Effect of Monopolar Electrocoagulation on Esophagus, Stomach and Duodenum in Dogs

The effects of electrocoagulation on the esophagus, stomach and duodenum of mongrel dogs were studied. A commercially available electrocoagulator unit and suction electrode were used. Various dial settings and duration times were used. The total number of sites electrocoagulated was 945; histologic section of each site was prepared. A dial setting of 7 and duration of 5 seconds was safe for the canine esophagus and duodenum; for the stomach it is a dial setting of 7 and duration of 3 seconds. This information will be useful in safe application of electrocoagulation to superficial bleeding lesions in the canine esophagus, stomach and duodenum.     

Carcinoma of the Stomach With Hyperkeratosis Palmaris et Plantaris and Acanthosis of the Esophagus

A 59-yr-old man with carcinoma of the stomach, concurrent acquired hyperkeratosis (tylosis) of the palms and soles, and acanthosis of the esophageal mucosa is reported. He presented the tylosis and esophageal lesions when the carcinoma was evident Resection of the stomach resulted in diminution of the skin and esophageal lesions. The association of sporadic tylosis and carcinoma of the stomach is extremely rare. This is the first case report documenting the association of gastric cancer, tylosis, and acanthosis of the esophageal mucosa.     

Small intestine transplantation

BACKGROUND: Significant progress has been made in clinical small bowel transplantation over the last decade mainly due advances in biotechnology and new immunosuppressive regiments. This transplantation has now been indicated to treat special cases of intestinal failure. AIM: This review highlights recent developments in the area of small bowel transplantation. MATERIAL AND METHODS: Over 600 reports on clinical and experimental small bowel transplantation were reviewed. Aspects concerning research development, different immunosuppressive strategies, patient and graft monitoring, and improvements in surgical techniques are discussed. RESULTS: About 700 small bowel transplantation were performed in 55 transplant centers, 44% intestine-liver, 41% isolated intestinal graft and 15% multivisceral transplantation. Rejection and infection are the main limitation of this procedure. Actual 5 years post transplantation graft survival of the total international experience is 46% for isolated intestinal graft, 43% for combined intestine-liver and nearly 30% for multivisceral transplantation. Higher graft and patient survival are seen at the more experienced centers. In a series of 165 intestinal transplantation at University of Pittsburgh, PA, USA, actuarial patient survival was reported to be over 75% at one year, 54% at 5 years and 42% at 10 years. Over 90% patients from Pittsburgh program resume an unrestricted oral diet. CONCLUSION: Small bowel transplantation has advanced from an experimental strategy to a feasible alternative for patients with permanent intestinal failure. Further refinements in graft acceptance, immunosuppressive regiments, infection management and prophylaxis, surgical techniques as well as appropriated patient referral and selection are crucial to improve outcomes.     

Alcohol and Aldehyde Dehydrogenases in Human Esophagus: Comparison With the Stomach Enzyme Activities

Alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH) isoenzymes from surgical esophageal and gastric mucosa were compared by agarose isoelectric focusing. Two prominent ADH forms, designated μ1 (equivalent to the recently reported μ-form) and μ2, were expressed in all the 15 esophagus specimens studied, whereas only four of seven examined gastric specimens exhibited a weak to moderately strong μ1-ADH activity band on the isoelectric focusing gels. p l values of the esophageal μ1-ADH and μ2-ADH, and the liver π-ADH were determined to be 8.61, 8.13, and 8.90, respectively. μ-ADHs exhibited high K_m for ethanol (12 mM) and low sensitivity to 4-methylpyrazole inhibition. ALDH3 (BB form) and ALDH1 were the major high- and low-K_m aldehyde dehydrogenase in the esophagus, respectively. The ADH and ALDH activities were determined at pH 7.5 to be 751 ± 78 and 29.9 ± 3.0 nmol/min/g tissue, respectively (measured at 500 mM ethanol or at 200 μM acetaldehyde; mean ± sem ; N = 15). The esophageal ADH activity was approximately 4-fold and the ALDH activity 20% that of the stomach enzyme. Because the presence of high activity and high K_mμ-ADHs as well as low-activity ALDH1 were found in human esophageal mucosa, it is suggested that there may exist an accumulation of intracellular acetaldehyde during alcohol ingestion. This reactive and toxic metabolite may be involved in the pathogenesis of alcohol-induced esophageal disorders.     

三种食管胃吻合法的临床比较

目的：探讨预防食管胃吻合口瘘和吻合口狭窄的方法。方法 156例病人采用一层间断缝合法(A组)(：38例病人采用一层连续缝合法(B组);86例病人使用吻合器行食管胃吻合(C组)。结果 吻合口瘘和吻合口狭窄总的发生率：A组7．62％;B组5．26％;C组1．16％。三比较有显性差异。结论 一层连续缝合法显优于一层间断缝合法。在胸内吻合,吻合器机械吻合显优于手工吻合。     

经左胸食管切除肌瓣移植颈部吻合126例临床分析

采用经左胸食管切除肌瓣移植颈部吻合治疗食管癌患者１２１例，食管破裂患者５例，其优点是（１）颈胸两切口较三切口创伤小，（２）经左胸食管床全胃代食管至颈部径路最短，符合生理要求；（３）肌瓣移植可预防吻合口瘘；（４）有良好的抗食物返流作用。