Outcomes of Heller Myotomy for Esophageal Achalasia: Lessons From a 48-Year Prospective Experience With 4 Different Techniques.

Objective: To provide information on long-term outcomes of Heller myotomy for esophageal achalasia with or without an antireflux fundoplication.

Background: Since the adoption of the Heller myotomy, surgeons have modified the original technique in order to balance the cure of dysphagia and the consequent cardial incontinence.

Methods: Totally, 470 patients underwent primary Heller myotomy between 1955 and 2020.

Quality of Life After Operation for End-Stage Achalasia: Pull-Down Heller-Dor Versus Esophagectomy.

Background: Therapy for end-stage achalasia is debated, and data on long-term functional results of myotomy and esophagectomy are lacking. We compared quality of life and objective outcomes after pull-down Heller-Dor and esophagectomy.

Methods: The study included 32 patients, aged 57 years (interquartile range [IQR], 49-70 years), who underwent the Heller-Dor operation with verticalization of the distal esophagus in case of first instance treatment or failed surgery caused by insufficient myotomy, and 16 patients, aged 58 years (IQR, 49-67 years; P = .

True Short Esophagus in Gastroesophageal Reflux Disease: Old Controversies With New Perspectives.

Objective: To explore the true short esophagus (TSE) frequency and long-term results of patients undergoing gastroesophageal reflux disease (GERD) or hiatus hernia (HH) surgery.

Background: The existence and treatment of TSE during GERD/HH surgery is controversial. Satisfactory long-term results have been achieved with and without surgical techniques dedicated to TSE.

Incidence and risk factors for the development of epidermoid carcinoma in oesophageal achalasia†.

Objectives: The risk factors for oesophageal achalasia, a precancerous condition that can lead to epidermoid carcinoma, are unknown. The aim of this study was to determine these factors.

Methods: Beginning in 1973, patients presenting with achalasia from 1955 to 2016 periodically underwent clinical assessment, the barium swallow test (the oesophageal diameter and residual barium column were measured) and endoscopy according to a prospective protocol.

Long-term results of the Heller-Dor operation with intraoperative manometry for the treatment of esophageal achalasia.

Objective: Quality of outcome of the Heller-Dor operation is sometimes different between studies, likely because of technical reasons. We analyze the details of myotomy and fundoplication in relation to the results achieved over a 30-year single center's experience.

Methods: From 1979-2008, a long esophagogastric myotomy and a partial anterior fundoplication to protect the surface of the myotomy was routinely performed with intraoperative manometry in 202 patients (97 men; median age, 55.

Do bone marrow isolated tumor cells influence long-term survival of non-small cell lung cancer?

Introduction: Inconsistent information on the prognostic significance of non-small cell lung cancer (NSCLC) isolated tumor cells (ITC) has been reported to date. We sought to evaluate the survival for NSCLC in a group of patients in which the presence of bone marrow isolated tumor cells and their DNA ploidy was assessed.

Materials And Methods: Seventy patients (58 males [83%]; median age 70 years, range 49-89) with T1-4, N0, M0 clinical staging entered the study; 68 who underwent complete resection, were included in the follow-up.

Improving the surgery for sigmoid achalasia: long-term results of a technical detail.

Objective: Heller myotomy results for the treatment of sigmoid achalasia are worse than those achieved for fusiform achalasia. We retrospectively examined two groups of sigmoid achalasia patients, in which we performed (1) the standard Heller-Dor procedure (no pull-down) and (2) the Heller-Dor plus a technique apt to obtain the verticality of the oesophageal axis (pull-down). We verified whether the latter technique improved long-term results.

[Laparoscopic and left thoracoscopic Collis-Nissen procedure: technique and short term results].

The aim of this paper is to illustrate a laparoscopic-thoracoscopic technique for the surgical management of foreshortened esophagus in patients affected by severe gastro-esophageal reflux disease. The patient is placed on the operating table with the left chest and arm lifted to perform a thoracostomy in theV-VI space, posterior to the axillary line. The hiatus is opened and the distal esophagus is mobilized.

Transthoracic endosonography for the intraoperative localization of lung nodules.

Background: Transthoracic ultrasonography has been advocated for the localization of lung nodules during video-assisted thoracoscopic surgery (VATS) for nonperipheral nodules.

Methods: Video-assisted thoracoscopic surgery for lung nodules was performed in 54 consecutive patients. Preoperative computed tomography (CT) diagnosed 65 lesions.

The surgical treatment of the intrathoracic migration of the gastro-oesophageal junction and of short oesophagus in gastro-oesophageal reflux disease.

Objectives: In the rush to implement laparoscopic surgery for gastro-oesophageal reflux disease (GORD), the necessity to treat a short oesophagus with dedicated techniques was not always adequately considered. The aim of this study was to define the frequency, patterns and surgical treatment of the intrathoracic migration of the g-o junction and short oesophagus in GORD.

Methods: Between 1980 and 2003 our group indicated surgery only for severe and complicated GORD and for drawbacks of medical therapy.

Hiatus hernia and intrathoracic migration of esophagogastric junction in gastroesophageal reflux disease.

The prevalence and clinical presentation of reducible and irreducible hiatus hernia were investigated within a gastro-esophageal reflux disease patient population. Reflux symptoms and esophagitis data were collected on 791 patients. The barium swallow was used to assess the esophagogastric junction.

Ultrasonographic localization of occult pulmonary nodules during video-assisted thoracic surgery.

The aim of our study was to evaluate the role of ultrasonography in the localization of pulmonary nodules during video-assisted thoracic surgery (VATS). Ultrasonography was performed in 35 patients for the localization of pulmonary nodules during VATS. Indication for VATS was excisional biopsy of undetermined nodules in 22 patients, single or multiple metastasectomy in 12 patients and resection of primitive pulmonary cancer in 1 patient with reduced pulmonary reserve.

Analysis of disputed single-parent/child and sibling relationships using 16 STR loci.

This study describes the validation of short tandem repeat (STR) systems for the resolution of cases of disputed parentage where only a single parent is available for testing or where the claimed relationship of both parents is in doubt and also cases where sibship must be tested. Three separate multiplex systems the Second Generation Multiplex, Powerplex 1.2 and FFFL have been employed, giving a total of 16 STR loci.

Surgical therapy for adenocarcinoma of the cardia: modalities of recurrence and extension of resection.

In order to define the optimal extent of resection for cancer of the cardia, we considered 116 patients operated upon with five different surgical techniques. The procedures were: transabdominal total gastrectomy associated with distal esophagectomy in 38 patients; transabdominal total gastrectomy and left thoracotomic esophageal resection at the inferior pulmonary vein level in 26 patients; transabdominal total gastrectomy and right thoracotomic esophageal resection at the azygos vein level in 27 patients; transabdominal total gastrectomy and transhiatal lower third esophagectomy in 18 patients; transhiatal total esophagectomy and upper third gastrectomy with cervical esophago-gastroplasty in seven patients. Grading, staging, neoplastic lymphangitis, satellite intramural metastases, infiltration of the resection margin, site of recurrence, and survival were analyzed.

Iliac crest biopsy versus rib segment resection for the detection of bone marrow isolated tumor cells from lung and esophageal cancer.

Objective: The presence of isolated tumor cells in the bone marrow affects the prognosis of both esophageal cancer and non-small cell lung cancer (NSCLC). Therefore, preoperative assessment of isolated tumor cells may be useful to plan multimodality treatment. Rib segment resection at surgery provides adequate amounts of bone marrow for the detection of isolated tumor cells while bone marrow aspirate from the iliac crest does not.

[Pulmonary metastasis of malignant peritoneal mesothelioma. Review of the literature and a case report].

The authors describe the clinical case of a 54 year old patient, affected by malignant peritoneal mesothelioma treated by chemotherapy, who subsequently developed a lung lesion, treated by surgical wedge resection. The histologic examination of the surgical specimen, which led to the diagnosis of an intraparenchymal necrotic focus, confirms the favourable result of the adjuvant therapy. A review of the literature showing the rarity of lung metastases from malignant peritoneal mesothelioma is presented.

Validation of short tandem repeat analysis for the investigation of cases of disputed paternity.

This study details validation of two separate multiplex STR systems for use in paternity investigations. These are the Second Generation Multiplex (SGM) developed by the UK Forensic Science Service and the PowerPlex 1 multiplex commercially available from Promega Inc. (Madison, WI, USA).

Clinical and surgical relevance of the progressive phases of intrathoracic migration of the gastroesophageal junction in gastroesophageal reflux disease.

Objective: The pathophysiologic influence of progressive intrathoracic migration of the gastroesophageal junction axial to the esophagus on gastroesophageal reflux disease was investigated.

Methods: A radiologic-manometric study was performed on hiatal insufficiency, concentric hiatus hernia, and short esophagus, the three radiologic steps of intrathoracic gastroesophageal junction migration, and on healthy volunteers. The distances between inferior and superior margins of the lower esophageal sphincter and the diaphragm were measured.

Surgery for esophageal achalasia. long-term results with three different techniques.

Background/aims: In surgery for achalasia, the length of the myotomy and the opportunity of associating an antireflux procedure are still debated. Prospective and comparative studies on different techniques are few. The aims of this work is to compare the long term results of three different techniques successively adopted by the same surgical group.

Transfer factor as an adjuvant to non-small cell lung cancer (NSCLC) therapy.

The rationale for using transfer factor (TF) in lung cancer patients is that the possibility of improving their cell-mediated immunity to tumour associated antigens (TAA) may improve their survival. From Jan 1984 to Jan 1995, 99 non-small cell lung cancer (NSCLC) resected patients were monthly treated with TF, extracted from the lymphocytes of blood bank donors. In the same period, 257 NSCLC resected patients were considered as non-treated controls.

Duodenogastric and non acid gastro-oesophageal reflux in patients with reflux oesophagitis.

Background/aim: The role and the identification criteria of non acid gastro-oesophageal reflux (GOR) are still debated. Moreover, the relationship between nonacid GOR and gastric alkalinizations, particularly if secondary to duodeno-gastric reflux is yet to be defined.

Materials And Methods: One hundred and forty one patients affected by GORD symptoms and oesophagitis entered the study.

Intraoperative study on the relationship between the lower esophageal sphincter pressure and the muscular components of the gastro-esophageal junction in achalasic patients.

Objective: The lower esophageal sphincter (LES) resting tone originates from the tension of the muscular fibers of the gastro-esophageal (GE) junction. This study determined which of the muscular structures' of the GE junction are actually responsible and to what degree for the LES resting tone in achalasic patients.

Summary Background Data: Controversy still exists as to the length of myotomy on the esophageal and gastric sides of the GE junction.

Indications for 24-hour gastric pH monitoring with single and multiple probes in clinical research and practice.

The methodology of prolonged gastric pH monitoring has not yet been standardized with regard to the number and position of pH probes. Twenty-seven healthy volunteers and 11 patients affected by nonulcer dyspepsia have been submitted to 24-hr ambulatory simultaneous pH monitoring of the distal esophagus, fundus, and antrum. Fundic and antral pH profiles have been compared and causes of pH variations (pH > 4) identified.

[Definition of a normal tracing in pH monitoring].

The adoption of specific criteria for the reading of tracings, together with a comparison of the results obtained during the course of patient tests with the thresholds of normality calculated in groups of healthy volunteers, are required to determine the normality or abnormality of pH monitoring. From such comparisons performed among groups of healthy volunteers, selected especially on the basis of age or nationality, it was found that age bears no significant influence in calculating the parameters pertinent to pH monitoring. On the other hand, different dietary and life habits could be responsible for a few, albeit limited, discrepancies, such as, for instance, the number of recorded occurrences of gastro-esophageal acid reflux.

[Intraoperative esophageal manometry].

Intraoperative manometry has been proposed as a supportive procedure during the execution of anti-reflux operations and in the surgical treatment of achalasia. This procedure is not necessary in preparing anti-reflux plasty such as Belsey or Nissen, the outcome of which depends mostly on the correct execution of the surgical technique. Utilization of intra-operative manometry provides considerable benefits during the surgical treatment of achalasia, both when executing the extra-mucous myotomy and for the correct preparation of the anti-reflux plasty according to Dor, which is associated to it.