Case report of Graves' disease manifesting with odynophagia and heartburn

Graves' disease is an autoimmune disease, which can manifest with a variety of extrathyroidal clinical syndromes like ophthalmopathy, pretibial myxedema(dermopathy), acropathy, cardiomyopathy, and encephalopathy. Though quite rare, this disease can also manifest with gastrointestinal symptoms such as dysphagia, heartburn, nausea, vomiting and diarrhea. We report a clinical case of Graves' disease manifesting with dysfunction of the esophagus and heartburn in a 61-year-old man. In the muscular layer of the esophagus we found dystrophic changes led to its atony, which was documented by endoscopy and high-resolution manometry. The pathology features of esophageal symptoms were: focal proliferation of the basal cells, vascular distension, and dystrophy of the epithelial cells. Antithyroid treatment led to decrease of all clinical symptoms after 5 d of Thiamazole administration. Complete restoration of peristalsis in the esophagus, according to manometry, was observed in 1 mo after initiation of treatment.

Yield of alarm features in predicting significant endoscopic findings among hospitalized patients with dyspepsia

BACKGROUND Dyspepsia is a very prevalent upper gastrointestinal tract symptoms complex.Some of these symptoms might arise from serious underlying diseases,so the promotion of evidence-based guidelines could potentially better align evaluation and treatment.AIM To determine the value of alarm features as a predictive factor for significant endoscopic findings(SEFs)among hospitalized patients presenting with dyspepsia.METHODS We conducted a retrospective case-control study including information about 6208 endoscopic procedures performed for hospitalized patients.Patients were divided into two groups,with and without SEFs,and compared to elucidate the ability of the different alarm features to predict SEFs.RESULTS During the study,605 patients fulfilled the inclusion criteria.When the demographics and clinical characteristics of the two groups were compared,tachycardia(P<0.05),normocytic anemia,(P<0.05),leukocytosis(P<0.05),and hypoalbuminemia(P<0.05)documented on admission prior to endoscopy were strong predictors of SEFs.Among the alarm features,upper gastrointestinal bleeding,persistent vomiting,odynophagia[odds ratio(OR)=3.81,P<0.05;OR=1.75,P=0.03;and OR=7.81,P=0.07,respectively]were associated with SEFs.Unexplained weight loss was strongly associated with malignancy as an endoscopic finding(OR=2.05;P<0.05).In addition,long-term use of anti-aggregate medications other than aspirin(P<0.05)was correlated to SEFs.CONCLUSION Novel predictors of SEFs were elucidated in this study.These parameters could be used as an adjunctive in decision making regarding performing upper endoscopy in hospitalized patients with dyspepsia.

Clinical characteristics and treatment of acute epiglottitis: A retrospective study of 28 cases

Objective:To evaluate the clinical profiles,diagnosis,and treatment of patients with acute epiglottitis at a tertiary care teaching hospital of eastern India.Methods:This is a retrospective study in which 28 patients of acute epiglottitis participated.This study was conducted between January 2016 and October 2019.The diagnosis of acute epiglottitis was based on the clinical presentations and fiberoptic laryngoscopic examinations of the larynx and hypopharynx.Details of age,gender,personal history,clinical symptoms,treatment,and hospital stay were evaluated.Results:Out of the 28 patients with acute epiglottitis,17(60.71%)were male and 11(39.29%)were female with age ranged from 4 years to 62 years and a mean age of 23.45 years.The median duration from the onset to resorting to physicians is 3 d.Among the 28 patients,4 patients(14.29%)were under the treatment for diabetes mellitus.Four cases(14.29%)required airway management with intubation and tracheostomy.Conclusions:Acute epiglottitis is an acute infectious condition of the supraglottis and may lead to airway obstruction.Clinical presentations alone are insufficient for the diagnosis of acute epiglottitis.Fiberoptic nasopharyngolaryngoscopic examination should be performed as soon as possible for confirmation of the disease.

清喉咽含片治疗急性咽炎的临床研究

研究评价了清喉咽含片相较于清喉咽合剂治疗急性咽炎(肺热阴虚证)的临床有效性和安全性。本试验共纳入144例受试者,随机分为试验组和对照组(各72例),试验组服用清喉咽含片,对照组服用清喉咽合剂,疗程5 d,以咽痛或吞咽痛消失率、中医证候的综合疗效、中医证候积分、单项症状及体征的消失率等为有效性评价指标,试验过程中密切观察生命体征、实验室检查指标、不良事件安全性评价指标。FAS结果显示,咳嗽消失率、中医证候愈显率、咽黏膜、悬雍垂轻度充血水肿体征消失率均为试验组优于对照组(P<0.05),中医证候积分的变化值2组间差异有统计学意义(P<0.05);试验组有3例不良事件,对照组有6例不良事件,2组之间不良事件发生率差异无统计学意义,无严重实验室检查异常,无生命体征异常。综合以上研究,清喉咽含片治疗急性咽炎(肺热阴虚证)疗效优于清喉咽合剂,安全性良好。

心脏手术中经食道超声心动图检查的老年患者术后吞咽痛研究

目的探讨老年患者心脏手术中经食道超声心动图检查（TEE）后吞咽痛的影响因素。方法将2010年11月至2012年8月我院96例心脏手术中经食道超声心动图检查的患者分为两组，其中≥65岁组60例，〈65岁组36例．收集患者的临床资料并随访，使用疼痛数字等级定量表评估术后吞咽痛。比较两组患者术后吞咽痛的特点，并运用Logistic回归分析方法探讨老年患者心脏手术后吞咽痛的影响因素。结果与〈65岁组相比，≥65岁组术后吞咽痛发生率高（88．3％对66．7％，P〈O．025）、疼痛评分高（2．6土1．7）分和（1．4±0．9）分（P〈0．01）。Logistic回归分析显示，会麻前I：1服利多卡因胶浆、VI咽黏膜损伤、TEE留置时间是老年患者术后吞咽痛的影响因素（P〈0．01）。结论老年患者心脏手术中TEE后吞咽痛发生率高，疼痛程度重。应在全麻前口服利多骨因胶浆，减少口咽黏膜损伤，缩短TEE留置时间以缓解患者术后吞咽痛。

含服利多卡因胶浆改善心脏手术中经食管超声检查致术后吞咽痛的随机对照研究

目的观察心脏手术中接受经食管超声心动图检查的患者，全身麻醉前含服2％利多卡因胶浆20ml对术后吞咽痛的影响。方法将接受心脏手术的60例患者随机分为对照组（c组）和口服利多卡因胶浆组（L组）各30例。L组于全麻诱导前含服2％利多卡因胶浆20ml，对照组不服用。比较2组术后吞咽痛。结果通过比较2组术后患者疼痛，显示口服2％利多卡因胶浆组患者术后吞咽痛较对照组明显降低。结论全麻诱导前口服2％利多卡因胶浆可以减轻心脏手术中经食管超声心动图检查所致术后吞咽痛。

以咽痛、咽部溃疡为主要表现的汞中毒1例

咽痛、咽部溃疡往往是某一种疾病在咽喉部的表现,咽部溃疡可见集中于双侧扁桃体、咽侧壁、咽后壁、软腭等处不规则的溃疡性病变。咽部溃疡在不同的年龄段均有发生,其病因多有特异性炎性或真菌感染,肿瘤或全身性系统疾病等^（[1]）,因此准确明确其致病原因尤为重要,然而临床上以咽痛、咽部溃疡为主要表现的汞中毒较为罕见,现报道如下。