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PARTIAL THORACIC STOMACH AND ESOPHAGEAL HIATUS HERNIA IN INFANCY AND CHILDHOOD FREE

PAUL R. SWYER, M.R.C.P. (London)
[+] Author Affiliations

Submitted for publication June 7, 1955.


AMA Am J Dis Child. 1955;90(4):421-451. doi:10.1001/archpedi.1955.04030010423007.
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INTRODUCTION  The recent recognition of the syndrome of partial thoracic stomach in infancy has provided a diagnosis for a hitherto puzzling group of cases with vomiting as a leading symptom. As a result indefinite diagnoses such as "marasmus" or "dystrophy" are less frequent. This syndrome is associated with partial dislocation of the stomach within the thorax through the esophageal hiatus, the diaphragmatic leaves being intact.It is the purpose of this paper to review present knowledge of the subject with particular reference to the younger age groups and to indicate rational management based on a consideration of the pathogenesis and prognosis. In this task the author has been aided by practical experience at the Hospital for Sick Children, Great Ormond Street, where over 100 cases have been followed for some years (Waterston, 1954). Discussion will be illustrated by reference to a small series of 18 cases personally examined by the

REFERENCES

Åkerlund, Å.; Ohnell, H., and Key, E.:  Hernia diaphragmatica Hiatus œsophagei vom anatomischen und röntgenologischen Gesichtspunkt , Acta radiol. 6:322, 1926; (104 refs.).
Allison, P. R.:  Peptic Ulcer of Esophagus , J. Thoracic Surg. 15:308-317 ( (Oct.) ) 1946; (2 refs.).
 Peptic Ulcer of Oesophagus , Thorax 3:20-42 ( (March) ) 1948; (3 refs.).
 Reflux Esophagitis, Sliding Hiatal Hernia, and the Anatomy of Repair, Surg ., Gynec. Obst. 92:419-431 ( (April) ) 1951; (no refs.).
Allison, P. R.; Johnstone, A. S., and Royce, G. B.:  Short Esophagus with Simple Peptic Ulceration , J. Thoracic Surg. 12:432-457 ( (June) ) 1943; (12 refs.).
Allison and Johnstone, A. S.:  The Oesophagus Lined with Gastric Mucous Membrane , Thorax 8: 87-101 ( (June) ) 1953; (2 refs.).
Allison and Da Silva, L. T.:  The Roux Loop , Brit. J. Surg. 41:173-180 ( (Sept.) ) 1953;.
Amendola, F. H.:  An Unusual Complication of Interruption of the Left Phrenic Nerve in the Management of Esophageal Hiatus Hernia , Surg., Gynec. & Obst. 100:379-282 ( (March) ) 1955; (7 refs.).
Astley, R., and Carré, I. J.:  Gastro-Oesophageal Incompetence in Children, with Special Reference to Minor Degrees of Partial Thoracic Stomach , Radiology 62:351-362 ( (March) ) 1954; (25 refs.).
Jones, F., in  Discussion on Hiatus Hernia , Proc. Roy. Soc. Med. 45:277-290 ( (May) ) 1952;.
Aylwin, J. A.:  The Physiological Basis of Reflux Oesophagitis in Sliding Hiatal Diaphragmatic Hernia , Thorax 8:38-45 ( (March) ) 1953; (16 refs.).
Barrett, N. R.:  Chronic Peptic Ulcer of the Œsophagus and "Œsophagitis," Brit. J. Surg. 38:175-182 ( (Oct.) ) 1950; (23 refs.).
in  Discussion on Hiatus Hernia , Proc. Roy. Soc. Med. 45:277-290 ( (May) ) 1952;.
Hernia:  A Review of Some Controversial Points , Brit. J. Surg. 42:343 ( (Nov.) ) 1954; (no refs.).
Beatty, C. C.:  Congenital Stenosis of the Œsophagus Brit . J. Child. Dis. 25:237-270 ( (Oct.) -Dec.) 1928; (46 refs.).
Belcher, J. R.:  Pulmonary Complications of Dysphagia , Thorax 4:44-56 ( (March) ) 1949;.
Belsey, R.:  Diaphragmatic Hernia , in Modern Trends in Gastro-Enterology , edited by F. Avery Jones, London, Butterworth & Co., Ltd., 1952;.
in  Discussion on Hiatus Hernia and Œsophagitis , Proc. Roy Soc. Med. 46:941-946 ( (Nov.) ) 1953;.
 Peptic Ulcer of the Oesophagus , Ann. Roy. Coll. Surgeons England 14:303-322 ( (May) ) 1954; (8 refs.).
Bloom, J.:  Hiatus Herniæ (A New Method of Demonstrating Hiatus Herniæ Radiologically) , Canad. M. A. J. 57:9-13 ( (July) ) 1947; (12 refs.).
Bock, A. V.; Dulin, J. W., and Brooke, P. A.:  Diaphragmatic Hernia and Secondary Anemia: Ten Cases , New England J. Med. 209:615-625 ( (Sept. 28) ) 1933; (15 refs.).
Bosher, L. H., Jr., and Taylor, F. H.:  Heterotropic Gastric Mucosa in Esophagus with Ulceration and Stricture Formation , J. Thoracic Surg. 21:306-312 ( (March) ) 1951;.
Brick, I. B., in discussion on  Treatment of Hiatus Hernia in Older Persons , J. A. M. A. 142:310-315 ( (Feb.) ) 1950; (no refs.).
Briggs, P. J.; Dick, R. C. S., and Hurst, A.:  Simple Ulcer of the Œsophagus and Short Œsophagus , Proc. Roy. Soc. Med. 32:1423-1424 ( (Sept.) ) 1939;.
Kelly, A.:  Congenital Stenosis of the Œsophagus in Children, Associated with Diaphragmatic Hernia of the Stomach , J. Laryng. & Otol. 45:680-685 ( (Oct.) ) 1930; (no refs.).
Kelly, H. D., in  Discussion on Hiatus Hernia and Œsophagitis , Proc. Roy Soc. Med. 46:941-946 ( (Nov.) ) 1953;.
Bund, R.:  Ein Fall von rechtsseitiger Hernia diaphragmatica mit Austritt des Magens in den persistierenden Rezessus pneumato-entericus dexter , Frankfurt Ztschr. Path. 21:257, 1918; (6 refs.).
Carré, I. J.; Astley, R., and Smellie, J. M.:  Minor Degrees of Partial Thoracic Stomach in Childhood: Review of 112 Cases , Lancet 2:1150-1153 ( (Dec. 13) ) 1952; (14 refs.).
Carver, G. M., Jr., and Sealy, W. C.:  Peptic Esophagitis , A. M. A. Arch. Surg. 68:286-295 ( (March) ) 1954; (16 refs.).
Clerf, L. H., and Manges, W. F.:  The Congenitally Short Esophagus , J. A. M. A. 102:2008-2012 ( (June 16) ) 1934; (6 refs.).
Collis, J. L.; Satchwell, L. M., and Abrams, L. D.:  Nerve Supply to the Crura of the Diaphragm , Thorax 9:22-25 ( (March) ) 1954; (4 refs.).
Collis Kelly, T. D., and Wiley, A. M.:  Anatomy of the Crura of the Diaphragm and the Surgery of Hiatus Hernia , Thorax 9:175-189 ( (Sept.) ) 1954; (10 refs.).
Creamer, B.:  Œsophageal Reflux , Lancet 1:279-281 ( (Feb. 5) ) 1955; (1 ref.).
Dornhorst, A. C.; Harrison, K., and Pierce, J. W.:  Observations on the Normal Œsophagus and Cardia , Lancet 1:695-698 ( (April 3) ) 1954; (2 refs.).
Evans, J. A.:  Sliding Hiatus Hernia , Am. J. Roentgenol. 68:754-763 ( (Nov.) ) 1952; (14 refs.).
Feldman, M.:  Peptic Ulcer of Lower Esophagus Associated with Esophageal Hiatus Hernia: Report of 2 Cases , Am. J. M. Sc. 198:165-166 ( (Aug.) ) 1939; (2 refs.).
Ferguson, D. J.; Sanchez-Palomera, E.; Sako, Y.; Clatworthy, H. W.; Toon, R. W., and Wangensteen, O. H.:  Studies on Experimental Esophagitis , Surgery 28:1022-1039 ( (Dec.) ) 1950; (59 refs.).
Findlay, L., and Brown Kelly, A.:  Congenital Shortening of the Œsophagus and the Thoracic Stomach Resulting Therefrom , J. Laryng. & Otol. 46:797-816 ( (Dec.) ) 1931; (15 refs.).
Friedenwald, J.: Feldman, M., and Zinn, W. F.:  Peptic Ulcer of Esophagus , Am. J. M. Sc. 177:1-14 ( (Jan.) ) 1929; (42 refs.).
Gertz, T. C.; Regout, J. E. P. M., and Thomsen, G.:  Late Results in Transthoracic Herniotomies , Thorax 6:316-324 ( (Sept.) ) 1951; (7 refs.).
Gilbert, N. C.; Dey, F. L., and Rall, J. E.:  Recurrent Hiatus Hernia , J. A. M. A. 132:132-134 ( (Sept. 21) ) 1946; (10 refs.).
Hamilton, W. J.; Boyd, J. D., and Mossman, H. W.: Human Embryology (Prenatal Development of Form and Function) , Cambridge, England, W. Heffer & Sons, Ltd., 1952;, p. 203.
Harrington, S. W.:  Esophageal Hiatal Diaphragmatic Hernia , Surg., Gynec. & Obst. 100:277-292 ( (March) ) 1955; (no refs.).
Hill, E. E.:  Chair for Infants with Gastro(Esophageal Incompetence , Lancet 2:71-72 ( (July 11) ) 1953;.
Hodgson, C. J., in  Discussion on Hiatus Hernia , Proc. Roy. Soc. Med. 47:531-539 ( (July) ) 1954;.
Husfeldt, E.:  Hiatus Hernia in Infants and in Adults , Great Ormond St. J. (No. (6) ) pp. 71-80, Dec., 1953; (no refs.).
Husfeldt, E.; Thomsen, G., and Wamberg, E.:  Hiatal Hernia and Short Esophagus in Children , Thorax 6:56-70 ( (March) ) 1951; (6 refs.).
Jackson, C.:  Peptic Ulcer of Esophagus , J. A. M. A. 92:369-372 ( (Feb. 2) ) 1929; (no refs.).
Johnstone, A. S.:  Peptic Ulceration of the Œsophagus with Partial Thoracic Stomach , Brit. J. Radiol. 16:357-361 ( (Dec.) ) 1943;.
in  Discussion on Hiatus Hernia , Proc. Roy. Soc. Med. 45:277-290 ( (May) ) 1952;.
Merendino, K. A.; Varco, R. L., and Wangensteen, O. H.:  Displacement of the Esophagus into a New Diaphragmatic Orifice in the Repair of Para-Esophageal and Esophageal Hiatus Hernia , Ann. Surg. 129:185-197 ( (Feb.) ) 1949; (13 refs.).
Moersch, H. J.:  Hiatal Hernia , Ann. Otol. Rhin. & Laryng. 47:754-767 ( (Sept.) ) 1938; (13 refs.).
Morris, E. W. T.:  A Note on the Development of the Human Pneumato-Enteric Recess , Brit. J. Surg. 42:243-244 ( (Nov.) ) 1954; (9 refs.).
Nicholson, F.:  Diaphragmatic Hernia , Ann. Surg. 136:174-182 ( (July) ) 1952; (7 refs.).
O'Mullane, E. J.:  Vomiting and Regurgitation During Anæsthesia , Lancet 1:1209-1212 ( (June 12) ) 1954; (2 refs.).
Pickhardt, O. C.; Rafsky, H. A., and Ghiselin, F. H.:  Treatment of Hiatus Hernia in Older Persons , J. A. M. A. 142:310-315 ( (Feb. 4) ) 1950; (17 refs.).
Pilcher, R. S.:  Hiatus Hernia in Children , Univ. Coll. Hosp. Mag. 36:177-181, 1951; (3 refs.).
Pringle, J. H., and Teacher, J. H.:  Digestion of the Œsophagus as a Cause of Post-Operative Hæmatemesis , Brit. J. Surg. 6:523-536 ( (April) ) 1919;.
Rennie, J. B.; Land, F. T., and Park, S. D. S.:  Short Œsophagus: A Review of 31 Cases , Brit. M. J. 2:1443-1449 ( (Dec. 24) ) 1949; (8 refs.).
Rigler, L. G., and Eneboe, J. B.:  The Incidence of Hiatus Hernia in Pregnant Women and Its Significance , J. Thoracic Surg. 4:262-268 ( (Feb.) ) 1935; (18 refs.).
Ritchey, J. O., and Winsauer, H. J.:  Anemia and Its Relation to Diaphragmatic Hernia , Am. J. M. Sc. 214:476-482 ( (Nov.) ) 1947; (22 refs.).
Schmidt, W.:  Regurgitation at the Esophago-Gastric Junction , Proc. Staff Meet., Mayo Clin. 29:153-163 ( (March 24) ) 1954; (no refs.).
Sheldon, W., and Ogilvie, A. G.:  Obstruction of the Œesophagus in Childhood , Arch. Dis. Child. 4:347-364 ( (Dec.) ) 1929; (14 refs.).
Smellie, J. M., in  Discussion on Hiatus Hernia , Proc. Roy. Soc. Med. 47:531-539 ( (July) ) 1954;.
Smithers, D. W.:  Association of Cancer of Gastric Cardia with Partial Thoracic Stomach, Short Œsophagus, and Peptic Ulceration , Brit. J. Radiol. 23:261-269 ( (May) ) 1950;.
Soresi, A. L.:  Diaphragmatic Hernia , Ann. Surg. 69:254-270 ( (March) ) 1919;.
Soutter, L.:  Analysis of Cases of Hiatus Hernia Treated by Surgery at Massachusetts General Hospital , S. Clin. North America 27:1121-1127 ( (Oct.) ) 1947;.
Stapleton, J. G.:  (Esophageal) Hiatus Hernia , Canad. M. A. J. 57:13-16 ( (July) ) 1947; (21 refs.).
Strauss, A. A., and Hess, J. H.:  Congenital Esophageal Stenosis Above Cardiac Orifice: A New Method of Surgical Treatment , J. A. M. A. 84:501-504 ( (Feb. 14) ) 1925; (2 refs.).
Sweet, R. H.:  Esophageal Hiatus Hernia of the Diaphragm: Anatomical Characteristics, Technic of Repair, and Results of Treatment in 111 Consecutive Cases , Ann. Surg. 135:1-13 ( (Jan.) ) 1952; (1 ref.).
Thomas, R. G.; Rappoport, A. E., and Keogh, J. P.:  Obstruction of the Esophagus by Diseased Ectopic Gastric Mucosa , Dis. Chest 26:92-99 ( (July) ) 1954; (18 refs.).
Thomsen, G.:  Peptic Ulcer of Oesophagus , Acta radiol . 32:193-209, 1949; (22 refs.).
Tucker, G.; Lautz, V.; Tracy, J. B., and Fearon, B. W.:  The Diagnosis and Treatment of Benign Stenosis of the Esophagus, with Special Reference to Treatment by Dilatation with the Indwelling Cannulated Bougie , Ann. Otol. Rhin. & Laryng. 59:823-836 ( (Sept.) ) 1950; (9 refs.).
Wamberg, E.:  On Brachyoesophagus , Acta pædiat . 34:293-305, 1947; (16 refs.).
Waterston, D. J.:  Discussion on Hiatus Hernia , Proc. Roy. Soc. Med. 47:536-538 ( (July) ) 1954; (4 refs.).
 Hiatus Hernia , in Recent Advances in Pædiatrics , edited by D. Gairdner, London, J. & A. Churchill, Ltd., 1954;, pp. 158-163 (9 refs.).

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References

Åkerlund, Å.; Ohnell, H., and Key, E.:  Hernia diaphragmatica Hiatus œsophagei vom anatomischen und röntgenologischen Gesichtspunkt , Acta radiol. 6:322, 1926; (104 refs.).
Allison, P. R.:  Peptic Ulcer of Esophagus , J. Thoracic Surg. 15:308-317 ( (Oct.) ) 1946; (2 refs.).
 Peptic Ulcer of Oesophagus , Thorax 3:20-42 ( (March) ) 1948; (3 refs.).
 Reflux Esophagitis, Sliding Hiatal Hernia, and the Anatomy of Repair, Surg ., Gynec. Obst. 92:419-431 ( (April) ) 1951; (no refs.).
Allison, P. R.; Johnstone, A. S., and Royce, G. B.:  Short Esophagus with Simple Peptic Ulceration , J. Thoracic Surg. 12:432-457 ( (June) ) 1943; (12 refs.).
Allison and Johnstone, A. S.:  The Oesophagus Lined with Gastric Mucous Membrane , Thorax 8: 87-101 ( (June) ) 1953; (2 refs.).
Allison and Da Silva, L. T.:  The Roux Loop , Brit. J. Surg. 41:173-180 ( (Sept.) ) 1953;.
Amendola, F. H.:  An Unusual Complication of Interruption of the Left Phrenic Nerve in the Management of Esophageal Hiatus Hernia , Surg., Gynec. & Obst. 100:379-282 ( (March) ) 1955; (7 refs.).
Astley, R., and Carré, I. J.:  Gastro-Oesophageal Incompetence in Children, with Special Reference to Minor Degrees of Partial Thoracic Stomach , Radiology 62:351-362 ( (March) ) 1954; (25 refs.).
Jones, F., in  Discussion on Hiatus Hernia , Proc. Roy. Soc. Med. 45:277-290 ( (May) ) 1952;.
Aylwin, J. A.:  The Physiological Basis of Reflux Oesophagitis in Sliding Hiatal Diaphragmatic Hernia , Thorax 8:38-45 ( (March) ) 1953; (16 refs.).
Barrett, N. R.:  Chronic Peptic Ulcer of the Œsophagus and "Œsophagitis," Brit. J. Surg. 38:175-182 ( (Oct.) ) 1950; (23 refs.).
in  Discussion on Hiatus Hernia , Proc. Roy. Soc. Med. 45:277-290 ( (May) ) 1952;.
Hernia:  A Review of Some Controversial Points , Brit. J. Surg. 42:343 ( (Nov.) ) 1954; (no refs.).
Beatty, C. C.:  Congenital Stenosis of the Œsophagus Brit . J. Child. Dis. 25:237-270 ( (Oct.) -Dec.) 1928; (46 refs.).
Belcher, J. R.:  Pulmonary Complications of Dysphagia , Thorax 4:44-56 ( (March) ) 1949;.
Belsey, R.:  Diaphragmatic Hernia , in Modern Trends in Gastro-Enterology , edited by F. Avery Jones, London, Butterworth & Co., Ltd., 1952;.
in  Discussion on Hiatus Hernia and Œsophagitis , Proc. Roy Soc. Med. 46:941-946 ( (Nov.) ) 1953;.
 Peptic Ulcer of the Oesophagus , Ann. Roy. Coll. Surgeons England 14:303-322 ( (May) ) 1954; (8 refs.).
Bloom, J.:  Hiatus Herniæ (A New Method of Demonstrating Hiatus Herniæ Radiologically) , Canad. M. A. J. 57:9-13 ( (July) ) 1947; (12 refs.).
Bock, A. V.; Dulin, J. W., and Brooke, P. A.:  Diaphragmatic Hernia and Secondary Anemia: Ten Cases , New England J. Med. 209:615-625 ( (Sept. 28) ) 1933; (15 refs.).
Bosher, L. H., Jr., and Taylor, F. H.:  Heterotropic Gastric Mucosa in Esophagus with Ulceration and Stricture Formation , J. Thoracic Surg. 21:306-312 ( (March) ) 1951;.
Brick, I. B., in discussion on  Treatment of Hiatus Hernia in Older Persons , J. A. M. A. 142:310-315 ( (Feb.) ) 1950; (no refs.).
Briggs, P. J.; Dick, R. C. S., and Hurst, A.:  Simple Ulcer of the Œsophagus and Short Œsophagus , Proc. Roy. Soc. Med. 32:1423-1424 ( (Sept.) ) 1939;.
Kelly, A.:  Congenital Stenosis of the Œsophagus in Children, Associated with Diaphragmatic Hernia of the Stomach , J. Laryng. & Otol. 45:680-685 ( (Oct.) ) 1930; (no refs.).
Kelly, H. D., in  Discussion on Hiatus Hernia and Œsophagitis , Proc. Roy Soc. Med. 46:941-946 ( (Nov.) ) 1953;.
Bund, R.:  Ein Fall von rechtsseitiger Hernia diaphragmatica mit Austritt des Magens in den persistierenden Rezessus pneumato-entericus dexter , Frankfurt Ztschr. Path. 21:257, 1918; (6 refs.).
Carré, I. J.; Astley, R., and Smellie, J. M.:  Minor Degrees of Partial Thoracic Stomach in Childhood: Review of 112 Cases , Lancet 2:1150-1153 ( (Dec. 13) ) 1952; (14 refs.).
Carver, G. M., Jr., and Sealy, W. C.:  Peptic Esophagitis , A. M. A. Arch. Surg. 68:286-295 ( (March) ) 1954; (16 refs.).
Clerf, L. H., and Manges, W. F.:  The Congenitally Short Esophagus , J. A. M. A. 102:2008-2012 ( (June 16) ) 1934; (6 refs.).
Collis, J. L.; Satchwell, L. M., and Abrams, L. D.:  Nerve Supply to the Crura of the Diaphragm , Thorax 9:22-25 ( (March) ) 1954; (4 refs.).
Collis Kelly, T. D., and Wiley, A. M.:  Anatomy of the Crura of the Diaphragm and the Surgery of Hiatus Hernia , Thorax 9:175-189 ( (Sept.) ) 1954; (10 refs.).
Creamer, B.:  Œsophageal Reflux , Lancet 1:279-281 ( (Feb. 5) ) 1955; (1 ref.).
Dornhorst, A. C.; Harrison, K., and Pierce, J. W.:  Observations on the Normal Œsophagus and Cardia , Lancet 1:695-698 ( (April 3) ) 1954; (2 refs.).
Evans, J. A.:  Sliding Hiatus Hernia , Am. J. Roentgenol. 68:754-763 ( (Nov.) ) 1952; (14 refs.).
Feldman, M.:  Peptic Ulcer of Lower Esophagus Associated with Esophageal Hiatus Hernia: Report of 2 Cases , Am. J. M. Sc. 198:165-166 ( (Aug.) ) 1939; (2 refs.).
Ferguson, D. J.; Sanchez-Palomera, E.; Sako, Y.; Clatworthy, H. W.; Toon, R. W., and Wangensteen, O. H.:  Studies on Experimental Esophagitis , Surgery 28:1022-1039 ( (Dec.) ) 1950; (59 refs.).
Findlay, L., and Brown Kelly, A.:  Congenital Shortening of the Œsophagus and the Thoracic Stomach Resulting Therefrom , J. Laryng. & Otol. 46:797-816 ( (Dec.) ) 1931; (15 refs.).
Friedenwald, J.: Feldman, M., and Zinn, W. F.:  Peptic Ulcer of Esophagus , Am. J. M. Sc. 177:1-14 ( (Jan.) ) 1929; (42 refs.).
Gertz, T. C.; Regout, J. E. P. M., and Thomsen, G.:  Late Results in Transthoracic Herniotomies , Thorax 6:316-324 ( (Sept.) ) 1951; (7 refs.).
Gilbert, N. C.; Dey, F. L., and Rall, J. E.:  Recurrent Hiatus Hernia , J. A. M. A. 132:132-134 ( (Sept. 21) ) 1946; (10 refs.).
Hamilton, W. J.; Boyd, J. D., and Mossman, H. W.: Human Embryology (Prenatal Development of Form and Function) , Cambridge, England, W. Heffer & Sons, Ltd., 1952;, p. 203.
Harrington, S. W.:  Esophageal Hiatal Diaphragmatic Hernia , Surg., Gynec. & Obst. 100:277-292 ( (March) ) 1955; (no refs.).
Hill, E. E.:  Chair for Infants with Gastro(Esophageal Incompetence , Lancet 2:71-72 ( (July 11) ) 1953;.
Hodgson, C. J., in  Discussion on Hiatus Hernia , Proc. Roy. Soc. Med. 47:531-539 ( (July) ) 1954;.
Husfeldt, E.:  Hiatus Hernia in Infants and in Adults , Great Ormond St. J. (No. (6) ) pp. 71-80, Dec., 1953; (no refs.).
Husfeldt, E.; Thomsen, G., and Wamberg, E.:  Hiatal Hernia and Short Esophagus in Children , Thorax 6:56-70 ( (March) ) 1951; (6 refs.).
Jackson, C.:  Peptic Ulcer of Esophagus , J. A. M. A. 92:369-372 ( (Feb. 2) ) 1929; (no refs.).
Johnstone, A. S.:  Peptic Ulceration of the Œsophagus with Partial Thoracic Stomach , Brit. J. Radiol. 16:357-361 ( (Dec.) ) 1943;.
in  Discussion on Hiatus Hernia , Proc. Roy. Soc. Med. 45:277-290 ( (May) ) 1952;.
Merendino, K. A.; Varco, R. L., and Wangensteen, O. H.:  Displacement of the Esophagus into a New Diaphragmatic Orifice in the Repair of Para-Esophageal and Esophageal Hiatus Hernia , Ann. Surg. 129:185-197 ( (Feb.) ) 1949; (13 refs.).
Moersch, H. J.:  Hiatal Hernia , Ann. Otol. Rhin. & Laryng. 47:754-767 ( (Sept.) ) 1938; (13 refs.).
Morris, E. W. T.:  A Note on the Development of the Human Pneumato-Enteric Recess , Brit. J. Surg. 42:243-244 ( (Nov.) ) 1954; (9 refs.).
Nicholson, F.:  Diaphragmatic Hernia , Ann. Surg. 136:174-182 ( (July) ) 1952; (7 refs.).
O'Mullane, E. J.:  Vomiting and Regurgitation During Anæsthesia , Lancet 1:1209-1212 ( (June 12) ) 1954; (2 refs.).
Pickhardt, O. C.; Rafsky, H. A., and Ghiselin, F. H.:  Treatment of Hiatus Hernia in Older Persons , J. A. M. A. 142:310-315 ( (Feb. 4) ) 1950; (17 refs.).
Pilcher, R. S.:  Hiatus Hernia in Children , Univ. Coll. Hosp. Mag. 36:177-181, 1951; (3 refs.).
Pringle, J. H., and Teacher, J. H.:  Digestion of the Œsophagus as a Cause of Post-Operative Hæmatemesis , Brit. J. Surg. 6:523-536 ( (April) ) 1919;.
Rennie, J. B.; Land, F. T., and Park, S. D. S.:  Short Œsophagus: A Review of 31 Cases , Brit. M. J. 2:1443-1449 ( (Dec. 24) ) 1949; (8 refs.).
Rigler, L. G., and Eneboe, J. B.:  The Incidence of Hiatus Hernia in Pregnant Women and Its Significance , J. Thoracic Surg. 4:262-268 ( (Feb.) ) 1935; (18 refs.).
Ritchey, J. O., and Winsauer, H. J.:  Anemia and Its Relation to Diaphragmatic Hernia , Am. J. M. Sc. 214:476-482 ( (Nov.) ) 1947; (22 refs.).
Schmidt, W.:  Regurgitation at the Esophago-Gastric Junction , Proc. Staff Meet., Mayo Clin. 29:153-163 ( (March 24) ) 1954; (no refs.).
Sheldon, W., and Ogilvie, A. G.:  Obstruction of the Œesophagus in Childhood , Arch. Dis. Child. 4:347-364 ( (Dec.) ) 1929; (14 refs.).
Smellie, J. M., in  Discussion on Hiatus Hernia , Proc. Roy. Soc. Med. 47:531-539 ( (July) ) 1954;.
Smithers, D. W.:  Association of Cancer of Gastric Cardia with Partial Thoracic Stomach, Short Œsophagus, and Peptic Ulceration , Brit. J. Radiol. 23:261-269 ( (May) ) 1950;.
Soresi, A. L.:  Diaphragmatic Hernia , Ann. Surg. 69:254-270 ( (March) ) 1919;.
Soutter, L.:  Analysis of Cases of Hiatus Hernia Treated by Surgery at Massachusetts General Hospital , S. Clin. North America 27:1121-1127 ( (Oct.) ) 1947;.
Stapleton, J. G.:  (Esophageal) Hiatus Hernia , Canad. M. A. J. 57:13-16 ( (July) ) 1947; (21 refs.).
Strauss, A. A., and Hess, J. H.:  Congenital Esophageal Stenosis Above Cardiac Orifice: A New Method of Surgical Treatment , J. A. M. A. 84:501-504 ( (Feb. 14) ) 1925; (2 refs.).
Sweet, R. H.:  Esophageal Hiatus Hernia of the Diaphragm: Anatomical Characteristics, Technic of Repair, and Results of Treatment in 111 Consecutive Cases , Ann. Surg. 135:1-13 ( (Jan.) ) 1952; (1 ref.).
Thomas, R. G.; Rappoport, A. E., and Keogh, J. P.:  Obstruction of the Esophagus by Diseased Ectopic Gastric Mucosa , Dis. Chest 26:92-99 ( (July) ) 1954; (18 refs.).
Thomsen, G.:  Peptic Ulcer of Oesophagus , Acta radiol . 32:193-209, 1949; (22 refs.).
Tucker, G.; Lautz, V.; Tracy, J. B., and Fearon, B. W.:  The Diagnosis and Treatment of Benign Stenosis of the Esophagus, with Special Reference to Treatment by Dilatation with the Indwelling Cannulated Bougie , Ann. Otol. Rhin. & Laryng. 59:823-836 ( (Sept.) ) 1950; (9 refs.).
Wamberg, E.:  On Brachyoesophagus , Acta pædiat . 34:293-305, 1947; (16 refs.).
Waterston, D. J.:  Discussion on Hiatus Hernia , Proc. Roy. Soc. Med. 47:536-538 ( (July) ) 1954; (4 refs.).
 Hiatus Hernia , in Recent Advances in Pædiatrics , edited by D. Gairdner, London, J. & A. Churchill, Ltd., 1954;, pp. 158-163 (9 refs.).

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