1/159. Crohn's disease and the melkersson-rosenthal syndrome.A 30-year-old woman with a 10-year history of recurrent bloody diarrhea and documented colitis of the descending colon, consistent with Crohn's disease, presented with an exacerbation of her gastrointestinal disease and an 18-month history of recurrent facial and genital swelling. Her course evolved to include severe ear pain, dysphagia and colonic dysmotility. She was diagnosed with melkersson-rosenthal syndrome and treated with multiple agents. The neurological aspects of her presentation are highlighted, and the melkersson-rosenthal syndrome is reviewed.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
2/159. radiation-induced esophageal carcinoma 30 years after mediastinal irradiation: case report and review of the literature.A 54-year-old man who had been irradiated in 1964 for cervical involvement by Hodgkin's disease was admitted in December 1994 to our clinic with strong complaints of dysphagia. The reason was a moderately differentiated squamous cell carcinoma of the proximal esophagus in the previously irradiated region. The patient had no risk factors (abuse of nicotine or alcohol) for the developement of esophageal carcinoma. A reirradiation was performed, but the disease progressed locally and two weeks after the beginning of the therapy the patient developed two tracheoesophagocutaneous fistulae. The radiation therapy was discontinued and the tumor stenosis was bridged by a tube closing the fistulae. A retrospective dose analysis to evaluate the applied doses will be performed. Furthermore, an overview of 66 cases of the literature with radiation-induced esophageal carcinoma analysed concerning applied dose and latent interval will be given. In conclusion the reported case fits the criteria for radiation-induced malignancies (Chudecki Br J Radiol 1972;45:303-4) known from literature: (1) a history of previous irradiation, (2) a cancer occurring within the irradiated area, (3) gross tissue damage due to an excessive dose of radiation, and (4) a long latent interval between irradiation and development of cancer. Esophageal carcinomas belong to the rare secondary malignancies after the therapeutic use of ionizing radiation. Nevertheless in patients with dysphagia they should be suspected as a differential diagnosis even many years after mediastinal irradiation. The treatment of these tumors is very difficult and is associated with a poor prognosis.- - - - - - - - - - ranking = 0.07224952132876keywords = area (Clic here for more details about this article) |
3/159. Posterior sternoclavicular dislocations--a diagnosis easily missed.Posterior dislocation of the sternoclavicular joint is a relatively rare injury and can be difficult to diagnose acutely. We report 3 cases of posterior dislocation of the sternoclavicular joint who presented to the Accident & Emergency Department within a 3 month period. All 3 patients had sustained a significant injury to the shoulder region and complained of pain around the medial clavicle. Two patients had also complained of dysphagia following the injury. Plain x-rays of the shoulder and chest were reported as normal by junior and senior medical staff. The diagnosis was delayed until CT scans were performed, and once this was established, open reduction and stabilisation was performed.- - - - - - - - - - ranking = 3.4432752009381keywords = chest, pain (Clic here for more details about this article) |
4/159. Saccular descending thoracic aortic aneurysm with dysphagia.A 76 year old woman had suffered from chest pain, back pain, and dysphagia for 8 months. She was diagnosed as having a thoracic aortic aneurysm by chest X-ray and chest enhanced computed tomography. Simultaneously, severe dysphagia developed. Chest enhanced computed tomography and chest aortic aortography at our hospital demonstrated a saccular descending thoracic aortic aneurysm. Esophagography demonstrated that the esophagus was compressed by the aneurysm; therefore, a graft replacement for the saccular descending thoracic aortic aneurysm was performed on February 17th, 1998. A left sided 6th intercostal approach was made, and graft replacement for the aneurysm using a 22 mm Hemashield prosthetic graft was performed under temporary bypass from the thoracic aorta just distal to the left subclavian artery and to the left femoral artery. The postoperative course was uneventful, the severe dysphagia improved dramatically, but a pleural effusion of 1000 ml collected 3 weeks after the operation. Surgical cases of saccular descending thoracic aortic aneurysm with dysphagia are rare, and with this in mind, we report this case to the the medical literature.- - - - - - - - - - ranking = 64.999930469435keywords = chest pain, chest, pain (Clic here for more details about this article) |
5/159. Medication-induced oesophageal injury leading to broncho-oesophageal fistula.Medication-induced oesophageal injury is one of the least recognised side-effects of oral medication and, in contrast to other oesophageal pathologies, is rarely considered in the differential diagnosis of chest pain. We describe a case of medication-induced oesophageal injury with a rare complication in which the diagnosis was not considered until the characteristic features were demonstrated at endoscopy.- - - - - - - - - - ranking = 56.670104866621keywords = chest pain, chest, pain (Clic here for more details about this article) |
6/159. Achalasia: diagnosis and management.Achalasia is a primary esophageal motor disorder of unknown cause that produces complaints of dysphagia, regurgitation, and chest pain. The current treatments for achalasia involve the reduction of lower esophageal sphincter (LES) pressure, resulting in improved esophageal emptying. calcium channel blockers and nitrates, once used as an initial treatment strategy for early achalasia, are now used only in patients who are not candidates for pneumatic dilation or surgery, and in patients who do not respond to botulinum toxin injections. Because of the more rigid balloons, the current pneumatic dilators are more effective than the older, more compliant balloons. The graded approach to pneumatic dilation, using the Rigiflex (boston Scientific Corp, boston, MA) balloons (3.0, 3.5, and 4.0 cm) is now the most commonly used nonsurgical means of treating patients with achalasia, resulting in symptom improvement in up to 90% of patients. Surgical myotomy, once plagued by high morbidity and long hospital stay, can now be performed laparoscopically, with similar efficacy to the open surgical approach (94% versus 84%, respectively), reduced morbidity, and reduced hospitalization time. Because of the advances in both balloon dilation and laparoscopic myotomy, most patients with achalasia can now choose between these two equally efficacious treatment options. Botulinum toxin injection of the LES should be reserved for patients who can not undergo balloon dilation and are not surgical candidates.- - - - - - - - - - ranking = 56.670104866621keywords = chest pain, chest, pain (Clic here for more details about this article) |
7/159. Anesthetic management of a patient with laryngeal amyloidosis.A 73-year-old woman who suffered from progressive hoarseness for 6 years and dysphagia without pain for 1 year presented with a soft tissue deposition on the posterior region of the vocal cords and narrowing in the subglottic area. biopsy of this soft tissue and histological examination revealed laryngeal amyloidosis. A tracheostomy and partial removal of the amyloid were performed with general anesthesia. The airway was secured with a smaller diameter endotracheal tube, which was inserted atraumatically with Magill's forceps. The larynx is a rare site for amyloidosis. Laryngeal amyloidosis is fragile and hemorrhagic. Therefore, massive bleeding may occur during intubation. Anesthetists should take care in intubating the tracheas of these patients and be aware of other systemic diseases in laryngeal amyloidosis.- - - - - - - - - - ranking = 1.0722495213288keywords = pain, area (Clic here for more details about this article) |
8/159. Acute reversible dysphagia and dysphonia as initial manifestations of sarcoidosis.A 60 year-old white woman presented with sudden painless dysphagia, hoarseness and dysphonia. A diagnosis of sarcoidosis was made based on bilateral hilar lymphadenopathy, gallium uptake, elevated serum angiotensin-converting enzyme levels, as well as non-caseating granulomatous lymphadenitis in a prescalenic node. Symptoms were attributed to isolated vagus neuropathy, a rare form of presentation of neurosarcoidosis.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
9/159. Dysphagia following intrathecal local anesthetic-opioid administration.We describe the case of a parturient who developed dysphagia shortly after the intrathecal injection of a local anesthetic-opioid combination for cesarean section. Dysphagia was the only symptom of cephalad spread of the spinal anesthetic, and it was not associated with a "high" motor or sensory block. Although it resolved spontaneously, the dysphagia was extremely distressing to the patient. We conclude that dysphagia, even in the absence of an overtly "high spinal," should be added to the possible side effects of intrathecal local anesthetic-opioid administration in parturients.- - - - - - - - - - ranking = 0.07224952132876keywords = area (Clic here for more details about this article) |
10/159. Atypical herpes simplex can mimic a flare of disease activity in patients with pemphigus vulgaris.We present a 69-year-old white woman with pemphigus vulgaris limited to the oral mucosa who presented with oral pain and difficulty swallowing of 2 days duration, followed by multiple irregular ulcers arising from normal mucosa with no grouping of individual lesions--herpes simplex should be considered in the differential diagnosis of lesions that appear suddenly in patients with PV, particularly if the lesions fail to respond to an increased dose of corticosteroids.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
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