Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0011168 (dysphagia)
 15,644 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Myasthenia gravis is an autoimmune disease resulting from the production of antibodies against the ACh receptors of the neuromuscular synapse. The thymus gland is involved in the autosensitization process, and the disease frequently is associated with thymic morphologic abnormalities. There is a consensus that all adults with generalized MG should have a thymectomy. This recommendation has been propagated by the safety of the procedure and excellent outcome. Removal of as much thymic tissue as possible (anterior mediastinal exenteration) by transsternal approach is the logical goal of thymectomy in the treatment of MG. Transcervical approach and VATS, however, are less invasive and have been used in patients who have MG unaccompanied by thymoma. Optimization of the condition of the myasthenic patients can markedly decrease the risk of surgery and improve the outcome. Two techniques have been recommended for general anesthesia in the myasthenic patient. Because of the unpredictable response to succinylcholine and the marked sensitivity to nondepolarizing muscle relaxants, some anesthesiologists avoid muscle relaxants and depend on deep inhalational anesthesia, such as halothane, isoflurane, or sevoflurane, for tracheal intubation and maintenance of anesthesia. Others, however, use a balanced technique of anesthesia that includes the use of carefully titrated muscle relaxants. The most important preoperative factor predicting the need for postoperative mechanical ventilation is the severity of bulbar involvement (Ossermann group 3 and 4), usually indicated by significant dysphagia and dysarthria associated with borderline respiratory dysfunction. Thymectomy benefits nearly 96% of patients: 46% develop complete remission, 50% are asymptomatic or improve on therapy, and 4% remain the same. The time from diagnosis to surgery is shorter than 8 months, and mild or moderate myasthenic symptoms are the main prognostic factors that predict the best outcome after thymectomy.
 ...
PMID:Anesthesia and critical care of thymectomy for myasthenia gravis. 1141 60

Dysphagia is a common symptom in various neurological disorders affecting pharyngeal functions. Cricopharyngeal dysfunction is one of the major findings in these patients. The most effective treatment for restoring normal swallowing function in persistent cricopharyngeal dysfunction is cricopharyngeal myotomy, especially when mechanical obstruction or a well-localized neuromuscular dysfunction, such as a cricopharyngeal muscle spasm, is present. However, when there is a more diffuse neurological disorder present the results of surgery are more disappointing. In unclear cases, or in patients with temporary problems, no good method other than swallowing training, bougienage, and tube feeding are available. During the past decade, botulinum toxin has been found to be of therapeutic value in the treatment of a variety of neurological disorders associated with inappropriate muscular contractions such as torticollis and spasmodic dysphonia. Recently, injections of botulinum toxin in patients with cricopharyngeal muscle dysfunction have been reported to result in marked relief of dysphagia. In this article we describe our experiences with botulinum toxin injections to treat four patients suffering from deglutition problems and cricopharyngeal dysphagia of different origins. Botulinum toxin was injected into the cricopharyngeus muscle that was identified by endoscopy under general anesthesia. In this study, no major side effects were observed. Three patients obtained a significant improvement of esophageal symptoms after the first injection. The treatment had limited effect in one patient who had reflux disease and only slight cricopharyngeus dysfunction.
Dysphagia 2001
PMID:Botulinum toxin in the treatment of cricopharyngeal dysphagia. 1145 61

The objective of this study was to investigate the effects on outcomes and morbidity of combining temperature-controlled radiofrequency (TCRF) tongue reduction with uvulopalatopharyngoplasty (UPPP) as an initial site-directed approach to the surgical treatment of obstructive sleep apnea syndrome (OSAS). This investigation was a prospective, nonrandomized, open-enrollment study of 20 consecutive eligible patients with OSAS. Seven patients had a single-level velopharyngeal obstruction (Fujita type I or IIa), and they were assigned to undergo UPPP only (group 1). Thirteen patients had a multilevel velopharyngeal and retroglossal obstruction (Fujita type IIb), and they were assigned to undergo TCRF tongue reduction in addition to UPPP (group 2). Patients who had only a retroglossal obstruction (Fujita type III) were not included in this study. Following their initial operation, nine patients in group 2 underwent two subsequent in-office TCRF tongue treatments under local anesthesia. Three patients in group 2 were lost to followup, and one patient underwent only one TCRF procedure at the initial operation; data on the latter patient are included in some of the outcomes measures reported here where indicated, but no data are reported on the three who were lost to followup. The primary post-treatment outcomes measures were the results of comparative polysomnography and clinician and patient evaluations regarding morbidity and symptom improvement. Analysis of these data showed that there was no difference between the two groups in terms of postoperative pain or dysphagia following the initial operative session. The degree of symptom improvement in the two groups was similar. Overall success rates--as measured by the apnea/hypopnea index (group 1: 57.1% success; group 2: 50.0%) and by the apnea index (group 1: 71.4% success; group 2: 70.0%)--were statistically comparable, given the small size of the sample (figures are based on 10 patients in group 2). The author concludes that combining TCRF tongue reduction with UPPP in patients with multilevel obstruction improves response rates to a degree that is comparable to that seen with UPPP alone in patients with single-level velopharyngeal obstruction. Moreover, the combination treatment does not increase the risk of additional pain, morbidity, and complications compared with UPPP alone.
 ...
PMID:Combined temperature-controlled radiofrequency tongue reduction and UPPP in apnea surgery. 1157 50

Treatment of achalasia by pneumatic balloon dilatation (PBD) is well established in adults. Due to limited experience and the rarity of the condition in children, there are relatively few reports in the paediatric literature. Although PBD has been reported as a primary method of treatment, there are no reports of secondary PBD for childhood achalasia. Between 1995 and 1999, five patients underwent treatment for achalasia (age: 9-14 years, M:F = 4:1). The presenting symptoms were dysphagia (5). vomiting episodes (2), aspiration (1), food-bolus obstruction (1), and failure to thrive (1). In all patients a barium swallow and manometry were used to confirm the diagnosis. Three underwent primary PBD. Two who had previously undergone surgical myotomy underwent secondary PBD for recurrence of symptoms. Dilatation was performed using a 35-mm balloon with the child under general anaesthesia. Technical success was defined as demonstration of a waist under screening at lower pressures followed by abolition of the waist at higher pressures. In addition to reviewing our results, a systematic review of the literature was performed (Medline, Cochrane Library, Pubmed, Embase). Three patients (primary dilatation) showed excellent improvement after a single dilatation. In two cases (secondary dilatation) three and five attempts were required. No complications were encountered. The mean follow-up period was 2 years (1-3.5 years) and four patients remained asymptomatic, an overall success rate of 80%. The literature review revealed similar good results in most of the recent reports. Thus, PBD as a primary treatment for childhood achalasia has a success rate of 70%-90% with minimal side effects, short hospital stay, and good patient acceptability over an operation. We have also established the usefulness of this method as a secondary treatment when symptoms recur after surgery.
 ...
PMID:Pneumatic dilatation for childhood achalasia. 1166 45

We report a 1-year-old girl with a type I Chiari malformation who presented with sleep apnea syndrome. Our patient experienced a change in characteristics of sleep apnea from obstructive to central after adenoidectomy was performed under general anesthesia. The patient also developed dysphagia, which worsened after adenoidectomy. Both disorders greatly diminished after posterior fossa decompression. Our results suggest that type I Chiari malformation should be considered in children with sleep apnea syndrome even when obstructive characteristics predominate. When the malformation is present, timely surgery can prevent irreversible neurologic damage.
 ...
PMID:Sleep apnea syndrome associated with a type I Chiari malformation. 1175 Oct 25

Two children aged three and seven years presented to the department of Otolaryngology with total dysphagia following the accidental swallowing of a steel ball bearing and a plastic ball. These rare spherical foreign bodies were removed successfully by oesophagoscopy under general anaesthesia using an innovative method involving a balloon angiographic catheter.
 ...
PMID:Spherical foreign bodies in the oesophagus removed by balloon angiographic catheter. 1189 64

The dynamics of deglutition were studied in relation to potential changes due to aging. Swallowing-related apnea time (SAT) was measured during "dry" and "wet" swallowing in 84 adults without dysphagia to examine if age-related variation of SAT corresponded to changes in deglutition dynamics due to aging and to determine possible significance. Swallowing movements were recorded using a transducer for measuring swallowing pressures. Respiratory flow rates during deglutition were measured with a heat-wave flowmeter as part of phonatory function testing system. Respiratory movements were recorded with a respiration pick-up band set at the diaphragm. Findings demonstrated that SAT did not change with aging but was prolonged in subjects over age 50 years. When topical anesthesia was omitted during study, SAT tended to be shorter during wet swallowing than during dry swallowing in all age groups. Statistically significant differences were observed between wet and dry swallowing SAT in subjects under the age of 39 years. When a topical anesthetic was applied to pharyngeal mucous membranes, SAT was prolonged. Finally, SAT results during wet swallowing determined in a anesthetized dog before and after topical anesthesia of the pharyngeal mucous membranes showed significant prolongation after topical anesthesia. These findings suggest that the sensation of the pharyngeal mucous membrane may be important in producing swallowing-related apnea and controlling its duration.
 ...
PMID:Factors that affect swallowing-related apnea times in humans. 1189 66

Malignant ascites is relatively common in patients with certain types of end-stage cancer. Traditional treatments based on fluid and salt restriction and diuretic therapy often are not able to contain neoplastic ascites. These patients consequently undergo repeated abdominal paracentesis, with further plasma protein loss and risk of injury to abdominal viscera. The aim of this study was to evaluate our experience with Denver peritoneovenous shunt and the outcome of patients with malignant ascites and suggest some modifications to improve device patency. From February 1997 to December 1999, 44 Denver peritoneovenous shunts were placed in 42 patients, 17 women and 25 men, aged between 38 and 77 years (mean, 62.3), affected with malignant ascites due to advanced abdominal cancer. At the time of admission, 72% of patients had pain, 88% dysphagia, 66% nausea and/or vomiting, and 83% dyspnea. Eleven patients underwent local anesthesia with lidocaine and 33 general anesthesia with rapidly metabolized drugs. In 27 cases we used the peritoneal-internal jugular right vein surgical approach and in 3 cases the peritoneal-femoral vein surgical access, joining the saphena vein to the cross. In 10 cases, a radiological positioning of the Denver peritoneovenous shunt was effected by a trans-subclavian access. Relief of ascites symptoms was obtained in 87.5% of cases, with reduction of dyspnea, an increased appetite and improved ambulation. Denver peritoneovenous shunt is a good device to relieve malignant ascites, thereby reducing the risk of complications and the number of hospital admissions due to repeated paracentesis and consequently improving the quality of life. A careful patient selection, an accurate follow-up and some device modifications could improve the shunt performance, allowing a wider application of the Denver peritoneovenous shunt.
 ...
PMID:Palliative treatment of malignant refractory ascites by positioning of Denver peritoneovenous shunt. 1208 51

Pharyngoesophageal pulsion diverticulum is the most common of all oesophageal diverticuli and is characterised by dysphagia, regurgitation, gurgling sounds in the neck and aspiration. This is a report of an 80-year old female who presented with progressive dysphagia, weight loss and recurrent bouts of pneumonitis. A barium swallow showed a pharyngoesophageal diverticulum and an upper endoscopy confirmed a wide ostium and no other pathology. She underwent surgical pharyngoesophageal diverticulectomy and cricopharyngeal myotomy under general anaesthesia and made complete recovery with total relief of dysphagia.
 ...
PMID:Pharyngoesophageal (Zenker's) diverticulum: case report. 1238 Aug 74

Elevation of the larynx during swallowing plays an important role in protecting the laryngeal inlet and in the opening of the upper esophageal sphincter (UES). The thyrohyoid (TH) muscle is the most important muscle for laryngeal elevation, and it is thought to be innervated by the thyrohyoid branch. However, in preliminary studies we found that laryngeal elevation was severely disturbed after sectioning of the pharyngeal branch of the vagus nerve (X-ph). In the present study, we examined the role of the X-ph in laryngeal elevation and the contribution of this nerve to UES pressure. Ten male rabbits under anesthesia were used. Sectioning of the X-ph not only abolished the electromyographic activities of the TH and cricopharyngeus (CP) muscles, it also greatly reduced the maximal value of laryngeal elevation during swallowing. On the other hand, sectioning of the hypoglossal nerve, which contains the thyrohyoid branch, produced no appreciable change in the electromyographic activity of either muscle and it reduced the maximal value of the elevation only slightly. These results indicate that the X-ph innervates the TH and CP muscles and suggest that the X-ph plays an important role in elevating the larynx and in regulating the UES pressure in rabbits.
Dysphagia 2003
PMID:Role of the pharyngeal branch of the vagus nerve in laryngeal elevation and UES pressure during swallowing in rabbits. 1249 98


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>