Peroral Endoscopic Myotomy in Diffuse Thickened Esophageal Wall in an Adolescent

Achalasia is an extremely rare pathology in children. Peroral endoscopic myotomy (POEM) is the gold standard for the surgical treatment of achalasia in adults, but only a limited number of cases of achalasia treatment using POEM in children have been published in the literature. Sometimes, high-resolution manometry signs of achalasia can mimic diffuse esophageal leiomyoma. This case report represents the first known successful performance of POEM on a 15-year-old female with diffuse thickening of the esophagus with signs and symptoms of achalasia and suspicion for Alport syndrome associated with diffuse esophageal leiomyoma

Associations in the commentary on Dostoevsky’s language dictionary entry as an associative text field reconstruction

The article discusses the possibility of the Dostoevsky’s Language Dictionary resources using as the writer’s linguistic personality reconstruction. The structure of the Dictionary, which provides enhanced linguistic commentary, allows a text associative field building generated by idioglossa, i.e. the dictionary entry input. The article gives argumentation for the analogy of the associative text fields and associative fields compiled on the free associative experiment basis. The associations in the Dictionary entry text are distributed between the commentary’s zones — idioglossa associative environment, idioglossa coordinative and subordinating relations, idioglossa relations with root words, its function in play of words, etc. The reconstructed by using Dostoevsky’s Language Dictionary resources associative text field СНЕГ (SNOW) is presented as an example. The analysis allows to determine the individual characteristics of the author’s vocabulary, his associative-verbal network as well as to identify the field structure (core, centre and periphery). The author makes an assumption that Dostoevsky is characterized primarily by the associations of parataxical type in particular based on paronymical attraction that can be connected with such a feature the author’s idiostyle as sense intensifying and enhancement through, for example, synonyms of one rode “stringing”.В статье рассматривается возможность использования ресурсов Словаря языка Достоевского в качестве метода реконструкции языковой личности писателя. Структура Словаря, в котором представлен расширенный лингвистический ком ментарий, позволяет построить текстовое ассоциативное поле, формируемое идиоглоссой, входом словарной статьи. Дается обоснование аналогии текстового ассоциативного поля и ассоциативного поля, составленного на основе проведения свободного ассоциативного эксперимента. Ассоциации в тексте словарной статьи Словаря распределяются по разным зонам комментария — ассоциативного окружения описываемой идиоглоссы, подчинительных и сочинительных связей слова, использованием в одном контексте однокоренных слов, игрового употребления слова и др. В качестве примера приводится реконструированное с использованием ресурсов Словаря языка Достоевского текстовое ассоциативное поле СНЕГ, анализ которого позволяет определить индивидуальные особенности авторского лексико на, его ассоциативно-вербальной сети, а также выявить структуру поля (ядро, центр и периферию). Делается предположение, что для Достоевского характерны прежде всего ассоциации паратаксического типа, в частности, основанные на паронимической аттракции, что может быть связано с такой особенностью авторского идиостиля, как нагнетание, усиление смысла посредством, например, «нанизывания» синонимов в одном сочинительном ряду.Публикация подготовлена в рамках поддержанного РГНФ научного проекта № 15-04-00135

Submucosal fibrotic changes in patients with esophageal achalasia

The OBJECTIVE of the study was to evaluate the severity of submucosal fibrosis in patients with esophageal achalasia, its influence on technical and clinical success of peroral endoscopic myotomies (POEM), and their results.METHODS AND MATERIALS. The study included 116 patients with esophageal achalasia who underwent POEM in the Clinic of the Pavlov First Saint Petersburg State Medical University from June 2015 to March 2019. The mean age of patients was 50 years. It included 42 men and 74 women. This research was based on the retrospective analysis of video recordings of 116 POEM that were performed on patients with esophageal achalasia at the Endoscopy Department at the Pavlov First Saint Petersburg State Medical University.RESULTS. The mean operation time was 89.6 minutes. During the operation, changes in the esophageal mucosa were recorded in all patients, which were classified according to the esophageal mucosa in achalasia (EMIA), and during creating the tunnel, the severity of submucosal fibrosis (SMF) was evaluated according to the three-stage classification (SMF from 0 to 3 stage). We found out that SMF-1 occurred in 20 patients, SMF-2 occurred in 44 patients and SMF-3 occurred in 48 patients; we identified a new group of severe submucosal fibrosis – 3b that accompanied in our study by the highest 25 % frequency of mucosal perforation during surgery.CONCLUSION. The submucosal fibrosis of various SMF grades was determined intraoperatively in the majority of the patients and affected the POEM duration and complications

Endoscopic treatment for persistent dysphagia after heller myotomy in a patient with spastic type of achalasia with the use of the intraoperative high-resolution manometry

A Peroral Endoscopic Myotomy was performed on the patient with the persistent dysphagia despite preceding Heller myotomy combined with partial fundoplication, relaparotomy, fundoplication wrap reconstruction, gastrostomy and left-sided thoracoscopy with the drainage of the thoracic abscess. The use of intraoperative High-Resolution Manometry during Endoscopic Peroral Myotomy helped to reveal the reasons for the failure of previous treatment and to address the dysphagia

Peroral Endoscopic Myotomy with Simultaneous Endoscopic Fundoplication for a patient with achalasia

To treat the patient with Achalasia and prevent the symptoms of gastroesophageal reflux the Peroral Endoscopic Myotomy with Simultaneous Endoscopic Fundoplication was done by the current authors. After performing a myotomy the endoloop was fixated to the stomach and was attached to the muscle of the esophagus by using the endoclips. The endoloop was tightened therefore shaping the cuff. This operation has been technically feasible and no immediate or delayed complications occurred