Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0014848 (achalasia)
 2,804 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Four cases of megaesophagus with esophageal motor disturbances secondary to adenocarcinoma of the cardia are hereby reported. There were common characteristics to all cases such as: 1) short duration of symptoms, 2) grade II megaesophagus by X-Rays with narrowing of the cardia, 3) the endoscopy showed esophageal dilatation and inability to pass the cardia with the endoscope, 4) histology (obtained by endoscopy or surgery) and exfoliative cytology were positive for malignancy, 5) the esophageal motility tests showed aperistalsis of the whole esophagus in all cases, and lack of relaxation of the lower esophageal sphincter in two. The urecholine test was positive in one patient with neoplastic infiltration of the myenteric plexus, 6) in two cases where esophageal resection was performed, infiltration of the Auerbach's plexus by cancer cells was proven. We conclude that in the presence of aperistalsis of the esophagus with or without achalasia of the lower esophageal sphincter, the diagnosis of megaesophagus secondary to cancer of the gastric fundus should be suspected when it is not possible to pass the cardia with the endoscope, even if biopsy and cytology are negative for malignancy.
 ...
PMID:[Megaesophagus secondary to carcinoma of the cardia: apropos of 4 cases]. 653 56

Based upon experience with cervicothoracic esophageal carcinomas in which resection of the manubrium, adjacent clavicles, and ribs has facilitated exposure of the tumor, it has been found that a partial upper sternal split (without resection) provides access to the upper thoracic esophagus to the level of the carina. With a knowledge of the anatomic relationships of the esophagus in this area, this direct anterior approach has been used for both benign and selected malignant diseases involving the upper thoracic esophagus. A partial median sternotomy has been used in 11 patients with the following esophageal pathology: upper- and/or middle-third malignancy (six), benign upper-third stricture (three), perforation of upper-third esophagogastric anastomotic stricture (one), and cricopharyngeal achalasia in association with a chronic cervical compression fracture that prevented extension of the neck (one). The following operations were performed: blunt esophagectomy with cervical esophagogastric anastomosis (six), segmental esophageal resection with primary anastomosis (three), drainage of perforation (one), and extended cervical esophagomyotomy (one). A chylothorax developed in one patient with carcinoma, the only major postoperative complication in this group. Transient hoarseness occurred in two patients. Careful evaluation of the patient with upper thoracic esophageal pathology, focusing on the type, extent, and location of the abnormality relative to the level of the carina, as well as the habitus of the patient, often indicates that a partial sternotomy can be utilized to facilitate the operation.
 ...
PMID:Partial median sternotomy: anterior approach to the upper thoracic esophagus. 669 Aug 49

In geographic areas where there is a high risk of esophageal cancer, analysis of cells obtained from the esophagus has been used effectively to detect early lesions. This has been demonstrated on a large scale in studies from China. Using abrasive balloon cytology techniques, 75% of the cancers detected were early lesions, where the 5-year survival after resection was in the range of 90%. Endoscopic followup studies indicate that dysplastic changes in the esophageal mucosa are a common precursor to malignancy. In many cases, the time course from dysplasia to carcinoma in situ to early invasive cancer may take place over many years, allowing a reasonable amount of time for screening. In low-incidence areas, such as the United States, most esophageal cancers are related to the excessive use of tobacco and alcohol. These factors are too common and the incidence of the disease too low, however, to justify screening on this basis. There are smaller groups at higher risk where selective screening by endoscopy with cytology and biopsy is recommended, usually every 1 to 3 years. These include patients with longstanding achalasia, lye strictures, and Plummer- Vinson syndrome. Patients with cancers of the head and neck region and patients with celiac disease may also be considered to be at increased risk. Tylosis is a rare inherited disease with a very high risk of esophageal cancer. There is an increased incidence of adenocarcinoma of the esophagus with Barrett's epithelium, and once identified such patients should be kept under endoscopic surveillance. The finding of severe dysplasia in any of these groups would indicate a shorter screening interval. Most patients with symptoms referable to the esophagus are first tested by barium esophagram. If negative, with persistent symptoms or if a suspicious lesion is identified, endoscopy with cytology and biopsy is recommended. Staging of the cancer is based on the size of the cancer both longitudinally and circumferentially and the presence of extraesophageal spread. At the present time, CT is the best noninvasive method for judging the extent of the cancer. Performance and nutritional status are also determinants of prognosis and should be considered in planning treatment.
 ...
PMID:Screening diagnosis and staging of esophageal cancer. 672 90

A 61-year-old male was evaluated for dysphagia. Esophageal manometry revealed vigorous achalasia. Upper-gastrointestinal endoscopy revealed a probable gastric neoplasm which was confirmed at laparotomy. Histologically the tumor was a lymphoma. Antineoplastic therapy resuted in rapid and complete improvement in the patient's dysphagia. Repeat esophageal manometry was normal. It is concluded that: (1) patients presenting with achalasia or vigorous achalasia should be carefully evaluated for the presence of a gastric malignancy involving the gastric fundus and lower esophagus; (2) chemotherapy may produce a resolution of esophageal symptoms.
 ...
PMID:Successful treatment of vigorous achalasia associated with gastric lymphoma. 738 32

In the last 5 years, surgery of the gastrointestinal tract has been revolutionized by the application of minimal access techniques. Following initial enthusiasm, which suggested that most abdominal surgery would ultimately be done via this approach, there is now need for appraisal and evaluation of the role of a number of these minimal access techniques when compared with open surgery. Undoubtedly, the most convincing and total application of minimal access techniques has been in the treatment of gallstone disease. Laparoscopic cholecystectomy is now standard therapy for cholelithiasis and endoscopic sphincterotomy with stone extraction is standard therapy for choledocholithiasis. Where the two conditions co-exist, operative cholangiography allows for the recognition of stones in the bile duct at the time of laparoscopic cholecystectomy and provides the potential avenue for treatment. Most major centres also would recommend routine operative cholangiography during laparoscopic cholecystectomy for the detection of unsuspected stones and as an extra safety procedure in the early identification of potential bile duct injuries. The efficacy of laparoscopic appendicectomy and laparoscopic or thoracoscopic treatment of achalasia of the oesophagus also is supported by data from well conducted prospective studies. Doubt remains regarding the advantage of laparoscopic surgery over other approaches in the treatment of gastro-oesophageal reflux, inguinal hernias and jaundice due to non-resectable cancer. For all three of these conditions, prospective trials are underway and the results of these trials should be assessed prior to widespread adoption of the laparoscopic techniques.(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:Minimal access surgery of the gastrointestinal tract. 761 75

We describe a 74-yr-old man with stage III adenocarcinoma of the lung who presented with suspected malignancy-induced secondary achalasia and responded clinically to intrasphincteric injections of botulinum toxin type A (Botox, Allergen Inc., Irvine, CA). We discuss the use of botulinum toxin in this setting, as well as diagnostic strategies to differentiate achalasia from pseudoachalasia.
 ...
PMID:Botulinum toxin for suspected pseudoachalasia. 763 37

Between 1984 and 1992, 14 cases of "secondary" achalasia were diagnosed at our institution, five due to malignancy and nine as a result of esophageal or paraesophageal surgery. Preoperative manometry had excluded preexistent achalasia in eight of nine of the latter patients. Dysphagia developed immediately postoperatively in all. Esophagram and subsequent manometry were consistent with achalasia. All failed conventional dilation sessions and eight of nine underwent pneumatic dilation: Five were cured by this alone, two required surgery (one for iatrogenic perforation), and one was lost to follow-up. This achalasia-like picture appears to be the result of a tight antireflux repair that impairs the ability of the lower esophageal sphincter to completely relax, creating a functional obstruction with proximal dilation and stasis. Such secondary achalasia appears to be a distinct clinical entity and was more common than that associated with neoplasia in our institution. Therapeutically, pneumatic dilation was required and probably causes partial disruption of a tight surgical repair.
 ...
PMID:Iatrogenic achalasia. A case series. 776 10

Achalasia of the esophagus is presumed by many to be a premalignant lesion leading to an increased risk of squamous cell carcinoma. There is disagreement, however, as to the precise risk of malignant degeneration and there is no consensus as to either the need for close surveillance of achalasia patients or the surveillance technique that should be employed. A review of the available literature on the subject has disclosed a wide range of reported cancer risks in achalasia patients, from zero to 33 times that of the normal population. Cancers, when discovered, are often unresectable and the median survival when they are resectable is low. A personal experience with 241 achalasia patients treated during the past quarter of a century disclosed that 9 had carcinoma, for a prevalence of 3.7%. Carcinoma developed in 3 of these 9 while they were under our observation. This translates into one cancer per 1,138 patient-years of follow-up, an incidence of 88 per 100,000 population, and a risk 14.5 times that of the age-adjusted and sex-adjusted general population. Because of the low postresection survival rate if treatment is delayed until carcinoma of the esophagus becomes symptomatic, closer surveillance of achalasia patients is recommended than has been the case. Because it seems unlikely that close endoscopic surveillance will prove to be cost-effective, periodic (every 2 to 3 years) blind brush biopsy warrants further study as a means of surveillance.
 ...
PMID:Achalasia and squamous cell carcinoma of the esophagus: analysis of 241 patients. 777 59

Between 1976 and 1993, 22 patients with intrathoracic esophageal perforations, none associated with carcinoma, underwent primary repair regardless of the interval between perforation and the time of repair. Eighteen perforations were iatrogenic and four were spontaneous. The interval from perforation to operation was less than 12 hours in 10 patients, 12 to 24 hours in 3, and more than 24 hours in 9. Principles of repair included (1) a local esophagomyotomy proximal and distal to the tear to expose the mucosal defect and normal mucosa beyond, (2) debridement of the mucosal defect and closure over a bougie, and (3) reapproximation of the muscle. The repair was buttressed with muscle or pleura in five patients. Associated distal obstruction caused by reflux stricture was treated with dilation and fundoplication in four patients. Of the four patients with achalasia, two underwent esophagomyotomy with a fundoplication and one underwent myotomy alone. There was one death. The esophageal repair healed primarily in 17 patients (80%). Four patients, three of whom underwent repair more than 24 hours after the perforation, had leaks at the site of repair. All four fistulas eventually healed with drainage alone, two with simple tube thoracostomy and two with rib resection and empyema tube placement. In the absence of cancer or an irreversible distal obstruction, meticulous repair of an intrathoracic esophageal perforation is the preferred approach, regardless of the duration of the injury, inasmuch as primary healing is likely, and the morbidity associated with prolonged drainage or diversion may be avoided.
 ...
PMID:Intrathoracic esophageal perforation. The merit of primary repair. 781 90

Although the risk of cancer is increased in patients with achalasia, biomarkers of an increased cancer risk have not been evaluated. In an esophagectomy specimen of a patient with achalasia-associated squamous cell carcinoma, normal mucosal and carcinomatous samples were systematically taken for flow cytometry and histology. The distribution of DNA aneuploidy and dysplasia was mapped within the resected specimen. Four of 10 tumor samples and 4 of 16 normal mucosal samples of the esophagus showed additional aneuploid stem lines. Gastric mucosa only showed diploid DNA histograms. S-phase fraction in normal esophageal samples (7.8% +/- 1.1%) was lower than in dysplastic and carcinomatous samples (8.8% +/- 2.4%; P = NS). Areas of mild to moderate dysplasia were detected in the esophageal mucosa adjacent to the neoplasm. This report shows the potential applicability of flow cytometry in the surveillance of patients with achalasia. However, prospective endoscopic studies with long follow-up periods are required before flow cytometric and histological parameters can be used as biomarkers of an increased cancer risk in achalasia.
 ...
PMID:Achalasia-associated squamous cell carcinoma of the esophagus: flow-cytometric and histological evaluation. 783 97


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>