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)

Zenker's diverticulum (hypopharyngeal/proximal oesophageal diverticulum/pouch) is a relatively uncommon cause of dysphagia usually in elderly patients. We describe the results of the first 10 patients operated for ZD with micro-endoscopic laserdiverticulotomy (LD), where the "spur" between the diverticulum and oesophagus is coagulated by means of a CO2 laser in our department. The results are compared with the results of the last nine patients operated with conventional diverticulectomy (DE) via incision on the neck. Two patients in the DE group had complications (wound infection and pneumonia), whereas no complications were seen in the LD group. An initially good result was seen in all the patients in both groups. Symptoms recurred in 11% in the DE group (one patient), whereas this was seen in 20% of the patients in the LD group (two patients). Re-operation of these two patients in the LD group relieved the patients of symptoms, but one patient was re-operated twice before this was achieved. Surgery time was reduced by 64%. Hospitalization time was shortened from a median of 16 (9-28) days with DE to 4 (0-9) days in the LD group. These factors represent a substantial economic saving by using LD as compared to DE. To be able to evaluate the result of LD roentgenographically, it has proven necessary to produce a pure lateral view of the diverticulum both pre- and post-operatively. The size and shape of the diverticulum is mostly seen as unchanged following surgery. With a pure lateral projection, it is however possible to see how the spur between the oesophagus and the diverticulum is diminished with resulting enhanced passage of contrast and practically no retention.
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PMID:[Microsurgical laser treatment of Zenker's diverticulum. Economic aspects]. 954 Apr 19

Cricopharyngeal dysfunction due to various causes can lead to severe upper pharyngeal dysphagia with or without laryngeal penetration. Resurgence of Dohlman's endoscopic diverticulotomy for Zenker's diverticulum has been brought about by the development of the diverticuloscope, improved intravenous analgesia, and the advent of the laser. Recent use of videofluoroscopy for swallowing documents a frame-by-frame picture of swallowing with special focus on the cricopharyngeal function and its stages of malfunction. The "cricopharyngeal crescent" (cricopharyngeal bar) as termed by Jackson is visible during endoscopy and can be incised in layers under the operating microscope with the CO2 or contact Nd:YAG laser. This paper introduces the staging of cricopharyngeal dysfunction regarding its initiation and progression in correlation with its symptoms and videofluoroscopic pictures. It also reports the application of endoscopic laser cricopharyngeal myotomy for 44 patients with cricopharyngeal dysfunction besides 4 with Zenker's diverticulum. This procedure is found to be effective, safe, brief, and prompt in restoring swallowing.
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PMID:Endoscopic CO2 laser cricopharyngeal myotomy. 1015 59

The development and patterns of respiratory failure (RF) are analyzed in 9 patients with disseminated sclerosis (DS). Forced ventilation of the lungs was carried out with consideration for main location of the process. Relationship between patterns of respiratory disorders and neuroanatomy of respiratory regulation is discussed. Involvement of the corticospinal routes is paralleled by dissociation during functional pulmonary tests: spontaneous volumes are less than controlled inspirations. The most severe symptom complexes were observed in RF of predominantly bulbar localization: respiratory anarchy, blocking of airways caused by impaired swallowing, impaired mechanism of coughing reflex, loss of spontaneous respiration, sometimes apnea during sleeping. Involvement of the respiratory nuclei of medullary respiratory center and airways and of the corticonuclear routes of caudal cranial nerves causes the development of a triad of symptoms: glossopharyngolaryngeal paralysis, dysfunction of respiratory nuclei of medulla oblongata, and decreased sensitivity of respiratory center to CO2. Aspiration complications caused by dysphagia are characteristic of bulbar DS. Respiratory function in 5 patients without clinical picture of RF are specially discussed. The authors emphasize unfavorable prognostic significance of signs of extracorporeal obstruction indicating the probability of RF long before its manifestation. Special attention is paid to early diagnosis of symptoms of coming RF when evaluating the status of patients with DS during treatment. Timely use of respiratory resuscitation methods reduces the mortality and ensures a good chance for remissions with recovery of respiratory function, which are characteristic of RF.
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PMID:[Respiratory failure in disseminated sclerosis]. 1101 1

A case of an 87-year-old female with pleomorphic adenoma of the tongue base is reported, with a review of the literature. The tumour had enlarged gradually over a period of three years, causing dysphagia and dysphasia. Computed tomography and magnetic resonance imaging showed that the tumour was exophytic and occupy the oropharynx with little extension into the muscle tissue. The tumour was resected by CO2 laser. Histological examination revealed a benign pleomorphic adenoma that originated from the minor salivary gland of the tongue base.
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PMID:Pleomorphic adenoma of tongue base causing dysphagia and dysphasia. 1112 55

Laryngeal amyloidosis is an uncommon disease accounting for 0.68% of benign tumors of the larynx. It can present as a nodular tumor or diffuse subepithelial deposition forming a bulging mass and causing hoarseness, dysphagia or even airway obstruction. We present our experience in the management of laryngeal amyloidosis, and discuss the clinical features and histopathological characteristics of the disease. Reports on benign laryngeal tumor from June 1988 to June 1998 at Taipei VGH were searched to identify and collect amyloid cases for chart review. Five cases of laryngeal amyloidosis were found in the records. The sites of involvement were false cord, ventricle, post-cricoid, and arytenoid-epiglottic fold. No evidence of systemic amyloidosis involvement was observed for any of the five cases. All cases were treated with CO2 laser excision. Recurrence occurred in two patients within one year. More extensive CO2 laser excision was subsequently performed, with no more recurrences noted as of the last follow-ups. Laryngeal amyloidosis is a benign disease; however, surgical management is required when it is symptomatic. Recurrences or large-sized tumors may be a problem; however, advances in laser technology and the cumulative experience of treating benign lesions of the larynx have made CO2 laser endoscopic excision an effective treatment option.
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PMID:Management of laryngeal amyloidosis--the experience of Taipei Veterans General Hospital. 1193 73

Endoscopic cricopharyngeal myotomy was performed on 29 patients with dysphagia from failed relaxation of the cricopharyngeal muscle. The patient outcome was retrospectively evaluated. The average age at the time of treatment was 62 years (range: 38-81 years), and the mean follow-up was 18 months (range:1-36 months). The procedure was the first to be performed in all except four of the patients. Preoperative and postoperative assessments included videofluoroscopic and flexible endoscopic evaluations of the swallow as well as patients' subjective ratings for dysphagia and aspiration. These investigations and self-assessments were rated from 0 (poor or abnormal) to 4 (good or normal). Surgical procedures were performed under general anesthesia. Using the diverticuloscope, the posterior portion of the cricopharyngeal muscle was exposed and CO2 laser sectioned. The wound was then covered with fibrin glue. Patients were parenterally fed for 72 h. Postoperative videofluoroscopy showed the absence of leakage, and all patients resumed oral intake on day 2. The median self-rating score improved from 1 to 4 for dysphagia and from 3 to 4 for aspiration. The outcome of the flexible endoscopic evaluation of swallow improved from 2 to 4 and videofluoroscopy improved from 2 to 4. No surgical complication occurred. Endoscopic CO2 laser-assisted surgery is an effective and safe alternative for the treatment of cricopharyngeal dysmotility.
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PMID:Endoscopic CO2 laser-assisted surgery for cricopharyngeal dysfunction. 1274 14

A case of atypical laryngeal carcinoid tumour of the right aryepiglottic fold is described in a 56-year-old female. The patient presented a 4-year history of dysphagia, occasional dyspnoea and pain originating in the right tonsillar fossa and radiating to the ear. A sessile, submucosal neoplasm of about 1 cm in diameter and apparently benign appearance was detected endoscopically in the supraglottic region. An excisional biopsy was collected by CO2 laser during direct microlaryngoscopy from which a diagnosis of atypical carcinoid tumour of the larynx was made, and later confirmed by histochemical and immunohistochemical staining. Post-operative course was uneventful, with return to a normal diet per os on the first post-operative day. Histopathological evaluation of the excised specimen revealed the presence of a neoplasm in proximity of the surgical margins, which were not, however, directly involved by the tumour. The close endoscopic follow-up was, nonetheless, implemented in order to promptly detect any evidence of relapse of the disease. After 18 months, a lesion, suspected of being a recurrence, was found, in the site of the original tumour. CO2 laser excision was again carried out, this time allowing for wider margins on the surgical resection. The post-operative diagnosis confirmed the clinical hypothesis of recurrence of atypical carcinoid tumour. The patient is presently alive and free from disease 7 years after the second endoscopic procedure. The difficult aspects of clinical and histopathological diagnoses, the surgical treatment as well as endoscopic and instrumental follow-up of this rare condition are discussed.
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PMID:Atypical carcinoid tumour of the larynx treated with CO2 laser excision: case report. 1281 35

Chondrosarcoma of the larynx is a rare slow-growing malignant tumour with approximately 240 cases reported in the literature: the cricoid cartilage is the most commonly affected site (72-75%), in rare case was described of epiglottis (1-2%). We report a case of a chondrosarcoma of the epiglottis treated with CO2 laser epiglottectomy. The patient was referred with dysphonia, dysphagia and halitosis that started four months before. Indirect laryngoscopy revealed a large smooth mass with a roundish appearance and a pearly-grey colour, as big as a nut, apparently arising from the laryngeal surface of the epiglottis, causing obliteration of the piriform fossa. The definitive histopathological report showed microscopically, the tumour was low-grade (grade I) chondrosarcoma. A literature review regarding chondrosarcomas of the epiglottis is presented. The diagnosis, histology and treatment of these tumours are discussed. In particular we examine the controversy of conservative surgery vs. total laryngectomy. A conservative surgical approach is typically appropriate in light of this tumour's low-aggressive nature.
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PMID:Chondrosarcoma of the epiglottis: report of a case treated with CO2 laser epiglottectomy. 1551 40

Hemangioma of the upper aerodigestive tract is a rarely reported occurrence in the pediatric literature. To date, there have been three published case reports of postcricoid hemangiomas contributing to unexplained dysphagia and respiratory distress. We present three children with a history of swallowing difficulty and stridor who were found to have an occult postcricoid mass. Valsalva maneuvers confirmed the suspicion of a vascular malformation in both patients. Transoral laser therapy (KTP and CO2) was used to ablate the lesions. The patients are symptom-free at 5 months, 5 years, and 2 weeks, respectively. The diagnostic challenge in evaluating these children and the therapeutic choices are described.
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PMID:Pediatric postcricoid vascular malformation: a diagnostic and treatment challenge. 1676 55

The laryngeal amyloidosis is an uncommon disease accounting for 1% of all benign lesions of larynx. The commonest symptom is the dysphonia, sometimes accompanied by stridor, laryngeal globus sensation, dysphagia and, in rare occasions, cough, dyspnea and hemoptysis, specially when the tracheobronchial tree is also affected. This paper describes the case of a 30-year-old female patient, whose main symptoms were progressive dysphonia and dyspnea, admitted at allergy service to rule out asthma. The respiratory function tests showed obstruction in the medium and small caliber ways without reversibility with salbutamol. Biopsies of ventricular band, vocal cord and arytenoid stained with positive Congo red for amyloid tissue, established the laryngeal amyloidosis diagnosis. The complementary studies to rule out amyloid tissue in the remaining tracheobronchial tree were negative. Dyspnea had characteristics of laryngeal origin, caused by a pulmonary ventilation disorder provoked by the difficult arrival of air to alveoli, which caused the decreased partial pressure of oxygen and CO2.
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PMID:[Asthma or laryngeal amyloidosis? A report of a case and literature review]. 1663 59


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