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- ItemSomente MetadadadosAnatomical analysis of the mediastinal lymph nodes of normal Brazilian subjects according to the classification of the Japanese society for diseases of the esophagus(Springer, 2003-01-01) Herbella, Fernando Augusto Mardiros [UNIFESP]; Del Grande, José Carlos [UNIFESP]; Colleoni, Ramiro [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Purpose. Extended mediastinal lymphadenectomy is gaining popularity in the treatment of esophageal cancer, but lymph node nomenclature and classification is still not standardized. The normal mediastinal lymph node distribution according to the classification of the Japanese Society for Esophageal Diseases has never been studied.Methods. We dissected 20 fresh adult cadavers to examine the mediastinal lymph nodes.Results. We found an unpredictable and inconstant distribution.Conclusion. Previous papers have evaluated the number and distribution of normal mediastinal lymph nodes, clinically, radiologically, and anatomically, but the results are conflicting and inconsistent.
- ItemSomente MetadadadosAre idiopathic and chagasic achalasia two different diseases?(Kluwer Academic/plenum Publ, 2004-03-01) Herbella, FAM; Oliveira, DRCF; Del Grande, J. C.; Universidade Federal de São Paulo (UNIFESP)Although Chagas' disease esophagopaty and idiopathic (primary) achalasia share several similarities, however, some differences between the two diseases have been noticed. To evaluate if treatment options and their results can be accepted universally, the authors review characteristics of both diseases in the international and Latin American literature. Neuronal denervation, sensitivity to gastrin, patient age, duration of symptoms, lower esophageal sphincter pressure, incidence of vigorous achalasia, and cancer risk are considered points of discrepancy between the maladies. Data with a high level of evidence base are scarce; however, differences between the diseases seem to exist, despite the fact that no influence on response to treatment was noticed.
- ItemSomente MetadadadosEponyms in esophageal surgery(Blackwell Publishing Asia, 2004-01-01) Herbella, FAM; Oliveira, DRCF; Del Grande, J. C.; Universidade Federal de São Paulo (UNIFESP)Eponyms are frequently used in the surgery in homage to remarkable surgeons, specially creators of new surgical techniques and instruments. Sometimes, however, the right person is not revered or the name persists, but the author's technique has been changed over time and the original procedure is lost. Eponyms of the 10 most famous procedures in esophageal surgery are revisited. Names like Lortat-Jacob, Toupet, Dor, Heller, Nissen, Ivor Lewis, Collis, Merendino, Hill, and Belsey, are reviewed, analyzing the man behind the name, the original technique and its modifications.
- ItemSomente MetadadadosEponyms in esophageal surgery, part 2(Blackwell Publishing Asia, 2005-01-01) Herbella, FAM; Matone, J.; Del Grande, J. C.; Universidade Federal de São Paulo (UNIFESP)Eponyms in medicine are frequently criticized because they may not represent the person who first described a syndrome or disease. Although eponyms are very commonly used, most readers are probably unaware of who it was that named the diseases and whether the original description of the disease still corresponds to the modern definition. the 10 most common eponyms in esophageal diseases were revisited. the men and the disease behind Barrett's esophagus, Boerhaave's syndrome, Mallory-Weiss syndrome, Cameron ulcer, Schatzki ring, Paterson-Kelly syndrome, Plummer-Vinson, Chagas's disease, Zenker diverticulum and Killian diverticulum are reviewed here.
- ItemSomente MetadadadosEsophageal carcinoma secondary to a chemical injury in a child(Springer, 1998-09-01) Schettini, S. T.; Ganc, A.; Saba, L.; Universidade Federal de São Paulo (UNIFESP)Twin sisters were clinically and endoscopically followed due to chemical injuries to the esophagus after ingestion of muriatic acid at 10 months of age. One of the girls developed esophageal carcinoma 10 years later and died after esophagectomy because of progression of the disease. Her twin sister has a severe stenosis at the distal esophagus and is waiting for surgical treatment. Malignization of a chemical injury to the esophagus in a child has not yet been described in the literature, emphasizing the role of endoscopic follow-up with periodic biopsies.
- ItemSomente MetadadadosEsophageal diverticula and cancer(Wiley-Blackwell, 2012-02-01) Herbella, F. A. M. [UNIFESP]; Dubecz, A.; Patti, M. G.; Universidade Federal de São Paulo (UNIFESP); Klinikum Nuernberg Nord; Univ ChicagoEsophageal diverticula are rare. the association of cancer and diverticula has been described. Some authors adopt a conservative non-surgical approach in selected patients with diverticula whereas others treat the symptoms by diverticulopexy or myotomy only, leaving the diverticulum in situ. However, the risk of malignant degeneration should be may be taken in account if the diverticulum is not resected. the correct evaluation of the possible risk factors for malignancy may help in the decision making process. We performed a literature review of esophageal diverticula and cancer. the incidence of cancer in a diverticulum is 0.37, 1.8, and 0.6% for pharyngoesophageal, midesophageal, and epiphrenic diverticula, respectively. Symptoms may mimic those of the diverticulum or underlying motor disorder. Progressive dysphagia, unintentional weight loss, the presence of blood in the regurgitated material, regurgitation of peaces of the tumor, odynophagia, melena, hemathemesis, and hemoptysis are key symptoms. Risk factors for malignancy are old age, male gender, long-standing history, and larger diverticula. A carcinoma may develop in treated diverticula, even after resection. Outcomes are usually quoted as dismal because of a delayed diagnosis but several cases of superficial carcinoma have been described. the treatment follows the same principals as the therapy for esophageal cancer; however, diverticulectomy is enough in cases of superficial carcinomas. Patients must be carefully evaluated before therapy and a long-term follow-up is advisable.
- ItemAcesso aberto (Open Access)Ingestão acidental de moedas por crianças: atuação do Setor de Otorrinolaringologia do Hospital João XXIII(ABORL-CCF Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, 2006-08-01) T-ping, Cheng [UNIFESP]; Nunes, Cassimiro Afonso; Guimarães, Gabriel Rabelo; Vieira, João Penna Martins; Weckx, Luc Louis Maurice [UNIFESP]; Borges, Tanner José Arantes; Universidade Federal de São Paulo (UNIFESP); Hospital João XXIII; Hospital João XXIII Setor de Otorrinolaringologia; Hospital Felício RochoThe ingestion of foreign bodies by children is frequently seen in emergency departments. ENTs can manage those lodged in the esophagus but experience is important for a successful intervention. AIM: Describe seven cases of children that ingested coins, managed at the ENT Department of João XXIII Hospital. STUDY DESIGN: Clinical/prospective. MATERIALS AND METHODS: We describe seven cases (gender, age, family status, coin size and treatment/evolution). RESULTS: Age ranged from one to nine years. Two patients were only children and five were the youngest in their families. Coins sizes ranged from 1.9 to 2.5 cm. After eight hours of observation, three cases were treated in the surgery room because the foreign body was lodged in the cricopharynx. Four cases resolved spontaneously. CONCLUSION: The ENT department has good results removing coins lodged in the upper esophagus using forceps and laryngoscopy; and also using rigid esophagoscopy for the lower esophagus. In this study it was not possible to establish the importance of coin size and patient age in attempting to predict spontaneous resolution, nor if the child being an only child or the youngest in the family may have some predisposition in this kind of accident.
- ItemAcesso aberto (Open Access)Perfuração de mucosa esofágica por sonda entérica: relato de caso(Associação de Medicina Intensiva Brasileira - AMIB, 2006-03-01) Santos, Cynthia Clabunde dos [UNIFESP]; Omura, Felipe [UNIFESP]; Guimarães, Hélio Penna [UNIFESP]; Falcão, Luiz Fernando dos Reis [UNIFESP]; Lopes, Renato Delascio [UNIFESP]; Saes, Letícia Sandre Vendrame; Universidade Federal de São Paulo (UNIFESP); Núcleo de Estudos em Emergências Clínicas; Instituto Dante Pazzanese de Cardiologia Divisão de Pesquisa; AMIB-AMBBACKGROUND AND OBJECTIVES: This study is a case report of a patient that was submitted to implant of enteric tube (ET) in the ICU, being evidenced false passage in proximal esophagus during endoscopic procedure, demonstrating tunnel for the submucosa. CASE REPORT: A 77 years old woman, transferred to ICU, where ET was installed (due to difficulty of being carried through both nostrils) being confirmed its position through thoraco-abdominal x-ray. The patient remained around 10 days with the ET, receiving diet, without any alteration. In the 10th day she was evolved with melena and reduction of the values of Hb/Ht, without hemodynamic repercussion. Submitted to the high digestive endoscopic that evidenced ulcer injury to bulbar, of about 2.5 cm, with signals of former bleeding. During the examination, a false passage of the ET in proximal esophagus was visualized: 2 cm below of the crico-faring, tunnel for the submucosa possibly for all above-mentioned segments, following its habitual passage until gastric chamber. CONCLUSIONS: Patients of high risk for esophagus perforation for ET installation can be identified and well-taken care of adjusted they can be used. If to occur perforation, this must be identified how much so early possible, for adequate treatment. The adequate treatment depends of each case and same the clinical therapy can be appropriate in selected cases.
- ItemSomente MetadadadosShort esophagus or bad dissected esophagus? An experimental cadaveric study(Elsevier B.V., 2003-09-01) Herbella, FAM; Del Grande, J. C.; Colleoni Neto, Ramiro [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Short esophagus is defined as the inability to reduce the gastroesophageal junction below the diaphragm. One of the factors responsible for this inability can be inadequate esophageal mobilization. We evaluated esophageal lengthening achieved by means of dissection in a cadaveric model. Fifty-one cadavers were dissected (27 transthoracically and 24 transhiatally). Abdominal esophageal length was assessed before and after dissection of the esophagus from the hiatus to the carina. in the transthoracic group, a mean of 1.7 +/- 1.3 cm (range 0.3 to 5.0 cm) was gained with dissection. in the transhiatal group, a mean of 1.8 +/- 0.8 cm (range 0 to 3.0 cm) was gained with dissection. in a comparison of results of transthoracic and transhiatal approaches, the difference was not statistically significant. We concluded that a significant increase in esophageal length was achieved after dissection;, however, the access route (thorax or abdomen) did not influence the results. (C) 2003 the Society for Surgery of the Alimentary Tract, Inc.
- ItemSomente MetadadadosTreatment of achalasia: lessons learned with Chagas' disease(Wiley-Blackwell, 2008-01-01) Herbella, F. A. M. [UNIFESP]; Aquino, J. L. B.; Stefani-Nakano, S.; Artifon, E. L. A.; Sakai, P.; Crema, E.; Andreollo, N. A.; Lopes, L. R.; Pochini, C. de Castro; Corsi, P. R.; Gagliardi, D.; Del Grande, J. C. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Catholic Univ; Santa Casa Goiania; Universidade de São Paulo (USP); Univ Fed Triangulo Mineiro; Universidade Estadual de Campinas (UNICAMP); Santa Casa São Paulo Med SchChagas' disease (CD) is highly prevalent in South America. Brazilian surgeons and gastroenterologists gained valuable experience in the treatment of CD esophagopathy (chagasic achalasia) due to the high number of cases treated. the authors reviewed the lessons learned with the treatment of achalasia by different centers experienced in the treatment of Chagas' disease. Preoperative evaluation, endoscopic treatment (forceful dilatation and botulinum toxin injection), Heller's myotomy, esophagectomy, conservative techniques other than myotomy, and reoperations are discussed in the light of personal experiences and review of International and Brazilian literature. Aspects not frequently adopted by North American and European surgeons are emphasized. the review shows that nonadvanced achalasia is frequently treated by Heller's myotomy. Endoscopic treatment is reserved to limited cases. Treatment for end-stage achalasia is not unanimous. Esophagectomy was a popular treatment in advanced disease; however, the morbidity/mortality associated to the procedure made some authors seek different alternatives, such as Heller's myotomy and cardioplasties. Minimally invasive approach to esophageal resection may change this concept, although few centers perform the procedure routinely.