Management of oesophageal cancer at Westmead Hospital from 1979-1985

The aim of this study was to evaluate the various treatment options, including radiotherapy, surgery and chemotherapy, when all patients with carcinoma of the oesophagus were assessed and managed by the same team. From December 1, 1979 to December 31, 1985, 144 patients with carcinoma of the oesophagus were referred to Westmead Hospital. Eighty-five patients were men, 59 patients were women and the median age was 63 years. Twenty-five patients were at stage I, 75 patients were at stage II, 24 patients were at stage III and 20 patients were at stage IV of oesophageal cancer. Forty-two patients underwent surgical resection. Fifty patients underwent radical radiotherapy, 30 patients underwent palliative radiotherapy and 22 patients underwent palliative intubation. The operative mortality of those patients who underwent surgery was zero. The treatment mortality of those who underwent radical radiotherapy was 6%, and for those who underwent palliative radiotherapy, was 16.7%. The mortality after intubation was 12.5%. The prevalence of benign strictures was 7.5% after surgery, 33% after radical radiotherapy and 8% after palliative radiotherapy. The prevalence of malignant strictures (recurrent disease) was 2.5% after surgery, 21% after radical radiotherapy and 20% after palliative radiotherapy. The median survival after surgery was 12 months; that after radical radiotherapy, 12 months; that after palliative radiotherapy, six months; and that after intubation, 3.5 months. Where all patients with carcinoma of the oesophagus were managed by a team approach the treatment mortality was low but the long-term survival remained poor.     

Isolated oesophageal cyst connected with the bronchus

We report an unusual case of a patient with an oesophageal cyst connected to the bronchus. A 24-year old male with a two-year history of repeated attacks of chest infection and haemoptysis was found to have a cyst of 4 x 4 cm affecting the anterior and apical segments of the right upper lobe. The cyst was excised in its entirety and the histopathological study of the cyst showed stratified squamous epithelium with submucosal and muscular layer but no cartilage. The pathological diagnosis was an oesophageal cyst. No previous case of isolated oesophageal cyst connected to the bronchus has been reported according to the available literature.     

胸腔出入口区CT研究

目的：探讨胸腔出入口区的正常CT解剖和CT对该区病变的诊断及鉴别诊断价值。方法：回顾性分析经病理及临床证实的117例胸腔出入口区病变的CT表现，对50例正常对照组在CT上分为5个解剖区：1区（甲状腺区）；2区（甲状腺内侧区）；3区（甲状腺外侧区）；4区（甲状腺后区）；5区（甲状腺前区）。结果：在117例中，1区11例（9．40％），2区8例（6．84％），3区72例（61．54％），4区1例（0．85％），5区3例（2．56％），跨1，3，5区15例（12．8％），跨1，2，3区7例（5．98％）。病变主要分布在3区，其中以淋巴结病变最为多见（55例）；甲状腺病变（33例）主要分布在1区和跨区生长。结论：在CT上对胸腔出入口区合理的划分5个解剖区，有利于病变的定位和定性1诊断，具有重要的临床应用价值。     

Enkephalin inhibits relaxation of the lower oesophageal sphincter

Five healthy volunteers were studied for the effect on oesophageal motility of a single subcutaneous injection of a synthetic analogue of enkephalin as compared with an injection of an equivalent volume (0.5 ml) of saline. The injections were given at random on separate days, and each was followed after 40 minutes by 2 mg naloxone given intravenously. Pressures were measured by manometry after dry and wet (5 ml) swallows at one-minute intervals, and traces were coded and analysed "blind". Twenty-five minutes after the injection of enkephalin the percentage relaxation of the lower oesophageal sphincter pressure was significantly less (p less than 0.005) than at the same time after saline. Within two minutes after intravenous naloxone this effect had disappeared completely. Enkephalin had no noticeable effect on pressure of the sphincter or on amplitude and duration of oesophageal peristalsis. The mechanism of action of enkephalin in selectively inhibiting relaxation of the lower oesophageal sphincter remains to be determined. That naloxone rapidly reversed the inhibition may be relevant in achalasia and warrants further study.     

Hypopharyngeal and oesophageal foreign bodies

Foreign bodies in the food passages are quite common in Jos Community. Majority of 119 cases seen over a period of four years were children 92.4% and a coin was the commonest foreign body (86.5%). The site of lodgement of the foreign body was hypopharynx and abdomen in 11 cases each while 97 were held in oesophagus, mainly in its upper part. Removal of the foreign body by oesophagoscopy was difficult in patients who presented late. The coins formed a pouch in posterior oesophageal wall in six cases while their anterior surfaces got discoloured in 14 cases causing difficulty in their identification. Besides coins in children and dentures in adults, nine patients accidently swallowed a wide variety of foreign objects of different shapes and sizes. Management of such cases has been discussed.