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)

From 1964 to 1979 a total of 1,702 patients with carcinoma of the oesophagus were admitted into the University Department of Surgery, Queen Mary Hospital, Hong Kong. Among these the tumour was situated at the hypopharynx in 112 cases and at the cervical oesophagus in 36 cases. The treatment of choice for resectable tumours of these sites was pharyngo-laryngo-oesophagectomy (81 cases). Reconstruction with pharyngo-gastric anastomosis was preferred (76 cases). Other methods of reconstruction were indicated only when the stomach had been resected previously. Although the hospital mortality after pharyngo-laryngo-oesophagectomy was 31% this was the only means by which a long term survival could be achieved. Occasionally even when the trachea was infiltrated by tumour, salvage could be attempted by including the posterior wall of the trachea in the resection and repairing with an in-turned delto-pectoral flap. Although the actuarial survival of patients after pharyngo-laryngo-oesophagectomy was only 9%, all the patients who survived the operation were relieved of their distressing symptom of dysphagia.
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PMID:Surgical treatment of carcinoma of the hypopharynx and cervical oesophagus. 721 13

Over a four year period, 66 patients have undergone fibreoptic endoscopy and Eder Puestow dilatation for a presumed benign oesophageal stricture. Ten patients were subsequently shown to have carcinoma of the oesophagus. There were 121 dilatations with only one perforation, which healed with conservative treatment. Twenty eight of the 56 patients with a benign stricture have required only one dilatation with relief of dysphagia during follow-up periods ranging from 11 months to 61 months (mean 29 months). In those requiring repeat dilatations, relief has been obtained for periods ranging from two weeks to 35 months (mean 6 months). Mean time to restricture in the carcinoma group was two weeks. We conclude that the Eder Puestow method is safe, well tolerated, and less than 5% will require surgery. Strictures which recur rapidly should arouse suspicion of malignancy.
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PMID:Conservative management of benign oesophageal strictures. 722 27

Two hundred and thirty-one patients of advanced oesophageal carcinoma were treated with Neodymium: Yttrium-Aluminium-Garnet (Nd:YAG) laser photocoagulation of tumour tissue to relieve distressing dysphagia. There were 155 males (67.1%) and 76 females (32.9%). The mean age was 59.6 years. Eighty-five percent (196 cases) were above 50 years of age. Distribution of tumour by site was as follows: upper one-third--24 cases (10.4%), mid one-third--98 cases (42.4%) and lower one-third--109 cases (47.1%). Squamous cell carcinomas accounted for 83.5% (193) of cases. Nearly two-thirds (144 cases, 62.3%) were more than 4 cm in length. Tumour deposits were found at more than one site in 11 cases (4.7%). Oesophageal lumen was restored in all cases but was poorly sustained in 19 cases (8.2%). Further sessions of laser therapy were required in all these cases. A mean of 2.7 sessions of laser treatment was required to achieve adequate lumen. One hundred and eighty-nine patients (82%) had good relief of dysphagia to liquids and semi solids. Complications were seen in 20 cases (8.6%). There were no deaths related to the procedure. Mean survival was 5.5 months (1-14 months). Nd:YAG laser therapy offers effective palliation of dysphagia in carcinoma of the oesophagus with acceptable morbidity and no mortality.
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PMID:Oesophageal carcinoma: laser palliation in 231 cases. 751 82

Nitinol stents were used in ten patients as palliative treatment for carcinoma of the esophagus and the cardia. Following insertion of the stent the severity of dysphagia decreased on average from 3.2 to 1.5 (on a scale from 0-4). Difficulties with stent opening and passage through the gut were found particularly in the region of metal sutures at esophago-jejunal anastomoses. One stent, which had been obstructed by mucosal folds, had to be removed and replaced. One stent which had been incorrectly placed was extended by introducing a second stent by a coaxial technique. During the period of observation, six patients died after an average of 4.6 months. The palliative effect of the stent lasted on average for eleven weeks. In two patients the tumour grew beyond the stent and in three there was tumour growth into the stent.
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PMID:[The nitinol stent as a palliative measure in inoperable carcinoma of the esophagus and cardia. Possibilities and limitations of the procedure]. 751 99

Surgery for carcinoma of the esophagus and cardia represents potentially curative therapy in early stage of tumor. In the advanced stage of tumor palliation is the only remaining therapeutic aim. In a retrospective study covering the period 1984-1992 we analyzed 51 patients who underwent surgery for esophageal or cardia cancer to determine whether palliation by surgery is feasible. We also analyzed morbidity and mortality of peri- and postoperative complications. In 88% we carried out standard esophagectomy consisting of abdomino-thoracic access, gastric interposition with thoracic anastomosis and extramucous pyloromyotomy. In the light of postresection histology, 53% of the operations were potentially curative (UICC stage I and II) [1], 47% palliative (UICC stage III and IV) [1]. Perioperative 30-days mortality was nil, perioperative 30-days morbidity 11% (3 patients developed pneumonia postoperatively, 2 patients with cervical anastomosis developed dehiscence of anastomosis which in both cases healed completely with conservative therapy, while a further patient with cervical anastomosis suffered persistent paralysis of the recurrent nerve. All patients were fully able to feed themselves at the time of discharge. 43% of patients had recurrent dysphagia and 24% underwent endoscopic dilatation. Three-year survival was 26%. From these results it may be concluded that esophageal resection represents either good palliation with low morbidity for the majority of patients with non-resectable carcinoma of the esophagus or potentially curative therapy with low morbidity in early stage of tumor.
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PMID:[Results of surgical therapy in esophagus and cardia carcinoma]. 752 49

12 patients with malignant inoperable esophageal obstruction (carcinoma of the esophagus n = 7, carcinoma of the esophagogastric junction n = 3, mediastinal lymph node metastasis n = 2) and high-grade dysphagia were treated with self-expanding metal stents (Ultraflex, Microvasive) made of a nickel titanium alloy (Elastalloy). Other forms of palliation had failed in 9/12 patients. The degree of palliation was expressed as a dysphagia score (0-4) before and after stent insertion. The stents were inserted under endoscopic and fluoroscopic control. They were placed successfully and without complications in all patients. A good functional result was achieved in 11 patients (91.7%). Thus, the dysphagia score decreased significantly from 3.2 +/- 0.4 before to 0.9 +/- 1.0 immediately after stent insertion (p < 0.001). The remarkable relief of dysphagia was sustained during a mean follow up of 101 days (10-278) with a dysphagia score of 1.1 +/- 1.0 at the end of the study (p < 0.001 compared to the score before the procedure). In one patient with mediastinal lymph node metastasis the stent expanded insufficiently. 7 days after insertion it was removed endoscopically and replaced successfully by another stent with a stronger expansive force (Instent). 3 patients experienced recurrent dysphagia (food impaction n = 1 tumor ingrowth through the meshes of the stent n = 2). They were successfully treated by an endoscopical intervention (endoscopical dilatation n = 1, laser therapy n = 1, insertion of a Wallstent n = 1). At the end of the study, 6 patients were alive, 6 patients were dead with a mean survival of 56 days (10-117).
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PMID:[Self-expanding wire-netting Elastalloy endoprosthesis in malignant esophageal stenosis]. 759 10

A 89 year old female patient presented with severe dysphagia and was suspected to have carcinoma of the esophagus. Endoscopy revealed an esophageal phytobezoar which passed down spontaneously after unsuccessful endoscopic extraction attempt. Barium swallow study revealed diffuse spasm of the esophagus. A review of English literature revealed only 17 previous cases of esophageal bezoar. Salient features of esophageal bezoars are discussed based on previous reports and the current case.
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PMID:Esophageal bezoar: a rare but distinct clinical entity. 764 54

Twenty-two patients were irradiated using two different dose schedules of intracavitary irradiation for palliation of locally advanced or metastatic carcinoma of the esophagus. Irradiation was given solely with either manually afterloaded low/intermediate dose Cesium-137 (LDR) or high dose rate Iridium-192 (HDR) delivered via remote afterloader. This study was designed to test the effectiveness of HDR intracavitary brachytherapy in the relief of dysphagia and the maintenance of esophageal patency and to compare with our previous experiences with LDR intracavitary brachytherapy. Accelerated treatments were especially suited for patients with poor physical condition or short life expectancy unlikely to complete a full course of external beam irradiation without treatment interruption. Two thousand cGY in three fractions of LDR was compared with 1,250 cGY in one fraction HDR with essentially equal results.
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PMID:Intracavitary radiation in the treatment of advanced esophageal carcinoma: a comparison of high dose rate vs. low dose rate brachytherapy. 768 63

Surgery for carcinoma of the esophagus and cardia represents potentially curative therapy in the early stage of the tumor. In the advanced stage of tumor, palliation is the only remaining therapeutic aim. In a retrospective study covering the period 1984-1992 we analyzed 51 patients who underwent surgery for esophageal or cardia cancer to determine whether palliation by surgery is feasible. We also analyzed mortality and morbidity of peri- and postoperative complications. In 88% we carried out standard esophagectomy consisting of abdomino-thoracal access, gastric interposition with thoracal anastomosis and extramucosal pyloromyotomy. In the light of postresection histology, 53% of the operations were potentially curative (UICC stage I and II) and 47 palliative (UICC stage III and IV). Perioperative 30-day mortality was nil, and perioperative 30-day morbidity 11% (3 patients developed pneumonia postoperatively, 2 patients with cervical anastomosis developed dehiscence of anastomosis which in both cases healed completely with conservative therapy, while a further patient with cervical anastomosis suffered persistent paralysis of the recurrent nerve. All patients were fully able to feed themselves at the time of discharge. 43% of patients had recurrent dysphagia and 24% underwent endoscopic dilatation. Three-year survival was 26%. From these results it may be concluded that esophageal resection represents good palliation with low morbidity for the majority of patients with non-resectable carcinoma of the esophagus.
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PMID:[Results of esophagectomy in carcinoma of the esophagus and cardia]. 768 41

A 60-year-old man was admitted to hospital because of severely impaired swallowing, retrosternal pain and marked weight loss. History and physical examination of the patient, whose general condition was obviously much reduced, pointed to carcinoma of the oesophagus. Contrast-medium swallow demonstrated subtotal stenosis in the oesophagus. Computed tomography and magnetic resonance imaging showed a space-occupying mass originating from the oesophagus, in close relationship to the trachea, main bronchi and descending aorta. Biopsy confirmed the diagnosis of oesophagus carcinoma and exploratory thoracotomy excluded curative surgical treatment. An attempt was made to introduce a feeding tube endoscopically to provide nutritional palliation. But the oesophagus was perforated during this manoeuvre and resulted in an oesophagobronchial fistula with subsequent mediastinitis and mediastinal emphysema. Using a self-expandable plastic-covered metal stent it was possible to cover the perforation and overcome the patient's dysphagia. The mediastinitis healed under intravenous administration of cefotaxim (2 g three times daily), netilmicin (400 mg daily) and metronidazole (500 mg three times daily), for 5 days.
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PMID:[Iatrogenic esophageal perforation in inoperable esophageal carcinoma. Its therapy with a plastic-coated metal stent]. 773 46


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