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 present here our experience of laser for the management of stenosed oropharyngeal scleroma. The diagnosis of scleroma was made 14 years ago and the patient underwent repeated procedures like dilatation, diathermy excision of adhesions and cryosurgery during this period. He attended our out-patient department with complaints of dysphagia and difficulty in breathing, progressing to stridor. On examination, severe oropharyngeal stenosis due to cicatrization extending between the base of the tongue and the post-pharyngeal wall was seen. Using CO2 laser, cicatrix was released by making radial cuts and the oropharyngeal opening was widened. No tracheostomy was needed; no blood loss occurred and the patient was discharged on the next day.
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PMID:Laser in the management of stenosing oropharyngeal scleroma. 130 17

Clinical, respiratory, and polysomnographic findings in three patients with syringomyelia and syringobulbia who developed severe respiratory complications are described. Neurological examination showed evidence of IXth and Xth cranial nerve involvement with dysphagia and dysphonia, but there were no complaints of serious sleep difficulties. Two patients died during sleep and the other was resuscitated during a nap. All patients showed moderate restrictive ventilatory defects with reduced maximal buccal pressures and one also showed a low ventilatory response to CO2 rebreathing. Protracted central, obstructive, and mixed apnoeas and hypopnoeas were commonly observed during sleep. There were no changes in heart rate during these events. A combination of respiratory and cardiovascular mechanisms might have been responsible for the severe complications described.
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PMID:Risk of sudden death during sleep in syringomyelia and syringobulbia. 164 Feb 36

Extended endotracheal intubation for assistive respiration can lead to cricoarytenoid joint fixation and subsequent bilateral midline vocal cord fixation--thus, complete glottic stenosis. Endoscopic CO2 laser arytenoidectomy was performed on 10 patients for bilateral midline vocal cord fixation caused by prolonged translaryngeal endotracheal intubation because of central nervous system respiratory insufficiency resulting from various causes. Eight of these patients had concomitant cricopharyngeal myotomy for associated severe upper pharyngeal dysphagia. All of these patients had successful return of airway, voice, and swallowing functions. The advantages of the CO2 laser for endoscopic arytenoidectomy are its facility, hemostasis, precision, and minimal scarring.
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PMID:Endoscopic CO2 laser arytenoidectomy for postintubation glottic stenosis. 175 48

A sporadic case of spinocerebellar degeneration with prominent involvement of the motor system has recently been encountered. A 54-year-old man without family history noticed speech disturbance at the age of 46 and weakness in his right hand the following year. The muscle weakness and atrophy were slowly progressive and made walk impossible at the age of 50, when his dysphagia increased. At the age of 54, he was admitted to our hospital when neurological findings revealed marked amyotrophy of general skeletal muscle and tongue with fasciculation. Deep tendon reflexes were decreased. Cerebellar ataxia was impossible to evaluate because of profound muscle weakness. And sensory disturbance was suspected in the distal portion of the lower extremities. CT scan revealed progressive atrophy of the brain stem and cerebellum. The patient died at the age of 54 due to CO2 narcosis. The clinical course was 8 years. A summary of the pathological findings was as follows: 1) Marked neuronal loss of the anterior horn of the spinal cord and motor cranial nerve nuclei except for oculomotor nuclei, with mild degeneration of pyramidal tract below lumbosacral level. 2) Degeneration of cerebellipetal system, spinocerebellar tract, Clarke's column and the middle root zone and cerebellifugal system, dentate nucleus, superior cerebellar peduncles, and red nucleus. 3) Mild degeneration of pontine nuclei, inferior olivary nuclei, pontine transverse fibers, the middle and inferior cerebellar peduncles, cerebellar white matter and Purkinje cells as in OPCA.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[A nosological study of a patient showing ataxia & lower motor neuron involvement]. 259 37

The case of an 8-month-old female with fibrous hamartoma of the tongue is reported with immunohistochemical and electron microscopic findings. An elastic hard mass at the base of the tongue gradually enlarged, causing dysphagia. The tumor was excised by CO2 laser. Under light microscopy, the tumor was observed as composed of fibroblast-like cells, fibrocollagenous bundles and striated muscle tissues. The majority of the cells were immunoreactive for vimentin. Electronmicroscopically, they contained numerous intermediate filaments, some had intercellular microvilli and cilia (9 + 2 type). These findings revealed that the cells of the fibrous hamartoma in our case may possess both mesenchymal and epithelial properties.
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PMID:Fibrous hamartoma of the tongue: report of a case with immunohistochemical and ultrastructural studies. 749 50

Hemangiomas of the upper aerodigestive tract may present a therapeutic challenge depending on their size, location and symptoms. We present a rare case of cavernous hemangioma of the aryepiglottic fold applaning in an adult. First symptoms were dysphagia and hoarseness. Surgical removal was performed with a CO2/Nd: YAG combination laser under microscopic control. After a regular postoperative course the patient has remained disease-free after a 2 year follow up period. We suggest the use of the CO2/Nd: YAG combination laser as preferred treatment in cases of exophytic hemangiomas, because of the favorable combination of excision with photocoagulation effects.
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PMID:[Laser surgical excision of a hypopharyngeal hemangioma using the CO2/Nd: YAG combination laser]. 764 1

Amyotrophic lateral sclerosis is a rapidly progressive disease of unknown etiology resulting in tetraparalysis, dysarthria, dysphagia, and ultimately death from respiratory insufficiency. In the course of the disease, recurrent episodes of aspiration, pneumonia, dehydration, and malnutrition may necessitate nasoenteral tube placement, an inconvenient and unattractive arrangement in patients with dribbling and impaired swallowing. A percutaneous endoscopic gastrostomy seemed a better, though potentially hazardous, alternative in view of the often severely restricted pulmonary function of these patients. Therefore, we prospectively investigated the use of percutaneous endoscopic gastrostomy in 68 consecutive patients with amyotrophic lateral sclerosis. Minimum required pulmonary function was defined as forced vital capacity (FVC) of 1 L or more and CO2 gas exchange capability as pCO2 of 45 mm Hg or less. The methodology of insertion was adapted to facilitate the early removal of gastric air. Fifty-five patients (median FVC, 1.7 L; pCO2, 40 mm Hg) were eligible for the gastrostomy procedure, and 13 patients (median FVC, 0.8 L; pCO2, 47 mm Hg) were not. Despite the fact that modification of the method of insertion rendered the procedure more difficult, the success rate was 89% (49/55); it was 96% (49/51) when failures related to distorted anatomy were excluded. The procedure-related mortality rate was 1.8% and the 24-hour in-hospital mortality rate was 3.6%, mainly related to respiratory insufficiency. The 30-day out-of-hospital mortality rate was 11.5%. Major complications (3.6%) consisted of a spontaneously draining cutaneous abscess in 2 cases. Peristomal redness was present in 6 cases, and 5 patients required analgesics for wound pain.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Percutaneous endoscopic gastrostomy in patients with amyotrophic lateral sclerosis and impaired pulmonary function. 792 37

A laparoscopic Heller cardiomyotomy technique was used on five patients whose esophageal achalasia was diagnosed clinically, radiologically manometrically. The physiological principles and operational steps are the same as in open surgery. with the patient in an anti-Trendelenburg 30 degrees position and the surgeon between the patient's legs, a CO2 pneumoperitoneum was produced. Five trocars were used. the esophagus was freed by blunt dissection and an 8 cm longitudinal myotomy was made on the anterior surface of the thoracic esophagus starting a few centimetres above the cardias and parallel and to the left of the anterior vagus, the magnified operative field facilitated more precise myotomy. The myotomy incision ended 2 cm from the esophageal-gastric junction. We closed the angle of His before performing a Dor anterior fundoplication with anchorages to the diaphragmatic crura. Mean operation time was 2 hrs 45 min. Intraoperative blood loss was less than 100 ml. In comparison with open-surgery, patients had less postoperative pain, needed only non-narcotic analgesics for the first 12 hrs, and had no unsightly operation scar. patients tolerated liquids between 24 and 48 hrs. Hospitalization time was 3 to 5 days. Long-term follow-up transit studies, manometry, and 24 hrs pH measurements are needed to fully evaluate the technique. At two months, the symptoms of dysphagia had completely disappeared in three patients: the results were qualified as excellent. As some dysphagia for solids remained in the other two, they were qualified as good.
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PMID:Esophageal achalasia: laparoscopic Heller cardiomyotomy. 874 Jun 89

From 1992 until 1995 the Ear, Nose and Throat Department at the National Hospital investigated 29 patients and completed treatment of 28 patients with a hypopharyngeal diverticulum. A myotomy of the cricopharyngeal muscle was performed endoscopically using CO2 laser. One patient developed mediastinitis as a result of perforation during initial hypopharyngoscopy. Most of the patients reported improvement of the dysphagia. The advantages of this method are a shortened stay in hospital and less morbidity. In addition, the operation can be performed in elderly patients with other complicating diseases. This paper describes the surgical technique and the results.
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PMID:[Laser diverticulotomy in hypopharyngeal diverticulum (Zenker's diverticulum)]. 910 75

An anterior neopharyngeal pseudodiverticulum is a mucosal pouch located between the tongue and hypopharynx due to an epiglottis-like posterior tissue band that forms after total laryngectomy. This condition has rarely been mentioned in literature. Incidence, symptoms, treatment, and possible etiologic factors were examined. Twenty post-laryngectomy patients were questioned about swallowing disorders and were examined clinically and by barium swallow. Eleven patients were found to have a pseudodiverticulum, of which 9 patients suffered from dysphagia. We found no correlation between the formation of a pseudodiverticulum and radiotherapy or post-laryngectomy complications. All symptomatic patients were treated by dissecting the posterior tissue band endoscopically with a CO2-laser, bringing complete relief of symptoms in 8 of 9 patients. Our study showed that the anterior pseudodiverticulum can be a frequent cause of dysphagia after laryngectomy. It can easily be diagnosed clinically and radiologically. Endoscopic treatment with a CO2-laser is simple and effective.
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PMID:[Anterior pseudodiverticulum after laryngectomy]. 953 58


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