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)

Esophageal carcinoma usually is diagnosed at an advanced, incurable stage. In patients with good operative risk, surgery is still considered the ideal treatment. Patients with coexisting major medical conditions in whom resective surgery is precluded may benefit from several therapeutic options, including photodynamic therapy (PDT) with porfimer sodium (Photofrin; manufactured by Lederle Parenterals, Carolina, Puerto Rico, under license from Quadra Logic Technologies, Inc, Vancouver, British Columbia, Canada), dilation, thermal destruction, Nd:YAG laser ablation, injection therapy, and placement of prosthetic tubes. Photodynamic therapy with porfimer sodium is thought to have a direct toxic effect on malignant cells via the production of singlet oxygen, which damages the microvasculature of the tumor and renders it ischemic. The 630 nm wavelength used for clinical PDT exhibits the greatest relative degree of light penetration into tissue, with corresponding activation of retained photosensitizer. The efficacy of PDT with porfimer sodium is closely related to stage of disease. It should be emphasized that PDT has been shown to be potentially curative in patients with early, noninvasive tumors of both squamous and glandular (adenocarcinoma) histologies. Eighty-three patients with esophageal carcinoma were treated using PDT. At presentation, 60% of patients had recurrence following previous radiotherapy or chemotherapy. Patients with less advanced disease had a better response to PDT with regard to relief of dysphagia and prolongation of survival. Photodynamic therapy was found to be more useful than Nd:YAG laser therapy for high, upper third lesions, especially circumferential ones. For tumors larger than 8 cm, PDT was twice as effective as Nd:YAG laser therapy in establishing prolonged lumen patency, especially for adenocarcinomas. Photodynamic therapy appears to have the added advantages of fewer treatments and less pain. The role of PDT in gastrointestinal malignancies continues to evolve.
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PMID:Photodynamic therapy and cancer of the esophagus. 799 3

A 45-year-old man with AIDS was treated for a recurrence of cerebral toxoplasmosis with sulphadiazine, 4 g, and pyrimethamine, 75 mg, daily. Owing to a lack of appetite and dysphagia he drank rather little water during the first week of treatment. On the 13th day after starting the drugs he had bilateral renal colics and renal failure was diagnosed (serum creatinine 3.8 mg/dl). Ultrasound examination demonstrated multiple stones with bilateral urinary retention. After parenteral fluid replacement, alkalization of the urine with sodium-potassium-hydrogen citrate and N-butylcopolamine a stone, consisting of sulphadiazine and acetylsulphadiazine, was passed after two days. Three days later the creatinine concentration was within normal limits, and in further two days the ultrasound picture was normal. It is pointed out that diarrhoea, fever or dysphagia often prevent sufficient fluid intake in AIDS patients. Satisfactory oral fluid intake and alkalization of urine is thus of great importance for avoiding complications during sulphadiazine treatment.
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PMID:[Acute kidney failure caused by sulfadiazine stones. A complication of the therapy of toxoplasmosis in AIDS]. 824 40

A 48-year-old patient with massive obesity developed a dramatic increase of serum glucose and sodium concentration as first symptom of a so far unknown diabetes mellitus. A treatment with intravenous insulin infusion and administration of free water was initiated. Two weeks after this event he became comatose, developed dysphagia, a speech disorder and ocular bobbing; finally, he showed the picture of a complete tetraparesis. Computertomographic findings of the brain were unremarkable. Two weeks later physical findings of the patient showed a significant improvement. Dysphagia, speech disorder and even the tetraparesis disappeared. Computertomography of the brain now yielded a hypodense area within the pons. The symptoms can be understood as signs of central pontine myelinolysis, which may be due to hypo-osmolarity or fast equilibration of a hypo-osmolarity. The history of this patient is a rare example of a central pontine myelinolysis with spontaneous remission.
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PMID:[Acute tetraplegia, diabetes mellitus (clin conference)]. 876 24

Eosinophilic esophagitis is an exceptional entity, although the number of published cases has increased three times during the last 3 years. We report the case of an 18-year-old male with a long esophageal stenosis due to eosinophilic esophagitis. Clinical, radiologic, endoscopic and manometric outcome was satisfactory after prednisone therapy. Although isolated esophageal involvement may occur, disseminated eosinophilic esophago-gastro-intestinal disease is more frequent. The disease is usually diagnosed in young male patients, presenting with dysphagia and, to a lesser extent, chest pain. Previous allergic conditions are reported in 80% of cases and peripheral eosinophilia is present in 80% of patients. Esophageal stenosis is present in 72% of cases and manometric alterations are found in 47% of patients. Radiographic findings are nonspecific and include stenosis and rigidity. Endoscopic features are not specific either, but diagnosis may be achieved by endoscopic biopsy. Corticosteroids and sodium chromoglycate have proved to be useful, with good therapeutic response being reported in 90% of patients with this underestimated disease.
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PMID:[Eosinophilic esophagitis: an underdiagnosed entity?]. 898 10

Current literature and some standard reference textbooks fail to adequately delineate the management of liquid household bleach (sodium hypochlorite) as different from other caustic agents. A literature review and retrospective study were conducted to focus attention on the clinical course and the low potential for development of long-term sequelae secondary to liquid household bleach ingestion in children. The records of 19 patients were reviewed. The mean age of children ingesting bleach was 24 months. Most children obtained the liquid from an open container such as a cup. There were no short- or long-term sequelae. We introduce an algorithm for the management of accidental ingestion of liquid household bleach in children. We conclude that in the United States accidental bleach ingestion in children is usually associated with a benign clinical course and usually does not require hospitalization, corticosteroids, or antibiotics unless there is severe dysphagia or signs of significant injury. Esophagoscopy may not be necessary, but fiberoptic examination of the pharynx and larynx should be included in the assessment of these children.
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PMID:Liquid household bleach ingestion in children: a retrospective review. 900 Dec 76

131I sodium iodide is the radiopharmaceutical of choice for both diagnosis and therapy in patients with various thyroid abnormalities. The radioiodide capsule has been the preferred dosage form, primarily because it provides a more convenient and safer vehicle for radioiodine administration. However, encapsulated 131I costs approximately twice as much a liquid 131I and does not provide as much flexibility as 131I solution in dosage selection. Also, the bioavailability of the capsular radioiodide preparation is inferior to that of the aqueous dosage form. The patient must swallow multiple capsules when a large amount of 131I activity is used. Capsule form is not suitable for any patient who has difficulty swallowing a capsule, has a feeding tube, or requires intravenous injection of 131I solution. In addition, radioiodide capsules must be analyzed statistically to ensure that the dosage units meet the United States Pharmacopeia uniformity requirements. If liquid radioiodine is used, distilled water rather than tap water should be used for dose preparation. It also is recommended that an antioxidant (e.g., sodium thiosulfate, sodium bisulfite), disodium edetate, and a pH adjustment of 7.5-9.0 be used to reduce radioiodide volatility. Due to the acceleration of the oxidative reaction caused by heat and light, 131I should be stored in a dark, cool environment. To comply with the quality management program implemented by the US Nuclear Regulatory Commission on January 27, 1992, all of the required information (e.g., prescribed dosage, procedure date, and signature of the authorized user) for a valid written directive is preprinted to ensure that the written directive is completed entirely and appropriately. Before each administration of therapeutic 131I solution, the calculated dose is verified by the prescribing physician, and the measured dose of 131I is reconfirmed by a second nuclear medicine technologist. Each patient's identity is verified by two methods (i.e., patient's full name and birth date).
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PMID:Radioiodine dispensing and usage in a centralized hospital nuclear pharmacy. 913 3

This study investigated the frequency and severity of symptoms during naturally occurring panic attacks recollected as "usual" and during sodium lactate-induced attacks. Seventy-six male and 126 female patients with panic disorder or agoraphobics with panic attack (DSM-III criteria) underwent lactate infusion studies and were serially administered the Acute Panic Inventory (API). Fifty-nine percent of the subjects were rated by an attending psychiatrist to have experienced lactate-induced panic attacks. Patients were also asked to API symptom rate their "usual" panic attacks. For panic recollected as usual, the most frequently reported symptoms (> or = 75%) at the moderate to severe levels included: afraid in general, difficulty concentrating, difficulty performing a job, desire to flee, afraid of losing control, palpitations, feeling hot or cold or both, dyspnea, dizzy-lightheaded. During lactate infusion, 25 of 29 API symptoms increased significantly from prelactate to point of panic; however, particularly robust effect sizes were exhibited for the desire to flee, dyspnea, tingling, twitching/trembling and difficulty doing a job. Comparison of panic recollected as usual and lactate-induced panic showed that more than half of the symptoms did not differ after Bonferroni correction; however, the most notable were fear in general, dyspnea, chest pain/discomfort, difficulty swallowing, feeling weak, desire to flee, and feeling hot/cold or both. These data point to a very distinctive role during both recollected and lactate-induced panic attacks for fearfulness the desire to flee (by definition), and for dyspnea, difficulty performing a job and fear of losing control. During lactate-induced panic, dyspnea exhibited the most robust effect size of all physical symptoms.
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PMID:Consistencies between recalled panic and lactate-induced panic. 916 May 44

A case of rhabdomyolysis after a possible viral infection and the use of a cold medication is reported. A 41-year-old man who presented with dysarthria, dysphagia, progressive weakness of his muscles and a high grade fever was admitted. He suffered from massive rhabdomyolysis, acute renal failure, and bronchopneumonia. Hemodialysis, antibiotics, and hydration therapy were effective in the treatment of his illness. Although the cause of the rhabdomyolysis was not completely clear, he was subsequently shown to be susceptible to malignant hyperthermia (MH) based on the results of a caffeine-halothane contracture test. When a mild recurrence occurred during a follow-up muscle biopsy, intravenous dantrolene sodium was administered and he improved immediately. This case suggests that MH should be considered in patients with rhabdomyolysis when the cause is unclear. The caffeine-halothane contracture test may also be helpful in the diagnosis.
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PMID:Rhabdomyolysis after infection and taking a cold medicine in a patient who was susceptible to malignant hyperthermia. 955 May 99

Toxic epidermal necrolysis is a severe dermatologic disorder clinically characterized by the acute onset of erythema and tenderness of the skin. Destruction of the epidermal barrier results in significant morbidity and mortality. Large erosions of mucous membrane, including the mouth and oral mucosa, are typical of toxic epidermal necrolysis. After ingesting naproxen sodium (Aleve) and aspirin, a previously healthy 43-year-old woman developed toxic epidermal necrolysis that resulted in hypopharyngeal stenosis complicated by dysphagia and recurrent aspiration.
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PMID:Hypopharyngeal stenosis and dysphagia complicating toxic epidermal necrolysis. 986 61

Huntington's disease is a dominantly inherited progressive autosomal disease that affects the basal ganglia. Symptoms appear later in life and manifest as progressive mental deterioration and involuntary choreiform movements. Patients with Huntington's disease develop a progressive but variable dementia. Dysphagia, the most significant related motor symptom, hinders nutrition intake and places the patient at risk for aspiration. The combination of involuntary choreoathetoid movements, depression, and apathy leads to cachexia. Factors of considerable concern to the anesthesiologist who treats patients with Huntington's disease may include how to treat frail elderly people incapable of cooperation, how to treat patients suffering from malnourishment, and how to treat patients with an increased risk for aspiration or exaggerated responses to sodium thiopental and succinylcholine. The successful anesthetic management of a 65-yr-old woman with Huntington's disease who presented for full-mouth extractions is described.
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PMID:Huntington's disease: review and anesthetic case management. 1048 87


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