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1.
Esophageal stricture is not reported to be a common complication of nasogastric intubation. Two patients who had a Levin tube inserted in the stomach for nutrition during a prolonged coma, and finally presented with a severe esophageal stricture were observed and treated. The clinical history of the patients suggests that the pathogenesis of this lesion is probably multifactorial, secondary to induced gastroesophageal reflux, impaired esophageal clearance, high gastric acid output, and use of steroids. Jejunostomy feeding, rather than nasogastric feeding, is probably a better means to provide nutritional support in comatose patients, thus averting the risk of such a serious complication. Esophageal replacement with left colon interposition appears the treatment of choice for these severe esophageal strictures. 相似文献
2.
G. Portale M. Costantini G. Zaninotto A. Ruol E. Guirroli S. Rampado E. Ancona 《Diseases of the esophagus》2007,20(2):168-172
Pseudoachalasia is a rare clinical entity which has clinical, radiographic and manometric features often indistinguishable from achalasia. A small primary adenocarcinoma arising at the gastroesophageal junction or a tumor of the distal esophagus are the most frequent causes. Rarely, processes other than esophagogastric cancers may lead to the development of pseudoachalasia. We present three cases of pseudoachalasia in which the primary cause of the disease was not an esophagogastric cancer. The causes were a pancreatic carcinoma, a breast cancer and an histiocytosis X. Aspects of these three patients' diagnostic and therapeutic course are discussed in detail. 相似文献
3.
M. Anselmino G. Zaninotto M. Costantini M. Rossi C. Boccu' D. Molena E. Ancona 《Surgical endoscopy》1997,11(1):3-7
Background: The Heller-Dor operation has recently been proposed for the treatment of esophageal achalasia even via a laparoscopic approach.
Methods: To measure the medium-term effectiveness of this new minimally invasive technique, an evaluation of pre- and postoperative
symptoms, esophagogram, endoscopic findings, esophageal manometry, and pH monitoring was prospectively designed in 43 patients
with primary esophageal achalasia. The mean clinical follow-up for all the patients is 12 months (range 3–43), while the mean
radiological follow-up is 11 months (range 1–23). Endoscopic data 1 year after surgery are currently available for 27 patients
(63%), whereas a 12-month (range 1–26) functional follow-up (including manometric and pH-monitoring studies of the esophagus)
is currently available for 35 patients (81.4%).
Results: No dysphagia was reported in 38 cases (88.4%); two (4.6%) complained of occasional swallowing discomfort which regressed
spontaneously; two (4.6%) had persistent dysphagia which regressed with pneumatic dilatation. One patient (2.8%) reported
mild occasional dysphagia after a 1-year asymptomatic period. Preoperatively, esophagograms showed an average maximum diameter
of 40.6 ± 9.1 mm which decreased to 24.1 ± 6.0 mm after operation. Mean lower esophageal sphincter (LES) resting and residual
pressures decreased significantly from 28.6 ± 10.7 mmHg to 8.8 ± 4.1 mmHg and from 17.0 ± 9.7 mmHg to 4.7 ± 4.0 mmHg, respectively
(p < 0.0001). These effects on esophageal diameter and LES function seem to persist over time. The complete absence of any peristaltic
contractions recorded preoperatively in all cases remained unchanged after surgery in all but four patients. However, this
rare recovery of peristalsis proved to be transient, and patients revealed a manometric impairment of their esophageal body
function, but without complaining of dysphagia. Twenty-four-hour pH monitoring showed abnormal gastroesophageal reflux episodes
in two (5.7%) of the 35 patients who were monitored: one was asymptomatic; the other had heartburn and endoscopically demonstrated
grade II esophagitis.
Conclusions: Laparoscopic Heller-Dor operation achieves excellent medium-term results which, together with the already-demonstrated advantages
of a minimal surgical trauma and rapid convalescence, validate the use of such a minimally invasive approach to treat patients
with primary achalasia of the esophagus.
Received: 19 March 1996/Accepted: 15 May 1996 相似文献
4.
Michelozzi P Perucci CA Forastiere F Fusco D Ancona C Dell'Orco V 《Epidemiologia e prevenzione》1999,23(3):230-238
Population groups with a lower socioeconomic status (SES) have a greater risk of disease and mortality. The aim of this study was to investigate the relationship between SES and mortality in the metropolitan area of Rome during the six-year period 1990-1995, and to examine variations in mortality differentials between 1990-92 and 1993-95. Rome has a population of approximately 2,800,000, with 6,100 census tracts (CTs). During the study period, 149,002 deaths occurred among residents. We compared cause-specific mortality rates among four socioeconomic categories (SES) defined by a socioeconomic index, derived from characteristics of the CT of residence. Among men, total mortality and mortality for the major causes of death showed an inverse association with SES. Among 15-44 year old men, the strong positive association between total mortality and low SES was due to AIDS and overdose mortality. Among women, a positive association with lower SES was observed for stomach cancer, uterus cancer and cardiovascular disease, whereas mortality for breast cancer was higher in the groups with higher SES. Comparing the periods 1990-92 and 1993-95, differences in total mortality between socioeconomic groups widened in both sexes. Increasing differences were observed for tuberculosis and lung cancer among men, and for uterus cancer, traffic accidents, and overdose mortality among women. The use of an area-based indicator of SES limits the interpretations of the findings. However, despite the possible limitations, these results suggest that social class differences in mortality in Rome are increasing. Time changes in life style and in the prevalence of risk behaviors may produce differences in disease incidence. Moreover inequalities in the access to medical care and in the quality of care may contribute to an increasing differentials in mortality. 相似文献
5.
Inequality in health: socioeconomic differentials in mortality in Rome, 1990-95 总被引:3,自引:3,他引:0 下载免费PDF全文
Michelozzi P Perucci CA Forastiere F Fusco D Ancona C Dell'Orco V 《Journal of epidemiology and community health》1999,53(11):687-693
STUDY OBJECTIVE: Population groups with a lower socioeconomic status (SES) have a greater risk of disease and mortality. The aim of this study was to investigate the relation between SES and mortality in the metropolitan area of Rome during the six year period 1990-1995, and to examine variations in mortality differentials between 1990-92 and 1993-95. DESIGN: Rome has a population of approximately 2,800,000, with 6100 census tracts (CTs). During the study period, 149,002 deaths occurred among residents. The cause-specific mortality rates were compared among four socioeconomic categories defined by a socioeconomic index, derived from characteristics of the CT of residence. MAIN RESULTS: Among men, total mortality and mortality for the major causes of death showed an inverse association with SES. Among 15-44 year old men, the strong positive association between total mortality and low SES was attributable to AIDS and overdose mortality. Among women, a positive association with lower SES was observed for stomach cancer, uterus cancer and cardiovascular disease, whereas mortality for lung and breast cancers was higher in the groups with higher SES. Comparing the periods 1990-92 and 1993-95, differences in total mortality between socioeconomic groups widened in both sexes. Increasing differences were observed for tuberculosis and lung cancer among men, and for uterus cancer, traffic accidents, and overdose mortality among women. CONCLUSIONS: The use of an area-based indicator of SES limits the interpretations of the findings. However, despite the possible limitations, these results suggest that social class differences in mortality in Rome are increasing. Time changes in lifestyle and in the prevalence of risk behaviours may produce differences in disease incidence. Moreover, inequalities in the access to medical care and in the quality of care may contribute to an increasing differentials in mortality. 相似文献
6.
Zaninotto G Parenti AR Ruol A Costantini M Merigliano S Ancona E 《The British journal of surgery》2000,87(8):1102-1105
BACKGROUND: The aims of this study were to evaluate the prevalence of invasive cancer in patients with high-grade dysplasia in Barrett's oesophagus and to verify whether a second endoscopy with multiple biopsies could improve the accuracy of preoperative diagnosis. In addition, the mortality, morbidity and survival rates in patients with high-grade dysplasia having oesophageal resection were recorded. METHODS: Fifteen patients were observed from 1982 to 1998; the first seven patients were offered primary oesophageal resection after diagnosis. The other eight patients underwent a second endoscopy with a median of 12 biopsies examined. All later underwent oesophageal resection. RESULTS: Invasive adenocarcinoma was found in five patients, with a minimal difference between the first and second periods (two of seven versus three of eight). There were no perioperative deaths. Early morbidity was observed in eight patients and late morbidity in four. The actuarial survival rate was 79 per cent at 5 years. The Karnofsky status was unchanged from preoperative values in 13 of 15 patients after a median follow-up of 46 months. CONCLUSION: These patients with high-grade dysplasia had a 33 per cent probability of harbouring invasive oesophageal carcinoma but even a second endoscopy failed to identify patients with invasive tumour. Oesophagectomy was performed with no deaths and remains a rational treatment in patients fit for surgery. 相似文献
7.
Echocardiographic features of post−transcatheter aortic valve implantation thrombosis and endocarditis 下载免费PDF全文
Marco Spartera MD Francesco Ancona MD Marta Barletta MD Isabella Rosa MD Stefano Stella MD Claudia Marini MD Leonardo Italia MD Matteo Montorfano MD Azeem Latib MD Ottavio Alfieri MD Alberto Margonato MD Antonio Colombo MD Eustachio Agricola MD 《Echocardiography (Mount Kisco, N.Y.)》2018,35(3):337-345
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