Novel insights into diminished cardiac reserve in non-obstructive hypertrophic cardiomyopathy from four-dimensional flow cardiac magnetic resonance component analysis.

AIMS: Hypertrophic cardiomyopathy (HCM) is characterized by hypercontractility and diastolic dysfunction, which alter blood flow haemodynamics and are linked with increased risk of adverse clinical events. Four-dimensional flow cardiac magnetic resonance (4D-flow CMR) enables comprehensive characterization of ventricular blood flow patterns. We characterized flow component changes in non-obstructive HCM and assessed their relationship with phenotypic severity and sudden cardiac death (SCD) risk. METHODS AND RESULTS: Fifty-one participants (37 non-obstructive HCM and 14 matched controls) underwent 4D-flow CMR. Left-ventricular (LV) end-diastolic volume was separated into four components: direct flow (blood transiting the ventricle within one cycle), retained inflow (blood entering the ventricle and retained for one cycle), delayed ejection flow (retained ventricular blood ejected during systole), and residual volume (ventricular blood retained for >two cycles). Flow component distribution and component end-diastolic kinetic energy/mL were estimated. HCM patients demonstrated greater direct flow proportions compared with controls (47.9 ± 9% vs. 39.4 ± 6%, P = 0.002), with reduction in other components. Direct flow proportions correlated with LV mass index (r = 0.40, P = 0.004), end-diastolic volume index (r = -0.40, P = 0.017), and SCD risk (r = 0.34, P = 0.039). In contrast to controls, in HCM, stroke volume decreased with increasing direct flow proportions, indicating diminished volumetric reserve. There was no difference in component end-diastolic kinetic energy/mL. CONCLUSION: Non-obstructive HCM possesses a distinctive flow component distribution pattern characterised by greater direct flow proportions, and direct flow-stroke volume uncoupling indicative of diminished cardiac reserve. The correlation of direct flow proportion with phenotypic severity and SCD risk highlight its potential as a novel and sensitive haemodynamic measure of cardiovascular risk in HCM.

Enhancing the Soil Health-Watershed Health Nexus: Introduction.

Scientific concepts and measurements that relate soil and water resources are lacking in several areas, limiting our development of a framework or nexus to assess soil-watershed health. Current research designs rely on land management practices as a proxy for soil condition. Yet, conservation practices are often studied in isolation of each other, and adoption may be driven by state and federal farm programs that can incentivize a given management practice without accounting for current, novel farmer-driven adoption of conservation systems. Despite the value of conservation management, its ability to predict soil health is often limited if based solely on land management because chemical, physical, and biological processes vary across time, discipline, and terrain. Similarly, connections between soil health and water quality are constrained due to several "grand challenges" that include dissimilar scales and the number of metrics required to correlate soil and water systems. Equally important is soil sampling within the critical flow path(s) that determines sediment/contaminant loading. In some instances, most of the sediment/contaminant loading during a portion or entire year results from channel and bank erosion and not overland flow that may not be within conservation management hectares. Additional challenges include legacy effects of prior land management, climate variability, and varying turnover rates of soil and water systems. This special section aims to frame research issues that inspire new approaches and collaborations for tackling the challenge of leveraging soil health to strengthen water management across plot, field, and watershed scales, using models, statistics, and other novel methodologies.

Temperature coefficients of Li-ion battery single electrode potentials and related entropy changes - revisited.

Usually the potentials of Li-ion battery electrodes (at constant temperature) are expressed against metallic lithium, assuming that it equals zero. In the case of potential temperature coefficients, and hence entropies, no similar assumption can be applied, as it is against the third principle of thermodynamics. Here, single electrode potential temperature coefficients were estimated using a 'negligible thermal diffusion potential assumption'. The open circuit voltage (Δφi) dependence on temperature T, for three Li-ion battery cathodes, was measured in non-isothermal symmetrical cells (both electrodes had the same composition but were kept in different temperatures). The measured values were interpreted as single cathode (LiMn2O4, LiFePO4 and LiCoO2) potential temperature coefficients dφi/dT, assuming that Soret and Thomson effects are negligible. The single cathode potential temperature coefficients, estimated in such a way, were positive (dφ(LiMn2O4)/dT = 0.86 mV K-1, dφ(LiFePO4)/dT = 0.86 mV K-1 and dφ(LiCoO2)/dT = 0.83 mV K-1). In addition to the measurements in non-isothermal cells, the temperature coefficients of the open circuit voltage of isothermal cells consisting of these cathodes and a metallic lithium reference (dE/dT) were determined. In this case, all temperature coefficients of the cell voltage were negative (dE(Li|LiMn2O4)/dT = -0.20 mV K-1, dE(Li|LiFePO4)/dT = -0.08 mV K-1 and dE(Li|LiCoO2)/dT = -0.25 mV K-1). The temperature coefficient of the single metallic-lithium electrode, dφLi/dT, was calculated from the temperature coefficients dE/dT of isothermal cells consisting of the cathodes and a lithium counter-electrode and the dφi/dT values measured in non-isothermal cells: dE/dT = dφi/dT - dφLi/dT. The dφLi/dT value was 1.03 mV K-1. The measured difference in the dφ/dT values for metallic lithium and graphite (LiC6) anodes was small (dE/dT = dφ(C6Li)/dT - dφLi/dT = -0.08 mV K-1). Literature data on the temperature coefficients of the isothermal cell open circuit voltage containing different electrodes at different states of charge (SOC) and metallic-lithium counter electrodes were used for the calculation of single electrode properties, taking into account that dφLi/dT = 1.03 mV K-1. The temperature coefficients of all single electrodes were positive for different SOC values and ranged between 1.69 mV K-1 and 0.84 mV K-1. The values of entropy change, ΔSi, for reversible single electrode reactions were all positive (for different states of charge) and ranged between ca. 70 J mol-1 K-1 and 120 J mol-1 K-1.

A commercial immune modulating feed additive restores L-selectin and CCL5 expression following dexamethasone treatment of murine immune cells in a MyD88-dependent manner.

Bovine mastitis costs the dairy industry billions of dollars every year and presents a health challenge in dairy facilities. Immunosuppressive effects of the periparturient period increase the incidence of mastitis. During this time, cattle experience an elevation in circulating cortisol, which reduces polymorphonuclear cell function and ability to clear infection. OmniGen-AF (OMN; Phibro Animal Health, Teaneck, NJ) is an immunomodulatory feed additive that alters gene expression and is used to reduce rates of mastitis. We hypothesized that OMN restores gene expression during periods of immune stress through inhibiting the suppressive effects of glucocorticoid receptor signaling on Toll-like receptor signaling. To test our hypothesis, wild-type (WT) or MyD88 knockout mice were supplemented with OMN and challenged with lipopolysaccharide following dexamethasone (Dex) treatment. Polymorphonuclear cell and macrophage RNA was isolated from intraperitoneal lavages and analyzed for gene expression profiles. Treatment of mice with Dex suppressed expression of l-selectin and CCL5 as compared with phosphate-buffered saline treatment of WT mice. Expression of l-selectin and CCL5 was significantly reduced with Dex treatment in control-fed but not OMN-supplemented WT mice. The protective effect of OMN supplementation on l-selectin expression during Dex treatment was abolished in MyD88 knockout mice. These results suggest that OMN supplementation restores responses of certain genes suppressed by Dex in immune cells in a MyD88-dependent manner. Future research will determine the specific Toll-like receptors, transcription factors, and biochemical properties of OMN that restore gene expression in immunosuppressed cells.

Potencial do óleo essencial de erva-luísa (Aloysia citriodora Palau) no controle de Fusarium sp. in vitro / Essential oil potential herb-luisa (Aloysia citriodora Palau) in the control of Fusarium sp. in vitro

RESUMO O presente trabalho teve como objetivo principal avaliar o potencial do uso do óleo essencial de Aloysia citriodora no controle in vitro de Fusarium sp., isolado de plântulas de beterraba infectadas com o mesmo. O trabalho foi realizado por meio de dois experimentos: um sobre o efeito do óleo essencial no crescimento micelial, e outro sobre o efeito na germinação de conídios do fungo. No primeiro trabalho, avaliou-se em delineamento inteiramente ao acaso, o efeito das concentrações 0,0155%; 0,0315%; 0,0625%; 0,125%; 0,250% e 0,500% do óleo essencial de A. citriodora em placas de Petri® com meio de cultivo BDA, mais a testemunha, com meio BDA puro. Cada placa foi considerada uma repetição, as quais foram incubadas a 24ºC±1ºC e submetidas a fotoperíodo de doze horas. Avaliou-se o crescimento radial do patógeno em função do crescimento micelial do patógeno quando este atingia as bordas da primeira placa. No segundo experimento, as mesmas concentrações foram testadas, nas mesmas condições de incubação, no entanto, em lâminas de microscopia com meio BD. Utilizou-se delineamento inteiramente ao acaso, sendo considerada como unidade experimental cada lâmina utilizada. Avaliou-se 24 horas após a incubação, em microscópio óptico, a germinação dos primeiros vinte conídios visualizados a partir do canto esquerdo superior para o direito. Os resultados do segundo experimento foram expressos em porcentagem de germinação de conídios. Os resultados obtidos permitiram concluir que este óleo essencial possui efeito fungistático e fungicida sobre o crescimento micelial e na germinação de conídios de Fusarium sp.. Além disso este efeito é maior em função do aumento da concentração do óleo essencial.

ABSTRACT This study aimed to evaluate the potential use of Aloysia citriodora essential oilisolated from beet seedlings infected with it. The study was performed by conducting two experiments evaluating the effect of the essential oil on mycelial growth and fungus conidia germination. In the first study, in a completely randomized design, the effect concentrations (0.0155%; 0.0315%; 0.0625%; 0.125%; 0.250% and 0.500%) of essential oil of A. citriodorawas evaluated on Petri® dish with a PDA cultivation medium, plus the control, with half pure PDA. Each plate was taken as a repeat, and incubated at 24°C±1°C and a photoperiod of twelve hours. The radial growth of the pathogen, when the first plate was hit by the mycelial growth of the pathogen on its edges was evaluated. In the second experiment, the same concentrations were tested under the same incubationconditions, however, on microscope slides with half PD medium. The design was used completely randomized, each microscope slide used was considered as one experimental unit. Germination of the first 2 conidia strains, viewed from the upper left to the right was evaluated24 hours after incubation, using an optical microscope. The results of the second experiment were expressed as a percentage of conidia germination. The results obtained showed that this essential oil has fungistatic and fungicidal effect on the mycelial growth and at the conidia germination of Fusarium sp., which has a greater effect with increasing concentrations.

Pharmacokinetics, Pharmacodynamics, and Safety of Lisinopril in Pediatric Kidney Transplant Patients: Implications for Starting Dose Selection.

Hypertension in pediatric kidney transplant recipients contributes to long-term graft loss, yet treatment options--including angiotensin-converting enzyme inhibitors--are poorly characterized in this vulnerable population. We conducted a multicenter, open-label pharmacokinetic (PK) study of daily oral lisinopril in 22 children (ages 7-17 years) with stable kidney transplant function. Standard noncompartmental PK analyses were performed at steady state. Effects on blood pressure were examined in lisinopril-naïve patients (n = 13). Oral clearance declined in proportion to underlying kidney function; however, in patients with low estimated glomerular filtration rate (30-59 ml/min per 1.73m(2)), exposure (standardized to 0.1 mg/kg/day dose) was within the range reported previously in children without a kidney transplant. In lisinopril-naïve patients, 85% and 77% had a ≥ 6 mmHg reduction in systolic and diastolic blood pressure, respectively. Lisinopril was well tolerated. Our study provides initial insight on lisinopril use in children with a kidney transplant, including starting dose considerations.

Use of opportunistic clinical data and a population pharmacokinetic model to support dosing of clindamycin for premature infants to adolescents.

Clindamycin is commonly prescribed to treat children with skin and skin-structure infections (including those caused by community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA)), yet little is known about its pharmacokinetics (PK) across pediatric age groups. A population PK analysis was performed in NONMEM using samples collected in an opportunistic study from children receiving i.v. clindamycin per standard of care. The final model was used to optimize pediatric dosing to match adult exposure proven effective against CA-MRSA. A total of 194 plasma PK samples collected from 125 children were included in the analysis. A one-compartment model described the data well. The final model included body weight and a sigmoidal maturation relationship between postmenstrual age (PMA) and clearance (CL): CL (l/h) = 13.7 × (weight/70)(0.75) × (PMA(3.1)/(43.6(3.1) + PMA(3.1))); V (l) = 61.8 × (weight/70). Maturation reached 50% of adult CL values at ~44 weeks PMA. Our findings support age-based dosing.

Diagnostic criteria and surgical procedure for megaesophagus--a personal experience.

Megaesophagus is the end-stage of achalasia cardiae. It is the result of peristaltic disorders and slow decompensation of the muscular layer of the esophagus. The aim of this article is to detail the diagnostic criteria and surgical management of megaesophagus. Criteria were acute bending of esophagus axis; lack of esophagus peristalsis, and no response to stimulation in the manometric test; and Los Angeles C/D esophagitis in the endoscopic examination. Between 1991 and 2004 seven patients (5 females, 2 males; age, 51-67 years; average age, 59 +/- 8 years) were treated. A bypass made from the pedunculated part of the jejunum connecting the part of esophagus above the narrowing with the praepyloric part of the stomach was made. Access was by an abdominal approach. A jejunum bypass was made in six patients with megaesophagus. A transhiatal esophageal resection was carried out, and in the second stage a supplementary esophagus was made from the right half of the colon on the ileocolic vessels in one patient who had experienced two earlier unsuccessful operations. Symptoms of dysphagia, recurrent inflammation of the respiratory tract, and pain subsided in all patients. Complications were not reported in the postoperative period. All patients survived. Subsequent radiographic and endoscopic examination showed very good outcome. The jejunum bypass gave very good results in the surgical treatment of megaesophagus.

Reflex influence of carotid baroreceptor inactivation on respiratory resistance in humans.

Our previous study demonstrated that selective carotid baroreceptors activation decreases airway resistance. The aim of the present study was to evaluate the effect of carotid baroreceptor inactivation on the reflex change of respiratory resistance. Twenty healthy men aged between 20 and 25 were included in the study. Selective inactivation of carotid baroreceptors was induced by generating a positive pressure of 40 mmHg for 5 s in two capsules placed bilaterally on the neck over the bifurcation of the carotid arteries. The oscillatory method (Siregnost FD5, Siemens) was used to measure continuously respiratory resistance. Inactivation of carotid baroreceptors produced a short increase in respiratory resistance by 0.39 +/- 0.01(SE) mbar/l/s, i.e., 21.7% above the resting level. We conclude that in humans, carotid baroreceptors might have a background contribution to bronchodilator tone. This observation seems to be important for clinical situations of impairment of baroreflex function.

Impairment of the baroreflex control of human respiratory resistance with age.

BACKGROUND: The mechanism responsible for the central baroreflex resetting with age are an area of limited knowledge. We previously demonstrated that in subjects aged above 50 the airway resistance did not change in response to baroreceptor activation, whereas in younger volunteers the airway resistance significantly decreased. OBJECTIVE: The aim of the present study was to evaluate the effect of carotid baroreceptor inactivation on the reflex change of respiratory resistance, in the course of aging. MATERIAL AND METHODS: 80 healthy men, divided in four groups: aged 20-30 (Group I), 31-40 (Group II), 41-50 (Group III), and 51-60 (Group IV) were included in the study. The selective inactivation of carotid baroreceptors was induced by generating a positive pressure of 40 mmHg for 5 s in two capsules placed bilaterally on the neck over the bifurcation of the carotid arteries. The oscillatory method (Siregnost FD5, Siemens) was used to measure continuously respiratory resistance. RESULTS: Inactivation of carotid baroreceptors produced a short increase in respiratory resistance by 0.38 +/- 0.01SE mbar/l/s, i.e., 21.7% above the resting level in Group I and by 0.25 +/- 0.01 mbar/l/s in Group II. In the two older groups (III and IV) respiratory resistance did not change in response to baroreceptors inactivation. CONCLUSIONS: In humans aged above 40, carotid baroreceptors do not contribute to bronchodilator tone, which causes imbalance between the activities of upper airway and chest wall inspiratory muscles leading to a collapsing effect on the upper airway.

A message of hope: creation of the Faces of Lung Cancer project for increasing awareness of clinical trials.

In 2002, the Thoracic Oncology Advocacy Program at H. Lee Moffitt Cancer Center and Research Institute was created with a mission to contribute to the prevention and cure of lung cancer by embracing the patient perspective. In an effort to increase awareness of clinical trials (CTs) and to humanize the CT process, members of the advocacy programme were involved in the creation of the Faces of Lung Cancer project. Twelve lung cancer patients who participated in a CT, four caregivers of patients who had been on a trial and four thoracic health care professionals were interviewed and photographed by a professional photographer with prior experience in photo-documentary work. Preliminary results indicate just the process of participating in the Faces of Lung Cancer project and creating the photo essay has had a positive impact on the lives of cancer patients and their caregivers. Formal evaluation of the Faces of Lung Cancer project is underway; however, preliminary results indicate that the project is viewed as successful in terms of conveying a message of hope and increasing awareness. By including visual displays, in conjunction with patient interviews, the photo essay is able to generate and blend powerful information and images that provide a richer, more complete portrayal of the context of a patient's experience.

Serum interleukin-12 and interleukin-18 levels in patients with oesophageal squamous cell carcinoma.

UNLABELLED: Interleukin-12 (IL-12) and interleukin-18 (IL-18) play an important role as immunomodulatory factors in cancer pathogenesis. THE AIM of the study was analyze changes of serum IL-12 and IL-18 concentrations in oesophageal squamous cell carcinoma patients depending on the progression of cancer. MATERIALS AND METHODS: Blood samples were taken from 41 patients with oesophageal cancer: 5 women and 36 men, mean age 59+/-9 years. 23 patients had surgical resection of oesophagus with II and III tumor stage, 18 patients with IV stage of cancer progression were treated by palliative procedures. The control group included 15 healthy blood donors: 4 female and 11 males, mean age 41+/-6 years. The concentrations of IL-12 and IL-18 were determined by ELISA tests. RESULTS: Serum IL-12 and IL-18 amounts detected in blood of oesophageal cancer patients were significantly higher in comparison to control group (p<0.001). Serum IL-12 level was higher in patients with IV stage of the disease than in patients with II and III stages. Also serum IL-18 level was significantly higher in patients with IV stage in comparison to patients surgically treated (p<0.05). Statistically significant differences were found in concentrations of IL-18 according to clinicopathological parameters such as: stage of cancer progression, tumor depth, lymph node metastasis (p<0.05). CONCLUSIONS: Serum IL-12 and IL-18 levels are significantly higher in oesophageal cancer patients than in the healthy subjects. A relation between IL-18 content and cancer progression has been registered.

[Comparative evaluation of postoperative complication in the reconstructive surgery of the esophagus]. / Porównawcza ocena wczesnych powiklan pooperacyjnych po zabiegach wytwórczych przelyku.

The paper presents 78 patients with stenosis of the middle thoracic segment of the esophagus. The substitute, being pedunculated intestinal graft, was brought to the neck through the retrosternal space. Early post-operative complications occurred in 8.9% of patients. Post-operative mortality rate was 7.6%. The most dangerous complication after esophageal plastic surgery is blood supply insufficiency. It was observed in 2 cases. Other complications included anastomotic leaks and respiratory distress syndrome. The authors emphasize that frequency of post-operative complications and mortality are related with the patient general condition and extent of the surgery.

[Postop complication of pancreatic resection]. / Powiklania po czesciowych resekcjach trzustki.

Early complications after partial pancreatic resections and benign pancreatic tumours were analysed. 276 patients with pancreatic tumours were treated in the years 1979-1997. In 77 cases radical operation was performed. 65 patients underwent Whipple and 12--Traverso-Longmire pancreatoduodenectomy. Malignant tumour was found in 55 cases and 22 were benign. In 4 patients tumour's resection along with invaded portal vessels and portal confluence reconstruction was performed. These were the first cases with vessels resection operated in Poland. There were 2 post-operative deaths observed in that group. Complications in our material were as follows: pancreatico-jejunal anastomosis fistulae, haemorrhage from ulcers in gastro-jejunal anastomosis, diffuse peritonitis, haemorrhage from pancreatic stump vessels, ileus, acute renal insufficiency, pneumonia and myocardial infarct. Mortality in whole group was 11%. In the last 5 years due to our growing experience and some technical modifications mortality fell to 4.4%.

Distribution of mast cells and eosinophils in nasal polyps from atopic and nonatopic subjects: a morphometric study.

The pathogenetic mechanism of nasal polyps remains unknown, although polyps seem to be an expression of chronic nasal inflammation of both allergic and nonallergic origin. The goal of our study was to compare the distribution mast cells and eosinophils (cells traditionally associated with allergic inflammation) in nasal polyps from well defined atopic and nonatopic patients, using advanced morphometric analysis system. Nasal polyps were removed during routine nasal polypectomy performed in 17 atopic and 19 nonatopic patients. Parafin sections of nasal polyps were stained with haematoxilin/eosin, chromotrope R2 or toluidine blue, and light microscopy, assisted with computerized picture analysis system, was used to count the number of cells in the superficial and stromal layer of the mucosa. Regardless of the presence or absence of atopy, eosinophils were predominant cells in the polyps, and both eosinophils and mast cells were more abundant in the superficial layer than in the stromal layer of the mucosa. The density of eosinophils in both layers and mast cells in the stromal layer was similar in atopic and nonatopic patients. Only the density of mast cells in the superficial layer of the mucosa was slightly higher (p < 0.005 in atopic compared to nonatopic patients): In both groups of patients a significant correlation between the number of mast cells and eosinophils in the superficial layer of the polyp mucosa was found (r = 0.84; p < 0.001). Our study demonstrates that eosinophils and mast cells are abundant in nasal polyps from both atopic and nonatopic patients and that mast cells seem to be more superficially distributed in atopic compared to nonatopic patients.

[Iatrogenic injuries of the cardia antireflux system]. / Jatrogenne uszkodzenia mechanizmu antyrefluksowego wpustu.

Among presented 18 patients with iatrogenic injury of the cardia antireflux system, 5 were females and 13 males aged 35-62 years of life. 13 cases were operated before for cardiospasmus, 5 had gastric resection B2 for duodenal ulcer. In consequence all the patients presented stricture of the thoracic lower and abdomen part of oesophagus. 16 patients required reoperations, 2 had dilatation. In 2 cases stricture were located in middle and lower part of oesophagus. In 4 cases in abdominal and supradiaphragmatic part of oesophagus, in 5 cases in abdominal part of oesophagus, and in 7 cases in the cardia. 11 patients required one corrective surgery, 4-two operations, and 1-three operations. As a final procedure: in 2 cases artificial oesophagus was formed with intestinal graft, in 8 cases the cicatrical part of the oesophagus was excised and replaced by a pedunculated graft by Merendino method, in 3 cases esophagogastric anastomosis were done using Heyrowsky method, in 2 cases bypass was made from pedunculated part of jejunum which connect the part of oesophagus above the narrowing with the prepyloric part of the stomach by the own method, in 1 case intrathoracic esophagogastric anastomosis was performed. The best results were obtained by oesophagogastric bypass.

[Pleural hernia of an esophageal graft--late postoperative complication]. / Przepukliny oplucnowe sztucznych przelyków--odlegle powiklania pooperacyjne.

Pleural hernia of the oesophageal substitute from pedicled intestinal segment is one of the late postoperative complications. 13 cases of patients with oesophagus reconstructed because of lye ingestion stenosis are presented. Problems concerning diagnosis and treatment of pleural hernia are analysed. Eight patients with minor symptoms were treated conservatively. Five patients were operated, two of them from acute necrosis of the substitute. Necrosis was caused by incarceration of the bowel and torsion of the mesentery. Elective operative treatment consisted of reduction of hernia sac contents, closing of the hernia orifice, chest drainage and temporary gastronomy. In patient operated as an emergency cases necrotic part of substitute was removed. This resulted in oesophageal exclusion in the neck, creating gastronomy. Chest drainage was also performed.

[Intraoperative portography in operations for resection of pancreas neoplasms]. / Portografia sródoperacyjna w operacjach resekcyjnych guzów trzustki.

Since 1993 during pancreatic resection routine intraoperative portography has been employed. Thus we are able to establish infiltration engaging portal vein and its branches. Facilitating decision making about resectability of the tumor. 29 portographies were performed. In eight cases malignant infiltration on portal vein was established. Because of that in seven cases no radical resection was undertaken.

[Difficulties in diagnosis of esophageal achalasia]. / Trudnosci diagnostyczne Kurczu wpustu.

The authors present the case of 36 years old patient with dysphagia. This symptom appeared three years ago and became more severe for six month. The endoscopic and radiologic examinations revealed achalasia of the cardia. The surgical treatment was performed. Two weeks after surgery all symptoms disappeared. We present this case because achalasia of the cardia is comparatively rare disease which diagnostic is not easy.