The investigation of using diffusion-weighted magnetic resonance imaging technologies to evaluate the therapeutic effect of esophageal primary carcinoma treatment with chemoradiotherapy / 中华放射医学与防护杂志

Objective To determine the efficacy of primary tumor of esophageal cancer,according to the result of magnetic resonance imaging before and after chemoradiotherapy of esophageal cancer,combined with clinical efficacy evaluation,and to verify the reliable evaluation of the short-term curative effect of magnetic resonance on esophageal cancer,combined with the original CT and esophagogram evaluation criteria.Methods From May 2010 to March 2014,totally 83 patients with esophageal carcinoma treated with 3D-CRT or IMRT were enrolled.The prescribed doses were ranged from 50-64 Gy with median dose of 60 Gy and 1.8-2.0 Gy per fraction,of which 34 of the patients received concurrent chemotherapy of FP or TP.All the patients performed the examinations of DWI,CT scan and esophagogram before and after radiotherapy.The treatment efficacy was evaluated by short-term therapeutic effect evaluation criterion of versions 1989 and 2013 and the hyperintense expression on DWI sequence.Results According to the short-term therapeutic effect evaluation criterion of versions 1989 and 2013 based on the examination of esophagogram and CT scan,45 patients achieved complete remission (CR) after treatment(54.2％) and 38 achieved partly remission(PR) (45.8％) version 1989,while 35 patients achieved CR (42.2％) and 48 achieved PR (57.8％) version vesion 2013.In the two differentcriterions,the local control rate and survival rate of the complete remission group in 1 to 5 years were better than those in the partial remission group.According to the examination of DWI,48 patients' hyperintense disappeared completely at the end of treatment (which was defined to CR),25 patients had a slightly hyperintense expression and 10 patients still had hyperintense expression on DWI sequence (which two defined to PR),the local control and survival rates of the former group were superior to the latter groups (x2 =6.125,11.652,P ＜0.05).The TE results evaluated by DWI and TE evaluation criterion of version 2013 were compared according to Kappa test,as a result,the Kappa coefficient 0.478.According to the examination of esophagogram,CT scan and DW1,25 patients achieved CR and 58 achieved PR in all exams,and the local control and survival rates of the former group were superior to the latter group (x2 =5.559,10.014,P ＜0.05).Conclusions The esophagogram and CT based TE evaluation criterion could well indicate local control status of esophageal cancer,and the examination of DWI could afford visualized and quantifying reference information about the TE of esophageal cancer.The expression of hyperintense at the end of treatment may indicate a high risk of recurrence and metastasis.The therapeutic effect evaluated by esophagogram,CT scan and DWI maybe more objective and more accurate.

Esofagograma: imágenes que valen más que mil palabras / Esophagograms: Images Worth a Thousand Words

Resumen El estudio de las enfermedades esofágicas requiere de múltiples exámenes diagnósticos, ya que ninguno, por sí solo, provee total información sobre la funcionalidad y la anatomía del tracto digestivo superior. Para los cirujanos generales y gastrointestinales, el esofagograma constituye una herramienta esencial que, además de sugerir un diagnóstico, ofrece una idea de la anatomía del órgano y nos permite esbozar un mapa de fácil evaluación (sin la necesidad de un radiólogo), para establecer o definir un plan quirúrgico. El objetivo del presente artículo es mostrar al lector la utilidad del esofagograma en centros de referencia en el estudio y el tratamiento de las enfermedades esofágicas, así como su representación en algunas enfermedades frecuentes.

Abstract The study of esophageal diseases requires multiple diagnostic tests since no one test alone can provide full information on upper digestive tract anatomy and functionality. For general surgeons and gastrointestinal surgeons, the esophagogram is an essential tool that can suggest a diagnosis while simultaneously providing an idea of ​​the anatomy of the organ and outlining an easily evaluated map without the need of a radiologist. This information can be used to establish a surgical plan. The aim of this article is to show readers the usefulness of esophagograms at referral centers for study and treatment of esophageal diseases while providing representations of several frequent diseases.

The value of ionic-contrast esophagogram in diagnosis of intrathoracic anastomotic leakage after oesophagectomy / 中国基层医药

Objective To investigate the value of ionic-contrast esophagogram in diagnosis of intrathoracic anastomotic leakage after oesophagectomy.Methods The data of 728 patients suffered esophagectomy were retrospectively collected.723 patients without clinical manifestations of anastomotic leakage were divided into group A(esophagogram before eating,n=465) and group B(non-esophagogram before eating,n=258).The incidence of anastomotic leakage was compared between the two groups.Results The discovery rates of anastomotic leakage in group A and B were 0.43%(2/465) and 0.78%(2/258),respectively,the difference was no statistically significant between the two group(P=0.55).The total incidence rates of anastomotic leakage in group A and B were 0.65%(3/465) and 0.78%(2/258),respectively,the difference was no statistically significant between the two groups(P=0.84).5 patients with clinically suspected anastomotic leakage,all had loculated pleural effusion,4 cases had fever,and 2 cases had abnormal chest drainage.Finally,4 cases(80%) were confirmed to be anastomotic leak by esophagogram.Conclusion Routine ionic-contrast esophagogram before eating do not improve intrathoracic anastomotic leakage detection rate after esophagectomy,but when patients have fever,loculated pleural effusion and abnormal chest drainage,esophagogram is necessary and can improve the detection rate of esophageal anastomotic leak.CT radiography may detect smaller anastomotic leakage than conventional esophagogram.

The use of a soft gel capsule as a medium for modified barium esophagogram in detecting esophageal foreign body

@#<p style="text-align: justify;"><strong>OBJECTIVES:</strong> To  test  a  soft  gel  capsule  with  barium  sulfate  as  a  medium  for  modified  barium esophagogram in detecting esophageal foreign body.<br /><strong>METHODS:</strong><br /><strong>Design:</strong> Preliminary Diagnostic Test Assessment; Consecutive Convenience Sample<br /><strong>Setting:</strong> Tertiary Government Hospital<br /><strong>Patient:</strong> Soft gel capsule with barium sulfate was pilot tested on patients with a history and diagnosis of radiolucent foreign body ingestion between June 1 and November 30, 2014.<br /><strong>RESULTS:</strong> Seven  patients  (6  males,  1  female;  aged  26  -  61  years)  underwent  the  procedure.  In all seven, the enhanced capsule immediately stopped above the level  of  the  esophageal foreign body, easily identifying the exact location of the obstruction. Foreign bodies included 1 embryonated  duck-egg  white "balut",  5  chunks  of  pork  meat  and  1  claspless  denture. All  were successfully  marked  by  the  capsule  on  fluoroscopy  and  documented  on  X-ray.  Esophagoscopy under general anesthesia was successfully performed after fluoroscopy in all patients.<br /><strong>CONCLUSION:</strong> We   were   able   to   improvise   a   new   medium   for   use   in   modified   barium esophagograms  that  was  easy  to  prepare  and  that  rendered  good  radiographic  imaging  and localization of radiolucent foreign bodies. A randomized trial in comparison to the prevailing test  may  confirm  our  findings  further.  Meanwhile,  we  recommend  exploring  the  procedure in  other  hospitals  as  an  alternative  to  barium-soaked  cotton  in  the  diagnosis  of  radiolucent esophageal foreign bodies</p>

Megaesôfago idiopático não avançado: relato de caso / Not advanced esophageal idiopathic achalasia: case report

Objetivo: relatar um caso de megaesôfago idiopático grau II, tratado pela técnicavideolaparoscópica, em um paciente de 32 anos, sexo masculino. Relato de caso: foram realizadosmanometria, endoscopia digestiva alta com biópsia e análise histopatológica e esofagograma, comométodos diagnósticos auxiliares. Em janeiro de 2007, o paciente foi submetido a tratamento cirúrgicopela técnica de Heller-Pinotti por videolaparoscopia, evoluindo com melhora clínica posterior,devido ao procedimento, com episódios reduzidos de disfagia e sem demais intercorrências.Considerações Finais: casos não avançados de megaesôfago devem ser tratados preferencialmentepela técnica de Heller-Pinotti por via laparoscópica, mostrando excelentes resultados. Os casos deetiologia idiopática não necessitam de qualquer outro tratamento adicional.

Objective: report a case of esophageal achalasia idiopathic stage II of a male 32 years oldpatient, treated by videolaparoscopic technique. Report case: manometry,esophagogastroduodenoscopy and esophagogram were performed as auxiliary diagnosticmethods. On January 2007, the patient went to surgical treatment through the technique ofHeller-Pinotti by videolaparoscopy. After that, the patient had a clinical improvement withreduced episodes of dysphagia and without other complications. Final considerations: casesnot advanced of esophageal achalasia should be treated preferentially by the technique of Heller-Pinotti by laparoscopy, which has shown excellent result. The idiopathic cases do notneed additional treatment.

Diagnosis of the Double Aortic Arch and Its Differentiation from the Conotruncal Malformations

PURPOSE: The clinical and radiological characteristics of the double aortic arch (DAA) and its differentiation from conotruncal malformations (CTM) were reported in order to familiarize pediatric practitioners with these congenital heart diseases. MATERIALS AND METHODS: From July 1994 to December 2006, a total of 6 patients (4 male and 2 female, aged 16 days to 6.5 years) with DAA were enrolled in this retrospective study. The study modalities included chart recordings, plain chest radiographs, barium esophagograms, echocardiograms, cardiac catheterization, cardiac angiograms, surgery, magnetic resonance imaging, and chromosome analysis. Patients with incomplete vascular rings or with right aortic arches and left ligamentum were excluded. In addition, the clinical and radiological profiles of 38 patients with CTM, including dextro-transposition of the great arteries (d-TGA) (n=28), hemitruncus arteriosus (HTA) (n=3), type I truncus arteriosus (TA) (n=4), and the aortopulmonary window (APW) (n=3), were comparatively reviewed. RESULTS: All 6 patients with DAA presented with postprandial choking and respiratory distress that prompted their initial visit to the hospital. One of the 6 patients presented with congestive heart failure, and none with cyanosis. Esophagograms showed indentations in 5 patients with DAA. All patients with d-TGA presented with cyanosis and heart failure, while patients with HTA, type I TA, and APW manifested overt heart failure. Suprasternal and subcostal approaches of the echocardiography may offer diagnositic windows for DAA. As for CTM, parasternal and subcostal approaches could always determine the causality. Cardiac catheterization with angiography comprehensively delineated the pathology. CONCLUSION: In case of postprandial choking and respiratory distress in neonates and infants, barium esophagograms can indicate the presence of DAA. Diagnosis of DAA and its differentiation from the CTM can be achieved by echocardiography, angiography, or magnetic resonance imaging.

Anillo vascular por doble arco aórtico simétrico. Reporte de un caso / Double symmetrical aortic arch. Case report

Describimos un paciente de 6 meses de edad con doble arco aórtico simétrico y sintomatología obstructiva traqueal y esofágica, tratado quirúrgicamente. Se realizó una correlación entre las imágenes diagnósticas obtenidas con esofagograma, ecococardiografía y angiografía con un espécimen anatómico, dando énfasis a la utilidad del ecocardiograma como estudio inicial.

We report a six-month-old patient with a double symmetrical aortic arch with tracheal and esophageal obstructive symptoms, who was treated surgically. The diagnostic images consisting of esophagogram, echocardiography and angiography were correlated with an anatomical specimen; the usefulness of the echocardiogram as an initial test is emphasized. (Arch Cardiol Mex 2005; 75: 178-181).

Value of ~(18)FDG PET-CT in defining the length of esophageal cancer / 中华放射肿瘤学杂志

Objective To assess the value of 18-fluoro-deoxy-glucose positron emission-CT(FDG PET-CT) in defining the length of primary esophageal cancer.Methods Thirty-two patients had underg- one esophagoscopy,esophagography and FDG PET-CT scans one week before esophagectomy.There was one tumor located in the upper thoracic esophagus,22 in the middle thoracic esophagus,and 9 in the lower tho- racic esophagus.The location and length of primary lesion of the tumor was determined by esophagoscopy, esophagography,and FDG PET-CT.The length of the abnormality seen on the CT portion of the PET-CT scan was determined separately and independently by two radiologists.All results were compared with the resected specimen.Results According to esophagography,CT and PET-CT,all lesion lengths were compared with that of the resected specimen.It was found that the tumor location determined by esophagoscopy was not in accordance with the resected specimen in 2 patients.The mean length of the primary tumor,being from short to long,were (3.8?1.4),(4.1?1.5),(4.4?1.6),(5.3?1.9) and (4.7?1.7) cm,as determined by esophagoscopy,esophagography,CT,actral length of the resected specimen and PET-CT.Compared with the resected specimen,there was obvious difference (P=0.000,0.007,0.025,0.001).Considering that there might be some kind of shrinkage in the resected specimen (about 83.59%,as reported by Ma et al), we rectified the length of resected specimen and compared with other findings again.It was found that insig- nificant difference existed between PET-CT and rectified length value of the resected specimen (P=0.082). Conclusions FDG PET-CT is effective in the length determination of primary esophageal cancer.It may he used to determine the length of esophagus to be resected for patients indicated for esophagectomy.It may also be used to ac- curately delineate the gross tumor volume for patients eligible for radiotherapy.

Radiologic Findings and Follow-Up Evaluation

In esophageal perforation, fistulous tracts commonly occur between the esophagus and mediastinal or pleural spaces, but rarely between the esophagus and bronchi. The clinical manifestations and radiologic findings of esophageal perforation are nonspecific, and diagnosis is the often delayed; esophagography is the standard technique for evaluation of its location and degree. CT is useful in demonstrating the extraluminal manifestations of esophageal perforation and for follow-up after medical treatment, and may depict the various manifestations of perforation, according to the causes.

Meanings and Indications of pretreatment assessment of esophageal carcinoma with bronchoscopy / 대한내과학회지

OBJECTIVES: To determine the yield of bronchoscopy for evaluating tracheobronchial spread in esophageal carcinoma and to identify the conditions for bronchoscopy in patients with newly diagnosed esophageal carcinoma, who planned to be operated. METHODS: From March 1989 to June 1997, 115 patients with esophageal carcinoma had received bronchoscopy. Bronchoscopic findings were classified into three types: Type I: no definitive endobronchial lesion, Type II: indirect effects(hyperemia and compression), Type III: invasion. CT findings were classified into three classes: Class A: tumor separated from tracheobronchial tree, Class B: abutting tree, Class C: compressing tree. We investigated the correlations of clinical presentation and non-invasive tests (including esophagogram) with bronchoscopic findings. RESULTS: 1) Among 115 patients, bronchoscopic findings were Type I in 67(58.3%), Type II in 34(29.6%), Type III in 14(12.2%). 2) Abnormal bronchoscopic findings are related with length of lesion by esophagogram.(p < 0.05) 3) Class C lesion by chest CT scan were closely correlated with abnormal bronchoscopic findings. 4) Chest symptoms were frequently associated with type III lesion of bronchoscopy CONCLUSION: We could recommend preoperative bronchoscopy in recently diagnosed as esophageal carcinoma who got more than 2 of 3 variables listed below: 1) patients who had chest symptoms, such as cough with sputum, hemoptysis, and dyspnea 2) length of tumor is long in esophagogram(above 5 cm in length), 3) tracheobronchial compressed lesion by chest CT scan. Bronchoscopy is not needed in cases with no chest symptom, short lesion length(below 5 cm) and normal chest CT finding for preoperative evaluation of esophageal carcinoma.

A Study for Causative Diseases of Globus Pharyngeus Patients Who Have NoPathologic Conditions in Laryngopharynx / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Globus pharyngeus is the feeling of a lump or foreign body in the throat. Otolaryngologists are often confronted with this condition, and some authors report that it represents 3 percent of all new clinic referrals. Unfortunately, we still do not completely understand the etiologies of globus pharyngeus, but there are recently increasing evidences to link the globus symptoms with various diseases. MATERIAL AND METHODS: We selected 32 globus patients, who exhibited no pathologic condition in physical examinations, and were analysed by general work up, barium esophagogram, 24 hour-ambulatory double-probe pH monitoring, esophageal manometry test, Fuchs' series, and MMPI. RESULTS: The results were as follows, gastroesophago-laryngopharyngeal reflux disease (n=15: 46.9%), various psychotic problems (n=11: 34.4%), esophageal motility disorders (n=7: 21.9%), duodenal ulcer (n=2: 6.3%), Eagle's syndrome (n=2: 6.3%), and hiatal hernia (n=1: 3.1%). In 5 cases, we couldn't find the etiology of globus pharyngeus. CONCLUSION: Globus pharyngeus patients, who had no pathologic findings in layrnx and pharynx, might have laryngopharyngeal-gastroesophageal reflux diseases and psychologic problems.