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)

Neuroendocrine (Merkel cell) carcinoma of the skin is a rare entity. Often locally aggressive, this lesion may also metastasize to organ systems, including bone, liver, and brain. The authors report a case of a 64-year-old male who presented with hoarseness and dysphagia 17 months after resection of a primary Merkel cell carcinoma of the nose. Additional studies revealed bilateral vocal cord paralysis secondary to central nervous system dysfunction. Cytologic evaluation of the cerebrospinal fluid revealed malignant tumor cells consistent with metastatic Merkel cell carcinoma. Presented are the cytologic and immunohistochemical findings in a case of metastatic Merkel cell carcinoma involving the central nervous system.
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PMID:Cytologic and immunohistochemical diagnosis of neuroendocrine (Merkel cell) carcinoma in cerebrospinal fluid. 247 4

Palliative therapy for obstructing esophageal carcinoma is more often necessary than curative surgery. The neodymium:yttrium-aluminum-garnet laser was used for vaporization of obstructing esophageal carcinoma in 18 patients requiring 24 treatments. Three women and 15 men (age range 42 to 87 years) had esophageal carcinoma (seven squamous cell and nine adenocarcinoma). Twelve tumors were at the esophagogastric junction, four at the midesophagus, and two in the cervical esophagus. Lengths varied from 3 to 7 cm. Inoperability was due to diffuse metastases in eight patients, local invasion in five, poor operative risk in one patient, and patient refusal for operative treatment in four patients. Energy use was 1000 to 22,600 J per session (mean 6120 J). Good results were achieved in 16 patients (88.9%): Seven returned to full diet, five to soft diet, and four to full fluids without dysphagia. Four patients required retreatment 1 to 3 months later because of recurrent dysphagia. One patient was not benefited by the treatment and died of carcinomatosis 1 week later. No intraoperative complications occurred. Postoperatively, one patient had laryngeal edema and another had a bronchoesophageal fistula 3 weeks later. The mean survival time is 3 1/2 months. Neodymium:yttrium-aluminum-garnet laser vaporization for obstructing esophageal carcinoma is effective palliation regardless of histologic tumor type. It can be performed under direct vision with a low frequency of postoperative complications.
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PMID:Neodymium:yttrium-aluminum-garnet laser vaporization for palliation of obstructing esophageal carcinoma. 247 31

Fifty-eight patients had surgery for carcinoma of the esophagus at Scripps Clinic, La Jolla, Calif, from 1976 to 1986. Esophagectomy with reconstruction by colon interposition was done in 24 patients with adenocarcinoma arising in columnar-lined epithelium (Barrett's). In 5 patients, obstructive symptoms had not yet developed and the diagnosis was made by endoscopy performed for evaluation of gastroesophageal reflux. Dysphagia had just started in 12 additional patients and no weight loss had been noted. The operation was palliative in 14 patients and potentially curative in the other 10. Only 3 patients had negative lymph nodes. Ten patients were alive after 2 to 11 years. Encouraging results were indicated for surgical treatment of adenocarcinoma of the esophagus developing in Barrett's epithelium. A good outcome can be obtained with resection even in patients with lymph node metastases.
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PMID:Early diagnosis of adenocarcinoma developing in Barrett's esophagus. 247 86

The fact that neoplasms of the cranial base or metastases of nasopharyngeal tumors may cause palsy of nerves which pass through the jugular and anterior condylar foramina has been well documented. On the other hand, very little has been reported about the traumatic causes of these diseases, probably because they are often underestimated or misdiagnosed. In this paper, the Authors report four cases of palsy of the last four cranial nerves caused by various kinds of trauma: glossopharyngeal thermo-rhizotomy, bullet wound, closed cranial trauma, neck surgery. The main symptom immediately following a lesion is mechanical dysphagia which causes inhalation of food and saliva and may sometimes require surgery, such as tracheotomy or cricopharyngeal myotomy. The most lasting symptom is dysphonia, which can only be treated by speech therapy. Because of the importance of these damaged functions, the above symptoms must be studied more thoroughly, also keeping in mind the modern techniques of surgical and non-surgical speech rehabilitation.
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PMID:Post-traumatic paralytic syndromes of the jugular and condylar foramina. 249 4

We have evaluated the sensitivity, specificity and accuracy of laparoscopy under general anaesthesia, ultrasound and computed tomography (CT) in detecting intra-abdominal metastases in 90 consecutive patients with carcinoma of the oesophagus or cardia. Metastases were histologically confirmed as hepatic in 25 patients, nodal in 35 and peritoneal in nine. All investigations had high specificity (86-100 per cent) for each type of metastasis. Laparoscopy was found to be significantly more sensitive (P less than 0.01; P less than 0.02) and more accurate (P less than 0.01; P less than 0.01) than either ultrasound or CT, respectively, with regard to hepatic status. Although laparoscopy performed best with regard to nodal metastases, this reached statistical significance only when sensitivity of ultrasound was compared (P less than 0.01). Neither ultrasound nor CT detected any peritoneal metastases, although laparoscopy detected eight out of nine, giving a sensitivity of 89 per cent and an accuracy of 98 per cent. There was no morbidity or mortality associated with laparoscopy, which offers a safe, reliable method of determining intra-abdominal status and may obviate the need for surgery in some patients with malignant dysphagia.
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PMID:Laparoscopy, ultrasound and computed tomography in cancer of the oesophagus and gastric cardia: a prospective comparison for detecting intra-abdominal metastases. 253 50

A primary small cell carcinoma of the esophagus in a 61-year-old woman was treated by transhiatal esophagectomy. The clinical data were correlated with data obtained from a review of the 129 cases reported in the world literature, thereby providing a clinical profile and suggested management strategy for this rare type of esophageal malignancy. Presenting symptoms of esophageal small cell carcinoma include dysphagia (75.3%), weight loss (38.4%), and chest pain (23.3%). Treatment regimens have included surgical intervention in 58%, radiotherapy in 10%, chemotherapy in 6%, or some combination of these in 26%. Overall survival is only 20.7 weeks after diagnosis. The fact that three fourths of affected patients had metastatic disease at the time of diagnosis leads us to recommend surgical intervention plus systemic chemotherapy in these patients.
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PMID:Primary small cell carcinoma of the esophagus. 253 65

A 60-year-old woman had progressive lower abdominal pain, nonbloody diarrhea, and weight loss, followed by severe epigastric pain and dysphagia. Radiographic evaluation of the colon showed segmental strictures which were interpreted as Crohn's disease. Medical treatment was not helpful. Neither gross endoscopic appearance nor multiple biopsies of the esophagus, stomach, and colon were diagnostic. Finally, laparotomy with full-thickness biopsies of the stomach and colon revealed linitis plastica. The clinician should be alert to colonic metastases from gastric linitis plastica, for it can produce focal or segmental strictures, mimicking more common colonic diseases such as Crohn's disease. A full-thickness biopsy is often necessary for a firm diagnosis. We review the literature on this occurrence, highlighting the clinical and radiologic spectrum, as well as the organ systems most often affected when gastric linitis plastica metastasizes.
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PMID:Gastric linitis plastica with metastases to the colon: a mimic of Crohn's disease. 255 55

Fifty-nine consecutive patients with stenosing carcinoma of the upper gastrointestinal tract were entered into a prospective study defining parameters of survival during laser treatment. A total of 322 laser sessions were performed, 56% of which on an outpatient basis. Life table analysis revealed that survival was poor in the presence of metastases, and in patients under 60 years of age. Survival was statistically independent of tumor histology, location, length or previous treatment of any kind. In contrast, the degree of stenosis both before and after laser treatment was related to survival in a significant fashion. The best separation into groups was achieved with the parameter dysphagia after laser treatment. Thus, the data are compatible with an important role of adequate enteral nutrition in these debilitated patients.
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PMID:Laser treatment of upper gastrointestinal tract carcinoma: determinants of survival. 261 29

The clinical data, diagnostic procedures and survival are reported in 19 cases diagnosed as malignant peritoneal mesothelioma. All patients were men and 74% had an occupational exposure to asbestos, whereas in 26% no information about asbestos exposure was available. The median interval between asbestos exposure and the diagnosis appeared to be 44.7 years (range 18-49 years). The most common presenting symptoms were abdominal pain, weight loss and dysphagia. Most patients presented with a large amount of ascites. In the majority of patients no therapy except pain relief was given and the median survival from the time of diagnosis was 6 months (range: 0-29 months). Some patients received surgery or chemotherapy, which however did not prolong survival. Only in 2 patients survival exceeded 1 year, although these patients did not receive therapy. The autopsy findings of some patients showed that there were positive abdominal lymph nodes in 2 of them, while in no case positive thoracic lymph nodes were found. The relative short survival period from the time of the first diagnosis in contrast to malignant pleural mesotheliomas is probably the reason for the absence of distant metastases. In this series only in a minority of patients cytology of the ascites was positive and often a laparotomy had to be done. Since cytologic specimens are often negative, we suggest that in patients suspected of a malignant peritoneal mesothelioma, laparoscopy with directed biopsies is the diagnostic procedure of first choice.
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PMID:Malignant peritoneal mesothelioma: a series of 19 cases. 261 45

Primary malignant melanoma of the esophagus is an uncommon neoplasm. The world literature reports only 139 cases. It is mainly a disease of older age, predominantly in the 6th and 7th decades, with a male-to-female ratio of 2 to 1. Of all published cases, 60 (43.16%) occurred in the lower third, 40 (28.77%) in the middle third, 25 (17.98%) at the junction of the middle and lower thirds, and 14 (10.07%) in the upper third. Dysphagia was the commonest symptom and was found in 79.5% of cases. The tumors were polypoid, pedunculated, often pigmented, and usually presented as clinically advanced neoplasms. The histological and cytological features were similar to those of lentigo maligna melanoma, but with a more aggressive biological behavior. Hematogenous and lymphatic metastases were common. The overall survival was 9.8 months, and two-thirds of the patients died within a year of diagnosis, irrespective of therapeutic modalities. Deaths were disease-related in 85% of cases. It is concluded that, for operable patients, radical surgical resection is the treatment of choice, either for palliation or for cure, with a 5-yr survival of 4.2%. Irradiation is useful as a palliative or adjuvant measure. The roles of chemotherapy and immunostimulation need further evaluation.
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PMID:Primary malignant melanoma of the esophagus. 237 95


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