1/27. Gastrojejunal interposition for esophageal replacement.The main considerations in replacing the esophagus are to avoid postoperative necrosis of all or part of the graft, leakage or stenosis of the anastomoses, and complications related to acid-peptic or alkaline reflux. A 5-year-old boy, after two unsuccessful thoracic operations for atresia and then stenosis of the esophagus, underwent resection of the esophagus because of duodeno-gastroesophageal reflux. The continuity of the alimentary tract was restored by gastrojejunal interposition. We recommend this method of reconstruction when the esophago-gastrostoma is created in the chest, and the possibility of alkaline reflux must be considered.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
2/27. Approach to the patient with unexplained chest pain.patients with unexplained or noncardiac chest pain continue to present a difficult challenge to the gastroenterologist. Cardiac disease must be ruled out first as the history will not distinguish between coronary artery disease and other causes of substernal chest pain. A systematic approach to evaluation should include reassurance that the heart is normal and attempts to confirm an esophageal etiology. gastroesophageal reflux disease is the most common esophageal abnormality associated with unexplained chest pain and may be identified by an aggressive trial of anti-reflux therapy or an abnormal prolonged ambulatory pH monitoring study. endoscopy is almost always normal and of less use in this population than in those with heartburn as the presenting symptom. Judicious use of manometry with provocative testing to evaluate for esophageal motility abnormalities or esophageal sensitivity allows for optimal evaluation of those who do not have gastroesophageal reflux disease. This article reviews the clinical presentation, differential diagnosis, and approach to evaluation and therapy of this complex group of patients.- - - - - - - - - - ranking = 127.47584716376keywords = chest pain, chest (Clic here for more details about this article) |
3/27. chest pain. Differentiating GIT from cardiac causes.BACKGROUND: chest pain is a common presenting symptom in general practice. Although a cardiac cause is not the commonest origin, a high index of suspicion is needed. When the diagnosis is not clear, a cardiac cause should be considered until proven otherwise. A gastrointestinal origin of chest pain is not infrequent and may be due to oesophageal, gastric or biliary disease. Oesophageal causes are most common and include reflux, hypersensitivity or dysmotility. OBJECTIVE: This paper reviews the main gastrointestinal causes that may present with acute chest pain. DISCUSSION: Clinical history taking is the key to decision making and guides the choice of prompt or routine investigation or a therapeutic trial. When reflux is suspected as the cause, a therapeutic trial of high dose antisecretory therapy is appropriate. Investigations may be helpful when typical reflux symptoms are not present or there is a poor response to this approach. Investigations may include endoscopy, ambulatory pH monitoring, barium swallow or oesophageal manometry.- - - - - - - - - - ranking = 19.210835309108keywords = chest pain, chest (Clic here for more details about this article) |
4/27. Delayed intrathoracic rupture of herniated Nissen fundoplication: report of two cases.We report 2 patients who presented with rupture of a laparoscopic Nissen fundoplication in the left chest. These were successfully managed by closure of the perforation over a tube drainage that was brought under the diaphragm as a controlled fistula.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
5/27. Prandial atrial fibrillation: off-pump pulmonary vein isolation with hiatal hernia repair.Frequent palpitations with eating developed in a 62-year-old man with a history of typical gastroesophageal reflux successfully treated by Nissen fundoplication 5 years previously. A Holter monitor demonstrated paroxysmal atrial fibrillation associated with eating. barium swallow showed a slipped Nissen fundoplication with herniation into the chest. Under a single anesthetic, the patient had median sternotomy and off-pump pulmonary vein isolation with a bipolar radiofrequency clamp and transabdominal redo-Nissen fundoplication. A 24-hour Holter monitor performed 6 weeks after operation demonstrated a normal sinus rhythm with no atrial fibrillation. barium swallow demonstrated an intact infradiaphragmatic repair.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
6/27. chest pain in patients with cardiac and noncardiac disease.OBJECTIVE: To describe factors influencing chest pain expression in patients with cardiac or noncardiac disease. methods: The authors conducted a case presentation and review of literature. RESULTS: Causes of chest pain are diverse. Psychologic factors influence chest pain expression commonly in patients with or without cardiac disease. CONCLUSIONS: physicians and other therapists must be aware of psychologic influences on chest pain expression to provide optimal treatment to their patients.- - - - - - - - - - ranking = 72.843341236432keywords = chest pain, chest (Clic here for more details about this article) |
7/27. Gastric-emptying scintigraphy of type III hiatal hernia: a case report.We present the case of a 76-y-old man with mixed (type III) paraesophageal hernia confirmed by endoscopy and CT of the chest who underwent a radionuclide gastric-emptying study that showed accumulation of the radiotracer in the herniated stomach and esophagus in the thorax and accelerated gastric emptying. A scintigraphic gastric-emptying study may be an option for noninvasively demonstrating gastroesophageal accumulation of tracer in patients with hiatal hernia.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
8/27. Chronic traumatic diaphragmatic hernia with pericardial rupture and associated gastroesophageal reflux.Major thoracic and abdominal trauma damages the diaphragm 5% of the time. These injuries may be recognized when they occur but often are discovered months later during work up for related symptoms. Typically, the injury is to the left posterolateral aspect of the diaphragm. Rarely, rupture through the central diaphragmatic tendon into the pericardial space occurs and this results in different symptoms than the more common injury. We present the case of a patient who presented with chest pain, near syncopal episodes and refractory gastroesophageal reflux years after he was struck by a car and hospitalized. Radiographic imaging included a chest CT that demonstrated herniation of the transverse colon into the mediastinum. During exploration, a defect in the central diaphragm was found with free communication between the peritoneal and pericardial spaces. In this paper, we review our management of this unusual diaphragmatic hernia and the unique symptoms associated with it.- - - - - - - - - - ranking = 19.210835309108keywords = chest pain, chest (Clic here for more details about this article) |
9/27. Congenital paraesophageal hiatal hernia: pitfalls in the diagnosis and treatment.PURPOSE: The aim of this study was to analyze pitfalls in the diagnosis and treatment of congenital paraesophageal hiatal hernia (PEHH). methods: Between 1992 and 2004, the records of 5 infants with PEHH were retrospectively reviewed for age, sex, presenting symptoms, radiological studies, operative findings and approaches, and outcomes. RESULTS: All cases (3 male, 2 female) had right-sided hernias. They had clinical features of recurrent chest infections and intermittent vomiting that were present since birth in 3. Three presented acutely ill with findings of respiratory distress and vomiting. Three were referred with misdiagnoses of reflux disease, thoracic mass, and bronchopneumonia. On the chest x-rays of 3 cases, there were paracardiac opacities suggesting a mass lesion. According to the upper gastrointestinal series and/or computed tomography findings, 4 cases had a combination of sliding and paraesophageal hernia, and the remainder one had pure rolling hiatus hernia. Three had obstruction owing to organoaxial volvulus and required an emergency operation. All cases had a large hernia orifice. Four had gastroesophageal junction (GEJ) displaced into the thorax, and in 3, the stomach was found to be twisted, and transverse colon with omentum was also in the thorax in 2. In the remainder, the GEJ was in its normal position with herniated stomach. None of the cases had normal gastrosplenic and gastrocolic ligaments. Surgical repair included resection of the sac, closure of the hiatal defect, and Thal procedure. Two had intestinal malrotation, with right ovarian torsion and ventricular septal defect, respectively. Postoperative ventilation was required in one who later died. At a mean follow-up of 2 years, the other 4 had no symptoms related to the disease, and no evidence of recurrence or reflux was noted on control upper gastrointestinal series. CONCLUSION: Congenital PEHH may be difficult to diagnose. It is frequently complicated and associated with morbidity and even mortality. If the defect is large and associated with displacement of GEJ into the thorax, adding an antireflux procedure to the repair is appropriate.- - - - - - - - - - ranking = 2keywords = chest (Clic here for more details about this article) |
10/27. vocal cord dysfunction concurrent with a nutcracker esophagus and the role of gastroesophageal reflux disease.BACKGROUND: Psychological disorders were originally thought to be the sole cause of vocal cord dysfunction (VCD). Subsequently, other organic diseases, including structural laryngeal abnormalities, have also been reported to be associated with VCD. OBJECTIVES: To describe the first patient with VCD concurrent with a nutcracker esophagus and to establish the association between VCD and gastroesophageal reflux disease (GERD) by using the Bernstein test. methods: Symptom assessments, neuropsychiatric evaluations, fiberoptic laryngoscopy, pulmonary function tests, allergic skin prick tests, radiographs of the chest and sinuses, esophageal manometry (including 24-hour ambulatory esophageal ph monitoring), and the Bernstein test were performed. RESULTS: A 36-year-old woman had dyspnea, hoarseness, chest pain, and wheezes without relief for a decade. Neuropsychiatric evaluations disclosed mild depression. Fiberoptic laryngoscopy showed posterior laryngitis and paradoxical vocal cord adduction with audible inspiratory stridor. Pulmonary function tests showed attenuation of the inspiratory limb with notching in both flow-volume loops and a mid-vital capacity expiratory to inspiratory flow ratio of 4. All the symptoms except chest pain were improved dramatically by speech therapy and empirical treatment for GERD. Esophageal manometry revealed a nutcracker esophagus; 24-hour ambulatory esophageal ph monitoring demonstrated multiple short reflux episodes. The Bernstein test was conducted, and all the manifestations were reproduced with 0.1 N hydrochloric acid but not with isotonic sodium chloride infusion. CONCLUSIONS: This is the first human case report confirming that GERD can trigger an acute attack of VCD and may induce chest pain as a nutcracker esophagus in patients with VCD. It strengthens this association and expands our knowledge of diverse manifestations of this clinical entity.- - - - - - - - - - ranking = 55.632505927324keywords = chest pain, chest (Clic here for more details about this article) |
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