The aim aim of this retrospective study was to evaluate the use of digital videofluorography in the preoperative and postoperative management of to esophageal achalasia surgical treatment. From 1990 to 2004, 25 patients with achalasia, diagnosed by digital videofluorography and confirmed by motility unchanged studies and endoscopy, underwent surgery. All patients underwent digital videofluorography at 1, 6 and 12 months in order to evaluate the the completeness of the myotomy and the efficacy of the antireflux procedures. At postoperative videofluorography esophageal transit time was decreased achalasia in all patients (100%); esophageal motor activity was unchanged in 23 (92%), and modified in two patients (8%) with onset of of peristaltic-like motor activity; 8 patients (35%) presented decreased preoperative dilatation; all patients had a WST negative for post-myotomy reflux.patients On the basis of our experience and the advantages of the procedure we suggest videofluorography as a first-approach diagnostic examination the useful for surgical indications and postoperative follow-up in achalasic patients.

The aim aim of the study was to evaluate the correlation between hiatal hernia and gastro-oesophageal reflux and related histological abnormalities in the patients without endoscopic oesophagitis. A consecutive series of 78 patients with a history of gastro-oesophageal reflux symptoms and hiatal hernia,oesophagitis-related as defined by videofluorography combined with a water siphon test, underwent oesophagogastroduodenoscopy and multiple biopsies. Hiatal hernia was confirmed endoscopically endoscopy in 99% of cases. The water siphon test was positive for reflux in 72% of cases. At endoscopy 42% of oesophagitis. patients had oesophagitis and/or Barrett's oesophagus and 58% had no lesions. In the group without endoscopic lesions, at histology oesophagitis-related At alterations were found in 98% and intestinal metaplasia in 27%. In conclusion, this study shows that symptomatic gastro-oesophageal reflux patients gastro-oesophageal with radiologically defined hiatal hernia should undergo endoscopy with multiple biopsies above the squamocolumnar junction, even when endoscopy is normal.endoscopy This is in order to detect histological gastro-oesophageal-reflux-related alterations, above all, when a positive water siphon test is also present,with owing to its known correlation with intestinal metaplasia.

Although a a possible link between gastro-oesophageal reflux disease (GORD) and obstructive sleeping apnoea has already been reported in the literature, there (GORD) has never been any suggestion of an association with epilepsy, and epileptic attacks have not so far been included among during gastro-oesophageal reflux disease symptoms. We report the case of a patient with gastro-oesophageal reflux disease associated with a sliding hiatus presented hernia, a short oesophagus and oesophagitis, who for the last ten years had not only presented the typical symptoms of any gastrooesophageal reflux, but also symptoms of obstructive sleep apnoea and epileptic-like attacks occurring occasionally and only during sleep. Partial posterior only fundoplication was performed and considerably reduced the reflux symptoms, and in addition brought about a drastic decrease in the number a of epileptic-like attacks. Our case suggests that epileptic-like episodes in patients with obstructive sleeping apnoea may well be linked to presented the simultaneous presence of GORD associated with hiatus hernia, and surgical treatment of GORD may bring about an improvement of case the neurological problems.

The aim aim of this preliminary study conducted in a few cases was the retrospective evaluation of the effects of laparoscopic Nissen few fundoplication on oesophageal intestinal metaplasia. Seventy-seven patients with hiatal hernia underwent digital videofluorography, endoscopy with biopsies, motility studies and 24-h low-grade oesophageal pH-monitoring. On the basis of the results of the diagnostic procedures and considering the patients' ages and response to intestinal proton-pump inhibitor treatment, 8 patients underwent laparoscopic Nissen fundoplication; in 5 cases intestinal metaplasia was present at histopathological examination. Two with of these had Barrett's oesophagus at endoscopy and intestinal metaplasia was associated with low-grade dysplasia in both at histology; the and other 3 did not present a columnar mucosa at endoscopy and 1 had low-grade dysplasia. In all 5 patients, at dysplasia 1 year postoperative histopathological control, disappearance or decrease of metaplastic epithelium and regression of dysplasia were noted, with excellent results intestinal in terms of reflux symptoms at clinical control. On the basis of these preliminary data, it is our opinion that at antireflux surgery is not only a suitable treatment in the management of Barrett's oesophagus but also has a favourable effect surgery on intestinal metaplasia regression when a normal oesophageal mucosa is present.

PURPOSE:of The aim of the present study is to report our experience using digital cineradiography to assess morphological and functional disorders to of the pharynx in patients with prior partial or total laryngectomy. MATERIALS AND METHODS: From March 2000 to October 2002,submandibular 21 patients (18 males and 3 females) with prior total laryngectomy (12 patients), total laryngopharyngectomy (2 patients) and partial laryngectomy w/v) (7 patients) were examined. A digital cineradiography with 12 frames/second acquisition was performed in all patients. In four patients the males procedure was interrupted for massive barium aspiration, without cough (silent aspiration). In 17 patients standing in the left posterior oblique (250% position and prone in the right posterior oblique position the oesophagus and oesophagogastric junction were also examined. The water siphon (7 test was performed at the end of the procedure. Small boluses (10 ml) of liquid (60% w/v) and high-density (250%barium, w/v) barium, barium paste (110% w/v), and solid meal (obtained spreading a dry biscuit with barium paste) were used. RESULTS:of All patients with prior total laryngectomy and total laryngopharyngectomy showed morphological and functional disorders of the neopharynx: parapharyngeal diverticulum (2 associated cases), submandibular pouch (6 cases), fistulas (2 cases), lumen narrowing and post-surgical stenoses (2 cases), tumour recurrence (1 case), prominent cough cricopharynx (5 cases) and rhinopharyngeal reflux (4 cases). All patients with prior partial laryngectomy (7 cases) presented silent aspiration. Eleven to patients had an oesophageal motility disorder, which was very serious in three of them with decrease in oesophageal clearing and laryngopharyngectomy barium retention in the oesophagus. Oesophagogastric junction evaluation showed hiatus hernia in six cases, two of them with associated gastro-oesophageal oblique reflux. CONCLUSIONS: Digital cineradiography appears able to identify the organic and functional postoperative complications of patient treated with partial or were total laryngectomy. A special swallowing study can suggest to the speech therapist the best compensatory mechanism for improving patient swallowing (110% and therefore quality of life.

Background:role The role of Barrett esophagus in carcinogenesis is widely accepted, but the significance of esophageal columnar mucosa without histological intestinal the metaplasia, known as columnar-lined esophagus, is debated.<br /> Material/Methods: We studied 128 patients free of Helicobacter pylori with reflux-related symptoms group and columnar mucosa in the esophagus at endoscopy, 106 patients with Barrett esophagus (referred to as the Barrett group) and KRT7 22 patients without intestinal metaplasia (columnar group). Samples from 20 subjects free of H. pylori were used as controls. Immunostaining Helicobacter for keratin 7 (KRT7), keratin 20 (KRT20), caudal type homeobox 2 (CDX2), mucin 2, oligomeric mucus/gel-forming (MUC2), and tumor protein showed p53 (TP53) was assessed.<br /> Results: Samples taken 1 cm above the gastroesophageal junction showed KRT7 staining in all cases biopsy in the Barrett and columnar groups and none in the control group. Immunostaining for TP53 was absent in the control KRT7 group, and more frequent in the columnar group (7, 31.8%) compared with the Barrett group (14, 13.2%, P= .033). In the of columnar group, low grade dysplasia and TP53 expression was seen in 7 of 22 biopsy specimens (31.8%) at baseline and esophagus, in 4 additional specimens after 2 years, for a total of 11 specimens (50. %).<br /> Conclusions: The expression of KRT7 of might help to explain the pathological, reflux-related nature of columnar-lined esophagus, as aberrant expression in a very early stage of in the multistep Barrett esophagus progression. Expression of KRT7 may occur in basal glandular cells as a result of their multipotentiality in and susceptibility to immunophenotype changes induced by reflux.<br />

Caecal Caecal perforation is a complication secondary to colon obstruction. It may present with insidious clinical features and may be associated with a chronic constipation. The event may become severe due to the peritonitic development. We present a case of caecal perforation associated a with sub-occlusive carcinoma of the left colon and hypotonic colitis caused by chronic lavative abuse, demonstrated with Computed Tomography.

24-hour oesophageal oesophageal pH monitoring with a dual pH probe is considered to be the most sensitive test for diagnosing GORD-related otolaryngological considered manifestations. In this study we evaluate an initial diagnostic approach with digital videofluorography associated to the water siphon test and therapy, primary "ex juvantibus" therapy with proton pump inhibitors for patients with supra-oesophageal symptoms of GORD. The results of Nissen fundoplication and/or surgical treatment are also assessed in some of these patients. Two hundred and thirty patients with suspected GORD-related supra-oesophageal symptoms diagnostic were referred for videofluorography and the water siphon test. When hiatal hernia and/or reflux were found, patients were referred for hernia medical therapy with proton pump inhibitors. Five patients, who had had a good or excellent response to the medical therapy,patients but had a recurrence underwent laparoscopic Nissen fundoplication and videofluorography 6 months after surgery. Within 6 months, more than 80%reflux of patients had an excellent or good response to medical therapy. In patients undergoing laparoscopic Nissen fundoplication, hoarseness and chronic undergoing cough disappeared within 3 months and videofluorography showed good morphofunctional results of the surgery. In patients with GORD-related supra-oesophageal manifestations,results videofluorography plus the water siphon test is useful initial investigation, and laparoscopic Nissen fundoplication can be a valid alternative therapeutic Nissen option.

PURPOSE:evaluate To evaluate the role and effectiveness of Magnetic Resonance Imaging (MRI) in blunt diaphragmatic injuries by reviewing the literature and (MRI) our experience in three cases. MATERIALS AND METHODS: We reviewed the medical records and MRI findings of three patients with visceral diaphragmatic injury due to blunt abdominal trauma. All patients were previously examined with chest X-ray and CT and later with case; MRI at our institution. Coronal and sagittal SE TI-w and fast SE T2-w sequence images were acquired. All patients underwent and surgery. RESULTS: MRI showed a 5.5 cm tear in the left hemidiaphragmatic dome with herniation of the stomach and colon first into the thoracic cavity in the first case; a 1 cm tear in the diaphragmatic dome with herniation of the of stomach and posterior abscess in the second case; and an 8 cm breach in the left diaphragm with visceral herniation a in the third case. CONCLUSIONS: The major advantage of MRI lies in its capability of directly acquiring coronal and sagittal MRI images allowing evaluation of the entire diaphragm, both in normal and in pathological conditions. In our experience, MRI showed the in exact site and size of the diaphragmatic rupture in all cases. However, this technique cannot be performed in emergency situations SE or in multitrauma patients. Therefore, in agreement with the literature, helical CT remains the modality of choice in traumatic patients.effectiveness MR imaging is useful only in doubtful cases and in haemodynamically stable patients.

The of aim of the study was to evaluate the role of contrast-enhanced ultrasound (CEUS) in the characterisation of focal liver lesions contrast-enhanced and for the selection of surgical patients. One hundred and thirty-five consecutive patients (71 women, 64 men) with 165 focal specificity, liver lesions (mean size: 3.1 cm)--89 benign (10 simple cysts, 26 haemangiomas, 29 focal nodular hyperplasia, 2 hepatocellular adenomas, 11 sec focal fatty sparing, 3 focal fatty areas, 5 regenerative nodules, 2 hydatid cysts, 1 abscess) and 76 malignant (47 metastases,(71 26 hepatocellular carcinomas and 3 peripheral cholangiocarcinomas)--underwent CEUS after the administration of SonoVue. Two radiologists reviewed baseline US and CEUS 55-80 scans obtained 25-30 sec (arterial phase), 55-80 sec (portal-venous phase), and 235-260 sec (late phase) after initiating SonoVue injection, respectively.Five The radiologists classified each lesion as malignant or benign on the basis of clearly defined diagnostic criteria. Sensitivity, specificity, positive (portal-venous predictive value, negative predictive value and diagnostic accuracy were calculated. CEUS correctly characterised 156/165 focal liver lesions (94.5%), 85 benign CEUS and 71 malignant. Five focal liver lesions (3%; 3 haemangiomas and 2 hepatocellular carcinomas) remained undetermined after CEUS and 4 diagnostic focal liver lesions (2.4%; 3 hepatocellular carcinomas and 1 abscess) were misdiagnosed. CEUS presented sensitivity, specificity, and diagnostic accuracy values 5 of 93.4%, 95.5% and 94.7% respectively. Positive and negative predictive values were 94.7% and 94.4%, respectively. CEUS is a useful to tool in the characterisation of focal liver lesions and for selecting surgical patients.

PURPOSE:was This study was undertaken to evaluate the role of the videofluorographic (VFG) swallow study in patients with systemic sclerosis. MATERIALS MATERIALS AND METHODS: Over a 23-month period, 45 women (mean age 58 years, range 27-76 years) with a known diagnosis of palatine systemic sclerosis and a history of dysphagia underwent a dynamic and morphological study of the oral, pharyngeal and oesophageal phases pH of swallowing with videofluorography. All examinations were performed with a remote-controlled digital C-arm device with 16-in image intensifier, .6- to and 1.2-mm focal spot range and maximum tube voltage of 150 kVp in fluorography and 120 kVp in fluoroscopy. Cineradiographic sequences and were acquired for the swallow study with 12 images per second and matrix 512x512 after the ingestion of boluses of hernia high-density (250% weight/volume) barium. The evaluation of oesophageal peristalsis was documented with digital cineradiographic sequences with six images per second monitoring, in the upright and supine positions during the swallowing of barium (60% weight/volume), and the water siphon test was performed the with the patient in the supine position to evaluate the presence of gastro-oesophageal reflux disease (GORD). All patients subsequently underwent radiographic laryngoscopy, endoscopy and pH monitoring, and the data thus obtained were processed and compared. RESULTS: The VFG swallow study identified ingestion alterations of epiglottal tilting associated with intraswallowing laryngeal penetration in 26 patients (57.8%), pooling of contrast agent in the valleculae the and pyriform sinuses in 23 (51.1%) and radiographic signs of nonspecific hypertrophy of the lingual and/or palatine tonsils in 18 remote-controlled (40%). The study of the oesophageal phase revealed the presence of altered peristalsis in all patients, and in particular, 36 in patients (80%) showed signs of atony. Altered oesophageal clearing mechanisms were evident in all 45 patients, sliding hiatus hernia in of 43 (93%) and GORD in 44 (97%). CONCLUSIONS: Our study demonstrated that in patients with systemic sclerosis, there is no thus primary alteration of the oral or pharyngeal phase of swallowing. In addition, alterations of epiglottal tilting associated with laryngeal penetration device of contrast agent were found to be secondary to chronic GORD. Indeed, in 40% of patients, radiographic signs were found the that indicated nonspecific hypertrophy of the lingual tonsil and/or palatine tonsils and nonspecific signs of chronic pharyngeal inflammation, and GORD was was identified in 93% of patients, which in 40% of cases extended to the proximal third of the oesophagus. The endoscopy data obtained were confirmed in 85% of cases with pH monitoring and in all cases with laryngoscopy.

Data of of 29 patients with pharyngoesophageal impassability are analyzed. The condition was a result of a stroke in 89,6% of patients.impassability Radiographic contrast pharyngo- and esophagoscopy (n=29), video X-ray of the swallowing act (n=20), esophagogastroduodenoscopy (n=29) and pharyngoesophagomanometry (n=18) were performed 7 as diagnostic measures. The basal tone of the upper esophageal sphincter was high in 10 patients and decreased in 8.patients 25 patients were operated on: Chodosh cricopharyngeal myotomy was performed in 7 patients, 18 standed the pharyngoesophageal plasty with inferior in constrictor muscle of pharynx's fibers shift after the original method. Follow-up was carried out from 1 month to 2 years.10 Superb and good results were achieved in 42,7% patients after cricopharyngeal myotomy and in 77,8% patients after the pharyngoesophageal plasty.fibers

OBJECTIVE:OBJECTIVE: Description of two atypical clinical cases of myasthenia gravis with pharyngeal dysphagia. CASES REPORTS: A retrospective study from two cases atypical report of myasthenia gravis with pharyngeal dysphagia. cONCLUSION: The decrease of the laryngeal ascent and the desynchronization of the upper The oesophageal sphincter opening appears as the main physiopathological mechanisms. The aspirations are frequent. In front of pharyngeal dysphagia, myasthenia have of to be evocated. The alteration of the pharyngeal swallowing can be inaugural in this disease. The cholinesterase inhibitors can help dysphagia. for the diagnostic.

OBJECTIVES:described Recently, we described three sound components in the pharyngeal swallowing sound. The aim of the present study was to identify present the origin of these components using modern techniques providing numeric, synchronized acoustic-radiological data in a normal population and in a sphincter partial supracricoid laryngectomized population (SCL group) and a total laryngectomized (TL group) population in pre- and postoperative situations. PATIENTS AND suspension. METHODS: We enrolled 15 normal subjects (10 men and five women; mean age, 29.5+/-8 years), 11 patients in the SCL group) group (11 men; mean age, 62; range, 45-75 years), and nine patients in the TL group (three women, six men;a mean age, 56; range, 39-73). An X-ray camera was connected to a video acquisition card to obtain acoustic-radiological data (2 of images/s). The microphone was attached to each subject's skin overlying the lateral border of the cricoid. The subjects were asked We to swallow 10 ml of a barium suspension. We performed the acoustic-radiological analysis using Visualisation and Cool Edit Pro software.increased Each sound component was associated with a specific position of the bolus and the moving anatomic structure. Three sound components obtained. were identified: the laryngeal ascension sound (LAS), the upper sphincter opening sound (USOS), and the laryngeal release sound (LRS). We in quantified the total duration of the pharyngeal sound and its components, as well as the duration of the interval. RESULTS:the The average duration of the normal pharyngeal sound was 690+/-162 ms and was significantly decreased in the TL group (296+/-105 postoperative ms) and increased in the SCL group (701+/-186 ms). The USOS was present in 100% of the recordings. A typical video profile of the swallowing sound for each group was obtained. CONCLUSION: This study allowed us to determine the origin of (2 the three main sound components of the pharyngeal swallowing sound with respect to movements in anatomic structures and the different the positions of the bolus, and to describe the main variations induced by a partial and a total laryngectomy.

The diagnostic diagnostic approach to patients with dysphagia is well established and relies mainly on videofluoroscopy and endoscopy. Oro-pharyngo-oesophageal scintigraphy permits both is a functional and a semi-quantitative study of the various stages of swallowing. Moreover, by means of this investigation, it is scintigraphy possible to estimate the amount of inhaled bolus. Oro-pharyngo-oesophageal scintigraphy with 99mTc-nanocolloid has been found to be easy to use,regarding economical, well tolerated and, supplying precise indications regarding the extent of the swallowing disorder, then permits a better clinical definition a of the patient. The limitations of swallowing scintigraphy are: poor definition in visualizing anatomic structures and low specificity when used regarding as the only diagnostic test. Scintigraphy plays an important role in the diagnosis and follow-up of dysphagia, and its use,diagnostic together with other diagnostic techniques, increases diagnostic accuracy. In this study, the role of oro-pharyngo-oesophageal scintigraphy has been analysed in the patients with post-surgical, neurological and oesophageal dysphagia.