[Cardiospasm and the gallbladder; three cases of cardiospasm associated with cholecystitis].
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A role of gastrointestinal hormones in the regulation of the lower esophageal sphincter was studied in 22 patients with cardiospasm and 21 with reflux esophagitis. The levels of gastrin, vasoactive intestinal polypeptide (VIP), glucagon, insulin, and c peptide were determined by radioactive assay before and after surgical treatment. In opposite abnormalities (cardiospasm and reflux esophagitis), there is a different degree of VIP secretion both at the beginning and after functional exercises. Before and after functional exercises, the level of VIP was higher than in those with cardiospasm. The value of VIP on fasting and after functional exercises may be an additional information to establish the diagnoses of cardiospasm and reflux esophagitis and to evaluate the efficiency of the treatment performed.
On the basis of investigations of the acid-formation and motor activity of the stomach in 95 patients with cardiospasm and results of the treatment of 50 of them the author has shown that most of the patients with cardiospasm had an increased acid-formation and a delayed gastric evacuation. Correction of these disorders in addition to routine methods of treatment of cardiospasm gives better early and late results.
The aim of the study is to assess the value of radiological examination in determining the efficacy of combined operative treatment of cardiospasm. The study group comprised 38 patients, in whom control radiological examinations were performed after surgical treatment of achalasia of oesophagus. The assessment of motor function and efficiency of the cardia was done with physical, radiological examination, oesophagoscopy including taking specimens for histopathologic examination, 24-hour pH-metry and manometry. Different radiological pictures of the gullet and cardia after cardiotomy surgery with subsequent antireflux procedure were presented. It was found that radiological examination in patients surgically treated for cardiospasm enabled the assessment of the efficacy of gullet emptying, width of fundoplication cuff and efficacy of antireflux procedure and that in the assessment of motor function it shows a limited value in correlation with manometric data.
Long-term results of operative treatment of cardiospasm and megaoesophagus in 111 patients are presented. There were 67 women and 44 men treated, age 4 to 65. The authors have for several years used their own, in this Department developed method of operation for cardiospasm, which joins Heller's operation with the reconstruction of the cardia to prevent reflux. In very advanced stages of the disease as megaoesophagus they use an original surgical procedure, which consists in connecting the thoracic segment of the oesophagus with the prepyloric part of the stomach by means of a pedicle jejunal graft. Clinical follow-up supported by x-ray examination and endoscopy has shown very good results of such treatment.
In 39 patients cardiospasm was associated with a hiatal hernia or the latter was formed in the process of treatment by cardiodilatation. An analysis of results of the treatment has shown that pneumocardiodilatation under control of esophagomanometry should be considered the method of choice in the treatment of such patients. The decreased gradient of the gastroesophageal pressure up to 12-14 mm of mercury is responsible for prevention of reflux-esophagitis. Operative treatment is indicated when cardiodilatation is ineffective or the manometric control is impossible. Cardiomyotomy in combination with an "incomplete" fundoplication is preferable. There are no good reasons for performing fundoplication after Nissen in patients with cardiospasm.
3 cases of cardiospasm successfully treated by psychotherapy are reported and some catamnestic conclusions and remarks are given after a follow-up of the patients for 10, 9 and 8 years, respectively. Unlike the clinical symptomatology, which was almost identical in all 3 cases, the precipitating factors, the deeper meaning and the unconscious symbolism of the symptoms were quite different but specific for each one of the patients. Some more thoughts are also given in the paper with reference to the clinical criteria to be considered when evaluating the final therapeutic results of the technique of the therapy applied.
Results obtained with Heller's operation in the management of 27 cases of cardiospasm are presented. The probable causes of oesophageal achalasia leading to dilatation and elongation of the wall are examined. These, in association with nervous changes, form the most marked features of the syndrome. The soundness of the operation employed is confirmed by the results achieved. These are most satisfactory when the disease is at the initial stages and dilatation is not excessive.
Results of treatment of 129 patients with dysphagia recurrency after operative treatment of cardiospasm and achalasia of cardia for the 1970-2000 yrs period were analyzed. There were operated 52 (40.3%) of patients, 77--were treated conservatively. The mainly applied methods of operation were those elaborated in the clinic: reoesophagocardiomyotomy with incomplete fundoplication (in 28 observations) and extirpation of the eosophagus with plasty using gastric tube (in 18). Positive result, noted in majority of observations, witnessed the correctness of substantiation of indications and choice of operative intervention in these patients.
The characteristic esophageal pressure tracings and radiological appearances of diffuse spasm and achalasia are reported. In two patients of the series spastic activity involves the gastroesophageal junction. The findings indicate that differentiation of so-called cardiospasm and achalasia can only be obtained by simultaneous electromanometric pressure measurement and serial film technique. The resulting surgical methods are briefly reviewed.
Long-term results are presented in 60 patients (4 to 50 years old) who underwent a diaphragmatic graft procedure for relief of cardiospasm (achalasia) from 1962 through 1987. The operative technique involves construction of a pedicle flap of diaphragm. The muscular defect on the lower segment of the esophagus and the transplanted diaphragmatic pedicle that is sutured to the defect must be the same size. Immediate operative results were good. Only one complication developed, a case of pneumonia that was cured. The patients were followed up from 11 months to 25 years. Two patients were lost to follow-up, 55 had excellent results, and three patients still had nausea and heartburn but were better than before the operation. This procedure has three advantages: (1) It prevents the development of fistulas and diverticula at the site of the esophageal muscular defect; (2) it effectively eliminates both restenosis resulting from scar tissue and reflux esophagitis; and (3) it allows the cardia to recover its normal function and the esophagus to return to normal size at the site of the operation.
The treatment by means of bloodless dilatation was carried out upon 82 cases of cardiospasm. Good results were achieved in 80 cases the results were satisfactory. An improved method of cardiodilatation is described.
Results of the treatment of 152 patients with cardiospasm are described, 46 of them were operated upon, including 12 patients operated by the method proposed by the authors. Good results were obtained in 11 out of 12 patients.
From a case in a 13 and half year old girl, the cardiospasm diagnostic basis are pointed out. Though infrequent this disease can occur in children and infants. During initial stage, the dynamic radiographic signs are difficult to recognize. In a more advanced stage, radiographic signs are clear. Radiographic examinations are also necessary in evaluation of surgical results, mainly in looking for post-operative gastroesophageal regurgitation.
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