Endoscopic laser therapy of chemical burns of the esophagus (clinico-morphologic studies)

Clinical and morphological studies were performed to evaluate the results of endoscopic helium-neon laser therapy in 34 patients with chemical esophageal burns. There was an accelerated epithelization of the impaired esophageal mucosa, which occurred on the second week following the esophageal burning. It was concluded that it was advisable to include local endoscopic laser therapy into the combined treatment of patients with chemical esophageal lesions.     

Morphology of the reparative processes in the early period following chemical burns of the esophagus]

Changes in 25 esophaguses following burns with cauterizing substances in patients treated with hormonal steroids and by bougienage were studied using histochemical methods. Effects of acids and alkalies were revealed at early stages of burn disease and consisted of lesions of a various depth of the esophagus wall. Formation of scars started from the first days after burns and led to the rearrangement of the esophagus wall. A year following the burn the healing of the damaged esophagus was not completed, and changes therein acquired a character of necrotic-ulcerative esophagitis. Hormonal treatment brought about a decrease in leucocytic infiltration in the esophagus wall. The periods of development of scars in the esophagus of patients treated with hormonal preparations according to the conventional scheme and treatment by bougienage coincided.     

Esophagogastroimpedancemanometry in diagnosis of gastroesophageal reflux in patients with chemical burns of the stomach

Esophagogastroimpedancemanometry conducted in 40 patients with chemical bums of the stomach (CBS) in acute and early postburn periods has revealed that CBS affect motor function of the cardia in 95% patients. This motor cardial dysfunction results in erosive and erosive-ulcerous reflux-esophagitis in 22.5% patients. Motor dysfunction of the cardia and esophagitis depends both on CBS severity and time since the trauma. Gastroesophageal reflux in CBS patients is triggered by intragastric hypertension accompanied with lowering of the esophageal-gastric pressure gradient provoking motor dysfunction of the esophagus and reduction of the esophageal clearance.     

Relationship between the epithelium and connective tissue at different stages of healing of chemical burns of the esophagus]

The interaction between the epithelial and connective-tissue structures was studied on 70 scarry changes in the oesophagus at various times (from 1 year to 45 years) following chemical burns. As sclerotic alterations progressed, proliferation of the layers of the stratified squamous epithelium decreased, which was particularly evident in the zones of strictures of the lumen of the damaged oesophagus. Exacerbation of inflammation due to repeated traumatization of the oesophagus wall was accompanied by proliferation of the epithelial layers. Only 25-30 years after the burns in the proliferative layers of the epithelium there were noted signs of atypia. The chronic inflammation was accompanied by marked lympho-plasmocytic infiltrations. This may indicate to concomitance of chronic oesophagitis with manifestations of autoimmune reactions.     

Squamous carcinoma of the esophagus in patients with Barrett esophagus

Adenocarcinoma of the esophagus is a well-known complication of Barrett esophagus, especially in white men. We present three cases of squamous carcinoma of the esophagus in Barrett patients. All three patients were white men. None had a history of symptomatic gastroesophageal reflux or of Barrett esophagus, but all had substantial usage of alcoholic beverages and tobacco. All three tumors were located in squamous-lined mucosa above the Barrett mucosa. Columnar epithelial dysplasia was present in the Barrett mucosa of two of our patients, and the third patient had a squamous carcinoma of the pharynx. Squamous carcinoma represented 2% of Barrett-associated esophageal carcinomas at our institution in 1980 through 1986. Five additional cases were found in the literature, and all were also in white men. This demographic predominance stood in striking contrast to the 26% prevalence of white patients among those with squamous carcinoma of the esophagus at our institution (P less than 0.0002) and to the 50% prevalence of white men among our patients with Barrett esophagus (P less than 0.02). Two of the literature cases also had substantial alcohol and tobacco usage and had synchronous adenocarcinoma arising in Barrett mucosa. Our findings of a strikingly high prevalence of white men and of multifocal neoplastic changes in the upper aerodigestive tract suggest a pathogenetic relationship between squamous carcinoma of the esophagus and Barrett esophagus, possibly due to alcoholic beverage and tobacco usage. Endoscopic surveillance of Barrett patients for early detection of adenocarcinoma has been recommended; contemporaneous evaluation of the squamous-lined esophagus by biopsy and cytopathology may be advisable.(ABSTRACT TRUNCATED AT 250 WORDS)     

The use of photodynamic therapy for diseases of the esophagus

This is a review of the uses, history, and current status of photodynamic therapy for diseases of the esophagus, specifically Barrett's dysplasia and early esophageal carcinoma. This paper describes the clinical experience of photodynamic therapy and compares the use of various photosensitizer drugs. Finally, important biophotonics developments are discussed, including their anticipated impact for improved endoscopic detection of dysplasia and carcinoma. In addition, methods for real-time photodynamic therapy and light dosimetry are provided in order to optimize ablation treatment outcomes while minimizing the risk of complications.     

The surgical management of patients with carcinoma of the midthoracic esophagus.

Clinical and pathological findings in 15 patients with carcinoma of the midthoracic esophagus were analyzed. The author concluded that preoperative radiotherapy reduces tumor size and improves resectability. Longer follow-up is required to determine whether or not preoperative radiotherapy improves survival rates in these patients.     

The effect of HeNe laser radiation on the thyroid gland of the rat

Although laser irradiation is becoming common practice in medicine, there is not always a clear understanding of the possible side-effects. The present report is a light and electron microscopic study of the effects of fixed low intensity doses of soft HeNe laser on the thyroid of Wistar rats. The immediate effects are mild multifocal degenerative changes; these lesions recover in less than 3 months. Long-term lesions are identified only by electron microscopy; they consist of an increased number of peroxisomes and free or intramitochondrial crystalline structures. We discuss the laser's hypothetical functions.     

Quantification of serum IgE in patients with burns

IgE levels in the serum of individuals with burns were sequentially measured and compared to IgE levels in normal control blood donors. Following a burn, the levels of IgE protein showed a significant, although modest, increase, usually evident between days 14 and 22. In an occasional patient, the IgE levels rose by as much as five times in value during this period. Because of the complexity of the clinical situation associated with the burn patients, we cannot ascribe these elevations of IgE to the burn per se, but must consider the possibility of other factors, especially those involved in the treatment of the burn as well as the infection. The magnitude of the elevation of IgE in the burn patients (geometric mean = 272 ng/ml) was considerably lower than the magnitude of the elevations seen in atopic dermatitis and generalized neurodermatitis (geometric means = 2265 and 2071 ng/ml, respectively). Thus simple trauma to the skin is not a sufficient explanation for the elevated serum IgE levels in atopic dermatitis and generalized neurodermatitis.     

Prevalence and characteristics of Barrett esophagus in patients with adenocarcinoma of the esophagus or esophagogastric junction

The prevalence and characteristics of Barrett esophagus in patients with adenocarcinoma of the esophagus or esophagogastric junction are uncertain. We studied 61 consecutive esophagogastrectomy specimens with adenocarcinoma, which were subjected to extensive histopathologic examination. Barrett esophagus was found in 64% of the cases (39 of 61), but had been recognized in only 38% of the patients with Barrett-associated carcinoma who had undergone preoperative endoscopy with biopsy (13 of 34). The median extent of Barrett esophagus with adenocarcinoma was 5 cm (range, 1 cm to 12 cm), and distinctive-type ("specialized") Barrett mucosa predominated (35 of 39; 90%). The Barrett adenocarcinomas were centered in the distal esophagus 2 cm +/- 0.3 cm above the esophagogastric junction. The patients with Barrett adenocarcinoma showed a striking predominance of white men (34 of 39; 87%) in contrast to gastric adenocarcinoma cases (21 of 69; 30%) and to Barrett patients without carcinoma or dysplasia (75 of 149; 50%), but similar to patients having adenocarcinoma of the esophagus or esophagogastric junction without demonstrable Barrett esophagus (16 of 22; 73%). Our findings suggest that most adenocarcinomas of the esophagus or esophagogastric junction are Barrett carcinomas, rather than gastric cardiac cancers or other types of esophageal adenocarcinoma; most Barrett adenocarcinomas occur in short segments of Barrett esophagus, which may be difficult to detect at endoscopy; and white men with Barrett esophagus may constitute a clinically identifiable at-risk group suitable for surveillance.