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2. Preoperative Chemo-Radiotherapy for Carcinoma of the Esophagus

Author

A Cosenza, Erika Martinelli, Giuseppe Catalano, Floriana Morgillo, Del Genio A, Merola Mc, Di Martino N, De Vita F, S Infusino, Michele Orditura, DE VITA, Ferdinando, Orditura, Michele, Infusino, S, Martinelli, Erika, Merola, Mc, Morgillo, Floriana, Cosenza, Angelo, Di Martino, N, Del Genio, A, and Catalano, G.

Subjects
Cancer Research, medicine.medical_specialty, Chemo-radiotherapy, Esophageal Neoplasms, business.industry, General surgery, General Medicine, medicine.disease, Combined Modality Therapy, medicine.anatomical_structure, Oncology, Chemotherapy, Adjuvant, Preoperative Care, Carcinoma, Humans, Medicine, Radiotherapy, Adjuvant, Radiology, Esophagus, business
Published
2001
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9. [Failure of surgical treatment for achalasia: diagnosis and treatment]

Author

DEL GENIO A, DI MARTINO N, MAFFETTONE V, IZZO, Giuseppe, ZAMPIELLO P, MUGIONE P., DEL GENIO, A, DI MARTINO, N, Maffettone, V, Izzo, Giuseppe, Zampiello, P, and Mugione, P.

Subjects
Esophageal Achalasia, Humans, Treatment Failure
Abstract

After a wide revision of the Literature, the most frequent causes of failure in the surgical therapy of esophageal achalasia are described. Above all there is the uncorrect execution of the Heller's myotomy as for its upward and downward extension or its deepness. An uncorrect myotomy, in fact, might cause the persistence or relapse of pre-operative symptoms, such as dysphagia and regurgitation. A correct myotomy, according to the authors, should be always carried out with the aid of intraoperative manometry (IEM), which allows the documentation of the alterations caused by surgery in the area of the high pressure zone, which corresponds to the sphincter (LES). A correct myotomy must produce the complete annulment of such a pressure. This technique creates the conditions sufficient to the genesis of gastroesophageal reflux (GER), which is one of the most frequent causes of failure in the surgery of achalasia. In fact, it causes a reflux esophagitis which can quickly evolve into a stricture with the reappearance of dysphagia. It is essential, therefore, to combine always the Heller's procedure with an antireflux procedure, which can protect the esophagus from GER and at the same time does not produce a mechanical obstacle to deglutition. The Authors report their last experience based on 114 primary operations of Heller's myotomy + Nissen fundoplication, performed since 1985 to date. IEM has been always used both for controlling the completeness of the myotomy and for the "calibration" of the Nissen's. Two patients, which had undergone elsewhere a Heller's myotomy alone, have been operated of re-myotomy + Nissen fundoplication. One patient, also operated elsewhere of myotomy of the esophageal body for diffuse esophageal spasm (DES), complained of dysphagia and had manometrical evidence of LES dischalasia; this patient has been reoperated of Heller's myotomy + Nissen fundoplication; another patient suffering from a reflux stricture after a Heller's myotomy without antireflux procedure, has been treated with a Roux esophago-jejunostomy. A last patient operated by Heller's myotomy + Dor fundoplication presented alkaline esophagitis without dysphagia; the treatment consisted in a Roux gastro-jejunostomy + bilateral troncular vagotomy. These data bring to the conclusion that the best treatment of achalasia relapses is their prevention, only obtainable by a good primary therapeutic approach and the routine use of IEM. The IEM avoids incomplete myotomies and inadequate antireflux procedures related to the incompetence (reflux) or hypercompetence (dysphagia recurrence) of the fundoplication.

Published
1995

18. NON-CARDIAC CHEST PAIN: ROLE OF 24 h PH-MONITORING

Author

Del Genio A., Di Martino N., Izzo G., Nuzzo A., Angilletta G., FEI, Landino, Bovero E, Poletti M, Torre F, Cheli R, Del Genio, A., Di Martino, N., Izzo, G., Fei, Landino, Nuzzo, A., and Angilletta, G.

Published
1993

23. LO SPASMO ESOFAGEO DIFFUSO

Author

Del Genio A., Izzo G., Di Martino N., Nuzzo A., Zampiello P., Angilletta G., FEI, Landino, Peracchia A, Roncoroní L, Violi V, Del Genio, A., Izzo, G., Di Martino, N., Fei, Landino, Nuzzo, A., Zampiello, P., and Angilletta, G.

Published
1990

24. 24-hour esophageal ambulatory manometry in patients with achalasia of the esophagus

Author

Maffettone, Del Genio A, Monaco L, Di Martino N, Giuseppe Izzo, Bortolotti M, DI MARTINO, Natale, Bortolotti, M, Izzo, Giuseppe, Maffettone, V, Monaco, L, and DEL GENIO, A.

Subjects
Adult, Male, medicine.medical_specialty, Supine position, Manometry, Posture, Achalasia, Internal medicine, medicine, Ambulatory Care, Transducers, Pressure, Humans, In patient, Circadian rhythm, Esophagus, Peristalsis, Aged, Monitoring, Physiologic, business.industry, Gastroenterology, General Medicine, Middle Aged, medicine.disease, Postprandial Period, Circadian Rhythm, Esophageal Achalasia, medicine.anatomical_structure, Ambulatory, Cardiology, Female, Esophagogastric Junction, business, Ambulatory system
Abstract

Absence of the peristaltic contractions in the esophageal body and the failure of the lower esophageal sphincter (LES) post-deglutitive relaxation are the major motor disturbances in patients with achalasia. These alterations are usually evidenced by means of stationary esophageal manometry, which is able to record changes over a brief period. The aim of this work has been to study the circadian esophageal motor activity of the esophageal body in patients with achalasia, using a non-perfused ambulatory manometry system. Ten patients with untreated esophageal achalasia (dilatationor = 5 cm) had a 24-hour ambulatory esophageal manometry. The portable recording system consisted of a computerized data logger and a probe with four microtransducers 5 cm apart, the distal one being positioned 5 cm above the LES. A microtransducer, positioned 1 cm below the upper esophageal sphincter, recorded the swallow activity. Contractions frequency (n/min), mean amplitude (mmHg), mean duration of contraction (sec), percentage of contraction7 sec, percentage of multipeaked, repetitive and isolated contractions, and percentage of peristaltic and simultaneous sequences were evaluated and analysed during the following periods: meal-time (MT); upright (UP); supine night-time (NT). On the basis of the relationship with swallows the contraction events were classified as post-deglutitive or spontaneous. The data out of a group of 65 normal subjects were used as control. Student's t-test and Wilcoxon's rank-sum test were used for statistical analysis. Peristaltic sequences were detected in all patients, 27.8 +/- 12.6% of the total, and the 19.5 +/- 11.06% of these were complete. Moreover primary peristaltic sequences were present in 33.1 +/- 23.4% of all peristaltic sequences. In contrast to current trends, our results show surprisingly the presence of peristaltic activity in patients with achalasia (27.9% MT; 26.9% UP; 28.1% NT). We believe these results are related both to the use of an ambulatory system, which allows 24-hour monitoring and to the use of microtransducers, which are able to detect motor events with great accuracy. These motor events are usually not detectable by stationary perfused systems.

Published
1997

43. LA TERAPIA CHIRURGICA DEL MEGAESOFAGO ACALASICO

Author

Caracò A., Pignatelli C., Amato G., Di Martino N., Del Genio A., FEI, Landino, Caracò, A., Pignatelli, C., Fei, Landino, Amato, G., Di Martino, N., and Del Genio, A.

Published
1980

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