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T1 Age 18 29 68-year-old T2 Sex 30 35 woman T4 History 88 157 no history of gastroesophageal reflux disease or esophageal disorders T5 Sign_symptom 213 219 nodule E2 Sign_symptom:T5 T6 Biological_structure 203 212 pulmonary T7 Detailed_description 194 202 solitary T8 Detailed_description 182 193 progressive R1 MODIFY Arg1:T6 Arg2:E2 R2 MODIFY Arg1:T7 Arg2:E2 R3 MODIFY Arg1:T8 Arg2:E2 T9 Area 221 228 1×1.3cm R4 MODIFY Arg1:T9 Arg2:E2 T10 Therapeutic_procedure 251 260 resection E3 Therapeutic_procedure:T10 T11 Detailed_description 233 250 right lower wedge R5 MODIFY Arg1:T11 Arg2:E3 T12 Date 278 291 December 2011 E4 Date:T12 T13 Nonbiological_location 300 339 University of Iowa pathology department T14 Coreference 355 360 tumor E5 Coreference:T14 R6 IDENTICAL Arg1:E5 Arg2:E2 T15 Disease_disorder 366 371 LCNEC E6 Disease_disorder:T15 #1 AnnotatorNotes E6 Large cell neuroendocrine carcinoma T16 Date 387 403 six months after E7 Date:T16 T17 Sign_symptom 465 474 dysphagia E8 Sign_symptom:T17 T18 Detailed_description 446 464 slowly progressing R7 MODIFY Arg1:T18 Arg2:E8 T19 Detailed_description 475 502 for both solids and liquids R8 MODIFY Arg1:T19 Arg2:E8 T20 Diagnostic_procedure 506 534 positron emission tomography E9 Diagnostic_procedure:T20 T21 Diagnostic_procedure 536 539 PET E10 Diagnostic_procedure:T21 R9 IDENTICAL Arg1:E10 Arg2:E9 T22 Date 559 563 2012 E11 Date:T22 T23 Date 565 586 one year post surgery E12 Date:T23 T24 Lab_value 592 604 unremarkable R10 MODIFY Arg1:T24 Arg2:E9 T25 Diagnostic_procedure 642 661 computed tomography E13 Diagnostic_procedure:T25 T26 Diagnostic_procedure 663 665 CT E14 Diagnostic_procedure:T26 R11 IDENTICAL Arg1:E14 Arg2:E13 T27 Date 670 679 June 2013 E15 Date:T27 T28 Date 681 703 18 months post surgery E16 Date:T28 T29 Sign_symptom 722 732 recurrence E17 Sign_symptom:T29 A1 POLARITY E17 NEG R12 MODIFY Arg1:E17 Arg2:E13 T30 Diagnostic_procedure 764 790 esophagogastroduodenoscopy E18 Diagnostic_procedure:T30 T31 Diagnostic_procedure 792 795 EGD E19 Diagnostic_procedure:T31 R13 IDENTICAL Arg1:E19 Arg2:E18 T32 Diagnostic_procedure 801 815 barium swallow E20 Diagnostic_procedure:T32 R14 SUB_PROCEDURE Arg1:E20 Arg2:E18 T33 Sign_symptom 833 842 stricture E21 Sign_symptom:T33 T34 Biological_structure 850 859 esophagus A2 POLARITY E21 NEG R15 MODIFY Arg1:T34 Arg2:E21 T35 Sign_symptom 864 871 failure E22 Sign_symptom:T35 T36 Biological_structure 875 914 primary and secondary peristaltic waves T37 Biological_structure 919 925 reflux R16 MODIFY Arg1:T36 Arg2:E22 R17 MODIFY Arg1:T37 Arg2:E22 T38 Date 930 939 July 2013 E23 Date:T38 T39 Diagnostic_procedure 941 961 esophageal manometry E24 Diagnostic_procedure:T39 T40 Sign_symptom 968 975 failure E25 Sign_symptom:T40 T41 Detailed_description 983 1018 lower esophageal sphincter to relax T42 Diagnostic_procedure 1027 1044 residual pressure E26 Diagnostic_procedure:T42 T43 Lab_value 1048 1054 32mmHg R18 MODIFY Arg1:T43 Arg2:E26 R19 MODIFY Arg1:T41 Arg2:E25 R20 SUB_PROCEDURE Arg1:E26 Arg2:E24 R21 MODIFY Arg1:E25 Arg2:E24 T44 Medication 1085 1109 calcium channel blockers E27 Medication:T44 T45 Sign_symptom 1123 1129 relief E28 Sign_symptom:T45 A3 POLARITY E28 MAYBE_POS T46 Duration 1141 1161 up to 18 months post E29 Duration:T46 T47 Diagnostic_procedure 1215 1221 weight E30 Diagnostic_procedure:T47 T48 Lab_value 1202 1210 maintain R22 MODIFY Arg1:T48 Arg2:E30 T49 Diagnostic_procedure 1230 1257 basic laboratory parameters E31 Diagnostic_procedure:T49 T50 Diagnostic_procedure 1269 1279 hemoglobin E32 Diagnostic_procedure:T50 T51 Diagnostic_procedure 1281 1288 albumin E33 Diagnostic_procedure:T51 T52 Diagnostic_procedure 1293 1304 cholesterol E34 Diagnostic_procedure:T52 R23 SUB_PROCEDURE Arg1:E32 Arg2:E31 R24 SUB_PROCEDURE Arg1:E33 Arg2:E31 R25 SUB_PROCEDURE Arg1:E34 Arg2:E31 R26 MODIFY Arg1:T48 Arg2:E31 T53 Date 1325 1337 January 2014 E35 Date:T53 T54 Sign_symptom 1362 1371 dysphagia E36 Sign_symptom:T54 A4 TREND E36 INC T55 Sign_symptom 1376 1387 weight loss E37 Sign_symptom:T55 T56 Lab_value 1391 1396 10lbs R27 MODIFY Arg1:T56 Arg2:E37 T57 Duration 1397 1423 over a period of one month E38 Duration:T57 T58 Clinical_event 1433 1441 referred E39 Clinical_event:T58 T59 Nonbiological_location 1449 1455 center R28 MODIFY Arg1:T59 Arg2:E39 T60 Disease_disorder 1485 1494 achalasia E40 Disease_disorder:T60 T61 Diagnostic_procedure 1505 1525 esophageal manometry E41 Diagnostic_procedure:T61 T62 Diagnostic_procedure 1545 1580 lower esophageal sphincter pressure E42 Diagnostic_procedure:T62 T63 Lab_value 1536 1544 elevated T64 Lab_value 1584 1590 50mmHg R29 MODIFY Arg1:T64 Arg2:E42 R30 MODIFY Arg1:T63 Arg2:E42 T65 Sign_symptom 1632 1644 contractions E43 Sign_symptom:T65 T66 Detailed_description 1616 1631 non-peristaltic T67 Detailed_description 1599 1614 non-propagative R31 MODIFY Arg1:T66 Arg2:E43 R32 MODIFY Arg1:T67 Arg2:E43 T68 Biological_structure 1660 1682 esophageal musculature R33 MODIFY Arg1:T68 Arg2:E43 T69 Diagnostic_procedure 1704 1707 EGD E44 Diagnostic_procedure:T69 T70 Therapeutic_procedure 1749 1767 pneumatic dilation E45 Therapeutic_procedure:T70 A5 POLARITY E45 UNCERTAIN T71 Sign_symptom 1821 1825 mass E46 Sign_symptom:T71 T72 Detailed_description 1811 1820 fungating T73 Detailed_description 1800 1809 ulcerated T74 Detailed_description 1777 1799 nearly circumferential R34 MODIFY Arg1:T72 Arg2:E46 R35 MODIFY Arg1:T73 Arg2:E46 R36 MODIFY Arg1:T74 Arg2:E46 T75 Biological_structure 1871 1896 gastroesophageal junction R37 MODIFY Arg1:T75 Arg2:E46 T76 Distance 1831 1849 approximately 36cm R38 MODIFY Arg1:T76 Arg2:E46 T77 Distance 1897 1904 at 39cm R39 MODIFY Arg1:T77 Arg2:T75 T78 Disease_disorder 1926 1931 LCNEC E47 Disease_disorder:T78 T79 Diagnostic_procedure 1906 1914 Biopsies E48 Diagnostic_procedure:T79 T80 Detailed_description 1937 1991 similar features to the primary tumor resected in 2011 R40 MODIFY Arg1:T80 Arg2:E47 T81 Sign_symptom 2019 2029 metastasis E49 Sign_symptom:T81 T82 Diagnostic_procedure 2054 2061 CT scan E50 Diagnostic_procedure:T82 T83 Disease_disorder 2091 2109 metastatic disease E51 Disease_disorder:T83 T84 Detailed_description 2083 2090 diffuse T85 Detailed_description 2071 2082 progressive R41 MODIFY Arg1:T84 Arg2:E51 R42 MODIFY Arg1:T85 Arg2:E51 T86 Medication 2148 2160 chemotherapy E52 Medication:T86 T87 Detailed_description 2133 2144 two courses R43 MODIFY Arg1:T87 Arg2:E52 T88 Outcome 2165 2169 died E53 Outcome:T88 T89 Date 2187 2203 after six months E54 Date:T89 T3 History 41 78 chronic obstructive pulmonary disease R44 BEFORE Arg1:E2 Arg2:E3 * OVERLAP E3 E4 E6 R45 MODIFY Arg1:T13 Arg2:E6 R46 BEFORE Arg1:E6 Arg2:E7 * OVERLAP E7 E8 R47 BEFORE Arg1:E8 Arg2:E9 * OVERLAP E9 E11 E12 R48 BEFORE Arg1:E12 Arg2:E13 * OVERLAP E13 E15 E16 E17 E18 E21 E22 R49 BEFORE Arg1:E22 Arg2:E23 * OVERLAP E23 E24 E27 E28 R50 BEFORE Arg1:E28 Arg2:E29 * OVERLAP E29 E30 E31 R51 BEFORE Arg1:E31 Arg2:E35 * OVERLAP E35 E36 E37 E38 R52 BEFORE Arg1:E38 Arg2:E39 T90 Therapeutic_procedure 1468 1477 treatment E1 Therapeutic_procedure:T90 * OVERLAP E39 E1 E40 E41 E42 E43 E44 E45 E46 E48 E47 E49 E50 E51 R53 BEFORE Arg1:E51 Arg2:E52 R54 BEFORE Arg1:E52 Arg2:E53 * OVERLAP E53 E54