Right-sided aortic arch and aberrant left subclavian artery.
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Angiography↗
Biomedical subjects
R Bardini
Publications and source records attributed to R Bardini.
Food groups and risk of squamous cell esophageal cancer in northern Italy.
To better understand the nutritional etiology of squamous cell esophageal cancer, we conducted a case-control study in 3 areas of northern Italy. A total of 304 incident, histologically confirmed cases of squamous cell carcinoma of the esophagus (275 men, 29 women) and 743 hospital controls (593 men, 150 women) with acute, non-neoplastic conditions, not related to smoking, alcohol consumption or long-term diet modification, were interviewed during 1992 to 1997. The validated food-frequency questionnaire included 78 questions on food items or recipes, which were then categorized into 19 main food groups, and 10 questions on fat intake pattern. After allowance for age, sex, education, area of residence, tobacco smoking, alcohol drinking and non-alcohol energy, a significant increased risk emerged for high consumption of soups (OR=2.1 for the highest vs. lowest quintile), whereas inverse associations with esophageal cancer risk were observed for pasta and rice (OR=0.7), poultry (OR=0.4), raw vegetables (OR=0.3), citrus fruit (OR=0.4) and other fruit (OR=0.5). The associations with dietary habits were consistent in different strata of tobacco smoking and alcohol drinking. Among added lipids, olive oil intake showed a significant reduction of esophageal cancer risk, even after allowance for total vegetable consumption (OR=0.4), while butter consumption was directly associated with this risk (OR=2.2). Our results thus provide further support to the evidence that raw vegetables and citrus fruit are inversely related to the risk of squamous cell esophageal cancer and suggest that olive oil may also reduce this risk.
Adult↗
[Palliative treatment of esophageal and cardial carcinoma].
Recent series reported increasing incidence of esophageal and cardial cancers with prognosis still severe in spite of surgical progress. The late diagnosis reduces the chance of radical surgery; on the other hand about 80-90% of patients develop local or distant recurrence. Therefore the treatment of esophageal and cardial cancer is often palliative: surgical resection is reserved only to selected cases. Endoscopic palliation was the treatment of choice in a total of 265 patients 174 of which received laser therapy and 91 prosthesis intubation. The results it good in about 80% of cases.
Adenocarcinoma↗
Treatment of a submucosal hemangioma of the esophagus using simultaneous video-assisted thoracoscopy and esophagoscopy: description of a new minimally invasive technique.
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Adult↗
[Pretherapeutic evaluation in cancer of the cardia].
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Adenocarcinoma↗
Thoracoscopic staging of esophageal cancer: a prospective, multiinstitutional trial.
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Esophageal Neoplasms↗
Aberrant right subclavian artery. An original median cervical approach.
The case of a 28-year-old woman with dysphagia secondary to oesophageal compression by an anomalous right subclavian artery is reported. A new single surgical approach, not previously described, for the treatment of dysphagia lusoria in the adults is presented. The aberrant vessel is dissected, divided close to its origin and implanted into the ipsilateral common carotid artery, all through a single median cervical incision.
Adult↗
Therapeutic options for cancer of the hypopharynx and cervical oesophagus.
Between 1980 and 1990, 291 patients with a cancer in the cervical area of the oesophagus were admitted to our Department: in 187 the cancer was located mainly in the cervical region, 76 in the hypopharynx and 28 had a tumour that had spread to the cervical oesophageal region following laryngectomy. Most tumours of the hypopharynx involved the cervical oesophagus when it was often difficult to define the site of origin. 153 patients (53%) underwent surgical resection which included a modified neck dissection followed by different kinds of reconstruction. 96 patients underwent pharyngogastric anastomosis. Twenty anastomotic leaks (23%) were recorded including both those clinically evident and asymptomatic ones detected radiologically. Moreover, segmental proximal necrosis was seen in ten patients. Hospital mortality rate after pharyngogastric anastomosis was 14.7% (14/95). Colon interposition was used in 11 patients. Two anastomotic leaks and two partial necroses were observed. Hospital mortality was 18% (2/11). Eighteen patients underwent laryngopharyngectomy and cervical oesophagectomy with reconstruction performed by means of revascularized jejunal loop. One anastomotic leak was observed and hospital mortality was nil in these cases. Twenty-four patients underwent total oesophagectomy with larynx preservation when the cancer was located at least 2 cm below the upper oesophageal sphincter. Five anastomotic leaks and two partial necroses occurred and hospital mortality was 8.3% (2/24) in these patients. The remaining five patients operated on underwent miscellaneous surgical procedures with one postoperative death. Overall survival for resections considered curative was 21%:37% for hypopharyngeal and 18% for cervical cancers respectively, while it was nil at three years after palliative resection and total oesophagectomy with larynx preservation.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Single-layered cervical esophageal anastomoses: a prospective study of two suturing techniques.
We carried out a prospective, randomized study over a 1-year period to compare the efficacy of a single layer of continuous absorbable monofilament (Maxon) with that of a single layer of interrupted Polyglactin sutures (Vicryl) in the performance of cervical esophagogastric anastomoses. Forty-two consecutive patients with carcinoma of the esophagus or cardia, in whom the stomach was transposed through the mediastinal route after esophagectomy, were enrolled in the study. There were 21 patients in each group. There was no hospital mortality. One asymptomatic anastomotic leak and two early anastomotic strictures requiring dilation occurred in patients in whom an interrupted technique was employed. The continuous technique required significantly less operative time (p < 0.0001), and the cost of the suture material was reduced markedly. We conclude that either a continuous or an interrupted monolayer esophagogastric anastomosis can give satisfactory results after esophagectomy for cancer, provided that the vascular supply to the gastric fundus is maintained adequately. The continuous technique has the advantages of being time-saving, cheaper, and easier to perform and to teach.
Adenocarcinoma↗
Surgical treatment of reflux stricture of the oesophagus.
The choice of surgery in patients with reflux-induced oesophageal stricture remains controversial. From 1976 to 1990, a total of 65 patients underwent fundoplication (36 patients), Collis gastroplasty plus fundoplication (ten), total duodenal diversion (four) and oesophageal resection (15). The postoperative mortality rate was 5 per cent (three patients): necrosis of the colon transplant in two patients and acute pancreatitis in one. The median follow-up was 25 (range 6-120) months. After conservative surgery, the median number of dilatations per patient per year significantly decreased (P < 0.001). Nine patients (25 per cent) complained of persistent or recurrent symptoms after standard fundoplication and six required reoperation. Clinical results were satisfactory in patients who underwent Collis fundoplication, total duodenal diversion and oesophageal resection. It is concluded that the causes of failed fundoplication are irreversible stricture or persistent gastro-oesophageal reflux; the latter may be caused by inefficacy or deterioration of the partial fundoplication wrap. A subtle degree of oesophageal shortening is probably underestimated in such patients and this may explain the better results obtained with the Collis fundoplication. Total duodenal diversion is a good therapeutic option in patients who have undergone previous oesophagogastric surgery. Oesophageal resection should be reserved for patients with tight strictures unresponsive to dilatation or those with scleroderma, multiple previous operations or severe dysplasia in Barrett's oesophagus.
Adolescent↗
[Primary malignant melanoma of the esophagus. Report of 3 cases and review of the literature].
Primary malignant melanoma of the esophagus is an extremely rare tumour with a fatal prognosis. Only 122 cases have been reported to date in the literature, of which 105 are undoubtedly primary. This study presents three new cases which were surgically treated: two cases underwent subtotal esophageal resection and intrathoracic esophagogastroplasty, and one case underwent total esophageal resection and cervical esophagogastroplasty. The histogenesis, role of immunochemical markers and the therapeutic problems related to malignant esophageal melanoma are discussed in the light of a new review of the literature.
Adult↗
Primary treatment of esophageal achalasia. Long-term results of myotomy and Dor fundoplication.
From 1976 to 1989, 206 patients referred for primary treatment of esophageal achalasia underwent transabdominal Heller's myotomy and anterior fundoplication according to the Dor technique. In the majority of the patients, the cardia was not mobilized, and the myotomy was extended in length for about 10 cm (8 cm on the esophagus and 2 cm on the stomach). There was no operative mortality. Two patients (0.9%) required reoperation due to bleeding from the myotomy site in one and leakage from the gastrotomy site in the other. One hundred ninety-three patients entered the follow-up study and were followed up from 12 to 144 months (median, 64.5 months). Five patients died during the follow-up of unrelated diseases, and in one patient, an esophageal cancer infiltrating the trachea was discovered 26 months after the operation. Clinical results were excellent or good in 93.8% of the patients, and fair in 2.6%. Disabling dysphagia recurred in seven patients (3.6%), six of whom required pneumatic dilation for relief and one patient who underwent reoperation because of a paraesophageal hiatal hernia. Postoperative roentgenographic studies showed a significant reduction in the mean value of the maximal esophageal diameter. Esophageal manometry showed a significant reduction of lower esophageal sphincter pressure and length over preoperative values. Twenty-four-hour esophageal pH monitoring showed an abnormal acid exposure in seven (8.6%) of 81 patients tested. Of these patients, one had erosive esophagitis on endoscopy. Esophageal transit scintigraphy, performed in 11 patients, showed a significant improvement of transit time in the erect position compared with preoperative values. We concluded that transabdominal esophagomyotomy combined with Dor fundoplication is a safe, effective, and durable procedure in the treatment of esophageal achalasia.
Adolescent↗
Functional evaluation of the intrathoracic stomach as an oesophageal substitute.
A study of duodenogastric reflux and gastric function was undertaken in 16 patients 1-7 years after oesophagectomy and high intrathoracic oesophagogastrostomy for oesophageal carcinoma. All were able to eat satisfactorily; ten complained of mild foregut symptoms and ten had endoscopic mucosal lesions. Biliary excretion scintigraphy demonstrated pathological duodenogastric reflux in 11 patients. The emptying of a semisolid radiolabelled meal from the intrathoracic stomach in the upright position was significantly quicker than in control subjects (P less than 0.01). No gastric motor activity was recorded on manometry, suggesting that the transposed stomach acts like an inert tube. Results of 24-h pH monitoring showed that the area under the curve at pH less than 4 in the stomach was significantly less than in control subjects (P less than 0.001). In addition, patients had a significantly greater oesophageal alkaline exposure (P less than 0.001). The vagotomized intrathoracic stomach therefore empties well in the upright position, but is subjected to reflux of alkaline duodenal contents and can retain the ability to produce acid. The interaction between alkaline and acid contents in the pathogenesis of symptoms and mucosal lesions needs further investigation.
Aged↗
Temporary double exclusion of the perforated esophagus using absorbable staples.
A new method for double exclusion of the esophagus is presented. Temporary closure of the cervical and intraabdominal esophagus using absorbable staples allows effective healing of esophageal perforations. The procedure should be routinely combined with drainage of the periesophageal abscess. Complete recanalization of the esophagus occurs 1 to 2 weeks after operation.
Adolescent↗
Videothoracoscopic enucleation of esophageal leiomyoma.
A new thoracoscopic technique to enucleate esophageal leiomyomas is described. The procedure has been successfully performed in 3 patients. All patients benefited by this new surgical approach due to the decreased operative trauma, reduced postoperative pain, quick recovery, and minute skin scars. Although further clinical experience and longer periods of follow-up are needed to evaluate the full benefits and limits of this new access, the early results of the thoracoscopic approach are promising.
Adult↗
Use of mini-invasive procedures in esophageal surgery.
The authors have applied the advantages of mini-invasive surgery to the treatment of esophageal diseases. The technical possibilities of esophageal dissection have been investigated in patients with cancer of the intrathoracic esophagus. The mini-invasive techniques have been applied in the clinical setting to perform the esophagectomy through a trans-hiatal approach or by means of thoracoscopy. Performing the esophagectomy through the trans-hiatal approach allows an accurate mediastinal dissection and lymphadenectomy of the paraesophageal nodes. Performing the esophagectomy by means of thoracoscopy requires division of the azygos vein. In our experience better to divide the esophagus high in the chest. At present, trans-hiatal esophagectomy with mini-invasive procedures seems to be the technique of choice. However, the approach based on thoracoscopy will gain popularity with the development of more sophisticated instruments. In selected cases, it could be advantageous to use both techniques.
Diverticulum, Esophageal↗
Early and long-term results of pneumatic dilation in the treatment of oesophageal achalasia.
Between 1967 and 1989, 60 patients underwent pneumatic dilation of the cardia at our institution. Of these, 33 had not undergone any previous treatment (group 1), whereas 27 presented with recurrent dysphagia after a failure of surgical treatment (group 2). In this series there was no procedure-related mortality and a perforation occurred only in 1 patient who was treated conservatively. The mean follow-up was similar in both groups (44 and 49 months, respectively). The results of pneumatic dilation were either excellent or good in 61% of group 1 patients, and in 76% of group 2 patients. Reflux oesophagitis requiring medical therapy occurred in 1 group 2 patient. We conclude that pneumatic dilation is a safe and relatively effective procedure in patients with achalasia. Patients with a failed Heller myotomy seem to respond better than patients without previous surgery. However, the risk of gastro-oesophageal reflux after pneumatic dilation should not be underestimated.
Catheterization↗
Esophageal carcinoma and achalasia: prevalence, incidence and results of treatment.
UNLABELLED: Between 1980 and 1988, we treated 1,521 patients with squamous cell carcinoma of the esophagus and 336 patients with adenocarcinoma of the gastric cardia. Between 1967 and 1988, 244 patients with esophageal achalasia were also observed. Among 1,857 patients with cancer, achalasia was present in 21 cases (1.1%). In 18 patients the mean and median interval between the diagnosis of achalasia and cancer was 11.5 and 8 years, respectively. In 3 cases achalasia was detected during the work-up for esophageal cancer. The previous treatment for achalasia administered elsewhere was as follows: balloon dilatation in 6 cases, myotomy and Nissen repair in 2, and distal esophageal resection in 1. Thirteen patients (61.9%) underwent resection, resulting in 1 postoperative death, and a mean and median survival of 23.3 and 13 months, respectively. Push intubation was performed in 4 cases, chemotherapy in 2, a by-pass procedure in 1, endoscopic Nd:YAG laser in 1, while 1 further patient did not receive any treatment for the carcinoma, but only balloon dilatation of the LES. The mean follow-up of the 244 patients with primary esophageal achalasia was 44.6 months (range 1-108), and only 1 patient developed an esophageal cancer, giving an incidence of 18.6 cases per 100,000 per year. CONCLUSIONS: in our experience, achalasia is present in a minority of patients with esophageal cancer, and larger prospective controlled trials are needed to assess the true incidence of malignant degeneration in the achalasic patient.
Adenocarcinoma↗