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

Hypopharyngeal hemangiomas are uncommon neoplasms that can cause dysphagia, recurrent bleeding, and airway obstruction. These lesions are a therapeutic challenge, and surgical resection is the mainstay of therapy. The goal of therapy is directed at control of the tumor and relief of symptoms rather than total eradication of the lesion. Laser therapy is a very useful adjunct in the management of these vascular neoplasms. The neodymium: yttrium-aluminum-garnet laser (Nd:YAG laser) functions at a wavelength that provides deep thermal coagulation. This allows its use for these vascular lesions. With laser surgery, hemorrhage is the most frequent and dangerous complication, and its control is extremely important. Ligation and suture remain the traditional methods of hemostasis in most surgical situations. However, on certain occasions problems arise, particularly with large oozing surfaces or when surgical access is poor. Topical hemostatic agents are widely used in a variety of surgical procedures to successfully solve such problems. Microfibrillar collagen (Avitene) is one of the absorbable, topical, hemostatic agents, and is used effectively to control bleeding in many surgical situations. Since we began to use microfibrillar collagen (AviteneTM, MedchemProduct, Inc., Woburn, MA01801) to stop the massive oozing of the laser-induced surgical wound, no episodes of bleeding had ever occurred. It is concluded that Avitene is an effective agent for maintaining hemostasis in many surgical procedures, and we consider it a good remedy for management of laser-induced bleeding complications.
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PMID:Microfibrillar collagen for hemostasis in laryngomicrosurgery of hypopharyngeal hemangioma. 1265 12

Historically, the development and marketing of the neodymium-yttrium-aluminum-garnet (Nd:YAG) laser was associated with the insertion of markedly fewer conventional prostheses for the palliation of malignant dysphagia. Subsequently, the introduction of self-expandable metal stents (SEMS) has, in turn, led to a diminished role not only for laser therapy but also for other ablative modalities, including bipolar cautery, argon plasma coagulation (APC), and the injection of caustics. Two ablative modalities deserve ongoing consideration, but not because they have been proven to be better or more cost-effective than SEMS. These include photodynamic therapy (PDT), because of its potential to ablate large areas of low-grade malignancy, and injection of chemotherapeutic agents or T-lymphocytes sensitized to an individual malignancy. The latter, while theoretically promising, will require considerably more study before widespread clinical application.
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PMID:Endoscopic palliation of esophageal malignancy. 1292 47

Combined chemoradiation therapy has proven to be an effective treatment for unresectable esophageal cancer. Nonsurgical endoscopic palliation of local disease has become feasible with neodymium:yttrium-aluminum-garnet laser, BICAP tumor probe, and metallic stents. Alternatively, endoscopic injections of ethanol are safe, inexpensive, and useful for palliation of malignant dysphagia. Two patients with unresectable squamous cell carcinoma of the esophagus were treated with 1 mL of absolute (95 g/L) alcohol injections once a week for 4 weeks, followed by chemoradiation therapy consisting of concomitant 5-fluorouracil 300 mg/m/d and radiation therapy (total of 60 Gy over 6 weeks). One patient had a complete response but died of alcoholism 25 months after diagnosis without evidence of tumor recurrence. The other patient had a partial response but died 16 months after diagnosis from disease progression. We conclude that tumor ablation by ethanol injection for palliation combined with chemoradiation may be a low-cost alternative for advanced unresectable esophageal cancer.
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PMID:Palliative ethanol injections of unresectable advanced esophageal carcinoma combined with chemoradiation. 1647 88

Despite numerous advances in the chemotherapeutic, radiotherapeutic, and surgical treatment of esophageal cancer, most patients require some type of endoscopic palliation for dysphagia during the course of their illness. Numerous modalities exist, including thermal ablation with neodymium:yttrium-aluminum-garnet laser, argon plasma coagulation, electrocautery, nonthermal ablation with alcohol injection or photodynamic therapy, or displacement of tumor with endoscopically placed stents. Each therapy carries with it a unique profile of efficacy and complications. Some therapies may be more appropriate for certain tumor locations and morphologies than others. During the past year, new studies have defined these parameters further. However, it remains essential that the endoscopist have both a thorough knowledge of these various modalities and an ability to chose among them when undertaking endoscopic palliation of this difficult and rapidly rising disease.
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PMID:Endoscopic therapeutic esophageal interventions. 1703 Nov 88

A 21-year-old woman developed midesophageal stricture two weeks after ingestion of aluminium phosphide (AlP) tablets. Aluminium phosphide is a lethal protoplasmic toxin and is also the most common cause of suicidal poisoning in northern India. Upper gastrointestinal endoscopy (UGIE) showed a tight esophageal stricture 29 cm from the incisors with a circumferential ulcer. Dilatation up to 17 mm was done using Savary-Gilliard dilators. She had repeated dilatations three times at nearly two-week intervals. In view of the resistant stricture, a silicone Polyflex stent was placed across the stricture and removed after 3 months; there was no recurrence of stricture even after three months of follow-up. Patients with recurrent esophageal stricture and those with fistula may benefit from silicone expandable stents.
Dysphagia 2008 Dec
PMID:Aluminium phosphide-induced esophageal stricture palliation with polyflex stent. 1868 93

Fifteen consecutive patients presenting with dysphagia due to aluminum phosphide (AP)-induced esophageal strictures were studied retrospectively to elucidate the natural history of AP-induced esophageal strictures and to evaluate the efficacy of bougie dilation. The median time lag between consumption of AP and occurrence of dysphagia was 3 weeks. All patients had a single stricture and could be dilated using a bougie dilator. Thirteen patients were relieved of dysphagia on a mean (SD) follow-up of 18 (7.3) months. Two patients had recalcitrant strictures and needed needle-knife incision of the stricture followed by balloon dilation. The strictures opened up well in both the patients and they were relieved of dysphagia. AP-induced esophageal stricture is a new cause of benign esophageal stricture. Most patients present with dysphagia around 3 weeks after consumption of AP tablets. A single esophageal stricture is found in these patients. Most strictures respond very well to bougie dilation. However, some of the strictures may be recalcitrant and may require needle-knife incision and balloon dilation.
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PMID:Aluminum phosphide-induced esophageal strictures: a new cause of benign esophageal strictures. 1883 21

Aluminium phosphide ingestion is the most common agricultural poisoning in suburban and rural India and with a high mortality rate. Among survivors of acute poisoning there are recent sporadic reports of esophageal complications such as esophageal strictures and tracheo-esophageal fistula. The present study was carried out to determine the incidence, natural history, and treatment outcome of local esophageal complications in survivors of aluminium phosphide poisoning with complaints of dysphagia. All confirmed cases of poisoning with aluminium phosphide ingestion were admitted in Hamidia Hospital, Gandhi Medical College, Bhopal, Madhya Pradesh, India, from October 2007 to October 2008. Survivors with complaints of dysphagia underwent a barium study and upper gastrointestinal endoscopy to determine site and nature of esophageal complications. All cases of strictures were treated with fluoroscopy-guided Savary-Gilliard bougie dilation, and patients with tracheo-esophageal fistula underwent surgery. Of 104 confirmed cases, 31 survived. Ten survivors with dysphagia were found to have single short-segment esophageal stricture and two patients with odynophagia and swallow-cough sequence had tracheo-esophageal fistula. All cases of esophageal strictures responded successfully to Savary-Gilliard dilation in six to ten sessions without any major complications. Patients with tracheo-esophageal fistula were treated successfully via surgery. Nearly one-third of survivors of aluminium phosphide ingestion developed esophageal complications. Hence, we conclude that all survivors of aluminium phosphide poisoning must undergo barium swallow and endoscopic examination for early detection of esophageal complications. Prevention of esophageal complications after aluminium phosphide ingestion needs to be given adequate attention because tracheo-esophageal fistula and esophageal stricture are associated with high morbidity. When one finds esophageal stricture or fistula, the possibility of aluminium phosphide ingestion should always be considered.
Dysphagia 2010 Dec
PMID:Esophageal complications following aluminium phosphide ingestion: an emerging issue among survivors of poisoning. 1972 54

Systemic sclerosis sine scleroderma is a rare form of limited cutaneous scleroderma. These patients manifest without cutaneous involvement, but do not differ in its clinical or laboratory features and prognosis from classical systemic sclerosis. In the absence of cutaneous signs/symptoms, its diagnosis is delayed leading to morbidity. The exact prevalence of dystrophic calcification in systemic sclerosis sine scleroderma, though a feature of systemic sclerosis, is not known. Development of dystrophic calcification further aggravates patient's woes. This paper describes systemic sclerosis sine scleroderma in a 17-year-old girl diagnosed initially as seronegative juvenile rheumatoid arthritis. She developed progressively increasing disk-like masses of calcinosis over the gluteal regions, knee, elbow, and ankle joints fixed to the overlying skin associated with malaise, anorexia, and weight loss. There was no Raynaud's phenomenon, dysphagia, dyspnoea, sclerodermatous skin, sclerodactyly, telangectasias, or muscle tenderness/weakness. Digital pitted scars, elevated anticentromere antibody values, esophageal hypomotility, and fluffy calcification in subdermal soft tissues in gluteal regions and around wrist, hip, knees, heels, and ankle joints (without affecting the underlying structures) were detected. Therapy with diltiazem and magnesium/aluminum antacids was useful in resolving calcinosis.
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PMID:Systemic sclerosis sine scleroderma and calcinosis cutis: report of a rare case. 1983 61

Microelements have an important role in many vital enzymatic functions. Their optimal intake and serum concentration are not properly defined. For nursing home residents, this issue is further complicated by the high prevalence of oropharyngeal dysphagia. The purpose of this study was to measure microelement concentrations in 3 groups of elderly subjects that differ in their feeding methods and functional state. Forty-six frail elderly patients, in stable clinical condition, 15 on naso-gastric tube (NGT) feeding, 15 orally fed (OF), from skilled nursing departments were recruited to this study. As controls, we studied a group of 16 elderly independent ambulatory patients. A battery of 16 microelements was examined using the Inductively Coupled Plasma Atomic Emission Spectrometry (ICP-AES) and Inductively Coupled Plasma Mass Spectrometry (ICP-MS). The OF frail elderly patients had significantly lower levels of chromium as compared to the NGT fed and the control group. Both frail elderly groups had lower levels of zinc and copper as compared to the controls. In contrast, in the nursing groups, we found higher levels of aluminum, boron, barium, bromine and nickel. Elderly, in particular frail and disabled subjects, are vulnerable to insufficiency or overload of microelements. There is a need to evaluate the actual requirements for each microelement for this population.
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PMID:Serum trace elements in elderly frail patients with oropharyngeal dysphagia. 1992 26

Aluminum phosphide (AlP) is a lethal solid fumigant pesticide which has been recently linked to esophageal stricture formation. This paper aims to study the clinical profile and response to treatment of AlP-induced esophageal strictures. Data on all patients of AlP-induced strictures seen between January 2004 and June 2008 were retrieved and analyzed for clinical parameters and response to endoscopic dilation. Each patient underwent barium swallow to define the site and length of stricture and then was dilated endoscopically. Twelve patients of AlP-induced esophageal stricture (seven males) with a mean age of 26.83+/-8.43 years were evaluated. They had consumed one to three AlP tablets, 4-156 weeks before reporting to us. They had onset of dysphagia within 2 to 8 weeks of ingestion of AlP. Of 14 strictures in 12 patients, seven were in upper third, two in middle third, and five in lower third of esophagus with a mean length of 1.96+/-0.75 cm. Nine patients responded to dilation requiring 5.56+/-2.65 dilations. Four patients were given intralesional steroids to augment the effect of dilation. Three patients failed and were operated upon. All patients remained symptom free over a follow-up of 3-30 (15.67+/-9.41) months. AlP-induced esophageal strictures can be dilated endoscopically in a majority of patients; however, 25% of them require surgical intervention. AlP-induced esophageal strictures, thus, behave like caustic-induced strictures.
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PMID:Clinical profile and outcome of aluminum phosphide-induced esophageal strictures. 2040 57


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