Current opinion in general surgery
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Pharyngoesophageal dysphagia is chiefly a disorder of the elderly. This review examines recent advances in the understanding of the normal physiology of oropharyngeal bolus transport. ⋯ Therapy for the condition is aimed at the underlying cause, and patients with neurologic deficits (largest subgroup of patients) should have a good response to myotomy provided they fulfill basic criteria. Surgery for Zenker's diverticulum is always necessary, and a short discussion of technique has been included.
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This review of early care covers issues pertaining to the analysis of system function, prehospital intravascular volume replacement, diagnosis of proximity vascular injury, the role of emergency thoracotomy, and the value of transesophageal echocardiography. The first six articles deal with various aspects of system function, from triage to analysis of outcome. The next series of articles reviews work in progress evaluating optimal fluid for resuscitation. ⋯ An article and two editorials summarize state of the art for diagnosis and treatment of proximity vascular injury. Two articles describe the potential use of the new technique of transesophageal echocardiography. This new modality has not formed a solid indication at present and can be considered investigational in trauma care.