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)

Since 1947, there have been 21 outbreaks of botulism in Alaska, involving 46 people with 13 deaths (28% fatality). In the last six months of 1974, there were four outbreaks. With one exception to date, type E toxin was involved in all outbreaks for which laboratory confirmation has been obtained, and in all instances, Eskimo and Indian foods were the source. Clinical signs and symptoms of nausea and vomiting, dysphagia, diplopia, dilated pupils, and dry throat occurred with great frequency, forming a diagnostic pentad. We recommend that treatment include close medical supervision, supportive care, and the use of antitoxin, cathartics, and possibly, penicillin. The source of an outbreak must be determined to prevent further cases. Only prompt recognition, therapy and epidemiologic investigation can reduce the death toll from botulism.
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PMID:Botulism in Alaska, 1947 through 1974. Early detection of cases and investigation of outbreaks as a means of reducing mortality. 94 98

A randomized prospective trial was performed to study the toxicity and efficacy of the hypoxic cell sensitizer, misonidazole (MISO), used as an adjunct to high fractional dose radiotherapy in the management of unresectable Stage III and IV squamous cell carcinomas of the oral cavity, oropharynx and hypopharynx. From June 1979 to February 1983, 42 patients were randomized with 40 patients available for analysis. In the radiotherapy (RT) only group, 19 patients received a short course of high fractional dose radiotherapy with 400 rad per day, 5 days per week, to a total of 4400 to 5200 rad. In the radiotherapy plus misonidazole group (RT + MISO) 21 patients received the same radiotherapy plus 1.5 gm/m2 of misonidazole 3 times a week for a total of 7 doses. The observed side effects associated with misonidazole were: persistent numbness and paresthesia (1 patient), transient peripheral nerve paresis and persistent paresthesia (1 patient), and nausea and vomiting (2 patients). The treatment related morbidities were similar in both groups. Acute mucositis was seen in 4 of 19 patients in the RT group and 3 of 21 patients in the RT + MISO group. Acute airway obstruction requiring tracheotomy was seen in 2 patients with massive tumor in the base of tongue (1 in each group). Severe dysphagia requiring NG tube feeding was seen in 3 patients in the RT + MISO group and 3 patients in the RT group. The initial complete response rate in the RT group was 53%, versus 48% in the RT + MISO group. The estimated 2-year loco-regional control rates were 10% for RT alone and 17% for RT + MISO (no significancy). These results indicate that the addition of misonidazole does not improve the efficacy of high fractional dose radiotherapy for management of unresectable head and neck carcinomas. However, high fractional dose radiotherapy can be administered for the management of advanced head and neck carcinomas with acceptable morbidity and thus, is a useful regimen for future clinical trials of hyperbaric oxygen or new hypoxic cell sensitizers.
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PMID:A phase I/II study of the hypoxic cell sensitizer misonidazole as an adjunct to high fractional dose radiotherapy in patients with unresectable squamous cell carcinoma of the head and neck: a RTOG randomized study (#79-04). 264 55

The ability of history taking to predict endoscopically verified pathology of the upper gastrointestinal tract was evaluated in a group of 1000 patients submitted to esophagogastroduodenoscopy (EGDS). The presence of one or more of the following symptoms at the time of EGDS or 4 weeks previously, was considered: epigastric pain, dysphagia, dyspepsia, gastrointestinal bleeding, pyrosis, anorexia and/or weight loss, nausea and/or vomiting. The results of this elaboration showed that the presence of recent symptomatology does not allow differentiation of patients with endoscopically verified pathology from those without it. The presence of an "at risk history" consisting of one or more of the following factors was also evaluated: smoking 10 cigarettes per day, drinking 100 g alcohol per day, previous diagnosis of upper gastrointestinal tract pathology, gastrointestinal-irritating therapy. Data analysis showed notable importance of the presence of an "at risk history"; in fact, when compared with subjects without this type of history, "at risk" patients were twice as likely to have a pathological condition diagnosed. Thus, when protocols for endoscopic examination are established the history of the patient and his lifestyle must be taken into consideration.
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PMID:[Predictability of the anamnesis in pathology of the upper tract of the digestive system. Computerized analysis concerning 1000 subjects submitted to esophagogastroduodenoscopy]. 270 13

This retrospective study of Crohn disease in 230 children and adolescents with a mean age of 12.5 years at the time of diagnosis and an average follow-up of 6.6 years showed that 30% had lesions of the esophagus, stomach, and duodenum. Three patients had Crohn disease isolated to the upper gastrointestinal tract. The 169 patients with both small and large bowel disease were at greater risk (33%, P less than .05) of having upper gastrointestinal lesions than the 37 with isolated small bowel disease and the 21 with disease limited to the colon and/or rectum. An aggregate of symptoms and signs more likely present in those with upper gastrointestinal involvement included: dysphagia, pain when eating, nausea and/or vomiting, and aphthous lesions of the mouth. Furthermore, weight loss was more severe and hypoalbuminemia more frequent. Because upper gastrointestinal series x-ray studies failed to detect upper gastrointestinal lesions in 13 patients of 69 of those with upper gastrointestinal disease, endoscopy should be considered in all children and adolescents in whom a diagnosis of Crohn disease is entertained. Endoscopy and biopsy of the upper gastrointestinal tract should be done in any patient with symptoms suggestive of proximal involvement. Finally, in view of the fact that endoscopy established the diagnosis of Crohn disease in five patients previously thought to have chronic ulcerative colitis, the procedure should routinely be performed in all patients with chronic ulcerative colitis or indeterminate colitis before surgery is performed.
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PMID:High incidence of upper gastrointestinal tract involvement in children with Crohn disease. 271 94

A case of a 56-year-old Korean man with cerebral cysticercosis was reported. This case demonstrated the first successful treatment with praziquantel in Japan and also the usefulness of a low-dose regime in the treatment of cerebral cysticercosis. The patient was admitted to our hospital with a 7 years history of generalized seizure and a 6 months history of gait disturbance. He had 6 subcutaneous nodules. A CT scan of the brain showed multiple cysts containing a small calcification and the largest lesion measured 5 cm in diameter in the cerebellar vermis. Posterior fossa craniectomy was performed and the cyst was pathologically confirmed as cysticercosis. A month postoperatively the patient was given praziquantel 50 mg/kg body weight in 3 divided doses per day. But medication with praziquantel was stopped on the 5th day because of severe headache, nausea and vomiting. He was readmitted 6 months later with appearance of gait disturbance, left facial paresis and dysphagia. A CT scan revealed enlargement of some of the residual cysts. The patient was then given smaller doses of praziquantel 8 mg/kg body weight in 3 divided doses with steroid cover for 48 days. He experienced no side effect during the therapy and became free from the neurological symptoms. A CT scan showed complete disappearance and only numerous small calcifications of the cysts.
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PMID:[Successful treatment of cerebral cysticercosis with praziquantel]. 320 70

Forty acoustic neuromas have been removed surgically between 1976 and 1986. The condition was unilateral in 32 and bilateral in four. There were 31 large, four medium and five small tumours. Excision was complete in 16 and incomplete in 24. Of the incomplete removals 14 were subtotal leaving microscopic remnants, eight were partial capsular and two were intracapsular. Follow-up ranged from two months to ten years (median 3.5 years).There was one early death in an 83-year-old. The overall incidence of post-operative complete facial paralysis was 20% but reached 55% for large tumours when excision was complete. Twenty-eight patients had hearing before operation and in eleven patients some preservation of hearing was possible (39%). In these, the excision was complete in three, subtotal in four, partial capsular in three and intracapsular in one.Of the unilateral tumours, there have been three recurrences requiring repeat surgery. All were initially incompletely excised. Two were of an invasive nature causing considerable erosion of the petrous temporal bone making complete excision impossible. For the bilateral tumours a deliberate incomplete excision was first performed on one side to ensure preservation of hearing. Further excision on this side was then left until such time as hearing was lost. Complications included CSF otorhinorrhoea (5%), persistent but temporary nausea and vomiting (10%), meningitis (5%), facial numbness (5%) and hoarseness and dysphagia (3%).
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PMID:Acoustic neuroma surgery in Northern Ireland 1976-1986. 323 48

Three hundred four patients have undergone cardiac transplantation at the University of Pittsburgh since 1980. Twenty patients have required 27 upper gastrointestinal (GI) endoscopic procedures. After heart transplantation the primary indications for endoscopy were epigastric pain (six patients with gastritis, one with multiple shallow gastric ulcers, and one with normal test results), mild upper GI bleeding (four patients with esophagitis, two with gastritis, and two with multiple shallow gastric ulcers), dysphagia and odynophagia (two patients with esophagitis), persistent nausea and vomiting (one with normal test results), lower GI bleeding (one with normal test results), and routine follow-up (one with normal test results). After heart-lung transplantation the primary indications for the endoscopy were massive upper GI bleeding (three patients with actively bleeding duodenal ulcers), dysphagia and odynophagia (one patient with esophagitis), mild upper GI bleeding (one patient with gastritis), and routine follow-up (one patient with normal test results). No complications resulted from endoscopy. The procedures were performed in the GI suite without cardiac monitoring. Prophylactic antibiotics were not routinely administered. No patient had a fungal infection of the upper GI tract--a finding attributed to the prophylactic use of nystatin in all patients. Opportunistic viral infections were identified histologically in six patients, including two patients with actively bleeding duodenal ulcers. The possibility of opportunistic viral infections in this immunosuppressed group required aggressive diagnostic techniques, including endoscopy and biopsy, which can be safely performed after cardiac transplantation.
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PMID:Upper gastrointestinal endoscopy after cardiac transplantation. 327 3

We reviewed records of all food-borne outbreaks of botulism in Alaska from 1947 through 1985. Fifty-nine confirmed or suspected outbreaks with 156 cases were reported. All outbreaks occurred in Alaska Natives and were associated with eating traditional Alaska Native foods. Forty-four (75%) of the outbreaks were laboratory confirmed and involved 133 persons. The overall annual incidence of confirmed or suspected botulism was 8.6 cases per 100,000 population. Seventeen persons died, an overall case-fatality rate of 11%. Type E toxin accounted for 32 (73%) laboratory-confirmed outbreaks; type A, six (14%); and type B, five (11%). Forty-one cases demonstrated botulinal toxin in one or more specimens (serum, gastric contents, or stool). Of the 41 botulinal toxin-positive persons, 38 (93%) had at least three of the commonly recognized pentad of signs or symptoms--nausea and vomiting, dysphagia, diplopia, dilated and fixed pupils, or dry mouth and throat--and 20 (49%) required respiratory assistance.
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PMID:Food-borne botulism in Alaska, 1947-1985: epidemiology and clinical findings. 337 20

12 cases of food-borne botulism were registered in Sion, Switzerland, between 31 December, 1993 and 12 January, 1994. A type B toxin was isolated from the serum of one patient and from the incriminated ham. Clinical data of 10 male patients aged 21 to 54 years and some epidemiologic data are reported. The clinical course was mild to moderate with predominant autonomic and gastro-intestinal symptoms and signs: blurred vision (10 patients of 10), dry mouth with dysphagia (9/10), asthenia (7/10), diarrhea and/or constipation (7/10), nausea and vomiting (6/10), abdominal cramps (5/10), impaired sexual function (5/10), dilated pupils (4/10). Some discomfort (mainly blurred vision, asthenia and impaired sexual function) persisted for several months in most patients. Neuromuscular involvement was never the reason for seeking medical assistance and had often disappeared at the time of the first visit. Two patients were hospitalized, one for transient ileus of unknown origin and the second (first suspected case) for monitoring and infusion of trivalent equine botulinum antitoxin. This treatment was administered on day eight after intoxication and had no effect on this patient's outcome when compared with others. No patient died. Epidemiology, diagnosis, treatment and prognosis of botulism are discussed.
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PMID:[Epidemic of type B botulism: Sion, December 1993-January 1994]. 748 37

The extent to which the different resections relieve the symptoms of gastric cancer is poorly defined. The symptoms of 57 consecutive patients undergoing standard resection of gastric adenocarcinoma by oesophagogastrectomy (n = 19), total gastrectomy [16] or partial gastrectomy [22] were studied prospectively. Common symptoms were relieved in 80% of cases and this was independent of tumour stage. Symptoms were significantly more frequent after total gastrectomy than after partial gastrectomy or oesophagogastrectomy, the difference being attributable principally to the development of new symptoms after total gastrectomy. While abdominal pain, nausea and vomiting were largely relieved by resection, dyspepsia or dysphagia worsened in 31% of patients following surgery, especially total gastrectomy (P < 0.05). Resection relieves the symptoms of gastric cancer adequately but outcome is influenced by operation type. As total gastrectomy gives a poorer symptomatic outcome, it should be avoided when the performance of an alternative procedure does not compromise established principles of resection.
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PMID:Symptomatic outcome following resection of gastric cancer. 778 Jun 11


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