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)

Transhiatal esophagectomy without thoracotomy has been performed in 65 adult patients with dysphagia from benign esophageal disease: strictures (30), neuromotor dysfunction (24), acute iatrogenic perforation (five), acute caustic injury (four), and recurrent gastroesophageal reflux (two). Nearly 70% (45) had undergone at least one prior esophageal operation, and 26% (17) had a history of between two and four esophageal operations. The esophagus was replaced with stomach in 53 patients (82%), colon being used only when there was a history of either prior gastric resection or caustic injury to the stomach (10 patients). Intraoperative blood loss averaged 1,050 ml. Intraoperative complications included pneumothorax in 38 patients (58%) and a tracheal laceration in one patient. Postoperative complications included transient recurrent laryngeal nerve paresis (11 patients, 17%), chylothorax (four patients, 6%), anastomotic leak (four patients, 6%), and small bowel obstruction (two patients). There were five hospital deaths (8% mortality), none related to the technique of esophagectomy. Follow-up ranges from 1 to 84 months (average 28 months). Of 46 patients with a cervical esophagogastric anastomosis in the original esophageal bed, 42 have had an excellent functional result although 17 have required at least one postoperative esophageal dilation. Two have developed true anastomotic strictures. Clinically significant gastroesophageal reflux has not occurred. Transhiatal esophagectomy for benign disease is feasible and safe, even after multiple previous esophageal operations. The stomach appears to be a better visceral esophageal substitute than colon, because it allows an initially easier technical operation and superior long-term functional results.
J Thorac Cardiovasc Surg 1985 Nov
PMID:Transhiatal esophagectomy for benign disease. 405 37

Ten case histories of patients with symptomatic aberrant retro-esophageal subclavian artery are presented. The diagnosis was made on a clinical basis in 8 cases because of symptoms of tracheo-esophageal obstruction, and confirmed by barium meal. All patients were investigated by angiography. Six patients with right abnormal retro-esophageal subclavian artery (arteria lusoria) and its mirror image were treated by transection of the aberrant subclavian artery and reimplantation into the common carotid artery through a single midline sternal splitting incision which gave ample access. Three patients with left abnormal subclavian artery (right aortic arch) were operated by transection of the patent ductus arteriosus or ligamentum arteriosum through a left lateral thoracotomy. After a follow-up of from one to 10 years (mean 6.4 years), 9 patients are free of symptoms like dysphagia, dyspnea or subclavian steal and normal pulses are present on both upper extremities in 8 cases.
Thorac Cardiovasc Surg 1984 Oct
PMID:Symptomatic aberrant retro-esophageal subclavian artery: considerations about the surgical approach, management and results. 608 21

Current management of benign and malignant esophageal lesions has changed little in the past 25 years. Treatment of unresectable lesions has consisted primarily of exclusion and bypass procedures as well as prosthetic intubations for relief of dysphagia. A case of a Celestin tube fragmentation in a patient with unresectable esophageal carcinoma causing small bowel obstruction is presented. Diagnosis, management, and review of the literature are discussed. Recommendations for use of the Celestin tube in patients with good long-term prognoses include keeping a high index of suspicion for possible complications, close and regular radiographic and endoscopic follow-up, and early surgical intervention upon tube fragmentation.
J Thorac Cardiovasc Surg 1984 May
PMID:Fragmentation of a Celestin tube causing intestinal obstruction. Case report and review of the literature. 620 82

Primary adenocarcinoma of the gastro-oesophageal junction, oesophagus or stomach is very rare in childhood (3, 5). Within that small patient population, dysphagia is an unusual presenting feature. We wish to report such a condition, occurring in a 14-year-old boy, to emphasise that dysphagia in childhood should always be taken seriously.
Scand J Thorac Cardiovasc Surg 1983
PMID:Primary adenocarcinoma of the gastro-oesophageal junction in childhood. A case report. 630 60

Dysphagia may be a continuing or added problem after operations for the control of reflux. In a series of 208 patients treated surgically for recurrent hiatal hernia, 34 (16.3%) presented with dominant dysphagia either caused by or aggravated by the operation. They were evaluated by history, radiology, manometry, and endoscopy. The causes of dysphagia were diagnosed in all patients: reflux stricture in nine patients, tight or long Nissen wrap in 15, muscle injury in three, inappropriate myotomy with reflux in three, myotomy with overcompetent repair in two, and early Nissen intussusception in two patients. Surgical correction was by total fundoplication gastroplasty in 32 patients, Nissen repair in one, and colon interposition in one. In four patients the myotomy was closed. Complete follow-up averages 5.4 years. There has been one anatomic recurrence, 28 patients are asymptomatic, and five are much improved but have minor persistent dysphagia. Only by complete investigation can the cause of dysphagia be recognized and treated.
J Thorac Cardiovasc Surg 1984 Dec
PMID:Dysphagia complicating hiatal hernia repair. 650 20

An unusual case of congenital lower oesophageal diaphragm (web) associated with achalasia is described. An 18-year-old nulliparous girl presented with severe cachexia and aphagia following progressive dysphagia. A barium swallow demonstrated the achalasia, and the oesophageal diaphragm with a central pinhole opening was seen at endoscopy. Parenteral hyperalimentation was required for ten weeks prior to surgery. Circumferential excision of the oesophageal diaphragm in conjunction with Y-V advancement oesophagoplasty gave a good result.
Scand J Thorac Cardiovasc Surg 1984
PMID:Lower oesophageal diaphragm and achalasia in an adult. An unusual association. 652 77

The second reported case and first successful treatment of oesophageal obstruction due to a saccular aneurysm of the distal thoracic aorta is described. The patient, a 69-year-old male, presented with severe dysphagia which was thought to be due either to achalasia or a tumour. Operation, however, revealed a large aneurysm at the level of the diaphragmatic hiatus which was compressing the oesophagus against the right crus. As the anatomy of the aneurysm was unknown and there was a significant risk of damage to the spinal arteries the oesophageal obstruction was treated by transposition of the oesophagus combined with an anti-reflux repair. This has given an excellent clinical result and the aneurysm has remained unchanged over a period of eighteen months.
Scand J Thorac Cardiovasc Surg 1984
PMID:Oesophageal obstruction due to saccular aneurysm of the distal thoracic aorta. 652 79

Between 1965 and 1982, we treated 46 patients with cystic lesions of the thymus. Thirty patients had anterior mediastinal cysts, nine had cysts which were large enough to be both cervical and mediastinal, and seven had cervical cysts. The majority (40/46) presented with asymptomatic masses. Six patients presented with distinct complaints: dysphagia (four patients), hoarseness owing to vocal cord paralysis (one patient), and cervical pain (one patient). All six had benign thymic cysts. The diagnosis of a cystic mass was established prior to operation by ultrasonography and computed axial tomography in our last three patients. These two techniques delineated the capsule and the central fluid in those three cases. All 46 patients had the mass resected without mortality or significant morbidity, except for resection of the phrenic nerve in one patient with malignant cystic thymoma. Cervical cysts were excised through cervical incisions. Cysts located in the anterior mediastinum and cervical-mediastinal cysts required median sternotomy or right thoracotomy for successful resection. Pathological examination showed that 39 patients had benign thymic cysts, three had benign cystic thymoma, two had malignant thymoma, one had a seminoma arising in the thymus, and one had a lymphoblastoma. We believe that a cystic thymic mass which can be detected by ultrasonography and computed tomography, although usually benign, does not eliminate the possibility of malignancy, and resection, therefore, is indicated.
J Thorac Cardiovasc Surg 1984 Feb
PMID:Cystic lesion of the thymus. An occasionally malignant cervical and/or anterior mediastinal mass. 669 20

The long-term results of five different operations for benign lower esophageal reflux stricture, carried out over the 5 year period 1973 to 1977, are presented and evaluated. The 94 patients, 51 women and 43 men (mean age 61 years), underwent one of the following procedures: I, transthoracic Nissen fundoplication (26 patients); II, Bingham gastroplasty (20 patients); III, colon interposition (17 patients); IV, jejunal interposition (10 patients); and V, jejunal bypass (21 patients). Residual dysphagia (mean follow-up period 62 months) was significantly less in groups III, IV, and V (p less than 0.05), the more radical procedures, 87% of the patients having no dysphagic symptoms. This observation was corroborated by the greatly reduced (one sixth) number of postoperative dilatations required and also by the reduced need for reoperation. Only the colon interposition group, however, had an acceptable operative mortality (0%). The Bingham gastroplasty group also had a 0% operative mortality but achieved less good functional results, only 55% of patients having no dysphagic symptoms. Further analysis of functional results showed groups III, IV, and V to be superior regardless of the preoperative grade of stricture. The pros and cons of surgical antireflux procedures coupled with dilatation versus radical procedures to excise the stricture are presented. We conclude that, for an established benign stricture of the lower esophagus, colon interposition may offer the best long-term relief from dysphagia, with very low operative mortality.
J Thorac Cardiovasc Surg 1984 Aug
PMID:Surgery for benign esophageal stricture. 674 11

Forty adult patients have undergone a 7 to 10 cm cervical esophagomyotomy (from the superior cornu of the thyroid cartilage to behind the clavicle) for cricopharyngeal dysfunction. A Zenker's diverticulum was present in 12 patients (30%) and in five was recurrent. Preoperative symptoms included cervical dysphagia (85%), expectoration of saliva (40%), and intermittent hoarseness (30%). Four patients were being fed through tubes because of total inability to swallow. "Heartburn" was experienced by one half of the patients, but only 12 had acid or food regurgitation. The duration of symptoms ranged from 1 month to 11 years (average 3.9 years). Weight loss had occurred in 15 patients (38%) and ranged from 5.5 to 40.9 kg (average 16 kg). Barium swallows showed no abnormalities in 10 patients. Abnormal findings included a Zenker's diverticulum (12), prominent cricopharyngeal sphincter (11), nasopharyngeal reflux or incoordinated initiation of deglutition, or both (seven), a sliding hiatal hernia (11), and abnormal esophageal motility (seven). Esophageal manometry revealed abnormalities of upper esophageal sphincter (UES) function in only 16 patients. Of 36 patients undergoing standard acid reflux testing, one third had moderate-to-severe gastroesophageal reflux. Seven patients underwent staple resection of a Zenker's diverticulum at the time of cervical esophagomyotomy. Postoperative complications included transient vocal cord paresis (four), vocal cord paralysis (one), and salivary fistula (one). There were no postoperative deaths. After 2 to 48 months (average 16 months) of follow-up, 34 patients (85%) have had a good to excellent result, and six (15%) have not been benefited by operation.
J Thorac Cardiovasc Surg 1980 Nov
PMID:Extended cervical esophagomyotomy for cricopharyngeal dysfunction. 677 51


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