1/297. Advances in gastrointestinal endoscopy.endoscopy has a rapidly expanding role in diagnosis and management of gastrointestinal disease.- - - - - - - - - - ranking = 1keywords = disease (Clic here for more details about this article) |
2/297. hypoglossal nerve injury as a complication of anterior surgery to the upper cervical spine.Injury to the hypoglossal nerve is a recognised complication after soft tissue surgery in the upper part of the anterior aspect of the neck, e.g. branchial cyst or carotid body tumour excision. However, this complication has been rarely reported following surgery of the upper cervical spine. We report the case of a 35-year-old woman with tuberculosis of C2-3. She underwent corpectomy and fusion from C2 to C5 using iliac crest bone graft, through a left anterior oblique incision. She developed hypoglossal nerve palsy in the immediate postoperative period, with dysphagia and dysarthria. It was thought to be due to traction neurapraxia with possible spontaneous recovery. At 18 months' follow-up, she had a solid fusion and tuberculosis was controlled. The hypoglossal palsy persisted, although with minimal functional disability. The only other reported case of hypoglossal lesion after anterior cervical spine surgery in the literature also failed to recover. It is concluded that hypoglossal nerve palsy following anterior cervical spine surgery is unlikely to recover spontaneously and it should be carefully identified.- - - - - - - - - - ranking = 3.1375834128068keywords = nerve (Clic here for more details about this article) |
3/297. 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 = 6keywords = disease (Clic here for more details about this article) |
4/297. 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 = 2keywords = disease (Clic here for more details about this article) |
5/297. Laparoscopic removal of an Angelchik prosthesis.The use of Angelchik prosthetic rings for the surgical treatment of gastroesophageal reflux disease has been associated with frequent complications, including dysphagia and migration, erosion, or disruption of the ring. Although reports of the laparoscopic insertion of Angelchik rings have been published, there have been no descriptions of the laparoscopic removal of rings inserted at open laparotomy. Our group recently removed an Angelchik ring laparoscopically in an 80-year-old woman with progressive, refractory dysphagia and esophageal narrowing due to an Angelchik ring originally placed in 1981 via an upper midline incision at open operation. Upper endoscopy and dilatation had failed to provide symptom relief. An extensive adhesiolysis was performed laparoscopically, and the Angelchik ring was dissected free from the proximal stomach, diaphragm, and liver. The fibrous pseudocapsule enclosing the ring was divided, and the prosthesis was removed from around the esophagus and abdominal cavity. Intraoperative upper endoscopy confirmed resolution of the esophageal stricture. There were no intraoperative complications, and the patient was discharged home on the 3rd postoperative day tolerating a regular diet. Postoperatively, she experienced resolution of her dysphagia and complained only of mild reflux symptoms, which were easily controlled with famotidine and antireflux precautions. This case suggests that laparoscopic removal of Angelchik prosthetic rings is feasible for surgeons familiar with advanced laparoscopic procedures of the esophageal hiatus and should be considered for symptomatic patients, even if the ring was inserted via an open operation.- - - - - - - - - - ranking = 1keywords = disease (Clic here for more details about this article) |
6/297. Achalasia and Down's syndrome: coincidental association or something else?Achalasia is an uncommon esophageal motor disorder. It has been associated with other diseases such as Parkinson's disease and depressive disorders, but coincidence of achalasia and Down's syndrome is rare. We report five cases of achalasia in Down's syndrome patients seen in our institution. Two of the five cases were diagnosed at pediatric age. Respiratory symptoms and growth retardation were the main clinical manifestations in pediatric patients, whereas adult patients mainly complained of dysphagia. Taking into account the prevalence rate of both disorders, the association seems higher than that expected by chance. The possible etiopathogenic implications of this association, as well as its clinical relevance, are discussed.- - - - - - - - - - ranking = 2keywords = disease (Clic here for more details about this article) |
7/297. Bilateral contemporaneous posteroventral pallidotomy for the treatment of Parkinson's disease: neuropsychological and neurological side effects. Report of four cases and review of the literature.The authors report the underestimated cognitive, mood, and behavioral complications in patients who have undergone bilateral contemporaneous pallidotomy, as seen in their early experience with functional neurosurgery for Parkinson's disease (PD) that is accompanied by severe motor fluctuations before pallidal stimulation. Four patients, not suffering from dementia, with advanced (Hoehn and Yahr Stages III-IV), medically untreatable PD featuring severe "on-off" fluctuations underwent bilateral contemporaneous posteroventral pallidotomy (PVP). All patients were evaluated according to the Core Assessment Program for Intracerebral Transplantations (CAPIT) protocol without positron emission tomography scans but with additional neuropsychological cognitive, mood, and behavior testing. For the first 3 to 6 months postoperatively, all patients showed a mean improvement of motor scores on the Unified Parkinson's disease Rating Scale (UPDRS), in the best "on" (21%) and worst "off" (40%) UPDRS III motor subscale, a mean 30% improvement in the UPDRS II activities of daily living (ADL) subscore, and 60% on the UPDRS IV complications of treatment subscale. Dyskinesia disappeared almost completely, and the mean daily duration of the off time was reduced by an average of 60%. Despite these good results in the CAPIT scores, one patient experienced a partially regressive corticobulbar syndrome with dysphagia, dysarthria, and increased drooling. No emotional lability was found in this patient, but he did demonstrate severe bilateral postoperative pretarsal blepharospasm (apraxia of eyelid opening), which interfered with walking and which required treatment with high-dose subcutaneous injections of botulinum toxin. No patient showed visual field defects or hemiparesis, but postoperative depression, changes in personality, behavior, and executive functions were seen in two individuals. Postoperative abulia was reported by the family of one patient, who lost his preoperative aggressiveness and drive in terms of ADL, speech, business, family life, and hobbies, and became more sleepy and fatigued. One patient reported postoperative mental automatisms, such as compulsive mental counting, and circular thoughts and reasoning during off phases; postoperative depression was found in two patients. However, none of the patients demonstrated these symptoms during intraoperative microelectrode stimulation. These findings are compatible with previous reports on bilateral pallidal lesions. A progressive lowering of UPDRS subscores was seen after 12 months, consistent with the progression of the disease. Bilateral simultaneous pallidotomy may be followed by emotional, behavioral, and cognitive deficits such as depression, obsessive-compulsive disorders, and loss of psychic autoactivation-abulia, as well as disabling corticobulbar dysfunction and apraxia of eyelid opening, in addition to previously described motor and visual field deficits, which make this surgery undesirable even though significant improvement in motor deficits can be achieved.- - - - - - - - - - ranking = 6keywords = disease (Clic here for more details about this article) |
8/297. 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 = 1keywords = disease (Clic here for more details about this article) |
9/297. Transpharyngeal approach for the treatment of dysphagia due to Forestier's disease.Forestier's disease (diffuse idiopathic skeletal hyperostosis) is characterized by extensive spinal osteophyte formation and endo-chondral ossification of paravertebral ligaments and muscles. Dysphagia in the setting of Forestier's disease is a rare and hence often unrecognized entity. The dysphagia is due to mechanical obstruction in the initial stages and later due to inflammation and fibrosis. Most of these patients are treated conservatively in the initial stages and later by excision of osteophytes through a lateral cervical approach. We present a case of dysphagia due to cervical osteophytes in the setting of Forestier's disease causing narrowing of the pharynx. The patient was treated surgically via a peroral-transpharyngeal route with excellent results.- - - - - - - - - - ranking = 7keywords = disease (Clic here for more details about this article) |
10/297. Severe hypopharyngeal dysphagia in a patient on chronic steroid treatment.A 44-year-old Caucasian male who had been on long-term steroid treatment for an unspecified collagen disease was referred to our Unit because of fever, severe hypopharyngeal dysphagia, night sweats and evidence of marked superior vena cava compression. Extrapulmonary disseminated tuberculosis also involving bone and liver was eventually diagnosed and proven by means of specific polymerase chain reaction assay. Antimycobacterial treatment, which led to a dramatic improvement within two months, was protracted for 18 months until the complete return to normal of both clinical and laboratory findings.- - - - - - - - - - ranking = 1keywords = disease (Clic here for more details about this article) |
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