Ernesto G. Zavaleta

Cleveland Clinic Florida

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Surat Piboonmanee

Mahidol University

Manuel Gómez Alzugaray

ORCID

Mariluz Hernández

Hospital Clínico Universitario Lozano Blesa

S.S.I. Santoso

Rumah Sakit Umum Pusat Nasional Dr. Cipto Mangunkusumo

J.L. Fuziwara

Tokyo University of Agriculture and Technology

W. Sadek

Menoufia University

H.M. Perez-Paz

G Alvarado

Promotora de Informaciones (Spain)

M. Perez

Secretaria de Salud

E Israël

Covenant University

Cooperative Institutions

Memorial Hospital of South Bend

University of Indonesia

World Health Organization - Pakistan

Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán

Cleveland Clinic Florida

Alexandria University

World Health Organization

Cleveland Clinic

Universidad Autónoma de Coahuila

Universidad Juárez del Estado de Durango

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A multicentred phase III comparative study of two hormonal contraceptive preparations given once-a-month by intramuscular injection II. The comparison of bleeding patterns

Contraception (1989)

Task Force On Long-Acting Systemic Agents for Fertility Regulation S. Said W. Sadek A. Kholeif Suporn Koetsawang

Discontinuation

Vaginal bleeding

Metrorrhagia

Breakthrough bleeding

Hormonal contraception

Norethisterone

10.1016/0010-7824(89)90126-1

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Citations (53)

A multicentred phase III comparative study of two hormonal contraceptive preparations given once-a-month by intramuscular injection: I. Contraceptive efficacy and side effects

Contraception (1988)

S. Said W. Sadek A. Knoieif Suporn Koetsawang Orawan Kiriwat

Intramuscular injection

Hormonal contraception

10.1016/0010-7824(88)90144-8

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Citations (58)

A 75-year-old woman with a swollen hand and supraclavicular lymphadenopathy

Cleveland Clinic Journal of Medicine (2000)

D. L. LONGWORTH J. K. STOLLER Gabriel Cárdenas Ernesto G. Zavaleta Miro Gorenšek

Supraclavicular lymph nodes

10.3949/ccjm.67.12.888

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Citations (1)

St. Anthony's Fire (Ergotamine Induced Leg Ischemia)

Angiology (2001)

Ernesto G. Zavaleta Bernardo B. Fernandez Mark K. Grove Marc D. Kaye

Ergotism, once an epidemic disease, is now a rare disorder. The most common manifestation is acute peripheral ischemia due to vasospasm, 1 with an incidence of 0.001%. 2 We report a case of a middle-age woman who presented with ergotamine-induced leg ischemia, due to chronic use of ergotamine-containing medications for migraine headaches. The diagnosis was confirmed with arteriography results, and she responded well to vasodilator therapy. The pharmacology, clinical presentation, diagnostic approach, and therapy of ergotism are reviewed.

Ergotamine

10.1177/000331970105200509

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Citations (49)

Anterior Cervical Osteophytes: A Rare Cause of Dysphagia and Upper Airway Obstruction in Older Patients

Journal of the American Geriatrics Society (2002)

Fernando F. Stancampiano Ernesto G. Zavaleta Frank C. Astor

To the Editor: An 82-year-old man presented with a 3-year history of progressive dysphagia and hoarseness. He was a nonsmoker and denied a history of alcohol abuse. He developed episodes of "choking" on solids and liquids, a sensation of "food getting stuck in the back of the throat," and a 35-pound weight loss. Two years earlier, an endoscopic laryngeal examination performed at a local hospital showed a swollen left piriform sinus; a biopsy was negative for malignancy. Endoscopic examination of the larynx revealed fullness of the left piriform sinus. A computerized tomographic (CT) scan of the neck demonstrated a large cervical esophageal spur compressing the esophagus and inflammation of the surrounding tissue. One month later, while awaiting elective surgery, the patient developed stridor and respiratory distress. Endoscopic examination revealed edema of both piriform sinuses and vocal cords and occlusion of the cervical esophagus. The patient was admitted to the intensive care unit and treated with racemic epinephrine, intravenous corticosteroids, and antibiotics. A CT scan of the neck (Figure 1) showed obliteration of the piriform sinuses and severe inflammation of the supraglottic, glottic, epiglottic, and cricoid regions. Plain films of the cervical spine revealed a large anterior cervical osteophyte extending from C3 to T1 and compressing the prevertebral soft tissue and esophagus. The patient underwent surgical removal of the osteophytes, tracheostomy, and percutaneous endoscopic gastrostomy (PEG) tube placement. The tracheostomy and PEG tubes were removed 6 and 12 weeks after surgery, respectively. A 6-month postoperative follow-up visit revealed no dysphagia. The patient continued to gain weight. Computed tomography scan of the neck showed obliteration of the piriform sinuses and severe inflammation of the supraglottic, glottic, epiglottic, and cricoid regions. Arrow points to osteophyte. Degenerative changes of the cervical spine can cause osteophytes of the anterior margins of the cervical vertebrae. They usually remain clinically silent but can be responsible for many complications. Cervical osteophytes affect 20% to 30% of the population, but progression to dysphagia1 and upper airway obstruction are rare. Dysphagia occurs in 17% to 28% of the patients and is most commonly seen in men aged 60 and older.2 The mechanisms of dysphagia include mechanical obstruction causing esophageal obstruction, periesophagitis and peripharyngitis, fibrosis and adhesions with fixation of the esophagus, cricopharyngeal spasm triggered by pressure on the esophagus, and impaired epiglottic motility. The most common symptom is progressive dysphagia to solids. If the condition worsens, dysphagia to liquids can develop.1 Decline in nutritional status and severe weight loss are frequent and potentially life threatening. Compression of the upper airway may be manifested as dyspnea,2, 3 stridor, cough,1 or dysphonia. Dysphonia may result from displacement of the laryngopharynx by a large osteophyte causing vocal cord paralysis. Frequent throat clearing may be present if the patient develops the feeling of a foreign body. Other complications include musculoskeletal and neurological symptoms,1 sleep apnea, aspiration pneumonia, pseudotumoral bulging of the posterior wall of the pharynx, and complete airway obstruction leading to death. In older patients with dysphagia as the predominant symptom, oropharyngeal carcinoma should always be excluded.4 Extensive evaluation may be needed before a diagnosis can be established, since cervical osteophytes may be incidental roentgenographic findings. Barium swallowing studies should always be included in the evaluation of older patients with dysphagia to assess all three phases of the swallowing process and identify patients at high risk for aspiration pneumonia.1 CT scan and magnetic resonance imaging of the neck should always be considered before surgery. In asymptomatic patients, no treatment is required. In patients with mild symptoms, swallowing evaluation and therapy may be sufficient to control the symptoms and decrease the risk of aspiration. During acute episodes of severe dysphagia, corticosteroids may be used. In patients with life-threatening airway obstruction, emergency tracheostomy can be lifesaving.2 Surgery is indicated in severe cases. In patients with increased surgical risk due to malnourishment, PEG tube placement for nutritional support along with swallowing therapy is the alternative.1 Since cervical osteophytes can recur, long-term follow up is recommended.

10.1046/j.1532-5415.2002.50528.x

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Citations (8)