New Options for Aerodigestive Tract Replacement After Extended Pharyngolaryngectomy

Objectives Assess the results of a new type of reconstruction of the aerodigestive tract after extended pharyngolaryngectomy. Study Design Follow‐up of a total of eight patients who had surgery using ileocolic free graft. Methods The surgical technique is described. Five patients underwent pharyngolaryngectomy/cervical esophagectomy, and three patients had total laryngectomy with subtotal pharyngectomy. Patients were monitored to assess complications and recovery of satisfactory swallowing and speech. Results The technique, thanks to the use of material from the colon, proved to be extremely useful for the reconstruction of the digestive tract. At the same time, ileal anastomosis with the tracheal stump enabled aerodigestive crossing restoration, protected by the ileocecal valve. All patients recovered good swallowing capacity and phoniatric expression, which were obtained by digital occlusion of the tracheostomy, forcing the expiratory air through the ileum and ileocecal valve. Manometric tests also showed that after a while there was a gradual synchronization of swallowing between the transplanted colic segment and the residual esophagus. Conclusions The technique described in the present study may be regarded, also in the light of possible further applications, as a new and interesting option for the reconstruction of the aerodigestive tract.     

HBV infection in hemodialysis patients: monitoring and prevention.

From 1986 to 91, 174 dialysis patients were studied. The prevalence of previous HBV infection and of chronic carriers was 33.3 and 4.6%, respectively. Immunization rate after vaccination (3 doses) was 63%. In 1991, we proposed a vaccination with 4 doses and recommend a 6-monthly anti-HBs evaluation to assess the timing of any booster dose needed.     

Long-term effects of gastric resection on the inferior esophageal sphincter

The manometric profile of the oesophagogastric junction has been studied in patients subjected one year earlier to partial gastric resection. A reduction in maximum basal pressure (--49.8%) and length of the lower oesophageal sphincter (--35.45%) were noted. These figures agree with what was observed one month after operation in a previous study. It is concluded that gastric resection lead to a non-transitory reduction in sphincter function.     

TSH response to TRH in hemodialysis and CAPD patients

The thyroid status was studied in 19 uremic patients (11 on HD and 8 on CAPD) and in a group of 17 healthy adult patients. In uremic patients T3 and T4 were significantly reduced (p less than 0.001) and rT3 was increased (p less than 0.001). The time course TSH response to TRH showed a lower peak response (in 5 patients it did not exceed 5 microU/ml) which on turn was also delayed (the peak was observed at 60 minutes in 63% of them). TSH concentrations in uremics were increased at 0 time (p less than 0.02), lower at 20 minutes (p less than 0.01) and increased at 120 minutes (p less than 0.02). No difference existed between HD and CAPD. The thyroid response to TSH was normal as showed by a normal percent increase over basal values of T3 concentrations at 120 minutes. Uremic patients also showed a peak GH response at 20 minutes which was not observed in controls. The data exclude the existence on a primary form of hypothyroidism and point to the existence of hypothalamic-pituitary abnormalities, which should not be taken as indicative of secondary and/or tertiary hypothyroidism since FT4 values were normal in HD and increased in patients undergoing CAPD (p less than 0.05) who on turn showed lower plasma albumin concentrations (p less than 0.05).     

Loss of interstitial cells of Cajal network in severe idiopathic gastroparesis

INTRODUCTION Gastroparesis syndrome is a clinical entity characterized by chronic nausea, epigastric discomfort and recurrent vomiting, in the absence of mechanical obstruction[1]. Gastroparesis may be either primary (idiopathic) or secondary, i.e. associ…     

Treatment of neoplastic stenosis of the left colon: presurgical expandable metal stent vs emergency surgery. Comparison of results and survival rates

In recent years there has been a substantial increase in the use of self-expandable metal stent endoprostheses for preoperative "bridge to surgery" treatment of obstructive colorectal cancer. Stent insertion for malignant tumours is still controversial because of the increased risk of metastasis and regional advance of the cancer. We compared the short-term results and long-term survival times with preoperative stent insertion vs emergency surgery without stents. From January 2004 to December 2005, 16 patients (9 stent+surgery vs 7 emergency surgery) were admitted to our emergency department with obstructive colon cancer. There was no significant difference in general condition (age and comorbidity) or in cancer classification between the two groups. The percentage of resections with primary anastomosis was significantly higher in the stent group and the percentage of stoma creation significantly lower in the stent group. There was no significant difference in prognosis between the two groups. Because preoperative expandable metal stent insertion for obstructive colorectal cancer had better postoperative results and no disadvantages in terms of long-term prognosis, the Authors recommend this procedure for the preoperative treatment of obstructive colorectal cancer.     

Botulinum toxin treatment of oesophageal achalasia in the old old and oldest old: a 1-year follow-up study

BACKGROUND: Intrasphincteric injection of botulinum toxin (BTX) has become one of the most frequent therapeutic approaches for the treatment of oesophageal achalasia. This treatment seems particularly effective in elderly patients who are not candidates for more invasive procedures. AIMS: There are few or no data on BTX treatment of achalasia in the old old and oldest old. Therefore, we evaluated BTX treatment in a group of patients with achalasia in the extreme age range who were too ill or frail to undergo surgery or pneumatic dilatation. PATIENTS AND METHODS: Twelve elderly achalasic patients (age range 81-94 years, average age 86 years) with American Society of Anesthesiologists (ASA) class III-IV status were recruited for the study. After baseline clinical and instrumental evaluations, BTX 100U was injected at time 0 and 1 month later. Clinical follow-up was carried out after 3, 6 and 12 months. RESULTS: A significant improvement in symptom score was documented at each follow-up step. On the basis of improvements in scores, approximately 70% of patients were considered responders at the end of follow-up. CONCLUSIONS: BTX treatment is an effective treatment in a substantial proportion of achalasic patients >80 years of age, in whom benefits are still detectable after 12 months. BTX is a therapeutic option in patients unsuitable for surgery or pneumatic dilatation.