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)

Optimum surgical management of the hypopharyngeal diverticulum is controversial. The authors discuss 48 consecutive patients (average age 72.1 years) with documented hypopharyngeal diverticula who were treated by cricopharyngeus myotomy, leaving the diverticula in situ. All came to the hospital with dysphagia; other symptoms included postdeglutitive cough, regurgitation, aspiration, and weight loss. Seven patients had had previous surgery for a Zenker's diverticulum with recurrence. Aspiration pneumonia was treated in 9 patients; 28 patients had concurrent chronic obstructive pulmonary disease or cardiovascular disease. Thirty-nine patients had cricopharyngeus myotomy under local anesthesia, 5 had cricopharyngeus myotomy under general endotracheal anesthesia, and 4 patients underwent myotomy with a cervical esophagostomy. There was one mortality (2.1%) and no incidence of postoperative bleeding, sepsis, or cranial nerve injury. Follow-up was done with 30 patients via telephone an average of 64 months after operation. Twenty-one of 30 patients reported excellent relief of symptoms, 5 reported improvement with occasional symptoms, and 4 patients described persistent dysphagia. Cricopharyngeus myotomy under local anesthetic is a safe and effective approach to the patient with a hypopharyngeal diverticulum. The awake patient can swallow on command, which enables the surgeon to identify the upper esophageal sphincter (UES) and to perform an accurate, complete myotomy. The absence of a pharyngeal suture line eliminates the risk of leakage and mediastinal sepsis, and allows early, postoperative feeding and discharge.
 ...
PMID:Treatment of Zenker's diverticula by cricopharyngeus myotomy under local anesthesia. 148 6

Dysphagia due to cricopharyngeal dysfunction is well known; however, there have been no previous data indicating an association between cricopharyngeal dysfunction and COPD. After observing marked cricopharyngeal dysfunction with aspiration in three patients who had frequent and severe exacerbations of COPD, we performed pharyngoesophageal examinations with videotaping in another 22 nonrandomized patients. Cineradiography or videofluoroscopic recording with capabilities of slow-motion and freeze-frame playback is mandatory, since the transit time of the bolus through the pharynx is rapid. Severe cricopharyngeal dysfunction was observed in 17 elderly patients with COPD. Deglutition disorders were elicited by careful questioning in 15 of these. In eight subjects, cricopharyngeal myotomy resulted in improvement of swallowing and complete or partial relief of acute exacerbations of respiratory distress. In one subject, myotomy relieved only the swallowing problem. The mechanism of cricopharyngeal dysfunction in elderly patients with COPD is unknown at this time, but may be related to gastroesophageal reflux, therapeutic agents, and/or alterations in pharyngoesophageal anatomic structures. We conclude that investigations for swallowing disorders should be considered in patients with COPD who have frequent acute exacerbations of respiratory distress.
 ...
PMID:Cricopharyngeal dysfunction in chronic obstructive pulmonary disease. 229 59

We reported a 71-year-old male with lateral medullary syndrome presented acute respiratory arrest after ataxic respiration. The patient had experienced transient diplopia repeatedly for about 2 weeks and then the developed persistent diplopia and vertigo. On the third day he was admitted to our hospital because of neurological deterioration and aspiration pneumonia. He showed left Horner's sign and double vision. And he had sensory disturbances of pain and temperature in the left face and the right side of the body, left limb ataxia and truncal ataxia. He showed dysarthria, severe dysphagia and left mild central facial paresis, but no hemiparesis. This case was clinically considered to be a typical case of left lateral medullary syndrome. When he was admitted to our hospital, he showed hypoxia with hypercapnea in spite of no history of chronic obstructive pulmonary disease. This condition was considered to be a central alveolar hypoventilation. He had two episodes of sudden-onset respiratory arrest following ataxic respiration on the 4th and 5th days, but no cardiac arrest. He was supported his respiration by mechanical ventilation until he was able to breathe spontaneously on the 29th day. The 22nd day MRI disclosed high intensity area in the left lateral and dorso-medial medulla in T2-weighted image, and this lesion was 1.5 cm in length. Therefore this case was diagnosed medullary infarction. This case developed ipsilateral facial pain in chronic stage. Pain existed around the eye and in the cheek, and pain was like toothache and unbearable like thalamic pain.(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:[A case of medullary infarction presented lateral medullary syndrome and respiratory arrest after ataxic respiration]. 268 32

This retrospective study investigated the prevalence and nature of dysphagia in 78 male outpatients whose primary diagnosis was chronic obstructive pulmonary disease (COPD) and who were referred for modified barium swallow studies at the Veterans Affairs Medical Center (VAMC) in Tucson, Arizona, 1992-1995. Nearly 85% of these patients evidenced some degree of dysphagia, and laryngeal penetrations or aspirations were observed in 44 of them. Agreement between VAMC swallow assessments and those of a three-judge panel of certified speech-language pathologists supported the reliability and validity of the information extracted from VAMC records. The high percentage of silent laryngeal penetrations and aspirations observed in this sample suggests that COPD patient's respiratory status should be considered as well as overt symptoms of a swallowing disorder, such as coughing, in making referrals for video-fluoroscopic swallow studies for such patients.
 ...
PMID:Prevalence and nature of dysphagia in VA patients with COPD referred for videofluoroscopic swallow examination. 1083 28

The purpose of this study was to examine the effects of age, gender, disease, and multisystem involvement on SpO2 levels of 104 dysphagic patients and 77 nondysphagic persons. Results indicated that solid aspirators had lower SpO2 levels than liquid aspirators, penetrators, and nondysphagics. In addition, SpO2 levels varied by age, with older persons having lower levels than younger persons among dysphagics but not among nondysphagics. Patients with COPD had lower SpO2 levels than dysphagics with other disorders. Significant interactions were found among age, gender, and disease. Multisystem involvement was found not to be a factor in SpO2 levels. It was concluded that although normal aging processes reduce swallowing and pulmonary functioning, it became a significant factor only when combined with an assault to the system, such as CVA or COPD.
Dysphagia 2001
PMID:Effects of age, gender, disease, and multisystem involvement on oxygen saturation levels in dysphagic persons. 1121 46

In a 64-year-old man who was suffering from chronic obstructive pulmonary disease, recurrent airway infections, dysphagia, and weight loss, achalasia was diagnosed on the basis of endoscopic and radiological examinations. Afterwards he underwent flexible bronchoscopy, which revealed a benign looking fistula between trachea and oesophagus. This appeared to be a congenital tracheo-oesophageal fistula. The fistula was closed surgically. Three months later breathlessness and a sputum-producing cough were the only remaining symptoms. This rare anomaly is mostly diagnosed during childhood, but can also manifest itself in adulthood. If a tracheo-oesophageal fistula is suspected, the diagnostic procedures of choice are a barium oesophagogram in a forward-sitting or supine position or endoscopy of the trachea. Treatment consists of division and closure of the fistula. The prognosis is good.
 ...
PMID:[Dyspnoea and dysphagia in an adult caused by a tracheo-esophageal fistula]. 1213 40

Aspiration pneumonia is a serious problem for the elderly institutionalized person, often requiring transfer to a hospital and a lengthy stay there. It is associated with a high mortality rate and is very costly to the health care system. The current study sought to determine the key predictors of aspiration pneumonia in a nursing home population with the hope that health care providers could identify those residents at highest risk and focus more efforts on prevention of this serious disease. A cross-sectional, retrospective analysis was done, using the Minimum Data Set (MDS) nursing home assessment data for three states (New York, Mississippi, Maine) from 1993 to 1994 (N = 102842). Nursing home residents were aged 65+. Standardized MDS summary scales and their component items were used, including: the Activities of Daily Living (ADL) scale, the cognitive performance scale (CPS), and the Resource Utilization Groups (RUGs). Results of these analyses showed the prevalence of pneumonia among this population was 3% (n = 3118). Results from the logistic regression models indicated 18 significant predictors of aspiration pneumonia. The strongest to weakest predictors of pneumonia were, respectively, suctioning use, COPD, CHF, presence of feeding tube, bedfast, high case mix index, delirium, weight loss, swallowing problems, urinary tract infections, mechanically altered diet, dependence for eating, bed mobility, locomotion, number of medications, and age, while both CVA and tracheotomy care were inversely predictive of pneumonia. The emergence of these significant predictors suggested a different pathogenesis of pneumonia in the elderly nursing home resident from the acute care patient or the outpatient. Nursing home residents have chronic medical conditions that gradually lead to "decompensation" in functional status, nutritional status, and pulmonary clearance. Dysphagia and aspiration are common complications of their medical conditions and may slowly worsen as their status deteriorates. Alternatively, a sudden adverse event may dramatically increase the amount aspirated or the ability to resist infection and lead to sudden decompensation. Clinical staff must identify residents with dysphagia and aspiration and work to prevent decline in functional status in all residents. They must be aware of the dangers of adverse events that lead to sudden inactivity or illness and increase the risk of aspiration pneumonia. Prevention of this disease whenever possible will reduce costs, improve health outcomes, and improve our quality of care.
Dysphagia 2002
PMID:Predictors of aspiration pneumonia in nursing home residents. 1235 45

The intimate anatomical and physiologic relationship between the upper airway and esophagus consists of complex interactions between various muscles and nerves with both voluntary and involuntary patterns of control. Alterations in this harmonic relationship can lead to swallowing abnormalities ranging from dysphagia to gross aspiration, gastroesophageal reflux disease (GERD) and chronic cough. There is a paucity of data regarding pathologic alterations in the upper airway-esophageal relationship in patients with COPD. The association between GERD and respiratory symptoms is well recognized in the setting of asthma; however, the nature of this relationship remains controversial. The association of GERD and COPD is even less clear. A review of the limited data on GERD and swallowing abnormalities in patients with COPD indicate that prevalence of GERD and esophageal disorders in patients with COPD is higher than in the normal population. However, its contribution to respiratory symptoms, bronchodilator use and pulmonary function in patients with COPD remains unknown. Although dysphagia and swallowing dysfunction on videofluoroscopic swallow evaluation are common in patients with COPD, their role as exacerbators of COPD remains to be elucidated. Further clinical research is necessary to evaluate the role of GERD and swallowing dysfunction in both stable and acute exacerbation of COPD.
 ...
PMID:Clinical implications of gastroesophageal reflux disease and swallowing dysfunction in COPD. 1472 11

To clarify the indications and usefulness of Percutaneous endoscopic gastrostomy (PEG) in patients with Silicosis and some co-morbidities, we analyzed eight cases of silicosis, who suffered from dysphagia and had received a PEG for tube feeding during the period from 1998 to 2002. The characteristics, and clinical course, of each case were statistically analyzed before and during PEG usage. All cases were bed-ridden males, with a mean age of 80 years. The profusion rate (PR) grade of silicosis was for five cases in category 2, and for three cases in category 4. Most of the co-morbidities were dementia (five cases), and chronic heart failure (four cases). There were no significant improvements in the measured nutrition criteria (albumin, lymphocytes) nor in respiratory function (arterial O2) between before and during PEG usage. Tube feeding through the PEG was not performed in three cases because of repeated aspiration pneumonia. The mean duration of PEG usage was 9 months, ranging from 5 to 20 months. Five cases died of the co-morbidities. Furthermore, there was significant deterioration in the bacteriological data (p = 0.001), suggesting a worsening of the swallowing disturbances during PEG usage, or the emergence of more resistant organisms as a result of empirical antibiotic therapy. The present results suggest that the indications of PEG in cases of severe chronic obstructive pulmonary disease (COPD) such as silicosis, associated with other morbidities, and with dysphagia, are somewhat limited. The patient's general condition should be an important factor in deciding whether or not this technique should be used.
 ...
PMID:Evaluation of percutaneous endoscopic gastrostomy in elderly patients with silicosis and co-morbidities. 1476 69

The presence of a hiatal hernia is generally considered a contraindication to gastric banding in the morbidly obese, despite recent reports indicating favorable outcomes following simultaneous repair of sliding hernias and laparoscopic adjustable gastric banding (LAGB). A 66-year-old woman weighing 120 kg (BMI 45) with arterial hypertension and gastroesophageal reflux-related chronic obstructive pulmonary disease underwent repair of a large paraesophageal hernia and LAGB. At 40 months followup, the patient had lost 44% excess body weight (BMI 36) and had no complaints of heartburn, regurgitation or dysphagia. She was no longer hypertensive and her pulmonary condition had improved significantly. Barium swallow at 30 months showed normal anatomy and positioning of the band. Because other minimally traumatic surgical options are lacking, the author believes morbidly obese patients with hiatal hernia should not be denied the advantages of LAGB. Adequate weight reduction, resolution of gastroesophageal reflux and other co-morbidities can be expected if an appropriate surgical technique is used.
 ...
PMID:Simultaneous paraesophageal hernia repair and gastric banding. 1582 83


1 2 3 4 Next >>