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Query: UMLS:C0011168 (dysphagia)
 15,644 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 28-year-old female with dysphagia due to the vascular ring (Edwards III B type) was operated successfully. Preoperative chest x-ray film showed a defect of the left first arch and deviation of the lower trachea to the left side. Esophagogram disclosed the upper thoracic esophagus stenotic and deviated left anteriorly. Arch aortogram showed the right aortic arch and aberrant left subclavian artery with the aortic diverticulum. Operation was performed through a left thoracotomy. Esophagus was squeezed by the aortic arch, aortic diverticulum and left ligamentum arteriosum. The left ligamentum arteriosum was divided. Its stump of aortic side was sutured and fixed with paravertebral pleura so that the squeeze by the diverticulum was released. The stenotic esophagus was dissected from surrounding tissue and its satisfactory distensibility was confirmed. Dysphagia disappeared after operation and postoperative esophagogram showed marked improvement of the stenosis. Eleven operated cases of this type of vascular ring in adult have been reported in Japan. Remarkable improvement of dysphagia was observed in all cases. Thus surgical treatment is recommended for cases suffering from severe dysphagia.
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PMID:[An operative case of vascular ring (Edwards III B type)]. 207 89

Oesophagus manometry with a small catheter transducer was performed in 20 patients after total gastrectomy (13 males and 7 females; mean age 60 [35-79] years) and four after partial gastric resection (2 males and 2 females; mean age 70 [60-78] years). All patients were also questioned about any symptoms. Thirteen of the 20 patients reported symptoms of reflux and of abnormal peristalsis (dysphagia, odynophagia). All but one of the 20 patients after total gastrectomy had manometrically abnormal contraction patterns (repetitive, simultaneous, deformed multiple-peak contractions), especially in the distal oesophagus. On average the contractions were diminished by 9 mmHg; resting pressure in the upper oesophagus was reduced by the same amount. These changes were probably due to increased reflux as well as changed biomechanics from the operation (decreased longitudinal tension, absent lower sphincter and postoperative adhesions). The four patients after subtotal resection (with preservation of the lower oesophageal sphincter) had hardly any reflux symptoms, even though the lower sphincter was insufficient in two patients (abdominal compression test), with a corresponding abnormal contraction pattern. Force of contraction in the body of the oesophagus and resting pressures of the two sphincters were also normal.
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PMID:[Motility disorders of the esophagus after surgery on the stomach]. 234 97

A lateral esophagocardiomyotomy extending from the level of inferior pulmonary vein to 3 cm on to the fundus of stomach for achalasia of esophagus was combined with a flap-valve constructed at the gastroesophageal junction. A total of 69 consecutive patients of achalasia cardia were subjected to this procedure between 1980 and 1994. There was no mortality. In a follow-up of up to 14 years, 73.9% patients had excellent results and 26.1% had good results. Recurrence of dysphagia and hiatus hernia were not detected and clinical, radiological and endoscopic studies did not show evidence of any significant gastroesophageal reflux.
Dis Esophagus 1997 Jan
PMID:Incorporation of a flap-valve at cardia, with esophagocardiomyotomy, for achalasia of the esophagus. 907 73

A case report of a patient presenting with long-standing progressive dysphagia due to intramural esophageal pseudodiverticulosis is presented. The possible etiology, presentation, diagnostic procedure and treatment of this rare entity are discussed.
Dis Esophagus 1997 Jan
PMID:Esophageal intramural pseudodiverticulosis. 907 77

We assessed the accuracy of patient localization of the site of dysphagia and its implications for radiological practice during the barium swallow examination. Several current texts dispute the value of such information. Fifty-two consecutive patients with dysphagia were asked to localize the site of discomfort on the skin surface. The ability of each patient to do so precisely or vaguely was noted. A detailed barium examination of the pharynx, esophagus and stomach was performed. Results suggested that patients who had symptoms more cranial than the sternal notch were highly accurate at localizing disease. Localization became less precise as symptoms moved caudally towards the epigastrium. Lateralization of symptoms was highly accurate in determining the site of pathology. In conclusion, we feel that in certain circumstances the barium examination can be usefully tailored to accelerate examination times, thus reducing radiation exposure and cost whilst improving diagnostic accuracy.
Dis Esophagus 1997 Jul
PMID:Patient perception and localization of dysphagia -- barium study correlation. 928 82

Intramural esophageal hematoma is a very rare condition. We report a case of a 40-year-old male, presenting with retrosternal pain and dysphagia. On the day before admission tarry stool and minimal vomiting of old blood was noticed. Diagnostic procedures showed an intramural esophageal hematoma, which had developed 2 weeks and 3 days after cardioversion and anticoagulation therapy. Etiology, differential diagnosis, the diagnostic approach and a brief review of the literature are discussed.
Dis Esophagus 1997 Jul
PMID:Intramural esophageal hematoma after cardioversion. 928 85

The outcome of 211 patients undergoing laser therapy as palliation for inoperable carcinoma of the esophagus is presented. The median age was 73 (range 44-97). The histology was adenocarcinoma for 127 patients and squamous-cell carcinoma for 84 patients. For 133 patients, laser was the only therapy while 56 patients had a combination of laser therapy and radiotherapy/chemotherapy. One patient underwent laser recanalization prior to resection while four patients had recurrence after resection treated by laser. Eleven patients underwent laser therapy for recurrent dysphagia after placement of an esophageal endoprosthesis. Eighteen patients died of procedure-related complications (i.e. 9% of patients and 2% of procedures). Of 32 procedures which perforated the tumour, 10 ended in death and the remaining patients were successfully treated conservatively. Good palliation was achieved for 170 patients (80%), while 19 patients underwent intubation after failure of laser therapy. Laser therapy failed to relieve dysphagia for 22 patients. The median survival was 20 weeks with the 1-year survival 12% and 2-year survival 4%; there were no significant differences in survival dependent on histology or administration of adjuvant radiotherapy or chemotherapy. Laser therapy provides a practical alternative to intubation in the treatment of malignant dysphagia for patients with unresectable esophageal carcinoma.
Dis Esophagus 1997 Oct
PMID:Palliation of malignant dysphagia by laser therapy. 945 50

We studied 13 patients before and after Nissen fundoplication and compared them with 11 healthy volunteers and 12 other patients with dysphagia after fundoplication. Esophageal manometry was performed to assess primary and secondary peristalsis induced by esophageal distention with air and water boluses. In patients with reflux disease, secondary peristalsis was initiated at a median rate of 60% of distending episodes, propagation of the secondary peristaltic wave occurred in 40% and lower oesophageal sphincter relaxation occurred with 70% of secondary peristaltic waves. Fundoplication did not alter the initiation or propagation rate of secondary peristalsis but it decreased the median lower esophageal sphincter relaxation rate to 45% (P < 0.03). Fundoplication was not associated with a change in the amplitude of primary peristaltic waves even in patients complaining of dysphagia. In post-fundoplication patients, successful secondary peristaltic waves had significantly lower (P < 0.005) proximal and distal amplitude than primary peristaltic waves. We conclude that there is no improvement in primary or secondary peristalsis after fundoplication and dysphagia after fundoplication is not due to altered peristalsis.
Dis Esophagus 1997 Oct
PMID:A prospective study of the effect of fundoplication on primary and secondary peristalsis in the esophagus. 945 51

In order to improve the results of functional surgical procedures on the esophagus, the authors, after a number of experimental studies, proposed the use of intraoperative esophageal manometry (IEM). The technique was performed for the first time in 1972. IEM has been employed in the course of Heller's cardiamyotomies and Nissen-Rossetti (N-R) fundoplications, respectively, to document the ablation of the lower esophageal sphincter (LES) high-pressure zone (HPZ) and to calibrate the pressure of the fundal wrap between values ranging from 20 to 40 mmHg ('hypercalibrated Nissen'). This hypercalibration resulted from the retrospective evaluation of a former series when, at the beginning of our experience, we used to calibrate the fundoplication to pressure values similar to those of a normal sphincter ('normocalibrated Nissen': 10-20 mmHg). This experience, in fact, was followed by a high rate of gastroesophageal reflux (GER) recurrence (28.5%) in the first 12 months after surgery. Since 1985 to date, IEM has been employed in the course of 309 functional surgical procedures on the esophagus. This paper, however, reports on 281 patients: 144 with achalasia treated with Heller's myotomy + Nissen-Rossetti fundoplication and 137 with gastroesophageal reflux disease (GER-D) submitted to Nissen-Rossetti fundoplication. Our data suggest that IEM can be a useful tool in the field of functional surgery of the esophagus, and its routine use seems to be able to improve the postoperative results. In this series, in fact, IEM was able to detect the persistence of an HPZ in 15.2% of apparently complete myotomies, all performed with the aid of intraoperative endoscopy. As regards the manometric calibration of the n-HPZ, our results seem to confirm the validity of the technique, yet some findings still remain unexplained: i.e. two patients with a hypotonic n-HPZ and GER recurrence and two with an n-HPZ, exceeding 20 mmHg with postoperative persistent dysphagia. Finally, we would like to emphasize that the concept of a 'hypercalibrated Nissen' contrasts with the 'floppy Nissen' of Donahue and DeMeester; our wrap is also loose around the esophagus and does not impair the esophagogastric transit.
Dis Esophagus 1997 Oct
PMID:Intraoperative esophageal manometry: our experience. 945 52

On the basis of 20 years' experience, the authors present the immediate and long-term results of operative treatment of Zenker's diverticulum. Comparison of two methods of surgery--diverticulopexia (in 21 patients) and excision (in 16), both associated with upper esophageal sphincter myotomy--shows good immediate and long-term results (from 1 to 19 years), with disappearance of symptoms (dysphagia) in all patients. There was no perioperative mortality. Postoperative complications were most commonly of pulmonary origin and were observed in a third of patients in both groups. In two patients from the group treated with excision, a leak from the suture line occurred, which healed spontaneously. These two patients had transient dysphagia in the postoperative period. On the basis of this analysis, the authors conclude that diverticulopexia is a safer surgical procedure than excision, giving less complications and a very good long-term functional result.
Dis Esophagus 1998 Jan
PMID:Results of surgical treatment of cervical esophageal diverticula. 959 35


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