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)

When the surgeon must obviate to an impending obstruction because of an unresectable tumor of the supramesocolic space and an intestinal bypass is not feasible, a jejunostomy is usually indicated. We describe a new method to provide enteral nutrition via a subcutaneous jejunostomy without any external device, which can be used only when the patient is at risk for developing an obstruction or dysphagia. The feeding tube is inserted into the jejunum and then connected to a Port-a-Cath lodged in a subcutaneous pocket. Subsequently, the nutrition can be delivered via a Huber needle inserted in the port, or, to minimize the need for strict aseptic surveillance, the tube can be exteriorized from the pocket and used as the usual tube jejunostomy. This procedure allows placing a precautionary jejunostomy without distortion of the body-image.
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PMID:Subcutaneous jejunostomy. 150 63

Pneumomediastinum is a rare pathological condition with air in the mediastinum outside the trachea and oesophagus. The etiology may be spontaneous/resulting from exertion, traumatic, iatrogenic or it may be due to inflammation, neoplasm or perforation of a hollow abdominal organ. In pneumomediastinum resulting from exertion, a pressure gradient occurs and this causes rupture of marginally situated pulmonary alveoli. Air escapes from the alveoli into the perivascular adventitia and dissects its way along the vessels to the mediastinum. The commonest symptoms are pain in the thorax in 80-90% of the patients, followed by sensation of oppression and dysphagia. Stethoscopic examination reveals crepitation synchronous with pulse and respiration in half of the cases. The diagnosis is verified by radiographic examination of the thorax where air can be seen as vertical radio-translucent regions in the mediastinum and along the borders of the heart. Patients with pneumomediastinum should be admitted to hospital for investigation as treatment of a possible basic condition, e.g. rupture of the oesophagus or bronchus, is important. In uncomplicated cases, the mediastinal emphysema disappears in the course of a week. Mediastinotomy with incisions for relief of pressure may prove necessary.
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PMID:[Pneumomediastinum]. 150 65

Anastomotic upper gastrointestinal strictures in 32 patients were dilated on an outpatient basis. Strictures had developed following resection-anastomosis of the esophagus in 27, total esophagectomy in two and total/partial gastrectomy in three patients. Patients with benign anastomotic strictures (group A; n = 21) presented within 6 (median 2) months of surgery while those with recurrent tumors at the site of anastomosis (group B; n = 11) presented 7 (median 14) months later. Dilation using Savary-Gilliard (n = 24), through the scope balloon (n = 2) and Eder Puestow (n = 1) dilators or a combination of these (n = 1) was possible in 20 (95%) patients in group A and 8 (73%) patients in group B. All the 28 patients had relief of dysphagia. Median duration of response after first dilation was 4.2 and 1.2 months in groups A and B respectively. Nature of previous surgery, length of the remaining stomach and recurrence of tumor at anastomosis appeared to affect the technique and outcome of dilation. Savary-Gilliard dilators can be used in a majority of patients except those with short stomachs where through the scope balloon dilators may be preferred.
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PMID:Outpatient dilation of anastomotic strictures of the upper gastrointestinal tract. 155 6

Body composition and energy expenditure were investigated before and 10-14 days after surgery in 44 patients with upper gastrointestinal cancer (23 esophageal and 21 gastric cancer) in order to assess the impact of preoperative weight loss on metabolic adaptation to the surgical trauma and on postoperative complications. Patients were divided in three groups with I: 0-5%, II: 5-10% and III: greater than 10% preoperative weight loss related to the usual body weight. 50% of the patients presented with no or just minor weight loss. Even in case of weight loss greater than 10% no decrease below the ideal body weight was observed. Body cell mass and fat mass were significantly (p less than 0.05) reduced in group III when compared with I. Since energy expenditure and substrate oxidation rates were rather normal in most patients weight loss was considered to be due to tumor related stenosis and dysphagia. More than 50% of the energy requirements were gained from fat oxidation. General criteria of malnutrition were not fulfilled. Perioperative weight loss was lowest (1.6 +/- 4.9 kg) in patients of group III related to group I (2.9 +/- 1.7 kg) and II (5.0 +/- 6.9 kg). Similar elevation of energy expenditure and lipid oxidation with concomitant reduction in glucose oxidation was observed in all groups of patients. This led to a similar decrease of body cell mass. Independent of preoperative weight loss major complications occurred in 8 cases--pneumonia in 6 and leakage of the anastomosis in 2 patients; no patient died. From this study can be concluded that with regard to perioperative weight loss the metabolic response to surgical trauma is adequate even in patients with marked preoperative weight loss. These patients remain compensated and preoperative weight loss is without major effect on postoperative complication rate.
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PMID:[Significance of preoperative weight loss for perioperative metabolic adaptation and surgical risk in patients with tumors of the upper gastrointestinal tract]. 156 4

The incidence of cysts of the thoracic duct is very low, and they are reported to account for only 0.0005-0.5% of all mediastinal tumors. As far as we have been able to determine, there have been no more than 24 case reports of the surgical resection of such cysts, including our own. Moreover, lesions of the left supraclavicular fossa as in the present case were noted in only 2 reports from Western countries, and 2 cases can be found in the Japanese literature. We encountered a case of thoracic duct cyst where we were able to make a diagnosis preoperatively by means of needle aspiration, and report it here together with a discussion of the relevant literature. The patient was a 64-year-old woman who was admitted with the chief complaint of pain in the throat and a sense of pressure in the neck. A swelling was noted in the patient's left supraclavicular fossa, and when this was aspirated it yielded approximately 15 cc of yellowish-white, chylous fluid. No hoarseness or dysphagia were noted. CT scan of the thorax revealed a smooth-surfaced tumor extending from the left supraclavicular fossa to the anterior mediastinum. It showed the simple cystic lesion. On the basis of these findings, a diagnosis of thoracic duct cyst arising in the left supraclavicular space was made. Following excision, the patient's postoperative course was favorable.
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PMID:[Preoperative diagnosis of a thoracic duct cyst arising in the supraclavicular fossa--surgical case report]. 159 78

We report three patients with metastases to the ENT-region mimicking a primary malignant tumour. A 36-year-old woman presented with vertigo, sudden hearing loss, partial facial palsy and headaches. CT scan suggested a meningioma or an acoustic neuroma. Histological examination of the neoplasm removed surgically showed a metastasis from an amelanotic melanoma. A 38-year-old woman with nodules in the tongue had dysphagia. The history revealed that she had been treated successfully with chemotherapy for a carcinoma of the uterine cervix one year ago. Histological examination of a tongue biopsy showed a metastasis from the uterine carcinoma. The primary tumour was in complete remission. The third patient was treated for recurrent epistaxis. Physical examination showed a tumour in the right nasal cavity. A CT scan showed a tumour of the ethmoid cells and of the maxillary sinus, protruding into the nose. Histology and immunohistology proved a metastasis from a primary carcinoma of the liver. Ultrasound and CT scan of the liver confirmed the diagnosis.
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PMID:[Metastasis to the ENT area]. 165 38

An extremely rare case of malignant glomus tumor originating in the superior mediastinum was evaluated immunohistochemically and ultrastructurally. A 78-year-old woman who had been suffering from dysphagia and dyspnea had poorly-defined soft tissue mass, 4.5 x 2.5cm, in the superior mediastinum with direct invasion into the esophagus, trachea, and bilateral thyroid glands. This case is believed to be unique in several respects. There were neither recognizable findings of benign glomus tumor nor sarcomatous areas, in contrast to the previously reported cases. A definite direct invasion into the surrounding organs was identified. We therefore interpreted this case as primary malignant glomus tumor, not as glomangiosarcoma arising in a benign glomus tumor.
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PMID:Malignant glomus tumor originating in the superior mediastinum--an immunohistochemical and ultrastructural study. 166 Nov 15

The clinical manifestations, pathology and surgical treatment of 10 cases of primary esophageal small cell carcinoma were presented with a detailed review of literature. The 10 cases accounted for 0.7% of all esophageal carcinomas treated surgically in the same period. The major symptom was dysphagia. 50% were of exophytic type grossly (fungating or intraluminal). The microscopic findings were not different from those of small cell lung cancer. All of these 10 cases had their cancer radically resected. The one and two year survival rates were 50% and 25%, respectively. The median survival time was 15.2 months. Case 2 has been living tumor-free for 48 months. The results of surgical treatment of this rare type esophageal carcinoma was poor as compared to that of squamous cell carcinoma of the esophagus.
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PMID:[Primary esophageal small cell carcinoma--a report of 10 cases and review of literature]. 166 17

In 26 patients with carcinoma of the esophagus or gastroesophageal junction, intestinal interposition was performed in post-resection reconstruction, using left colon in 21 cases, right colon in one and a long jejunal segment in four cases. The tumor involved the gastric cardia in 16 patients with colonic interposition and five underwent palliative resection. Infectious pulmonary and abdominal complications were common. Three patients required reoperation, for empyema, ischemic colonic segment and subphrenic abscess, respectively. Ischemia of the interposed segment occurred in two patients, necessitating removal of the segment in one. There was no anastomotic dehiscence and no tumor in the margins of the resected tissue. The 30-day postoperative mortality was 1/22 and the mean postoperative hospital stay 24 days, with 11 patients discharged directly to their homes. The functional results 6 months postoperatively were favorable in most survivors, and only three complained of dysphagia.
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PMID:Colonic interposition for reconstruction after resection of cancer in the esophagus and gastroesophageal junction. 167 28

The aim of this study was to report long-term results of endoscopic Nd-YAG laser therapy in the palliative treatment of 144 esophageal and cardial carcinomas and to define parameters that could predict the long-term outcome in order to better define the indications and limitations of Nd-YAG laser therapy for esophagocardial cancer. One hundred nineteen men and 25 women were treated. The mean age was 67 +/- 12 years. Histology showed 94 patients with squamous cell carcinoma and 50 with cardial or esophageal adenocarcinoma. Improvement of dysphagia was achieved in 119 of the 144 patients (83%) after a median of 2.9 sessions. For the 105 patients initially symptomatically improved by the first laser course, the cumulative probability of remaining symptomatically improved at three and six months was respectively 38.5 +/- 5% and 22 +/- 4%. Four perforations and nine esophagotracheal fistulas occurred. In the stepwise regression analysis (Cox model), among 11 variables, three variables had an independent prognostic value at six months. The importance of improvement after the initial laser treatment (P less than 0.005) and the presence of an adenocarcinoma (P less than 0.05) were positively correlated with the symptom improvement duration. The initial tumor length (P less than 0.01) was negatively correlated with the symptomatic improvement duration. Therefore, in inoperable patients, we think that laser therapy should be proposed first for adenocarcinoma and for squamous cell carcinoma less than 6 cm in length.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Endoscopic Nd-YAG laser therapy as palliative treatment for esophageal and cardial cancer. Parameters affecting long-term outcome. 170 29


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