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)

Esophageal carcinoma simulated Paget's disease in a 60-year-old Japanese man with 3 months of difficulty swallowing and pain. Results of an esophageal biopsy indicated undifferentiated carcinoma, but after esophagectomy and partial gastrectomy, the resected esophagus showed that the mucosa was diffusely indurated with irregular, reticulated erosions. There was no tumor mass or ulcer. Histologic examination showed an extensive intraepithelial growth of cancer cells without any glandular or squamous cell differentiation. Tumor cells were large and round and contained large nucleoli and ample, clear, or pale-staining cytoplasm, similar to the cells of Paget's disease. Tumor cells multifocally invaded into the mucosal and submucosal ducts where they formed papillary and tubular nests, indicating adenocarcinomatous differentiation, but there was no invasive growth beyond the basement membrane. Tumor cells in the epithelial layer were negative for periodic acid Schiff (PAS) and alcian blue, but partly positive for epithelial membrane antigen (EMA) and CEA, whereas those in the submucosal ducts and glands were strongly positive for PAS, alcian blue, carcinoembryonic antigen, and EMA, especially at their luminal surfaces. Tumor cells were negative for S-100, neuron-specific enolase, and melanin. These findings indicate that the tumor in the present case was a primary esophageal carcinoma with partial adenocarcinomatous differentiation, showing an extensive intraepithelial Pagetoid growth of its undifferentiated component. This is the first case of esophageal Paget's disease presenting as intraepithelial growth alone.
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PMID:Paget's disease of the esophagus. 838 66

The patient, a 78-year-old female with history of headache and progressive gait disturbance for almost one year, was admitted to our department because of dysphagia and dysphonia since three months before. Neurological examination revealed nystagmus, cerebellar ataxia, deafness, and vesical incontinence. No cerebral injuries were detected by computed tomography (CT) scan, although Paget's. Disease of Bone (PDB) was suggested, confirmed by biochemical and scintigraphic studies. The plain skull X-ray showed platybasia. As all the disarrangements were not explained by PDB complications alone, nuclear magnetic resonance imaging (MRI) was performed which demonstrated an Arnold-Chiari malformation (ACM) type I, with mild tonsillar herniation and anterior compression of the brainstem due to basilar impression, without syringomyelia. The association of PDB and ACM is a peculiarity seldom reported. The surgical approach was rejected, but the severity of symptoms and osteitis deformans biochemical activity needed a treatment; it was orientated to modify bone turnover using etidronate, a bisphosphonate, which induced clinical improvement and a decrease in serum alkaline phosphatase as well as in other bone resorption markers, without side effects. The good status and biochemical remission have been maintained a year later.
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PMID:[Paget's disease of bone and basilar impression associated with an Arnold-Chiari type-1 malformation]. 942 43

Risedronate sodium is an orally active antiresorptive agent and a member of the pyridinyl class of bisphosphonates. It has been approved for the treatment of Paget's disease of the bone and is under development as a chronic therapy for the treatment and prevention of osteoporosis. A novel cellulose film-coated tablet formulation was developed to optimize esophageal transit of this bisphosphonate. The aim of the present study was to compare the esophageal transit of the film-coated tablet formulation of risedronate with its original gelatin capsule dose form. A total of 25 elderly, healthy volunteers (mean 66 years), who were dysphagia-free, participated in this randomized cross-over study. On separate occasions, volunteers swallowed radiolabeled placebo formulations with 50 ml water. Dynamic images with participants in a sitting position were recorded for 10 min using a gamma camera. Scintigraphic imaging showed a delay in esophageal transit (greater than 15 s) in 28% of patients in the capsule group but in none of the tablet group (P<0.05). The mean transit times of the capsules and tablets were 23.8 and 3.3 s, respectively. Esophageal transit of film-coated tablets was faster than gelatin capsules, suggesting that film-coated tablets would be the appropriate formulation for all pivotal trials with risedronate and for subsequent commercialization.
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PMID:Esophageal transit of risedronate cellulose-coated tablet and gelatin capsule formulations. 1048 35

The bisphosphonate, alendronate sodium (e.g. Fosamax) is a bone resorption inhibitor used to treat postmenopausal osteoporotic women and osseous Paget's disease. Esophagitis is one of the adverse effects (AE) associated to its use. Five (5) patients with alendronate-associated esophagitis assisted in the Gastroenterologic Center, Rosario, Argentina, between October 1996 and December 1999 are described. The aim is to correlate the clinical, endoscopic and histopathological findings in 5 women (ages 57-71) complaining for upper digestive symptoms (dysphagia, epigastralgia, retrosternal pain.). All had osteoporosis treated with alendronate 10 mg/day and received detailed instructions about how to take the medication. The time from the beginning of alendronate intake and the appearance of the symptoms was elapsed 30, 35, 67, 85 and 90 days. The esophagitis was graded according to the Savary-Miller Classification. The videoscopy disclosed esophagitis of III and IV grades. Three patients had also antral and antroduodenal lesions, one of them associated to Helicobacter Pylori. Anatomopathologic findings confirm esophagitis and esophagic ulceration. Some authors claim that bisphosphonates as a new class of gastrotoxic drugs with AE similar to aspirin. Even when it is administrated according to the instructions of the manufacturers it should be used with caution. Our contribution emphasize the importance of this AE and suggest measures to diminish or suppress them, and take into consideration those patients who are taking aspirin. With alendronate, as well as with other potentially corrosive agents, is very important to take in mind the measures to prevent AE.
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PMID:[Esophagitis associated with use of alendronate in 5 postmenopausic patients]. 1147 18

Human size and shape vary widely. Relative obesity or apparent under nutrition may not limit survival into old age. Normal body appearance can mask gross malnutrition, particularly mineral and vitamin deficiency, problems of measurement in the elderly. Obesity is associated with joint degeneration and systemic disease but with reduced incidence of fractures. Undenutrition is associated with skin breakdown, poor wound healing and fractures. Body composition changes due to disease include dysphagia, myxoedema, anaemia, chronic cardiac and renal disease. Skeletal changes include osteoporosis and Paget's disease. Body composition can change due to treatment, control of dietary energy intake and tube-feeding.
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PMID:Body composition and aging: a practising clinician's point of view. 2439 52

Primary esophageal Paget's disease is rare. Only a few case reports have described the intraepithelial papillary capillary loop (IPCL) pattern obtained by magnified Narrow Band Imaging (M-NBI) endoscopy in this rare pathology. This report highlights the usefulness of M-NBI and the successful diagnosis using a large bloc specimen obtained by endoscopic mucosal resection with the cap method (EMR-c). A 53-year-old man was referred to endoscopic examination for dysphagia. The endoscopic image revealed a ring-shaped scarring of the esophagus suggestive for eosinophilic esophagitis. The IPCL pattern by M-NBI endoscopy showed an inflammatory pattern, and the entire epithelium of the esophagus was not stained by Lugol iodine spraying. Based on six biopsies randomly performed, a poorly differentiated adenocarcinoma was diagnosed. Since the M-NBI pattern and the histology were completely different, EMR-c was performed to obtain large bloc specimens for a more detailed diagnosis. The pathological findings revealed extensive Paget's cells infiltration into the epithelium and multifocal invasion from the mucosa to the submucosal layer with adenocarcinoma. In conclusion, a large bloc specimen by EMR-c might be more useful than a small biopsy for an accurate diagnosis of the rare esophageal Paget's disease.
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PMID:Rare Primary Esophageal Paget's Disease Diagnosed on a Large Bloc Specimen Obtained by Endoscopic Mucosal Resection. 2925 58

Paget's disease (PD) is an intraepithelial growth of neoplastic cells showing glandular differentiation. Primary esophageal PD is extremely rare, with only 14 cases reported to date. We report a case of esophageal PD in a 63-year-old man presenting with progressive dysphagia. On gross examination, the esophageal mucosa had a slightly mottled appearance and felt slightly thickened and indurated. Microscopically, the atypical tumor cells were mostly located in middle to basal cell layers of the squamous epithelium. Some tumor cells were difficult to be distinguished from normal squamous epithelium. Some regions of the lesion showed full-thickness cellular atypia with mitotic figures, and some tumor cells invaded through the basement membrane into the lamina propria, mimicking a squamous cell carcinoma. Acantholytic regions were prominent in the epithelium, and some gland-like clefts were formed. One recurrent laryngeal nerve lymph node showed metastatic foci. Immunohistochemically, tumor cells were positive for cytokeratin (CK) 7, CK8/18, carcinoembryonic antigen (CEA) and Her-2, but negative for CK5/6, p63, S-100 protein and HMB45, yielding the diagnosis of PD. This is the first case report of esophageal invasive Paget's disease (invPD) and the first case report of esophageal acantholytic anaplastic Paget's disease (AAPD).
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PMID:Esophageal invasive acantholytic anaplastic Paget's disease: report of a unique case. 3193 55