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At least 487 records · Page 27Linked to original sources
PubMed1993

Pseudotumoral appearance of cytomegalovirus esophagitis and gastritis in AIDS patients.

Cytomegalovirus (CMV) is frequently isolated from patients with acquired immunodeficiency syndrome (AIDS), and often causes disseminated disease. Gastrointestinal CMV involvement is recognized with increased frequency in AIDS patients. It can involve the entire alimentary tract and usually produces mucosal ulceration. Pseudotumoral lesions develop very infrequently. We report two unusual detailed cases of biopsy-proven CMV esophagitis and gastritis resembling carcinoma, in patients with human immunodeficiency virus infection. In AIDS patients, the gastrointestinal CMV involvement could show pseudotumoral appearance.

AIDS-Related Opportunistic Infections↗
PubMed1977

[Diagnostic problems in a patient with progressive sclerodermia (author's transl)].

3 characteristic problems of progressive sclerodermia are discussed on the basis of one case: 1. The differential diagnosis of stenosis of the esophagus due either to the disease or to carcinoma, 2. in the presence of a round focus in a lung, the question of its connection with pulmonary fibrosis or bronchial carcinoma, 3. in rapidly increasing interstitial marking the distinction between increasing fibrosis of interstitial superimposed edema.

Carcinoma, Bronchogenic↗
PubMed1996

[Gore-tex covering of ultraflex stent and its usefulness for malignant esophageal stenosis: preliminary clinical results].

Malignant esophageal stenoses develop esophagorespiratory fistulae or perforations so frequently that esophageal stents must be required. We devised a covered stent with a thin Gore-Tex sheet and a nitinol stent system, Ultraflex, without increasing the size of the introducer assembly. Nine patients with malignant esophageal stenoses, including seven patients with perforation or fistulation, were carefully treated with the covered stent. All stent deployments were successfully carried out under fluoroscopic guidance. The average time required for full self-expansion was two weeks. The average grade of dysphagia improved from 3.7 to 1.2. Clinical symptoms due to esophagorespiratory fistulae were improved in three of four patients. No clinical or technical complications, such as migration, were observed, but a fistula developed at the bare site of the stent. This covering method for the flexible stent was simple and safe, and was considered to be useful in the treatment of malignant esophageal stenosis.

Adenocarcinoma↗
PubMed1997

[Palliative intubation of esophageal prosthesis in two patients with lung cancer].

Case one: A 61-year-old man was admitted to the hospital because of coughing. Adenocarcinoma of the lung was diagnosed. The patient was treated with bronchial artery infusion of cisplatin and mitomycin C, followed by irradiation; and there was a partial response. Eighteen months later he was admitted to the hospital because of dysphagia. An esophageal prosthesis was inserted because of esophageal stenosis surrounded by local recurrent tumor. After intubation, the patient was able to eat and was discharged. Although the patient died 5 months later, the tube was patent and functional until that time. Case two: A 63-year-old man was admitted to the hospital because of coughing. Adenocarcinoma of the lung was diagnosed. The patient was treated with 3 cycles of chemotherapy consisting of cisplatin, vindesine, and mifomycin C, which were followed by irradiation; and there was a partial response. Six months later he was admitted to the hospital because of dysphagia. An esophageal prosthesis was inserted because of esophageal stenosis surrounded by mediastinal lymph nodes. Although the patient was able to eat, bilateral pleuritis and mediastinitis developed and he died ten days after intubation. At autopsy the esophagus was found to have been perforated. Palliative intubation of an esophageal prosthesis can be effective in patients with esophageal stenosis due to lung cancer, but care must be taken to prevent fatal complications.

Adenocarcinoma↗
PubMed1997

Expression of p53 in oesophageal squamous epithelium from surgical specimens resected for squamous cell carcinoma of the oesophagus, with special reference to uninvolved mucosa.

Accumulation of p53 protein has been considered an intermediate biomarker in multistage oesophageal carcinogenesis. The aim of the present study was to investigate p53 expression by immunohistochemistry in 13 thoroughly sampled oesophagectomy specimens from a geographical area with a high oesophageal cancer incidence (Basse Normandie, France). Expression of p53 was looked for in tissue samples of cancer, intraepithelial neoplasia, and uninvolved mucosa. The streptavidin biotin peroxidase complex method was used for p53 immunostaining. p53 expression was found in invasive squamous cell carcinoma in 8 out of 11 cases and in intraepithelial neoplasia in 10 out of 11 cases. In all 13 cases, in uninvolved oesophageal mucosa, expression of p53 was focally present in areas of chronic oesophagitis. Chronic oesophagitis has been regarded by epidemiologists as a precursor lesion for squamous cell carcinoma of the oesophagus. Since oesophageal carcinogenesis is a multistage process, the study of precursor lesions could provide information on the timing of p53 gene abnormalities during oesophageal carcinogenesis. These preliminary data require to be confirmed by molecular analysis of the p53 gene.

Carcinoma in Situ↗
PubMed1980

Palliative management of esophageal carcinoma.

The surgical treatment of esophageal carcinoma is palliative surgery in 90 percent of cases. Much can be done by the motivated surgeon to ease the suffering of the patients and to help them die with dignity. In this context, compassion is more important than surgical statistics. Age, depletion resulting from complications and distant metastases are no longer contraindications to palliative surgery as defined herein.

Bronchial Fistula↗
PubMed1976

Positioning of a plastic prosthesis under fiberendoscopic control in the palliative treatment of cardio-esophageal cancer.

A method is described for non surgical peroral positioning of a plastic prosthesis under visual control in patients with obstructing cardio-esophageal malignancy or with pulmonary-esophageal fistula. The ACMI-F7 small calibre endoscope is well suited for guiding the prosthesis mainly because of easy maneuvrability and sufficient sturdiness to withstand substantial pushing force.

Adenocarcinoma↗
PubMed1996

Palliative therapy using polyurethane-covered self-expandable metallic stents for malignant esophageal strictures: experiences in six patients.

To evaluate the utility and limitations of palliative stenting with polyurethane-covered self-expandable metallic stents, 6 patients (3 males and 3 females ranging in age from 58-85 [mean 72.1] years) with malignant esophageal strictures were treated with these stents between April 1993 and October 1995. Three had esophageal carcinoma, two had gastric carcinoma and one had lung carcinoma. Song-type self-expandable metallic stents were inserted by intubation under local laryngeal anesthesia. A retriever was attached in 4 stents and an anti-reflux mechanism was attached in 2 stents placed over the esophagocardiac strictures. The stents were placed successfully in all patients, and no major complication related to intubation was encountered. All the stents fully expanded within 3 days after insertion. The grade of dysphagia was improved in 5 (83%) of the 6 patients. One stent was extracted using a retriever in one patient with no improvement. No reflux symptoms were observed in 2 patients whom received stents with an anti-reflux mechanism. No blockage of the stent due to food impaction or secondary stricture occurred in any patient during the observation period. One stent migrated into the stomach in one patient 27 days after insertion. Esophageal stenting with polyurethane-covered self-expandable metallic stents is a relatively safe and effective palliation for malignant esophageal strictures.

Aged↗
PubMed2003

Mitomycin C for the treatment of pharyngoesophageal stricture after total laryngopharyngectomy and microvascular free tissue reconstruction.

OBJECTIVES: To assess the role of mitomycin C (MMC) in the management of pharyngoesophageal stricture after total laryngopharyngectomy and free flap reconstruction. STUDY DESIGN: Five patients since 1998 underwent evaluation and treatment for pharyngoesophageal stricture after total laryngopharyngectomy and free flap reconstruction. The method of reconstruction included four tubed radial forearm free flaps and one jejunal free flap. All patients underwent barium swallow, computed tomography, and endoscopic examination and were proven to be free of recurrent disease. METHODS: The patients were taken to the operating room. After dilation, the stenotic segment was exposed, and 1 mL of 0.4 mg/mL mitomycin-C was applied for 4 minutes using a cotton pledget. The patients were then followed clinically and with barium swallows for a minimum follow-up period of 18 months. RESULTS: All five patients experienced improved swallowing ability. The need for further dilatations was either eliminated or lessened. All patients were happy with the treatment results. No complications occurred. CONCLUSIONS: This small case series suggests that MMC is a safe and effective adjunctive treatment for pharyngoesophageal stricture after total laryngopharyngectomy and free flap reconstruction.

Adenocarcinoma↗
PubMed2001

Laparoscopic gastrostomy: results of 121 patients over 7 years.

Laparoscopic gastrostomy was introduced in various technical variants 7 years ago. However, larger series and long-term results of these new methods are still lacking. In a prospective study, laparoscopic gastrostomies were performed by two institutions in 121 patients (88 men, 33 women; mean age, 58.3 +/- 11.16 years [range, 24-82]) with esophageal stenosis in locally advanced hypopharyngeal or oropharyngeal carcinoma, incurable esophageal carcinoma, and cerebral dysphagia. Operating time was 40 +/- 22 (range, 10-160) minutes. Procedure-related mortality was 0%, early mortality was 1.6%, the overall intraoperative complication rate was 7.4%, and the early complication rate was 9.9%. During a cumulative usage time of 1086.2 months, the complication rate in 1000 usage days was 0.8, and the stoma infection rate was 0.65. Laparoscopic gastrostomy is a reliable method for safe and economic establishment of enteral nutrition, even in patients for whom long-term nutrition by gastrostomy is expected.

Adult↗
PubMed1998

Palliation of malignant esophageal obstruction due to intrinsic and extrinsic lesions with expandable metal stents.

OBJECTIVE: Metal stents have become the standard of care for esophageal stenting. The aim of this study was to determine the safety and efficacy of metal stents for the palliation of dysphagia caused by extraesophageal malignancies compressing the esophagus, compared with that caused by intrinsic lesions involving the esophagus. METHODS: Expandable metal stents were placed in 46 consecutive patients with dysphagia caused by malignant extrinsic compression of the esophagus (n=24) and intrinsic esophageal strictures (n=22). Quality of life was determined by a dysphagia score and the Karnofsky performance scale. Patients were followed until death. RESULTS: Stents were successfully deployed in all 24 patients. Dysphagia scores improved from a median of 3 (range, 3-4; mean, 3.5+/-0.2) to a median of 2 (range, 1-4; mean, 1.6+/-0.4; p < 0.0001) in the extrinsic group, and from a median of 3 (range, 2-4) to a median of 1 (range, 1-3) in the intrinsic group (p < 0.0001). The improvement was significantly greater (p=0.01) in the intrinsic group. There was no significant difference in the Karnofsky score between the two groups. CONCLUSIONS: Patients with intrinsic lesions have better palliation of dysphagia than those with extrinsic lesions. Future studies with other study designs will need to consider this.

Aged↗
PubMed1993

Malignant esophageal strictures: treatment with a self-expanding nitinol stent.

A self-expanding esophageal nitinol stent was implanted under fluoroscopic guidance in 40 patients with malignant esophageal strictures and clinically significant dysphagia. The strictures were caused by squamous cell carcinoma (n = 14), adenocarcinoma (n = 12), recurrent anastomotic carcinoma (n = 8), and mediastinal tumors (n = 6). Eight stents were balloon dilated to maximum diameter immediately after insertion. Sixteen stents self-expanded to maximum diameter within 24 hours, and the other stents expanded to maximum diameter during further observation. There were no serious stent-related complications, and the dysphagia was reduced considerably in all patients immediately after stent insertion. Persistent tumor bleeding occurred in two patients, and ingrowth of tumor into the stent was seen in eight patients. Two stents occluded due to tumor ingrowth but were successfully recanalized with endoscopic laser coagulation. At the end of the study, 28 patients were dead with a mean survival of 2.9 months (range, 0.1-7.0 months), and 12 patients were alive with a mean follow-up of 8.8 months (range, 4.0-15.0 months).

Adult↗
PubMed1996

Palliation of malignant esophageal strictures with self-expanding nitinol stents: drawbacks and complications.

PURPOSE: To evaluate the usefulness of self-expanding nitinol stents in the palliative treatment of malignant dysphagia. MATERIALS AND METHODS: Eighty self-expanding nitinol stents were placed in 59 patients (43 men, 16 women; mean age, 55 years; age range, 23-75 years) with inoperable malignant stenosis due to squamous cell carcinoma of the esophagus (n = 36), adenocarcinoma (n = 19), invasion of the esophagus due to carcinoma of the lung (n = 2), and recurrent anastomotic carcinoma (n = 2). Dysphagia was graded on a scale of 0 to 3. Follow-up esophagograms were obtained to evaluate stent patency. RESULTS: Stent placement was successful in all patients. The severity of dysphagia decreased at least one grade in all but one patient. Tumor ingrowth and overgrowth were seen in 21 (36%) patients 2 days to 7 months after stent placement and caused recurrent dysphagia. These 21 patients underwent balloon dilation and additional stent placement. A mediastinal fistula was seen in three patients (5%), ulceration in four (7%), stent torsion in three (5%), and incomplete expansion of the stent in two (2%). Repeat intervention was necessary in 51% of the patients. CONCLUSION: There is a substantial range of drawbacks and complications associated with the use of self-expanding nitinol stents for palliation of malignant esophageal strictures. A covering would be necessary to prevent tumor ingrowth.

Adenocarcinoma↗