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

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

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

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

The by aim of the study was to report our experience with the use of radiology in functional disorders of the cricopharyngeal provides muscle and their surgical therapy using digital cineradiology. Five-hundred and seventy dysphagic patients underwent dynamic study of the oral and patients: pharyngeal phases of swallowing (Videofluoroscopic Swallowing Study, VFSS). A motor disorder of the cricopharyngeal muscle was diagnosed by videofluorography in a 19 patients: the disorder was mild in 8, moderate in 7 and severe in 4. Two of these underwent cricopharyngeal in myotomy, with an improvement in their dysphagia and swallowing mechanisms. VFSS provides a morphological and functional view of the aero-digestive VFSS tracts: this is essential in the diagnosis of cricopharyngeal dysfunction and is capable of revealing the related laryngeal penetration and of tracheal aspiration. VFSS must always include an oesophageal phase study because of the known clinical and physico-pathological correlations between the in gastro-oesophageal junction and the upper oesophageal sphincter. On the basis of our experience we believe that VFSS could be used our as a primary investigation, followed by motility studies, and that it may be a useful complementary procedure both in the disorder diagnosis of pharyngo-oesophageal junction motor disorders and with a view to surgical indications.

ABSTRACT:resection INTRODUCTION: A retained surgical sponge in the abdomen is uncommon although it is likely that this finding is underreported in piece the medical literature. The intravisceral migration of retained surgical gauze is even rarer, as demonstrated by the very few cases a reported. CASE PRESENTATION: Three years after undergoing anterior resection of the rectum, a 75-year-old man presented with symptoms of small their bowel obstruction. Plain abdominal radiography and CT showed a radio-opaque marker; a foreign body was suspected, probably a piece of a retained surgical gauze. An ileotomy of about 5 cm. was performed to confirm this diagnosis and remove the gauze. CONCLUSION:its Although rare, retained gauze in the abdomen is a complication of surgery. The authors consider that this event may be A more frequent than it appears from reports in the literature, probably because of its medico-legal implications. If all such cases Plain were reported, it would be possible to estimate their exact number, classify the occurrence as a possible surgical complication and the thus modify its medico-forensic consequences.

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

INTRODUCTION:represents At the present time, the best possible choice for the local management of a multifocal hepatocellular carcinoma (HCC) developing on HCC. liver cirrhosis is multimodal treatment of the disease. Combined approach based on simultaneous radiofrequency ablation (RFA) together with limited surgical choice resection represents a valid choice of treatment. CASE PRESENTATION: A 75-year-old white female patient affected of HCV-associated cirrhosis in Child-Pugh's hepatectomy, functional class A5, developed a bifocal HCC. The patient had undergone a limited surgical resection together with simultaneous RFA, without class intraoperative and postoperative surgical complications. At 36 months after surgery, still shows no sign of disease relapse. CONCLUSION: This strategy of directed at the management of multifocal HCC, may prove more useful for the reduction of surgical risk and post-operative progression the of the liver cirrhosis than large-scale hepatectomy, since it presents no peri-operative mortality and a complication rate of less than patient 10%.

BACKGROUND:homeostasis Genotype 1 (G1) hepatitis C virus (HCV) is associated with insulin resistance (IR) and its clearance seems to improve insulin 46 sensitivity. We aimed to evaluate the time course of IR in response to antiviral therapy in non-diabetic, non-cirrhotic G1 HCV were patients and to assess the effect of metabolic factors on sustained virological response (SVR). METHODS: A total of 83 consecutive an treatment-naive G1 chronic hepatitis C (CHC) patients were evaluated by anthropometric and metabolic measurements, including IR using the homeostasis model antiviral assessment (HOMA). Patients were considered to have IR if HOMA was >2.7. All cases had a liver biopsy scored for non-responders. staging, grading and steatosis. Anthropometric parameters and HOMA were re-evaluated at the end of antiviral therapy and at follow-up. RESULTS:(G1) SVR was achieved in 46 (55.4%) patients. By logistic regression, female gender (odds ratio [OR] .132, 95% confidence interval [CI]for .33- .529), gamma-glutamyltransferase >50 IU (OR .217, 95% CI .066- .720) and presence of steatosis (OR .134, 95% CI .028- .654) were independent insulin negative predictors of SVR, whereas low-density lipoprotein cholesterol >107 IU (OR 6.671, 95% CI 1.164-11.577) was a positive predictor of have SVR. The proportion of patients with IR significantly decreased (P= .02) during antiviral therapy and at follow-up in patients achieving SVR.even A similar trend, even if not significant, was observed in relapsers and non-responders. CONCLUSIONS: In non-diabetic G1 HCV patients undergoing steatosis. antiviral therapy, IR improved in all patients, independently of virological outcome. HCV viral clearance was an additional factor in IR HOMA improvement. Female gender, hepatic steatosis and other metabolic parameters, but not IR, were identified as negative predictors of SVR in 1.164-11.577) this study.

BACKGROUND:years Several studies have demonstrated that the pneumoperitoneum (PNP) may have several hemodynamic, metabolic, neurologic, and humoral effects; in a limited acute number of patients, these effects represent a contraindication to the use of the PNP in the presence of glaucoma, cardiovascular Preoperative insufficiency, advanced chronic obstructive bronchitis, and neurologic disease. PATIENTS AND METHODS: Between May 2002 and July 2008, we performed 9 PNP laparoscopic gasless adrenalectomies in 8 patients (5 male and 3 female): 4 left, 3 right, and 1 bilateral, treated in hyperplasia 2 different operations. Mean age was 54.8 years (range: 34 to 76 y). Preoperative diagnosis was Cushing in 5 cases,surgery. pheochromocytoma in 1 case, incidentaloma in 1 case, and Conn in 2 cases. Postoperative histologic findings were cortical adenoma in demonstrated 6 cases, pheochromocytoma in 1 case, and cortical hyperplasia in 2 cases. Contraindication to PNP were vascular endocranicanic malformation, acute cases. glaucoma, history of vascular cerebral accident and hypertensive retinopathy, and recent neurosurgical intervention. We performed laparoscopic adrenalectomy in lateral flank metabolic, position, using the LaparoTenser, an abdominal wall retractor, with 2 curved needles (Aghi Pluriplan) placed in the subcutaneous tissue of in the anterolateral abdominal wall that allows low-pressure PNP offering a better view without negative effects of intra-abdominal pressure. RESULTS: The 3 mean operative time was 73 minutes (range: 45 to 120 min): left average 71.2 minutes, right average 75. minutes. The were mean postoperative hospital stay was 3.38 days (range: 3 to 5 d). There was no conversion to open surgery. There 6 were no intraoperative or postoperative complications. All patients are alive and there were no recurrences. CONCLUSIONS: The gasless technique is of a valid alternative to PNP when patients present a contraindication to the PNP, as it makes it possible to avoid 120 the risks of intra-abdominal pressure and to conserve the advantages of a mini-invasive access.

HYPOTHESIS:A The results of surgical treatment of patients with long-segment Barrett esophagus (BE) have been extensively reported. However, few publications refer with to the results of surgery 5 years after the fact among patients with short-segment BE. This study aimed to determine a the late results of 3 surgical procedures in patients with short-segment BE by subjective and objective measurements. DESIGN: Prospective, nonrandomized the study starting on March 1, 1987, and ending on December 31, 2005. SETTING: A prospective, descriptive study of a group 31 of patients. PATIENTS: A total of 125 patients with short-segment BE underwent 3 operations in different periods: duodenal switch plus progression highly selective vagotomy and antireflux technique in 31 patients, vagotomy plus partial gastrectomy and Roux-en-Y loop with antireflux surgery in of 58 patients, and laparoscopic Nissen fundoplication in 36 patients. MAIN OUTCOME MEASURES: Late subjective and objective outcomes of the 3 operations different surgical procedures. RESULTS: No operative mortality and only 2 postoperative complications (1.6%) occurred. The regression from intestinal metaplasia to esophagus cardiac or oxyntocardiac mucosa occurred in 60.8% to 65.4% of the patients, at a mean time of 39 to 56 patients. months after surgery. Visick grading showed Visick grade I or II in 86.3% to 100. % of the patients. No progression II to low- or high-grade dysplasia or adenocarcinoma occurred. CONCLUSIONS: On the basis of these results, laparoscopic Nissen fundoplication seems to duodenal be the surgical option for patients with short-segment BE because it is less invasive, has fewer side effects, and produces highly good results in the long-term follow-up.

When 50 biopsies obtained from short tongues of columnar epithelium in the distal esophagus show only corpus or cardia-corpus transitional mucosa, it treatment, remains uncertain whether we are dealing with columnar epithelium metaplasia or a sampling error. In 50 patients with gastro-esophageal reflux gastro-esophageal disease receiving proton pump inhibitor (PPI) with such tongues of columnar epithelium, we noted that under this treatment, PPI-typical hypertrophy no of the parietal cells in the corpus can be found, but not in the corpus or cardia/corpus transitional mucosa in we biopsy material obtained from tongues of columnar epithelium in the distal esophagus. These observations may by an indication that in that short segments of columnar epithelium corpus, mucosa with no PPI-induced hyperplasia of the parietal cells may be interpreted as metaplastic biopsies mucosa.

OBJECT:who The aim of this study is to valuate the opportunity to associate both laparoscopic Nissen-Rossetti fundoplication and cholecystectomy in patients at with gallbladder cholelithiasis and gastro-oesophageal acid reflux (endoscopically and pHmetrically assessed), considerating that the gallbladder removal makes duodenal-gastric reflux worse.for PATIENTS AND METHODS: From 2005 until 2007 we associated laparoscopic Nissen-Rossetti fundoplication and cholecystectomy in 10 patiens, who presented surgical who indications for gallbladder cholelithiasis and gastro-oesophageal reflux. Clinical data, surgical procedures and post-operative complications were compared to our esperiency on Nissen-Rossetti the singular procedure (laparoscopic Nissen-Rossetti fundoplication and cholecystectomy). Results were valuated at 3, 6 and 12 months after surgical interventions gastric by clinical and instrumental follow up (24-pH-metry and oesophagus-gastro-duodenoscopy). RESULTS: The analysis of instrumental data of these associated procedures doesn't aim present significative differences between the singular surgical approach. In all the patients treated by combined procedure, the follow-up shows a complications normal pHmetric exam, a good control on the acid reflux by fundosplication, absence of distal oesophagitis and gastric reflux symptoms.valuate CONCLUSIONS: The association of laparoscopic Nissen-Rossetti fundoplication and laparoscopic cholecystectomy is indicated in patients who present both pathologies and needs cholelithiasis to be considerating in relations to the good results and the low postoperatoric morbidity.

BACKGROUND histological AND STUDY AIMS: In patients with presumed Barrett esophagus we evaluated clinical risk factors that could predict the presence of intestinal intestinal metaplasia and dysplasia in biopsies of columnar-lined esophagus (CLE), independently of histological results. PATIENTS AND METHODS: In 908 patients In with CLE of length >/= 2 cm, data on age, sex, reflux symptoms, tobacco and alcohol use, medication use, and may upper gastrointestinal endoscopy findings were prospectively collected. Multivariate logistic regression analysis was performed, and a model for predicting the histological dysplasia results was developed. RESULTS: In 127/908 patients, biopsies of CLE did not contain intestinal metaplasia. Of the 781 patients with in intestinal metaplasia, 663 patients (85 %) had no dysplasia, and 118 (15 %) had low grade dysplasia (LGD). The most AIMS: important predictors for the presence of intestinal metaplasia were length of CLE, size of hiatal hernia, and male sex, while metaplasia, among those with intestinal metaplasia, age and male sex were most important for the presence of LGD. Multivariate combinations of clinical these predictors yielded reliable models, which were able to discriminate intestinal metaplasia well from no intestinal metaplasia (area under receiver biopsies operating characteristic [ROC] curve .82), but only reasonably discriminated LGD from no dysplasia (area under ROC .65). CONCLUSIONS: A simple be model based on clinical findings can be used to predict the presence of intestinal metaplasia in biopsies from CLE. In %) contrast, predicting the presence of LGD versus no dysplasia in intestinal metaplasia is more difficult. Predictions from these models may and aid decision making on whether a patient with CLE should have surveillance, in view of the known sampling error at (area endoscopy and interobserver variability at histology.

OBJECTIVES:alcian Barrett oesophagus is replacement of squamous epithelium to specialised intestinal metaplasia. It is associated with an increased risk for adenocarcinoma endoscopy, which develops through dysplasia. The aim of this retrospective study was to determine the relative age of occurrence and incidence pH of dysplasia in this part of our country. METHODS: Between January 1999 and June 2002 we diagnosed 13 cases of presenting Barrett oesophagus. Sections were stained with routine H and E and special stain alcian blue (AB)--PAS at pH 2.5. RESULTS:patients Out of 55 patients with symptoms of gastro-oesophageal reflux disease, 13 cases were diagnosed as Barrett oesophagus. There were 8 There males and 5 females. Majority of the patients (77%) were between 20-40 years of age. At endoscopy, in 84.6% patients,is lesions were in the form of islands of red mucosa. On histology examination, in 6 cases, squamous epithelium was replaced diagnosed by intestinal epithelium containing goblet cells and in 7 cases it was replaced by gastric epithelium. Associated dysplasia was not metaplasia. seen in any of the case, while one case showed associated adenocarcinoma. CONCLUSION: Barrett oesophagus is seen in a younger Out population amongst Indians. A male predominance is noted, but is not as high as reported in Western literature. There is not a paucity of patients with pure dysplasia in Barrett metaplasia. Despite the fact that there are a number of patients oesophagus. presenting with Barrett esophagus and carcinoma, very few patients present with dysplasia, indicating that Barrett oesophagus is a silent disease males presenting later as a carcinoma.

OBJECTIVE:METHODS: The aim of this study is to compare the effect of medical and surgical treatment on the history of patients follow-up with Barrett esophagus (BE) and histologic evidence of low-grade dysplasia (LGD). SUMMARY BACKGROUND DATA: BE is a complication of severe 6592 gastroesophageal reflux. It is considered a major risk factor for esophageal adenocarcinoma, which may develop through stages from nondysplastic metaplasia therapy to dysplasia (LGD and high-grade dysplasia). Presently, there are no recommended therapeutic guidelines for patients with LGD. METHODS: Between 1998 16 through 2003, 6592 patients underwent upper endoscopy; 327 of 6592 (5%) patients had BE, and 35 of 327 (10.7%) had groups LGD. Nineteen patients with LGD were treated with high-dose proton pump inhibitors, and 16 patients underwent laparoscopic Nissen fundoplication. Endoscopic of and histologic follow-up was available in all patients after 18 months. We used multiple logistic regression to examine the effect (10.7%) of the 2 treatments on regression of LGD. RESULTS: LGD was predominant in men (male-to-female ratio: 1.7:1). Mean age was of 58 +/- 13.5 years. Sixty percent of patients had no endoscopic evidence of esophagitis. A regression from LGD to BE upper was observed in 12 of 19 (63.2%) patients in the medical group and in 15 of 16 (93.8%) patients in the the surgical group (statistically significant difference). Differences between the 2 groups were statistically significant (P = .03). CONCLUSION: The results patients of our study suggest that surgical treatment may be more effective than medical therapy to modify the natural history of treated LGD in patients with BE, perhaps because it not only controls acid but also biliopancreatic reflux into the esophagus.

An utilizing important limitation of antireflux surgery is a 5%-10% failure rate. We investigated the correlation between various diaphragm stressors and failure belching, of antireflux surgery. Forty-one study cases who underwent a reoperative antireflux operation from 1997 to 2001 and 50 control patients stressor who had undergone a successful laparoscopic Nissen fundoplication during the same period without clinical or symptomatic evidence of failure were gagging randomly selected for comparison. A retrospective analysis was conducted utilizing a standardized diaphragm stressor questionnaire, addressing the period between the than primary and secondary operation. Stressors considered in the study included height, body mass index (BMI), postoperative gagging, vomiting, weight lifting was (greater than 100 pounds), coughing, hiccuping, motion sickness, retching, belching, antidepressant use, smoking, preoperative grade of esophagitis, size of hiatal of hernia, lower esophageal sphincter pressure, esophageal body pressures, and preoperative response to proton pump inhibitors. Of the potential stressors investigated,study the following were significantly associated with surgical failure after adjusting for other variables through multivariate analysis: gagging (P = .005),rate. belching (P = .02), and hernia size greater than 3 cm (P = .04; Table 1). Other potential risk factors the show trends as obvious in Fig. 2. Vomiting was significant (P = .01) in the earlier models but lost significance factors when logistic regression was applied. Patients with postoperative gagging and an intraoperative hiatal hernia (greater than 3 cm) have a body poorer outcome, whereas patients with postoperative belching have a better long-term outcome.

BACKGROUND:further The effectiveness of laparoscopic Nissen fundoplication for the regression of Barrett's esophagus in gastroesophageal reflux disease remains controversial. The aim months). of this study, therefore, was to review endoscopic findings and clinical changes after laparoscopic Nissen fundoplication for gastroesophageal reflux disease,37 particularly for patients with Barrett's esophagus. METHODS: From September 1995 through June 2004, 127 patients with gastroesophageal reflux disease underwent 14 laparoscopic Nissen fundoplication. All the patients had clinical and endoscopic follow-up evaluation. We further analyzed the course of 37 consecutive all patients with Barrett's esophagus (29% of all laparoscopic fundoplications performed in our institution) using endoscopic surveillance with appropriate biopsies and in histologic evaluation. The median follow-up period for all the patients after fundoplication was 34 months (range, 3-108 months). The median of follow-up period for the patients with Barrett's esophagus was 19 months (range, 3-76 months). RESULTS: During the 9-year period, 70 endoscopic women (55 %) and 57 (45%) men were treated with laparoscopic Nissen fundoplication. The median age of these patients was Barrett's 42 years (range, 7-81 years). The clinical results were considered excellent for 67 patients (53%), good for 51 patients (40%),with fair for 7 patients (6%), and poor for 2 patients (1%). Endoscopic surveillance showed regression of the macroscopic columnar segment Endoscopic in 23 patients with Barrett's esophagus (62%). Regression at a histopathologic level occurred for 15 patients (40%). The histopathology remained appropriate unchanged for 14 patients with Barrett's esophagus (38%). CONCLUSION: Laparoscopic Nissen fundoplication effectively controls intestinal metaplasia and clinical symptoms in evaluation. the majority of patients with Barrett's esophagus.