Diagnosis and combined treatment of esophageal chemical burns in children]

The experience of management of 426 children with chemical burns of the esophagus and the stomach has been analyzed. The necessity of earlier (up to 3 hours) lavage not only of the stomach, but also of the esophagus, is substantiated. It is considered advisable to carry out diagnostic fibrogastroesophagoscopy not later than 1 day after the trauma and to give up early prophylactic bouginage of the esophagus. The latfer rather stimulates sear formation than prevents it. The developed scheme of treatment was used in 256 patients with resultant decrease of postburn stenoses of the esophagus 3 times is the results of conventional methods of treatment.     

局限性胃淀粉样变病

目的 提高局限性胃淀粉样变病的诊断率。方法 报告１例局限性胃淀粉样变病并复习有关文献,对其病因、发病机制、临床表现、诊断、治疗及预后进行分析。结果 本例局限性胃淀粉样变病患者无家族史及慢性疾病史,全胃切除术后病理诊断为局限性胃淀粉样变病ＡＡ型,其他组织如食道、十二指肠、直肠、骨髓未见淀粉样变质沉淀。结论 对于胃恶性肿瘤的鉴别诊断,应考虑本病的可能;为避免本病并发症的发生,应行切除手术。     

Use of a single-row suture in surgery of the gastrointestinal tract]

The authors show the results of experimental and clinical study of a single-row Pirogov-Mateshuk serous-muscular-subserous suture with the knots inside the lumen. It was demonstrated in experiments on 191 dogs that regeneration in the zone of anastomoses formed by a single-row suture is more perfect and occurs earlier than with the application of a double-row suture. Among 2,623 anastomoses formed on the esophagus, stomach, small intestine, colon, and rectum by means of a single-row suture, 1.5% were incompetent. The authors consider the single-row Pirogov-Mateshuk suture to be the method of choice.     

Endoscopic laser therapy for gastrointestinal neoplasms

Neoplasms of the esophagus, stomach, duodenum, ampulla, colon, and rectum have been treated with endoscopic laser therapy. For the most part, the therapy has been palliative, although curative treatment has sometimes been achieved. Considerations involved in management of cancers of the GI tract by the laser are discussed and future options envisioned.     

Time Trends and Disparities in Lymphadenectomy for Gastrointestinal Cancer in the United States: A Population-Based Analysis of 326,243 Patients

Background

The value of lymphadenectomy in most localized gastrointestinal (GI) malignancies is well established. Our objectives were to evaluate the time trends of lymphadenectomy in GI cancer and identify factors associated with inadequate lymphadenectomy in a large population-based sample.

Methods

Using the National Cancer Institute’s Surveillance Epidemiology and End Results Database (1998–2009), a total of 326,243 patients with surgically treated GI malignancy (esophagus, 13,165; stomach, 18,858; small bowel, 7,666; colon, 232,345; rectum, 42,338; pancreas, 12,141) were identified. Adequate lymphadenectomy was defined based on the National Cancer Center Network’s recommendations as more than 15 esophagus, 15 stomach, 12 small bowel, 12 colon, 12 rectum, and 15 pancreas. The median number of lymph nodes removed and the prevalence of adequate and/or no lymphadenectomy for each cancer type were assessed and trended over the ten study years. Multivariate logistic regression was employed to identify factors predicting adequate lymphadenectomy.

Results

The median number of excised nodes improved over the decade of study in all types of cancer: esophagus, from 7 to 13; stomach, 8–12; small bowel, 2–7; colon, 9–16; rectum, 8–13; and pancreas, 7–13. Furthermore, the percentage of patients with an adequate lymphadenectomy (49 % for all types) steadily increased, and those with zero nodes removed (6 % for all types) steadily decreased in all types of cancer, although both remained far from ideal. By 2009, the percentages of patients with adequate lymphadenectomy were 43 % for esophagus, 42 % for stomach, 35 % for small intestine, 77 % for colon, 61 % for rectum, and 42 % for pancreas. Men, patients >65 years old, or those undergoing surgical therapy earlier in the study period and living in areas with high poverty rates were significantly less likely to receive adequate lymphadenectomy (all p?<?0.0001).

Conclusions

Lymph node retrieval during surgery for GI cancer remains inadequate in a large proportion of patients in the USA, although the median number of resected nodes increased over the last 10 years. Gender and socioeconomic disparities in receiving adequate lymphadenectomy were observed.     

Conservative management of nongangrenous esophageal and gastric pneumatosis

Pneumatosis intestinalis, or air within the wall of the gastrointestinal tract, has been documented from the esophagus to the rectum. Its presence can suggest gangrenous changes of the stomach or colon and represents a surgical emergency. However, pneumatosis intestinalis can also occur as a result of a benign, nongangrenous condition. We report the conservative management of a patient with nongangrenous gastric and esophageal pneumatosis.     

Total Gastrointestinal Tract Necrosis After Ingesting a Considerable Amount of Hydrochloric Acid

Background  It has not been reported that ingesting large amounts of strong acid resulted in total gastrointestinal tract necrosis. Here we describe a case of a man with total gastrointestinal tract necrosis after ingestion of a considerable amount of hydrochloric acid. Discussion  Computed tomography (CT) scan showed significant free air in the neck, lateral esophagus, and abdominal cavity, which indicated perforation of the esophagus and gastrointestinal tract. In addition, the abdominal CT image showed splenic subcapsular hematorna and swollen pancreatic head caused by strong acid causis. We found the entire gastrointestinal tract from stomach to rectum necrosis in the emergency exploratory laparotomy. Our case suggests that ingestion of a considerable amount (e.g., 500 mL) and concentration of strong acid could result in total gastrointestinal tract necrosis. Emergency laparotomy should be performed as early as possible to benefit this kind of patient.     

A case of spontaneous rupture of the esophagus

Spontaneous rupture of the esophagus is rare. It's initial symptoms are so varied that we often have a hard time for making early diagnosis of esophageal rupture. In this case, emergency surgery was performed immediately after early diagnosis by chest CT. When the left thoracotomy was done, the upper portion of the stomach protruded with it's mucous membrane was reflected outward into the thoracic cavity above the diaphragm. When the reflected stomach was drawn back into the abdominal cavity for replacement, a ruptured wound of about 5 cm was observed on the left wall of the esophagus above the diaphragm. The stomach was seen protruded from this ruptured wound of the esophagus, with the mucous membrane reflected outward. No pathological abnormalities of esophagus itself was detected even after through investigation to search the cause for this clinically manifested weakness of the esophageal wall which eventually ruptured causing protrusion of the upper portion of the stomach into the thoracic cavity. The mechanism of this gastric protrusion is difficult to define. The most informative diagnostic investigation was the chest CT.     

Transesophageal gastrostomy

For gastrostomy after thoracic esophagus extirpation its distal stump was used. It is confirmed, that transesophageal gastrostomy has a number of advantages. Pezzer's catheter can be used as gastrostomic tube which self-fixes in given position and secures reliable gastrostoma sealing. Suturing of the stomach to parietal peritoneum around gastrostoma is not more necessary. Deformation and reduction of the stomach size are excluded and stomach is kept ready for subsequent plastic replacement of the oesophagus. The operation gets oncologically more radical as a result of removal of paraesophageal cellular fat and potentially metastatic lymph nodes during mobilization of the oesophagus and cardia distal stump. The routine technique of transesophageal gastrostomy is described. This technique is applied in 17 patients. Complications were not registered.     

Neural blockage of phenol-glycerine for cancer pain

Neural blocking of phenol-glycerine was used for the treatment of cancer pain originated from the esophagus, stomach, liver, lung, rectum, ovary, nasopharynx, head and neck. According to the dose difference, 148 cases were divided into three groups of 7-10% 4-5 ml (30 cases), 15-20% 3-4 ml (70 cases), and 25% 2-2.5 ml (48 cases). The result observed among the three groups as good or fair was 46.7%, 80% and 89.6% respectively, however, complications occurred too within the rate of 13.3%, 34.3% and 14.6% respectively. It is indicated that 2.5 ml of 15-25% phenol-glycerine seems better.     

Alkaline gastritis and alkaline esophagitis: a review.

Alkaline gastritis and alkaline esophagitis are now precisely defined syndromes. They occur most often after gastric surgery in which function of the pyloric and lower esophageal sphincter is compromised. Reflux of bile in these patients can then lead to severe inflammation of the gastric and lower esophageal mucosa. Epigastric pain, nausea and bilious vomiting are characteristic symptoms. Gastroscopy with biopsy is, therefore, the definitive diagnostic test; during endoscopy bile is seen in the lower esophagus or stomach, and the mucosa is red, friable and contains acute erosions. Conservative therapy including the administration of cholestyramine has not been helpful. Surgery consisting of diversion of the duodenal contents away from the stomach and lower esophagus is the treatment of choice. The Roux-en-Y procedure has been used most often and has resulted in the amelioration of the symptoms and signs in most patients.     

食管球囊扩张吻合的临床研究

目的 防止食管手术后吻合口瘘及吻合口狭窄并发症。方法 用末端带有气囊的胃管,插至食管断端,支撑和扩张食管腔,与胃或肠作开放式吻合。结果 １２１例病人均未发生吻合口瘘及吻合口狭窄。结论 食管球囊扩张吻合法明显优于传统的吻和方法,可以显著降低食管吻合口瘘及吻合口狭窄并发症。     

Removal of open safety pins in infants by flexible endoscopy is effective and safe

PURPOSE: In our country, safety pin ingestion by infants is commonplace. When swallowed, open safety pins are mostly found within the esophagus or stomach, and they cannot be easily removed by rigid esophagogastroscopy. Our aim was to evaluate the removal of safety pins using flexible endoscopy in infants. MATERIALS AND METHODS: We evaluated the cases of 7 infants who had ingested open safety pins between 2001 and 2004. In all the patients, the primary diagnostic tool was a direct x-ray of the neck, chest, and abdomen. In all cases, the safety pins were removed by flexible esophagogastroduo-denoscopy. Clinical records for the cases were reviewed. RESULTS: Four of the open safety pins were lodged in the esophagus, two in the stomach, and one in the duodenum. One infant had a safety pin lodged in the esophagus with the pin's open end pointed caudally; the pin was held with the endoscopic forceps by its tail end and removed. Three safety pins in the esophagus had their open ends pointing cephalad; these were held by their tail ends using the endoscopic forceps and pushed into the stomach. Then they were rotated in the stomach and removed tail end first. The safety pins located in the stomach or duodenum were also removed similarly. All safety pins were successfully removed, and there were no operative complications. CONCLUSION: Open surgery or other invasive removal methods are not necessary in infants with open safety pin ingestions. In our opinion, the best way to extract an open safety pin from the esophagus, stomach, or duodenum is by using a flexible endoscopic device.     

Subtotal leiomyomatosis of the esophagus and proximal part of the stomach

Generalized leiomyomatosis of the esophagus and stomach is a rare disease. According to literature data, age of the patients ranges from 9 to 84 years, in men this disease is diagnosed 2 times more often than in women. It is necessary to differentiate this disease with cancer, esophageal diverticulum, achalasia of the cardia, hiatal hernia. In our case a woman of 32 years was ill from 5 years of age. Correct diagnosis was not made before surgery. Endoscopic examination suspected leiomyoma. Only repeated urgent histological tests during surgery resulted in accurate diagnosis (subtotal leiomyomatosis of the esophagus and proximal stomach) and in adequate surgical policy--subtotal resection of the esophagus and proximal resection of the stomach with Toprover gastrostoma creation. Then, retrosternal esophagocoloplasty was performed. 2 years after the first surgery the state of the patients is satisfactory, there are no symptoms of recurrence of the disease.     

Guía de uso e indicaciones de la fluorescencia con verde de indocianina (ICG) en cirugía general: recomendaciones basadas en la revisión descriptiva de la literatura y el análisis de la experiencia

Indocyanine Green is a fluorescent substance visible in near-infrared light. It is useful for the identification of anatomical structures (biliary tract, ureters, parathyroid, thoracic duct), the tissues vascularization (anastomosis in colorectal, esophageal, gastric, bariatric surgery, for plasties and flaps in abdominal wall surgery, liver resection, in strangulated hernias and in intestinal ischemia), for tumor identification (liver, pancreas, adrenal glands, implants of peritoneal carcinomatosis, retroperitoneal tumors and lymphomas) and sentinel node identification and lymphatic mapping in malignant tumors (stomach, breast, colon, rectum, esophagus and skin cancer). The evidence is very encouraging, although standardization of its use and randomized studies with higher number of patients are required to obtain definitive conclusions on its use in general surgery.The aim of this literature review is to provide a guide for the use of ICG fluorescence in general surgery procedures.     

The relative effects of lesser curvature vagotomy and esophageal vagotomy on the acid secretory effect of proximal gastric vagotomy

Proximal gastric vagotomy is an operation consisting of division of all vagal fibers to the acid-secreting portion of the stomach. These fibers are usually divided along the lesser curvature of the stomach; however, because of a high rate of duodenal ulcer recurrence in some series, it has become apparent that it is important to divide the vagal fibers to the stomach leaving the main vagal trunks along the distal 5 cm of esophagus in order to achieve both adequate control of acid secretion and also a lower duodenal ulcer recurrence rate. The data presented in this study of ten mongrel dogs suggest that, in the dog, division of the vagal fibers along the lesser curvature is more important in reducing acid secretion than is esophageal vagotomy; but the data also emphasize the contribution of the vagal fibers along the distal esophagus since a marked reduction in 2 DG-stimulated acid secretion can only be achieved by dividing the vagal fibers around the distal esophagus as well as those along the lesser curvature.     

Possibilities of chromoesophagoscopy for diagnosis of Barrett's esophagus

When the distal esophagus is covered with columnar gastric mucosa up to 2 cm from the esophagogastric junction it is considered normal. If the distal esophagus is covered with columnar epithelium more than 2 cm from the esophagogastric junction, it is called Barrett's esophagus. We have developed a new chromoesophagoscopic method to improve diagnostic testing for Barrett's esophagus. The distinctive feature of this method is that 4 to 5 ml of a 1% solution of neutral red is administered intravenously, after which excretion of the stain by the esophageal mucosa is examined by endoscopy. Chromoesophagoscopy has been carried out in 11 patients with reflux esophagitis. It revealed Barrett's esophagus in four patients, which was proved by histologic evaluation of biopsy specimens obtained from the stained zone of the esophageal mucosa. These observations suggest that chromoesophagoscopy is an effective, accessible, feasible, safe method for diagnosing Barrett's esophagus. It allows us to determine the length of the metaplastic epithelium and the topography of gastric glands; it also allows us to examine parietal cells in the esophagus and estimate the functional activity of these parietal cells in metaplastic epithelium.     

瘢痕食管切除胃代食管治疗腐蚀伤后瘢痕狭窄

收治食管及胃腐蚀伤１０５例，对病变位于食管中下段１２例采用瘢痕食管切除胃代食管术治疗。术中解剖较松动，出血少，无术后并发症；２例病变明显高于术前估计，切除食管至颈部吻合，手术甚为困难。结论：中下段的瘢痕狭窄可行瘢痕食管切除，胃代食管也甚方便，对中段以上狭窄，仍以旷置狭窄段食管结肠代食管为宜。     

Endoscopic diagnosis of Barrett's adenocarcinoma]

Biopsy specimens can reveal that esophageal cancer is an adenocarcinoma but they cannot show that its origin is Barrett's mucosa. Therefore we must show during endoscopy that the tumor exists in Barrett's mucosa. We reported that Barrett's esophagus could be clearly diagnosed at endoscopy as the columnar mucosa lying on the longitudinal vessels in the lower esophagus. We define Barrett's esophagus as "the columnar mucosa in the esophagus which exists continuously more than 2 cm in circumference from the stomach." Short-segment Barrett's esophagus (SSBE) is "the columnar mucosa which exists in the esophagus continuously from the stomach but its length has a part under 2 cm in length." Endoscopically Barrett's adenocarcinoma is visualized as a lesion with a reddish and uneven mucosal surface. Barrett's adenocarcinomas occur in the SSBE as well. Endoscopic observation at periodic intervals is necessary not only for cases with Barrett's esophagus but also with SSBE. A further examination is necessary to determine the application of EMR for superficial Barrett's adenocarcinoma.