1,720,985 research outputs found
Laparoscopic/Thoracoscopic surgery for complex non axial hiatus hernia.
No full textBackground: In order to demonstrate the feasibility and the corner stones of the minimally invasive
surgical technique for the treatment of paraoesophageal and massive incarcerated hiatus hernia
we show the case of a 66 years old woman with 20 years history of GORD symptoms, dyspnoea
with orthopnea, erosive oesophagitis and recurrent sideropenic anaemia. Barium swallow shows
a paraoesophageal hiatus hernia. We present a second case of a 56 years old man complaining
severe GORD symptoms since 6 years with painful dysphagia, erosive oesophagitis. Barium
swallow shows a non-reducible 10 cm diameter massive incarcerated hiatus hernia.
Methods: The steps of the surgical procedure are: 1) complete resection of the hernia sac and
fat pad with preservation of the vagus nerves, 2) localization of the position of the GO junction
with respect to the apex of the hiatus with a combined endoscopic–laparoscopic procedure, 3)
measurement of the length of the esophageal submerged segment, 4) isolation of the mediastinal
oesophagus, 5) Collis gastroplasty in case of short oesophagus , 6) hiatus alloplasty, 7) Nissen
floppy fundusplication.
Results: After maximal oesophageal mobilization , in the first patient the GO junction was placed
2,5 cm below the hiatus and a standard fundusplication was performed , in the second case the
GO junction was placed across the hiatus and a combined laparoscopic-left thoracoscopic Collis
gastroplasty was necessary.
Conclusions: The minimally invasive approach for complex hiatus hernias appears feasible. 15
patients (mean age 65.8 ± 11.7 years) underwent laparoscopic Nissen and 14 (mean age 66.5 ±
11.7 years) thoraco-laparoscopic Collis-Nissen. Median follow up was 21 months (r. 6-58) with
1 mortality in each group (pulmonary embolus and Collis fistula). Results were excellent and
good in 93%, and fair or poor in 7%
Frequency of true short oesophagus in non axial hiatus hernia (NAHH)
No full textBackground/Objectives: The length of the abdominal oesophagus (AO) in patients undergoing
surgery for NAHH is still controversial. This lack of information may concur to the high
rate of hernia’s recurrence after repair. We measured intra operatively the distance between the
gastrooesophageal junction (GOJ) and the hiatus in patients undergoing surgery for NAHH.
Materials & Methods: 34 patients (26 females 76.4%, mean age 65.3 range 41-84 yrs) underwent
a laparoscopic approach. After full isolation of the GOJ and complete 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 apex of the diaphragm was measured with a dedicated ruler before and
after the esophageal dissection. In case of AO <1.5 cm a Collis-Nissen was performed.
Results: Mean duration of symptoms was 100 months (r. 12-360), reflux symptoms were moderate
in 21/34 (61.7%), severe in 13/34 (38.3%), oesophagitis was present in 16/34 (47%). NAHH
were type II (para-oesophageal) in 4 (11.8%), type III 24 (mixed) (70.6%), type IV (organo-axial
volvolus) in 6 (17.6%). Before dissection the AO was ≤1.5 cm in 26 pts (76.4%), median length
of the mediastinal dissection was 10 cm (range 6-13 cm). After dissection AO was still <1,5 cm in
17 (50%), respectively in 0/4 of type II, in 13/24 of type III and in 4/6 of type IV. No difference
was calculated between AO longer or shorter than 1.5 cm with respect to duration and severity
of symptoms and oesophagitis. 17 pts (50%) underwent the Collis-Nissen.
Conclusions/Uploads: Short oesophagus is present in 50% of NAHH , mainly in type III
and IV. The intra operative measurement of the length of the AO is an objective method for
recognizing these cases.
Disclosure: All authors have declared no conflicts of interest
The Heller-Dor operation for the therapy of oesophageal achalasia 1979-2009. History, Rationale, technique and definitive results.
No full textBackground/Objectives: to show step by step the technical details of the Heller-Dor operation
in light of the evolution of surgery for the cure of oesophageal achalasia occurred in 30 years
in a surgical group.
Materials & Methods: The current technique is based on two corner stone principles originated
from two groups of patients operated upon in the sixties and seventies respectively with the trans
abdominal and the trans thoracic myotomy. In order to avoid post operative reflux (41%) and
dysphagia (8%) due to scar of the myotomy (abdominal myotomy without antireflux procedure)
and the relapse of dysphagia (21%) due to insufficient myotomy (limited thoracic myotomy),
we pursued: 1) the complete abolition of the lower esophageal sphincter by a long myotomy
extended to the U and sling fibers below the angle of His which are part of the lower oesophageal
sphincter (LOS) (according to Dr. Liebermann-Meffert), 2) protection of the surface of
the myotomy with an anterior fundusplication to prevent reflux without impairing oesophageal
emptying. The operation was performed under manometric control.
Results: In the period 1978-2009 262 patients were operated upon, 202 with open (median FU 96
months r. 12-324), and 60 with laparoscopic technique (median FU 48 months r. 6-161). In laparotomy
poor results (19/201 9.5%) were secondary to reflux oesophagitis in 15/201 (7.5%), in 2 cases diagnosed
after 184 and 252 months, and to recurrent dysphagia in 4/201 (2%) all with end stage sigmoid
achalasia. In laparoscopy 2/60 (3.3%) had reflux oesophagitis and none recurrent dysphagia.
Conclusions/Uploads: A long esophago-gastric myotomy protected by the Dor fundusplication
offers good long term results.
Disclosure: All authors have declared no conflicts 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
Risultati a lungo termine dell'intervento di Heller Dor con l'ausilio della manometria intraoperatoria per il trattamento della manometria esofagea.
No full textRisultati a lungo termine dell'intervento di Heller Dor con l'ausilio della manometria intraoperatoria per il trattamento della manometria esofagea
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
The open anatomical pulmonary segmentectomy for the treatment of T1A N0 M0 NSCLC: a reappraisal for the development of new techniques?
No full textThe open anatomical pulmonary segmentectomy for the treatment of T1A N0 M0 NSCLC: a reappraisal for the development of new techniques
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
Dispelling the Myths Behind First-author Citation Counts
Full text linkWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
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