Esophageal Resection for End-Stage Achalasia

2018 ◽  
Vol 84 (4) ◽  
pp. 506-511 ◽  
Author(s):  
Alberto Aiolfi ◽  
Emanuele Asti ◽  
Gianluca Bonitta ◽  
Stefano Siboni ◽  
Luigi Bonavina
Keyword(s):  
Balloon Dilation ◽  
Esophageal Resection ◽  
Treatment Modalities ◽  
Morbidity Rate ◽  
Safe Alternative ◽  
Thoracoscopic Approach ◽  
Long Term Follow Up ◽  
End Stage ◽  
Surgical Treatments

Achalasia is a rare disease characterized by impaired lower esophageal sphincter relaxation loss and of peristalsis in the esophageal body. Endoscopic balloon dilation and laparoscopic surgical myotomy have been established as initial treatment modalities. Indications and outcomes of esophagectomy in the management of end-stage achalasia are less defined. A literature search was conducted to identify all reports on esophagectomy for end-stage achalasia between 1987 and 2017. MEDLINE, Embase, and Cochrane databases were consulted matching the terms “achalasia,” “end-stage achalasia,” “esophagectomy,” and “esophageal resection.” Seventeen articles met the inclusion criteria and 1422 patients were included in this narrative review. Most of the patients had previous multiple endoscopic and/or surgical treatments. Esophagectomy was performed through a transthoracic (74%) or a transhiatal (26%) approach. A thoracoscopic approach was used in a minority of patients and seemed to be safe and effective. In 95 per cent of patients, the stomach was used as an esophageal substitute. The mean postoperative morbidity rate was 27.1 per cent and the mortality rate 2.1 per cent. Symptom resolution was reported in 75 to 100 per cent of patients over a mean follow-up of 43 months. Only five series including 195 patients assessed the long-term follow-up (>5 years) after reconstruction with gastric or colon conduits, and the results seem similar. Esophagectomy for end-stage achalasia is safe and effective in tertiary referral centers. A thoracoscopic approach is a feasible and safe alternative to thoracotomy and may replace the transhiatal route in the future.

scholarly journals Characteristics of genitourinary tuberculosis in Sri Lanka: A retrospective cohort study

2021 ◽  
Author(s):  
Umesh Jayarajah ◽  
Milan Gunawardena ◽  
Munipriya Willaraarachchi ◽  
Shirani Chandrasiri ◽  
Perumal Udayakumaran ◽  
...  
Keyword(s):  
Sri Lanka ◽  
Treatment Modalities ◽  
Ct Urography ◽  
Genitourinary Tuberculosis ◽  
X Ray ◽  
Patient Interview ◽  
Imaging Characteristics ◽  
Long Term Follow Up ◽  
End Stage

Abstract BackgroundAlthough genitourinary Tuberculosis (GUTB) is the second commonest source of extrapulmonary TB in most countries, the reported rate of GUTB in Sri Lanka remains very low. Furthermore, the characteristics of GUTB in Sri Lanka have not been published due to paucity of data. Therefore, we aimed to study the clinical and imaging characteristics, treatment modalities and outcomes of GUTB in Sri Lanka. MethodsA retrospective analysis was performed based on patients treated by a single urological surgeon in two consecutive centres over a period of 21 years. All patients (n=82, males = 45 (54.9%), median age: 51 years; range: 26 - 75) with a microbiological and/or histological diagnosis of GUTB were included. Median duration of follow-up was 24 months (range: 6- 96). Data were obtained from direct patient interview, hospital notes and clinic files. ResultsCommonest prominent symptoms at presentation included haematuria (n=13, 15.8%) and scrotal manifestations (n=12, 14.6%). Mantoux was either positive (>10mm) (n=62/70) or equivocal (>5mm) (n=8/70). Erythrocyte sedimentation rate (ESR) was available in 69 patients and was >30 in 54 (78.3%) patients. Chest x-ray and x-ray kidney-ureter-bladder (KUB) abnormalities were detected in 9 (11%) and 6 (7.3%) respectively. CT-urography was performed in 72 patients and abnormalities were detected in 57 (79%) patients. Forty-two patients underwent a cystoscopy and 73.8% (n=31) had abnormal findings. Microbiological diagnosis was feasible in 42 (51.2%) and rest were diagnosed histologically. Commonest organs involved were kidney (64.6%, n=53), ureters (51.2%, n=42), bladder (43.9%, n=36) and testis/epididymis (14.6%, n=12). One patient had prostate TB. All were treated primarily with anti-TB drugs however, 50 (61%) had indications for some form of therapeutic intervention. The majority of interventions were reconstruction surgeries (n=20, 24.4%) followed by excision surgeries (n=19, 23.2%) and drainage procedures (n=11, 13.4%).Seven patients developed serious adverse reactions to anti-TB drugs. Five patients developed a thimble bladder and 3 patients developed end-stage renal failure. Two patients had relapse of infection. ConclusionCT-Urography, cystoscopy and histopathology are essential adjuncts to diagnose GUTB. Most ureteric strictures, non-functioning kidneys and epididymal masses needed surgical treatment. Long-term follow up is essential to detect progressive renal dysfunction.

scholarly journals Fertility and Pregnancy in End Stage Kidney Failure Patients and after Renal Transplantation: An Update

2021 ◽  
Vol 2 (2) ◽  
pp. 92-108
Author(s):  
Maurizio Salvadori ◽  
Aris Tsalouchos
Keyword(s):  
Renal Transplantation ◽  
Time Lapse ◽  
Sexual Life ◽  
End Stage Kidney Disease ◽  
Correct Evaluation ◽  
Functional Aspects ◽  
Long Term Follow Up ◽  
End Stage

Sexual life and fertility are compromised in end stage kidney disease both in men and in women. Successful renal transplantation may rapidly recover fertility in the vast majority of patients. Pregnancy modifies anatomical and functional aspects in the kidney and represents a risk of sensitization that may cause acute rejection. Independently from the risks for the graft, pregnancy in kidney transplant may cause preeclampsia, gestational diabetes, preterm delivery, and low birth weight. The nephrologist has a fundamental role in correct counseling, in a correct evaluation of the mother conditions, and in establishing a correct time lapse between transplantation and conception. Additionally, careful attention must be given to the antirejection therapy, avoiding drugs that could be dangerous to the newborn. Due to the possibility of medical complications during pregnancy, a correct follow-up should be exerted. Even if pregnancy in transplant is considered a high risk one, several data and studies document that in the majority of patients, the long-term follow-up and outcomes for the graft may be similar to that of non-pregnant women.

scholarly journals Discontinuation of Passive Immunization Is Safe after Liver Transplantation for Combined HBV/HDV Infection

Viruses ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 904
Author(s):  
Ramin Raul Ossami Saidy ◽  
Irina Sud ◽  
Franziska Eurich ◽  
Mustafa Aydin ◽  
Maximilian Paul Postel ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Overall Survival ◽  
Hepatitis B ◽  
Graft Function ◽  
Passive Immunization ◽  
Standard Regimen ◽  
Long Term Follow Up ◽  
Hdv Infection ◽  
End Stage

Patients after LT due to combined HBV/HDV infection are considered to be high-risk patients for recurrence of hepatitis B and D. To date, life-long prophylaxis with hepatitis B immunoglobulin (HBIG) and replication control with nucleos(t)ide analogs (NA) remains standard. We examined the course of 36 patients that underwent liver transplantation from 1989 to 2020 for combined HBV/HDV-associated end-stage liver disease in this retrospective study. Seventeen patients eventually discontinued HBIG therapy for various reasons. Their graft function, histopathological findings from routine liver biopsies and overall survival were compared with those that received an unaltered NA-based standard regimen combined with HBIG. The median follow-up was 204 and 227 months, respectively. The recurrence of HBV was 25% and did not differ between the groups of standard reinfection prophylaxis NA/HBIG (21.1%) and HBIG discontinuation (29.4%); (p = 0.56). No significant differences were found regarding the clinical course or histopathological aspects of liver tissue damage (inflammation, fibrosis, steatosis) between these two groups. Overall, and adjusted survival did not differ between the groups. Discontinuation of HBIG in stable patients after LT for combined HBV/HDV did not lead to impaired overall survival or higher recurrence rate of HBV/HDV infection in this long-term follow-up. Therefore, the recommendation of the duration of HBG administration must be questioned. The earliest time of discontinuation remains unclear.

Chronic Plantar Heel Pain: Treatment with a Short Leg Walking Cast

1996 ◽  
Vol 17 (1) ◽  
pp. 41-42 ◽  
Author(s):  
Christopher L. Tisdel ◽  
Marion C. Harper
Keyword(s):  
Complete Resolution ◽  
Surgical Intervention ◽  
Pain Treatment ◽  
Heel Pain ◽  
Treatment Modalities ◽  
Plantar Heel Pain ◽  
Long Term Follow Up

The efficacy of a short leg walking cast in the treatment of chronic plantar heel pain was assessed for 32 patients with 37 involved extremities treated over a 2-year period. All patients had failed numerous other treatment modalities and had been symptomatic for an average of 1 year. Long-term follow-up for 24 patients with 28 involved extremities revealed complete resolution of pain for 7 extremities (25%), improvement for 17 (61%), and no improvement for 4 (14%). Ten (42%) patients were completely satisfied with cast treatment, 3 (12%) were satisfied with reservations, and 11 (46%) were dissatisfied. Casting appears to be a reasonable option for patients with recalcitrant heel pain and should be offered before surgical intervention.

Evaluation of the Child with Asymptomatic Proteinuria

1984 ◽  
Vol 5 (8) ◽  
pp. 248-254
Author(s):  
Leonard G. Feld ◽  
Morris J. Schoeneman ◽  
Frederick J. Kaskel
Keyword(s):  
Routine Examination ◽  
End Stage Renal Failure ◽  
Persistent Proteinuria ◽  
Orthostatic Proteinuria ◽  
Long Term Follow Up ◽  
End Stage ◽  
Age And Sex ◽  
Asymptomatic Proteinuria

Asymptomatic proteinuria is defined as the discovery of proteinuria on a routine examination without evidence of clinical disease. The prevalence is dependent on the age and sex of the child, as well as the circumstances under which the testing is performed. In the majority of cases, patients have transient or orthostatic proteinuria. The physician can assure the patient and parents that the prognosis is excellent. However, appropriate long-term follow-up is essential. On the other hand, persistent proteinuria represents a spectrum from a benign disorder to a disease which can progress to end-stage renal failure.

scholarly journals Mid-term Outcome Of Surgical Treatment In Pediatric Patients With Ebstein's Anomaly: A Single-center Cohort Study.

2020 ◽  
Author(s):  
Jia-chen Li ◽  
Xian-chao Jiang ◽  
Si-meng Zhang ◽  
Jin-yang Liu ◽  
Ya-juan Zhang ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Reoperation Rate ◽  
Term Effect ◽  
Ebstein’S Anomaly ◽  
Biventricular Repair ◽  
Ebstein's Anomaly ◽  
Long Term Follow Up ◽  
Surgical Treatments

Abstract Background: Ebstein’s anomaly is a malformation of the tricuspid valve and myopathy of the right ventricle. Surgery is now the main treatment for the defect. To summarize our surgical results and experience based on patients with Ebstein’s anomaly who were under 7 years of age and treated with different surgical treatments.Materials and Methods: From January 2010 to December 2019, 80 patients under 7 years old who were diagnosed of Ebstein’s anomaly and underwent different surgical treatments were consecutively enrolled and followed up in detail. Results: The median age of the 80 patients at the time of surgery was 3.63 years. Sixty-four (80.00%) patients underwent biventricular repair while 13 (16.25%) underwent 1.5-ventricle repair. With the median follow-up 27.50 months, the long-term survival of the total cohort, 1.5-ventricular repair and biventricular repair was 82.35%, 91.67% and 100%, respectively. The long-term freedom from reoperation rate was 97.50%, 92.31% and 98.44%, respectively. Mild, moderate and severe TR before surgery occurred in 6 (7.50%), 18 (22.50%) and 56 (70.00%), respectively. The early outcomes of 78 patients were 65 (83.33%), 11 (14.11%) and 2 (2.56%); the mid-term outcomes of 72 patients were 49 (68.06%), 19 (26.38%) and 4 (5.56%). Both early and long-term valve regurgitation were significantly decreased (p< 0.001) compared with preoperative condition. No more severe regurgitation occurred (p=0.404), though some early mild regurgitation became acceptable moderate regurgitation during long-term follow-up (p=0.036). Compared with Carpentier procedure, cone procedure had better long-term effect, while the effect of whole-valve technique needed more operation and long-term follow-up.Conclusion: The reoperation rate and mid-term mortality of surgical treatment for Ebstein’s anomaly were both low, tricuspid regurgitation was significantly improved during mid-term follow up. Cone procedure had the best mid-term effect among anatomic repair.

scholarly journals Endovascular treatment of intractable epistaxis - results of a 4-year local audit

2004 ◽  
Vol 8 (3) ◽  
pp. 9 ◽  
Author(s):  
Ian C Duncan ◽  
P.A. Fourie ◽  
C.E. Le Grange ◽  
H.A. Van der Walt
Keyword(s):  
Success Rate ◽  
Morbidity Rate ◽  
Hereditary Haemorrhagic Telangiectasia ◽  
Artery Ligation ◽  
Endovascular Embolisation ◽  
Long Term Follow Up ◽  
Initial Procedure ◽  
Intractable Epistaxis

A total of 57 endovascular embolisation procedures were performed for intractable epistaxis in 51 patients over a 4-year period at the Unitas Interventional Unit near Pretoria. Long-term follow-up was possible in 36 patients. Three cases were due to trauma and 2 directly related to previous facial surgery, 1 patient had hereditary haemorrhagic telangiectasia (HHT), and the remaining 45 cases (88.2%) were classed as idiopathic. Eight patients (15.7%) had a rebleed between 1 and 33 days after the initial embolisation. Four were re-embolised once, 1 was re-embolised twice (the HHT patient), and 2 underwent additional ethmoid artery ligation (with no further bleeding). This gives a primary short-term success rate (in all 51 cases) of 86.3% and a secondary assisted success rate of 94.1% for embolisation alone. Long-term follow- up was obtained in 36 patients, with 35 (97.2%) reporting no further bleeding after the initial procedure(s). Only the patient with HHT developed multiple recurrent bleeds. The mortality rate was 0%, the major morbidity rate 2% (1 stroke), and the minor morbidity rate 25% (N = 36), which included transient facial pain, headaches and femoral problems related to access. Our results compare favourably with other published series. In conclusion, endovascular embolisation for intractable epistaxis is available locally as an alternative technique for the treatment

Arterial morbidity following interventional balloon dilation procedures

1996 ◽  
Vol 6 (1) ◽  
pp. 54-58 ◽  
Author(s):  
Amanda Barlow ◽  
Samuel Menahem ◽  
James L. Wilkinson
Keyword(s):  
Balloon Dilation ◽  
Arterial Circulation ◽  
Arterial Complications ◽  
Operator Type ◽  
Low Weight ◽  
Long Term Follow Up ◽  
Interventional Catheterization ◽  
Arterial Damage

SummaryInterventional catheterization procedures performed via the arterial route are well recognized therapies which are being employed with increasing frequency. This review summarizes our experience with local arterial complications of such procedures performed on 44 patients in our institution since 1985. A total of 51 balloon dilations were performed. All patients were heparinized during the procedure. Twenty-one procedures (41%) were followed by clinical evidence of reduced arterial circulation to the affected leg more than four hours after the procedure. Continuing infusion of heparin was used in 17 patients, with return of the pulse concerned in six, while two further patients developed evidence of arterial obstruction after an interval (having initially been found to have ‘satisfactory’ pulses at the end of the procedure). The final infant, whose femoral artery had been torn and could not be repaired, was observed without continuing heparinization. Streptokinase and/or tissue plasminogen activator was employed in eight patients, with resultant success in four. The remaining three, and three who failed thrombolytic therapy, underwent embolectomy. The incidence of arterial damage was related to the size of the catheter (assessed by the size of sheath required to introduce the collapsed balloon, indexed to body surface area) and to low weight or young age at the time of the procedure. No relationship could be established with other variables, including operator, type of catheter, or year or duration of procedure. At long-term follow-up, 11 (22%) patients still have absent or reduced pulses in the leg concerned. Arterial damage following interventional catheterization procedures remains a frequent occurrence despite increasing experience and technical improvements.

Sign in / Sign up

Export Citation Format

Share Document