History Of Dysphagia Research Articles

Non‐functional metastatic thyroid carcinoma with oesophageal invasion and ulceration in a cat

AbstractAn adult, male, neutered, domestic shorthair cat was presented with a 2‐month history of dysphagia and a movable cervical mass. Cytology of the cervical mass was consistent with carcinoma. Thoracic radiographs revealed pleural effusion, cardiomegaly, diffuse patchy interstitial pattern and pulmonary nodules. Fluid analysis of the pleural effusion was consistent with marked septic neutrophilic inflammation, and Pasteurella multocida was isolated. Contrast‐enhanced cervical and thoracic computed tomography scan revealed a cervical mass in the region of the right thyroid lobe, with circumferential invasion of the oesophageal wall and well‐defined pulmonary nodules consistent with distant metastases. Oesophago‐gastroscopy was performed and revealed a proximal, oesophageal, mural mass causing severe intraluminal obstruction. Humane euthanasia was elected. Postmortem examination with histology and immunohistochemistry confirmed a thyroid carcinoma with oesophageal invasion and pulmonary metastases. The oesophageal mucosa was extensively disrupted and ulcerated by the thyroid carcinoma. Additionally, echocardiogram and postmortem examination confirmed cardiomyopathy and congestive heart failure.

Middle Lobe Syndrome: A Case Report and Literature Review

Background: Middle lobe syndrome (MLS) is a distinct clinical and radiographic entity characterized by recurrent or chronic collapse of the middle lobe of the right lung, but it can also involve the lingula of the left lung. Case Study: This study presents a rare case of MLS caused by a vascular ring never described in the literature until now and provides physicians with the clinical and instrumental tools in order to early recognize and promptly treat this condition. The case report was reported according to CARE guidelines. A literature research on PubMed/MEDLINE was also performed using the MeSH terms “Middle lobe syndrome OR MLS AND double aortic arch” “Middle lobe syndrome OR MLS AND vascular rings”. No case described in the literature was found. In most cases, MLS presents non-specific respiratory symptoms, which unfortunately is responsible for the diagnostic delay that patients with this pathology often suffer. The diagnostic delay is estimated to be 8 months (range 3 to 36 months). A history of dysphagia and regurgitation can be indirect signs of a vascular compression, such as vascular rings, which can cause MLS. Conclusion: To date, the reported case is the only case in the literature of MLS caused by double aortic arch. The key point for the diagnosis of MLS is diagnostic suspicion. Early recognition of MLS is essential to quickly start a targeted therapeutic program avoiding the persistence of vicious circle atelectasis-recurrent respiratory infections, and this could significantly improve the long-term outcome of these patients.

Solitary fibrous tumor of the stomach

Abstract Introduction/Objective Solitary fibrous tumor (SFT) is an uncommon fibroblastic tumor that originates from the mesenchymal tissue. It has been rarely reported within the stomach. None of these reported tumors have occurred in a background of autoimmune atrophic gastritis as was seen in our patient. Methods/Case Report Case report Results (if a Case Study enter NA) An 85-year-old female with history of anemia and autoimmune atrophic gastritis presented with two-month history of dysphagia and abdominal discomfort. Upper gastrointestinal endoscopy showed a 1 cm subepithelial lesion in the gastric body along the greater curvature. Upper endoscopic ultrasound showed mildly hypoechoic lesion in the submucosa of the stomach with the differential of leiomyoma, neuroendocrine tumor, gastrointestinal stromal tumor, and an atypical looking lipoma. The entire gastric lesion was lifted with submucosal saline injection and then resected using cap endoscopic mucosal resection (EMR) snare cautery. Gross examination showed a well-circumscribed lesion with firm, tan-white cut surface. On microscopy, a bland appearing spindle cell proliferation within a collagenous stroma was seen with alternating hypercellular and hypocellular areas and few dilated vessels. No significant mitosis, nuclear pleomorphism or necrosis was identified. Immunohistochemical stains were performed and the lesional cells were positive for STAT6. Markers for gastrointestinal stromal tumor (CD117, DOG1), smooth muscle tumor (desmin, smooth muscle actin) and schwannoma (S100, SOX10) were negative. Nuclear staining for STAT6 is a sensitive and specific marker for SFTs. This particular SFT was considered to be of low risk and non-malignant considering its small size, lack of mitotic activity and tumor necrosis. The etiology for SFT is not entirely clear but molecular studies have shown that the NAB2::STAT6 translocation in a spindle cell neoplasm is a diagnostic hallmark for SFTs. Conclusion Solitary fibrous tumors have been rarely reported within the stomach. Complete surgical resection with negative margins is the mainstay of treatment as they may recur after an incomplete resection.

Case Report and Therapeutic Approach for Achalasia Cardia

Achalasia cardia is an uncommon esophageal motility disorder characterized by the impaired relaxation of the lower esophageal sphincter (LES) and the absence of peristaltic contractions in the esophageal body. This report presents a case of a 42-year-old woman with a prolonged history of dysphagia and regurgitation of solids and liquids. The patient's clinical history included a 10-year history of neck swelling, hypothyroidism, and diabetes mellitus. Physical examination and laboratory investigations revealed normal findings, except for elevated blood glucose, thyroid hormone levels, and thyroid-stimulating hormone (TSH) levels. An esophagogram showed proximal dilation of the distal esophagus with a contrast fluid level, and endoscopy revealed a tight LES, which was difficult to pass through. Based on these findings, the diagnosis of achalasia cardia was established. Initial medical management with nitrates and proton pump inhibitors did not provide significant improvement. Subsequently, the patient underwent laparoscopic Heller's myotomy with fundoplication, which successfully resolved her dysphagia symptoms. This case report highlights the diagnostic challenges and the importance of a multidisciplinary approach in managing achalasia cardia. It emphasizes the role of surgical interventions, such as Heller's myotomy with fundoplication, in alleviating symptoms and restoring esophageal function when conservative medical management fails

Dysphagia Is an Underrecognized Risk Factor for Viral Pneumonia Severity.

The aim of this study was to examine the role of pre-existing dysphagia as a risk factor for COVID-19 severity among adults ≥50years of age presenting to the emergency department (ED). This was a retrospective cohort study that used electronic health record data from two Midwestern EDs in the same health care system. The sample included patients ≥50years of age who tested positive for SARS-COV-2 during an ED visit between March 15, 2020 and November 19, 2020. Patients were dichotomized based on documented history of dysphagia. The primary outcome was the highest World Health Organization COVID-19 clinical severity score within 30-days of ED arrival. Patients with a score of <4 were classified as non-severe whereas a score ≥4 was considered severe. Chi-square tests were used to assess differences in clinical severity scores between patients with and without dysphagia. A logistic regression model was created to estimate the odds of a severe COVID-19 clinical score. The sample included 126 patients without dysphagia and 40 patients with dysphagia. Patients with a history of dysphagia were more likely to develop severe COVID-19 disease compared to patients without (65.0% vs. 41.3%, p = 0.015). In multivariable analysis, patients with preexisting dysphagia (OR 2.38, 95% CI: 1.05-5.42; p = 0.038) and diabetes (OR 2.42 95% CI: 1.15-5.30; p = 0.021) had significantly increased odds of developing severe COVID-19. This study showed that a pre-existing diagnosis of dysphagia was independently associated with COVID-19 severity in adults ≥50years of age.

Asymptomatic Dysphagia and Aspiration in Patients with Idiopathic Bronchiectasis

PurposeAlthough considered contributors to idiopathic bronchiectasis (IB), neither dysphagia nor silent aspiration have been systematically evaluated in IB patients. We aimed to explore the prevalence of asymptomatic dysphagia and silent aspiration in IB patients and to identify parameters predictive of their presence.MethodsThis prospective cohort study included IB patients from our Pulmonary Institute without prior history of dysphagia and without prior dysphagia workup. Swallowing function was assessed by the Eating Assessment Tool (EAT-10) questionnaire and by the Fiberoptic Endoscopic Evaluation of Swallowing (FEES) test.ResultsForty-seven patients (31 females, mean age 67 ± 16 years) were recruited. An EAT-10 score ≥ 3 (risk for swallowing problems) was present in 21 patients (44.6%). Forty-two patients (89.3%) had at least one abnormal swallowing parameter in the FEES test. Six patients (12.7%) had a penetration aspiration score (PAS) in the FEES of at least 6, indicating aspiration. An EAT-10 score of 3 was found to be the ideal cutoff to predict aspiration in the FEES, with a good level of accuracy (area under the curve = 0.78, 95% CI 0.629–0.932, p = 0.03) and sensitivity of 83%. This cutoff also showed a trend towards a more severe disease using the FACED (forced expiratory volume, age, colonization with pseudomonas, extension of lung involvement, dyspnea) score (p = 0.05).ConclusionDysphagia is prevalent in IB and may be undiagnosed if not specifically sought. We recommend screening all patients with IB for dysphagia by the EAT-10 questionnaire and referring all those with a score of ≥ 3 to formal swallowing assessment.

A243 BONE MINERAL DENSITY AND DIETARY BONE NUTRIENTS DIFFER IN PATIENTS WITH CROHN'S DISEASE STRICTURES

Abstract Background Crohn’s disease (CD) phenotypes include inflammatory (non-stricture) and stricture behaviours. Strictures are bowel narrowing’s that may lead to obstructions and subsequent dietary restrictions to prevent blockages. Bone mineral density (BMD) in CD is affected by many factors including corticosteroid use, CD itself, but also dietary changes. Clinical gold standard for measuring BMD is by dual x-ray absorptiometry (DXA) scans. High-resolution peripheral quantitative computed tomography (HR-pQCT), a more precise imaging modality assesses volumetric BMD, bone geometry and bone microarchitecture. We aim to compare dietary intake, and bone quality in both stricture and non-stricture CD. Aims To identify nutritional patterns, bone quality differences and deficiencies between two subtypes of CD; including energy intake, dietary components and/or micronutrients Methods Individuals (≥55 years old) with ileal CD strictures (fixed, angulated bowel or thickened bowel with pre-stenotic dilation on diagnostic imaging), or inflammatory CD were prospectively recruited. Patients with short gut, celiac disease, dysphagia history were excluded. All patients completed DXA hip and spine scans and HR-pQCT radius and tibia scans. Dietary assessment questionnaires (Automated Self-Administered 24-hour Dietary Assessment Tool (ASA24), and Diet History Questionnaire III for food frequency over the past year were completed. Results 56 (27 inflammatory (48% female, mean age 64.2, BMI 28.7, 16 years CD duration) and 29 strictures (45% female, mean age 65.9, BMI 27.3, 25 years CD duration, 15 (51.7%) prior bowel resection) were included. 31/56 (55.4%) patients were on biologics and 11 (19.5%) had past corticosteroid exposure. DXA-based BMD for stricture versus non-stricture CD patients was not significantly different at the hip or spine. However, HR-pQCT-based radial total BMD (p=0.03), cortical thickness (p=0.01) and cortical area (p=0.04) were lower in stricture than non-stricture patients.11 (7 stricture, 4 inflammatory) patients with past steroids consumed more dairy (p=0.01), vitamin D (p = 0.04), and calcium (p=0.03) than other CD patients. Stricture patients had significantly less consumption of vitamin K (p=0.001), vegetables (p=0.02), calcium (p=0.03), and dairy (p=0.03). Conclusions Patients with CD strictures have lower BMD and cortical bone quality at the radius than those without strictures. Patients with CD strictures also consume significantly less vitamin K, calcium, and dairy, all vital dietary components to prevent OP, compared to non-stricture patients. Overall, the skeletal fracture risk is likely much greater in CD patients with strictures than without, due to greater inherent bone fragility, and less consumption of key nutrition building blocks of bones. Funding Agencies Koopmans Memorial Research Fund

Lymphoma presenting as a parapharyngeal space tumour

Among all head and neck tumours, approximately 0.5% to 0.8% localize in the parapharyngeal space, with Non-Hodgkin’s lymphomas in this region being exceptionally rare. They are documented in the literature either as isolated cases or in small case series. Here, we present a case involving a middle aged man who exhibited 4 month history of dysphagia and hoarse voice. Upon examination, showed a bulged left side of the soft palate and medialization of the pharyngeal wall. CT and MRI revealed a large lesion in the left parapharyngeal region pushing the pharynx anteromedially. Similar intensity enhancing lesion noted in nasopharynx. A transoral excision of parapharyngeal mass was performed, revealing a large B-cell non-Hodgkin’s lymphoma. Typically, parapharyngeal space tumours are benign, and surgery is the preferred treatment. Patient was transferred to tertiary care oncology hospital for further treatment. This case underscores the rarity but potential presence of extranodal non-Hodgkin’s lymphomas in the head and neck. Recognizing this pathology is crucial due to the different treatment approach it necessitates.

Child Neurology: Allgrove Syndrome: An Intriguing Etiology of Motor Neuron Disease in Children

Motor neuron diseases are a rare group of neurodegenerative disorders with considerable phenotypic heterogeneity and a multitude of etiologies in the pediatric population. In this study, we report 2 unrelated adolescents (a boy and a girl) who presented with 4-6 years of progressive difficulty in walking, thinning of limbs, and gradually progressive darkening of the skin. Examination revealed generalized hyperpigmentation of skin and features suggestive of motor neuron involvement such as tongue atrophy, wasting of distal extremities, and brisk deep tendon reflexes. On detailed exploration for systemic involvement, history of dysphagia, inability to produce tears, and Addisonian crises were evident. An etiologic diagnosis of Allgrove syndrome, which is characterized by a triad of achalasia, alacrimia, and adrenal insufficiency was considered. Next-generation sequencing revealed pathogenic variants in the AAAS gene, confirming the diagnosis. Steroid replacement therapy was initiated along with relevant multidisciplinary referrals. The disease stabilized in the boy and a significant improvement was noted in the girl. These cases highlight the value of non-neurologic cues in navigating the etiologic complexities of motor neuron diseases in children and adolescents. It is imperative for neurologists to develop awareness of the diverse neurologic manifestations associated with Allgrove syndrome because they are often the first to be approached. A multidisciplinary team of experts including neurologists, endocrinologists, gastroenterologists, ophthalmologists, and dermatologists is essential for planning comprehensive care for these patients.

Pre-hospitalization dysphagia and feeding tube placement in nursing home residents with advanced dementia.

Despite research demonstrating the risks of using feeding tubes in persons with advanced dementia, they continue to be placed. The natural history of dysphagia among patients with advanced dementia has not been examined. We conducted a secondary analysis of a national cohort of persons with advanced dementia staying at a nursing home stay before hospitalization to examine (1) pre-hospitalization dysphagia prevalence and (2) risk of feeding tube placement during hospitalization based on preexisting dysphagia. A retrospective cohort study consisting of all nursing home (NH) residents (≥66 years) with advanced dementia (Cognitive Function Scale score ≥2), a hospitalization between 2013-2017, and a Minimum Data Set (MDS) 3.0 assessment within 120 days before hospitalization. Pre-hospitalization dysphagia status and surgically placed feeding tube insertion during hospitalization were determined by MDS 3.0 swallowing items and ICD-9 codes, respectively. A multivariate logistic model clustering on hospital was used to examine the association of dysphagia with percutaneous endoscopic gastrostomy (PEG) feeding tube placement after adjustment for confounders. Between 2013 and 2017, 889,983 persons with NH stay with advanced dementia (mean age: 84.5, SD: 7.5, and 63.5% female) were hospitalized. Pre-hospitalization dysphagia was documented in 5.4% (n = 47,574) and characterized by oral dysphagia (n = 21,438, 2.4%), pharyngeal dysphagia (n = 24,257, 2.7%), and general swallowing complaints/pain (n = 14,928, 1.7%). Overall, PEG feeding tubes were placed in 3529 patients (11.2%) with pre-hospitalization dysphagia, whereas 27,893 (88.8%) did not have pre-hospitalization dysphagia according to MDS 3.0 items. Feeding tube placement risk increased with the number of dysphagia items noted on the pre-hospitalization MDS (6 vs. 0 dysphagia variables: OR = 5.43, 95% CI: 3.19-9.27). Based on MDS 3.0 assessment, only 11% of PEG feeding tubes were inserted in persons with prior dysphagia. Future research is needed on whether this represents inadequate assessment or the impact of potentially reversible intercurrent illness resulting in feeding tube placement.

A rare case of large retropharyngeal pre-vertebral chordoma presented as oropharyngeal swelling

Posterior oropharyngeal swelling can result from various pathologies, including chordomas. Chordoma is a notochordal remnant origin tumor. It is a rare bone and central nervous system tumor, especially in the cervical region. Chordoma is a tumor with properties such as slowly growing and frequently recur in most patients. This case report aims to comprehensively understand the clinical presentation and radiological features of a rare C2 retropharyngeal pre-vertebral chordoma. A 24-year-old male with a two-year history of dysphagia presented with progressively worsening symptoms, including dyspnea, dysphonia, and weight loss. On examination, a large mass was observed in the posterior oropharynx. Radiologically, a large soft tissue mass involves the C2 vertebral body, extending into the pre-vertebral soft tissue and compromising the airway. The mass appears hypointense in T1 weighted images, heterogeneously hyperintense in T2, and shows heterogeneous contrast enhancement. The chordoma was confirmed through histopathological analysis, showing characteristic physaliferous cells within a myxoid stroma. Posterior oropharyngeal masses require prompt and accurate evaluation. Radiological evaluation is crucial in identifying the tumor's origin, extent, and vascularity, aiding in diagnosis and treatment planning. Surgical resection is the primary treatment, but chordomas have a high recurrence rate even after complete removal. Radiotherapy can improve survival and reduce recurrence. This case highlights the importance of multidisciplinary collaboration in providing individualized care for rare chordoma presentations.

A rare case of congenital adult pharyngeal web causing airway obstruction managed by coblation technology

Congenital pharyngeal web is a rare anomaly almost always diagnosed in the paediatric population due to airway obstruction and feeding difficulties. The combination of congenital oropharyngeal and laryngopharyngeal web in an adult is extremely rare and has not commonly been published in the literature. We experienced a 47-year-old woman undiagnosed with pharyngeal web until difficult intubation upon surgery. A 47-year-old woman diagnosed with right ovarian complex cyst was scheduled for total laparoscopic hysterectomy and bilateral salpingo-oopherectomy. pharyngeal webs were incidentally found during intubation and necessitated a reschedule of surgery and tracheostomy. The patient had no history of dysphagia, weight loss or other symptoms of airway obstruction. Fibre optic laryngoscopic examination revealed a combination of congenital oropharyngeal and laryngopharyngeal webs. Patient denied previous history of caustic agent ingestion, oral airway surgeries, chemoradiation. After 2 days, awake tracheostomy with endoscopic guided coblator assisted excision of pharyngeal web was done first, followed by total laparoscopic hysterectomy and bilateral salpingo-oopherectomy in the same sitting. Coblation assisted excision of the pharyngeal web will allow the airway to be feasible for intubation in the future. Congenital pharyngeal webs are extremely rare findings, especially in adult patients. Prediction of difficult airways preoperatively is necessary to prevent difficult airway situations. Controlled ablation of the pharyngeal web gives a good outcome in terms of less post-operative pain and blood loss.

Accuracy of the volume-viscosity swallow test for clinical screening of dysphagia in post COVID-19 patients

Up to 30% of patients hospitalized for COVID-19 had oropharyngeal dysphagia, particularly those in the ICU. Many cases remained underdiagnosed due to difficulties in conducting instrumental evaluations during the pandemic. Consequently, screening tests were mandatory during this period. To evaluate the accuracy of the volume-viscosity swallow test (V-VST), compared to gold standard videofluoroscopy, for screening dysphagia in a post-COVID cohort of patients. We conducted a prospective single-center study involving 58 post-COVID adult patients with no previous history of dysphagia. Blinded raters performed the index V-VST upon admission and a standardized videofluoroscopy (VFSS, the reference test) within 72h of patient intake. Oropharyngeal residue was considered a sign of impaired efficacy. Cough, decreased oxygen saturation, and voice changes were noted as signs of impaired safety. Accuracy, sensitivity, specificity, positive, and negative predictive values, and likelihood ratios were calculated for V-VST results and compared to the gold standard. Patients (aged 59.98 (SD11.53) years) spent a mean of 46.98 (SD 28.43) days in ICU, 33.76 (SD34.88) days with tracheostomy, and 19.46 (SD13.26) days in the NeuroRehabilitation Unit. The V-VST showed the following properties, compared to VFSS: sensitivity 55.6%, specificity 62.9%, positive predictive value 44.5%, negative predictive value 37.1%, and accuracy 61.5%. The V-VST showed mild accuracy, sensitivity, and specificity, compared to VFSS. Therefore, it should not be used as a stand-alone test for screening dysphagia in patients with a history of COVID.

Diagnostic Dilemma due to Atypical Presentation of Sublingual Thyroid Ectopia: A Case Report

Thyroid tissue may be found in an abnormal location along the thyroglossal duct tract or other sites due to abnormal embryologic development and migration. Thyroid ectopia is an uncommon but well-documented clinical entity. In the event of any neck swelling, it should be kept as a differential diagnosis. Thyroid scintigraphy plays a very important role in diagnosing ectopic thyroid, with the complementary primary role of high-resolution neck ultrasonography (HRUS). Reported case of an 18-year-old male referred to INMAS for evaluation of a slowly enlarging submental swelling with no history of dysphagia or dyspnea was biochemically hypothyroid. Patient had a history of submental swelling that was misdiagnosed as an abscess, creating a diagnostic dilemma, as he was found to have glandular tuberculosis after surgical drainage of the lesion. Bangladesh J. Nuclear Med. 25(2): 125-127, 2022

Unmasked immune reconstitution inflammatory syndrome towards B-cell non-Hodgkin lymphoma during treatment of esophageal actinomycosis in a patient with advanced HIV: a case report

BackgroundActinomycosis is an unusual chronic bacterial infection, even rarer in people living with HIV. It is not considered an AIDS-defining disease. However, the role in co-presentation or overlap with other opportunistic conditions of advanced HIV is unknown.Case presentationA 49-year-old Peruvian male presented with a 4-month history of dysphagia, odynophagia, hyporexia and wasting. He underwent an upper digestive endoscopy, in which ulcers with a necrotic center were observed, therefore, the initial diagnostic assumption was esophageal cancer. Subsequent pathology report excluded neoplasms and confirmed the diagnosis of actinomycosis. Serology for human immunodeficiency virus was requested, yielding a positive result. Antimicrobial treatment with amoxicillin and antiretroviral therapy were indicated, with slow clinical improvement. After 4 months, epigastric discomfort presented, for which a new upper digestive endoscopy was performed, revealing a deep gastric ulcer, which was compatible with diffuse large B-cell non-Hodgkin lymphoma.ConclusionEsophageal actinomycosis in people living with HIV is very rare. We suggest HIV-associated immunosuppression is not enough to allow for actinomycosis to develop, and masked underlying entities should be sought. The existence of such entities in people living with HIV should raise awareness of the possibility of unmasked immune reconstitution inflammatory syndrome once treatment has started.

Concurrent Killian-Jamieson and Zenker's Diverticula.

Pharyngoesophageal diverticula are rare causes of dysphagia. Zenker's diverticulum is the most common type, followed by Killian-Jamieson diverticulum. A 44-year-old male presented to our clinic with a longstanding history of dysphagia and globus sensation. Bilateral pharyngoesophageal diverticula were confirmed by imaging CT and esophagogastroscopy. He underwent transcervical resection, and a right Killian-Jamieson diverticulum was observed during surgery. The left diverticulum was found to originate above the cricopharyngeus muscle and was labeled as Zenker's diverticulum. Bilateral pharyngoesophageal diverticula are rare, and physicians should be aware of the variable clinical presentations and management options for pharyngoesophageal diverticula.

Gastrointestinal Complications After Transesophageal Echocardiography for Mitral Valve Transcatheter Edge-to-Edge Repair: Insights From a Large Contemporary Cohort

Transesophageal echocardiography-related complications (TEE-RC) are higher in structural heart interventions than in traditional operative settings. In mitral valve transcatheter edge-to-edge repair (MV-TEER), the incidence of TEE-RC may be higher than in other structural interventions. However, existing reports are limited and robust data evaluating TEE safety in this patient population are lacking. The authors sought to describe the incidence and risk factors of upper gastrointestinal injuries after TEE in patients undergoing MV-TEER. A retrospective observational study. A single tertiary academic hospital. A total of 442 consecutive patients who underwent MV-TEER, specifically with MitraClip, between December 2015 and March 2022. Transesophageal echocardiography was performed intraoperatively to guide all MV-TEERs. The study's primary goal was to investigate an association between TEE procedure duration and TEE-RC risk. The contribution of demographic risk factors and intraprocedural characteristics also was investigated. Transesophageal echocardiography-RCs were observed in 17 out of 442 patients (3.8%). Dysphagia was the most common TEE-RC (n=9/17, 53%), followed by new gastroesophageal reflux (n=6/17, 35%) and odynophagia (n=3/17, 18%). There were no esophageal perforations or upper gastrointestinal bleeds. History of dysphagia was the only variable associated with TEE-RCs (p=0.008; n=9 [2.1%] v n=3 [18%]), with a relative risk of 8.67 (95% CI 2.57, 29.16). The TEE procedure duration was not statistically different between the 2 groups (46 minutes [39-64] in TEE-RCs v 49 minutes [36-77] in no complications). In patients undergoing MV-TEER, TEE-RCs are uncommon, and major complications are rare. The authors' outcomes reflect those of a high-volume referral center with TEEs performed by cardiac anesthesiologists.

Pectoralis Major Metastasis of Esophageal Adenocarcinoma: An Unusual Site

Esophageal cancer is a tumor of poor prognosis and its most common sites of metastases are lymph nodes, lung, liver and bones. However, it has also been reported some unexpected metastasis to uncommon sites which has consequently affected the pathway of diagnosis, management and staging. We report the case of a 31year old man patient with history of dysphagia, weight loss and induration in the left pectoral region. Endoscopic, radiological and pathological examination confirmed the diagnosis of Esophageal adenocarcinoma with pectoralis major metastasis. The patient was qualified for radiotherapy and concurrent systemic chemotherapy. Unfortunately, the patient died 3 months after the first CRT.

Pectoralis Major Metastasis of Esophageal Adenocarcinoma: An Unusual Site Abdelfettah Touibi, Imane Mouslim, Rachid Laaroussi, Sanaa Berrag, Fouad Nejjari, Tarik Adioui, Mouna Tamzaourte Published: May 30, 2023 | 10 19 DOI: 10.36347/sjmcr.2023.v11i05.069 Pages: 1034-1037 Downloads Abstract Esophageal cancer is a tumor of poor prognosis and its most common sites of metastases are lymph nodes, lung, liver and bones. However, it

The case revolves around a 62-year-old male patient who was a smoker and had inadequately-controlled hypertension and dyslipidemia. He was admitted to the Medical Intensive Care Unit after having an emergency PCI (percutaneous coronary intervention) performed on his LMS (left main stem) and LAD (left anterior descending). The patient had gone into acute cardiogenic pulmonary edema, which immediately warranted intubation. He had been diagnosed with a case of anterolateral STEMI (an ST-elevation myocardial infarction) which had led him to develop this condition. A bedside ECHO carried out revealed problems with his heart as well, and particularly the left ventricle. This put him at a great risk of developing cardiac arrest, which could have fatal consequences if not appropriate interventions were not carried out. To resolve this condition, an IABP (an intra-aortic balloon pump) was inserted under the guidance of an ECHO, and only once the ROSC (return of spontaneous circulation) had been achieved. Once everything had been settled, an infusion of noradrenaline and vasopressin was started. The IABP was maintaining pressure at 100 mm Hg. The patient was extubated after six days and his IABP was removed four days later. To assess if there was any internal damage to his brain, a plain CT scan of the brain without contrast was ordered, which revealed cerebellar infarcts. This infarct had manifested itself in the form of hypophonia and wide-based ataxia. By the end of his stay at the hospital, the patient had started to walk and had greatly stabilized. The prognosis seemed favorable and the patient’s life was saved on discharge medications protocol. This case study is an example of how cardiopulmonary resuscitation, if done correctly and promptly, can help save the life of a patient with very little hope. It can be a matter of seconds before a patient’s condition deteriorates or turns fatal. The same applies to patients undergoing sudden cardiac arrest (SCD), .........

Unusual Presentation of Anca Vasculitis with Otitis Media and CVA

A 42-year-old African female (Kenyan in origin), known to have hypertension that was diagnosed during gestation and persisted; presented with a history of dysphagia for four years. Before her admission, she had presented to the surgical clinic with ear fullness and ear pain with throbbing headaches, and she was diagnosed with bilateral oto-mastoditis. Her symptoms subsequently, progressed to a multisystemic disease involving the lungs, brain, kidneys, and peripheral nerves. ANCA vasculitis is a rare disease, the main target organs in granulomatous polyangiitis include the ear, nose throat, and upper respiratory tract, and glomerulonephritis of the kidney and the lungs. Localized disease manifestation can include the nose (rhinorrhea, nasal crusts, septal perforation) and ear (otitis media, hearing loss, sensorineural deficits). The diagnosis of vasculitis from localized disease manifestation can be difficult to diagnose.