Achalasia cardia (“cardiospasm”, “phrenospasm”, “dolichoesophagus”, “megaesophagus”, “stenosis of cardia”) represents a primary impairment of esophageal motor function associated with impaired lower esophageal sphincter relaxation and peristalsis defects of the thoracic esophagus. It is diagnosed at the age of 25 to 60 years, making up to 20% of all diseases of the esophagus, and is characterized by a triad of symptoms: dysphagia, regurgitation and chest pain when swallowing. In most cases the first manifestations of achalasia are preceded by stress situations in the anamnesis that complicates the differential diagnosis of psychogenic esophageal spasm. The presented clinical case illustrates difficulties of early diagnosis of achalasia cardia in a young femalepatient with severe anxiety and depressive symptoms which develop under conditions of chronic stressful situations in the family or at work. The issues of interdisciplinary interaction of health professionals (physician, gastroenterologist, psychiatrist, psychotherapist, and surgeon) on the course of examination and management of patients with comorbid physical and mental pathology are discussed. The efficiency of the integrative approach to treatment and rehabilitation with the use of modern reconstructive surgical interventions as well as conservative methods of therapy, psychopharmacotherapy and personality-oriented psychotherapy proves the relevance of studying psychosomatic aspects of achalasia cardia.
Background. Currently, the introduction of pre-rehabilitation programs has shown its effectiveness in various sections of abdominal surgery, however, its role in surgical pancreatology is still not entirely clear Aim. To study the effectiveness of the implementation of pre-rehabilitation programs (preoperative exercises and diet therapy) during the waiting period for surgery and their effect on the physical and nutritional status, as well as postoperative complications and the duration of hospital stay in patients who underwent pancreatoduodenal resection. Material and methods. A prospective study was carried out including 44 patients who underwent pancreatoduodenal resection. The patients included in the study were divided into two groups. The control group (23 patients) preoperative preparation, which was carried out according to the standard method. The main group consisted of 21 patients who underwent pre-rehabilitation. Results. Among the patients in the compared groups, there were no statistically significant differences in age, gender, ASA and body mass index, concomitant diseases, and basic laboratory parameters. In the group of patients who underwent pre-rehabilitation, there was a statistically significant increase in the 6-minute walk test (p = 0.02), as well as the prognostic nutritional index (p = 0.01). There was no statistically significant difference between the compared groups in the incidence of major postoperative complications (Clavien - Dindo III / IV) (p = 0.8), clinically significant pancreatic fistulas (p = 0.5), and mortality (p = 0, 6), however, in the pre-rehabilitation group there was a significant decrease in the incidence of gastric evacuation disorders in comparison with the control group (9.5% versus 34.8%, p = 0.04). The average postoperative bed-day was 16.1 5.6 days in the pre-rehabilitation group and 19.8 6.2 days in the control group (p = 0.04). Conclusion. The introduction of pre-rehabilitation in patients undergoing pancreatoduodenal resection is effective and allows improving the physical and nutritional status of the patient, reducing the postoperative bed day and reducing the frequency of delayed gastric evacuation.
According to clinical and instrumental data original surgical repair completely cures the symptoms of cardiac achalasia and restores normal esophageal dimensions and structure early after intervention.
Objective. The frequency of detection of cystic neoplasm of the pancreas (CNP) has recently increased. Some of these neoplasms are benign, while others are malignant. Differential diagnosis between benign and malignant CNP remains challenging.Aim: to develop a combined method for differential diagnosis of CNP and to evaluate the role of the neutrophil to leukocyte ratio (NLR) as a diagnostic criterion of malignant CNP.Material and Methods. A retrospective analysis of the treatment of 82 patients with CNP, who underwent surgery between 2008 and 2018, was carried out. Benign lesions were detected in 62 patients and malignant tumors were diagnosed in 20 patients. The NLR and the serum levels of CA 19-9 as well as the presence of intracystic lesions were assessed as predictors of malignant CNP.Results. The presence of intracystic lesions detected by contrast-enhanced computed tomography and the elevated levels of serum CA 19-9 (>39 U/mL) and NLI (>1.876) were proven to be independent predictors of malignant CNP with statistical significance. The combination of all three criteria indicated malignant cystic neoplasm. The sensitivity, specificity and overall accuracy of the combined method were 71.4 %, 95.6 % and 86.5%, respectively.Conclusions. The combined method for differential diagnosis of malignant CNP is easy to use and has high accuracy. There is a direct correlation between NLI and malignant CNP.
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