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)

Esophagogastric hematoma is a rare condition occurring spontaneously or after esophageal instrumentation. In this report, we describe a patient with acute dysphagia in whom a lower esophageal mass was detected radiographically. Upper endoscopy revealed an esophageal mass that extended from the mid-esophagus to the gastroesophageal junction and was associated with a malignant-appearing ulcerated mass (5 to 6 cm) in the cardia. Gastric cancer with esophageal extension was the presumptive diagnosis. Computed tomography showed that the esophageal mass had a density similar to blood, a finding suggesting the presence of an esophageal hematoma. Biopsy specimens of the ulcer revealed acute inflammation but no malignant involvement. The patient was treated conservatively, and the initial symptoms resolved. Esophagogastric hematomas can mimic a neoplasm; thus, establishing the correct diagnosis is important because this condition has a favorable prognosis, and only conservative treatment is needed.
 ...
PMID:Esophagogastric hematoma mimicking a malignant neoplasm: clinical manifestations, diagnosis, and treatment. 955 38

We report herein the unusual case of a 59-year-old woman with Plummer-Vinson syndrome who developed gastric cancer. The patient had a longstanding history of dysphagia and iron deficiency anemia, for which she had sporadically taken iron supplements that improved the dysphagia to some extent, but not completely. Owing to her tolerance of the dysphagia, she had not been taking iron supplements for the past 17 years. On admission, she was in fair nutritional condition and not anemic. Blood chemistry results were all normal, including the serum iron level. Gastrointestinal radiographic series demonstrated cervical esophageal webs and advanced gastric cancer. Her dysphagia was successfully treated by endoscopic bougienage through the webs, and a distal partial gastrectomy with nodal dissection was performed. Histology of the resected stomach revealed atrophic mucosal change and, by chance, an adenomatous lesion in addition to adenocarcinoma. Her postoperative course was uneventful and she is now well, without any signs of recurrence. Although Plummer-Vinson syndrome is known to be associated with upper alimentary tract cancers, gastric cancer is extremely rare. A discussion on the etiology of Plummer-Vinson syndrome and its link with potential carcinogenesis follows this case report.
 ...
PMID:Gastric cancer occurring in a patient with Plummer-Vinson syndrome: report of a case. 978 78

Recently published guidelines for the treatment of dyspepsia have emphasized the importance of age, Helicobacter pylori infection, and alarm symptoms such as weight loss, anemia, and dysphagia in patient assessment. However, the currently available guidelines were not designed specifically for regions in which the incidence of gastric cancer is high, as is the case in Japan, and could lead to cases of gastric cancer being missed at a stage when they are treatable. Therefore a Japanese working group was organized to consider the design of dyspepsia treatment guidelines in Japan, with specific attention to the problem of gastric cancer and the lack of health insurance coverage for H pylori testing and eradication in Japan. To date, the group has prepared and tested clinically the feasibility of two drafts of the guidelines, and has incorporated a number of features and risk factors not currently included in other guidelines for dyspepsia treatment. This article describes the development of the guidelines and their provision of a rational basis for the management of patients with dyspepsia.
 ...
PMID:Guidelines for dyspepsia treatment in Japan. 991

The aim of the present review is to summarize the most recent progress in gastroenterological topics, particularly of the upper gastrointestinal tract, which are of special interest in the elderly. The changes in oesophageal function, particularly disorders of motility, may explain, only in part, the unique clinical characteristics of oesophageal pathologies in the elderly. Dysphagia and gastro-oesophageal reflux disease present diagnostic, clinical and therapeutic characteristics that need to be studied with attention to avoid eventual disability, an impairment of nutritional status and a reduction in the quality of life. Aging, per se, does not significantly modify gastric aggressive factors, however, a selective and specific reduction in some gastric defensive mechanisms seems to occur with aging. The prevention of gastric mucosal injury, particularly that due to drugs, requires a better understanding of these age-related changes. Helicobacter pylori infection in the elderly presents peculiar epidemiological aspects particularly for subjects living in nursing homes. An understanding of Helicobacter pylori-related histological modifications of the gastric mucosa, particularly intestinal metaplasia, gastric atrophy and gastric cancer, the incidence of which seems to be both age- and Helicobacter pylori-related, is greatly needed. Moreover, some diagnostic and therapeutic aspects of Helicobacter pylori infection, i.e., the role of serology and the efficacy, side effects and compliance of drug therapies, are specific for the elderly and require a unique clinical approach. Bleeding is dramatically more frequent in this population. The identification of risk factors, i.e., drugs, pathophysiological mechanisms, i.e., the possible relationship between non-steroidal anti-inflammatory drugs and Helicobacter pylori infection, along with the clinical presentation in the elderly patient, must be the foundation of preventive medical care in geriatric gastroenterology.
 ...
PMID:Aging and the gastrointestinal tract. 1036

We report a 63-year-old man who died of respiratory failure. He was well until 1992 (57 years of his age), when he had an onset of progressive weakness of the bilateral upper limbs. He showed no improvement with TRH administration in other hospital. On January 12, 1994, he admitted to our department because of the progressive muscle weakness. Neurologic examination revealed a muscular atrophy associated with severe weakness and hyporeflexia in both upper limbs, and fasciculation were seen in his tongue. Electrophysiological studies revealed mild conduction block in the left medial nerve, and F-waves were not evoked in the left ulnar nerve and bilateral median nerves. After an administration of 25 g/day of human gamma-immunoglobulin for 5 days, conduction block as well as F-wave abnormalities in the left median and left ulnar nerve were improved, yet no improvement of muscle weakness was seen. The anti-GM1 IgG titer was transiently elevated in the patient's serum after gamma-immunoglobulin therapy. On September 8, 1994, subtotal gastrectomy was performed because of the early stage gastric cancer. Histological examination showed poorly differentiated adenocarcinoma (signet-ring cell carcinoma). His muscle weakness had been gradually extended to the lower limbs and he couldn't walk himself on January, 1998. On March, 1998, he developed tetraplegia, mild dysphagia, dysuria and the respiratory disturbance. On April 12, 1998, he admitted to our department for the second time. Neurologic examination revealed a muscular atrophy and fasciculation associated with severe weakness in all of his limbs, tongue and musclus masseter. Neither deep tendon reflex nor pathologic reflex was evoked in his upper and lower extremities. His ocular movements and sensations were well preserved. He died of respiratory failure on May 1, 1998. The patient was presented in a neurological CPC. Neurological and laboratory findings suggested a spinal progressive muscular atrophy (SPMA). However, there were several unusual points as a typical SPMA in this case, that is, an improvement of the electrophysiological abnormalities by gamma-globulin treatment, as well as transient elevation of anti-GM1 antibody. The clinical neurologists have arrived at the conclusion that the patient had lower motor neuron syndrome associated with anti-ganglioside antibody and cause of death was ascribed to the respiratory failure. We discussed whether this case was SPMA or multifocal motor neuropathy. Postmortem examination revealed numerous diverticulums in the ascending colon and lymphothyroiditis. No recurrent carcinoma was detected. Neuropathologically, both severe atrophy of the anterior spinal roots, and severe gliosis and neuronal loss in the anterior horn of the spinal cord were observed. Onuf nuclei were not affected. Neurogenic muscular atrophy was detected in the tongue, diaphragm, and limb muscles. Motor neurons of the brainstem were relatively preserved, but skein-like inclusions as detected by anti-ubiquitin antibody, were present in the facial and hypoglossal nuclei. Neither motor cortex nor cortico-spinal tracts were affected. Demyelination, remyelination or cellular infiltrations were not apparent in the right median nerve and sciatic nerves. The neuropathologic features were compatible with SPMA.
 ...
PMID:[An autopsy case with lower motor neuron disease showing a transient-appearance of anti-GM1 antibody and an improvement of conduction block after gamma-globulin administration]. 1039 55

A 68-year-old man was hospitalized on March 4, 1998 for disturbances in consciousness. In 1995, he had received proximal subtotal gastrectomy and reconstructive surgery of the jejunal interposition for gastric cancer. Thereafter he had been taking enough food without the habit of taking liquor. In October 1997, his short term memory was becoming gradually worse. On February 12, 1998, he suffered from numbness in the feet, and then dysphagia, unsteady gait, and diplopia developed gradually. On February 26, brain MRI showed no abnormalities. On March 3, he had a fever of 38.5 degrees C and his consciousness became unclear. Neurological examination revealed semi-coma, total ophthalmoplegia, and absence of doll's eye movement. Deep tendon reflexes were absent. The serum thiamine level was 9 ng/ml (normal range: 20-50). Brain MRI demonstrated symmetrical high intensity lesions in the periaqueductal area of the midbrain, dorsomedial nuclei of bilateral thalami, and vestibular nuclei. About 30 seconds after intravenous infusion of thiamine, his consciousness improved dramatically, but returned to semi-coma after about two minutes. Wernicke-Korsakoff syndrome usually occurs acutely. In the present case, however, the disease showed slow onset, chronic progression, and then rapid worsening after fever. Reconstructive surgery of the jejunal interposition might have caused the slow onset of Wernicke-Korsakoff syndrome, and fever might have facilitated the rapid progression of the disease. An immediate high concentration of thiamine modifies the kinetics of acetylcholine receptor ion channels, thereby maintaining wakefulness, and the level of consciousness may change dramatically.
 ...
PMID:[A case of Wernicke-Korsakoff syndrome with dramatic improvement in consciousness immediately after intravenous infusion of thiamine]. 1068 93

AIMS: A valid measure of quality of life (QL) that is sensitive to clinically significant changes in health is important for the assessment of patients with gastric cancer. The aims of this study were to examine whether the EORTC (European Organisation for Research and Treatment of Cancer) QLQ-C30 core questionnaire alone could distinguish between two clinically different groups of patients and to design a module, which included relevant patient-defined gastric cancer-specific variables. METHODS: The QLQ-C30 was completed by patients with potentially curable disease and those undergoing palliative treatment, and the results were compared between the two groups. A disease-specific module was then developed in four distinct phases according to EORTC guidelines. Relevant issues were identified from a literature search and structured interviews with patients and healthcare professionals, and worded into a provisional questionnaire which was pretested to determine any problems in its content, before formal validation. RESULTS: All of the subscales and single items within the QLQ-C30 were scored similarly by 144 patients, 86 with operable disease and 58 having palliative treatment, except constipation (P = 0.001). On the basis of interviews with 58 patients and 24 professionals, from the UK, France, Germany and Spain, 43 issues were reduced to produce a provisional questionnaire consisting of 24 items and pretested in 114 patients undergoing radical gastrectomy, palliative resection or other supportive measures. The resulting questionnaire, containing 22 items divided into five scales (dysphagia, pain, reflux, dietary restrictions and specific emotional problems related to gastric cancer and its treatment) and four single items, is undergoing validation. CONCLUSIONS: The EORTC QLQ-C30 is a valid generic instrument, but does not address all factors constituting QL in patients with gastric cancer. A specific module has been developed, which includes issues volunteered by patients to increase sensitivity and improve the evaluation of treatments for a disease where QL is important.
 ...
PMID:Development of an EORTC module to improve quality of life assessment in patients with gastric cancer 1071 72

Palliative endoscopic treatment of esophagogastric cancer is now possible using expandable metal stents. The properties, advantages, and drawbacks of these stents have been extensively analyzed, and there is no doubt that they are now easy and safe to introduce, without serious morbidity. However, the frequency of persistent thoracic pain and delayed complications, as well as the high rate of repeat interventions required, justify limited use of the procedure. The major indication for the procedure is dysphagia due to cancer in the esophagus or at the cardia. Enteral stents have been used in the treatment of malignant duodenal or jejunal stenoses, but the results are poor. A promising new area is the treatment of benign stenoses using expandable and biodegradable stents. It may be possible to use this technique for surgical anastomoses after tumor resection. Careful endoscopic analysis of the mucosal surface is necessary to establish the strict indications for endoscopic mucosal resection for mucosal malignancy. Biopsy evidence of the relation between lesion diameter, a depressed surface pattern and the depth of invasion into the submucosa, as well as the extent of regional or distant lymphatic invasion, provides the best guidelines for safe curative mucosectomy in gastric cancer. Endoscopic therapy is always safe in lesions less than 1cm in diameter; for other lesions, resection is safe when the depth of submucosal invasions is less than 300 microm. In other situations, surgery is preferable in patients who are otherwise in good health. In Japan, the results of the National Survey of Gastric Cancer, with cases detected by screening, confirmed the benefits of adherence to these guidelines; most patients were treated surgically, and only 7% with endoscopic therapy.
 ...
PMID:Treatment of esophagogastric tumors. 1077 74

The incidence of oesophageal adenocarcinoma continues to rise rapidly in the West whereas cancer of the stomach is becoming less common. Most patients present with advanced disease that is not amenable to curative treatment. This review focuses on recent evidence on the endoscopic therapy of oesophago-gastric cancer. Although there are many treatment modalities available, there is a paucity of good quality randomised trial evidence on which to base palliative treatment decisions. Furthermore, although palliation of dysphagia may be improved by expandable metal stents or ablative therapy, there is no evidence that this improves survival and each of these therapies has a high frequency of complications particularly in longterm survivors. Exciting developments have however been reported in the therapy of early stage oesophago-gastric cancer. Endoscopic mucosal resection is particularly promising with high rates of complete removal of early cancer or high grade dysplasia. Long-term follow up of these patients is required because of high rates of metachronous tumour formation and at present there are no randomised trial data comparing endoscopic mucosal resection with conventional surgery.
 ...
PMID:Treatment of oesophago-gastric tumours. 1182 9

We report a rare case of Barrett's adenocarcinoma asso-ciated with acquired eventration of the diaphragm in a 71-year-old woman. She initially developed dysphagia and epigastric discomfort in May, 1997. On July 9, she was referred to our Department of Surgery at the Ryukyus University Hospital for thorough examination and treatment. Esophageal adenocarcinoma and eventration of the diaphragm were revealed by exhaustive examinations, including chest X-ray, computed tomography, and magnetic resonance imaging, and proximal gastrectomy with reconstruction of jejunal interposition was performed, on August 8. Histologically, the tumor revealed that the adenocarcinoma arose from short-segment Barrett's esophagus (SSBE). It thus appears that eventration of the diaphragm may induce SSBE and Barrett's adenocarcinoma. We therefore recommend that periodic examinations of the esophagus and stomach be performed in patients with eventration of the diaphragm. Barrett's adenocarcinoma associated with acquired eventration of the diaphragm is reported. Patients with eventration of the diaphragm should undergo periodic examinations of the esophagus and stomach.
Gastric Cancer 1998 Dec
PMID:Barrett's adenocarcinoma associated with acquired eventration of the diaphragm. 1195 49


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