Hematoma disecante del esófago a causa de abdomen agudo quirúrgico / Dissecting Hematoma of the Esophagus due to Acute Surgical Abdomen

RESUMEN El hematoma disecante del esófago es poco frecuente y solo existen pocos casos registrados en la literatura. Generalmente, se presenta después de un trauma asociado a procedimientos endoscópicos o de forma espontánea. Se describe clínicamente con la triada clásica de dolor torácico, odinofagia, disfagia o hematemesis. Se ha relacionado con un aumento rápido de la presión intraesofágica o un mecanismo de deglución anómala particularmente en presencia de trastornos de la hemostasia. La mayoría de los pacientes tienen un buen pronóstico pues resuelven con tratamiento conservador. Presentamos el caso clínico de un paciente con diagnóstico de hematoma disecante de esófago con ruptura a cavidad abdominal que causó hemoperitoneo importante. Se realiza una revisión del tema(AU)

ABSTRACT Dissecting hematoma of the esophagus is a rare condition and there are only few cases reported by the literature. Generally, it occurs after trauma associated with endoscopic procedures or spontaneously. It is described clinically with the classic triad of chest pain, odynophagia, dysphagia or hematemesis. It has been associated with a rapid increase in intra-esophageal pressure or an abnormal swallowing mechanism particularly in the presence of haemostasis disorders. Most patients have a good prognosis because they obtain a solution by means of a conservative treatment. We present the clinical case of a patient with a diagnosis of dissecting hematoma of the esophagus with rupture to the abdominal cavity causing significant hemoperitoneum. A review of the subject is carried out(AU)

Specific characteristics of the medical history of swallowing before and after application of botulinum toxin in patients with cervical dystonia

OBJECTIVES: To compare signs and symptoms of dysphagia in individuals with cervical dystonia (CD) before and after application of botulinum toxin (BTX). METHODS: A prospective study was conducted with 20 patients diagnosed with CD with indications for BTX application. We selected 18 patients who met the study inclusion criteria. All individuals were patients from the Movement Disorders Unit, Department of Neurology, Federal University of São Paulo. BTX was applied in the cervical region at the necessary dose for each individual. To identify signs/complaints of changes in swallowing, we used a specific questionnaire that was completed by patients and/or their companions on the day of BTX injection and repeated 10 to 15 days after BTX injection. RESULTS: Among the 18 study subjects, 15 (83.3%) showed primary and three (16.7%) showed secondary cervical dystonia. The most frequent dystonic movements were rotation (18), tilt (5), forward shift (3), backward shift (7), shoulder elevation (12), shoulder depression (2), and cervical tremor (6). The main complaints reported before BTX application were voice changes in 10 (55.6%), need for adjustment of eating position in 10 (55.6%), coughing and/or choking while eating in nine (50%), and increased eating time in nine (50%) individuals. The main complaints reported after BTX application were coughing and/or choking while eating in 11 (61.1%), voice changes in nine (50%), sensation of food stuck in the throat in eight (44%), and increased eating time in eight (44%) individuals. CONCLUSION: The administration of a swallowing-specific questionnaire to individuals with CD before and after BTX application enabled the identification of possible dysphagia symptoms prior to drug treatment resulting from CD, which are often subsequently interpreted as side effects of the drug treatment. Thus, dysphagia can be managed, and aspiration symptoms can be prevented.

Conhecimento das equipes médicas e de enfermagem sobre o manejo de medicamentos orais no paciente adulto disfágico hospitalizado / Knowledge of the medical and nursing teams about the management of oral medications in hospitalized adult dysphagic patients

RESUMO Objetivo Descrever o conhecimento das equipes assistenciais sobre a disfagia e prescrição e administração de medicamentos orais em pacientes disfágicos adultos. Métodos Estudo transversal, realizado com médicos, enfermeiros e técnicos de enfermagem das unidades de internação e terapia intensiva em hospital universitário do Sul do Brasil. Participaram 102 profissionais, que responderam questionários adaptados e previamente testados para a pesquisa. As variáveis exploratórias foram: dados sociodemográficos; orientação acadêmica e profissional sobre disfagia; conhecimento sobre disfagia; fases da deglutição; sinais, sintomas e comorbidades associados à disfagia; manejo, prescrição e administração de medicações no paciente disfágico. Resultados Dos entrevistados, 93,5% dos médicos, 100% dos enfermeiros e 97,8% dos técnicos de enfermagem sabiam o que é disfagia. A maioria reconheceu o fonoaudiólogo como responsável pela reabilitação da deglutição, mas não identificou os sinais e sintomas da disfagia, sendo o engasgo na deglutição o mais reconhecido. Ao prescrever medicamentos, 58,1% dos médicos responderam que não cogitam vias alternativas (enteral ou endovenosa) para administração medicamentosa e 22,5%, que orientam a equipe de enfermagem sobre como administrar em pacientes disfágicos. A maioria dos enfermeiros e técnicos - 50,0% e 68,9% respectivamente -, informou que tritura o medicamento, misturando com água, e 65,4% e 46,7%, respectivamente, mencionaram que se sentem pouco preparados para administrar medicamentos em pacientes disfágicos. Conclusão O conhecimento das equipes assistenciais ainda é incipiente, quando relacionado ao cuidado do paciente adulto disfágico hospitalizado e ao uso de medicações por via oral. O compartilhamento de saberes, o investimento em educação permanente e a qualificação durante a formação destes profissionais é fundamental para melhorar o atendimento integral ao paciente.

ABSTRACT Purpose To describe the knowledge of healthcare teams about dysphagia, prescription, and administration of oral medications in dysphagic adult patients. Methods Cross-sectional study that included physicians, nurses, and nursing technicians from Hospitalization and Intensive Therapy Units of a university hospital in southern Brazil. A total of 102 professionals participated and answered an adapted and previously tested survey for this research. Exploratory variables were: sociodemographic data; academic and professional guidance on dysphagia; knowledge about dysphagia; phases of swallowing; signs, symptoms, and comorbidities associated with dysphagia; management, prescription, and administration of medications in the dysphagic patient. Results 93.5% of the physicians, 100% of the nurses, and 97.8% of the nursing technicians know what dysphagia is. Most recognize the speech therapist as being responsible for swallowing rehabilitation; however they do not identify the signs and symptoms of dysphagia; choking during swallow was the most recognized symptom. For prescription drugs, 58% of the physicians do not consider alternative routes (enteral or intravenous) for administration, and 22.5% advise the nursing staff on how to manage patients with dysphagia. Most nurses and nursing technicians, 50,0% and 68,9% respectively, crush the medicine and mix it with water; and 65,4% and 46,7%, respectively, feel unprepared to administer medications in patients with dysphagia. Conclusion The knowledge of healthcare teams is still incipient when it comes to the care of the hospitalized adult dysphagic patients and the use of oral medications. Knowledge sharing, investment in permanent education, and qualification during the education of these professionals is fundamental to improve the integral care to the patient.

Acalasia, experiencia de 6 años. Hospital "Dr. Rafael Ángel Calderón Guardia" (2001-2007) / Achalasia, a 6 Years Study at the Calderon Guardia Hospital

Objetivos: Caracterizar la población de pacientes vistos con esta entidad en el Hospital "Dr. Rafael Angel Calderón Guardia" durante los últimos 6 años y determinar su presentación clínica, método(s) de diagnóstico utilizado (s), tratamiento brindado y evolución durante el primer año postratamiento. Materiales y métodos: Se analizaron los expedientes clínicos de hospitalización de los pacientes con acalasia atendidos desde enero de 2001 hasta enero de 2007; luego se revisaron las notas de evolución de la consulta externa de Gastroenterología durante el año posterior a la terapia brindada. Resultados: Durante el periodo se analizaron 30 pacientes en total. Hubo una discreta predominancia del género masculino y la edad promedio en el momento del diagnóstico fue de 50,37 años. El 100% de los pacientes presentó disfagia de larga data y los síntomas asociados más frecuentes fueron la pérdida de peso y el dolor torácico. Los métodos diagnósticos más utilizados fueron la manometría esofágica, la endoscopía y el esofagograma. El tratamiento que más se empleó fue la dilatación neumática seguida de la cirugía. El 50% de los pacientes reinició o persistió con disfagia durante el año siguiente a su tratamiento. La incidencia de complicaciones fue baja y no hubo perforación esofágica. Conclusiones: Las características generales y la presentación clínica de los pacientes coincidieron con lo descrito en la bibliografía. El tratamiento que más se brindó fue la dilatación neumática. La mitad de los pacientes presentaron o continuaron con síntomas postratamiento.

Objectives: To determine the general characteristics of patients with diagnosis of achalasia seen during the last 6 years at the Dr. Rafael Angel Calderon Guardia Hospital, their clinical presentation, diagnostic methods utilized, treatments given and the presence of disphagia within the following year after therapy. Methods: We analized the clinical records of patients with achalasia seen from january 2001 to january 2007. We also reviewed out patient clinic notes, looking for the persistence or recurrence of disphagia during the first year after therapy. Results: 30 patients were found and included in the study. There was a slight male gender predominance, and an average age of 50,37 years. All the patients had long standing dysphagia, the other most frequent symptoms were weight loss (43,33%) and chest pain (13,33%). The more commonly used diagnostic methods were esophageal manometry, endoscopy and barium esophagogram. Pneumatic dilation was the most frequently utilized treatment (46,67%) followed by surgery (26,67%). Half the patients recurred or continue having dysphagia during the year following treatment. The rate of complications was low and there were no esophageal perforations or mediastinitis. Conclusions: The general characteristics and clinical presentation of the patients agreed with those mentioned in the literature. Esophagic manometry was the most used diagnostic test and esophageal dilation was the preferred treatment. The rate of dysphagia within a year posttreatment was high.

Forma intermediária de síndrome de Foix-Chavany-Marie / síndrome de Worster-Drought associada a movimentos involuntários: aspectos neuropsicológicos e fonoaudiológicos / Intermediary form of Foix-Chavany-Marie / Worster-Drought syndromes associated to involuntary movements: neuropsychological and phonoaudiological features

A síndrome de Foix-Chavany-Marie (SFCM) caracteriza-se por apraxia da fala associada à paralisia bilateral da face, palato mole, língua e musculatura da faringe, mas com preservação das funções reflexas e automáticas. Na síndrome de Worster-Drought (SWD), há predomínio da disartria. Descrevemos o caso de uma jovem de 18 anos, que apresenta os achados clínicos e radiológicos compatíveis com a forma intermediária de SFCM/SWD, acompanhados de movimentos involuntários (coréia e distonia), fato de ocorrência rara na descrição destas síndromes.

Drogas, disfagia e nutriçäo / Drugs, dysphagia and nutrition

After reviewing this article you should be able to:understand the term " dysphagia" and its clinical manifestations; understand the different components of the swallowing system; understand how different agents interact with the components of a swallowing system; be able to identify those most at risk of dysphagia and what drugs may contribute to, or exacerbate their dysphagia

Disfagia y odinofagia en el síndrome de inmunodeficiencia adquirida: presentación de un caso y revisión de la literatura / Dysphagia and odynophagia in acquired immunodeficiency syndrome: One case report and review of the literature

La esofagitis es una entidad nosológica frecuente en los pacientes con síndrome de inmunodeficiencia adquirida e inclusive puede ser la primera manifestación de seroconversión al virus de inmunodeficiencia humana. En este trabajo presentamos el caso de un paciente con odinofagia y una úlcera esofágica inespecífica que respondió al tratamiento con esteroides, así como una revisión de la literatura respecto a diagnóstico, tratamiento y pronóstico de la enfermedad

Alcoolizaçäo dos tumores inoperáveis do esôfago para paliar a disfagia: relato de 10 casos / Alcohol for unoperable esophageal tumors to lessen dysphagia: report of ten cases

Dez pacientes com disfagia causada por tumores esofágicos e da cárdia (nove com carcinomas de células escamosas e um com adenocarcinoma) foram submetidos a tratamento paliativo da disfagia pela injeçäo de álcool absoluto (95(GL), misturado ao azul de metileno a 0,5 por cento, intratumoral. O volume total injetado por via endoscópica variou de 4 a 41ml, em sessöes intervaladas de cinco dias. Avaliamos os resultados por estudo radiológico do esófago, observaçäo endoscópica e segundo os critérios de Bown, modificados. Anteriormente ao início do tratamento, o valor médio da disfagia era de 3,5 na escala de Bown. Ao fim das sessöes, essa média foi de 1,3. Todos os pacientes passaram a deglutir dieta pastosa, semi-sólida ou sólida. O tratamento era repetido quando havia recidiva da disfagia, com intervalo médio de 32,4 dias. Nao houve complicaçöes ou mortalidade em nossa casuística.

Use of isosorbide dinitrate for the symptomatic treatment of patients with Chagas' disease achalasia: a double-blind, crossover trial

1. A randomized, double-blind, placebo-controlled trial was carried out to determine the efficacy of isosorbide dinitrate (ISD) on diasphagia in patients with Chagasic achalasia. 2. Twenty-three patients with Chagas' disease and dysphagia entered the study ans 20 (87%) complelted the two 7-day treatment periods. Subjects were given either 5 mg ISD (12 patients) or placebo (11 patients) by the sublingual route for the first 7 days. On the 8 th day, patients crossed over and began another 7-days period during which they received the opposite, identical-appearing tablets. 3. Scores attributed by uniformed investigators for the frequency and severity of dysphagia were signidicantly lower (P,0.05) following ISD treatment than after the placebo period or for the pretreatment condition. A significantly higher degree of improvement of dysphagia was experienced by the patients during ISD treatment than during the placebo period. Fourteen patients experienced meal-related headaches during ISD, but not placebo treatment. The extent of improvement in general well-being due to ISD was the same when the drug given in the first or second test period. 4. Our results indicate that ISD, 5 mg by the sublingual route, is effective in alleviating dysphagia in patients with Chagasic achalasia but its usefulness is limited by the high rate of headache as a side effect