Aortoesophageal fistula caused by aneurysm of the thoracic aorta: successful surgical treatment, case report, and literature review. (1/27)

Aortoesophageal fistula induced by atherosclerotic thoracic aortic aneurysm is rare, but is usually a fatal disorder, with few survivors reported. We report the case of a 72-year-old man with aortoesophageal fistula successfully treated in a two-stage operation. In the first stage, we performed resection and replacement of the aortic aneurysm with a prosthetic graft in situ, esophagectomy, cervical esophagostomy, and jejunostomy. After the patient recovered well postoperatively, a transmediastinal retrosternal interposition of the stomach was performed, with esophagogastroanastomosis in the cervical area, to re-establish the gastrointestinal tract. We include a discussion of the causes, diagnostic approach, management of the aorta and esophagus, and review of the literature.  (+info)

Effects of vitamin E and selenium supplementation on esophageal adenocarcinogenesis in a surgical model with rats. (2/27)

Two well-known antioxidative nutrients, vitamin E and selenium, were used in this study to investigate possible inhibitory action against the formation of esophageal adenocarcinoma (EAC) in rats. In this model, carcinogenesis is believed to be driven by oxidative stress. Male Sprague-Dawley rats (8 weeks old) were divided into four groups and received esophagoduodenal anastomosis (EDA) surgery plus iron supplementation (12 mg/kg/week). Vitamin E and selenium were supplemented in the diet in the forms of alpha-tocopheryl acetate (750 IU/kg) and sodium selenate (1.7 mg Se/kg), which were 10 times the regular amounts in the basic AIN93M diet. At 40 weeks after surgery, all the EDA groups had lower body weights than the non-operated control group. Iron nutrition (hemoglobin, total serum iron and transferrin saturation) was normal as a result of iron supplementation after EDA. Vitamin E supplementation maintained the normal plasma level of alpha-tocopherol in EDA rats, but not those of gamma-tocopherol and retinol. Selenium supplementation increased the serum and liver selenium contents of the EDA rats. Histopathological analysis showed that selenium supplementation increased the incidence of EAC and the tumor volume. The selenium level in the tumor is higher than that in the duodenum of the same animal. Vitamin E supplementation, however, inhibited carcinogenesis, especially in the selenium-supplemented group. We believe that vitamin E exerts its effect through its antioxidative properties, and a high dose of inorganic selenium may promote carcinogenesis by enhancing oxidative stress.  (+info)

Esophageal impacted dentures. (3/27)

OBJECTIVES: This study aims to highlight the problems associated with impacted acrylic dentures and proffers advice to check them. PATIENTS AND METHODS: Retrospective review of all cases of impacted acrylic dentures over a 16-year period. RESULTS: Twenty-two adults had impacted esophageal acrylic dentures of which 16 (72.7%) and six (27.3%) were males and females, respectively (M:F ratio = 2.7:1) with age range 23-77 years. Fourteen patients (63.6%) had worn their dentures for more than 10 years without check-up, and 54.5% presented within 48 hours of impaction. The common symptoms in all the patients were difficulty with swallowing, throat pain and discomfort, followed by tenderness in the neck in 15 (68.2%). Dentures were extracted through esophagoscopy (17 cases) and cervical (three cases) esophagotomy, respectively. Observed complications included pulmonary edema in one and esophageal perforation in five patients. CONCLUSION: Endoscopic extraction of dentures carries a high risk of perforation. Extraction of an impacted denture via esophagoscopy can be undertaken under direct vision and in an ideal situation with judicious use of the Shears forceps. In the absence of these, the safest option is an esophagotomy. Proper treatment planning in the fabrication of dentures with incorporation of radiopaque materials in the dental resins and adequate postdenture delivery instructions are necessary as preventive measures.  (+info)

Utilization of the delay phenomenon improves blood flow and reduces collagen deposition in esophagogastric anastomoses. (4/27)

OBJECTIVE: Complications of anastomotic healing are a common source of morbidity and mortality after esophagogastrostomy. The delay phenomenon is seen when a skin flap is partially devascularized in a staged procedure prior to its definitive placement, resulting in increased blood flow at the time of grafting. This effect may be applied to esophagogastrectomy, potentially reducing anastomotic complications. SUMMARY BACKGROUND DATA: The purpose of this investigation was to apply the delay principle to the gastrointestinal tract, investigate mechanisms by which it occurs and examine the effects of delay on anastomotic healing. METHODS: Thirty-seven opossums were assigned to Sham (n = 5), Immediate (n = 14), and Delay (n = 18) groups. Each underwent laparotomy and measurement of baseline gastric fundus blood flow. The Delay and Immediate animals underwent ligation of the left, right, and short gastric vessels and subsequent measurement of gastric fundus blood flow. The Delay group underwent repeat measurement of blood flow, esophagogastrectomy, gastric tubularization, and esophagogastrostomy 28 days after vessel ligation. The Immediate group completed the procedure immediately after vessel ligation. The anastomoses in both groups were harvested 32 days after esophagogastrostomy. The Sham group underwent blood flow measurement on initial laparotomy, followed by harvesting of esophagogastric junction 60 days later. Sections taken through the anastomoses were examined with trichrome-staining and immunohistochemistry (IHC) for actin. Collagen content of the gastric submucosa 5 mm below the anastomosis was quantified, and preservation of the muscularis propria and muscularis mucosa was determined histologically. Capillary content of the esophagogastric junction was quantified using IHC for vascular endothelium in the Delay and Sham groups. RESULTS: Blood flow decreased by 73% following vessel ligation in Delay and Immediate groups. The Delay group had over 3 times the gastric blood flow of the Immediate group at the time of anastomosis at 16 (interquartile range [IQR] 11-17) versus 5, (IQR 5-6) mL/min/100 g (P = 0.000003). Two Immediate animals developed anastomotic leak and died; the Delay group had no complications. Submucosal collagen content in Sham, Delay, and Immediate groups were 57% (IQR 52-62), 65% (IQR 57-72), and 71% (IQR 60-82), respectively (P = 0.0004). The median distance of full-thickness atrophy of the muscularis propria was 0.10 mm (IQR 0-0.60 mm) in the Delay group and 0.53 mm (IQR 0.03-0.80 mm) in the Immediate group (P = 0.346). Five percent of the Delay group had atrophy of the muscularis mucosa, whereas 19% of Immediate animals had atrophy of this layer (P = 0.023). Compared with the Sham group, all Delay animals developed dilation of the right gastroepiploic artery and vein. A median of 27 (IQR 23-33) capillaries per 20x field was observed in the Sham fundus and 38 (IQR 31-46) in the Delay fundus (P = 0.037). CONCLUSIONS: The delay effect is associated with both vasodilation and angiogenesis and results in increased blood flow to the gastric fundus prior to esophagogastric anastomosis. Animals undergoing delayed operations have less anastomotic collagen deposition and ischemic injury than those undergoing immediate resection. Clinical application of the delay effect in patients undergoing esophagogastrectomy may lead to a decreased incidence of leak and stricture formation.  (+info)

Cervical esophagostomy using indwelling catheter for analysis of gastric physiology in dogs. (5/27)

PURPOSE: To describe the technique of cervical esophagostomy with indwelling catheter for the collection of secretions and study of gastric emptying. METHODS: Esophagostomy was performed in 14 dogs, and a tube was introduced into the animals' stomachs and maintained previous for eight weeks. The technique consisted of opening the left lateral surface of the neck for insertion of the tube, with the aid of a Mixter forceps, and the subsequent subcutaneous tunneling and exteriorization of the catheter on the dorsum of the animals. RESULTS: Successful use of the tube and its total permeability were observed in 13 animals (92.8%). In one animal, the tube was obstructed by hair, and it was replaced. Formation of a small abscess occurred in 3 animals (21.4%), followed by spontaneous drainage. No accidents occurred, and the bleeding was minimal. No deaths were registered. CONCLUSION: The described technique can be used in similar researches, as well as for animal feeding in investigations of the upper digestive tract, after esophageal resection and in major neck surgeries.  (+info)

Oesophageal-impacted denture requiring open surgery. (6/27)

The successful removal of impacted denture in the oesophagus in a patient is reported, with a review of the literature. A 36-year-old Malay man complained of dysphagia after swallowing his denture. Following unsuccessful attempts at removal via a rigid oesophagoscope, open surgery was performed. Without further delay, the impacted denture was removed by cervical oesophagotomy, and the patient recovered uneventfully. Oesophageal foreign bodies are usually removed by endoscopy. However, in situations where this appears potentially hazardous, such as with impacted denture, open surgical extraction that is promptly performed is a safe option.  (+info)

Mid-term outcomes of side-to-side stapled anastomosis in cervical esophagogastrostomy. (7/27)

This study was conducted to evaluate the mid-term results of cervical esophagogastric anastomosis using a side-to-side stapled anastomosis method for treatment of patients with malignant esophageal disease. A total of 13 patients were reviewed retrospectively from January 2001 to November 2005 who underwent total esophagectomy through a right thoracotomy, gastric tube formation through a midline laparotomy and finally a cervical esophagogastric anastomosis. Average patient age was 62.6 yr old and the male to female ratio was 11:2. The mean anastomosis time was measured to be about 32.5 min; all patients were followed for about 22.8+/-9.9 months postoperatively. There were no early or late mortalities. There were no complications of anastomosis site leakage or conduit necrosis. A mild anastomotic stricture was noted in one patient, and required two endoscopic bougination procedures at postoperative 4th month. Construction of a cervical esophagogastric anastomosis by side-to-side stapled anastomosis is relatively easy to apply and can be performed in a timely manner. Follow up outcomes are very good. We, therefore, suggest that the side-to-side stapled anastomosis could be used as a safe and effective option for cervical esophagogastric anastomosis.  (+info)

Carcinosarcoma of the stomach: a case report and review of the literature. (8/27)

Carcinosarcomas are rare, malignant, biphasic tumors. We report the case of a 62-year-old man with gastric carcinosarcoma, along with its clinical, macroscopic and histopathological features. Macroscopically, a specimen of deformed stomach was obtained that measured 200 mm x 150 mm x 100 mm. A 150 mm x 100 mm x 50 mm exophytic tumoral mass (Borrmann type I) was found, which involved the posterior wall from the cardia to the antrum. Histopathologically, a mixed type of malignancy was revealed: an adenocarcinoma with intestinal metaplasia, with interposed fascicles of fusiform atypical cells and numerous large, rounded and oval cells. The tumor showed positive histochemistry for cytokeratin 18, epithelial membrane antigen, carcinoembryonic antigen, chromogranin A and vimentin. Liver metastases were diagnosed 8 mo postoperatively, and the patient died 4 mo later. A review of the available literature is also presented.  (+info)