Weitere Untersuchungen zur Insuffizienz des Dehnverschlusses der terminalen Speiseröhre

Zusammenfassung Beim Hund, der zur Untersuchung der Speiseröhrenfunktion oft herangezogen wird, wurde die Anatomie des Abschlusses des terminalen Oesophagus erarbeitet. Mit Hilfe der Aufhellungsmethode haben wir auch hier einen Dehnverschluß nachgewiesen, der dem des Menschen ähnelt. Eine operativ erzeugte, refluxgeneigte Hiatushernie läßt die erwartete, erzwungene Entspannung der Muskelschraube erkennen.Dieser insuffizient gewordene Dehnverschluß gleicht einem abschlußunfähigen Ringsphincter. Die Wiederherstellung des Verschlusses durch Nachspannung und Gastropexie, in der Praxis vielbewährt, wird besprochen.

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Further investigations of insufficient stretching-closing mechanism of the terminal esophagus

Summary The anatomy of the closing mechanism of the terminal esophagus was studied in the dogs since this animal is frequently utilized for investigations of esophageal function.With the aid of a special method we have demonstrated a stretching-closing mechanism similar to that of the human subject.An operatively placed hiatus hernia with a tendency to reflux shows the expected reaction of the muscular screw mechanism. This insufficient stretching-closing mechanism is similar to an insufficient ring sphincter. The reconstruction of the closing mechanism by means of stretching and gastropexie which has proven successful in practice is discussed.

     

219. Ursachen und Behandlungsprobleme der syminetrischen Unterschenkelfraktur

Zusammenfassung Als Ursache der symmetrischen Unterschenkelfrakturengibt es direkte Trauma durch Kantensturz, Fahrzeugkollision oder Stoßstangenanprall. Gehäuft treten die zweizeitigen Kombinationsverletzungen Beine, Kopf, Becken auf. Lokal überwiegen die offenen Trümmerbrüche verschiedener Höhe. Gefäß-Nerven-Verletzung ist relativ selten. Therapeutisch erfordert die Mehrfachverletzung individuelle Indikationsstellung nach vitaler Dringlichkeit. Daher Osteosynthese praktisch nur verzögert primär möglich, und dann eventuell mit zwei Operationsgruppen. Vorbeugend sind verbesserte Sicherheitssysteme zur Unfallverhütung zu fordern.     

Secretory territories and rate of matrix production of osteoblasts

The secretory territories of rat osteoblasts on the parietal bone were measured directly using scanning electron microscopy. The mean territory of 4620 cells in 19 fields was 154 m² per osteoblast. The range for the fields was 136 to 177 m² per osteoblast. Four hundred cells were measured individually—for these the mean value per osteoblast was 143 m² with a standard deviation of 33. The daily rate of apposition over an 8 day period was 3.12 m (standard deviation 0.22) measured by tetracycline marking of the mineral front. This gave a daily matrix production rate of approximately 470 m³ per osteoblast.

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Zusammenfassung Die Ausscheidungsbereiche von Ratten-Osteoblasten des Scheitelbeines wurden mit dem Raster-Elektronenmikroskop direkt gemessen. Der durchschnittliche Bereich von 4620 Zellen in 19 Gesichtsfeldern war 154 m² per osteoblast. Der Streubereich lag in den verschiedenen Gesichtsfeldern zwischen 136 und 177 m² per Osteoblast. 400 Zellen wurden einzeln gemessen. Bei diesen war der Durchschnittswert per Osteoblast 143 m², mit einer Standard-Abweichung von 33. Die tägliche Anlagerungsrate während einer Periode von 8 Tagen war 3,12 m (Standard-Abweichung 0,22); sie wurde mittels Tetracyclinmarkierung der Mineralisierungsfront gemessen. Dies ergab eine tägliche Produktionsrate der Matrix von etwa 470 m³ per Osteoblast.

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Résumé Les territoires sécrétoires des ostéoblastes d'os pariétal de rats sont déterminées en utilisant la microscopie électronique à balayage. Le territoire moyen de 4.620 cellules, dans 19 territoires, est de 154 m² par ostéoblaste. Les valeurs extrêmes par champ varient de 136 à 177 m² par ostéoblaste. Quatre cent cellules sont mesurées individuellement; la valeur moyenne par ostéoblaste est de 143 m³ avec une déviation standard de 33. Le taux d'apposition journalier, mesuré par la tétracycline pendant 8 jours, est de 3.12 m (déviation standard 0.22). Ce qui correspond à une production matricielle journalière d'environ 470 m³ par ostéoblaste.

     

Does division of the left renal vein during aortic surgery adversely affect renal function?

Between July 1980 and July 1988, 478 consecutive patients underwent aortic aneurysm operations at Royal Prince Alfred Hospital. Renal function was assessed by measurement of serum creatinine levels. The left renal vein was divided in 28 (8%) of the 355 patients undergoing elective aneurysm resection. The mean immediate postoperative creatinine values were significantly higher after left renal vein division, 193±174 mol/L, compared to 133±93 mol/l for those whose left renal vein remained intact (p < 0.05 by Mann-Whitney U test). After one month, serum creatinine levels had decreased but were still significantly higher in those patients in whom the left renal vein had been divided, 170±166 mol/l, compared to those in whom it was left intact 109±49 mol/l (p<0.05 by Mann-Whitney U test). The suprarenal aorta was cross-clamped in seven (25%) of the 28 patients in whom the left renal vein was divided, compared to 21 (6%) of the 327 with the left renal vein intact. A rise in creatinine level was observed after suprarenal aortic cross-clamping. The left renal vein was divided in 17 (14%) of the 123 patients having emergency surgery for ruptured aortic aneurysm, 61 (49%) of whom survived more than 30 days. The mean immediate postoperative creatinine values were significantly higher after left renal vein division, 426±277 mol/l, compared to those in whom the vein was left intact, 178±136 mol/l (p < 0.05 by Mann-Whitney U test). After one month, serum creatinine levels were still significantly higher in those patients in whom the left renal vein had been divided. Although division of the left renal vein is a useful way to improve exposure of the juxtarenal aorta, the maneuver is associated with an adverse effect on renal function.Presented at the Annual Meeting of the Peripheral Vascular Surgical Society, New York, New York, June, 1989.     

Types of “H2O” in human enamel and in precipitated apatites

Summary Types of H₂O in human enamel and in precipitated apatites are characterized using X-ray diffraction, infrared (IR) absorption spectroscopic and thermogravimetric analyses. Changes in lattice parameters (principally in the -axis dimensions) and in the character of the IR absorption bands are correlated with weight losses at pyrolysis temperatures of 100° to 400°C and with effect of rehydration and reignition of previously ignited samples.This study demonstrated that the loss of H₂O below 200°C is reversible and causes no significant change in the lattice parameter of these apatites, whereas loss of H₂O between 200° and 400°C is irreversible and causes a contraction in the -axis dimension. It is proposed that two general types of H₂O are present in these apatites: (a)adsorbed H ₂O—characterized by reversibility, thermal instability below 200°C, and lack of effect on lattice parameters; and (b)lattice H ₂O—characterized by irreversibility, thermal instability between 200 and 400°C, and induction of expansion in the -axis dimensions of human enamel and precipitated apatites. Lattice H₂O is assumed to be due to H₂O-for-OH and/or HPO₄-for-PO₄ substitutions in these apatites. Loss of adsorbed H₂O caused sharpening of the OH absorption bands in the spectra of these apatites. Loss of lattice H₂O caused the appearance of P–O–P absorption bands (due to the presence of P₂O₇ ^4– group) in precipitated apatites containing small amounts of CO₃ ^2–.The observed larger -axis of human enamel apatite, i.e., 9.445±0.003A, compared to that of the mineral or synthetic (prepared at 1000°C) OH-apatite, i.e., 9.442A, may be attributed to the presence of lattice H₂O, Cl-for-OH, and concerted substitutions of larger cations (e.g., Sr, Ba, Pb, K) for Ca in this apatite.This paper was presented in part at the International Association for Dental Research Meeting in Copenhagen, March, 1977 (abstract no. 48).     

Late upper extremity embolic complications of occluded axillofemoral grafts

The use of axillary femoral grafting in the treatment of patients at high risk for aortoiliac reconstruction has become a widely accepted treatment modality. Ischemia and even loss of the donor upper extremity have been reported to occur early after graft occlusion. This report describes three patients who developed emboli to the upper extremity at nine, 15, and 34 months following occlusion of their axillary femoral graft. Based on our experience, we consider an occluded axillofemoral graft a permanent threat to the viability of the donor upper extremity. Anatomic changes suggestive of potential ischemia include: presence of a blind pouch in the graft stump, or Y elongation of the artery with proliferative changes in the intima.     

Potentiation of transforming growth factor (TGF-β1) by natural coral and fibrin in a rabbit cranioplasty model

The association of a biodegradable material and a growth factor could be of clinical value for treating bone defects. We therefore tested the association of transforming growth factor (TGF-1) in fibrin glue and coral granules to heal skull defects in rabbits. Adult rabbits underwent a double trepanation symmetrically in both parietal bones. Using histomorphometry, we compared bone repair after 1 month in control animals (n=5) and in animals treated with either TGF-1 as a single injection of 1 g in methylcellulose (n=5) or in fibrin glue (n=5), or with coral granules in fibrin glue (n=4) or with coral granules and TGF-1 1 g in fibrin glue (n=5). We measured the diameter of the remaining defect and the surface of the bone growth. TGF-1 without coral in either methyl cellulose or fibrin induced a partial closure of the defect as assessed by a significant decrease in the defect diameter, compared with the control group. However, the association of TGF-1 in fibrin and coral induced an area of the bone growth higher than in any other groups (P<0.05). Two months after surgery, this triple association induced a better healing of the defect than coral alone or control group. In each group treated with TGF-1, the mineralization rate was increased not only at the treated side but also in the contralateral defect which was untreated, suggesting a diffusion of the growth factor. Indeed, when pooled together, the diameter of the defect at the contralateral side of 14 animals that had received TGF-1 was reduced compared with the control group. Significant coral granules resorption occurred between month 1 and 2 and was unchanged by the addition of TGF-1. In conclusion, the triple association of coral granules and TGF-1 in fibrin could be of interest for treating bone defects.     

In-vivo and ex-vivo renal preservation

Summary A new renal perfusate of modified intracellular electrolyte composition made hyperosmolar with mannitol and requiring no additional additives was successfully used to preserve canine kidneys ex-vivo for 48 hours by initial perfusion and hypothermic storage. The new perfusate was also successful in protecting totally ischemic canine kidneys from the lethal effect of two-hours of normothermic exposure in-vivo. — The preservation technique is uncomplicated, the materials involved are inexpensive, and the preservation apparatus is readily transportable.Supported by the Max Kade Foundation, New York, New York.     

The Graf stabilisation system: early results in 50 patients

Summary The results of the first 50 consecutive patients using the Graf stabilisation system are presented. The average age of the patients was 41 years; there were 32 women and 18 men in the group. All patients suffered from intractable symptomatic degenerative disc disease which could be localised to one or more levels. All patients gave a history of chronic back pain, but the mean period of severe disability was 24 months. The mean preoperative disability score (Oswestry questionnaire) was 59%. The average period of follow-up was 24 months (range 19–36 months). At the latest review, the mean disability ability score was 31%. The clinical results were classified as excellent or good in 72% of patients, fair in 10%, the same in 16% and worse in 2%. All but three patients felt that surgery was worthwhile. The results have not deteriorated over the period of follow-up.     

Absorptiometry and “osteoporosis”: problems

connecting the dots between diverse clinical and other matters and an updated bone physiology reveals relationships that could modify some ideas about the roles and uses of absorptiometry in osteoporosis work. Herein, absorptiometry means that part of clinical densitometry that depends on X-ray absorption by bone and other tissues, thus excluding ultrasound methods and magnetic resonance imaging. The modifications concern, in part, some limitations of bone mineral density data, the kinds of physiological information that absorptiometry can and cannot provide, the relative importance of bone mass and whole-bone strength, how to define and study bone health and osteoporosis, and two kinds of osteoporotic fractures. As those modifications concern important national health care issues, they deserve answers based on hard evidence. Identifying those modifications might help others to evaluate them.     

381. Die operative Therapie beim Thoraxtrauma — eine retrospektive Studie

Zusammenfassung Nach multiplem Trauma sinken intracelluläre Aktivität und Konzentration der Elastase in polymorphkernigen Leukocyten (PMNL), die aus Blut ( = 67 U und 6154 g/10⁹ PMNL) und bronchoalveolärer Lavage (BAL)-Flüssigkeit ( = 44 U und 5957 g/10⁹ PMNL) isoliert wurden im Vergleich zu PMNL Gesunder ( = 106 U und 9962 g/10⁹ PMNL). Gleichzeitig wurde ein Anstieg der extracellulären Elastase-Konzentration in Plasma von = 84 g/1 auf = 399 g/1 und in BAL Flüssigkeit von = 8 g/1 auf = 561 g/1 beobachtet. Die durch Stimulation freigesetzte Elastase wird teilweise von einem spezifischen Receptor auf PMNL erneut gebunden. Die Ergebnisse unterstützen die PMNL-vermittelte ARDS-Pathogenese.     

Comparison of adrenoceptor subtype expression in porcine and human bladder and prostate

We have quantified and characterized ₁-, ₂-and -adrenoceptor subtypes in porcine bladder detrusor and bladder neck, human bladder detrusor, and porcine and human prostate. ₁-, ₂- and -adrenoceptor were identified in radioligand binding studies using [³H]prazosin, [³H]RX 821002 and [¹²⁵I]iodocyanopindolol, respectively, as the radioligands. In porcine male and female detrusor and bladder neck and male prostate, adrenoceptors were detected in the order of abundance > _{2 1} (not detectable), with no major differences between the sexes or between detrusor and bladder neck. In human detrusor and prostate the order of abundance was > _{2 1} (not detectable) and ₁ > ₂. respectively. The ₂-adrenoceptors in all tissues were homogeneously of the _2A-subtype as evidenced by competition binding studies with yohimbine, prazosin, ARC 239 and oxymetazoline. The -adrenoceptors represented a mixed population with a dominance of the ₂-subtype in all tissues as demonstrated by competition binding with ICI 118,551 and CGP 20,712A. We conclude that pigs may be a suitable model for studies of detrusor function with respect to adrenoceptor expression. They may be less suitable for studies of bladder neck or prostate function.     

Constriction of the capsule around breast prostheses

The capsule formed around an implant contracts and tends to become spherical, a tendency limited by the consistency of the implant. Another factor in this is the size of the implantation pocket. If the pocket fits too tightly, spherical development occurs earlier and becomes more marked. A dead space between the tissues and the implant, on the other hand, leads to proliferation in the wall of the pocket and hence a thickened capsule.The spherical form of the breast and its firmness need not necessarily be due to fibrotic thickening of the capsule, and the diagnosis of constrictive fibrosis does not always apply. The same symptoms may result from contraction of a thin capsule when the implantation pocket was made too small.     

New method of anesthesia in neurosurgery

Zusammenfassung Die Endotrachealnarkose ist die Methode der Wahl bei allen Operationen am Gehirn und Rückenmark.Eine extreme Blutdrucksenkung mil Pendiomid birgt die Gefahr einer anoxischen Schädigung parenchymalöser Organe in sich. Es ist daher die kontrollierte Blutdrucksenkung bei gleichzeitiger Stoffwechselsenkung durch Anwendung von Phenothiazine vorzuziehen.Die Dämpfung der vegetativen und psychischen Funktionen durch die Phenothiazine ist als Operationsvorbereitung besser als die Anwendung von Opiaten oder Barbituraten.

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Summary The endotracheal anesthesia is the preferred method for all operations on brain and spinal cord.An excessive lowering of the blood pressure by means of Pendiomid may lead to an anoxic damage of the parenchymatous organs.Therefore the controlled hypotension is preferred with a simultaneous metabolic decrease by means of Phenothiazine.It is better to prepare the patient for the operation with decreasing of the vegetative and psychical functions by means of Phenothiazine than using opiates or barbiturates.

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Resumen La narcosis endotraqueal es el método preferido para todas las intervenciones sobre el cerebro y médula espinal.Una disminución excesiva de la presión arterial por medio del Pendiomid Ileva en sí el peligro de un daño anóxico sobre los órganos parenquimatosos. Por esto, es preferible lá hipotensión controlada, con contemporánea disminución del recambio material con el empleo de Phenothiazina.La obnubilación de las funciones vegetatives y psíquicas como preparación a la intervención se obtiene mejor con la Phenothiazina que no con opiáceos y barbitúricos.

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Résumé La narcose intratrachéale est la méthode préférée pour toutes les interventions sur le cerveau et sur la moëlle épinière.Une diminution extrême de la tension artérielle au moyen du «Pendiomid» peut devenir la cause d'une anossie des organes parenchymateux. Voilá la raison parce que une ipotension contrôlée avec diminution simultanée du métabolisme tissulaire au moyen de la «Phénothiazine» est une méthode á préférer. Afin de diminuer les fonctions végétatives et psychiques pour la préparation á l'intervention, il vaut mieux employer la «Phénothiazine» que les opiacées ou les barbituriques.

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Riassunto L'anestesia endotracheale è il melodo di preferenza per tutti gli interventi sul cervello e sul midollo spinale.Una eccessiva diminuzione della pressione arteriosa per mezzo del Pendiomid porta con sè il pericolo di una anossia degli organi parenchimatosi. Perciò è da preferire l'ipotensione controllata con contemporanea riduzione del metabolismo tissulare per mezzo della Phenothiazina.L'obnubilamento delle funzioni vegetative e psichiche come preparazione all'intervento si ottiene meglio con la Phenothiazina che non con oppiacei o barbiturici.

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Vorgetragen auf der 30. Tagung der Bayerischen Chirurgenvereinigung vom 24. und 25. Juli 1953 in München.     

173. Tierexperimentelle Ergebnisse mit einem voll implantierbaren Distraktionsgerät zur operativen Beinverlängerung

Zusammenfassung Zur operativen Beinverlängerung wurde ein neues Femur-Distraktionsgerät entwickelt. Das Gerät besteht aus einem elektronisch programmierbaren Distraktionsaggregat einschließlich Kraftquelle und einer zweiteiligen Führungsschiene. Das Gesamtsystem ist voll versenkbar und schafft Übungsstabilität während der Distraktionsphase. Die Funktionen Vorlauf — Stop —Rücklauf können transcutan induktiv gesteuert werden. Ein für das Tierexperiment speziell entwickelter Prototyp des Gerätes wurde an Schafen erfolgreich erprobt.     

Case Report: Intracerebral Hemorrhage After γ-Knife Surgery for Metastatic Brain Tumor

The authors report a case of a 69-year-old man with metastatic brain tumors who died of spontaneous intracerebral hemorrhage 3 days after -knife surgery. He had been suffering from lung cancer with multiple systemic metastasis. Preoperative magnetic resonance images showed two well-defined round lesions with intratumoral hemorrhage in the left frontal and right occipital lobe. There was no bleeding tendency in the hematological examination and the patient was normotensive. -Knife surgery was performed on both lesions in a single session. However, the patient died of massive intracerebral hemorrhage from the left frontal lesion 3 days after the surgery. There have been no previous reports of mortality resulting from spontaneous intracerebral hemorrhage after -knife surgery in metastatic brain tumors documented in the literature. It is likely that the two events, -knife surgery and spontaneous intracerebral hemorrhage, occurred separately and were not associated. However, it is worth noting that there is a possibility of bleeding after -knife surgery, especially in a metastatic brain tumor with preexisting intratumoral hemorrhage as in our case.     

Tierexperimentelle Untersuchungen über die Wundheilung unter dem Einfluß von Phenothiazinderivaten

Zusammenfassung Zur Klärung der Frage, ob der Künstliche Winterschlaf in irgendeiner Form Wundheilungsvorgänge beeinflußt, wird die primäre und sekundäre Wundheilung am Meerschweinchen untersucht, die durch Gagen von täglich je 10 mg N-(2-Dimethylaminopropyl)-Phenothiazin (A) und N-(3-Dimethylaminopropyl)-3chlor-Phenothiazin (M) und 20 mg Methylphenylpiperidincarbonyläthylhydrochlorid (D) je Kilogramm bis zu 6 Tagen in den sog. künstlichen Winterschlaf versetzt werden. Die Tiere werden 2,4 und 6 Tage nach den Eingriffen getötet. Das Wundgebiet wird histologisch untersucht und das Ergebnis mit dem an Kontrolltieren gewonnenen verglichen.Die Versuche zeigen, daß in den genannten Zeiträumen bei den Winterschlaftieren gegenüber den Kontrolltieren keinerlei Unterschiede in der Wundheilung auftreten.Während die histologische Untersuchung der Nieren keinen pathologischen Befund ergibt, zeigt der histologische Befund der Leber bei einer großen Zahl der Winterschlaftiere kleinfleckige Massennekrosen im SinneRössles, die bei keinem der Kontrolltiere zu finden sind und deren Genese erörtert wird.     

Über einen bemerkenswerten,bisher nicht bekannten Fremdkörperileus

Zusammenfassung Es wird über einen höchst ungewöhnlichen Fall von Obturationsileus berichtet, den ein gut pflaumengroßer Fremdkörper im Dünndarm verursachte. Der Fremdkörper bestand zum Teil aus Speiseresten, im wesentlichen aber aus UHU-Klebstoff (polymerisiertem Polyvinylacetat), welcher die Speisereste zusammenballte. Histochemisch gelang es, die Fremdmassen als UHU-Alleskleber zu identifizieren. Nachträglich gab der Patient zu, den Klebstoff lange Zeit als Kaugummiersatz benutzt und oftmals verschluckt zu haben. Nach operativer Entfernung des Fremdkörpers durch Enterotomie komplikationslose Heilung.Mit 1 TextabbildungHerrn Prof. Dr.F. Spath zum 65. Geburtstag gewidmet.     

Serum hippuric acid concentration in renal allograft rejection,ureter obstruction,and tubular necrosis

Plasma from 35 renal allograft recipients (21 males and 14 females) was sampled daily and analyzed for hippuric acid (HA) by highperformance liquid chromatography (HPLC) and serum creatinine. Twelve of these patients experienced an acute renal allograft rejection or a ureter obstruction as proven by clinical signs and biopsy, as well as by radiography or ultrasound, respectively. Two patients suffered from tubular necrosis followed by rejection during the postoperative period. Mean serum HA increased by 39.9 mol/l from baseline (range 20.4–115.5 mol/l) in patients with acute rejection 3 days after an initial increase that was observed 24 h before the mean serum creatinine increased by 107.1 mol/l (range 21–193 mol/l). In cases of ureter obstruction, HA rose by 1.6 mol/l (range 1–8.2 mol/l), significantly less than elevations due to rejection. The increase in creatinine, however, amounted to 65.3 mol/l (range 22–140 mol/l) and was not different from the change in rejecting patients. Successful antirejection treatment coincided with a decrease in serum HA starting 24 h earlier than the decrease in the serum creatinine concentration. Of special interest was the observation of a parallel decrease in HA with creatinine concentration in patients with tubular necrosis after allotransplantation; HA increased in cases of an additional rejection. Our data suggest that HA, which is excreted by tubular secretion and glomerular filtration, could be a sensitive and early marker of acute allograft rejection. Furthermore, it seems to discriminate between acute renal allograft rejection and ureter obstruction. It might, therefore, be of value in the diagnosis of rejection complicating tubular necrosis after transplantation.     

Distal Margin Requirements After Preoperative Chemoradiotherapy for Distal Rectal Carcinomas: Are ≤ 1 cm Distal Margins Sufficient?

Background:Sphincter-sparing alternatives to abdominoperineal resection (APR) in the treatment of rectal cancer often are underused out of concern for inadequate distal margins and local failure. The present study addresses whether sphincter-sparing techniques with distal margins 1 cm adversely influence oncological outcome in patients given preoperative chemoradiotherapy.Methods:Thirty-seven patients with rectal cancer 8 cm from the anal verge were enrolled in the study. Preoperative external beam radiotherapy (5400 Gy) was administered together with continuous infusion of 5-fluorouracil (300 mg/m²/day). Surgical resection was performed in 36 patients with pathological assessment of tumor response and margins. Patients with sphincter-sparing resection and distal margins > 1 cm or 1 cm and those who underwent APR were compared.Results:Thirty-six patients completed preoperative chemoradiotherapy, with successful sphincter-preservation in 28 patients. At a median follow-up of 33 months, there were 12 recurrences overall, which included 11 distant failures and four pelvic failures. Disease-free survival (DFS) was not different between those who had an APR compared with sphincter-sparing resection with distal margins 1 cm. DFS was worse (P < .02) when radial margins were 3 mm compared with > 3 mm.Conclusions:Sphincter preservation is feasible in more than 75% of patients with tumors 8 cm from the anal verge after preoperative chemoradiotherapy. Sphincter-sparing surgery with distal margins 1 cm can be used without adversely influencing local recurrence or DFS. Limited radial margins ( 3 mm), however, are associated with increased disease recurrence.Presented at the 1998 Annual Meeting of the Society for Surgery of the Alimentary Tract, New Orleans, Louisiana, May 18, 1998