Esophageal schwannoma: Case report and epidemiological,clinical, surgical and immunopathological analysis

IntroductionSchwannoma is a tumor of the peripheral nervous system originated in the Schwann cells of the neural sheath.Presentation of caseA 43-years-old male complained of odynophagia, dysphagia and hemoptysis. The upper gastrointestinal endoscopy showed a smooth elevated lesion, 20 cm from the incisor teeth, occupying the entire lumen of the esophagus. The chest computed tomography (CT) scan showed a lesion of 7 cm and superior mediastinal, lower paraesophageal and cardiac enlarged lymph nodes. A posterolateral thoracotomy was performed with total esophagectomy without intraoperative complications. The anatomopathological analysis revealed fusocellular mesenchymal neoplasia of low malignancy potential. The immunohistochemical study showed positivity for S-100 protein and KI67 antibodies and absence of staining for CD117, CD34, ALK protein, SMA and Desmin. Thus, the morphological and immunohistochemical findings pointed to the diagnosis of esophageal Schwannoma.DiscussionAlthough rare and indolent, Schwannoma occurs in the peripheral nervous system, being uncommon in the esophagus.ConclusionThe immunohistochemical study is essential for the diagnosis, which is based on the positivity for S-100 protein and absence of staining for CD34 and CD117.     

Esophageal intramural diverticulosis: a clinical and pathological survey

This paper presents 3 patients with esophageal intramural diverticulosis and discusses the roentgenographic, manometric, histological, and microbiological picture attendant to this disease. Evidence is given to support chronic infection of esophageal submucosal glands as the predominant cause.     

Role of endoscopy in the treatment of non-variceal upper gastrointestinal hemorrhage

Over the past three decades important progress has been made in the diagnosis and treatment of non-variceal upper gastrointestinal bleeding. We discuss the endoscopic techniques available today in combination therapies. The data in the literature regarding endoscopic techniques are discordant and no single technique has proved statistically superior in the management of bleeding. We believe that the initial injection approach is still the procedure of choice, particularly when performed by less expert endoscopists.     

Epileptic seizures in intracerebral hemorrhage: a clinical and prognostic study of 55 cases

Fifty-five cases of epileptic seizures associated with spontaneous intracerebral hemorrhage are reported. Seizures appeared as the first symptom in 23 patients, early (within two weeks after HI) in 18 and late (later than 2 weeks after HI) in 14. From the analysis of the observed cases we noticed that: 1) partial seizures were most frequent type (63%). These appeared mainly in cases with lobar hemorrhage above all; 2) development chronic epilepsy occurred frequently in the case of patients affected by late seizures. We compare our data with those reported in literature in order to highlight main factors which affect the onset and development of seizures associated with spontaneous intracerebral haemorrhage.     

Esophageal perforations and fistulas: clinical management

Aim of this study was the literature review regarding esophageal perforations and fistulas. We examined the most common causes, clinical findings (symptoms and signs), laboratory and imaging studies for differential diagnosis and complications. Finally, we examined the surgical or endoscopic treatment and the prognosis.     

Suicide by burning: epidemiological and clinical profiles

Self-immolation constitutes a rare form of suicide in developed countries, though it accounts for unique injury characteristics in the burn intensive care unit. The aim of this study was to present the epidemiological and clinical features of patients burned during a suicidal attempt seen in a North Rhine-Westphalia burn intensive care unit (BICU). To address this aim, we undertook a 21-year retrospective study involving patients with thermal injuries admitted to the largest burn unit in Germany. A total of 125 suicide-related burn victims were identified in the study period (9.4%). Comparing the self-immolation group with the rest burn patient cohort, suicide victims were more likely to be single and to act under the influence of alcohol. The suicidal group had a larger extent of burns, higher incidence of inhalation injury, required more surgical procedures, catecholamines, blood transfusions, and a longer BICU stay. Their clinical course was complicated by prolonged intubation period, higher rate of multiple drug-resistant bacteria acquisition and sepsis, leading to a higher mortality rate. Although the proportion of self-immolation victims among all burned patients is not high, the markedly higher severity of their burns and their poorer quality of outcomes makes them an important clinical subgroup for further study.     

Spontaneous hemopneumothorax: epidemiological details and clinical features

Purposes

Spontaneous hemopneumothorax (SHP) may cause life-threatening blood loss. The objective of this study was to elucidate the epidemiological and clinical features of SHP.

Methods

We reviewed the records of 26 patients who underwent surgery for SHP between 1989 and 2010. We evaluated their epidemiology and clinical features by comparing them with those of 681 patients with spontaneous pneumothorax treated during the same period.

Results

The proportion of smokers in the SHP group was higher than that in the spontaneous pneumothorax group (P < 0.01). Seventeen cases (65.4 %) of SHP occurred on the left side. The most frequent bleeding area was the superior thoracic aperture (STA:17 cases, 65.4 %), followed by the left superior mediastinum (six cases, 23.1 %). Ten cases had intrathoracic clots greater than 500 mL, which could not be drained preoperatively. The postoperative stay of patients treated with video-assisted thoracic surgery (VATS) was shorter than that of patients treated with open thoracotomy (21 versus five cases; P < 0.05).

Conclusions

A higher proportion of smokers was revealed in the SHP patients. VATS shortened the hospital stay of the patients. The particular areas that should be observed intraoperatively are the STA and the left superior mediastinum.     

Acetabular fractures: a 16-year prospective epidemiological study

We prospectively analysed the epidemiology of acetabular fractures over a period of 16 years in order to identify changes in their incidence or other demographic features. Our study cohort comprised a consecutive series of 351 patients with acetabular fractures admitted to a single institution between January 1988 and December 2003.There was no significant change in the overall incidence of acetabular fractures, which remained at 3 patients/100 000/year. There was, however, a significant reduction in the number of men sustaining an acetabular fracture over the period (p < 0.02). The number of fractures resulting from falls from a height < 10 feet showed a significant increase (p < 0.002), but there was no change in those caused by motor-vehicle accidents. There was a significant reduction in the median Injury Severity score over the period which was associated with a significant decrease in mortality (p < 0.04) and a reduction in the length of hospital stay. The incidence of osteoarthritis noted during follow-up of operatively-treated fractures declined from 31% to 14%, reflecting improved results with increasing subspecialisation. Our findings suggest that there will be a continuing need for some orthopaedic surgeons to specialise in the management of these fractures. In addition, the reductions in the Injury Severity score and mortality may be associated with improved road and vehicle safety.     

Kidney disease in Bahrain: a biopsy-based epidemiological study

The aim of this study was to establish the incidence of renal diseases in Bahrain during January 2003 through October 2006, based on biopsy results. This study continued a previous biopsy-based survey covering 13 years from January 1990 through December 2002. Comparisons were made with the previous study to ascertain whether the disease pattern continued in the same trend. The current study included 145 biopsies on 130 patients, of whom glomerular diseases constituted 64.8%; transplant biopsies, 23.4%; chronic glomerulosclerosis, 8.9%; and other etiologies, 4.1%. There were comparable numbers of primary and secondary glomerular diseases in the present series. The incidence of renal biopsies per 100,000 population per year did not significantly change over the last 15 years: 5.4/100,000 per year in the present series versus 5.8/100,000 per year in the previous study. The pattern of primary glomerular diseases showed the minimal change disease--focal segmental glomerulosclerosis (MCD-FSGS) complex--remained the most common of all primary glomerular diseases, although decreased in absolute numbers compared with the previous study. A significant increase in the number of patients with immunoglobulin A nephropathy was observed over the years. Secondary glomerular diseases showed an increased incidence with lupus nephritis the number one diagnosis. Also we observed a steady increase in the number of allograft biopsies.     

重型原发性脑室出血临床研究

目的:提高脑室出血的抢救治疗水平。方法:回顾性分析45例重型原发性脑室出血病人的病史、体检、CT扫描及诊疗经过对其相关资料综合分析,总结。结果:尿激酶灌洗治疗脑室内出血症状改善率100％。结论:尿激酶灌洗治疗脑室内出血安全有效;重性脑室内出血病人易并发MSOF;血压控制对治疗效果影响极大。     

The cephaloceles: A clinical,epidemiological and therapeutic study of 50 cases

IntroductionCephaloceles are congenital malformations characterized by externalization of the meninges and/or brain tissue through a congenital skull bone defect. In developed countries, this malformation is rare but in our developing countries, this pathology remains one of our concerns.ObjectiveTo describe the epidemiological, clinical and therapeutic aspects of the cephaloceles.Materials and methodA retrospective study was conducted from 2007 to 2013 on all cases of cephalocele supported in the department of neurosurgery of the Yalgado Ouédraogo University Teaching Hospital of Ouagadougou. The malformations were supplemented by CT scan. All patients were operated. The surgical procedure in cephaloceles of the convexity consisted of a direct approach. Sincipital cephaloceles were operated by transcranial approach or combined approach associating transcranial and transnasal approaches.ResultsFifty patients were gathered during the 7-year period. There were 18 boys and 32 girls. The ages ranged from 1 day to 11 years. The cephaloceles were located on the vault of the skull in 78%; the lesion was sincipital in 22%. The malformation was covered with normal skin in 92%; it was pediculated in 78%. CT scan allowed the classification of cases as meningo-encephaloceles in 31 cases (62%) and meningoceles in 18 cases (36%) and one pure encephalocele. The immediate postoperative course was uneventful in 42 cases (84%); 8 postoperative deaths were recorded. At medium and long term, 4 patients (8%) developed complications of psychomotor deficiency in 3 cases and hydrocephalus in 1 case. The main reasons for the poor prognosis were superinfection, hydrocephalus and/or other brain malformations.ConclusionCephaloceles remain relatively frequent in our practice. After surgery, mental failure and hydrocephalus can occur impairing the prognosis. The most suitable solution is a policy of prevention with folic acid treatment before and during pregnancy and following up adequate pregnancies.     

Drug-resistant tuberculosis in Waltham Forest, 1953-68: A clinical and epidemiological study

A study of acquired and primary drug resistance in pulmonary tuberculosis has been made in the London Borough of Waltham Forest over the 15-year period 1953-68. Aetiology, clinical and bacteriological features, treatment, and prognosis are examined and contrasted for both groups of patients. The incidence of both types of resistance is compared with the national incidence and is considered in relation to Commonwealth immigration into the borough. Reasons are suggested for the decline of the acquired and the rise in the primary type of resistance. National surveys of drug-resistant tuberculosis have served a valuable purpose in focussing epidemiological attention on the many problems raised by this potentially dangerous form of the disease.     

H2-receptor antagonists and the incidence of gastroduodenal ulcer perforation and hemorrhage. An epidemiological study

The only curative treatment to proximal bile duct cancers with involvement of both hepatic ducts is liver transplantation. A curative resection with wide lateral clearance is limited due to the neighbourhood of vital anatomic structures in the liver hilum. The majority of patients with bile duct cancers is over 60 years of age and due to concomitant disease, they do not fulfill the requirements for liver transplantation. Our treatment strategy in adequate cases is palliative tumor resection and reconstruction of bile passage by sutureless biliodigestive anastomosis as proposed by Rodney Smith. We treated 11 patients with this method, in 5 patients an additive combined radiotherapy by percutaneous radiation and intraluminal after-loading therapy was performed. Our results indicate that this strategy leads to effective palliation in cases provided that only microscopic residual tumor is left in situ (R1-resection). Our observed survival times compare favorably to survival times after liver transplantation (average survival time 11.5 months median survival time 10 months).     

Esophageal and tracheal distortion by the Esophageal-Tracheal Combitube: a cadaver study

PURPOSE: To understand the anatomical relationships of the Esophageal-Tracheal Combitube (ETC) with the larynx, pharynx, esophagus and trachea. METHODS: An extensive dissection of the neck and thorax of a 70-yr-old caucasian male cadaver was done to expose the larynx, pharynx, trachea and esophagus. The ETC was inserted following the manufacturer's recommendations. Effects of the ETC on the surrounding structures were observed with the ETC first inserted in the esophagus and then, in the trachea. RESULTS: When inserted in the esophagus, the ETC produced marked bulging of the anterior wall of the esophagus and anterior displacement (4.5 cm) of the trachea. Inflation of the distal cuff of the ETC produced distension of the esophagus. When inserted in the trachea, the ETC also caused anterior protrusion. CONCLUSION: Protrusion of the anterior wall of the esophagus and distension resulting from inflation of the distal cuff could lead to esophageal injuries. These observations may explain the previously reported complications associated with the use of the ETC.     

Esophageal and gastric malignancies after bariatric surgery: a retrospective global study

BackgroundBariatric surgery can influence the presentation, diagnosis, and management of gastrointestinal cancers. Esophagogastric (EG) malignancies in patients who have had a prior bariatric procedure have not been fully characterized.ObjectiveTo characterize EG malignancies after bariatric procedures.SettingUniversity Hospital, United Kingdom.MethodsWe performed a retrospective, multicenter observational study of patients with EG malignancies after bariatric surgery to characterize this condition.ResultsThis study includes 170 patients from 75 centers in 25 countries who underwent bariatric procedures between 1985 and 2020. At the time of the bariatric procedure, the mean age was 50.2 ± 10 years, and the mean weight 128.8 ± 28.9 kg. Women composed 57.3% (n = 98) of the population. Most (n = 64) patients underwent a Roux-en-Y gastric bypass (RYGB) followed by adjustable gastric band (AGB; n = 46) and sleeve gastrectomy (SG; n = 43). Time to cancer diagnosis after bariatric surgery was 9.5 ± 7.4 years, and mean weight at diagnosis was 87.4 ± 21.9 kg. The time lag was 5.9 ± 4.1 years after SG compared to 9.4 ± 7.1 years after RYGB and 10.5 ± 5.7 years after AGB. One third of patients presented with metastatic disease. The majority of tumors were adenocarcinoma (82.9%). Approximately 1 in 5 patients underwent palliative treatment from the outset. Time from diagnosis to mortality was under 1 year for most patients who died over the intervening period.ConclusionThe Oesophago-Gastric Malignancies After Obesity/Bariatric Surgery study presents the largest series to date of patients developing EG malignancies after bariatric surgery and attempts to characterize this condition.