Dysphagia malignant

Sorafenib is a protein kinase inhibitor that is used in malignant disease. Patients should be advised to take tablets an hour before food or on an empty stomach. Side-effects include gastrointestinal disturbances including diarrhoea or constipation, dyspepsia, dysphagia and anorexia. 

The essential feature of Neuroleptic Malignant Syndrome is the development of severe muscle rigidity and elevated temperature in an individual using neuroleptic medication. This is accompanied by two (or more) of the following symptoms diaphoresis, dysphagia, tremor, incontinence, changes in level of consciousness ranging from confusion to coma, mutism, tachycardia, elevated or labile blood pressure, leukocytosis, and laboratory evidence of muscle injury (e.g., elevated creatine phosphokinase [CPK].1... 

Among the complications of neuroleptic chemotherapy, the most serious and potentially fatal complication is malignant syndrome, which is characterized by extreme hyperthermia lead pipe skeletal muscle rigidity that causes dyspnea, dysphagia, and rhabdomyolysis autonomic instability fluctuating consciousness leukeocytosis and elevated creatine phosphokinase levels. 

J.D. Luketich, N.T. Nguyen, T.L. Weigel, R.J. Keenan, P.F. Person, C.P. Belani (1999). Photodynamic therapy for treatment of malignant dysphagia. Surg. Laparosc. Endosc. Percutan. Tech., 9, 171-175. 

For palliation of dysphagia in patients with advanced EAC, laser and argon beam are the first choice for friable intraluminal disease (with stent use in the majority of cases). Covered stents should be used to minimize ingrowth of tumor. Covered stents are also the treatment of choice for perforated cancers and malignant tracheo-esophageal cancer. Chemotherapy should only be used in the context of appropriate controlled clinical trials. 

Which is the Best Stent to Treat Malignant Dysphagia 37... 

Fig. 2.7a-c. Treatment of malignant dysphagia with a covered Gianturco stent, a A 79-year-old patient with a distal malignant stricture, b A covered Gianturco stent has been advanced to the level of the stricture (as defined by surface marker). The stent is constrained by the delivery sheath, c The stent was deployed. This 24-h esophagogram shows good position and expansion... 

Malignant fistulas between the esophagus and the respiratory system are a serious complication of esophageal cancer and occur in 5%-15% of patients (Martini et al. 1970 Little et al. 1984 Duranceau and Jamieson 1984). They may arise spontaneously as a result of tumor invasion or they may be caused by radiation therapy, surgery, pressure necrosis caused by a previously placed plastic or metallic stent, or laser therapy (Burt et al. 1991 Duranceau and Jamieson 1984 Saxon et al. 1994 Cwikiel et al. 1998). The onset of symptoms of aspiration is a devastating development for patients aheady debilitated by malnutrition caused by the dysphagia. Patients are often unable to swallow their own saliva without aspirating. 

With the introduction of plastic-covered metallic stents for the palliation of malignant dysphagia, interventionists found that these devices were also very effective at closing fistulas and perforations. Metallic stents are better that plastic stents in this regard because they expand to the diameter of the esophagus and the covering material provides an effective seal over the defect (Watkinson et al. 1995b Do et al. 1993). 

The technique is very similar to the procedure for palliation of malignant dysphagia. Preprocedural esophagography should be performed with nonionic contrast medium to confirm the presence of the fistula or perforation and to identify its approximate location in the esophagus. With the patient in the left-lateral position, a catheter is passed into the esophagus to the site of the lesion. The exact location of the fistula or perforation is defined by the direct injection of contrast medium into the esophagus. The site is marked with the use of residual contrast medium at the site of the defect, bony landmarks, or a surface marker. 

The complications of stenting for malignant fistulas and perforations are similar to those reported for the use of stents in malignant dysphagia. 

Carter R, Smith JS, Anderson JR (1992) Laser recanalization versus endoscopic intubation in the palliation of malignant dysphagia a randomised prospective study. Br J Surg 79 1167-1170... 

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