Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0011168 (dysphagia)
 15,644 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Endoscopic gastrointestinal laser therapy was originally inspired by the haemostatic properties of the laser beam and was subsequently used to destroy tumours. In endoscopic gastroenterology, the most commonly used type of laser is the neodyme+-doped yttrium aluminium garnet (Nd:YAG) laser. Endoscopic Nd:YAG laser therapy of obstructive cancers of the oesophagus and cardia rapidly reduces dysphagia in 70 to 100% of the patients. In the treatment of colorectal cancers, the intestinal transit returns to normal in 57 to 83% of the cases, and rectal haemorrhages are controlled in 38 to 92% of the cases. However, sustained results can only be obtained by a maintenance treatment with at least one application every 4 weeks. The Nd:YAG laser makes it possible to destroy villose tumours in patients who cannot, or will not, be operated upon; the number of applications depends on the size of the tumour. Finally, the Nd:YAG laser seems to be able to control bleeding due to gastrointestinal angiodysplasia and to stabilize the course of Rendu-Osler-Weber disease.
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PMID:[Laser in gastroenterologic endoscopic therapy]. 200 81

Vascular lesions of the gastrointestinal (GI) tract include arterio-venous malformations as angiodysplasia and Dieulafoy's lesion, venous ectasias (multiple phlebectasias and haemorroids), teleangiectasias which can be associated with hereditary hemorrhagic teleangiectasia (HHT), Turner's syndrome and systemic sclerosis, haemangioma's, angiosarcoma's and disorders of connective tissue affecting blood vessels as pseudoxanthoma elasticum and Ehlers-Danlos's disease. As a group, they are relatively rare lesions that however may be a major source of upper and lower gastrointestinal bleeding. Clinical presentation is variable, ranging from asymptomatic cases over iron deficiency anaemia to acute or recurrent bleeding that may be life-threatening. Furthermore, patients may present with other symptoms, e.g. pain, dysphagia, odynophagia, the presence of a palpable mass, intussusception, obstruction, haemodynamic problems resulting from high cardiac output, lymphatic abnormalities with protein loosing enteropathy and ascites, or dermatological and somatic features in syndromal cases. Diagnosis can usually be made using endoscopy, sometimes with additional biopsy. Barium radiography, angiography, intraoperative enteroscopy, tagged red blood cell scan, CT-scan and MRI-scan may offer additional information. Treatment can be symptomatic, including iron supplements and transfusion therapy or causal, including therapeutic endoscopy (laser, electrocautery, heater probe or injection sclerotherapy), therapeutic angiography and surgery. The mode of treatment is of course depending on the mode of presentation and other factors such as associated disorders. If endoscopic or angiographic therapy is impossible and surgical intervention not indicated, pharmacological therapy may be warranted. Good results have been reported with different drugs, albeit most of them have not been tested in large trials.
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PMID:Vascular lesions of the gastrointestinal tract. 1261 28

Improper performance by a nurse of a medical study/procedure (e.g., video capsule endoscopy performed on a wrong patient) raises novel, previously unexplored questions regarding: 1) whether the study should subsequently be interpreted; 2) which physician should interpret the study; and 3) whether study interpretation requires another informed consent due to the extraordinary circumstances. Two such cases are reported. First, the Chief of Gastroenterology (GI) contacted the hospital ethics committee regarding procedure interpretation after the wrong patient underwent video capsule endoscopy by a nurse. The committee recommended to inform and apologize to the patient about the nursing error, to not charge for this study, and to interpret the study, likewise without charge, provided that a new informed consent was obtained that included discussion of the small potential patient benefit of study interpretation in this circumstance. These recommendations were followed. Study interpretation revealed a 3 mm wide characteristic angiodysplasia in the distal jejunum. Endoscopic therapy was not performed due to the small lesion size, and absence of gastrointestinal bleeding or significant anemia. Second, the Chief of GI was informed of an esophageal manometry performed for chronic dysphagia that had not been interpreted for 7 months due to its being performed by a nurse without any arrangement for a gastroenterologist to interpret the study. The referring gastroenterologist lacked training or privileges in esophageal manometry. The Chief of GI arranged for a motility expert to interpret the study. The study was read as technically inadequate because the nurse had been unable to intubate the stomach and the referring gastroenterologist had declined to assist in this difficult intubation. The motility expert noted that had he been involved earlier in the case he would have himself attempted gastric intubation. In conclusion, a reasonable approach to a medical study improperly performed by a nurse includes: 1) inform and apologize to the patient about the error; 2) obtain informed consent for study interpretation, and 3) interpret the study at no charge. Consultation with an institutional Ethics Committee is advisable. An interpreting physician should be identified at the time of scheduling a medical study. Although illustrated for GI studies, these recommendations pertain to studies performed by nurses or technicians in numerous medical fields, such as echocardiograms or pulmonary function tests.
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PMID:Should a physician interpret a medical study improperly performed by a nurse or technician, such as capsule endoscopy performed on a wrong patient? A reasonable solution to a medicolegal dilemma. 2210 31