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At least 19 recordsLinked to original sources

PubMed1978

[Cardia function following Billroth I and Billroth II gastrectomy (studies on the significance of duodenal passage for cardia function)].

To clarify whether the duodenum is important to the regulation of cardia function, patients with B-I and B-II resections were investigated manometrically. A test meal can stimulate the LES in patients with a B-I resection almost to the same extent as that in healthy test persons. Symptom-free patients with the distal stomach resection and gastrojejunostomy (B-II) do not show this pressure reaction. Therefore, the duodenal passage could be of importance to cardia function. In patients with a transformation operation of B-II in B-I, because of postgastrectomy symptoms a stimulation of the LES cannot be achieved either before or after the transformation operation. We cannot presently clarify the type of the cardia regulation since the IRG levels measured do not explain this phenomenon.

Adult↗

PubMed1977

Surgical treatment of carcinoma of the oesophagus and cardia.

A clinical series of 216 patients with carcinoma of the oesophagus or cardia, who underwent surgical resection of the oesophagus, is presented. There were 104 patients with oesophageal carcinoma and 112 patients with carcinoma of the cardia. Histologically, there were 102 squamous cell carcinomas, 98 adenocarcinomas, 11 anaplastic carcinomas and 7 non-differentiated carcinomas. Oesophago-gastrotomy was the procedure mostly used; colon interposition was done in only 13 cases. The hospital mortality was 21%. The 5-year survival rate for the whole series after oesophageal resection was 23%. The duration of symptoms, location of the tumour, age and sex of the patients, pre- or postoperative radiotherapy and the histological type of the tumour had only a minor bearing on survival. The two most important prognostic factors were the spread of the tumour at time of operation and a preceding lye stricture. The 5-year survival rate was 34% for the patients with a local tumour at operation and 44% for those in whom the carcinoma developed at the site of a previous lye stricture. The variance of the results in the literature is discussed. Surgical approach to the carcinoma of the oesophagus and cardia is recommended in all the cases in which the patient and tumour seem to be eligible for resection.

Adult↗

PubMed1978

[Diagnosis and surgical treatment of functional disorders of the cardia in duodenal ulcer].

The article deals with the problem of the functional status of the cardia in duodenal ulcer. The cardial function was studied in 27 patients with complicated duodenal ulcer. The results make it possible to judge about the degree of manifestation of cardia insufficiency. While tackling the problem of a character of surgical intervention upon the duodenal ulcer cases it is necessary, in author's opinion, to take into consideration the results of the functional examination of the cardia.

Adult↗

PubMed1978

[Activity of vagal efferent fibres innervating the smooth muscle of the dog's cardia].

Our experiments were performed on dogs in which the central end of the left thoracic vagus had been sutured to the peripheral end of the left phrenic nerve. In such preparations, the activity of motor units of the re-innervated left hemidiaphragm indicated the activity of the vagal efferent fibres. After the left hemidiaphragm had been transformed into subcutaneous muscle, we studied, (using electromyography in the unanesthetized dog), the discharge of vagal fibres which originally supplied the lower oesophageal sphincter (cardia). The present paper only deals with fibres showing low frequency tonic discharge. 1. For some fibres (VIC type ; N = 42), the spontaneous firing rate (1.5 less than f less than 4.5 spikes/s) is suddenly enhanced just after the buccopharyngeal stage of swallowing (12 less than f less than 16 spikes/s). The this discharge stops abruptly just before the end of oesophageal peristalsis and starts again 2 to 3 seconds later at a low frequency (15 less than f less than 4.5 spikes/s). 2. Other fibres (VEC ; N = 18), which also have a slow discharge frequency (1 less than f less than 3 spikes/s) stop firing soon after the onset of swallowing and remain silent until the end of oesophageal peristalsis. At this time, i.e. when the bolus enters the stomach, the discharge starts again with an increased frequency (5 less than mean frequency less than 9 spikes/s). 3. The behaviour of the tonic vagal fibres during swallowing, as well as their low discharge frequency, strongly suggest that these fibres originally controlled the smooth muscle of the lower oesophageal sphincter and excited either an inhibitory (VIC = vagal inhibitory fibres of cardia) or an excitatory control (VEC = vagal excitatory fibres of cardia) upon this area.

Action Potentials↗

PubMed1979

[Cardia function after proximal-gastric vagotomy (author's transl)].

In 36 patients with chronic duodenal ulcer disease LES-function before and after proximal-gastric vagotomy was examined manometrically and by determining pH-values in a prospective study. In addition, esophagus biopsies were taken 5 cm proximal of the cardia. 12 healthy volunteers served as controls. A direct effect of proximal-gastric vagotomy on LES-function could not be shown. On the contrary, in 38,9% of the patients examined, preoperatively proven esophagitis disappears nearly completely 12 months following proximal gastric vagotomy. This positive effect of vagotomy is to be interpreted as a beneficial effect on regurgitated intestinal juice, more so than an effect on cardia function itself.

Adult↗

PubMed1979

Treatment of megaesophagus with forced dilatation of cardia through hydrostatic balloon attached to a fiberesophagoscope.

The treatment of megaesophagus through the forced dilatation of the cardia has been used in Brazilian medical centers for the treatment of megaesophagus in the initial stage. In patients with advanced megaesophagus without surgical conditions due to the involvement of various systems or those who present severe degrees of malnutrition it is necessary to perform the dilatation of the cardia even with an temporary effect for the improvement of the general condition. The dilatation balloon usually employed does not permit the device to be used safely due to the deviation of the axis of the distal third of the esophagus. A hydrostatic balloon attached to the fiberesophagoscope was adapted to allow the dilating apparatus to be introduced under direct vision for greater safety. Twenty-one patients were treated under the above mentioned conditions and the results justified the indication.

Adult↗

PubMed1977

Carcinoma of the cardia and thoracic oesophagus coexisting with and following sliding hiatal hernia and peptic stricture.

A series of 207 cases of carcinoma of the cardia and thoracic oesophagus was reviewed. Ten patients (9-8% of those with carcinoma of the cardia) had a hiatal hernia with a coexisting adenocarcinoma. Five other patients (2-4%) had long-standing records of hiatal hernia, and chronic peptic oesophagitis with stricture before the development of carcinoma. In the cases of hiatal hernia coexisting with carcinoma, there is insufficient evidence of the hernia predisposing to carcinoma. The relationship is thought to be purely coincidental. However, malignant changes may occur in long-standing cases of chronic oesophagitis with peptic stricture.

Adenocarcinoma↗

PubMedDate not supplied

[Transdiaphragmatic shunt with a Roux loop in non-resectable neoplastic processes of the cardia].

On the basis of 26 cases with non-operable primary or secondary neoplastic obstructions of the cardia the authors express the opinion that the best solution is the transdiaphragmatic pontage with a jejunal loop mounted in Y. Enlargement of this indication should not be made on behalf of radical or palleative resections, but on the contrary internal derivations should increase the range of surgical solutions in cancer of the cardia. Making an analysis of the major aspects (death-rate, indications and some technical details) in connection with the by-pass with a Roux loop the authors stress the benignity of this type of surgery and the chances it has to take the place of external derivations, compared with which it provides both nutritional and moral advantages.

Cardia↗

PubMedDate not supplied

Brushing cytology for the diagnosis of gastric cancer involving the cardia or the lower esophagus.

In 173 patients with gastric cancer involving the cardia or the lower esophagus, endoscopic biopsy and/or brushing cytology were utilized in establishing the diagnosis microscopically. Biopsy was positive in 132 of 170 patients (77.0%) while brushing was positive in 78 of 93 patients (83.8%). However, a combined use of biopsy and brushing yielded a higher diagnostic accuracy of 88.0 per cent. Further, endoscopic findings of the lower esophagus or the cardial orifice and diagnostic yields of the two methods were correlated. In patients with mucosal elevation, thick fold or a tight cardial stenosis as a pattern of esophageal involvement by gastric cancer on esophagoscopy, supplementary application of brushing increased diagnostic accuracy approximately 20 per cent compared to that of biopsy alone. It is concluded that brushing cytology should be utilized more frequently in gastric cancer involving the cardia to the lower esophagus, especially in the three types of esophageal involvement mentioned above.

Biopsy↗

PubMed1979

Intramural hematoma of the gastric cardia.

A case of intramural hematoma of the gastric cardia occurring in a young woman with S.L.E. and on warfarin is presented and discussed. This unusual case illustrates the importance of careful evaluation of radiological mass lesions of the cardia.

Adult↗

PubMed1976

[Upward extension of esophago-gastric resection in carcinoma of the cardia: our current trend in the light of experience in 52 cases].

A first lot of patients (18 cases) operated for carcinoma of the cardias, with oesophageal resection performed at a distance of 4-5 cm. from the neoplasia, evidenced high mortality (7 cases) within the first twelve months. In a second lot of patients (17 cases), a study of the oesophageal section was made and showed invasion in 7 cases; this led to the level of the oesophageal resection being extended to a distance of 8-10 cm. from the tumour; in 17 cases thus operated (third lot) only one case of invaded oesophageal section was found. Systematic extension of the oeophageal resection, in cases of cancers of the cardias, to the level of the inferior pulmonary vein is therefore proposed in order to obtain a radical surgical result.

Adenocarcinoma↗

PubMed1977

[Review of patients with carcinoma of the cardia treated in the hospital of Celje during 1966-1975].

At the department of visceral surgery of the hospital in Celje has been during past ten years surgically treated 41 patients with cancer of cardia. This number of patients represents 11,48% of all patients suffering from cancer of stomach treated in the some period of time. In this short survey we present our methods, complications and results of treatment. Mortality rate of our surgically treated patients with cancer of cardia represents nearly 10% all cases.

Adult↗

PubMed1978

Results of Heller's operation for achalasia of the cardia.

A survey of 102 patients with achalasia of the cardia treated by cardiomyotomy is reported. The technique of operation was unchanged throughout and the patients were followed up for a maximum of 22 years. Only 6 patients (5.8 per cent) developed renewed symptoms of reflux and 7 patients (6.8 per cent) had peptic strictures. Over 80 per cent of the patients had no dysphagia or regurgitation postoperatively, but 61 per cent still complained of achalasic pain. The development of mucosal hernias after cardiomyotomy and the use of drinking times in the assessment of outflow at the cardia are discussed.

Adolescent↗

PubMed1978

Achalasia of the cardia in elderly patients.

Achalasia of the cardia frequently presents as dysphagia in middle age. In the elderly, dysphagia is usually due to a neoplasm of the oesophagus or cardia. The authors have been interested to see five patients over the age of 70 presenting with oesophageal symptoms due to achalasia which is uncommon in this age group and may be mistaken for neoplastic disease.

Aged↗

PubMed1979

The surgical management of malignant tumours of the oesophagus and cardia: a review of the results in 292 patients treated over a 15-year period (1961--75).

Of 292 patients, excision of the tumour with replacement by stomach or jejunum was carried out in 216 in whom the lesion was considered operable on both technical and general grounds, intubation was performed in 45 and the remaining 31 were managed without operation. Of the 216 in whom resection was performed, only 20 per cent were free from local spread, lymph node involvement or secondary deposits at the time of operation. Hospital mortality was 18 per cent and did not significantly differ between one 5-year period and another. Survival at 1 year was 54 per cent, at 2 years 25 per cent and at 5 years 14 per cent. The average length of survival following intubation was 2.6 months and following non-operative management 2.8 months. The poor average survival of between 3.5 and 5 months obtained in those patients with secondary deposits at the time of resection suggests that resection is of questionable value in this group. There was a marked difference in survival following Roux loop procedures compared with upper partial gastrectomy for tumours of the lower third and cardia in patients without lymph node involvement or secondary deposits, strongly suggesting that upper partial gastrectomy, although a rather simpler and quicker operation, is not the operation of choice in these patients. On 31 December 1976, after a minimum follow-up of 1 year, there were only 22 patients still alive of the original 292 (7.5 per cent).

Adult↗

PubMed1979

The Celestin tube in the palliation of carcinoma of the oesophagus and cardia.

A series of 105 patients with dysphagia due to inoperable carcinoma of the oesophagus or cardia of the stomach, and 11 patients with dysphagia secondary to malignant medistinal nodes, was treated by intubation with a Celestin tube. The hospital mortality was high but 81 patients left hospital and 29 were still alive at 6 months. The prognosis for those with dysphagia due to malignant posterior mediastinal nodes was very poor, with no survivors at 6 months. Oesophageal perforation was a serious operative complication, with a hospital mortality of 83 per cent. Chest and wound infections were the most common postoperative complications occurring in 28 and 20 per cent of the patients, respectively. The restoration of swallowing was satisfactory in the majority of survivors although readmission with a blocked or displaced tube was not uncommon.

Adult↗

PubMed1979

Diagonal abdominothoracic incision as an approach to carcinoma of the cardia and upper gastric region.

An operative technique consisting of a diagonal epigastric incision extending to the left chest wall and severing the inner side of diaphragm adjacent to the pericardium to the hiatus is introduced. This technique was successfully used in 16 cases and the present surgical approach facilitates frontal visualization of the lower esophagus without disruption of the circulatory system. Furthermore, a sufficiently large operative field is obtained and radical dissection of cardia and upper gastric region or combined resection of infiltrated adjacent organs is facilitated. Postoperative recovery of pulmonary function in terms of PaO2 and PaCO2 was similar to that of patients who had received an upper median incision. We found no postoperative complications peculiar to the operative technique introduced here in any of the 16 patients.

Adult↗

PubMed1975

[Radiological and clinical aspects of resection of the cardia].

Following resection of the cardia, problems may arise during two phases; in these, clinical and radiological examination may be required. Immediately after the operation one is concerned particularly with checking the incision or the extent and localisation of suture abnormalities. In the late post-operative period the problems are different. In addition to a description of the anatomy at the proximal and distal ends of the stomach, it is necessary to estimate functional conditions, such as passage through the anastomosis and the pylorus, the reservoir function of the gastric remnant and gastro-oesophageal reflux. An important task is to demonstrate tumour recurrence. For this purpose endoscopic, biopsy and cytological examinations are required.

Cardia↗