1,721,091 research outputs found
Effectivenes of Antireflux Surgery(Fundoplication) for the cure of Chronic Cough with or without GERD Symptoms.
No full textBackground: The outcome of surgical therapy for atypical extra-esophageal symptoms allegedly secondary to GERD is controversial. Aim of this study was to assess the results of antirefl ux surgery in patients affected by 1) typical, 2) typical atypical, (chronic cough), in whom a dedicated preoperative work up was performed. Methods: Between 1995 and 2010, 151 patients with GERD-related typical and/or atypical symptoms were submitted to antirefl ux surgery. One hundred percent preoperatively underwent semi-quantitative evaluation of typical/atypical symptoms, chronic cough and esophagitis, barium swallow, endoscopy and histology and esophageal manometry (24 h pH-recording or intraluminal impedance/pH monitoring system in the absence of gross esophagitis). In addition, patients with chronic cough underwent chest HRCT scan, methacholine challenge test and spirometry. Surgery was performed exclusively on patients positive for GERD and negative for pulmonary diseases. Preoperative tests for GERD were repeated at follow-up. Results: Patients were ordered into two groups: A) 83 patients with typical symptoms only, B) 68 patients with typical symptoms and chronic cough. In both groups, antirefl ux surgery demonstrated to signifi cantly improve typical symptoms. The global score for outcome showed no signifi cant differences between group A and B. In group B, antirefl ux surgery signifi cantly improved chronic cough as well. Discussion: The preoperative work up was highly effective in selecting patients for antirefl ux surgery which achieved very satisfactory results in the treatment of GERD and GERD-related chronic cough. Disclosure: All authors have declared no confl icts of interest
Surgical repair of Type II-IV Hiatal Hernia: frequency of True Short Esophagus and Results.
No full textBackground: The surgical management of type II-IV hiatal hernia is controversial.
Failure to recognize the condition of short esophagus may concur
to the high rate of hernia’s recurrence. We measured intraoperatively the
distance between the gastro-esophageal junction (GEJ) and the hiatus
(length of the abdominal esophagus) in patients undergoing surgery for type
II-IV hiatus hernias.
Methods: 34 patients underwent minimally invasive surgery. After isolation
of the GEJ and resection of the sac, the position of the gastric folds was
localized endoscopically and two clips were applied. The distance between
the clips and the diaphragm (abdominal esophagus) was measured with a
dedicated ruler after mediastinal dissection. In case of abdominal esophagus
1.5 cm a Collis-Nissen was performed.
Results: 17 (50%) fl oppy Nissen and 17 (50%) thoracoscopic Collislaparotomic
Nissen were performed. In the latter group, (all type III-IV
hernia), after mediastinal mobilization the length of the abdominal esophagus
was ≤1.5 cm. Post-operative mortality was 5.8% and morbility 17.6%.
Global results (median follow up 48 months) were excellent in 43.8%, good
in 50%, fair in 3.1%, and poor in 3.1%. Hiatal hernia relapse occurred in
3.1% of patients.
Discussion: True short esophagus is present in 50% of type III-IV and in
none of type II hiatus hernia. The intraoperative measurement of the length
of the abdominal esophagus is an objective method for recognizing these
patients.
Disclosure: All authors have declared no confl icts of interest
Roux en Y Gastrojejunostomy for the treatment of complex Esophago-Gastric problems.
No full textBackground: Roux en Y gastrojejunostomy has been proposed for the treatment:
a) of complex benign esophageal problems generally in alternative to
distal esophagus resection; b) of complex redo antirefl ux surgery; c) of associated
gastric antrum and gastro-esophagel junction diseases, to avoid acidalkaline
esophageal refl ux, common after Billroth II gastrojejunostomy. The
Roux Stasis Syndrome (RSS) may impair results in 10% to 50% of cases. Aim
of the study is to evaluate the incidence of RSS after Roux en Y gastrojejunostomy
performed avoiding division of the jejunal mesentery, the gastrojejunal
terminolateral anastomosis being vertical to optimize emptying.
Methods: Of 38 patients, 27 were followed up in long term. Patients were
consecutively submitted to distal gastric resection for neoplastic or functional
disease of the esophageal and/or gastric tract and reconstruction with
Roux en Y jejunostomy. Patients were followed up with clinical interview,
barium swallow, endoscopy.
Results: Mortality was 2.6% and morbility was 16.2%. Median follow-up
was 113.6 months (range 6–192 months). RSS were found in 2 on 27 patients
(7.4%). Two patients (with caustic injury) were then subjected to esophagocolo-
gastroplasty for esophageal stenosis not otherwise treatable, one
patient (already undergone two redo surgery for esophageal achalasia) complained
of signifi cant dysphagia. In the remaining patients the functional
result is satisfactory.
Discussion: Roux en Y gastrojejunostomy is an effective option for the treatment
of complex esophago-gastric problems. The Roux Stasis Syndrome
may be minimized with few technical details.
Disclosure: All authors have declared no confl icts of interest
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
PN Status in adenocarcinoma of the distal oesophagus and cardia (ADOC).
No full textpN status in adenocarcinoma of the distal oesophagus and cardia (ADOC).Objectives Adenocarcinoma of the distal oesophagus and cardia (ADOC) are grouped among the thoracic tumors according to the TNM 7~ ed., however controversy is pending on the unique or dual pathogenesis (GORD or gastric-like cancerogenesis). We investigated the pathways of Iymphatic spreading in two cohorts of ADOC with or without Barrett's metaplasia. Methods ADOC + Barrett's (group 1) was diagnosed in 54 (subtotal oesophagectomy and oesophagogastrostomy at the neck or chest dome); no Barrett's was detected in 140 ADOC (group 2), (oesophagectomy at the azygos vein + total gastrectomy with Roux oesphagojejunostomy). A11 194 cases, were approached through a right thoracotomy and upper laparotomy. Radical Iymphadenectomy (stations 4L/R-34-7-10-8-9-15-16-17-18-19-20 TNM 7th ed. + pancreatic and pyloric nodes) was identical in both procedures except for the greater curvature stations. Results Histology confirmed the preop. Barrett-non Barrett grouping. Groups I and 2 were not different (p>0,05) for sex, age, mortality, morbidity, R0 resection rate and grading. They were different (p<0,05) for the number of patients with positive nodes (27/54 50% in group I and 98/140 70% in group 2), stage I (13/54 24% in group I and 4/140 3% in group 2), stage 3a4 (5/54 9°/O in group I and 44/140 31% in group 2). Median number (IQR) of resected nodes was 29 (15-36.5) in I and 30 (20-40) in 2 (p=.5 1). Distribution of pN+ and site of recurrence are reported in table 1. Survival of group I and 2 at Syrs is 42%, at 10yrs is 41% for group 1 and 36% for group 2 (log-rank p=0,679). Conclusions ADOC with Barrett's spreads preferentially to the thoracic stations opposite to ADOC without Barrett's which involves mostly perigastric nodes comprising the greater curvature's in 16.5%. The role of total gastrectomy should be questioned. These data deserve further investigation to improve surgery but possibly also surveillance programs. Disclosure: All authors have declared no conflicts of interest
Pharyngo-oesophageal perforation following anterior cervical discectomy and fusion: management and results
No full textOBJECTIVES: Pharyngo-oesophageal perforation is a rare, life-threatening complication of anterior cervical discectomy and fusion surgery; its management remains poorly defined. We reviewed our experience to understand the treatment of this dreadful complication.METHODS: Data regarding the demographics, clinical course, diagnosis, management and outcomes of 15 cases of pharyngo-oesophageal perforations in 14 patients were collected during the period from 2003 to 2016.RESULTS: Pharyngo-oesophageal perforation occurred at a median of 32 days (range 1âday-102 months) after anterior cervical discectomy and fusion surgery. Clinical manifestations included neck abscesses and cutaneous fistulas (10 cases), cervical swelling (two cases), salivary leakage from cervicotomy (two cases), dysphagia, halitosis and regurgitation (one case). In all cases, conservative management was utilized. Two patients affected by minor external fistulas were successfully managed conservatively. In 13 cases, the following surgery was performed: (i) radical bone debridement, total or partial removal of spine fixation devices, autologous bone graft insertion or plate/cage replacement in one case each; (ii) anatomical suture of the fistula; or (iii) suture line reinforcement with myoplasty (in 11/13 cases). Perforation recurred in three cases. One patient underwent reoperation. The other two patients were treated conservatively At a median follow-up of 82 months (range 1-157 months), all patients exhibited permanent resolution of the perforation.CONCLUSIONS: Patients with minimal leaks in the absence of systemic infection can be managed conservatively. For cases of large fistulas with systemic infection, we recommend partial or total removal of the fixation devices, direct suture of the oesophageal defect and coverage with tissue flaps
The gastro-esophageal prolapse in GERD : clinical patterns and surgical outcome.
No full textthe gastro-esophageal prolapse in GERD : clinical patterns and surgical outcome
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
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