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

In this review, we analyse critically the effects of systemic lupus erythematosus (SLE) on the gastrointestinal (GI) tract from mouth to anus, attempting to distinguish the features that are most likely to be due to therapy. GI manifestations of SLE include mouth ulcers, dysphagia, anorexia, nausea, vomiting, haemorrhage and abdominal pain. GI vasculitis is usually accompanied by evidence of active disease in other organs. Early recognition of the significance of these symptoms offers the best opportunity to improve the symptoms and to aid long-term survival.
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PMID:A review of gastrointestinal manifestations of systemic lupus erythematosus. 1053 41

We report a patient with autosomal dominant polycystic kidney disease (ADPKD) undergoing long-term hemodialysis who underwent transcatheter arterial embolization (TAE) of the renal arteries to shrink enlarged kidneys. In 1983, the patient started hemodialysis because of chronic renal failure secondary to ADPKD. However, renal size continued to increase. In January 1997, he was admitted to our hospital with abdominal distension and anorexia, in addition to progression of anemia. Upper gastroendoscopy showed an esophageal ulcer and severe external compression of the stomach. Renal angiography using the Seldinger technique showed stretched and deformed segmental renal arteries with massive enlargement of the kidneys. TAE with stainless steel coils was performed on both renal arteries. With a rapid and progressive decrease in kidney size, anorexia and anemia were improved, and the gastrointestinal compression was eliminated. In some patients with ADPKD, renal size continues to increase even after the initiation of dialysis. In about 10 years, patients develop gastrointestinal complications, such as dysphagia, ileus, severe constipation, and intestinal perforation. Surgical procedures such as nephrectomy are not satisfactory. This report shows that TAE is a safe and effective therapy for patients with ADPKD with massively enlarged kidneys.
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PMID:Transcatheter renal arterial embolization therapy on a patient with polycystic kidney disease on hemodialysis. 1056 Nov 51

We describe a case of unilateral IX, X and XI cranial and upper cervical nerve palsies involving zoster sine herpete (ZSH). A 63-year-old man experienced nausea, loss of appetite and general fatigue. On 4 days of illness, dysphagia, dysarthria and difficulty in elevation of his right arm appeared. Neurological examination showed the right curtain sign, a nasal voice and a decreased right gag reflex. He could hardly elevate his right arm laterally. Needle electromyography revealed positive sharp waves in his right trapezius muscle. Although no skin lesion was detected, anti-varicella-zoster virus antibodies were positive in both serum and cerebrospinal fluid. Acyclovir and a steroid were ineffective for these symptoms. Although case reports of unilateral IX, X and XI cranial nerve palsies with ZSH is very rare, ZSH should be kept in mind in the differential diagnosis of multiple cranial nerve palsies.
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PMID:[A case of zoster sine herpete with involvement of the unilateral IX, X and XI cranial and upper cervical nerves]. 1061 62

A multivariate analysis of the data was conducted to evaluate the effects of age, gender, and performance status on symptom profile. A comprehensive prospective analysis of symptoms was conducted in 1,000 patients on initial referral to the Palliative Medicine Program of the Cleveland Clinic. The median number of symptoms per patient was 11 (range 1-27). The ten most prevalent symptoms were pain, easy fatigue, weakness, anorexia, lack of energy, dry mouth, constipation, early satiety, dyspnea, and greater than 10% weight loss. The prevalence of these 10 symptoms ranged from 50% to 84%. Younger age was associated with 11 symptoms: blackout, vomiting, pain, nausea, headache, sedation, bloating, sleep problems, anxiety, depression, and constipation. Gender was associated with 8 symptoms. Males had more dysphagia, hoarseness, >10% weight loss and sleep problems; females, more early satiety, nausea, vomiting, and anxiety. Performance status was associated with 14 symptoms. Advanced cancer patients are polysymptomatic. Ten symptoms are highly prevalent. Symptom prevalence for 24 individual symptoms differs with age, or gender, or performance status.
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PMID:The symptoms of advanced cancer: relationship to age, gender, and performance status in 1,000 patients. 1078 56

Denutrition is frequent among HIV-infected (HIV+) adults in sub-Saharan Africa. One of the risk factors for denutrition is a reduction in dietary intake. Eating disorders may be partly responsible for such decreases in food intake. We prospectively analyzed the frequency, associated factors and progression of anorexia, dysphagia and food aversion in a cohort of 330 HIV-infected adults included in a trial of early chemoprophylaxis with cotrimoxazole in Abidjan, Ivory Coast. Patients were followed-up by means of scheduled monthly visits. Eating disorders were assessed using a standardized questionnaire after 6, 12 and 18 months of follow-up. After six months of follow-up, 28% of the patients reported anorexia, 9% dysphagia and 28% food aversion. Multivariate analysis showed that anorexia was significantly more frequent in women than in men (odds ratio (OR) = 2.0 [95% confidence interval: 1.2-3.5]) and in patients with a CD4+ lymphocyte count < 200/mm3 (OR = 1.8 [1.0-3.5]). The risk of dysphagia was also higher for women than for men (OR = 1.8 [1.0-3.5]). The risk of dysphagia was also higher for women than for men (OR = 3.3 [1.3-8.4]). Patients with < 200 CD4+ lymphocytes/mm3 were more likely than those with CD4+ lymphocyte counts of over 200 to suffer food aversion (OR = 1.8 [1.1-3.0]). We analyzed the progression of dietary problems during follow-up and found that anorexia and dysphygia tended to disappear from one evaluation to the next whereas the number of patients reporting food aversion tended to increase. For patients reporting anorexia at the 6-month evaluation, significantly more women than men reported the persistence of anorexia at the 12-month evaluation (16% versus 5%; p = 0.03). Among patients with dysphagia at six months, those with a CD4+ lymphocyte count below 200/mm3 were much more likely than those with a CD4+ count above 200 to report persistent dysphagia at the 12-month evaluation (7% versus 0%; p = 0. 02, Fischer's exact test). For patients with no dietary problems after six months, those taking cotrimoxazole were significantly more likely than those of the placebo group to report food aversion at the 12-month evaluation (21% versus 8%; p = 0.01). We found that dietary problems were associated more with the stage of immunodeficiency that with socioeconomic factors, with the exception of sex, which was associated with several outcomes. These data stress the importance of detecting these frequent dietary problems as part of the overall clinical management of HIV+ adults in Africa, and of providing affected individuals with early nutritional counseling.
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PMID:[Nutrition problems experienced by adults infected with the human immunodeficiency virus in Abidjan (Ivory Coast)]. 1082 57

Marshall's syndrome or periodic fever syndrome was first described in 1987 in the USA based on observations of 12 children under the age of five with periodic fever (> 38 degrees C) and accompanying aphtous stomatitis, pharyngitis, and cervical adenopathy (PFAPA). In 1998, a national retrospective study was carried out in France by the pediatric infectious pathology group, and a semeiological analysis was made of 22 cases. The main characteristics of Marshall's syndrome found in this patient population were in agreement with those reported in the literature. The onset of symptoms occurred between the age of 3 months and 12 years, with a mean age of 5 years; no geographical or ethnic predisposing factors were noted. The diagnosis of symptoms was subsequently established at an age ranging from 5 months to 16 years, with a mean age of 6.5 years. It was determined that following an initial phase of generalized clinical manifestations (asthenia, cranial neuritis, dysphagia, anorexia), the symptoms become stereotyped, with the sudden appearance of high fever (> 40 degrees C), shivering, aphtous stomatitis, pharyngitis, and cervical adenopathy. Other symptoms such as cranial neuritis, arthralgia, and abdominal pain may also be present (50% of cases in the present study), but due to their variability of appearance they are of lesser diagnostic value. The main characteristic of Marshall's syndrome is its periodic aspect; with fever occurring every 6 to 9 weeks, with a mean interval of 66 days before recurrence of fever compared to the shorter interval of 21 to 28 days reported in the literature. After excluding the presence of an infection, the differential diagnosis includes the following: familial Mediterranean fever, hyper IgD syndrome, and feverish neutropenia. During the periods of fever, an inflammatory syndrome with hyperleucocytosis and a marked increase in C-reactive protein (CRP) levels and sedimentation rate is observed. The most effective treatment seems to be the early administration of corticoids during the initial phase, prior to the appearance of more specific symptoms. The prognosis is excellent, with a progressive decrease in the incidence of periodic fever and an absence of complications. However, the etiology of Marshall's syndrome has not yet been determined.
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PMID:[Marshall syndrome: results of a retrospective national survey]. 1094 83

Symptoms related to fungal esophagitis were studied in patients with alcoholic liver disease who underwent upper gastrointestinal endoscopy. Data of 517 patients were studied retrospectively (group I) and 100 alcoholic liver disease patients, that were successively admitted to hospital, were enrolled in the prospective part (group II). Out of the 41 cases with fungal esophagitis found in group I, data of 38 could be evaluated. In group II 13 of the 93 evaluable patients had fungal esophagitis; according to Kodsi's grading 10 patients had grade 1., one patient grade 2. and two patients grade 2-3. oesophagitis. There was no case with grade 4. esophagitis. The rate of symptoms among the 51 patients with fungal esophagitis was: anorexia 23 (45.0%), abdominal pain 22 (43.1%), vomiting 17 (33.3%), nausea 15 (29.4%), occult gastrointestinal bleeding 12 (23.5%), weight loss 9 (17.6%), melena 7 (13.7%), bloating 6 (11.7%), acidic regurgitation 3 (5.8%), haematemesis 2 (3.9%), thoracic pain 2 (3.9%), singultus 1 (1.9%), odynophagia 0 and dysphagia 0. In 7 patients (13.7%) none of the studied symptoms could be identified. Despite the relatively high frequency of symptom free fungal esophagitis reported in the literature, the total lack of odynophagia and dysphagia in our patient group was remarkable. In the lack of deglutition disorders the other symptoms do not raise the suspicion of esophagitis. The diagnosis in such cases can be established only by endoscopy.
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PMID:[Symptoms of fungal esophagitis in alcoholic liver disease]. 1094 8

The clinical significance of studies on survival predictors in terminal cancer patients is hindered by both methodological limitations and the difficulty of finding common predictors for all final events in cancer related deaths. To evaluate the published medical literature concerned with the survival of patients with terminal cancer and identify potential prognostic factors, major electronic databases including MEDLINE (1966-), CANCERLIT (1983-) and EMBASE (1988-) were searched up to September 1999. Studies were included in our review if published in English, were cohort studies, addressed the identification of clinical prognostic factors for survival and looked at samples with median survival of < or = 3 months. Data extracted from selected papers included: sample size, median survival, type of study, sampling frame, cohort type, type of statistical analysis (univariate or multivariate), choice of models and underlying assumptions, predictors examined and their reported level of statistical significance. A total of 24 studies were found and reviewed. On the basis of these studies, performance status and the presence of cognitive failure, weight loss, dysphagia, anorexia and dyspnoea appear to be independent survival predictors in this population. Clinical estimation of survival by the treating physician appeared independently associated with survival but the magnitude of the association generally appeared small. Clinical predictions should be considered as one of many criteria, rather than as a unique criterion by which to choose therapeutic interventions or health care programmes for terminally ill cancer patients. The use of convenient samples as opposed to more representative inception cohorts, the inclusion of different variables in the statistical analyses and inappropriate statistical methods appear to be major limitations of the reviewed literature. Methodological improvements in the design and conduction of future studies may reduce the prognostic uncertainty in this population.
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PMID:Survival prediction in terminal cancer patients: a systematic review of the medical literature. 1106 83

Esophageal cancer is among the 10 most frequent cancers in the world. Iran is one of the known areas with a high incidence of esophageal cancer. Most of the patients in Iran have been reported from the north and northeast regions of the country. In one survey by the Iran Cancer Institute, 9% of all cancers and 27% of gastrointestinal cancers were esophageal carcinoma. The male to female ratio was 1.7/1. The distal portion of the esophagus is involved more often than other parts. Consumption of wheat flour, exposure to residues from opium pipes, drinking hot tea, and chewing nass (a mixture of tobacco, lime, ash, and other ingredients) are the suspect etiologic agents for esophageal cancer in Iran. Dysphagia, weight loss, anorexia, abdominal pain, and odynophagia are the common symptoms and signs of Iranian patients with esophageal cancer. For clinical staging, chest computed tomographic scanning is performed. Adenocarcinoma of the esophagus is not as common in Iran as in western countries. Public education, nutritional support, and eradication of opium addiction may decrease the morbidity and mortality that result from esophageal cancer. Surgery has traditionally been the mainstay of esophageal cancer treatment in Iran. Radiotherapy is mainly used postoperatively. The usual combination chemotherapy regimen is cisplatin plus flurouracil (5-Fu). Semin Oncol 28:153-157.
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PMID:Esophageal cancer in Iran. 1130 77

A study on AIDS subjects carried out at the Calmette Hospital in Phnom-Penh between the 1st January 97 and the 30th December 98. The objective of this study was to describe the most frequent clinical manifestations as well as the opportunistic infections according to the 1993 CDC classification (purely clinical classification). Three hundred and fifty six AIDS patients hospitalized in medicine B were included in our study. A complete file was prepared for each subject, specifying his/her social and family situation, profession, sexual behavior and history. The clinical condition was specified and the paraclinical examinations were recorded. The average age was 35 years with 250 men and 106 women, i.e. a M/F sex ratio of 2.4. The majority of male contaminations were due to sexual relationships with multiple partners, 82%, and women with a single partner was of 78%. The use of condoms was of 60% (versus 40% occasional); the extent of drug-addiction was 1.12% (4 cases). A history of STD was found in 56% of cases. The presenting symptoms most frequently found were asthenia, anorexia, fever and weight-loss. In decreasing order, the clinical manifestations often associated were: weight-loss > 10% or a catechetic condition 58.70% (209/356), fever > 38 degrees C >1 month 53% (189/356), diarrhea (> one month) 41.60% (148/356). The most frequent opportunistic infections were: oral candidiasis 51.40% (183/356) and 40% are oro-oesophageal (oral candidiasis + dysphagia or odynphagia), pulmonary and extrapulmonary tuberculoses (TB) 43.50% (155/356) (pulmonary TB in 65.16%, TB of the lymph nodes 23.22% and disseminated TB and cerebral TB 11.61%), cryptococcal meningitis 11.80% (42/356) and pneumocystosis 6.50% (23/356), CMV retinitis 1.12% (4/356). The other opportunistic manifestations such as toxoplasmosis and Kaposis sarcoma are much more rarely encountered due to the difficulties of the paraclinical diagnosis. The mortality in the department was of 17.40% (62/356). In conclusions, tuberculosis is the most frequent of the opportunistic infections in Cambodia. Cryptococcal meningitis is in 3rd place for opportunistic infections. It is the first diagnosis that should be evoked in a meningeal irritation.
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PMID:[Clinical aspects of AIDS at the Calmette hospital in Phnom Penh, Kingdom of Cambodia A report on 356 patients hospitalized in the Medicine "B" Department of the Calmette Hospital]. 1131 28


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