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Query: UMLS:C0017168 (gastroesophageal reflux disease)
 11,783 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The major postoperative complications of esophagocardiomyotomy (ECM) for achalasia are peptic esophagitis due to gastroesophageal reflux and recurrence. According to other authors, the incidence of postoperative esophagitis is 15% ot 25%. We report the results obtained in 40 patients treated by our own surgical technique, which is based on precise anatomic and physiopathological criteria. With this technique an ECM without esophagogastric mobilization is performed via a lower thoracotomy with partial perihiatal phrenotomy. There were no intraoperative or postoperative deaths. Two patients had postoperative basal pleurisy which was cured easily in a short time. In 36 of these patients, a follow-up ranging between 15 years and 6 months revealed a complete remission of dysphagia. The patients had significant and speedy improvement in their general condition. Seven patients had substernal pyrosis when lying down, but this was relieved in a few months in six of them. In only one patient did it persist for 4 years after the operation. Ph-manometric serial control studies performed in all the patients revealed, except in one case, normal pressure and pH values in the lower esophagus. Because of these results, we consider our ECM technique very effective in the treatment of achalasia.
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PMID:New approach to esophagocardiomyotomy: report of forty cases. 712 Oct 46

Physiology of pain is a manifold and very complex phenomenon that is far from being understood. It cannot be explained without reference to psychosocial conditions. Pain has the function of a warning system, but the system is far from perfect, because a number of chronic diseases (e.g., arterial hypertension or malignant neoplasms) begin slowly and nearly painless. The role of pain in internal medicine will be exemplified by thoracic and abdominal pain. With regard to diagnoses both types of pain represent ambiguous symptoms. Their anatomic and physiologic substrates often cannot be ascertained completely by anamnestic means (according to localization, quality, trigger factors, time structure, and concomitant symptoms of pain). Visceral pain is regularly characterized by the phenomenon of the so-called "transferred pain": that means that the perception of pain is not restricted to the place of its origin but is also found in distant regions of the body, primarily in well defined dermatomes ("Head's areas"). This makes the differential diagnosis of internal diseases very difficult because of the parallel connection of nociceptive afferences from the skin and deeper-seated strata on identical spinal segments. Statements according to the pharmacotherapeutic aspects of pain primarily focus on the causal therapy of the prethoracic pain. In this regard differential-therapeutic aspects of angina pectoris, pericarditis, pleurisy, gastro-esophageal reflux, and vertebragenic, myogenic, and neurogenic disturbances are well to the fore.
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PMID:[Pain--from the physiological and internal medicine viewpoint]. 852 23