1,721,006 research outputs found
The Gastroesophageal Prolapse in GERD: Clinical Patterns and Surgical Outcome.
No full textAims. To assess the clinical profile of patients with gastro-esophageal prolapse and GERD and the outcome of surgical therapy.
Methods. Since 1983 to 2006, 50 patients, mean age 48.84, r. 27-73 were observed. The severity of symptoms and Reflux esophagitis were graded from 0 to 3. The anatomy of the gejunction was assessed by barium swallow.
Results. Median symptoms duration was 51 months (r. 2~300). Epigastric pain was in 98% of pts. Belching or gagging in 70% (35/50), Sl=38, 76%; S2=11, 22%, SR3=31, 62%; SR2=19, 38%. Reflux esophagitis in 94% (47/50; El=15, 30%; E2= 21, 42%; E3=11, 22%). At barium swallow 18 pts (36%) had normal anatomy, 11 (22%) had Sliding Hiatus Ernia, while in 21 pts (42%) the oral migration of the g-e junction. NissenFundoplication was performed in 28 (56%) with 2 Collis techniques. No mortality, morbility (7,1%), (Median FU 15 months, r 6-192 ). 22 patients underwent medical therapy (Median FU 60 months, r 24-120). Postoperative symptoms and reflux esophagitis improved statistically after surgery and after medical treatment (Preoperative versus Postoperative p = 0.000).
In the comparison between surgical versus medical patients statistically significant differences were observed with regard to severity of pre-treatment reflux symptoms (p = 0.034) and with regard to post-treatment clinical evaluation of symptoms and esophagitis (p = 0.000).
Conclusions. Epigastric pain, belching and gagging seem to be related to the g-e prolapse because they are reduced more by surgery than by antacid therapy. In g-e prolapse+GERD, surgery is more effective than medical therapy
Long-term endoscopic follow-up in small bowel transplant recipients: single-center series.
No full textIntestinal transplantation is gaining worldwide acceptance as the main option for patients with irreversible intestinal failure and complicated total parenteral nutrition course. In adults, the main cause is still represented by short bowel syndrome, gut tumors (Gardner syndrome) and dismotility disorders (chronic intestinal pseudo-obstruction [CIPO]) have been treated increasingly by this kind of transplantation procedure. We reviewed our series from the disease point of view: although SBS confirmed results achieved in previous years, CIPO is nowadays demonstrating an excellent outcome similar to other transplantation series. Our results showed indeed that recipients affected by Gardner syndrome must be carefully selected before the disease is to advanced to take advantage of the transplantation procedure
Total Lymphadenectomy and Nodes-Based Prognostic Factors in Surgical Intervention for Esophageal Adenocarcinoma
No full textAbstract
BACKGROUND:
To evaluate prognostic factors based on the number of resected lymph nodes, we considered 202 patients who underwent radical resection and "total lymphadenectomy" for esophageal adenocarcinoma according to a prospective protocol.
METHODS:
Fifty-eight tumors surrounded by Barrett's epithelium underwent esophagectomy and esophagogastrostomy, and 144 tumors without Barrett's epithelium underwent esophageal resection at the azygos vein level, total gastrectomy, and Roux-en-Y esophagojejunostomy. All nodes and fat tissue were resected at the following stations: chest 4L and R3, R4, R7, R8, and R9 (TNM seventh edition) and abdomen 1-12 according to the Japanese Classification of Gastric Carcinoma (1998). The nodes were counted, excluding fragments. The correlations between the number of nodes yielded and the ratio of the metastatic lymph nodes/lymph nodes yielded with pT stage, grading measurements, and cancer-specific survival (CSS) were calculated.
RESULTS:
A total of 6,270 nodes were yielded (interquartile range per patient, 22-38; minimum, 4 nodes; maximum, 61 nodes). In 3 of 21 (14%) stage pT1 cases, less than 10 nodes were counted, in 2 of 27 (8%) stage pT2 cases, less than 20 were counted, and in 73 of 154 (47%) stage pT3-4 cases, less than 30 nodes were counted. The lymph node yield (LNY) and T stage were not correlated (r = 0 .048; p = 0.5). The metastatic lymph nodes to lymph nodes yielded ratio was correlated with pT stage (r = 0.272; p = 0.0001), and G (r = 0.385; p = 0.0001). CSS positively correlated with pT stage (p = 0.02), G (p = 0.001), and metastatic lymph nodes/lymph nodes yielded ratio (p = 0.01) (multivariate analysis).
CONCLUSIONS:
The total number of lymph nodes to be removed in total and within each T stage indicated as thresholds could not be reached in up to 38.6% of patients. The metastatic lymph nodes/lymph nodes yield ratio not the total LNY, did correlate with cancer-specific survival
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