Cases reported "Esophagitis"

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1/4. Progressive esophagitis caused by candida albicans with reduced susceptibility to caspofungin.

    Candida esophagitis, a defining illness of acquired immunodeficiency syndrome (AIDS), requires systemic antifungal therapy. candida albicans can become resistant to commonly administered azole antifungal agents. An attractive alternative is caspofungin, an echinocandin antifungal that has generally displayed predictable activity against C. albicans. We report the case of a 29-year-old woman with AIDS who developed recurrent esophagitis caused by a strain of C. albicans that showed reduced susceptibility to caspofungin (elevated minimum inhibitory concentration of 8 mg/L). Analysis of the strain revealed that it contained a serine-to-proline substitution at position 645 in the FKS1 gene. Clinicians who prescribe caspofungin to treat esophagitis caused by C. albicans should recognize the potential risk, albeit slight, for acquired resistance to caspofungin and possibly other echinocandin antifungal agents in the face of persistent disease. In patients who are refractory or unresponsive to caspofungin therapy, susceptibility testing and/or alternative therapy should be considered.
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2/4. Persistent oesophageal candidiasis treated with ketoconazole.

    ketoconazole is a synthetic imidazole derivative indicated in the treatment of superficial and deep mycoses (1). This paper reports its successful use in the management of a patient with oesophageal candidiasis which had failed to respond to alternative therapies.
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3/4. Oesophagoplasty in the treatment of oesophageal stricture.

    Two children with oesophageal stricture due to corrosive oesophagitis and retained foreign-body respectively, were treated with resection and primary oesophageal reconstruction. Both were complicated by anastomotic leaks which healed after adequate drainage with temporary enterostomy feeding. The long-term results have remained excellent without dysphagia or reflux. The technique of primary repair is recommended for short-length stricture of the oesophagus as an alternative to reconstruction by gastric or colonic tube interposition.
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4/4. Thoracoscopic vagotomy as a safe adjunct to remedial gastric surgery.

    patients who have had prior subdiaphragmatic dissection with an incomplete vagotomy or Nissen fundoplication present added challenges when they require vagotomy and gastric resection. In this setting, thoracoscopic vagotomy offers significant advantages. A second attempt at vagotomy in a previously dissected field can be prolonged and frustrating. In addition to these concerns, repeat dissection can also lead to failure to find the vagal trunks, perforation of the esophagus, hemorrhage, and/or splenic injury. In our experience, three patients requiring gastrectomy or resection of a marginal ulcer have undergone thoracoscopic vagotomy at the time of transabdominal gastric surgery. The thoracoscopic approach avoided either a thoracoabdominal incision or combined thoracic and abdominal incisions while allowing dissection of the vagal trunks to be performed in normal tissue planes. The minimally invasive approach afforded decreased postoperative pain and excellent clinical results. Thoracoscopic vagotomy offers a welcome alternative to re-exploration of a previously dissected distal esophagus in search of vagal trunks, especially when they have been missed at the time of the first operation. Further application of this approach is recommended.
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