominal distention in the symptomatology of such patients. Strategies that evaluate the motor functions of the digestive tract and the extrinsic neural control are available; they aid in selection of rational therapies for these patients, which include physical therapy and biofeedback training (for dysphagia or incontinence), prokinetic agents (for neuropathic forms of gastroparesis, chronic intestinal dysmotility, or slow transit colonic disorders), and nutritional support using the enteral or parenteral route. Electrical or magnetic stimulation of lumbosacral roots provides a novel method to alleviate constipation in paraplegics.
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PMID:Gastrointestinal dysfunction in neurologic disease. 908 70


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