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)

Infection of the central nervous system with Nocardia sp. usually manifests as supratentorial abscesses. Supratentorial and cerebellar abscesses from infection with Nocardia sp. following immunosuppression with long-term corticosteroids for idiopathic thrombocytopenia (ITP) have not been reported. An 83 years-old, human immunodeficiency virus (HIV)-negative, polymorbid male with ITP for which he required corticosteroids since age 53 years developed tiredness, dyspnoea, hemoptysis, abdominal pain, and progressive gait disturbance. Imaging studies of the lung revealed an enhancing tumour in the right upper lobe with central and peripheral necrosis, multiple irregularly contoured hyperdensities over both lungs, and right-sided pleural effusions. Sputum culture grew Nocardia sp. Neurological diagnostic work-up revealed dysarthria, dysphagia, ptosis, hypoacusis, tremor, dysdiadochokinesia, proximal weakness of the lower limbs, diffuse wasting, and stocking-type sensory disturbances. The neurological deficits were attributed to an abscess in the upper cerebellar vermis, myopathy from corticosteroids, and polyneuropathy. Meropenem for 37 days and trimethoprime-sulfamethoxazole for 3 months resulted in a reduction of the pulmonary, but not the cerebral lesions. Therefore, sultamicillin was begun, but without success. Long-term therapy with corticosteroids for ITP may induce not only steroid myopathy but also immune-incompetence with the development of pulmonary and cerebral nocardiosis. Cerebral nocardiosis may not sufficiently respond to long-term antibiotic therapy why switching to alternative antibiotics or surgery may be necessary.
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PMID:Cerebellar nocardiosis and myopathy from long-term corticosteroids for idiopathic thrombocytopenia. 2004 27

Foreign body in the esophagus is a common emergency presentation. Foreign body aspirations comprise the majority of accidental deaths in childhood. Conventional x-ray imaging is usually obtained to aid the diagnosis during the initial evaluation. The decision for surgical intervention is usually based on a suspicious history, physical examination and radiologic findings. Rigid bronchoscopy is very effective procedure for inhaled foreign body removal with fewer complications. Proper use of diagnostic techniques provides a high degree of success and the treatment modality to be used depending on the type of the foreign body is mostly satisfactory. Live foreign body is a rare entity but common emergency presentation. The approach towards a patient with leech infestation comprises a thorough history and systematic examination followed by relevant investigations. However, there is considerable debate over the most appropriate treatment option for such patients. A living foreign body, or parasite, in the oro-or naso-pharynx is rare in Western countries, but in other parts of the world is a fairly common cause of problems. In the past 10 years 28 cases of foreign bodies due to infestation with leeches were treated in our departments. In all patients, 2-70 years old, the complaint was of recurrent episodes of epistaxis, blood-spitting, odynophagia, dysphagia, dyspnea and hemoptysis several days before admission. Examination showed a green-brown mass protruding from different naso- and oro-pharengeal areas, which is in every case, was a blood-engorged leech. Treatment consisted of removing the leech by applying a forceps to the middle of the leech's body and giving a quick pull. Bleeding ceased immediately after removal of the leech. This review aims to develop a comprehensive approach towards patients presenting with foreign body ingestion by developing clinical practice guidelines. These guidelines address not only the initial evaluation of the patient but also the various management alternatives and their advantages, limitations and applicability in various scenarios, based upon a review of the literature.
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PMID:Meta analysis of the leech as a live foreign body: detection, precaution and treatment. 2033 16

Granular cell tumors (GCTs) are uncommon neoplasm. They can originate in any part of the body. The most common sites of origin are in the head and neck, while the larynx is a relatively uncommon location. Patients affected with a laryngeal GCT typically present with persistent hoarseness, stridor, hemoptysis, dysphagia, and otalgia but, the tumor may be asymptomatic. Care must be taken to differentiate this lesion from others due to the presence of pseudo-epitheliomatous hyperplasia which overlies the GCT and may occasionally mimic squamous cell carcinoma. Therefore, a confirmative diagnosis should be made histopathologically and should be supported by immunohistochemical staining. These tumors are treated by complete surgical resection. Examining the complete removal of the tumor through securing a negative free margin is considered to be a consequential procedure. We experienced a 64-yr-old man with a laryngeal granular cell tumor involving the right true vocal cord. He was treated by surgical resection under a fine dissection laryngomicroscope. Here we present this case and a review of literature.
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PMID:Granular cell tumor on larynx. 2037 4

Transoesophageal echocardiography (TEE) is an important tool for diagnosis and monitoring during anaesthesia in cardiac operation. TEE is generally considered a safe and minimally invasive technique. However, adverse events may occur during probe insertion or manipulation. We report a case of delayed distal oesophageal stricture with an associated scarring probably due to TEE during a cardiac operation. The patient, a 75-year-old female, underwent coronary artery bypass graft, mitral valve replacement, and tricuspid valve annuloplasty. Seven days after surgery, the patient complained of dysphagia without haemoptysis and drop of haematocrit. At 24 days after surgery, severe stricture of distal oesophagus with scarring was observed by oesophagography and stent insertion was done.
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PMID:Distal oesophageal stricture after transoesophageal echocardiography in a cardiac surgical patient. 2056 14

This was an eight year (2000-2007) retrospective study of tuberculosis in patients admitted to the UMMC. A total of 131 cases were analyzed. Malays constituted the most cases, (43%), followed by Chinese (22%), Indians (17%) and others (18%). The majority of cases were within the 21-60 year old age group, which constituted 69.5% of the total. Males were more commonly affected (65%). Most cases were reported among Malaysians (83%). The majority of patients were unemployed (39%), followed by housewives (10%), laborers (9%), students (8%), shop assistants (7%), and other occupations (27%). The most common presenting complaints were prolonged productive cough, night sweats, fever, anorexia, weight loss (57%), hemoptysis (34%), and undifferentiated symptoms, such as prolonged diarrhea and dysphagia (9%). Sputum was positive for acid-fast bacilli (AFB) in 89%, but only 69% of cases had abnormal chest radiographs. The majority of patients (65%) developed no complications. The most common complications were pleural effusion, pneumothorax and pulmonary fibrosis. The majority of patients (82%) suffered either from diabetes mellitus, hypertension, ischemic heart disease or all 3 conditions. Regarding risk factors for tuberculosis, two were HIV positive and two were intravenous drug users. The majority of the patients (85%) did not complain of any side effects from their anti-tuberculosis treatment. Among those who did complain of side effects, the most common were nausea and vomiting (41%), drug induced hepatitis (37%), blurring of vision (11%) and skin rashes (11%). Two cases of death were reported.
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PMID:Tuberculosis: an eight year (2000-2007) retrospective study at the University of Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia. 2057 21

Paraquat is a nonselective contact herbicide of great toxicological importance, being associated with high mortality rates, mainly due to respiratory failure. We report the case of a 22-year-old male admitted to the emergency room with a sore throat, dysphagia, hemoptysis, and retrosternal pain after the ingestion of 50 mL of a paraquat solution, four days prior to admission. Chest CT scans revealed pulmonary opacities, pneumomediastinum, pneumothorax, and subcutaneous emphysema. The patient was submitted to two cycles of immunosuppressive therapy with cyclophosphamide, methylprednisolone, and dexamethasone. The pulmonary gas exchange parameters gradually improved, and the patient was discharged four weeks later. The clinical and tomographic follow-up evaluations performed at four months after discharge showed that there had been further clinical improvement. We also present a brief review of the literature, as well as a discussion of the therapeutic algorithm for severe paraquat poisoning.
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PMID:Severe paraquat poisoning: clinical and radiological findings in a survivor. 2083 1

Oesophageal cancer presents as advanced disease; in the majority of patients the symptoms are present for many months prior to diagnosis. Dysphagia has been described as the key to an early diagnosis of oesophageal cancer. This study aims to assess the public perception of the importance of this symptom. Ninety-six patients completed a questionnaire. This evaluated patient understanding of symptoms of dysphagia compared to the finding of a breast lump, haemoptysis, chest pain and loss of weight concerning urgency, probable cause of symptoms and treatment required. Sixty-five patients (71%) would visit their GP within 24 h of finding a breast lump or suffering from haemoptysis (82%) or having chest pain (82%). Forty-seven patients (51%) who experienced dysphagia would seek medical advice after one week and further 18 (19%) after one month (P<0.0001). Only eight patients (10%) associated dysphagia with cancer compared to 53 patients (57%) with the finding of a breast lump (P<0.031). This study concludes that there is poor understanding of the main symptoms of oesophageal cancer. New health campaigns are needed if the cancer is to be detected at an earlier and potentially curable stage.
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PMID:Poor awareness of symptoms of oesophageal cancer. 2092 60

Pancreatic pseudocyst is a common complication of acute and chronic pancreatitis. Extension of a pancreatic pseudocyst into the mediastinum is rare. We present a case of a 43-year-old male with a history of pancreatitis, who presented with dysphagia and was found to have a pancreatic pseudocyst. The pseudocyst was extending to the mediastinum and compressing the esophagus. It was successfully drained externally by computed tomography-guided catheter intervention. Depending on the location and size, patients may present with dyspnea, chest pain, palpitations, or dysphagia; sometimes with hemoptysis, acute respiratory compromise, or cardiogenic shock. There are no recommended guidelines for management. Watchful waiting for spontaneous regression, medical therapy, or drainage internally or externally with endoscopic, percutaneous, or open surgical approach are available options. Based on our own experience and literature review of such cases, we present a management strategy that can limit both complications and recurrence rate. This case emphasizes the importance of the possibility of mediastinal extension of a pancreatic pseudocyst and provides reference guidelines to approach the same.
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PMID:Mediastinal extension of pancreatic pseudocyst--a case with review of topic and management guidelines. 2113 51

Foreign bodies in the aerodigestive tract are common. They may cause minimal disturbance of function, severe morbidity or even sudden death. They enter the aerodigestive tract because of haste during eating, disturbances in physical function, impairments due to extreme youth or age, or contamination of food with foreign bodies. Common symptoms are pain, dysphagia, odynophagia, cough, airway distress, hemoptysis and hematemesis. Signs include point tenderness, respiratory distress and surgical emphysema. Clinical, radiological and endoscopic investigations are described, as are principles of crisis and elective management.
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PMID:Foreign bodies in the aerodigestive tract. 2126 32

This is a case report about a rare oropharyngeal foreign body causing oropharyngeal symptoms such as sore throat, dysphagia and hemoptysis. We reported a 7 year-old boy who had ingested a leech from a bottle which had been filled with water and it had attached to the palate within 4 days. The leech was identified as approximately 3 cm in length. Leech was removed under premedication by using monopolar cauterization. Although child infestation by a leech in the upper respiratory tract is very rare, it should be investigated when contaminated liquids are ingested. Electro cauterization should be borne in mind as a therapeutic option in the treatment of leech infestations in the upper respiratory tract under pre-medication in pediatric patients.
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PMID:Oropharyngeal leech infestation and therapeutic options. 2139 Nov 94


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