A GGO ratio ≥0.75 provided a favourable prognostic prediction in patients with resected lung adenocarcinoma. Sublobar resection and lymph node sampling revealed a fair outcome regardless of tumour size. However, anatomical resection is still the standard approach for patients with tumours with a GGO ratio <0.75, size >2 cm.
Elevated relaxation pressure in combination with intact or weak peristalsis characterizes esophagogastric junction (EGJ) outflow obstruction. Symptoms of EGJ outflow obstruction include dysphagia and atypical chest pain. EGJ outflow obstruction can be diagnosed using high-resolution manometry (HRM), but there is a lack of consensus regarding treatment. We present a case report of a 43-year-old man with a history of headache and mitral valve disorder who suffered from intermittent atypical chest pain for 20 years. A diagnosis of EGJ outflow obstruction was made using esophageal HRM.Due to medication intolerance, robotic-assisted esophageal myotomy and Belsey-Mark IV fundoplication were performed. The symptoms went into complete remission and no motility disorders were detected on postoperative HRM. HRM is a useful diagnostic examination for EGJ outflow obstruction. The robotic systems-assisted long segment myotomy may potentially play an important role in the treatment of EGJ outflow obstruction-related functional chest pain. J Thorac Dis 2017;9(5):E432-E436 jtd.amegroups.com of a cardiovascular disorder. He visited a local GI clinic where panendoscopy revealed gastroesophageal reflux. The Eckardt score was 9. The pain was poorly controlled with symptoms worsening despite more than 5 years of treatment with proton-pump inhibitors and hyoscine-N-butylbromide under the guidance of the local clinic.The patient underwent HRM and esophagraphy at the Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan and there was no acid reflux and chest pain during the examination. The esophagraphy reveal peristalsis passes normally through the entire esophagus ( Figure 1A). The Chicago Calculation data for swallows (liquid) revealed an abnormal IRP. The median IRP was 15 mmHg (Figure 2A). The distal latency in 5 out of 10 swallows (5 mL each) was normal (>4.5 s), and for 6 out of 10 swallows, the contractile front velocity was normal (<9 cm/s). In addition, the median and maximum distal contractile integrals were 1,445 mmHg/s/cm (<5,000 mmHg/s/cm) and 2,725 mmHg/s/cm (<8,000 mmHg/s/cm), respectively. The amplitude of proximal esophagus (25.0 cm) was 49 mmHg; The amplitude of middle esophagus (30 and 35 cm) were 104 and 119 mmHg, respectively; The amplitude of distal esophagus (40 cm) was 102 mmHg. The HRM finds with elevated median IRP (>15 mmHg) and normal distal latency. The esophagraphy reveal peristalsis passes normally through the entire esophagus. The patient was diagnosed as having EGJ outflow obstruction based on the Chicago Classification of esophageal motility disorders, v3.0 (4). However, the chest pain was not provoked during the HRM, thus the possibility of diffuse esophageal spasm (DES) was considered. We tried a calcium channel blocker and nitrite for pain control. The chest pain improved, but a side effect of severe headache occurred. After discussion, Because of worsening symptoms, the patient decided to undergo surgery and refused any additional attempt at endoscopic treatment.R...
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