Diseases List

Eosinophilic Esophagitis Causing Esophageal Dysmotility

We describe a case of eosinophilic esophagitis in a 38- year-old man with aspirin-sensitivity asthma which presented as noncardiac chest pain. Manometric mea­surements demonstrated tertiary contractions. Biopsies showed a dense eosinophilic infiltrate in the mucosa. There was no response to therapy for reflux. Symptoms quickly resolved with corticosteroid therapy. Subsequent manometric values recorded after corticosteroid therapy showed resolution of the dysmotility. Biopsies showed normal mucosa. Adult asthmatic subjects with noncardiac chest pain should receive further investigation if reflux therapy fails to resolve the symptoms.

The most common esophageal symptoms in asthmatic subjects are due to gastroesophageal reflux. Reflux may worsen the asthma, and control of the asthma may not occur until the reflux is adequately managed. Many medications used to treat asthma decrease lower esophageal sphincter tone. This may contribute to the reflux symptoms. Therefore, reflux is commonly seen in both children and adults with asthma, both as a cause of the asthma and as a consequence of treatment.

In this case report, we describe an asthmatic patient with a long history of reflux who develops a new chest pain syndrome related to, but distinct from, the reflux. Initial attempts to manage the reflux did not decrease the pain. A  diagnosis of dysmotility was made by esophageal manometric measurements. Mucosal biopsy demonstrated eosinophilic esophagitis. The patient promptly responded to corticosteroid treatment. 

Case Report

A 38-year-old man with asthma was seen for a 1-month history of atypical chest pain. The pain was substemal, squeezing, and did not radiate. The pain often awoke the patient at night. Sometimes the pain was preceded by heartburn. It was partially relieved by antacids and swallowing cold liquids. The episodes of pain would last from 15 min to several hours. There was no shortness of breath or diaphoresis. There was no exertional component. The chest pain was preceded by a 2-week history of increased nasal discharge. There were no new medications, new foods, or changes in diet.

Recently, it has become apparent that invasive thymoma is relatively sensitive to combination chemotherapy and that survival is relatively long. In two fairly large series using the РАСregimen or a combination of cisplatin, doxorubicin, vincristine, and cyclophosphamide, overall response rates ranged from 70 to 91.8%, with median durations of response averaging 11.9 months and median survival ranging from 15 to 37.7 months. Recendy, РАСwith etoposide and concurrent granulocyte colony-stimulating factor had been used for advanced thymoma or thymic cancer with a reported 42.9% response rate (all partial remissions) but with significant bone marrow toxicity. The РАСregimen was chosen for our patients because of the favorable response rates noted. We substituted carboplatin for cisplatin for easier outpatient administration. The concurrent use of oral prednisone in case 1 was not a likely confounding factor because his tumor progressed during low-dose steroid therapy.

Our patients developed progressive thymoma after ini­tially responding to combination chemotherapy consisting of cyclophosphamide, doxorubicin, and carboplatin. The standard treatment options for this situation, in order of decreasing effectiveness, are a subsequent surgical resection, radiotherapy, and corticosteroid use. There are reports of small prospective trials of second-line chemotherapy using various regimens (single or in combination) with disappoint­ing results.^{3 7} The role of low-dose oral etoposide in the management of recurrent thymoma has not been evaluated in clinical trials although there are reports of some efficacy as first-line therapy in combination with cisplatin. We elected to use the same chemotherapeutic regimen to treat our patients’ recurrences because their disease had re­sponded to the РАСregimen previously, because the disease-free interval was greater than 6 months, and because there was evidence that secondary responses occurred with the same regimen in lung, breast, and ovarian cancers as well as in Hodgkin’s lymphomas. Higher response rates were noted when the disease-free intervals were greater than 12 months in breast cancer, 24 months in epithelial ovarian cancer, and 12 months in Hodgkin’s lymphoma. The disease-free intervals in our patients were 14 and 60 months, respectively.  

Several investigators have reported cases of second-line chemotherapy using different regimens with mixed results. In three patients who had relapses following therapy with a regimen of combination cisplatin, doxorubicin, vincristine, and cyclophosphamide, treatment  with cisplatin, etoposide, and ifosfamide resulted in stable disease in two patients.³ Only one other report of a response to salvage chemotherapy with the same regimen was noted in the medical literature. Kosmidis et al reported a case of unresectable invasive thymoma treated with radiotherapy with an 80% response but 4 months later there was disease progression. Local recurrence was treated with cyclophosphamide, doxorubicin, and vincristine, which produced a partial response. The patient refused further treatment against medical advice. Nine months later, the patient presented with renal and abdominal lymph node metastasis. This was treated with the same combination of drugs, again producing a significant improvement consisting of a more than 50% reduction in tumor bulk, noted both clinically and radiographically. The patient eventually had a relapse 9 months after reinitiation of chemotherapy and died of renal failure.

A 54-year-old white man without any significant past medical history presented to our institution in June 1989 with a 4-year his­tory of vague anterior neck swelling and discomfort. A neck MRI at this time demonstrated a large solid soft-tissue mass in the lower area of the left side of the neck with mediastinal extension, tracheal deviation, and left innominate vein occlusion. A chest radiograph suggested a right pleural effusion. He was subsequently admitted to the hospital, and a needle biopsy of the neck mass demonstrated malignant thymoma. He received 3 courses (every 21 days) of cy­clophosphamide (500 mg/m ), doxorubicin (50 mg/m²), and cis- platin (50 mg/m²) from July 28 to September 20, 1989, resulting in a 50% reduction in the tumor size and resolution of the pleural ef­fusion. A thymectomy was performed in October of 1989 with re­section of all visible tumor. He had mediastinal radiotherapy (60 Gy) thereafter, completing treatment in December 1989. He did well for 5 years until February 1995 when he presented with cough and hoarseness. An ear, nose, and throat evaluation revealed left vocal cord paralysis, tracheal deviation to the right, and a palpable mass in the suprasternal notch adjacent to the left sternoclavicular joint. A CT scan of the neck and chest demonstrated an ill-defined 3.0×2.5-cm mass to the left of the trachea at the thoracic inlet and a 1.5×2.0-cm anterior mediastinal lymph node. Recurrent thymoma was confirmed by ultrasoundguided biopsy of the tumor. He began 4 courses (every 28 days) of carboplatin (300 mg/m²), doxorubicin (40 mg/m²), and cyclophosphamide (400 mg/m²) from Feb­ruary to June 1995. A postchemotherapy chest CT scan showed that the tumor and anterior mediastinal lymph node were no longer detectable. A positron emission tomography scan done 2 months later revealed no evidence of malignancy. He continues to do well and remains in remission as of February 1996, 8 months after his remission was noted.

A 26-year-old Asian man was first seen at our institution in No­vember 1978 with a diagnosis of myasthenia gravis requiring ther­apy with prednisone and subsequently a thymectomy in December 1978. During the next decade, he suffered recurrent upper respiratory tract infections and myasthenic exacerbations. He was read­mitted to this hospital in May of 1992 for productive cough and fe­ver. A chest radiograph done at this time showed an anterior mediastinal mass, and a subsequent CT scan confirmed the presence of recurrent mediastinal thymoma with pleural metastasis which was later confirmed by mediastinoscopy and biopsy. In late May, an open thoracotomy was performed, which showed tumor involvement of the parietal pleura and both vagus and phrenic nerves, precluding complete resection of the tumor. The patient was therefore offered and agreed to treatment with chemotherapy consisting of four courses (every 21 days) of a combination of carboplatin at 300 mg/m², doxorubicin at 50 mg/m², and cyclophosphamide at 500 mg/m² beginning on July 6, 1992. Prior to starting chemotherapy and throughout the treatment period, the patient received prednisone for myasthenia gravis and asthma with daily oral doses averaging 10 to 15 mg. The patient eventually completed chemotherapy on September 28, 1992. Chest radiographs taken immediately before and after chemotherapy revealed a reduction in size of the tumor from a 5×4-cm irregularly sized mass to an indistinct haziness over the left lung field. He continued to remain in clinical remission until December 1993 when he was readmitted for a malignant right-sided pleural effusion requiring chest tube drainage and pleurodesis. The chest radiograph at this time revealed a 6.5-cm pleural based mediastinal mass in the left hemithorax consistent with recurrent thymoma. A chest CT showed multiple large inhomogenous pleural-based soft tissue masses in the left hemithorax and the anterior mediastinum (Fig 1). At this time, the patient received another course of the РАСregimen at adjusted doses: carboplatin, 300 mg/m²; doxorubicin, 40 mg/m²; and cyclophosphamide, 400 mg/m²; the therapy was administered at 4-week intervals for a total of 4 cycles beginning in late December 1993. Another chest CT scan in April 1994 showed a reduction in the size of the mediastinal mass from 9×10 cm at the widest dimensions to 7×3 cm (Fig 2). By May of 1994, a month after the last cycle of therapy was administered, a chest CT scan revealed complete res­olution of the mass adjacent to the aortic arch. Throughout this time, he was receiving prednisone at an average dose of 2.5 mg daily for myasthenic symptoms. He remained in clinical remission for 6 months when recurrence of the tumor was noted over the anterior mediastinum and left hemithorax. His health progressively deteriorated until he died with severe pneumonia and progressive thymoma in June of 1995.

Invasive thymoma recently has been shown to be sen­sitive to combination chemotherapy and in some cases to be relatively indolent. Two cases of extensive thymoma which responded to primary treatment with a combination of a platinum compound (carboplatin or cisplatin), doxorubicin (Adriamycin), and cyclophos­phamide (or РАС) are described. Tumor progression occurred 14 (case 1) and 60 months (case 2) after completion of initial РАСtherapy and was treated with the same regimen resulting in a second remission, which lasted 6 months in case 1 and is continuing at 8 months in case 2. Similar reports of secondary re­sponses using the same chemotherapy have been de­scribed in breast, lung, and ovarian cancers, as well as in Hodgkin’s lymphomas. Our observations suggest that retreatment with the same platinum-based regimen should be considered in patients who have progressive thymoma following a previous chemotherapeutic response and a disease-free interval of greater than 12 months.

Thymomas are rare tumors of the anterior superior me­diastinum, accounting for about 15% of all mediastinal masses. Although thymomas are histologically benign and grow indolently, some invade the surrounding structures and behave as malignant tumors. Only 40% of thymomas are completely encapsulated, with no evidence of microscopic invasion. Traditional management of invasive thymomas generally involves surgical resection and radiotherapy, but recently cytotoxic chemotherapy, particularly regimens us­ing cisplatin, doxorubicin (Adriamycin), and cyclophosphamide (РАС), has been shown to produce response rates of 70 to 91.8%. In addition to being relatively sensitive to chemotherapy,⁵ it appears that invasive thymomas are somewhat indolent with some incurable patients surviving for years. Therefore, some patients who initially responded to chemotherapy will be candidates for salvage chemother­apy.

This is a report of two patients with unresectable invasive thymoma who initially responded to a course of a platinum compound, РАС, and whose recurrence again responded to  РАС. These appear to be the first reported cases of thymoma in which the same platinum-based regimen achieved a sec­ondary remission.

Venous Leak

I tell patients to think of their penis like a tire, with a hose and a valve being present. The hoses are represented by the left and right cavernosal artery while the valve mechanism is the veno-occlusive mechanism. Positioned between a tunica albuginea externally and the corporal smooth muscle internally are a series of subtunical venules. As the smooth muscle expands in a three-dimensional fashion under nitric oxide control, the subtunical venules are compressed against the tunica. This is the venoocclusive mechanism. In condi-tions where the muscle fails to expand adequately some or all of the subtunical venules are left in a noncompressed state, and this results in the concept we know as venous leak (synonyms: corporo venocclusive dysfunction, venogenic erectile dysfunction). The two things that lead to failure of the corporal smooth muscle to expand are adrenaline, the world’s most potent antierection chemical and structural changes such as fibrosis. Priligy Australia – dapoxetine online.

Nehra et al. have shown in human corporal tissue biopsy taken at the time of cavernosome try that once smooth muscle content in the penis drops below 40% venous leak occurs. Indeed, the further this figure dropped below 40%, the greater the magnitude of leak is. Iacono et al. have shown that as early as 2 months after radical prostatectomy in an untreated man there is a marked increase in collagen deposition and a marked increase in elastic fiber content in erectile tissue. This is in keeping with the animal data outlined above that suggest even in the earliest stages after cavernous nerve injury, structural changes occur. Mulhall et al. have shown in a series of 16 patients who had preoperative and postoperative hemodynamic assessment that more than half of the men had venous after surgery. In a more recent analysis by Mulhall et al., in men who had partner corroborated excellent erectile function prior to surgery, who underwent duplex Doppler penile ultrasound after surgery, there was an increase in the incidence of venous leak (based on elevated and diastolic velocities) as time progressed after surgery. The incidence of venous leak less than 4 months after surgery was approximately 10% and rose to 35% between 8 and 12 months after surgery and 50% after 12 months. The importance of this information is that in the same series, men with normal erectile hemodynamics were more likely to have recovery of natural erectile function. However, only 8% of men who had venous leak had recovery of natural functional erections after surgery. We also know from other data that men with venous leak are far less likely to respond to PDE5 inhibitors than men with arterial insufficiency.

Shingles is a virus that occurs in the body when the Chicken Pox (varicella virus) becomes re-activated again at a later stage of life. This most commonly occurs in adults or seniors, mainly due to a weakened or compromised immune system. Severe stress can also result in the virus appearing.

The first symptom of Shingles is a pain that appears in a specific region of the body. Soon after, a rash of blisters will appear. It will be extremely painful, and sometimes even be itchy or have a burning sensation. While most doctors will prescribe medication or drugs, it is important to be aware of the various home treatment for Shingles that are available.

What is the best Home Treatment for Shingles?

The best home treatment for Shingles is lemon balm. Lemon in general is very healthy and helps in any illness and virus due to its immune system boosting abilities and a lot of Vitamin C content. It is also an anti-viral and when taken, can help slow down and even stop the internal spread of the virus.

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• There are many ways to use lemon, one is to use it in a paste or balm and apply it to the burning skin. Drink it warm or cool; just make sure that you drink plenty of it, at least seven cups daily. It will not only provide you a good quantity of Vitamin C, but also relax you to feel comfortable against the virus attack. The teabag of your tea is also very effective. Let it cool, or if you find that cool compresses help ease the itch, burn and nerve pains then stick it in the fridge for a while and then apply directly to the skin.
• Another great home treatment for Shingles is to take an Oatmeal Bath, which has been used for ages for the Chicken Pox as well. Other popular bathing procedures are using Baking Soda or Neem Leaves. This helps ease the pain and reduce itchiness.

Since the primary cause of the virus is due to a weakened or compromised immune system, it is important to take care of your health and eat well so that you can boost your immune system. You also want to reduce stress from your life. If you do this, added to the home treatment for Shingles mentioned above, you will be well on your way to getting rid of your rash in a safe, natural and effective way.

Millions of people suffer from chronic rhinosinusitis. For those who have failed medical management with antihistamines and other over-the-counter or prescription medications, surgical treatment may be necessary to improve the natural drainage of the sinuses. The technical aspects of surgery have advanced her medically over the last several years.

Sinus surgery started out many years ago as a surgery which needed several days of recovery and often required packing to be placed into the nose. Today, the latest technology allows for sinus surgery to be performed on an awake patient in an office setting without the need for packing. The technology is called a balloon sinuplasty and has shown to be effective at long-term followup.

For patients who suffer from chronic rhinosinusitis, the first step to determining if surgery is necessary is to obtain imaging of the sinuses with a CT scan. If there is an anatomic obstruction to the natural flow of the sinuses, surgery may be needed to open the sinus drainage pathways. In some patients, the nasal anatomy needs to be improved.

For patients with favorable anatomy, the balloon sinuplasty technique can be used. The technique uses balloons similar to those used in heart surgery which are placed through the nose into the natural openings of the sinuses. The balloon is then inflated and the opening is widened. This can be used to open the maxillary, frontal, and sphenoid sinuses. The ethmoid sinuses must be dealt with in other ways.

For patients with nasal polyps or who require the middle part of the inside of the nose call the nasal septum to be straightened, balloon sinuplasty can still be undertaken but is often performed with more than local anesthesia. For patients with more favorable anatomy, anesthesia can be provided in an office setting while the patient is awake inside of the nose and the balloon sinuplasty technique can be undertaken. This allows the patient to minimize the risk from general anesthesia and allows the patient to drive to and from the procedure as long as no other medications are given.

To determine if you are an appropriate candidate for awake sinus surgery, consultation with an ear, nose, and throat doctor who performs the procedure is necessary. The same technique can be performed using general anesthesia or with other procedures that may be necessary to completely address chronic rhinosinusitis in certain patients. As with all surgeries, there are risks inherent to this surgery and specific to each patient.

The goal of this article is to lay on the table an option for the severe colitis sufferers and to express my empathy to anyone living with this disease. The option is of a surgical nature that one may not be totally familiar with called the BCIR or Barnett Continent Intestinal Reservoir. Ultimately, I’d like to help you decide if it’s right for you, from the ramblings of a guy who actually has it. Years had gone by before I had even heard of the BCIR. I want to explain what it is in my own words and experiences. With something like 1.2 million cases in the US, colitis is more than just a few of us. But especially for the kids out there, I want to tell them not to let this disease beat them mentally, but to be positive, and remain hopeful. Don’t let this disease get the best of you; laugh at it, believe you are healed, and get proactive.

The Barnett Continent Intestinal Reservoir or BCIR is an intra-abdominal continent pouch that is surgically constructed from about two feet of your small intestine with a stoma located below your waistline. Primary candidates include the most severe colitis patients, and as I understand, people who require the removal of the entire colon, due to colon tumors, etc., are also candidates for the BCIR. So the operation is obviously not a cure for colitis but a solution to end the disease. Colitis being located in the colon, is removed along with the colon itself. Though the disease will be permanently removed from your body, it is just that, a permanent solution. Your anatomy and digestive process will be changed forever. This is where the pro and cons will come into play.

If your colitis is manageable and maybe new for you, a serious operation as the BCIR, may not be for you. But on the other hand, if you’ve been suffering for years and are in danger of colon cancer, then the pros of having the BCIR surgery may outweigh the cons. With a BCIR, you should be quite healthy and the effects of the colitis will no longer be present. So what are the cons of the BCIR? The most notable con that will impact one’s decision is the serious change in how you will use the bathroom. The BCIR is designed in a way that you would have to use a catheter to go number two. The catheter is inserted through a small hole below your waste called a stoma. Though a serious change, it’s something no one can see as long as you are wearing underwear. In less than a year, the whole process of using the bathroom with a BCIR is second nature.

With the BCIR my colitis is gone, and I have been living a terrific life never giving a second thought to the change in my digestion.