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 usually is diagnosed at an advanced, incurable stage. In patients with good operative risk, surgery is still considered the ideal treatment. Patients with coexisting major medical conditions in whom resective surgery is precluded may benefit from several therapeutic options, including photodynamic therapy (PDT) with porfimer sodium (Photofrin; manufactured by Lederle Parenterals, Carolina, Puerto Rico, under license from Quadra Logic Technologies, Inc, Vancouver, British Columbia, Canada), dilation, thermal destruction, Nd:YAG laser ablation, injection therapy, and placement of prosthetic tubes. Photodynamic therapy with porfimer sodium is thought to have a direct toxic effect on malignant cells via the production of singlet oxygen, which damages the microvasculature of the tumor and renders it ischemic. The 630 nm wavelength used for clinical PDT exhibits the greatest relative degree of light penetration into tissue, with corresponding activation of retained photosensitizer. The efficacy of PDT with porfimer sodium is closely related to stage of disease. It should be emphasized that PDT has been shown to be potentially curative in patients with early, noninvasive tumors of both squamous and glandular (adenocarcinoma) histologies. Eighty-three patients with esophageal carcinoma were treated using PDT. At presentation, 60% of patients had recurrence following previous radiotherapy or chemotherapy. Patients with less advanced disease had a better response to PDT with regard to relief of dysphagia and prolongation of survival. Photodynamic therapy was found to be more useful than Nd:YAG laser therapy for high, upper third lesions, especially circumferential ones. For tumors larger than 8 cm, PDT was twice as effective as Nd:YAG laser therapy in establishing prolonged lumen patency, especially for adenocarcinomas. Photodynamic therapy appears to have the added advantages of fewer treatments and less pain. The role of PDT in gastrointestinal malignancies continues to evolve.
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PMID:Photodynamic therapy and cancer of the esophagus. 799 3

One hundred thirty-one patients (107 men and 24 women) underwent transhiatal esophagectomy for carcinoma of the esophagus. Median age was 65.3 years (range, 30 to 89 years). Signs and symptoms were present in 130 patients, which included dysphagia in 96 (73.3%) and weight loss (median, 7.7 kg) in 52 (39.7%). The cancer involved the gastroesophageal junction in 94 patients, the lower half of the intrathoracic esophagus in 25, the upper half in 10, and multiple sites in 2. An adenocarcinoma was present in 101 patients (77.1%), squamous cell carcinoma in 29 (22.1%), and adenosquamous cell in 1 (0.8%). The cancer was classified as stage 0 in 4 patients, stage I in 16, stage IIA in 26, stage IIB in 18, stage III in 65, and stage IV in 1. The stomach was used to replace the esophagus in all patients. Operative mortality was 2.3%. Anastomotic leak developed in 32 patients; 6 leaks were not clinically significant, 12 healed with drainage alone, and 14 required further surgical intervention. Follow-up ranged from 1 month to 6.7 years (median, 1.4 years). Currently, 42 patients are alive, 34 without evidence of recurrence. Overall 5-year survival was 20.8% and varied according to stage. Five-year survival was 47.5% for patients with stage I disease compared with 37.7% for patients in stage II and only 5.8% 4-year survival for patients in stage III. Cell type also influenced survival. Five-year survival for patients with adenocarcinoma was 27.1% compared with zero for patients with squamous cell carcinoma (p < 0.03).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Transhiatal esophagectomy for carcinoma of the esophagus. 821 60

Esophageal carcinoma is one of the most common malignant diseases in China. In order to clarify the pathophysiology of the esophageal motor dysfunction in the disease, a comparative study was done with esophageal manometry and 24 hour pH monitoring in 90 patients with esophageal carcinoma (EC) including 17 cardiac carcinoma (CC) and 56 healthy adult volunteers. The results showed that the resting pressure of the esophagus in patients was lower, particularly during swallowing and Valsalva test, than that of the normal subjects. It indicated that the patients with EC and CC had a hypodynamic esophagus so that a series of abnormal esophageal peristalsis and contractive waves were found. Besides the effect of mechanical obstruction of the tumor itself, it was believed to be a causative factor, at least in part, for the production of the clinical symptoms such as dysphagia and spastic odynophagia occurred during swallowing. Being the lower LESP, the patients with EC and CC presented pathological gastroesophageal reflux which was proved by 24 hour pH monitoring findings.
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PMID:[Motor function of the esophagus in patients with esophageal or gastric cancer]. 822 25

A retrospective review was undertaken of all oesophagectomies performed within a single unit over a 12-year period. In all, 298 patients with primary oesophageal cancer underwent resection between March 1979 and December 1991. Four patients had a three-stage oesophagogastrectomy, 27 a thoracoabdominal oesophagogastrectomy and 267 a Lewis procedure. Dysphagia was the predominant presenting symptom. The duration of symptoms was not related to the stage of disease. Before diagnosis, 52 per cent of patients tolerated symptoms for 2-4 months. Adenocarcinoma was found in 180 tumours and squamous cell carcinoma in 103. Half of the patients had evidence of metastatic spread at the time of laparotomy or thoracotomy. The 30-day mortality rate was 10 per cent and the overall actuarial 5-year survival rate of all patients 23 per cent. The actuarial 5-year survival rate of patients without lymph node involvement was 39 per cent compared with 17 per cent for those with positive nodes (P < 0.05). Five of eight patients who had anastomotic leakage died. The almost unselected nature of this series, coupled with the favourable results of oesophagectomy, support the contention that resection remains the preferred mode of treatment for carcinoma of the oesophagus of all histological types.
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PMID:Oesophagogastrectomy for carcinoma of the oesophagus and cardia. 782 May 1

In order to identify the most effective approaches for detecting early carcinoma of the esophagus, 46 patients with such lesions, including three epithelial, 13 mucosal and 30 submucosal carcinomas, were studied. Among 16 patients with epithelial and mucosal carcinomas, five (31%) were symptomatic, and in 15 (94%), the lesions were detected by endoscopy. Among 30 submucosal carcinomas, 17 (57%) were associated with symptoms such as mild dysphagia and a sharp pain, and 22 (73%) were detected by endoscopy. With respect to the gross appearance of early esophageal carcinoma, a protruded type frequently caused symptoms (70%) and was often detected by radiology (50%). Although endoscopy always permitted a correct diagnosis of the lesion (100%), radiology often failed to detect it (47%), especially when the lesion was of the superficial type. In asymptomatic patients, most early esophageal carcinomas were detected during the follow-up of gastric diseases, mass-screening or medical examination for gastric cancer, and in connection with abdominal pain due to other diseases. These results indicate that, in order to detect early carcinoma of the esophagus, it is important to perform Lugol-combined endoscopy with biopsy rather than radiology.
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PMID:How to detect early carcinoma of the esophagus. 832 84

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

Adequate palliation of dysphagia due to inoperable oesophageal carcinoma is difficult to achieve with low morbidity. Thirty-three patients (21 men and 12 women of mean(s.e.m.) age 69(2) years) with inoperable carcinoma of the oesophagus underwent insertion of self-expanding metal stents. In 22 patients the tumours were in the lower third of the oesophagus, in eight in the middle third and in three in the upper third. A stent was inserted as primary palliative therapy in 14 patients, after failed laser therapy in 13 and after oesophageal perforation following other treatments in six. Patients presented with dysphagia of grade 3 or 4. Three types of stent were used: Wallstent, Strecker and Gianturco; stents were inserted under fluoroscopic guidance after balloon dilatation of the stricture. All attempted insertions of metal stents were successful. Dysphagia reduced from grade 3 or 4 to 0 or 1. There were no perforations related to insertion. Patients who had stents inserted to seal previous perforations left hospital a median 7 days later. Dysphagia recurred in six patients, due to migration of the stent (three), blockage by food bolus (one) and tumour overgrowth (two). These problems were easily treated. Self-expanding metal stents seem to offer excellent palliation with minimal morbidity for patients with inoperable carcinoma of the oesophagus.
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PMID:Self-expanding metal stents for the palliation of dysphagia due to inoperable oesophageal carcinoma. 868 28

A 75-year-old man presented with dysphagia and subsequent paraparesis. He was treated by oesophageal dilatation and by the placement of an 8.4 cm Atkinson tube. It was shown that an oesophago-subarachnoid fistula, a rare complication of carcinoma of the oesophagus, had developed. This resulted from direct extension of the tumour to the spinal cord and caused paraparesis unrelated to treatment.
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PMID:Carcinoma of the oesophagus causing paraparesis by direct extension to the spinal cord. 859 Jan 31

We experienced a case of small cell carcinoma of the esophagus treated by operation. A 57-year-old female was examined for a complaint of dysphagia. The radiologic and endoscopic examination revealed Borrmann III like tumor (8 cm long) at lower esophagus (EiEa). Endoscopic biopsy led to a diagnosis of poorly differentiated squamous cell carcinoma. Chest X-ray and chest CT showed no lung tumor, no swelling of lymph node and no invasion of esophageal tumor. Lower esophagectomy, proximal gastrectomy and esophago-gastrostomy through intrathoracic route was performed. Histopathologically, resected tumor was diagnosed as small cell carcinoma (Oat-cell type) with rosette formation. Grimerius stain revealed negative reaction and immunohistochemical stain by NSE monoclonal antibody revealed positive reaction in tumor cells. Histological staging was a0, n1(+), M0, P1(zero), stage II. Recurrence at paraaortic lymph node occurred in 2 months after the surgery. Chemotherapy (CDDP, 5-FU and Leucovorin) was performed, but not effective. She died from multiple metastases in 5 months after the surgery (6 months after the diagnosis).
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PMID:[A case of small cell carcinoma (oat-cell type) of the esophagus]. 874 55

Primary small cell carcinoma of the esophagus is a rare neoplasm. The incidence was 2% in our series. A primary lung tumor must be excluded before the diagnosis can be made. Two cases of primary small-cell carcinoma of the esophagus are presented. The radiological features of this tumor are nonspecific. Its unusual histological appearance is described. One patients had received radiotherapy for breast carcinoma 21 years earlier and the possible relationship of this type of cancer to radiotherapy has not been previously described in the literature. Each patient had a short-term response to therapy.
Dysphagia 1996
PMID:The radiological features of primary small-cell carcinoma of the esophagus. 875 64


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