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)

Epiglottitis may occur at any age. The typical presentation in the young child and young adult is well known, but the presentation in patients at the extremes of age has not been characterized. At our locale, from 1974 to 1984, 19 children 24 months of age or less and, from 1979 to 1984, 9 adults 50 years of age or greater with epiglottitis were seen in the emergency department. In the infantile group, rapidly progressive interference with swallowing, vocalization, and respiration was encountered in less than half the patients. Symptoms were often prolonged before parents sought attention for their child. No preference was shown for maintenance of the upright position while at rest, as recumbency did not promote stridor or initiate respiratory distress. Respiratory complaints were common and included cough, tachypnea, and retractions. Drooling or retention of pharyngeal secretions was uncommon. The adult population had a history of symptoms that spanned several days. Extreme sore throat, pooling of oral secretions, muffled voice, and elevated temperature were uncommon. Dysphagia and mild respiratory complaints were frequent. Upper airway obstruction did occur. At both extremes of age, exceptions to the classic clinical pattern of epiglottitis occurred with significant frequency. Despite this, diagnosis and management in the emergency department were appropriate in most cases.
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PMID:Epiglottitis at the extremes of age. 337 97

The clinical and physiologic features of 28 infants with Pierre Robin syndrome and those of 20 infants with various types of nasal obstruction were reviewed to determine whether different causes of upper airway obstructure may lead to a common syndrome. The patients had no significant differences in distribution of main clinical manifestations. Their features included cyanosis with respiratory distress, apneic spells, oropharyngeal dysphagia, vomiting, failure to thrive, cor pulmonale, brain damage, and sudden death during sleep. The common physiologic manifestation appeared to be an oropharyngeal obstruction caused by glossoptosis, which occurred mainly during wakefulness. Upper airway obstruction led to hypoxemia, which, in many instances, was not associated with hypercapnia and was not relieved by oxygen administration. It is concluded that regardless of a specific cause, any airway obstruction that results in a decreased inspiratory pressure overcoming the airway maintaining genioglossus action causes a glossoptosis-apnea syndrome.
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PMID:Glossoptosis-apnea syndrome in infancy. 399 Dec 69

Tonsillectomy and adenoidectomy, though less frequently performed now than in the 1930s, remain among the most common surgical procedures in the United States. The need for and benefits of tonsillectomy and adenoidectomy have been a source of controversy for several decades. Nonetheless, there are situations in which these procedures definitely are beneficial. Tonsillectomy and adenoidectomy are two distinct procedures with separate indications, and they are performed concurrently only when the specific indications for each coexist. Tonsillectomy is indicated by recurrent tonsillitis, peritonsillar abscess, chronic tonsillitis, tonsillar neoplasm, or tonsillar hypertrophy that is obstructive to the upper aerodigestive tract (respiratory distress, dysphagia, or interference with performance of an adenoidectomy). Adenoidectomy is indicated for nasal airway obstruction due to adenoidal enlargement from hypertrophic or inflammatory processes. Although correlation exists among obstructive adenoids, mouth breathing, and dentofacial anomalies, present evidence is not sufficient to justify adenoidectomy solely on the basis of craniofacial or dentofacial abnormalities. Today, elimination of an occult source of infection (once called focal infection) in patients with disorders such as rheumatic fever or serous otitis media is not a valid indication for either operation. Contraindications to tonsillectomy and adenoidectomy include bleeding disorders, familial anesthetic intolerance, velopharyngeal insufficiency, and concurrent disease that may enhance operative risks. Like all surgical procedures, tonsillectomy and adenoidectomy entail morbidity and risk of mortality. The most frequent complication of these operations is hemorrhage. Risk of mortality is approximately 0.006%. Mortality and morbidity can be minimized by appropriate preoperative evaluation, complete control of the airway with endotracheal anesthesia, and meticulous surgical technique.
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PMID:Current thinking on tonsillectomy and adenoidectomy. 636 11

Thirty-six of 915 patients with non-Hodgkin's lymphoma presented with superior vena cava syndrome (SVCS). The histologic types associated with SVCS were diffuse large cell in 23 patients, lymphoblastic in 12, and follicular large cell in one patient. Radiotherapy alone appeared equal to chemotherapy alone or in combination with radiotherapy in achieving relief of SVCS symptoms. Chemotherapy alone or in combination with radiotherapy was superior to radiotherapy alone in prolonging relapse-free survival and overall survival. No differences in relapse-free survival and survival were found between the patients treated with chemotherapy alone and those treated with chemotherapy and radiotherapy, but the addition of radiotherapy appeared to prevent local relapses in the group with large-cell lymphoma. The presence of symptoms of involvement of other mediastinal structures such as dysphagia, hoarseness, or stridor (DHS), a higher grade of intensity, and a shorter duration of symptoms (less than or equal to 2 weeks) appeared to adversely influence relapse-free survival and survival. The following conclusions were made: (1) a histologic diagnosis before the onset of treatment is desirable and feasible in patients presenting with SVCS except in those with severe respiratory distress, (2) both chemotherapy and radiotherapy are equally effective in alleviating the symptoms of SVCS, and (3) combined modality treatment with chemotherapy and radiotherapy results in a lower frequency of local relapses compared to chemotherapy alone but survival was similar in both groups.
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PMID:Clinical features and results of management of superior vena cava syndrome secondary to lymphoma. 636 59

Out of our last 70 cases of esophageal atresia, a circular myotomy of the upper pouch (Livaditis technique) was required in six patients to achieve an end-to-end anastomosis: all had a lower tracheoesophageal fistula. They were operated on between 15 and 96 hours after birth, without any preoperative attempt of elongation of the upper pouch. Follow-up ranged from 14 to 77 months. Three patients had an uneventful postoperative course and late outcome, despite a moderate ballooning at the myotomy site in one. Three babies developed a mild stricture which responded easily to a few dilatations. Asymptomatic ballooning at the myotomy site was observed in one baby; the other two developed a diverticulum responsible for acute respiratory distress in one case and severe dysphagia in the other. both required esophageal replacement. These observations call attention to the fact that patients treated by myotomy should be followed very carefully early and late, especially if an anastomotic stricture develops or in case of associated tracheomalacia.
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PMID:Diverticulum formation after circular myotomy for esophageal atresia. 642 26

In the diagnosis of esophageal foreign bodies in children, stridor and dyspnea as well as dysphagia are important. The history is often negative. Long-standing esophageal foreign bodies often present as a neck mass and develop Zenker-type diverticula in the cricopharyngeal sphincteric area. CT scanning has proven to be highly useful in delineating radio-transparent foreign bodies and their precise location in this clinical situation. Two cases with dysphagia and three cases with respiratory distress are presented and discussed.
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PMID:Esophageal foreign bodies in children. 643 Aug 36

The occurrence of cranial nerve palsies in cervical injuries is described in eight patients. The clinical features were dramatic and usually presented soon after injury, the most common picture being that of a bulbar palsy, with acute respiratory distress and dysphagia. Neurologic recovery, both from cranial nerve palsies and motor and sensory deficits, was substantial in all instances, suggesting that brain-stem ischaemia due to vertebral artery spasm or compression had been a factor in their causation. Alternatively, differential movement between the base of the skull and the upper part of the cervical spine at the time of injury could have caused an extracranial injury to the lower cranial nerves.
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PMID:Cranial nerve palsies in cervical injuries. 647 46

During the course of 872 thyroidectomies performed at the University of Michigan Medical Center between 1972 and 1982, 50 patients (5.7%) were found to have substernal goiters, 42 of which were benign and eight malignant (16%). Symptoms included airway compression (22 patients), dysphagia (13 patients), hoarseness (four patients), weight loss (three patients), and thyrotoxicosis (10 patients). Five patients with compression symptoms, four of whom had benign disease, had superior vena cava syndrome. Most patients were elderly (mean age 66 years), were women (3.2 women:1 man), and had long-standing goiters (mean duration 16 years). All but one operation was performed through a cervical incision. There were no intraoperative deaths. Complications were: pneumonia (one patient), wound hematoma (one patient), transient hypocalcemia (two patients), and atrial fibrillation (two patients). This series illustrates five reasons to support operative management. (1) There is no other treatment for long-standing large multinodular goiters. (2) Iodine 131, the alternative to operation for patients with large thyrotoxic goiters, can precipitate acute reactions in the elderly that can result in respiratory distress. (3) A long history of having a large multinodular goiter precluded neither malignancy, hyperfunction, nor complications such as tracheal or esophageal compression. (4) Malignancy occurs in a significant number of these lesions, which are inaccessible to needle biopsy. (5) Nearly all substernal goiters can be removed through a cervical incision. Presence of a substernal goiter is in itself an indication for operation.
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PMID:Rationale for the operative management of substernal goiters. 664 12

A retrospective study of 46 horses with retropharyngeal lymph node (RPLN) infection presented to the Rural Veterinary Centre between 1977 and 1992 was undertaken. Horses aged less than one year were most commonly represented (46%). Thirty-nine percent of cases had been exposed to horses with confirmed or suspected strangles (Streptococcus equi subsp equi infection) within the previous 8 weeks. Most frequent signs were unilateral or bilateral swelling of the throat region (65%), respiratory stertor/dyspnoea (35%), purulent nasal discharge (20%), inappetence and signs of depression (15%), and dysphagia (9%). All horses had a soft tissue density in the retropharyngeal region on radiographs. Rhinopharyngoscopy, ultrasonography, haematology as well as cytological and microbial analysis of material aspirated from the soft tissue swelling facilitated diagnosis in some horses. Fifteen horses (33%) were treated with procaine penicillin intramuscularly for 4 to 7 days followed by oral trimethoprim-sulphadimidine for 7 to 14 days. Non-steroidal anti-inflammatory drugs were administered to 6 horses. Four required tracheostomy for severe respiratory distress. The 15 horses treated medically responded to treatment and were discharged from hospital. Three horses (6%) with mild signs received no treatment and recovered uneventfully. Twenty-eight horses (61%) underwent general anaesthesia and surgical drainage of a RPLN abscess. Nineteen received procaine penicillin G for 4 to 7 days. Four of the nine horses that did not receive antibiotic treatment after surgery required further surgical drainage 10 days to 7 weeks after the initial surgery. Limited follow-up information was available for 37 horses.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Retropharyngeal lymph node infection in horses: 46 cases (1977-1992). 766 15

Forty-two children with ingestion of foreign bodies (FB) were managed conservatively. Thirty one (74%) of them were under 5 years of age. At presentation history revealed accidental ingestion in 95% and of being put in the oral cavity by elder sibs in 5% patients. Fifty seven per cent had respiratory distress, 38% had dysphagia and 12% had hematemesis. Foreign bodies were located in the gastrointestinal tract in the stomach (40%), esophagus (26%), small intestine (19%), duodenum (12%) and rectum (2%). A large majority of the FB were constituted by household objects. All the FB above the duodenojejunal junction and one in the rectum were retrieved successfully with fiberoptic endoscopes. In 19% patients, the FB had crossed duodenojejunal junction, and had come out in the stools during 4-5 days observation and these were mostly round in shape. Endoscopic procedures were carried out under intravenous diazepam or ketamine sedation. On endoscopic examination, 21% of them showed erosions in stomach and/or esophagus. No complications of endoscopic procedure or sedation were observed and none of the patients required surgical removal. Removal of FB with flexible fiberoptic endoscopes is less invasive and the best therapeutic option to avoid preventable complications of FB ingestion. In this procedure there is need of a trained and skilled Pediatric endoscopist with lot of patience and a good team work.
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PMID:Endoscopic removal of foreign bodies from gastrointestinal tract. 812 96


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