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 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The relationship between the diameter of the esophageal body and the clinical profile of the disease and response to treatment was analyzed in 151 patients with idiopathic achalasia by pneumatic dilation of the cardias. Of the 151 patients, 46 presented an esophageal diameter < or = 3 cm (group I), 78 a diameter > 3 cm up to a maximum of 5 cm (group II) and 27 presented a diameter > 5 cm (group III). The result of pneumatic dilatation of the cardias under endoscopic control was analyzed in 117 patients with a minimum follow up of one year after the last dilatation session. Of all the clinical parameters studied, significant statistical differences were only found in group III in respect to the time of symptom evolution and the presence of regurgitation. Manometric data in basal pressure of the esophageal body and in contraction wave width were lower in groups I and III, respectively. The remaining variables were similar in the three groups although group III showed a trend to older age and the frequency of pulmonary complications with lesser thoracic pain and registry of a strict pattern. Endoscopic pneumatic dilation carried out in all the cases was effective in 83% of the patients and was similar in the three study groups. The rate of complications (perforation) was also similar. The therapeutic efficacy of pneumatic dilatation was accompanied by a significant reduction in esophageal diameter. It was concluded that the increase in esophageal diameter in idiopathic achalasia is associated with chronological, clinical and functional parameters which suggest greater disease evolution but do not determine significant changes in the therapeutic response to endoscopic pneumatic dilatation.
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PMID:[The clinical significance of the magnitude of esophageal dilatation in idiopathic achalasia]. 875 63

Although atypical chest pain has been well described in the Western population, its frequency in Chinese is unknown. Over a period of 42 months, we studied 521 Chinese patients with chest pain and identified 108 patients (20.7%) whose pain was not related to cardiac causes, as determined by exercise ECG or cardiac catheterization. Using 24 h ambulatory pH monitoring and baseline oesophageal manometry, 28.7, 19.4 and 5.6% of these patients were found to have abnormal reflux parameters, abnormal manometric findings or both, respectively. There were significantly more patients complaining of chest pain during the study in the gastro-oesophageal reflux disease (GERD) group than in the non-GERD group (16/31 vs 20/77; P < 0.001). The lower oesophageal sphincter pressure was lower in those with abnormal reflex parameters than in those with normal reflux parameters (12.7 +/- 5.4 vs 17.8 +/- 5.8 mmHg; P < 0.05). There was no significant difference in symptoms, such as heartburn (54.8 vs 42.9%), regurgitation (38.7 vs 35.1%) and dysphagia (19.4 vs 24.7%), among the two groups. Non-specific changes were the most frequent baseline motility pattern. In conclusion, atypical chest pain and gastro-oesophageal reflux disease are not uncommon in Chinese and this deserves special emphasis as the continuation of anti-anginal drugs may aggravate their condition.
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PMID:Abnormal gastro-oesophageal reflux in Chinese with atypical chest pain. 887 78

The combination of the two typical symptoms - heartburn and regurgitation - is almost proving gastrooesophageal reflux disease (GORD). Further - atypical - symptoms are dysphagia, odynophagia, pharyngitis, reflux-induced pulmonary symptoms or intermittent chest-pain. Endoscopic signs of GORD are patchy reddening of the mucosa, erosions, ulcers and stricture. Barretts oesophagus is characterized by columnar epithelial metaplasia. Consequence: Typical symptoms of GORD may be treated without further diagnostic procedure whereas in the case of atypical symptoms diagnosis of GORD has to be established by endoscopy.
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PMID:[Reflux esophagitis--diagnosis and differential diagnosis]. 897 50

A prospective study was undertaken in 40 patients to determine whether suturing of the faucial pillars has any effect in relieving pain and discomfort associated with tonsillectomy. The first 20 patients (5 adults and 15 children) had tonsillectomy without suturing of the faucial pillars. The next 20 patients (3 adults and 17 children) had the anterior and posterior faucial pillars approximated and sutured with 3.0 chromic catgut. Objective methods of evaluating pain and discomfort were undertaken immediately and 24 hours postoperatively. The pain and discomfort were the same in both groups. Adults experienced more pain than children, in both groups. Complications occurred in 3 patients, all belonging to the sutured group: 2 had palatal haematoma and 1 nasal regurgitation. Approximation of the faucial pillars to cover the raw tonsillar bed after tonsillectomy does not relieve pain. It is disadvantageous in that it produces complications and prolongs the anaesthetic time significantly. Therefore suturing of the faucial pillars is not recommended.
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PMID:Are sutured faucial pillars really an advantage in tonsillectomy? 901 44

A 64-year-old woman complaining of severe lumbar pain was admitted to our hospital because of the finding of pre-existing mitral valve regurgitation on examination. Laboratory data revealed the proximal type of renal tubular acidosis, renal glucosuria, phosphaturia, generalized aminoaciduria and low-molecular-weight proteinuria. She did not have any cause of these tubular dysfunctions, and was diagnosed as adult idiopathic Fanconi syndrome. Dual energy X-ray absorptiometry (DEXA) revealed a reduction of bone mineral density in the lumbar spine to about 65% of the age-and gender-matched control value. Alkali agents (sodium citrate and potassium citrate), calcium lactate and 1 alpha-hydroxyvitamin D3 were administered. Bone mineral density estimated with DEXA improved with a reduction of serum alkali phosphate and disappearance of lumbar pain, and was restored to 82% of the age-and gender-matched control value after about 30 months of treatment. DEXA is useful for the long-term follow-up study of bone mineral density in a patient with Fanconi syndrome.
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PMID:[Long-term follow-up study of bone mineral density in a patient with adult idiopathic Fanconi syndrome]. 913 37

Male gender and smoking have an established discriminant value of increased risk for duodenal ulcers. The present analysis is focused on whether this could be generally enhanced by considering Helicobacter pylori status in dyspeptic patients consulting their primary physician. Patients were enrolled into our Dyspepsia Study if they met the following criteria: Symptoms for minimum one month, informed consent for drug trial, including upper gastrointestinal endoscopy (UGE), if required. All were prospectively screened for criteria suggesting an organic origin of the disorder such as nocturnal pain, severe pain, severe regurgitation or heartburn, loss of weight, pain relieved by food, age > 50 years. 16% of patients had one or more relevant lesion: 7.8% oesophagitis, 8.5% duodenal ulcers, and 1.8% gastric ulcers. Of the clinical criteria enumerated only nocturnal pain and/or severe regurgitation or heartburn had a marginal discriminant power (P < 0.1). In contrast smoking and/or positive CLO-urease test had a substantial and significant (P < 0.001), discriminant value both for oesophagitis and duodenal ulcers. Patients with both a positive CLO-urease test and who smoked accounted for only 16% of the population but for 46% of the lesions, but this was only 4% for the 42% subjects who were non-smokers and had a negative CLO-urease test. Positive H. pylori status and smoking appear to have an important and probably additive discriminant value to distinguish between organic and functional dyspepsia.
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PMID:Epidemiology of dyspepsia: discriminant value of smoking and Helicobacter pylori status as predictors of peptic lesions in primary care. 944 58

Short term results following laparoscopic Nissen fundoplication were evaluated in 31 patients with symptomatic gastroesophageal reflux. 6 were females and 26 males, and they ranged in age from 5 months to 64 years (mean: 4.9 years in 19 younger than 18 years, and 39.3 years in 12 adults). Most of the adults who complained of pain and heartburn underwent pH monitoring, endoscopy, and manometry as needed. Milk scan was the most useful diagnostic tool for the evaluation of the children, who suffered mainly from gastroesophageal-related pulmonary disease. Indications for laparoscopic operation were identical with those for conventional open Nissen fundoplication. 1 case of dysautonomia died postoperatively; the rate of complications, mostly minor, was 22.5%. 3 patients required conversion to open Nissen fundoplication due to cardiorespiratory instability secondary to pneumothorax in 2, and to esophageal perforation in the third. 5 adults developed temporary dysphagia. 3 children had only partial improvement in their pulmonary disease following the operation, while the other 15 had complete relief. The total time for the laparoscopic operation averaged 245 minutes in adults, and 228 in children. Discharge was usually on the fourth postoperative day in adults (mean: 6.0 days). Regurgitation and heartburn were cured in 10 out of 11 adults (91%). All parents of children were satisfied. Symptomatic outcomes following laparoscopic Nissen fundoplication compare favorably with those of open surgery with respect to mortality, complications, and outcome.
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PMID:[Nissen fundoplication by laparoscopy]. 946 84

In a randomized, controlled trial, 62 patients (47 men and 15 women) with severe antisocial snoring, but no sleep apnea, were allocated to one of three surgical treatments. These were uvulopalatopharyngoplasty, laser palatoplasty, and diathermy palatoplasty. Postoperative morbidity was measured on a visual analogue scale of severity of pain, dysphagia, and nasal regurgitation at 1, 2, and 7 days after the operation. Efficacy of each procedure was measured by asking the sleeping partner to record the severity of snoring before and after the operation, again on a visual analogue scale. Measurements were taken at 1, 3, and 6 months. There were no significant differences in early postoperative morbidity among the treatment groups. Diathermy palatoplasty is a new technique for the relief of snoring that is associated with low morbidity and requires little in the way of expensive equipment.
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PMID:Palatoplasty for snoring: a randomized controlled trial of three surgical methods. 974 85

Dysphagia is related to the impairment of food passage from the mouth to the stomach. Globus pharyngis implies the frequent and often painful sensation of a lump in the throat that usually does not interfere with swallowing and may even be relieved by food intake. The diagnosis is based upon a careful history, clinical examination, endoscopy, dynamic imaging (videofluoroscopy, cinematography, videosonography) and electrophysiologic procedures (including pharyngoesophageal manometry, electromyography and pH determinations). Structural lesions of the cervical spine such as diffuse idiopathic skeletal hyperostosis are rare causes of dysphagia. Dysphagia following anterior cervical fusion as well as globus and dysphonia due to dysfunction of the vertebral joints are more likely. Symptoms with swallowing fluids indicate a neurogenic origin. Dyscoordinated swallowing, nasal reflux, dysphonia or general weakness may also occur. Chronic aspiration with respiratory compromize is the main consequence in a variety of neurological disorders as well as in cases of postsurgical dysphagia. Relaxation of the upper esophageal sphincter indicates coordinated muscle movement between the pharynx and esophagus. Dysfunction of the pharyngoesophageal segment may lead to cricopharyngeal achalasia. A dyskinetic sphincter commonly represents an extrapharyngeal cause: i.e., disease associated with gastroesophageal reflux. Disorders of the esophageal phase of deglutition can produce retrosternal pain, heartburn, regurgitation and vomiting, as well as laryngeal and respiratory signs. Esophageal motility disorders include lower achalasia, tumors, peptic strictures, inflammatory diseases, drug-induced ulcers, rings and webs. Motility disorders present with aperistaltic, spontaneous contractions, diffuse esophagospasm, or a hypermotile esophagus. Gastroesophageal reflux with esophagitis must always be excluded, especially in patients with a globus sensation. The multiple features of the appearance of the symptoms of dysphagia and globus makes multidisciplinary approach necessary in order to establish a diagnosis and begin effective treatment.
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PMID:[Deglutition disorders]. 977 28

The symptomatic presentation of an unruptured sinus of Valsalva aneurysm is rare. A 48 year old man with a history of treated hypothyroidism, and a five year history of ileocolonic Crohn's disease of chronic low grade activity presented with a profound left hemiplegia. He was in sinus rhythm and normotensive. Cardiac auscultation was repeatedly normal. Computed tomography of the head performed early in the course of the illness was reported as normal. Duplex Doppler examination of the carotid arteries performed six months later revealed no significant atheroma. There was complete resolution of the neurological deficit over a period of months. A year later he presented with chest pain suggestive of myocardial ischaemia. Computed tomography, magnetic resonance imaging, transthoracic and transoesophageal echocardiography, and cardiac catheterisation pointed to a sinus of Valsalva aneurysm protruding into the left ventricular outflow tract. In view of the previous neurological event and ongoing chest pain suggestive of myocardial ischaemia, the lesion was resected. The patient made a good recovery and postoperative transoesophageal echocardiography showed normal aortic valve function with no residual regurgitation. This is the first reported case of pure left ventricular outflow tract extension of an unruptured left sinus aneurysm. The presentation with ischaemic cardiac pain does not seem to be explained by conventional mechanisms.
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PMID:Unruptured aneurysm of the left sinus of Valsalva extending into the left ventricular outflow tract: presentation and imaging. 981 68


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