Achalasia is rare disorder with an estimated prevalence of 0.5~1 per 100,000 per year and secondary achalasia due to trauma is rarer. The following case report describes a patient who developed achalasia after chest trauma. This report presents a 22 year-old male with chest trauma who had hoarseness and postprandial reflux. We suggested the achalasia through video-fluoroscopic swallowing study (VFSS), and confirmed superior and recurrent laryngeal neuropathies through laryngeal electromyography (EMG). VFSS and laryngeal EMG are helpful to diagnose the achalasia due to vagus nerve injury after chest trauma.
Deglutition ; Electromyography ; Esophageal Achalasia ; Hoarseness ; Humans ; Male ; Prevalence ; Thorax ; Vagus Nerve ; Vagus Nerve Injuries

Dysphagia secondary to peripheral cranial nerve injury originates from weak and uncoordinated contraction-relaxation of cricopharyngeal muscle. We report on two patients who suffered vagus nerve injury during surgery and showed sudden dysphagia by opening dysfunction of upper esophageal sphincter (UES). Videofluoroscopy-guided balloon dilatation of UES was performed. We confirmed an early improvement of the opening dysfunctions of UES, although other neurologic symptoms persisted. While we did not have a proper comparison of cases, the videofluoroscopy-guided balloon dilatation of UES is thought to be helpful for the early recovery of dysphagia caused by postoperative vagus nerve injury.
Cranial Nerve Injuries ; Deglutition Disorders ; Dilatation* ; Esophageal Sphincter, Upper* ; Humans ; Muscles ; Neurologic Manifestations ; Vagus Nerve Injuries* ; Vagus Nerve*

OBJECTIVE: Vagus nerve stimulation (VNS) has been used in epilepsy patients refractory to standard medical treatments and unsuitable candidates for resective or disconnective surgery. In this study, we investigated the efficacy of VNS to patients who had refractory result to epilepsy surgery and patients with post-traumatic epilepsy. METHODS: We analyzed the effect of VNS in 11 patients who had undergone previous epilepsy surgery and patients with intractable post-traumatic epilepsy associated with brain injury. All patients underwent VNS implantation between October 2005 and December 2006. RESULTS: We evaluated seizure frequency before and after implantation of VNS and maximum follow up period was 24 months. In the first 6 months, 11 patients showed an average of 74.3% seizure reduction. After 12 months, 10 patients showed 85.2% seizure reduction. Eighteen months after implantation, 9 patients showed 92.4% seizure reduction and 7 patients showed 97.2% seizure reduction after 24 months. Six patients were seizure-free at this time. CONCLUSION: We conclude that the VNS is a helpful treatment modality in patients with surgically refractory epilepsy and in patients with post-traumatic epilepsy due to severe brain injury.
Brain Injuries ; Electric Stimulation ; Epilepsy ; Epilepsy, Post-Traumatic ; Follow-Up Studies ; Humans ; Seizures ; Vagus Nerve ; Vagus Nerve Stimulation

PURPOSE: This study is to evaluate the efficacy and safety of vagus nerve stimulation (VNS) in intractable childhood onset epilepsy by reviewing our experiences. MEHTHOD: Involved in the study are five patients who underwent VNS from July 23th, 1999 and had been followed up over 12 months. We reviewed data prospectively collected with a focus on clinical features, therapeutic outcomes and safety, developmental progress, and EEG findings. RESULTS: Three patients were classified as Lennox-Gastaut syndrome. One patient of the two remaining patients had gelastic seizure caused by hypothalamic harmatoma, while the other patient had partial seizure with secondary generalization. Among the 5 patients, one patient showed a seizure frequency reduction rate of about 50% from baseline in 3 months after VNS implantation and more than 90% in 12 months, 2 patients of about 50% in 3 months and of about 75% in 12 months, but the other two patients didn't show any change in seizure frequency. Side effects such as hoarseness, dyspnea during sleep and wound infection could be controlled simply through the adjustment of output current or wound revision. However, efficacy in cognitive function and EEG findings was not satisfactory. CONCLUSIONS: VNS might be an effective adjunctive therapy for intractable childhood epilepsy and transient side effects can be controlled without discontinuation of VNS therapy.
Dyspnea ; Electroencephalography ; Epilepsy* ; Generalization (Psychology) ; Hoarseness ; Humans ; Prospective Studies ; Seizures ; Vagus Nerve Stimulation* ; Vagus Nerve* ; Wound Infection ; Wounds and Injuries

PURPOSE: Recently, Vagus nerve stimulation (VNS) has been reported to show promising results as an adjunctive therapy for medically intractable seizures. We report early experiences with VNS for medically intractable epilepsy in young adults and pediatric patients. METHODS: Eleven patients ages ranging from 7 years to 29 years underwent implantation of vagal nerve stimulators (Cyberonics, Houston, TX) from September 1999 to April 2003. We reviewed clinical findings in 11 patients and recorded changes of seizure frequency, quality of life (QOL), and antiepileptic drug (AED). RESULTS: The mean age of seizure onset was 4.5 years old (range:3 months-11 years). The seizure duration before VNS was mean 8.7 years (range:1.5-19 years). Seven patients had symptomatic partial epilepsies, and one had cryptogenic partial epilepsy. Unclassified patients had 2 Lennox-Gastaut syndrome and 1 reflex epilepsy. Two patients received total callosotomy for reducing drop attack, but refractory. One patient, who underwent a temporal lobectomy, failed to obtain desirable results. One implantation was performed with total callosotomy, simultaneously. All of implantations were successful, except for one wound revision due to a subcutaneously protruded anchoring device of electrode. About two weeks after the implantation, programming of the stimuli was started and increased the output current to the levels, at which patients was tolerated. The most common adverse effect was hoarseness or voice alteration (44%). Mean reduction of seizure frequency compared with baseline before VNS was 23.6% after 3 months, 33.5% after 6 months, 41.3% after 1 year, and 46.6% at latest follow-up. Three patients had no response to VNS. One patient was added 1 one new AED after VNS. Two patients were reduced 1 or 2 drugs. But there was no correlation between VNS effect and AED change. Six patients had some improvement of QOL. Mean follow-up period, which was 28 months (range:12-48 months). CONCLUSIONS: We concluded that VNS has a role of adjunctive therapy for medically intractable epilepsy and the further studies should be focused on the prediction of unresponsiveness and the adjustment of VNS parameters for maximal efficacy in patients with various backgrounds.
Electrodes ; Epilepsies, Partial ; Epilepsy* ; Epilepsy, Reflex ; Follow-Up Studies ; Hoarseness ; Humans ; Quality of Life ; Seizures ; Syncope ; Vagus Nerve Stimulation* ; Vagus Nerve* ; Voice ; Wounds and Injuries ; Young Adult

Child ; Cranial Nerve Injuries ; drug therapy ; etiology ; Diagnosis, Differential ; Female ; Glossopharyngeal Nerve ; pathology ; Humans ; Malaria, Cerebral ; complications ; diagnosis ; drug therapy ; Vagus Nerve ; pathology

We reported a 56-year-old man who presented with vagus nerve injury after deep laceration in the neck. During being treated the neck insult, he was performed pyloplasty and vagotomy and used total parenteral nutrition due to peptic ulcer perforation and panperitonitis. He suffered from swallowing difficulty and underwent percutaneous endoscopic gastrostomy placement. As formerly, recurrent gastroesophageal reflux symptoms and gastric feeding intolerance were developed. We fixed a transgastrostomal jejunal tube in jejunum through the gastric stoma. The gastroeophageal reflux and feeding intolerance did not recur. After 30 days later, jejunal tube was removed, nutritional support was replaced by gastric tube. We were able to provide a temporary nutritional bridge with percutaneous endoscopic gastrojejunostomy placement for patients who suffered from dysphagia.
Deglutition ; Deglutition Disorders ; Gastric Bypass* ; Gastroesophageal Reflux ; Gastrostomy ; Humans ; Jejunum ; Lacerations ; Middle Aged ; Neck ; Nutritional Support ; Parenteral Nutrition, Total ; Peptic Ulcer Perforation ; Vagotomy ; Vagus Nerve Injuries

PURPOSE: In treating schwannoma patients, it is critical to determine the origin of the tumor to preserve nerve function. We evaluated the validity of preoperative imaging studies in distinguishing the neurological origin of the schwannomas of the head and neck, and the efficacy of intracapsular enucleation in preserving nerve function. MATERIALS AND METHODS: In 7 cases of schwannomas in the head and neck region, we predicted whether the tumor originated from the vagus nerve or the cervical sympathetic chain through imaging studies including computed tomography (CT) and magnetic resonance imaging (MRI). All patients were performed intracapsular enucleation, and the function of the vagus nerve and the sympathetic nerve was evaluated preoperatively and postoperatively. RESULTS: Preoperative imaging studies showed 6 cases where the tumor was located between the carotid artery and the internal jugular vein, and 1 case where the tumor was located posteriorly, displacing the carotid artery and the internal jugular vein anteriorly. At the time of operation, we confirmed schwannoma originating from the vagus nerve on the first 6 cases, and schwannoma originating from the sympathetic nervous system on the last case. All patients went through successful intracapsular enucleation, and of the seven schwannoma cases, 6 patients maintained normal postoperative neurological function (85.7%). CONCLUSION: Preoperative imaging studies offer valuable information regarding the location and origination of the tumor, and intracapsular enucleation helped us to preserve the nerve function.
Aged ; Diagnostic Imaging/methods ; Female ; Follow-Up Studies ; Head and Neck Neoplasms/complications/diagnosis/*pathology ; Humans ; Magnetic Resonance Imaging/methods ; Male ; Middle Aged ; Neurilemmoma/complications/diagnosis/*pathology ; Peripheral Nervous System/injuries/physiology ; Sympathetic Nervous System/physiology ; Tomography, X-Ray Computed/methods ; Treatment Outcome ; Vagus Nerve/physiology

Endoscopy plays an important role in the diagnosis and treatment of postoperative complications of gastric cancer. Endoscopic intervention can avoid the second operation and has attracted wide attention. Early gastric anastomotic bleeding after gastrectomy is the most common. With the development of technology, emergency endoscopy and endoscopic hemostasis provide a new treatment approach. According to the specific circumstances, endoscopists can choose metal clamp to stop bleeding, electrocoagulation hemostasis, local injection of epinephrine or sclerotherapy agents, and spraying specific hemostatic agents. Anastomotic fistula is a serious postoperative complication. In addition to endoscopically placing the small intestine nutrition tube for early enteral nutrition support treatment, endoscopic treatment, including stent, metal clip, OTSC, and Over-stitch suture system, can be chosen to close fistula. For anastomotic obstruction or stricture, endoscopic balloon or probe expansion and stent placement can be chosen. For esophageal anastomotic intractable obstruction after gastroesophageal surgery, radial incision of obstruction by the hook knife or IT knife, a new method named ERI, is a good choice. Bile leakage caused by bile duct injury can be treated by placing the stent or nasal bile duct. In addition, endoscopic methods are widely used as follows: abdominal abscess can be treated by the direct intervention under endoscopy; adhesive ileus can be treated by placing the catheter under the guidance of endoscopy to attract pressure; alkaline reflux gastritis can be rapidly diagnosed by endoscopy; gastric outlet obstruction mainly caused by cancer recurrence can be relieved by metal stent placement and the combination of endoscopy and X-ray can increase success rate; pyloric dysfunction and spasm caused by the vagus nerve injury during proximal gastrectomy can be treated by endoscopic pyloromyotomy, a new method named G-POEM, and the short-term outcomes are significant. Endoscopic submucosal dissection (ESD) allows complete resection of residual gastric precancerous lesions, however it should be performed by the experienced endoscopists.
Anastomosis, Surgical ; adverse effects ; Bile Ducts ; injuries ; Constriction, Pathologic ; etiology ; therapy ; Digestive System Fistula ; etiology ; therapy ; Duodenogastric Reflux ; diagnostic imaging ; etiology ; Endoscopy, Gastrointestinal ; methods ; Enteral Nutrition ; instrumentation ; methods ; Female ; Gastrectomy ; adverse effects ; Gastric Outlet Obstruction ; surgery ; Gastritis ; diagnosis ; Gastrointestinal Hemorrhage ; etiology ; therapy ; Hemostasis, Endoscopic ; methods ; Hemostatics ; administration & dosage ; therapeutic use ; Humans ; Male ; Neoplasm Recurrence, Local ; surgery ; Postoperative Complications ; diagnosis ; therapy ; Precancerous Conditions ; surgery ; Pylorus ; innervation ; physiopathology ; surgery ; Stents ; Stomach Neoplasms ; complications ; surgery ; Treatment Outcome ; Vagus Nerve Injuries ; etiology ; surgery