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Biomedical subjects

A Duranceau

Publications and source records attributed to A Duranceau.

At least 19 recordsLinked to original sources
PubMed2002

Long-term effects of myotomy and partial fundoplication for esophageal achalasia.

Controversy persists in the surgical approach to treat esophageal achalasia. This investigation reports the long-term effects of esophageal myotomy and partial fundoplication in treating this disorder. From 1984 to 1998, 32 patients with achalasia underwent myotomy and partial fundoplication (Belsey Mark IV) using a left thoracotomy. The median follow up is 7.2 years. Assessments include clinical evaluation, esophagogram, radionuclide transit, manometry, 24-h pH, and endoscopy. There is no complication and no mortality. Preoperative assessment was compared with that in 0-3, 3-7, and 7-16 postoperative years. Clinically, the prevalence of dysphagia was decreased from 100% to 6%, 12%, and 13%, respectively (P < 0.001). Heartburn remains unchanged (P > 0.25). On radiology, the prevalence of barium stasis was decreased from 97% to 44%, 48%, and 47%, respectively (P=0.001), whereas a pseudo-diverticulum was observed in two-thirds of patients after operation (P=0.001). Percent radionuclide stasis at 2 min was measured as 70%, 17%, 20%, and 20%, respectively (P=0.001). Manometrically, lower esophageal sphincter (LES) gradient was decreased from 29 to 10, 9, and 9 mmHg, respectively (P=0.001). LES relaxation was improved from 41% preoperatively to 100% postoperatively at each postoperative period (P < 0.001). An abnormal acid exposure was observed in four patients after the operation. Endoscopy documented mucosal damage in three patients (P > 0.25). In conclusion, on long-term follow up, myotomy and partial fundoplication for achalasia relieve obstructive symptoms and improve esophageal emptying, and reduce LES gradient and improve LES relaxation. Acid reflux is recorded in 13% of patients and esophageal mucosal damage is identified in 11% of the patient population. A longer myotomy not covered by the fundoplication results in pseudodiverticulum formation and increased esophageal retention.

Adult↗
PubMed2001

Preoperative embolization in the management of a mediastinal paraganglioma.

Parangliomas are rare and highly vascular tumors of neuroendocrine cell origin which are treated by complete surgical resection. Preoperative embolization to reduce perioperative bleeding complications, although described in paragangliomas of the neck and carotid body, has never before been described in the case of a mediastinal paraganglioma. The following is a presentation of such a case of mediastinal paraganglioma, in which embolization was used successfully before surgical resection.

Adult↗
PubMed2001

Evidence-based investigation for reflux disease.

Hiatal hernia and gastroesophageal reflux disease are measurable conditions. Evidence-based evaluation techniques should be applied to quantify these conditions, to standardize investigations, to define indications, and to provide objective results.

Evidence-Based Medicine↗
PubMed2001

The staging of severity in gastroesophageal reflux disease.

The concept of staging gastroesophageal reflux disease (GERD) has evolved in past decades. In 1974, it was recommended that a standardized method be used to assess the severity and degree of reflux; in 1988, it was proposed that staging be used to evaluate and to report GERD objectively. Some clinicians have since experimented with the staging system by reporting on definite forms of GERD, and others have offered ideas to improve the objectivity of evaluating and reporting GERD.

Gastroesophageal Reflux↗
PubMed2001

Medical management of gastroesophageal reflux disease.

Gastroesophageal reflux disease (GERD) is the most frequent problem seen in the esophageal clinic and laboratory Most patients who have a small hiatal hernia or an occasional reflux require only symptomatic treatment and some lifestyle modifications. However, prolonged medical treatment becomes mandatory in more severe cases, and these patients must significantly modify their lifestyle and try to correct the underlying causes of their condition.

Antacids↗
PubMed2001

Reflux esophagitis and scleroderma.

Despite improvement in pharmacologic management, the reflux seen in patients who have scleroderma is significantly greater than the reflux seen in patients who have idiopathic reflux. Furthermore, even with significant symptom improvement, half of the patients who have scleroderma do not show complete healing of esophagitis, owing to residual gastroesophageal reflux. Acid and bile reflux monitoring and endoscopic control examination should be used routinely to provide quantitative information on reflux damage and control. These patients need repeated adjustment of maintenance drug doses.

Esophagitis, Peptic↗
PubMed2001

Esophagectomy for gastroesophageal reflux disease.

Failed control of pathologic gastroesophageal reflux leads to irreversible esophageal damage and progressive loss of function. Patients develop severe intractable symptoms, incapacitating dysphagia, and, with end-stage disease, stricture formation or Barrett's esophagus. When medical management and repeated antireflux operations have failed, resection of the diseased esophagus may become the only valid alternative. Careful preoperative evaluation and patient selection are essential to obtain satisfactory long-term functional results with acceptable rates of morbidity and mortality.

Esophagectomy↗
PubMed1999

Results of reoperation on the upper esophageal sphincter.

OBJECTIVE: Reoperation on the upper esophageal sphincter is infrequent. We reviewed our experience in patients who underwent reoperation on the upper esophageal sphincter. METHODS: This is a retrospective report of accumulative series from 2 separate institutions. RESULTS: From September 1, 1976, to February 28, 1997, 37 patients underwent reoperation on the upper esophageal sphincter for recurrent or persistent obstructive symptoms. There were 29 men and 8 women. The median age was 69 years (range, 38-87 years). The original indication for the operation was a pharyngoesophageal (Zenker's) diverticulum in 33 patients (89.2%), oculopharyngeal dystrophy in 3 patients (8.1%), and muscular dystrophy in 1 patient (2.7%). One prior upper esophageal sphincter operation had been performed in 26 patients (70.3%), two operations in 9 patients (24. 3%), and three operations in 2 patients (5.4%). All patients were symptomatic; 35 patients (94.6%) had dysphagia; 23 patients (62.2%) had regurgitation; and 12 patients (32.4%) had episodes of aspiration. Thirty of the patients (91.0%) with Zenker's diverticulum were found to have a recurrent or persistent diverticulum at reoperation. A diverticulectomy and cricopharyngeal myotomy were performed in 23 patients (62.2%); cricopharyngeal myotomy alone, in 7 patients (18.9%); diverticulopexy and cricopharyngeal myotomy, in 6 patients (16.2%); and diverticulectomy alone, in 1 patient (2.7%). There were no operative deaths. Complications developed in 10 patients (27.0%). Follow-up was complete in 34 patients (91.9%) and ranged from 2 to 149 months (median, 39 mo). Thirty-two patients (94.1%) were improved. Functional results were classified as excellent in 26 patients (76. 5%), good in 2 patients (5.9%), fair in 4 patients (11.7%), and poor in 2 patients (5.9%). CONCLUSIONS: Reoperation for patients who have persistent or recurrent symptoms after an operation on the upper esophageal sphincter is associated with acceptable morbidity and mortality rates. Resolution of symptoms occurs in most patients.

Adult↗
PubMed1999

Early detection of esophageal squamous cell carcinoma and its effects on therapy: an overview.

Squamous cell carcinoma of the esophagus shows a wide variation in incidence worldwide. It is the fifth leading cause of cancer-related death in men and usually diagnosed at an advanced stage with unsatisfactory therapeutic results. The techniques available for early detection of esophageal carcinoma are reviewed in this paper, as well as its overall effect on survival. For the time being, only surgical resection at a very early stage may improve survival of the disease. Esophageal cancer can be treated at an earlier stage when it is diagnosed by mass screening detection. However, despite a high survival rate at 5 years, local recurrences and distal metastases may still occur even 10 years after treatment. Prevention and therapeutic intervention at an earlier stage before the oncologic process has resulted in cancer changes is necessary to alter the natural evolution of the disease.

Carcinoma, Squamous Cell↗
PubMed1998

Short GCG expansions in the PABP2 gene cause oculopharyngeal muscular dystrophy.

Autosomal dominant oculopharyngeal muscular dystrophy (OPMD) is an adult-onset disease with a world-wide distribution. It usually presents in the sixth decade with progressive swallowing difficulties (dysphagia), eyelid drooping (ptosis) and proximal limb weakness. Unique nuclear filament inclusions in skeletal muscle fibres are its pathological hallmark. We isolated the poly(A) binding protein 2 gene (PABP2) from a 217-kb candidate interval on chromosome 14q11 (B.B. et al., manuscript submitted). A (GCG)6 repeat encoding a polyalanine tract located at the N terminus of the protein was expanded to (GCG)8-13 in the 144 OPMD families screened. More severe phenotypes were observed in compound heterozygotes for the (GCG)9 mutation and a (GCG)7 allele that is found in 2% of the population, whereas homozygosity for the (GCG)7 allele leads to autosomal recessive OPMD. Thus the (GCG)7 allele is an example of a polymorphism which can act either as a modifier of a dominant phenotype or as a recessive mutation. Pathological expansions of the polyalanine tract may cause mutated PABP2 oligomers to accumulate as filament inclusions in nuclei.

Adult↗
PubMed1997

Cricopharyngeal myotomy for neurogenic oropharyngeal dysphagia.

BACKGROUND: Forty patients (18 women, 22 men) with incapacitating oropharyngeal dysphagia of neurologic origin underwent cricopharyngeal myotomy. The subjective and objective response to myotomy was analyzed retrospectively with a mean postoperative follow-up of 48 months (range 1 to 255 months). RESULTS: Radiologic evidence of functional obstruction caused by incoordination and incomplete relaxation of the upper esophageal sphincter was significantly reduced. Manometric recordings of resting and closing pressures of the upper esophageal sphincter were also significantly altered by the myotomy. Resting pressures decreased from 65 to 18 mm Hg and closing pressures dropped from 69 to 22 mm Hg. The relaxation time and poor coordination at the level of the upper esophageal sphincter, observed in the preoperative period, persisted after the operation. Radionuclide emptying studies in which a single liquid bolus was used showed persistent hypopharyngeal stasis with a 20% retention of radioactive material at 120 seconds. Subjectively, 33 patients initially had frequent aspiration episodes. Twenty became free of symptoms after myotomy (p < 0.01) and in six others the symptoms were improved. Overall, seven patients claimed to be free of symptoms of dysphagia and no longer had pharyngo-oral or pharyngonasal regurgitations and aspirations after their operation. Twenty-three other patients had improvement in symptoms. Ten patients reported no change in symptoms. All of them either were unable to swallow voluntarily or had dysarthria when assessed before the operation. One retropharyngeal hematoma is the only postoperative complication recorded. The operative mortality was 2.5% (1/40). CONCLUSIONS: Cricopharyngeal myotomy palliates neurogenic oropharyngeal dysphagia in patients with intact oral-phase deglutition.

Adult↗
PubMed1997

Cricopharyngeal myotomy in the management of neurogenic and muscular dysphagia.

Oropharyngeal dysphagia results from disruption of the integrated mechanism of swallowing. Neurogenic dysphagia is caused by central nervous system disorders or by cranial nerve involvement and it may be distinguished from muscular dysphagia such as that seen mostly in oculopharyngeal muscular dystrophy (OPMD). Based on our 20-year experience in a university hospital thoracic surgery service, we describe the results of the clinical evaluation, the laboratory testing and the surgical management of a recent subgroup of patients experiencing dysphagia from neurogenic and muscular disorders.

Adult↗
PubMed1997

Sleeve recording of upper esophageal sphincter resting pressures during cricopharyngeal myotomy.

OBJECTIVE: The manometric effects of a 6-cm cricopharyngeal myotomy are recorded while the operation is being performed from cervical esophagus to the cricopharyngeus and then to the hypopharynx. SUMMARY BACKGROUND DATA: Cricopharyngeal myotomy is used in the treatment of oropharyngeal dysphagia of different causes. The operation decreases the resting pressure in the upper esophageal sphincter (UES). The components responsible for this decrease have not been clarified. METHODS: Fourteen patients with oropharyngeal dysphagia underwent a sleeve recording of the UES resting pressures under general anesthesia before and after sequential myotomy of the pharyngoesophageal junction. Patients were assessed in the awake state before and after the whole myotomy. RESULTS: Upper esophageal pressures remain unchanged after division of 2 cm of the cervical esophageal muscle. Section of 2 cm of the cricopharyngeal area results in a significant decrease of the sphincter resting pressure (p < 0.01). The division of 2 cm of hypopharyngeal muscle results in a further significant reduction of the resting pressure (p < 0.005). CONCLUSIONS: Extension of the cricopharyngeal myotomy over hypopharyngeal musculature produces a more significant decrease of UES resting pressure.

Aged↗
PubMed1997

Pitfalls and complications of cricopharyngeal myotomy.

Despite a meticulous operative technique, complications still may occur following cricopharyngeal myotomy. In our series of 205 patients, infection was seen in 11 patients (5.3%) with fistula formation for two patients (1.0%). These complications were seen more frequently in patients treated for a pharyngoesophageal diverticulum. Mortality directly related to the surgical procedure was seen in three patients (1.4%), all suffering from muscular dystrophy.

Adult↗
PubMed1997

Duodenal content reflux esophagitis in the rat: an animal model for the ulcer-associated cell lineage (UACL)?

We have studied the histological changes observed in the mucosa of 10 rats in the region of a esophagojejunostomy to evaluate it as a model for the ulcer-associated cell lineage (UACL). In man, the UACL has a distinctive morphology, proliferative organization, and pattern of trefoil peptide localization. We have therefore examined these aspects aided by immunohistochemistry and in situ hybridization to the trefoil peptides TFF1, TFF2, and TFF3. Only TFF2 was studied by immunohistochemistry, whereas the mRNAs for all three peptides were examined by in situ hybridization using 35S-labeled riboprobes. The marker MIB-1 to the Ki67 proliferation-related antigen was used to examine the proliferative organization of UACL-like changes. In all cases, columnar epithelialization of the distal esophagus was seen, and in all, glands with morphological and gene expression attributes of the UACL were identified. TFF3 mRNA localized patchily throughout the UACL, whereas TFF1 mRNA was found in the upper portions of the lineage and TFF2 mRNA and its product in the acini. These lineages showed virtually no intrinsic proliferative activity. These appearances are similar to those seen in early human UACL, and we therefore propose this that this represents the first published animal model of this lineage.

Animals↗
PubMed1995

Uncut Collis-Nissen gastroplasty: early functional results.

BACKGROUND: This study reviewed the short-term results of the uncut Collis-Nissen gastroplasty. METHODS: From 1990 through 1993, 27 consecutive patients (16 men, 11 women) underwent an uncut Collis-Nissen gastroplasty. Mean age was 59 years (range, 30 to 75 years). Three patients had a previous failed antireflux procedure. Indications for operation were gastroesophageal reflux disease resistant to medical treatment in 18 patients and symptomatic hiatal hernia in 9 patients. Fourteen patients had Barrett's esophagus and 4 had a peptic stricture. Complete esophageal function testing including barium swallow, endoscopy, manometry, and 24-hour pH recording was performed in 26 of 27 patients preoperatively and postoperatively. RESULTS: Five patients (19%) had complications, which included atelectasis in 2, cardiac dysrhythmia in 2, and prolonged ileus in 1. There were no operative deaths. Follow-up was complete in all patients and ranged from 8 to 45 months (mean, 22 months). Subjectively, symptoms of reflux were resolved in all patients. Six patients complain of slow esophageal emptying and 3 have occasional episodes of dysphagia. None required postoperative dilation. Ulcers and erosions healed in all 26 patients who underwent endoscopy but recurred in 2 at 21 and 36 months postoperatively. Mean lower esophageal sphincter gradient increased from 8.3 mm Hg preoperatively to 14.6 mm Hg (p = 0.0001). Total percent of acid exposure decreased from 8.0% preoperatively to 1.7% (p = 0.003). CONCLUSIONS: We conclude that the uncut Collis-Nissen procedure provides acceptable short-term control of gastroesophageal reflux disease.

Adult↗