Cases reported "Spasm"

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1/10. Acute pyloric spasm and gastric hypomotility: an extracardiac adverse effect of percutaneous radiofrequency ablation for atrial fibrillation.

    OBJECTIVES: This study sought to describe a new adverse effect of percutaneous radiofrequency (RF) ablation for atrial fibrillation (AF). BACKGROUND: Extension of the RF lesion beyond atrial myocardium may affect mediastinal structures other than the esophagus. methods: Circular mapping-guided isolation of the pulmonary veins was performed in two different electrophysiology laboratories, either individually and supplemented by ostial and posterior left atrial (LA) ablation or two by two with a series of ostial and posterior LA lesions. The RF energy was delivered point by point through a 5-mm open-tip irrigated catheter (40 W maximum) or an 8-mm-tip catheter (45 W maximum). RESULTS: In four (two in each electrophysiology laboratory) of 367 patients undergoing catheter ablation for AF, abdominal pain and distension developed within 48 h after the procedure. Investigation showed acute pyloric spasm and gastric hypomotility, probably the result of LA endocardially delivered RF affecting the periesophageal vagi. Complete spontaneous recovery occurred in two patients, but laparoscopic esophagojejunal anastomosis and endoscopic intra-pyloric Botulinum toxin injection, respectively, were performed to remedy delayed gastric emptying in two patients. CONCLUSIONS: Thermal injury during endocardial LA RF energy delivery may extend into the mediastinum and rarely may involve the periesophageal nerves, resulting in a syndrome of acute delayed gastric emptying. Marked anatomic variability of periesophageal vagi renders it difficult to reliably avoid the area overlying this plexus, therefore, we advocate a reduction in maximum RF power and application duration on all of the posterior LA to try to avoid this complication.
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ranking = 1
keywords = esophagus
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2/10. Steakhouse spasm.

    Sudden esophageal obstruction after eating poorly chewed meat has been called the Steakhouse syndrome. Some cases have demonstrable esophageal narrowing above which food impacts, but in many patients with identical symptoms no underlying obstruction is demonstrated. We report four patients with acute dysphagia who were unable to swallow liquids or solids for as long as 72-96 h. Onset occurred after eating meat in three patients and after taking psyllium in one. All had a structurally normal esophagus demonstrated by x-ray and endoscopy, but motor disorders were defined by manometry in three. We hypothesize that an underlying motor abnormality led to food impaction and call this presumed spastic variant "Steakhouse spasm." We suspect that this is a common but frequently unrecognized manifestation of esophageal dysmotility.
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keywords = esophagus
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3/10. Brainstem lesions due to granular ependymitis in symptomatic diffuse esophageal spasm: a case report.

    An 80 year-old man had symptomatic diffuse esophageal spasms for a few months. They were documented by radiographic, endoscopic and manometric findings. The post-mortem neuropathological examination showed a granular ependymitis of the fourth ventricle involving the dorsal region of the motor dorsal nuclei of the vagus nerve which showed frank neuronal loss. The muscular wall of the esophagus, its myenteric plexus and the fasciculi of the vagus nerve were histologically normal. This is the first published case of such a brainstem lesion associated with symptomatic diffuse esophageal spasms. These pathological data are compared with those already published on achalasia.
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keywords = esophagus
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4/10. Surgical treatment of nutcracker esophagus.

    The "nutcracker esophagus" has become a commonly diagnosed esophageal motility disorder due to the advent of the more accurate low-compliance perfusion system. The disorder is characterized by high-amplitude peristaltic contractions often of prolonged duration and manifested by dysphagia and chest pain. Typically, symptomatic control is achieved with medical management. We report a case of "nutcracker esophagus" that was refractory to conventional modes of treatment but responded with symptomatic and manometric resolution after an extended esophagomyotomy.
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ranking = 6
keywords = esophagus
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5/10. Transition from peristaltic esophageal contractions to diffuse esophageal spasm.

    A patient with dysphagia and chest pain was shown by manometry to have high-amplitude peristaltic esophageal contractions (nutcracker esophagus). Worsening symptoms over the next two years led to the performance of repeated manometric studies, which showed diffuse esophageal spasm. This demonstration of a transition from nutcracker esophagus to diffuse esophageal spasm lends further support for consideration of the nutcracker esophagus as a manometric disorder associated with chest pain or dysphagia. Furthermore, it suggests a pathophysiologic relationship between the nutcracker esophagus, a disorder with preserved peristalsis, and diffuse esophageal spasm, the classic dysmotility considered to be of neurogenic origin.
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ranking = 4
keywords = esophagus
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6/10. Transition from nutcracker esophagus to diffuse esophageal spasm.

    The nutcracker esophagus is a newly defined subset of primary esophageal motility disorders that can be responsible for dysphagia and/or chest pain. Any possible relationship between this entity and diffuse esophageal spasm is poorly understood. Herein we report a case of nutcracker esophagus that showed a transition to classical diffuse esophageal spasm during 1 year follow-up. This transition supports the hypothesis that nutcracker esophagus and diffuse esophageal spasm may be related disorders.
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ranking = 7
keywords = esophagus
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7/10. Idiopathic muscular hypertrophy of the esophagus. Postmortem incidental finding in six cases and review of the literature.

    Six cases of idiopathic muscular hypertrophy of the esophagus were found at autopsy in a relatively short period of time. As has been the experience in previously reported cases, our finding was incidental at the autopsy in all of the cases. In only one of our patients were there relevant symptoms and radiographic changes that could be attributed to the disease. How often patients with muscular hypertrophy of the esophagus have the clinical syndrome of diffuse esophageal spasm remains unclear. It is therefore evident that only by awareness of this entity can studies of esophageal funtion, x-ray films, and appropriate treatment prevent serious morbidity and occasional mortality from the disease.
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ranking = 6
keywords = esophagus
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8/10. Surgical management of primary motor disorders of the esophagus.

    Primary motor disorders of the esophagus can be managed surgically with excellent results. Between the years 1972 and 1983, 40 patients were managed by us. The patients ranged in age from 14 to 79 years (mean 36.3 years). Thirty-six patients were managed primarily by the authors and 4 patients secondarily. The distribution of the hypodynamic states were achalasia in 29 patients, vigorous achalasia in 5 patients, and diffuse spasm in 1 patient, whereas the hyperdynamic states were squeeze syndrome in 2 patients, super-squeeze syndrome in 1 patient, and hypertensive lower esophageal sphincter in 2 patients. Of the 36 patients in hypodynamic states, 27 had a modified Heller myotomy and reconstruction of the gastroesophageal junction with a Belsey fundoplication and 9 had only a modified Heller myotomy. There was only one patient with reflux esophagitis. It occurred after myotomy and Belsey fundoplication for a hypertensive lower esophageal sphincter and hiatus hernia. Four patients were managed secondarily for complicated recurrent problems, one with a Belsey fundoplication and three with a jejunal interposition graft. We recommend myotomy, with or without a Belsey fundoplication, for management of primary motor disorders and avoidance of total Nissen fundoplication and a lengthening Collis gastroplasty.
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ranking = 5
keywords = esophagus
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9/10. atrioventricular block induced by swallowing in a patient with diffuse esophageal spasm.

    A patient had syncope induced by swallowing. Electrocardiographic monitoring during eating and esophageal balloon inflation demonstrated a second-degree atrioventricular block (Mobitz type II) with dizziness. Radiologic and manometric examinations of the esophagus showed diffuse esophageal spasm associated with hypertension of the upper esophageal sphincter (UES), gastroesophageal reflux, and a sliding hiatal hernia. Cineradiographic observations were made during ingestion of a meal mixed with barium; at the time of cardiac dysrhythmia, the proximal part of the esophagus containing the bolus assumed a balloonlike shape, while the distal part and the UES contracted. On the basis of these observations and review of all published cases, we propose the pathways of this esophagocardiac reflex and discuss up-to-date treatment.
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ranking = 2
keywords = esophagus
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10/10. Intramural diverticulosis of the oesophagus.

    Four cases of intramural diverticulosis of the oesophagus are described, and the findings are reviewed in 12 previously reported cases. Evidence is presented that this condition is a true pulsion diverticulosis due to deranged motor activity and raised intraluminal pressure. It may occur in cases of diffuse oesophageal spasm, or it may follow inflammation, stricture or surgery. The course is benign, complications being those of the underlying disorder.
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ranking = 5
keywords = esophagus
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