Cases reported "Esophageal Achalasia"

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1/190. Synovial sarcoma of the esophagus simulating achalasia.

    Synovial sarcoma is a rare malignancy occurring mainly in the extremities. Only seven cases have been described arising in the esophagus. All of them presented as a polypoid mass involving the upper third of the esophagus. A case of infiltrating synovial esophageal sarcoma simulating achalasia in a 63-year-old woman is reported. According to the literature, the location and the clinical pattern of this tumor are exceptional. The clinical features, pathologic findings, differential diagnosis, and management of this condition are discussed.
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2/190. Double pylorus and esophageal achalasia.

    29 cases of double pylorus have been reported so far. It is thought that in 85% of the cases it has been due to a fistulous gastro-duodenal ulcer and the remaining 15% would be of a congenital origin. In the case we have reported the double pylorus is believed to be a congenital anomaly associated with a mega-esophagus of similar etiology.
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3/190. leiomyosarcoma of the esophagus in a patient with chagasic megaesophagus: case report and literature review.

    leiomyosarcoma constitutes approximately 0.5% of the malignant neoplasias of the esophagus and its association with megaesophagus has not been described. We report on a case of a woman with dysphagia that was slowly progressive from the age of 19 due to chagasic megaesophagus. The woman was subjected to cardiomyotomy at the age of 49. She presented a rapid worsening of the dysphagia due to leiomyosarcoma at the age of 61, and was subjected to subtotal esophagectomy with cervical esophagogastroplasty. She developed pulmonary and hepatic metastases 14 months after surgery and died six months later.
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4/190. Megacystis-microcolon-intestinal hypoperistalsis syndrome associated with megaesophagus.

    Megacystis-microcolon-intestinal hypoperistalsis syndrome is a rare congenital disorder characterized by megacystis and hypoperistalsis of the gastrointestinal tract. About 80 cases have been reported, predominantly in females. We present a female newborn with typical features of the syndrome associated with megaesophagus.
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5/190. Primary small cell carcinoma of the esophagus with achalasia in a patient in whom pro-gastrin-releasing peptide and neuron-specific enolase levels reflected the clinical course during chemotherapy.

    We report a case of primary small cell carcinoma of the esophagus in a patient with achalasia in whom pro-gastrin-releasing peptide (ProGRP) and neuron-specific enolase (NSE) levels were measured. Although chemotherapy markedly reduced the size of the primary tumor and lymph node metastases, it had no effect on liver metastases. The tumor marker levels decreased after chemotherapy as the primary tumor and lymph node metastases decreased in size, and they increased as the liver metastases enlarged. However, there was a discrepancy between the levels of ProGRP and NSE during the patient's clinical course. We demonstrate the usefulness of measuring ProGRP and NSE levels to assess the effect of chemotherapy in patients with esophageal small cell carcinoma.
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6/190. Neuromotor disorders of the esophagus.

    Esophageal motility studies are helpful in diagnosing hypertensive and hypotensive disorders of the esophagus and its sphincters, including the exact measurement of the strength of contraction, temporal sequence and duration of the pathophysiology involved. In addition, the assessment of the extent of neuromotor involvement may be of great help to the surgeon in planning a myotomy. PH metering is probably the most accurate way to assess reflux in hypotonic states.
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7/190. Massive tracheal necrosis due to compression by an innominate artery aneurysm associated with a grade IV Chagasic megaesophagus and chronic duodenal ulcer.

    A 49-year-old man suffered necrosis of the cephalad tracheal segment due to compression by an innominate artery aneurysm. A peritracheal abscess, a grade IV chagasic megaesophagus, and a duodenal ulcer were also present. The patient underwent a three-stage surgical treatment, and 7 years later he is doing well, and breathing and eating normally.
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8/190. Infiltrating carcinoma simulating achalasia.

    Three cases of carcinoma infiltrating the esophagus and simulating achalasia are presented and the differential diagnostic problems discussed. The radiologic distinction between achalasia and carcinoma can be extremely difficult. Any rigidity, irregularity, nodularity, or ulceration of the distal-most esophagus or gastric fundus or symptoms of short duration in older patients should alert the radiologist to the possibility of carcinoma. It is suggested that all patients with suspected achalasia undergo esophageal and gastric endoscopy with biopsy and esophageal manometry to confirm the diagnosis, expecially if pneumatic dilatation is contemplated.
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9/190. Secondary achalasia due to a mesenchymal tumour of the oesophagus.

    A rare case of a secondary achalasia or pseudoachalasia due to a mesenchymal tumour of the oesophagus is presented. A 67-year-old Caucasian man had symptoms including dysphagia, odynophagia, and weight loss for 8 months. Radiological examination revealed no signs of neoplasia but an exploratory laparotomy revealed the presence of a mesenchymal tumour of the oesophagus. Tucker's criteria constitute an important tool in the differential diagnosis of secondary achalasia from primary achalasia with clinical value, but in this case, exploratory laparotomy rather than non-invasive diagnostic procedures provided the final and definite diagnosis.
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10/190. Rapidly developing airway obstruction resulting from achalasia of the oesophagus.

    Megaoesophagus resulting from achalasia is a rare but serious cause of airway obstruction. The exact aetiology remains unclear. Although 29 cases have previously been reported, the potential need for urgent treatment has not been sufficiently emphasized. Some forms of treatment with drugs or decompression with a fine tube have been advocated but emergency tracheal intubation may become necessary. A 90-year-old lady had a bolus of food lodged in her oesophagus but with no respiratory symptoms. The bolus was removed under anaesthesia. Six weeks later she suffered similar symptoms after eating but developed severe airway obstruction over 10 min. Emergency intubation of the trachea was necessary before removing the food bolus under general anaesthesia. This case demonstrates the urgency with which these patients may need to be treated. The condition can rapidly worsen due to swallowing of air and saliva.
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