维生素A,E对化学性烧伤的食管粘膜修复的实验研究和临…

以不同浓度的氢氧化钠浓度烧伤家兔食管后对食管观察显示，局部病变的程度与所服腐蚀剂的浓度呈正相关，以维生素Ａ、Ｅ治疗烧伤动物和患儿表明，二者对食管粘膜再生有促进作用，即减少食管烧伤后胶原纤维的生成，从而减轻瘢痕的形成。     

050.儿童食管疤痕狭窄丹尼里瓦食管内切除术25年之治疗体会

25年之治疗体会作者报告儿童食管疤痕狭窄100例,其中83例按丹尼里瓦食管内疤痕切除术治疗,指出应用本术的适应症是:在食管腐蚀烧伤后至少六个月,尤其以膜性狭窄为宜,对狭长的疤痕狭窄不     

食管化学性烧伤

食管化学性烧伤系由于误服化学制剂酸、碱或含酸、碱的一些制品如洗涤剂,消毒剂等所引起。【病理改变】食管碱烧伤最常见。有人作实验性食管碱烧伤观察,肉眼所见反应包括肌肉痉挛,括约肌功能紊乱,剧烈的逆蠕动,胃内容反流等;显微改变在烧伤后1～5天粘膜表面皂化、栓塞、坏死以及细菌侵犯;4～7天出现坏死,组织脱落;8～12天后在坏死组织区出现成纤维细胞,坏死组织逐渐由胶元纤维所取代在7～21天是食管壁最脆弱的时期,大约至烧伤后21天,出现食管狭窄症状,28天以后狭窄完全形成。狭窄也可以发生在烧伤后一周以内,这主要     

硅胶探与金属探联用治疗严重食管瘢痕狭窄

目的：探讨食管瘢痕狭窄的有效治疗方法。方法：对６例食管化学性烧伤后瘢痕狭窄患者,以胃造瘘硅胶探与金属探联用进行扩张治疗。结果：６例疗效均满意,无任何并发症发生。结论：硅胶探与金属探联用行食管扩张术安全,并发症少,缩短疗程,疗效可靠,可作为较严重的食管瘢痕狭窄首选的扩张治疗方法。     

食管烧伤并发食管狭窄的治疗

作者认为:在食管烧伤时给予激素治疗是很必要的。因为无论是咽下强酸或强硷后,应用激素都可预防休克。特别在病后24—72小时内胸部有剧痛时应用激素的效果更好。激素亦可预防瘢痕形成。一旦发生瘢痕狭窄需行食管扩张时,使用激素可预防粘膜及粘膜下组织损伤后发生的肉芽。在烧伤后早期放置适当粗细的鼻饲管亦非常有效。应根据病情选用扩张子或食管镜进行食管扩张。     

冷冻治疗对食管形态和功能的影响

为确定冷冻治疗对食管的安全性和有效性,作者们进行了以下的动物实验研究。用猫12只,在麻醉和外科处理后,以一氧化氮作冷冻剂,在喉镜直视下以特制的冷冻探头经口插入食管,对远端食管以-70℃至-80℃冷冻2分钟。于冷冻后90分钟、4日、10日、14日、28日和42日将动物分批成对处死。处死前,对全部动物进行了食管X线钡餐透视检查及食管测压。结果发现,全部动物均可耐受这种食管低温冷冻,并可在冷冻后随意进食。食管测压检查见食管冷冻区蠕动波减小,但迅速恢复正常。X线钡透未见食管功能障碍。动物处死后食管形态学检查发现:冷冻后     

儿童纽扣电池食管异物临床治疗

目的　分析儿童纽扣电池食管异物临床诊断、治疗及预后特征,为纽扣电池类食管异物临床处理提供参考。方法　选取本院2016年4月~2018年5月收治的341例食 管异物中8例纽扣电池食管异物的患儿,结合纽扣电池大小、嵌顿时间、术中食管黏膜损伤情况及预后,综合分析纽扣电池类食管异物的临床特征。结果　8例患儿均为学龄前儿童;最短异物嵌顿时间3小时20分钟,最长243小时35分钟;7例异物位于食管第一狭窄,1例位于食管第二狭窄;食管黏膜轻度充血水肿1例;黏膜明显烧伤4例;食管狭窄,可疑穿孔1例;食管穿孔1例;气管食管瘘1例。术后胃肠减压最短3天,最长12天,1例气管食管瘘予空肠营养127天后治愈。结论　儿童纽扣电池类食管异物需急诊手术取出,门急诊需警惕纽扣电池类食管异物;术中需仔细检查食管黏膜损伤情况,并彻底清洗创面;术后并发症种类较多,需密切观察和积极对症治疗。     

内镜活检孔道注气法用于显露下咽癌患者食管入口处的临床研究

目的 探讨下咽癌内镜检查时食管入口处的显露方法,以提高喉镜对下咽癌侵犯范围判断的准确性.方法 113例下咽癌患者术前均行喉镜检查及影像学检查,喉镜下食管入口的显露采用活检孔道注气法,与影像学检查对比,观察这种方法对下咽癌侵犯食管入口处的判断情况.卡方检验比较两种方法的显露情况.结果 本组113例下咽癌患者常规喉镜检查均无法对食管入口处是否受侵犯做出判断.喉镜下使用活检孔道注气法后,96.5％ (109/113)的病例能够清晰显露食管入口处,其中33例患者食管入口受侵犯,76例未见侵犯.而影像学仅发现25例食管入口侵犯.经统计学分析喉镜检查对食管入口是否受侵的判断优于影像学检查(x2 =9.103,P=0.003).结论 喉镜检查是下咽癌术前诊断的一种重要方法,使用活检孔道注气法可以显露食管入口处,从而明显提高下咽癌术前分期的准确性.     

食管异物伴食管穿孔的诊治

食管异物是耳鼻咽喉科常见的急诊,单纯的食管异物,经食管镜取出后患者很快恢复健康.一旦异物导致食管穿孔后可以引起严重的并发症,甚至危及生命.我科2000年3月～2005年12月共收治了42例食管异物并发食管穿孔的患者,现就其诊治情况报道如下.     

食管言语患者的食管切除

本文报告二例因喉癌而行喉全切后利用食管说话的患者。例一手术后6年又发现食管下1/3处长一癌瘤,切除食管下段后行食管胃吻合。其食管声仅于术后第一天有些变弱,其后则迅速恢复至术前水平,至死均无恶化。例二于术后9年发现横膈裂孔疝及食管严重狭窄,遂切除食管下段并作食管胃吻合。术后次日食管发声变弱,出院时已恢复原状,只是觉得需咽下更多的空气才能维持与术前相同的发声时间。据此,作者们认为食管阻塞、狭窄或食管下段切除对食管发声均无任何长期的不良影响,因为食管下段及下括约肌对于储存空气和振动以产     

突聋患者血中GSH－PX，SOD和VitE测定

本文对３２例突聋患者进行全血ＧＳＨ－ＰＸ，红细胞ＳＯＤ，血浆ＬＰＯ和ＶｉｔＥ的活性测定，结果具有抗脂质过氧化物作用的ＧＳＨ－ＰＸ和氧自由基特异清除酶ＳＯＤ活性均降低，对细胞有损害作用的ＬＰＯ升高，而ＶｉｔＥ无明显变化。本文从氧自由基反应及氧化还原系统的角度对突聋时的病理生理机制进行探讨。     

Severe dysphagia secondary to Plummer-Vinson Syndrome. Report of a case and review of the literature

The Plummer-Vinson Syndrome is characterized by the presence of dysphagia, iron deficiency anemia and esophageal webs. We report the clinical case of a 67 year-female who was admitted with aphagia, glositis and important sialorrea. After performing a digestive endoscopy we found a double membrane located on Killiam region (upper esophageal tract) and proceeded, under general anestesia, to neumatic dilatation. The patient followed periodic controls yearly by Digestive Department and Internal Medicine with a significant clinical improvement.     

Structural and functional organization of the upper esophageal sphincter

Using traditional anatomical and histological methods, the muscle envelope of the pharynx-esophagus junction was investigated in humans and dogs. In the upper (cranial) portion of the esophagus of man and dogs, an inferior anatomical sphincter was detected which histologically can be referred to the group of rhabdo-sphincters. The upper esophageal sphincter is a purely esophageal structure which in man is located at a distance of 25-30 cm from the maxillary incisors. In adult humans, it is 25-30 mm long and is situated obliquely to the long esophageal axis. The posterior semicircle of the sphincter is located higher than the anterior one. In the area of the upper esophageal sphincter the esophageal wall is of different thickness. Due to the muscle envelope and submucous membrane of the base, the right wall is 1.7-2.0 times thicker than the left, anterior or posterior wall. The data obtained from fiber esophagoscopy of patients and electromyography of the pharynx-esophagus junction of dogs have shown that the upper (cranial) esophageal sphincter control food passage from the pharynx to the esophagus and prevents food reflux to the laryngopharynx, protecting airways from aspiration.     

Cortactin as a potential predictor of second esophageal neoplasia in hypopharyngeal carcinoma

Objective

Hypopharyngeal carcinoma has a very poor prognosis. The high incidence of second esophageal neoplasia is one of the major causes. To establish an efficient follow-up scheme for increasing the diagnostic yield and reducing the adverse impact of second esophageal neoplasia on survival, the purpose of this study was to explore a biomarker to predict second esophageal neoplasia.

Anatomic continuity of longitudinal pharyngeal and esophageal muscles

OBJECTIVES: The pharyngeal and esophageal shortenings during deglutition are attributable to longitudinal muscle contraction. The two shortenings may be independent events because the longitudinal pharyngeal and esophageal muscular insertions are believed to be separated from each other. The aim of this study was to investigate the superior attachments of the longitudinal esophageal muscle. STUDY DESIGN: Prospective. METHODS: With use of dissection, sectional anatomy, and confocal microscopy, 30 adult cadavers were examined in this study. RESULTS: We found that the longitudinal esophageal muscle fibers had multiple superior insertions. Some of the fibers were continuous with the longitudinal pharyngeal muscles and merged with a membrane-like fascia that anchored the pharyngoesophageal wall to the thyroid cartilage. CONCLUSIONS: This study demonstrates that the longitudinal pharyngeal and esophageal muscle fibers are continuous with each other and are integrated with fibrous and cartilaginous structures. Such anatomic integrity at the pharyngoesophageal junction is important for the function of the upper esophageal sphincter.     

Complete esophageal stenosis secondary to peptic stricture in the cervical esophagus: case report

Complete esophageal stenosis secondary to peptic stricture in the upper esophagus is rare. It is, however a serious medical problem that may require otolaryngologic intervention because of life-threatening dysphagia and weight loss. We report the case of an elderly patient who presented with an upper esophageal stricture, without the typical symptoms of gastroesophageal reflux disease, that progressed to complete esophageal obstruction despite use of proton pump inhibitors and esophageal dilatation. Definitive management of this difficult problem required esophagectomy and gastric pull-up. We discuss the pathophysiology, clinical presentation, differential diagnosis, and multidisciplinary management of peptic esophageal strictures. This case illustrates the difficulty in managing high peptic strictures.     

Temporal bone histopathology in a patient suspected of inner ear extension of otitis media

We report the histopathological findings in the temporal bone of a 30-year-old female who died of cervical esophageal carcinoma. The temporal bone sections revealed severe bilateral suppurative labyrinthitis and otitis media that presumably occurred immediately before her death. Many inflammatory cells were present in the middle ear, particularly around the stapes and the round window niche. They had also infiltrated the inner ear via the annular ligament of the stapes and the round window membrane. Inflammatory cell accumulation was also observed in the peri- and endolymphatic spaces, and it was most severe in the basal turn. Most of the inner and outer hair cells were preserved, but some had degenerated or were missing. Numerous round cells were observed in the modiolus, and some of the spiral ganglion cells had degenerated. On the basis of these findings, we concluded that bacterial otitis media had extended in to the inner ear via the oval window and round window membrane and had resulted in suppurative labyrinthitis. These findings are consistent with those of stage II suppurative labyrinthitis according to the classification of Schuknecht.     

Loss of secondary esophageal peristalsis is not a contributory pathogenetic factor in posterior laryngitis

Secondary esophageal peristalsis helps prevent the entry of gastric acid into the pharynx by clearing the refluxed gastric contents back into the stomach. Because the loss of this mechanism may contribute to the pathogenesis of reflux-induced laryngeal disorders, our aim was to study the frequency of stimulation and parameters of secondary esophageal peristalsis in patients with posterior laryngitis (PL). We studied 14 patients (45 +/- 5 years) with PL documented by videolaryngoscopy and 11 healthy controls (46 +/- 6 years). The upper esophageal sphincter (UES) pressure was monitored by a sleeve assembly incorporating an injection port 5 cm distal to the sleeve. The esophageal body and lower esophageal sphincter (LES) pressures were measured by an LES sleeve assembly. Primary esophageal peristalsis was induced by 5-mL water swallows. Secondary esophageal peristalsis was induced by abrupt injection of volumes of air, incrementally increased by 5 mL, into the esophagus. Secondary esophageal peristalsis could not be elicited by injection of any volume (up to 60 mL) in 3 PL patients and 2 controls. These 5 subjects had normal primary peristalsis. The threshold volume of air required to stimulate secondary esophageal peristalsis in PL patients (median, 15 mL) was similar to that of controls (median, 10 mL). The parameters of the secondary esophageal peristaltic pressure wave were similar in both groups, and in both groups, they were similar to those of primary peristalsis. The UES response to the injection of the threshold volume that induced secondary esophageal peristalsis in PL patients was contraction in 58% of the trials, partial relaxation in 3%, and no response in 39%. The findings were similar to those in the controls. The LES response to injection of the threshold volume was complete relaxation in both the PL patients and the controls. We conclude that the integrity of secondary esophageal peristalsis is preserved in PL patients.     

Successful rigid endoscopic removal of an esophageal subtotally covered nitinol stent 11?months after initial placement

Formation of granulation tissue and stricture at the stent’s ends are well-known long-term complications of esophageal subtotally covered externally self-expandable metal stents (SEMS). Removal is associated with an increased risk of mucosal injury, severe bleeding, mediastinis, and consecutive stenosis. We report on a case of successful endoscopic removal of an esophageal SEMS 11 months after original placement to cover an iatrogenic esophageal perforation created during rigid esophagoscopy in a patient with cancer of unknown primary (CUP) syndrome. This case shows that safe SEMS late removal is achievable and at the same time illustrates the disadvantages of using SEMS for benign esophageal pathology. Particularly in cases of accidental esophageal injury during endoscopy, esophageal SEMS placement should be considered as a therapeutic option only if conventional surgery is contraindicated.     

Pharyngoesophageal dysmotility in globus sensation

Ambulatory esophageal pH monitoring, radiologic examination, endoscopy, and manometry were undertaken in 142 patients with globus. The results demonstrate that abnormal gastroesophageal reflux occurred in 23% of patients, implying that, while reflux may be responsible for globus in some patients, it is not the cause of globus sensation in the majority of individuals with this symptom. Comparing patients with globus and control subjects, there were no differences in lower esophageal sphincter pressures, esophageal body motility, or tonic upper esophageal sphincter pressures, but patients with globus exhibited higher pharyngeal and upper esophageal sphincter after-contraction pressures during deglutition. The physiological significance of this pharyngeal and upper esophageal dysmotility is not clear and it may be no more than a secondary phenomenon. Alternatively, it may contribute to the generation of globus, perhaps in combination with other physical and psychological triggers.