1/8. Foreign body ingestion in children with severe developmental disabilities: a case study.Dysphagia is common in children with severe developmental disabilities. The nature of these difficulties can predispose them to foreign body ingestion. This article presents a case that highlights the need for vigilance in diagnosing dysphagia in children with multiple and complex developmental disabilities where severe cognitive impairment and an inability to communicate may mask the presence of underlying problems.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/8. Dysphagia lusoria: a case study.Dysphagia lusoria is described in the literature as difficulty swallowing because of a "jest of nature." The "jest of nature" is a birth defect encompassing any aortic root vascular anomaly that causes esophageal dysphagia. persons with dysphagia lusoria can be categorized according to their specific subclavian anomaly (ie, depending on the presence of an aneurysm, occlusive disease, or esophageal compression). All patients with this anomaly have an aberrant subclavian artery in a transposed position that courses posterior to the esophagus. The operative approach to repair this condition has been controversial. An extrathoracic approach is documented as superior to a repair involving thoracotomy because there is decreased rate of complications that may be associated with a thoracotomy and greater visibility of the subclavian and carotid artery. This case study describes a 25-year-old woman with dysphagia lusoria related to an aberrant right subclavian artery. The report includes a literature review and describes the perioperative approach and nursing care. The use of the preadmission and same-day admission services are supported as is an extrathoracic surgical approach. At follow-up this patient reported no symptoms of dysphagia and showed no evidence of esophageal compression confirming that persons with symptomatic dysphagia lusoria can be managed with positive long-term results.- - - - - - - - - - ranking = 2keywords = nature (Clic here for more details about this article) |
3/8. Clinitest burns of the esophagus.Five children developed esophageal stricture from the ingestion of a Clinitest tablet. The sodium hydroxide contained in these tablets induced a short, dense stricture that was resistant to dilation and necessitated resection. In all patients primary esophageal resection with end-to-end anastomosis was technically possible. Four of the patients needed two or more dilations postoperatively and 1 still requires dilation. Prevention of accidental ingestion by use of a childproof container and parental education about the caustic nature of Clinitest are both essential to eliminate this child health hazard.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/8. Spontaneous passage of a dislocated esophageal metal stent: report of two cases.Delayed transpyloric impaction is a very rare complication of esophageal metallic stent placement. Authors report different endoscopic removal techniques, but none of these has been validated yet because of their variable success, time-consuming nature, and risk of perforation and hemorrhage. We report that a "wait-and-see" approach is a safe and effective policy in patients with permeable transpyloric impacted esophageal stents.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/8. Congenital esophageal stenosis due to tracheobronchial remnants: a rare but important association with esophageal atresia.Congenital esophageal stenosis caused by tracheobronchial remnants occurred in eight children, six of whom had associated esophageal atresia and/or tracheoesophageal fistula. Symptoms usually began in early infancy but delayed diagnosis was a common feature. The mean lag period between presentation and definitive operation was 4.6 years (range, 1 month to 16 years). Errors in diagnosis were common. Six were initially diagnosed as having inflammatory strictures secondary to reflux esophagitis. Seven children were subjected to repeated esophagoscopy and bouginage of the "stricture" (mean no. = 3.4), with invariable failure to ameliorate dysphagia. Antireflux procedures were performed in three patients. In all children, symptoms were dramatically relieved following resection of the stenotic segment or esophageal replacement. Although a rare entity, congenital esophageal stenosis due to tracheobronchial remnants should be considered a possibility in patients with esophageal stricture, presumed to be inflammatory in nature, which fails to respond to standard therapy.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/8. barrett esophagus: reticular pattern of the mucosa.barrett esophagus is an acquired condition with progressive columnar metaplasia of the esophagus due to chronic reflux esophagitis. The premalignant nature of this entity is well recognized. However, radiologic diagnosis has been limited by the nonspecificity of findings associated with the condition. We recently reviewed 29 cases of pathologically proved barrett esophagus. Radiologic examinations revealed hiatal hernias, gastroesophageal reflux, esophagitis, and strictures. None of these findings are diagnostic of barrett esophagus. In seven cases, however, double-contrast radiography also revealed a delicate reticular pattern in the esophagus. In all but one case, there was an adjacent stricture, and this reticular appearance extended distally a short but variable distance from the stricture. To our knowledge, this unusual reticular pattern has not been described previously, and it represents a valuable radiologic sign of barrett esophagus. The etiology of this finding is uncertain, but correlation with the gross surgical specimen in one case suggests that it results specifically from areas of "villous" metaplasia in Barrett epithelium. This delicate reticular pattern appears to be a specific radiologic criterion for the diagnosis of barrett esophagus.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/8. Salivary gland enlargement during oesophageal stricture dilatation.A case of recurrent salivary gland enlargement occurring during fibreoptic oesophagoscopy and oesophageal stricture dilatation with Eder-Puestow dilators is described. The genesis of this condition is discussed and its transient and usually benign nature emphasized.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/8. Dysphagia lusoria: aberrant right subclavian artery with a Kommerell's diverticulum.A retroesophageal right subclavian artery, the most common congenital aortic arch abnormality, is an unusual cause of dysphagia in adults. The embryologic abnormality of the aortic arch is involution of the fourth vascular arch, along with the right dorsal aorta, leaving the seventh intersegmental artery attached to the descending aorta. This persistent intersegmental artery assumes a retroesophageal position as it proceeds out of the thorax into the arm. Since compression of the esophagus by this right subclavian artery may produce dysphagia, the term "dysphagia lusoria" ("dysphagia by freak of nature"), has been used to describe the symptom complex. The presence of an aneurysm of the artery or Kommerell's diverticulum at its aortic origin is more likely to produce symptoms from esophageal compression. This case presents a middle aged adult with an associated Kommerell's diverticulum and dysphagia. Surgical correction was used to relieve his symptoms and to correct the diverticulum of the proximal right subclavian artery. The embryologic changes that occur are discussed in detail.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |