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  • 1
    ISSN: 1436-2813
    Keywords: esophageal diverticulum ; esophageal carcinoma
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A case of carcinoma developed in the middle esophageal (parabronchial) diverticulum is reported. In recent literature, 44 cases of carcinoma in esophageal diverticulum were reported. Most of the patients who had carcinoma in a diverticulum have a long-term history of symptom related to diverticula. Prognosis of these patients was poor because the carcinomas were far advanced when they were found. Therefore, the patient with esophageal diverticulum should be checked with esophagogram, esophagoscopy and biopsy, considering the possibility of development of carcinoma. Most of the cases of carcinoma in a diverticulum were treated with diverticulectomy. However, we consider that radical esophagectomy is a better method of treatment.
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  • 2
    ISSN: 1436-2813
    Keywords: recurrent tracheo-esophageal fistula ; congenital esophageal atresia ; latissimus dorsi muscle flap
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We report herein, a case of a child in whom a prepared latissimus dorsi muscle flap was successfully utilized in the treatment of recurrent tracheo-esophageal fistula (TEF). A 12-month-old girl who had undergone a primary repair of Gross’s type C esophageal atresia at 6 days of age and a secondary repair of recurrent TEF at 4 months of age experienced, postoperatively, repeated episodes of aspiration pneumonia caused by recurrence of the fistula. Thus, we performed a reoperation in which the fistula was excised, and a latissimus dorsi muscle pedicled flap was interposed between the tracheal and esophageal suture lines. Viability of the muscle flap was adequately achieved by means of a three-stage delayed operation. Although a minor anastomotic leakage of the esophagus was found postoperatively, it healed spontaneously, and the patient was commenced on a normal diet orally without any problems at 26 months of age.
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  • 3
    ISSN: 1436-2813
    Keywords: gastropericardial fistula ; gastrobrachiocephalic vein fistula ; gastric tube ulcer ; esophageal cancer operation ; postoperative complication
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The gastric pedicle is commonly used for reconstruction following resection of esophageal cancer. However, we recently experienced a case in which two gastric tube ulcers occurred three months postoperatively; one penetrating into the pericardial cavity and the other into the left brachiocephalic vein. To our knowledge, no other such a case has ever been reported and we therefore report and discuss its etiology and management.
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  • 4
    ISSN: 1436-2813
    Keywords: esophageal anastomosis ; leak ; mechanical suture ; postoperative complication
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Esophageal anastomotic leaks remain the most serious problem following extirpative procedures for esophageal carcinoma. We conducted a retrospective analysis of 352 patients with carcinoma in the thoracic esophagus who had undergone esophageal anastomosis following esophagectomy at the Kurume University Hospital between 1981 and 1990. Of these, 94 patients (27%) developed anastomotic leaks, and out of this subgroup, 21 (6%) died as a direct result of the leak. A further 20 patients (6%) underwent repair of the leak, after which they were able to tolerate oral intake. The anastomotic leak healed spontaneously in the other 53 patients (15%). The risk factors predisposing to leaks from esophageal anastomoses were determined as: (1) the anastomosis being performed via a retrosternal or subcutaneous route as opposed to an intrathoracic route, (2) the use of colonic interposition as opposed to a gastric pedicle, (3) performing a manual anastomosis as opposed to a mechanical anastomosis, and (4) employing an end-to-end anastomosis, as opposed to an end-to-side anastomosis, using a mechanical method. By introducing an anastomotic stapling device, a microvascular technique, a staged operation based on the preoperative risk analysis, and improvement in pre- and postoperative management, the incidence of anastomotic leakage could be decreased from 35% to 14%, and that of consequent hospital mortality, from 9% to 2%.
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  • 5
    ISSN: 1436-2813
    Keywords: esophageal cancer ; surgical treatment ; hospital mortality ; risk analysis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A series of 100 patients with thoracic esophageal cancer who underwent subtotal esophagectomy through a right thoractomy between 1985 and 1989, were statistically analyzed to assess the risk factors predicting hospital mortality from complications. Hospital mortality was termed as “complication death”, and the analyzed factors were age, pulmonary function [% vital capacity (%VC) or % forced expiratory volume1.0 (%FEV1.0)], cardiac function [ECG and Master test], renal function [creatinine clearance (CCR)], hepatic function [15′ indocyanine green test (R15·ICG)], diabetes mellitus [75 g oral glucose tolerance test (75OGTT)], depth of tumor invasion [T-factor], and the type of operative procedure [operation]. Each patient was scored according to risk severity on a scale from 0–3, with the higher numbers representing higher risk. Patients not succumbing to complication death had less than 8 points in the total score, while those who suffered a complication death had 8 or more points. Through stepwise logistic regression analysis, we produced a prediction formula. In cases where eight or more points are scored by the semi-quantitative analysis, or 0 or more, by the prediction formula, the operative procedure should be changed to a less radical one for improved prognosis. The introduction of this semi-quantitative analysis for postoperative risk reduced the incidence of complication death from 6% to 3%, and of hospital mortality from 13% to 3%.
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  • 6
    ISSN: 1436-2813
    Keywords: squamous cell carcinoma of the esophagus ; monoclonal antibody KIS1 ; F(ab')2 fragment ; radioimmunodetection ; radioimmunotherapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The monoclonal antibody (MoAb) KIS1 has been shown to react specifically with an antigen of human squamous cell carcinoma (SCC); however, a major problem in its clinical application is that the intact murine antibody induces a human anti-mouse antibody (HAMA). To overcome this problem, we produced the KIS1 F(ab')2 fragment, then radioiodinated the intact KIS1 antibody and its F(ab')2 fragment. Nude mice bearing human esophageal SCC implants were injected with 100μCi of131I-intact, KIS1 or131I-KIS1 F(ab')2, and images were obtained using a gamma camera. Radioimmunotherapy (RIT) was performed by injecting the tumor-bearing nude mice with131I-intact KIS1 or131I-KIS1 F(ab')2 at a dosage of 300μCi, following which 7 or 3 days were required to produce high quality tumor images by scintigraphy. The tumor-bearing mice treated with131I-KIS1 F(ab')2 showed significant tumor growth inhibition, about 5.4 times greater than that of the control group and 1.8 times greater than that of the131I-intact KIS1 group 21 days after the injection. These results indicate that the KIS1 F(ab')2 fragment is superior to intact KIS1, and that it may be clinically useful for radioimmunodetection followed by tumor targeting therapy for patients with SCC of the esophagus.
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  • 7
    ISSN: 1436-2813
    Keywords: trachea ; viability ; regional blood flow ; devascularization
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract This experiment was designed to evaluate the effect of varying extents of devascularization to the viability of the trachea, and the influence of preservation of the right bronchial artery on the ischemia of the widely devascularized trachea. In experiment 1, the canine trachea was devascularized in a stepwise manner, and the regional blood flow was measured in each situation. This experiment revealed that the regional blood flow decreased to one-third of the non-treated trachea when the bilateral bronchial arteries were transected, and to nil when the cervical and mediastinal trachea was devascularized. In experiment 2, in which dogs were divided into 2 groups depending on preservation of the right bronchial artery, the trachea was stepwisely devascularized and the regional blood flow measured. This experiment indicated that the regional blood flow in the trachea when the right bronchial artery was preserved did not so remarkably diminish, though the cervical and mediastinal trachea was devascularized. In experiment 3, dogs were divided into 3 groups according to the extent of devascularization of the trachea and to the presence or absence of the preserved right bronchial artery, and were followed for 2 months postoperatively. This experiment demonstrated that the preservation of the right bronchial artery prevented tracheal necrosis caused by devascularization of the cervical and mediastinal trachea. We concluded that the regional tracheal blood flow markedly decreased and that tracheal necrosis occurred following devascularization of the cervical and mediastinal trachea when the bilateral bronchial arteries were transected. The preservation of the right bronchial artery however, prevented a decrease in the regional blood flow and necrosis of the widely devascularized trachea.
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  • 8
    ISSN: 1436-2813
    Keywords: latissimus dorsi muscle flap ; tracheal defect ; tracheomalasia
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract An experiment was designed to evaluate the limitations of the muscle flap method in treating various locations and sizes of tracheal defects. Five groups of dogs with several types of tracheal defects were prepared. Each defect was covered by the latissimus dorsi muscle flap. Defects of the tracheal membrane (posterior one-third of the tracheal wall) were successfully repaired by the muscle flap without stenosis, even if they extended to 10 rings in length or were situated at the carina. Defects in the posterior one-half of the trachea, up to 5 rings long, were repaired, with minimal stenosis. Defects of the posterior two-thirds, or anterior one-third of the trachea, resulted in marked stenosis following muscle flap repair. Tracheal movement as seen in the saver sheath type of tracheomalasia was observed when anterior support of the trachea was lost. On the other hand, the movement seen in the crescent type of tracheomalasia was observed when posterior support of the trachea was lost. We concluded that a defect of less than the posterior one-half of the trachea can be repaired by muscle flap, without inducing respiratory insufficiency. Therefore, muscle flap coverage for tracheal defects should be a useful technique in the combined resection of the tracheobronchial tree in cases of esophageal cancer.
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  • 9
    ISSN: 1436-2813
    Keywords: giant leiomyoma of the esophagus ; latissimus dorsi muscle flap
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A giant leiomyoma of the esophagus, 11.5×5.0 cm in size, which occupied half of the esophageal circumference, was surgically enucleated. A small epithelial defect caused by the enucleation of the tumor was directly closed, and a large muscular defect was covered with a latissimus dorsi muscle flap, introduced into the thoracic cavity through the space where the second rib had been resected. Postoperatively, a leakage at the epithelial suture line was noted, however, it was localized by the muscle flap coverage and spontaneously healed two weeks postoperatively. During the follow-up period of 1.5 years, no diverticle formation or stenosis occurred, and the patient had no complaints. The present clinical experience indicates that this procedure may be a useful method of grafting after excision of giant leiomyoma of the esophagus.
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  • 10
    ISSN: 1436-2813
    Keywords: diaphragm ; latissimus dorsi muscle ; esophago-gastrectomy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In three patients with cardial cancer invading the esophagus and the diaphragm, wide resection of the left diaphragm and its reconstruction using a latissimus dorsi muscle flap were performed during radical esophago-gastrectomy. More than two thirds of the diaphragm could be resected because the muscle flap was large enough to be brought into the thoracic cavity without difficulty, to repair the diaphragmatic defect. The postoperative respiratory function of these patients was adequately maintained. A technique for diaphragmatic reconstruction by means of the latissimus dorsi muscle flap is described in this report.
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