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

The nervous mechanisms that generate swallowing are still largely unknown. It has been suggested that a central pattern generator that contains a serial network of linked neurons must produce the successive excitation of motoneurons (Mns) and then the sequential activation of muscle through excitatory connections. Inhibitory connections have also been envisioned but never evidenced at the membrane level of the swallowing neurons. We investigated, by intracellular recordings, the behavior of 96 Mns in the rostral nucleus ambiguus during swallowing induced by application of superior laryngeal nerve stimulation to anesthetized sheep. The Mns were identified by antidromic activation following stimulation of glossopharyngeal, pharyngoesophageal, or cervical vagal nerves. Nine Mns showed a bell-shaped depolarization during the buccal or the early pharyngeal stage of swallowing. They probably projected to muscles of the soft palate (palatopharyngeal) and upper pharynx (stylopharyngeal, hyopharyngeal). Thirty-eight Mns exhibited a chloride-dependent hyperpolarization, indicating that they were under an active inhibition throughout the buccopharyngeal stage of swallowing. These Mns constitute a heterogeneous pool: some of them, producing spontaneous inspiratory discharges, probably innervated laryngeal or pharyngeal muscles; others might also be Mns of the esophagus, whose swallowing pattern was modified because of the anesthesia (suppression of the esophageal peristalsis). Forty-nine Mns showed a chloride-dependent hyperpolarization with a variable duration at the onset of swallowing, followed by a depolarization that could take place during either the buccopharyngeal (HD1-Mns) or the esophageal (HD2- and HD3-Mns) stage of deglutition. HD1-Mns probably projected to the median and inferior constrictors of the pharynx. HD2-Mns produced depolarizations with longer latencies and durations than those of the HD1-Mns. They probably projected to either the superior esophageal sphincter or the cervical esophagus (CE). HD3-Mns showed a buccopharyngeal hyperpolarization that was followed first by a lower-amplitude hyperpolarization accompanying the proximal CE contraction and then by a delayed depolarization. These Mns probably innervated the inferior CE or thoracic esophagus. We conclude that the initial inhibition exerted on the HD-Mns, by delaying the excitation of Mns, may play a role in the nervous mechanisms involved in temporal organization of the swallowing motor sequence. We suggest that swallowing disorders in humans such as dysphagia by failure of cricopharyngeal relaxation, diffuse esophageal spasm, and achalasia might be caused by impaired inhibitory mechanisms.
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PMID:Intracellular activity of motoneurons of the rostral nucleus ambiguus during swallowing in sheep. 906 58

Authors report a Launoise-Bensaude-Madelung disease case, in a 64 year old man, admitted to a Plastic Surgical Department for obesity, dysphonia, dysphagia, dyspnea. Early symptoms appeared 20 years before Hospital admission. Lipomatous tissue occupied nape, mandible, neck and shoulders. Surgical exeresis of lipomatous tissue under general anesthesia needed for the patient. Neck movements and mouth opening were short (Mallampati Score = 4); a neck computed tomography showed a tracheal compression and right displacement. Tracheal intubation was considered difficult or impossible. Nose-tracheal intubation was performed using a pediatric fiberoptic instrument as guide for a small gauge tracheal tube. Tracheal stenosis required many attempts for correct nose-tracheal intubation. Fiberoptic instrument as guide for tracheal tube can be useful for patients with Launoise-Bensaude-Madelung disease, when tracheal intubation is considered difficult or impossible. Knowledge of fiberoptic tracheal intubation techniques is mandatory for anesthesiologists, allowing tracheal intubation in patients with anatomical variations of mouth or upper respiratory airways.
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PMID:[Anesthesiologic problems in patients with Launois-Bensaude-Madelung disease. Clinical case]. 910 81

Without different types of palliation the patients with inoperable oesophageal cancer have a poor quality of life, rapid weight loss which leads to death. The aim of palliation is the complete relief of dysphagia. Our modified procedure is a simplified way of a well known method described by Tytgat in 1986. The prosthesis is positioned under continuous visual control using only local anaesthesia. This method is safe and not expensive. During the last three years 73 consecutive patients were treated with palliative fiberoscopic intubation with Tygon prosthesis. 46 patients had esophageal carcinoma, 19 had gastric, 8 had pulmonary carcinoma obstructing the gullet. Among them 11 patients had bronchoesophageal fistula. The early complications were perforations (7) bleeding (2), and later complications: food impaction (5) tumor overgrowth (5) and tube migration (2). The mortality was 2%. All patients have received antibiotic prevention. Although the improvement of life quality is more important than extension of life, for many patients survival will be prolonged due to improved nutrition as a result of treatment. This study summaries our experience with this technique and analyzes the problems and complications encountered in our patients.
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PMID:Improvement of swallowing ability in advanced oesophageal cancer. 940 35

This is a report of two patients with leech inhalation. The first patient presented with severe attacks of inspiratory stridor, cyanosis and cough of five days duration. He had no fever. Indirect laryngoscopy revealed a black, smooth foreign body between the vocal folds. Lateral soft tissue X-ray of the neck revealed shadow involving the glottic and the subglottic areas of the larynx. Laryngoscopy under general anaesthesia showed a living leech. This was removed and the patient improved. The second patient presented with difficulty of breathing, dysphagia, and spitting of blood of two weeks duration. Indirect laryngoscopy revealed a brown foreign body in the larynx. Laryngoscopy under general anaesthesia showed a living leech. This was removed by forceps.
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PMID:Leeches in the larynx. 942 93

Percutaneous endoscopic gastrostomy (PEG) was introduced in 1980 by Ponsky et al. This technique does not require general anesthesia and is performed safely and rapidly under local anesthesia without laparotomy. For the past twelve years, in order to maintain enteral alimentation for patients who suffered from dysphagia due to cerebral angiopathy, and to reduce patients' suffering from the long-term placement of a nasogastric tube, PEGs were performed in 150 patients (130 patients for enteral nutrition and 20 for drainage of gastrointestinal contents). We also provided home care service for 30 (27 for enteral nutrition and 3 for decompression) of these patients. We pointed out two problems connected with our retrospective studies for PEG. One is related to the indication of PEG, especially to the evaluation of preoperative status. We suggested a new method for measuring the preoperative status of patients for PEG (PEG-POS score). Retrospective studies showed the PEG-POS score was effective. Using this PEG-POS score, we have not had any early-stage deaths after PEG. Another is related to the home care service for patients with PEG. Consulting the questionnaire survey of families who experienced PEG home care, we examined various problems of home care.
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PMID:[Our experience of PEG and home care for twelve years]. 942 54

Thoracoscopic enucleation of a bronchogenic cyst of the esophagus was successfully performed in two cases. The first patient was a 26-year-old female complaining of dysphagia and retrosternal discomfort. The second patient was a 56-year-old female complaining of retrosternal discomfort. A close examination revealed a cystic lesion compressing the esophagus in both cases. Three trocars were employed under general anesthesia. Thoracoscopy offering excellent visualization allowed us to perform a precise anatomical dissection between the muscle layer and the mucosa. Both patients recovered uneventfully and the symptoms disappeared postoperatively. Thoracoscopic surgery is thus considered to be beneficial for the treatment of a benign esophageal tumor because of the small chest wall entry, which might positively contribute to a favorable postoperative course.
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PMID:Thoracoscopic enucleation of a submucosal bronchogenic cyst of the esophagus: report of two cases. 959 Jul 18

Dysphagia and recurrent gastroesophageal reflux complicate use of the Angelchik prosthesis. The authors developed an inflatable silicone device, similar to the Angelchik prosthesis, that may allow for the adjustment of the total pressure exerted around the gastroesophageal junction after implantation. To estimate its potential to prevent gastroesophageal reflux in humans, we used a short-term porcine model in which we measured the effective lower esophageal sphincter pressure in 10 anesthetized pigs using a computerized, three dimensional pressure vector volume analysis. Anesthesia and mobilization of the gastroesophageal junction did not modify the three dimensional pressure vector volume at the lower esophageal sphincter. Implantation of the deflated device significantly increased effective lower esophageal sphincter three dimensional pressure vector volume compared with baseline. Inflation of the device with 30 ml of saline further increased lower esophageal sphincter pressure significantly. Deflation of the device returned the pressure to the pre-inflation values. Using an animal model and short-term implantation, this new antireflux device appeared to offer the potential ability to adjust the pressure selectively at the gastroesophageal junction postoperatively. An added future feature of this device may be the ease of insertion using laparoscopic techniques. Long-term animal implantation studies and clinical trials are required to help establish the safety and efficacy of this device in humans.
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PMID:Development of an adjustable prosthesis for the treatment of gastroesophageal reflux: preliminary results in a porcine model. 961 42

Palliation is necessary in over 50% of patients with oesophageal cancer, and the most effective means of achieving this is still debated. Plastic or stainless steel reinforced endoprostheses have been available for some 20 years, but have the disadvantages of bulky introducing systems, a significant incidence of perforation and, frequently, sub-optimal palliation. The introduction of self-expanding metallic stents (SEMS) in 1990 was received enthusiastically on account of their relative ease of insertion, with low perforation risk and greater internal diameter of 20-25 cm, resulting in better relief of dysphagia. However, disadvantages of SEMS include the high cost of the stents and disposable delivery systems, the difficulty in removing or repositioning these stents, and the high rate of re-intervention because of tumour ingrowth with uncovered stents, stent displacement with their covered counterparts, and obstruction owing to stent compression or tumour overgrowth at either end of the stent. Published studies include a randomized study between conventional plastic prostheses and uncovered Wallstents, a non-randomized study comparing uncovered Wallstents and Ultraflex stents, and the study published in this issue comparing uncovered Ultraflex stents with covered Wallstents. Somewhat surprisingly, 30 day mortality and relief of dysphagia were similar between conventional prostheses and uncovered Wallstents, and despite a 10-fold increase in cost of the SEMS over plastic prostheses, the overall cost of palliation was less because of a mean hospital stay of 5.4 days compared with 12.5 days for plastic prostheses, which is higher than many reported series and may relate to their insertion under general anaesthesia in this study. From the comparative studies of different SEMS, uncovered stents are associated with a higher incidence of tumour ingrowth and covered stents with a higher incidence of stent migration, particularly when they traverse the cardia. Thirty day mortality is relatively high (16-27%), although one study found no procedure-related mortality using the uncovered Ultraflex stent, but the reintervention rate was uniformly higher with those stents as compared with covered or uncovered Wallstents. Improvements in SEMS design are likely to overcome many of the technical problems, at which point it would be necessary to conduct prospective randomized studies against conventional prostheses inserted under sedation, with quality of life and economic assessment and sufficient numbers to enable sub-group analysis for variables such as tumour site and morphology. In the meantime, specialized centres should have facilities for each of the current palliative modalities so as to be able to deploy those most suited to individual circumstances.
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PMID:Self-expanding metal oesophageal endoprostheses: which is best? 961 81

Presented are 16 patients (4 women and 12 men) of a neurological early rehabilitation ward with various neurological initial situations. Diagnoses range from traumatic brain damages to hypoxic brain lesions caused by complications during anaesthesia, from subarachnoid haemorrhages with consecutive complications, to intracerebral haemorrhages. All patients have been examined at the beginning by an ENT specialist and/or phoniatrically. Regarding the structure of the patients' complex neurological symptoms, they were all suffering from more or less severe impairments in the faciooral tract. At the beginning of the multifocal neurological rehabilitation treatment all patients had been submitted to dysarthrophony and/or dysphagia examination according to K. Coombes. We will compare results, objectives and therapeutic developments during the faciooral therapy including physiotherapy and ergotherapy based on the Bobath concept. We will further discuss the periods between occurrence of the damaging event and the onset of multimodular neurological rehabilitation. Further discussed is the influence of secondary complications on the therapeutic development and, finally, the clinical-social outcome of the patients.
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PMID:[Facial-oral therapy in craniocerebral diseases]. 965 90

The authors present a safe, conservative method of endless-loop bougienage (ELB) through the oral cavity and esophagus to a gastrostomy without general anesthesia in three children with corrosive esophageal burns treated since 1966. Esophagogastroscopy was performed to evaluate for esophagitis at an early phase after ingestion of the caustic substance. When esophageal stricture formation was recognized after subsequent conservative treatment, a feeding gastrostomy was made. A continuous string loop with plummets of progressively larger size was positioned to pass through the patient's oral cavity and esophagus to the gastrostomy. Strictures were found in the upper esophagus in two patients and in the middle and lower esophagus in one. The gastrostomy was performed 15 months, 20 days, and 2 months after the injury, respectively, and the periods of ELB were 3, 5, and 2(1/2) years, respectively. The patients were able to start eating at 26, 42, and 29 months after injury, respectively. They are now 30, 18, and 17 years old, and slight dysphagia remains in patients 1 and 2. No patient developed esophageal carcinoma at the site of the corrosive stricture. Our method of ELB through the patient's oral cavity and esophagus to the gastrostomy appears to be safe, reliable, and useful. We believe that most caustic esophageal strictures in children can be treated by this conservative measure.
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PMID:Effective endless-loop bougienage through the oral cavity and esophagus to the gastrostomy in corrosive esophageal strictures in children. 971 74


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