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)

We studied a series of 176 patients undergoing esophageal resection with the aid of the EEA surgical stapling device (Auto Suture U.K. Limited, Great Britain) during a period of 7 1/2 years. A total of 160 patients (91%) were operated on for malignant disease. Operative death occurred in 15 patients (8.5%), and there were three anastomotic leaks (1.7%). The prevalence of dysphagia caused by both benign and malignant strictures after esophageal resection in which the EEA stapler was used was 17.4%. The rate of benign anastomotic narrowing in discharged patients was 12.5%. Anastomotic stricture resulting from recurrent tumor caused dysphagia in 6.2% of the patients undergoing resection for malignant disease. The highest rate of benign anastomotic narrowing occurred in patients who had undergone esophageal resection for benign, nondilatable strictures. In these patients, the prevalence of benign anastomotic narrowing was 37.5%, compared with 9.6% in the patients undergoing resection for malignant disease (p less than 0.001). An additional trend was noted: The smaller the stapling head used to construct the anastomosis, the higher the prevalence of benign anastomotic narrowing; however, a statistically significant difference could not be documented. Ninety-five percent of patients with benign anastomotic narrowings complained of dysphagia within the first 6 months after the operation; 79% of these patients required two or fewer dilatations to relieve the dysphagia. Dysphagia after esophageal resection with the aid of EEA stapler occurred in just over one of six patients. The usual cause of the dysphagia was benign anastomotic narrowing, which responds well to dilatation.(ABSTRACT TRUNCATED AT 250 WORDS)
J Thorac Cardiovasc Surg 1989 Mar
PMID:Anastomotic narrowing after esophagogastrectomy with the EEA stapling device. 291 39

The annual incidence of primary tracheal tumours in Sweden is less than 1 per million population. Five cases of malignant tracheal neoplasm treated with segmental resection and primary reconstruction are described. Exploration and mobilization of the trachea were performed via right thoracotomy. Suprahyoid laryngeal release was also done in two cases, using a cervicomediastinal approach. The length of resected segment in these cases was 6 and 7 cm. High-frequency positive-pressure ventilation was used in four of the five cases and greatly facilitated the operation. Recovery was uneventful. Adenoid cystic carcinoma was too extensive for extirpation in one case, but 4 months after radiotherapy a 7 cm tracheal segment with residual tumour was removed; 3 years later the patient is well. There was no stenosis or other late complication and no local recurrence in the long-term survivors. No vocal paralysis occurred. The two patients with laryngeal release had remarkably little and transitory dysphagia. Technical problems are discussed and conclusions are presented.
Scand J Thorac Cardiovasc Surg 1987
PMID:Surgical management of tracheal tumours. 303 55

Ninety-one adult patients (average age 49 years) with various benign esophageal disorders treated by total thoracic esophagectomy and a cervical esophagogastric anastomosis have been followed up with personal interviews and examinations from 6 to 104 months (average 34 months). Outpatient esophageal dilation has been used liberally for any degree of postoperative cervical dysphagia. At their latest follow-up, 39 patients (43%) eat without dysphagia; four patients (4%) have mild dysphagia necessitating no treatment; 34 patients (37%) have undergone one to three dilations during the first 6 to 12 postoperative months for intermittent dysphagia; and 14 patients (16%) have more severe dysphagia necessitating regular anastomotic dilations (two thirds of these perform home self-dilations). Mild regurgitation of gastric contents has been experienced by 27 (30%), particularly when recumbent after eating, but only four patients sleep with the head of the bed elevated to prevent nocturnal regurgitation. No patient has had pulmonary complications resulting from aspiration. Twenty patients (22%) have had varying degrees of "dumping syndrome," generally transient and well controlled with medication. Two patients have required an additional gastric drainage operation 16 months and 82 months, respectively, after the esophagectomy. At their latest evaluation, 33% of the patients weigh 3 to 83 (average 19) pounds more than they weighed preoperatively, 38% weigh 5 to 40 (average 12) pounds less, and 29% have had no change in their weight. The stomach functions well as a visceral esophageal substitute and, like the esophagus, is more thick-walled and resilient than colon. Significant gastroesophageal reflux is uncommon after a properly performed cervical esophagogastric anastomosis. Postoperative dysphagia can be minimized by attention to technique in constructing the anastomosis. These data support our belief that the stomach is the preferred organ for esophageal replacement, not only for carcinoma, but also for benign diseases as well.
J Thorac Cardiovasc Surg 1988 Dec
PMID:Cervical esophagogastric anastomosis for benign disease. Functional results. 319

Dysphagia is often present early, with varying degrees of involvement, in patients with myasthenia gravis. Twenty-five patients with a clinical status of myasthenia gravis were graded according to a modified Osserman classification and the esophageal manometric results were reported according to their clinical status. The results were also compared with those in 20 normal control subjects. Twenty-four patients (96%) had abnormal motility. The only patient who was in class I had a normal tracing. There was no significant difference in function of the lower esophageal sphincter, but a significant decrease in mean amplitude (15.1 +/- 6.1 versus 29.7 +/- 4.7 mm Hg) and a prolongation in mean duration of the peristaltic wave (7.4 +/- 2.8 versus 4.5 +/- 0.2 seconds) was noted in the upper esophagus. The cricopharyngeal sphincter pressure also showed a significant decrease (23.4 +/- 9.5 versus 43.1 +/- 3.1 mm Hg), but relaxation and coordination were good. The mean amplitudes, mean duration of peristaltic waves, and cricopharyngeal pressures between the myasthenic and control populations were statistically significant, with a p value of 0.001. Besides this, frequent spontaneous contractions, simultaneous contractions, and biphasic repetitive contractions typical of peristaltic dysfunction were also found in myasthenic patients. Motor dysfunction of the esophagus as assessed by manometric study correlates well with Osserman's modified clinical classification.
J Thorac Cardiovasc Surg 1988 Feb
PMID:Esophageal manometric studies in patients with myasthenia gravis. 333 94

Fifteen patients with oculopharyngeal muscular dystrophy underwent cricopharyngeal myotomy for palliation of dysphagia. The aim of this work was to assess the effectiveness of this operation by using a radionuclide pharyngeal emptying study as a new quantitative method in addition to clinical and manometric evaluation. Radionuclide study was performed with the patient in both the upright and the supine positions after ingestion of 15 ml of water labeled with sulfur colloid 99mTc. Computerized data were acquired at 0.5 second intervals for 15 minutes and a pharyngeal time-activity curve was generated. Four quantitative parameters were evaluated: the time for pharyngeal clearance of 25%, 50%, and 75% of the ingested radioactive water and the pharyngeal stasis at 15 minutes. Manometric studies were also performed before and after cricopharyngeal myotomy. The pharyngeal clearance of 25%, 50%, and 75% of the water and pharyngeal stasis at 15 minutes were all improved by cricopharyngeal myotomy, decreasing from 1.2 to 0.9 second (p less than 0.04), 4.2 to 2 seconds (p less than 0.005), 15 to 7 seconds (p less than 0.02), and 10.3% to 6% (p less than 0.01), respectively. Both pharyngoesophageal and tracheobronchial symptoms were also significantly improved by cricopharyngeal myotomy. Manometric evaluation showed a decrease of the upper esophageal sphincter closing pressure from 60.1 mm Hg before to 28.2 mm Hg after the operation (p less than 0.001), and the resting pressure decreased from 34.4 to 15.7 mm Hg (p less than 0.0005). Cricopharyngeal myotomy significantly improves both symptoms and pharyngeal emptying in patients with oculopharyngeal muscular dystrophy.
J Thorac Cardiovasc Surg 1988 May
PMID:Manometric and radionuclide assessment of pharyngeal emptying before and after cricopharyngeal myotomy in patients with oculopharyngeal muscular dystrophy. 336 34

A follow-up study of 35 patients was performed 1.5 to 22 years after simple closure and drainage of the esophagus for nonmalignant intrathoracic perforation or rupture, with special attention to dysphagia. Of the seven patients with spontaneous rupture, only one required supplementary postoperative treatment, for severe reflux esophagitis. None of the eight patients with iatrogenic lesion and no prior esophageal disorder had any dysphagia postoperatively. Postoperative swallowing problems were absent in 13 of the 20 patients with perforation caused by examination or treatment of an already diseased esophagus. Four required repeated esophageal dilation and three underwent further surgery. Simple closure and drainage of nonmalignant intrathoracic perforation or rupture of the esophagus is concluded to be a safe procedure in regard to late postoperative dysphagia.
Scand J Thorac Cardiovasc Surg 1988
PMID:Long-term observation following perforation and rupture of the esophagus. 338 55

Gastroplasty has been used in surgical management of reflux for 25 years. The creation of a gastric tube before fundoplication complicates further corrective procedures should the original operation fail. Experience has been gained with 51 patients, 34 having partial fundoplication gastroplasty and 17 having total fundoplication, who have had major persistent or recurrent symptoms. All were evaluated by history, radiology, endoscopy, manometry with pH, and acid perfusion testing before surgical management. The patients undergoing partial fundoplication gastroplasty had heartburn (85.3%), reflux (70.6%), and dysphagia (94.1%). Radiologic recurrence was present in 26.5%, endoscopic incompetence in 94.1%, and a stricture in 26.5%. The patients who had a total fundoplication gastroplasty had heartburn (52.9%), reflux (29.4%), and dysphagia (82.4%). Radiologic recurrence was present in 29.4%, endoscopic incompetence in 35.3%, and a stricture in 5.9%. On average, these patients had had 2.3 prior operations (range one to five operations). The dominant cause of failure (in the absence of anatomic recurrence) with partial fundoplication gastroplasty was continued or recurrent reflux and with total fundoplication gastroplasty, too tight or too long a fundoplication. All patients had a thoracoabdominal revision total fundoplication gastroplasty and a 1 cm completion fundoplication. Pyloromyotomy was added if not previously performed. There were no deaths or major morbidity. Follow-up in 51 patients averages 4.2 years (range 0.3 to 8.8 years). None has radiologic recurrence, one has minor reflux, one a traumatic diverticulum, and one has moderate esophageal obstruction. Of these patients, 82.4% are asymptomatic, 13.7% have minor symptoms, and 3.9% (two patients) have significant residual symptoms. This conservative surgical approach avoids the higher mortality of resection with interposition and provides satisfactory results.
J Thorac Cardiovasc Surg 1986 Jan
PMID:Surgical management of the failed gastroplasty. 351 Mar 39

Twelve patients with oesophageal smooth muscle tumour were operated on between 1955 and 1984 in the Department of Thoracic and Cardiovascular Surgery of Helsinki University Central Hospital. Eleven tumours were leiomyomata, the twelfth was a leiomyosarcoma. Dysphagia (83%) and chest or epigastric pains (67%) were the most common symptoms presented. All patients underwent transthoracic removal of the tumour. Complications of the surgery included two cases of postoperative oesophageal fistula; in both instances the lumen of the oesophagus had been entered during the extirpation of the tumour. The surgery was effective in eliminating the most prominent symptom, i.e. dysphagia. However, follow-up examinations 11.1 +/- 6.8 (SD) years later revealed reflux symptoms and endoscopically and histologically verified oesophagitis in seven of the nine (78%) surviving patients. Additionally, two of them had developed Barrett's oesophagus, 10 and 19 years, respectively, after the primary surgery. These two patients underwent subsequent transabdominal antireflux procedures (Nissen fundoplication). We conclude that long-term follow-up of patients who have been treated for benign oesophageal tumour is indicated.
Scand J Thorac Cardiovasc Surg 1987
PMID:Smooth muscle tumours of the oesophagus. 358 96

Two cases of an aberrant right subclavian artery causing dysphagia lusoria in the adult are presented. The first patient was treated by dividing the aberrant vessel through a right posterolateral thoracotomy and anastomosing the divided subclavian artery to the ascending aorta with a Dacron graft. The second patient, had a simple division of the anomalous vessel through a left posterolateral thoracotomy, but developed a subclavian steal syndrome. These symptoms were relieved by anastomosing the stump of the artery to the ascending aorta with the use of a graft. The world literature is reviewed with reference to the operative treatment of the dysphagia lusoria in adults. A total of twenty surgically treated patients have been recorded. The mechanisms involved in the production of symptoms and the surgical approaches are reviewed and discussed.
J Cardiovasc Surg (Torino)
PMID:Surgical treatment of the aberrant retroesophageal right subclavian artery in adults (dysphagia lusoria). Report of two new cases and review of the literature. 359 36

Eighty-seven adults have undergone reoperation for recurrent gastroesophageal reflux or complications of prior antireflux procedures. Operations performed included the transthoracic Collis-Nissen procedure (59), Collis-Belsey repair (14), Nissen fundoplication (one), repair of acute postoperative paraesophageal hernia (one), division of obstructing crural suture (one), and esophageal resection (23). Among the 73 patients undergoing an additional hiatal hernia repair, there were two postoperative deaths. Follow-up averages 28 months. Subjectively, results have been excellent or good (no or mild reflux symptoms or dysphagia) in 47 (67%); fair in eight (12%), who have moderate dysphagia or reflux symptoms controlled medically; and poor in 15 (21%), 12 of whom have required additional operations. Early postoperative esophageal dilations were required in 25 patients (36%) and regular dilations in seven (10%). Among the 23 patients undergoing esophageal resection, four had a distal esophagectomy and short-segment colon interposition and 19 had a transhiatal esophagectomy without thoracotomy; stomach was used for esophageal replacement in 14 and colon in five. There were no operative deaths. Follow-up averages 17 months. Thirteen patients have had esophageal dilations (nine early and four regularly), and one has clinically significant reflux. Overall, subjective results are good or excellent in 64 (76%). The results of "redo hiatal hernia operation" are far from ideal. Optimal surgical treatment after the failed antireflux operation requires careful analysis of the existing anatomy and experience to decide when esophageal resection is a safer and more reliable approach than another hiatal hernia repair.
J Thorac Cardiovasc Surg 1986 Oct
PMID:Surgical treatment after the failed antireflux operation. 376 98


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