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

Thoracoscopic enucleation of leiomyoma of the esophagus was successfully performed in two cases. This paper mainly describes a 53-year-old man who experienced with a slight dysphagia and retrosternal discomfort when moving. Esophagoscopy showed a mass beneath normal mucosa located at 26 cm from the incisor of the left anterior esophagus. Endoscopic ultrasonography showed a sharply delineated low echoic mass with regular echo-pattern, measuring 4 cm along the axis. The lesion was diagnosed as leiomyoma. The operation was performed under general anesthesia, keeping the patient on the left postero-lateral position. A double-lumen endotracheal tube was utilized and the right lung was collapsed. Six trocars were inserted through right intercostal spaces for operation. The azygos vein first of all was dissected and divided by an EndoGIA. The esophagus was then mobilized lengthwise enough to rotate the left side to the right with two slings traction for better visualization of the lesion site. Intraluminal balloon-mounted esophagoscope was useful enough to expose the tumor inner side out of the esophageal wall and the tumor was easily enucleated. After resection, intact esophageal mucosa was confirmed by endoscopy and the proper muscle layer of the esophagus was closed with 2-0 Vicryl. In the 2nd case, leiomyoma located at 32 cm from the incisor of the right esophageal wall, 4 x 1.5 x 1 cm in size, was removed by the same technique using five trocars, where neither the azygos vein divided nor the esophagus mobilized. Both patients showed uneventful recovery and the symptoms disappeared after operation. Intraluminal balloon-mounted esophagoscope was useful to do this kind of thoracoscopic procedure.
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PMID:[Thoracoscopic enucleation of leiomyoma of the esophagus--report of two cases]. 771 87

Intracranial section of the glossopharyngeal and upper vagal rootlets for the treatment of vagoglossopharyngeal neuralgia may cause dysphagia or vocal cord paralysis from injury to the motor vagal rootlets in 10% to 20% of cases. To minimize this complication, we recently applied a technique of intraoperative monitoring of the vagus nerve (previously described by Lipton and McCaffery to monitor the recurrent laryngeal nerve during thyroid surgery) in a patient undergoing intracranial rhizotomy for vagoglossopharyngeal neuralgia. By inserting an electrode in the ipsilateral false vocal cord and stimulating the rostral vagal rootlets intraoperatively under general anesthesia, we could differentiate the rostral vagal motor rootlets from the sensory rootlets. In this patient, the technique allowed us to preserve a rostral vagal rootlet, which if sectioned, could have caused dysphagia or vocal cord paralysis. We conclude that intraoperative monitoring of the rostral vagal rootlets is an important technique to minimize complications of upper vagal rhizotomy.
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PMID:Intraoperative monitoring of the vagus nerve during intracranial glossopharyngeal and upper vagal rhizotomy: technical note. 764 15

Percutaneous gastrostomy is reported to be an effective alternative to total parenteral feeding or long-term nasogastric tube in the treatment of mechanical or functional dysphagia. The authors report their personal experience with 137 percutaneous gastrostomies performed on 98 men and 39 women from January 1986 through December 1993. All the maneuvers were performed under fluoroscopic guidance in the patients with head or neck cancer, neoplastic, vascular or post-traumatic neuropathy and upper GI tract cancer. To avoid left hepatic lobe trauma, percutaneous gastrostomy needs to be performed under US guidance. A 7F nasogastric tube is used to fill the stomach with air. After distending the gastric cavity, with the Seldinger technique under local anesthesia, fascial dilators of progressively increasing caliber are introduced into the gastric cavity and the final 12F gastrostomy catheter is positioned under fluoroscopic guidance. No major complications, such as hemorrhage or peritonitis, occurred. In one case, during the maneuver, the patient complained of severe epigastric pain which regressed with no further problems two hours later. In three cases the gastrostomy catheter fell out of place and was replaced by running the fistolous tract with a venous cannula and then a guidewire for gastrostomy repositioning. With this type of treatment, the patient can be given enteral feeding the following day. The maneuver requires approximately 10 minutes to perform and is well tolerated by the patient as it requires no general anesthesia. Percutaneous gastrostomy is more cost-effective than surgery or endoscopy and hospitalization is shorter. The only contraindications to this maneuver are hepatomegaly (because of the risk of liver trauma during percutaneous maneuvers), ascites (because of the risk of infection) and finally the complications resulting from gastric resection.
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PMID:[Percutaneous gastrostomy. Personal experience in 137 cases]. 787 38

From 1983 to 1991, 6 cases of retropharyngeal abscess were treated at the University Hospital Center of Dakar. A retrospective review of these cases showed that most occurred in children between the ages of 3 months and 3 years. All patients were examined late, i.e. with a delay of more than one week between the onset of symptoms and consultation of a specialist. The clinical signs were dysphagia, dyspnea, and, in all but one case, fever. In 5 patients, diagnosis was based on the observation of a mass in the middle section of the posterior wall of the pharynx that led to peroral incision and drainage without general anesthesia. In the remaining patient, whose abscess involved the lower part of the wall, endoscopy was necessary to allow diagnosis and incision under general anesthesia after tracheotomy. In all cases, complete healing was obtained after 10-day single-agent antimicrobial therapy. Practitioners in tropical areas should bear in mind that retropharyngeal abscesses are not uncommon in these regions and that they can cause serious complications (rupture and mediastinal extension).
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PMID:[Retropharyngeal abscess. 6 case reports]. 793 82

Enteral nutrition has many advantages over parenteral nutrition and is being increasingly used. Percutaneous endoscopic gastrostomy is performed under local anaesthesia by means of a gastroscope inserted for 15-20 minutes. From January 1993 til January 1994 we performed ten percutaneous endoscopic gastrostomies in patients suffering mainly from stroke and dysphagia. The article includes a description of the method and the results. The mean application time for the gastrostomies was 67.9 days (14-238 days). No serious complication was observed, two local wound infections were noted. It is concluded that percutaneous endoscopic gastrostomy is a safe and efficient method for enteral nutrition. The method seems to have few complications, is cheap and is simple to perform.
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PMID:[Percutaneous endoscopic gastrostomy. Experiences with the first 10 cases in a medical department]. 799 90

Tube feeding is commonly used in providing enteral nutrition to the patient with dysphagia. The percutaneous endoscopic gastrostomy (PEG) is an alternative to the nasogastric tube (NG) and the surgical gastrostomy. The advantages of PEG are short procedure time, the avoidance of using an operating theatre and general anaesthesia and reduced cost. The main indication for PEG is dysphagia due to neurological disease and cancer in the pharynx and oesophagus. A gastrostomy is cosmetically more acceptable than NG, self extubation is more difficult for the confused patient, tube diameter is larger and therefore the tube is not so easily blocked. The patient with a gastrostomy tube is more mobile and is able to start oral nutrition at the same time as receiving enteral nutrition through the gastrostomy tube.
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PMID:[Percutaneous endoscopic gastrostomy]. 806 31

One hundred ASA grade 1 and 2 patients requiring orotracheal intubation for various general surgical procedures were randomly assigned to receive either expert rigid laryngoscopic or novice fibreoptic orotracheal intubation under total intravenous anaesthesia. Five anaesthesia residents in the 4th year, with no prior experience in fibreoptic laryngoscopy, participated in a fibreoptic training course, viewing two instructional videos and practising on the intubation manikin. Each resident intubated 20 patients in a randomised fashion either as an expert laryngoscopist or as a fibreoptic novice. The time (SEM) to achieve successful intubation was statistically different for fibreoptic and rigid intubation (77.2 (5.1) s vs 17.7 (1.6) s, p < 0.01). The time to achieve successful rigid laryngoscopic intubation remained constant over the ten intubations, whereas time required for fibreoptic intubation decreases significantly (p < 0.01). The learning objectives (fibreoptic intubation times in 60 s or less and with 90% or greater success rate on the first intubation attempt) were met by all residents. The haemodynamic profile was similar for fibreoptically intubated and conventionally intubated patients and there was no difference between the first two or the last two fibreoptic or rigid intubations. The study was designed to detect a difference of 10% in means (assuming alpha = 0.05 and beta < or = 0.2). The incidence of postoperative sore throat, dysphagia or hoarseness was similar in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)
Anaesthesia 1994 Apr
PMID:Teaching fibreoptic intubation in anaesthetised patients. 817 44

A 79-year-old man with a diagnosis of myocardial infarction treated with streptokinase and heparin developed a large lingual haematoma, precipitating dysphagia and upper airway obstruction. Spontaneous haemorrhage into the tongue is a previously unreported but serious complication of thrombolytic therapy. Tracheal intubation was performed under local anaesthesia.
Anaesthesia 1994 May
PMID:Lingual haematoma following treatment with streptokinase and heparin; anaesthetic management. 820 85

There are no published studies evaluating the sensory capacity of the region innervated by the superior laryngeal nerve. A normal sensory capacity is important in this area, since hypesthesia or anesthesia of the pharynx and supraglottic larynx may result in dysphagia and aspiration. This often occurs after stroke or after ablative surgery of the pharynx and larynx. Evaluating the efficacy of restorative procedures for supraglottic and pharyngeal sensation is dependent on defining and quantifying the sensory deficit. We have developed a new, noninvasive method to measure sensation in the pharynx and supraglottic larynx. A puff of air--of precisely controlled duration and pressure--was delivered via a flexible telescope to the anterior wall of the pyriform sinus. Surface sensibility was determined according to the psychophysical method of limits by varying air pressure while holding puff duration constant. We conducted 204 trials in 20 healthy adults. The average sensory discrimination threshold was 2.09 +/- 0.15 mm Hg. An intraclass correlation revealed excellent consistency (R = .80). There was no statistically significant difference between the right and left sides. Brief air pulse stimulation is an easy, relatively safe, and reliable method of determining supraglottic and pharyngeal sensory discrimination thresholds.
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PMID:Air pulse quantification of supraglottic and pharyngeal sensation: a new technique. 821 97

Botulinum toxin is known as a relatively safe and efficacious agent for the treatment of various neurologic and ophthalmologic disorders. Since dysphagia and deglutition problems combined with aspiration are often caused by spasticity, hypertonus, or delayed relaxation of the upper esophageal sphincter (UES), conventional treatment including lateral cricopharyngotomy was replaced by localized injections of botulinum toxin into the cricopharyngeal muscle (CM) in a series of 7 patients. The study comprised patients with slight dysphagia caused by isolated hypertonus of the UES, as well as patients with severe deglutition disorders, complete inability to swallow, and aspiration problems. Preoperative diagnostic evaluation included careful history-taking, physical examination, cineradiography, and esophageal manometry to exclude other causes of dysphagia. For precise localization, injections were performed under general anesthesia after location of the CM by direct esophagoscopy and electromyographic guidance. Injections were administered into the dorsomedial part and on both sides into the ventrolateral parts of the muscle. Depending on the severity of symptoms and the intraluminal pressure of the UES, the dose varied between 80 and 120 units (botulinum toxin A from Dysport). The treatment outcome was evaluated by a disability rating score: patients' complaints were scored by subjective and objective parameters before and after injection. All but 2 patients experienced complete relief or marked improvement of their complaints. There were no severe side effects or postoperative complications. Local botulinum toxin injection proved to be an effective alternative treatment to invasive procedures for patients with isolated dysfunction of the UES, and also for patients with more complex deglutition problems combined with aspiration.
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PMID:Treatment of dysfunction of the cricopharyngeal muscle with botulinum A toxin: introduction of a new, noninvasive method. 829 57


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