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Mechanism of the haemostatic effect of ethanolamine oleate in the injection sclerotherapy for oesophageal varices
494
ment evolved whose main features were the accurate demonstration of anatomy by preoperative contrast radiology, intraoperative assessment of the distal esophagus, and where possible, primary anastomosis. The authors recommend that a gastrostomy be routinely performed at the initial operation, at which time the length of the distal esophagus is assessed by the passage of a sound. If sufficient length is present, then an immediate primary anastomosis should be performed with thoracic ligation of the fistula if exposure is adequate. If at initial assessment the length of the gap is judged to be too long, the fistula should be divided via the appropriate route, cervical or thoracic, and alimentary continuity can be effected at a later time by delayed anastomosis or esophageal replacement. The major morbidity and mortality (40%) occurred in the group with a long gap between esophageal segments.--Prem Purl Oesophageal Atresia Without Fistula--Anastomosis or Replacement? N.A. Myers, S.W. Beasley, A.W. Auldist, et al. Pediatr Surg
Internat 2:216-222, (July), 1987. At the Royal Children's Hospital, Melbourne, 553 babies with esophageal atresia and/or tracheoesophageal fistula have been admitted during the past 39 years. Thirty-six (6.5%) of these had esophageal atresia without a tracheoesophageal fistula. Definitive surgery was performed in 27 patients: the primary definitive procedure was esophageal anastomosis in 15 and esophageal replacement in 12. Aspects of diagnosis and selection of the most appropriate treatment modality are discussed, with the results of treatment presented. The authors current policy is to perform an esophageal anastomosis whenever possible, and this has been successful in seven of the last 11 patients.--Prem Puri Esophageal Stenosis with Esophageal Atresia. M.A. Thomason
and B.B. Gay. Pediatr Radiol 17:197-210, (March), 1987.
Esophageal atresia with tracheosophageal fistula may be associated rarely with distal esophageal stenosis. Three patients are reported with this combination of esophageal anomalies. In addition, the clinical and radiologic features of 24 patients previously reported in the literature are reviewed. Careful evaluation of the distal esophagus during postoperative contrast studies in patients with eosphageal atresia should be obtained to exclude distal stenosis. The presence of unrecognized distal esophageal stenosis may lead to complications of postoperative anastomotic leaks, poor healing of the anastomosis, aspiration, and impaction of a solid food bolus proximal to the stenosis.--Prem Purl Oesophageal Atresia and Vertebral Anomalies. D.R.V. Dickens and N.A. Myers. Pediatr Surg Internat 2:278-281, (September), 1987.
Esophageal atresia and/or tracheoesophageal fistula are relatively common congenital anomalies, occurring once in 3,000 births. Associated anomalies are seen frequently, and in a series of 538 patients admitted to the Royal Children's Hospital, Melbourne, 256 had additional anomalies (47.5%). Evaluation of the spine was possible in 345 patients and in 57, structural vertebral anomalies were present (16.5%). Of the 57 with a structural abnormality of the spine, 40 had an abnormality of formation, six an abnormality of segmentation, and ten had a combined defect. In the other patient, a bipartite cervical vertebra was present. Eight patients had scoliosis without a recognizable congenital spinal abnormality. In 81 there was a congenital rib abnormality. Fifty-six of this group had a normal spine, 24 had a structural abnormality of the spine, and in one patient scoliosis was present without a structural abnormality of the spine. Comparison is made between the authors findings and the
INTERNATIONAL ABSTRACTS
findings in other reported series and comments are made on the significance of spinal and/or rib anomalies in association with esophageal atresia.--Prem Purl Coexisting Left Diaphragmatic Hernia and Esophageal Atresia. R.
Udassin, O. Zamir, O. Peleg, et al. Pediatr Surg Internat 2:301-303, (September), 1987.
Coexisting left diaphragmatic hernia (DH) and esophageal atresia, a rare phenomenon, is described in two newborns, one with tracheoesophageal fistula (TEF) and the other without. The coexistence of DH and TEF in the one resulted in uncontrolled gastrointestinal distention with severe respiratory distress. Transabdominal division of the TEF was feasible and was performed concurrently with the diaphragmatic repair. Severe hypoplastic lungs and persistent pulmonary hypertension resulted in early postoperative death in both cases.--Prem Purl Congenital Tracheo-Oesophageal Fistula. N.A. Myers and K. Egami. Pediatr Surg Internat 2:198-211, (July), 1987.
At the Royal Children's Hospital, Melbourne, 28 patients with a congenital tracheoesophageal fistula were seen during a 38-year period, representing 5.2% of all babies seen with esophageal atresia and/or tracheoesophageal fistula. Diagnostic delay occurred frequently because of failure to appreciate the significance of the clinical picture. There was variation in the level of the fistula. The basic pattern of investigation and management is now quite uniform.--Prem Purl Mechanism of the Haemostatic Effect of Ethanolamine Oleate in the Injection Sclerotherapy for Oesophageal Varices. J.H. Kang, J.
Kambayashi, M. Sakon, et al. Br J Surg 74:50-53, (January), 1987.
In 20 patients undergoing injection sclerotherapy of esopahegal varices using ethanolamine oleate, the levels of two plasma fibrinopeptides (A and B 15-42) were raised one hour after injection and returned to preinjection levels after 48 hours. This indicates activation of coagulation and fibrinolysis. Plasma fibrinogen, which is regarded as a marker of inflammation, gradually increased to a maximum three days after injection. In vitro studies indicated that ethanolamine oleate prolonged clotting time and inhibited plasma fibrinopeptide A production due to chelation of calcium by the ethanolamine, whereas oleate alone shortened clotting time. The application of ethanolamine oleate and oleate alone to decapsulized rat kidney led to an increased accumulation of 12~I-labelled fibrinogen. The authors conclude that injection of ethanolamine oleate activates the local coagulation system; this may be accelerated by an acute inflammatory process.--N.P. Madden Fluoroscopically Controlled Removal of a Blunt Esophageal Foreign Body Using a Foley Catheter in Children. A. Hadary, P. Mogle, O.
Zamir, et al. Pediatr Surg lnternat 2:247-248, (July), 1987.
The removal of foreign bodies from the esophagus with a Foley catheter is a simple, safe, and highly successful procedure. This technique should be used initially when managing a blunt foreign body in the esophagus. It reduces the risk, time, and expense involved in endoscopic removal. Prem Purl Congenital Microgastria. N.H. Aintablian, M.S. Slim, and B.W.
Antoun. Pediatr Surg Internat 2:307-310, (September), 1987.
An 81/z-year-old boy with microgastria associated with a sliding hiatal hernia and skeletal anomalies involving the spine and right
ment evolved whose main features were the accurate demonstration of anatomy by preoperative contrast radiology, intraoperative assessment of the distal esophagus, and where possible, primary anastomosis. The authors recommend that a gastrostomy be routinely performed at the initial operation, at which time the length of the distal esophagus is assessed by the passage of a sound. If sufficient length is present, then an immediate primary anastomosis should be performed with thoracic ligation of the fistula if exposure is adequate. If at initial assessment the length of the gap is judged to be too long, the fistula should be divided via the appropriate route, cervical or thoracic, and alimentary continuity can be effected at a later time by delayed anastomosis or esophageal replacement. The major morbidity and mortality (40%) occurred in the group with a long gap between esophageal segments.--Prem Purl Oesophageal Atresia Without Fistula--Anastomosis or Replacement? N.A. Myers, S.W. Beasley, A.W. Auldist, et al. Pediatr Surg
Internat 2:216-222, (July), 1987. At the Royal Children's Hospital, Melbourne, 553 babies with esophageal atresia and/or tracheoesophageal fistula have been admitted during the past 39 years. Thirty-six (6.5%) of these had esophageal atresia without a tracheoesophageal fistula. Definitive surgery was performed in 27 patients: the primary definitive procedure was esophageal anastomosis in 15 and esophageal replacement in 12. Aspects of diagnosis and selection of the most appropriate treatment modality are discussed, with the results of treatment presented. The authors current policy is to perform an esophageal anastomosis whenever possible, and this has been successful in seven of the last 11 patients.--Prem Puri Esophageal Stenosis with Esophageal Atresia. M.A. Thomason
and B.B. Gay. Pediatr Radiol 17:197-210, (March), 1987.
Esophageal atresia with tracheosophageal fistula may be associated rarely with distal esophageal stenosis. Three patients are reported with this combination of esophageal anomalies. In addition, the clinical and radiologic features of 24 patients previously reported in the literature are reviewed. Careful evaluation of the distal esophagus during postoperative contrast studies in patients with eosphageal atresia should be obtained to exclude distal stenosis. The presence of unrecognized distal esophageal stenosis may lead to complications of postoperative anastomotic leaks, poor healing of the anastomosis, aspiration, and impaction of a solid food bolus proximal to the stenosis.--Prem Purl Oesophageal Atresia and Vertebral Anomalies. D.R.V. Dickens and N.A. Myers. Pediatr Surg Internat 2:278-281, (September), 1987.
Esophageal atresia and/or tracheoesophageal fistula are relatively common congenital anomalies, occurring once in 3,000 births. Associated anomalies are seen frequently, and in a series of 538 patients admitted to the Royal Children's Hospital, Melbourne, 256 had additional anomalies (47.5%). Evaluation of the spine was possible in 345 patients and in 57, structural vertebral anomalies were present (16.5%). Of the 57 with a structural abnormality of the spine, 40 had an abnormality of formation, six an abnormality of segmentation, and ten had a combined defect. In the other patient, a bipartite cervical vertebra was present. Eight patients had scoliosis without a recognizable congenital spinal abnormality. In 81 there was a congenital rib abnormality. Fifty-six of this group had a normal spine, 24 had a structural abnormality of the spine, and in one patient scoliosis was present without a structural abnormality of the spine. Comparison is made between the authors findings and the
INTERNATIONAL ABSTRACTS
findings in other reported series and comments are made on the significance of spinal and/or rib anomalies in association with esophageal atresia.--Prem Purl Coexisting Left Diaphragmatic Hernia and Esophageal Atresia. R.
Udassin, O. Zamir, O. Peleg, et al. Pediatr Surg Internat 2:301-303, (September), 1987.
Coexisting left diaphragmatic hernia (DH) and esophageal atresia, a rare phenomenon, is described in two newborns, one with tracheoesophageal fistula (TEF) and the other without. The coexistence of DH and TEF in the one resulted in uncontrolled gastrointestinal distention with severe respiratory distress. Transabdominal division of the TEF was feasible and was performed concurrently with the diaphragmatic repair. Severe hypoplastic lungs and persistent pulmonary hypertension resulted in early postoperative death in both cases.--Prem Purl Congenital Tracheo-Oesophageal Fistula. N.A. Myers and K. Egami. Pediatr Surg Internat 2:198-211, (July), 1987.
At the Royal Children's Hospital, Melbourne, 28 patients with a congenital tracheoesophageal fistula were seen during a 38-year period, representing 5.2% of all babies seen with esophageal atresia and/or tracheoesophageal fistula. Diagnostic delay occurred frequently because of failure to appreciate the significance of the clinical picture. There was variation in the level of the fistula. The basic pattern of investigation and management is now quite uniform.--Prem Purl Mechanism of the Haemostatic Effect of Ethanolamine Oleate in the Injection Sclerotherapy for Oesophageal Varices. J.H. Kang, J.
Kambayashi, M. Sakon, et al. Br J Surg 74:50-53, (January), 1987.
In 20 patients undergoing injection sclerotherapy of esopahegal varices using ethanolamine oleate, the levels of two plasma fibrinopeptides (A and B 15-42) were raised one hour after injection and returned to preinjection levels after 48 hours. This indicates activation of coagulation and fibrinolysis. Plasma fibrinogen, which is regarded as a marker of inflammation, gradually increased to a maximum three days after injection. In vitro studies indicated that ethanolamine oleate prolonged clotting time and inhibited plasma fibrinopeptide A production due to chelation of calcium by the ethanolamine, whereas oleate alone shortened clotting time. The application of ethanolamine oleate and oleate alone to decapsulized rat kidney led to an increased accumulation of 12~I-labelled fibrinogen. The authors conclude that injection of ethanolamine oleate activates the local coagulation system; this may be accelerated by an acute inflammatory process.--N.P. Madden Fluoroscopically Controlled Removal of a Blunt Esophageal Foreign Body Using a Foley Catheter in Children. A. Hadary, P. Mogle, O.
Zamir, et al. Pediatr Surg lnternat 2:247-248, (July), 1987.
The removal of foreign bodies from the esophagus with a Foley catheter is a simple, safe, and highly successful procedure. This technique should be used initially when managing a blunt foreign body in the esophagus. It reduces the risk, time, and expense involved in endoscopic removal. Prem Purl Congenital Microgastria. N.H. Aintablian, M.S. Slim, and B.W.
Antoun. Pediatr Surg Internat 2:307-310, (September), 1987.
An 81/z-year-old boy with microgastria associated with a sliding hiatal hernia and skeletal anomalies involving the spine and right