Chest wall syndrome among primary care patients: a cohort study

BACKGROUND: The epidemiology of chest pain differs strongly between outpatient and emergency settings. In general practice, the most frequent cause is the chest wall pain. However, there is a lack of information about the characteristics of this syndrome. The aims of the study are to describe the clinical aspects of chest wall syndrome (CWS). METHODS: Prospective, observational, cohort study of patients attending 58 private practices over a five-week period from March to May 2001 with undifferentiated chest pain. During a one-year follow-up, questionnaires including detailed history and physical exam, were filled out at initial consultation, 3 and 12 months. The outcomes were: clinical characteristics associated with the CWS diagnosis and clinical evolution of the syndrome. RESULTS: Among 24 620 consultations, we observed 672 cases of chest pain and 300 (44.6%) patients had a diagnosis of chest wall syndrome. It affected all ages with a sex ratio of 1:1. History and sensibility to palpation were the keys for diagnosis. Pain was generally moderate, well localised, continuous or intermittent over a number of hours to days or weeks, and amplified by position or movement. The pain however, may be acute. Eighty-eight patients were affected at several painful sites, and 210 patients at a single site, most frequently in the midline or a left-sided site. Pain was a cause of anxiety and cardiac concern, especially when acute. CWS coexisted with coronary disease in 19 and neoplasm in 6. Outcome at one year was favourable even though CWS recurred in half of patients. CONCLUSION: CWS is common and benign, but leads to anxiety and recurred frequently. Because the majority of chest wall pain is left-sided, the possibility of coexistence with coronary disease needs careful consideration

Laparoscopic Transhiatal Esophagectomy for Esophageal Cancer

The incidence of esophageal cancer has increased over the last several decades, and the incidence of adenocarcinoma now surpasses that of squamous cell carcinoma. Esophagectomy is the best curative option for the treatment of resectable esophageal cancer but is a complex operation with significant morbidity and mortality. While the overall morbidity and mortality in those who are surgically treated has declined, approaching 40–50 % and 8–11 %, respectively, it is still significant. Over the past decade, minimally invasive esophagectomy (MIE) has been gaining favor as an attractive alternative to open resection with the potential to reduce surgical trauma, decrease morbidity, and shorten the length of hospital stay. Laparoscopic techniques were first adapted into the field of esophageal disease in 1991 with laparoscopic fundoplication, performed by Dallemagne et al. With this, the shift toward minimally invasive esophageal surgery began. Traditional approaches via open transhiatal or transthoracic (Ivor Lewis) resections were first “hybridized” with minimally invasive techniques, where parts of the procedure were performed in a minimally invasive fashion and other parts via standard incisions. In 1993, Collard and colleagues published their initial experience with thoracoscopic mobilization of the esophagus. The first esophagectomy performed completely via laparoscopy through a transhiatal approach was in 1995 by DePaula et al. In 1999, Watson et al. first described a completely minimally invasive Ivor Lewis technique