- Email: [email protected]
Perioperative considerations in esophageal replacement for epidermolysis bullosa: Report of two cases successfully treated by colon interposition
502
fewer reflux episodes, both total and those lasting more than five minutes, and less time at pH <4 in the non-Barrett's group. The authors' conclusion is that the increased duodenogastric reflux of bile acids is an important pathogenic factor in the development of complications in Barrett's esophagus.--R.R. Turnock Perioperative Considerations in Esophageal Replacement for Epidermolysis Bullosa: Report of Two Cases Successfully Treated by Colon Interposition. R.J. Touloukian, S.M. Schonholz, ,I.D. Gry-
boski, et al. Am J Gastroenterol 83:857-861, (August), 1988. Patients with epidermolysis bullosa frequently develop esophageal strictures. Esophageal replacement is often considered a high risk procedure because of limited exposure of the airway, malnutrition, and postoperative skin bullae, which can easily become infected. Two patients, a 26-year-old man and a 19-year-old woman underwent successful substernal ileocolonic interposition for esophageal strictures secondary to epidermolysis bullosa. The key factors in the operative, intraoperative, and postoperative management of these patients leading to a successful outcome are detailed in this report. The multidisciplinary management by a surgeon, gastroenterologist, anesthesiologist, and dermatologist is stressed.--Richard R. Ricketts Trial of Sclerosing Agents in Patients With Oesophageal Verices.
S. Kitano, Y. lso, H. Yamaga, et al. Br J Surg 75:751-753, (August), 1988. Forty-five cirrhotic patients with esophageal varices underwent endoscopic injection sclerotherapy in a prospective randomized trial designed to compare two sclerosing agents (5% ethanolamine oleate and 2% sodium tetradecyl sulphate [STD]) with respect to safety, efficacy, and complications. Twenty-three patients were allocated to the ethanolamine group and 22 to the STD group. The rate of control of acute bleeding was 100% (6/6) in the ethanolamine group and 75% (3/4) in the STD group. There was a significantly lower rate ( P < .01) of postinjection bleeding after the overtube was removed at the initial session of sclerotherapy when ethanolamine was injected (0/23), as compared with 32% in the STD group (7/22). At the second session, there was a significantly higher rate ( P < .01) of jet-like bleeding from injection sites in the STD group (6/21) than in the ethanolamine group (0/22). The disappearance rate of red color signs 1 week after the initial session of sclerotherapy in the ethanolamine group was 100% and 62% in the STD group. Early esophageal ulcers developed less frequently in the ethanolamine group (0 and 9%) than in the STD group (24%), both after the initial ( P < .05) and the second session ( P < .01) of sclerotherapy. Early bleeding from an esophageal ulcer occurred only in the STD group (5/12) before the third session of sclerotherapy ( P < .05). The early mortality rate did not differ between the two groups. The authors conclude that ethanolamine seems to be safer and more efficacious than STD for sclerosing esophageal varices.--Lewis Spitz Development of Squamous Cell Carcinoma of the Esophagus After Endoscopic Varicesl Scierotherapy. G.S. Bochna, R.F. Harry, R.K.
Harned, et al. Am J Gastroenterol 83:564-568, (May), 1988. A 45-year-old man with portal hypertension and cirrhosis was treated for hematemesis by endoscopic sclerotherapy with sodium morrhuate. At the time of the initial endoscopy, there was no evidence of esophageal ulceration of tumor. Over the course of 3 months, at least four courses of sclerotherapy were performed. Eight months later, the patient presented with dysphagia, and at endoscopy, he was found to have squamous cell carcinoma of the esophagus. Although this report did not establish a causal relationship between sclerotherapy and the subsequent development of
INTERNATIONAL ABSTRACTS
squamous cell carcinoma of the esophagus, it emphasizes that carcinoma of the esophagus should be considered in the differential diagnosis of postsclerotherapy dysphagia. Many children now receive sclerotherapy for treatment of variceal bleeding due to portal hypertension. Careful endoscopic evaluation of the esophagus should he done in any of these patients who develop dysphagia.--Richard R. Ricketts Dieulafoy's Lesion Associated With Truncus Arteriosus Type IV: An Unusual Cause of Upper Gastrointestinal Hemorrhage. C. de
Virgilio, T.J. Dubrow, J.M. Robertson, et al. Am J Gastroenterol 83:865-867, (August), 1988. A 17-year-old boy with a history of type IV truncus arteriosus presented with massive upper gastrointestinal bleeding. A celiac and left gastric artery angiography showed extravasation from the left gastric artery into the area of the gastric fundus. Embolization of the left gastric artery was successfully performed. However, the patient continued to bleed, and during emergency surgery, a bleeding arterial vessel high on the lesser curvature of the stomach was ligated. There was no visible abnormality of the surrounding mucosa or stomach wall. In type IV truncus arteriosus, the pulmonary arteries are atretic, and pulmonary circulation is via bronchial branches of the descending aorta. The abnormal submucosal artery in the stomach (Dieulafoy's lesion) may have derived from a left gastric artery that was hypertrophic as a result of its anastomosis to an enlarged bronchial artery supplying the left lower lobe of the lung.--Richard R. Ricketts Intramural Haematoma of the Alimentary Tract in Children. S.
Chittmittrapap, B. Chandrakamol, and S. Chomdej. Br J Surg 75:754-757, (August), 1988. Thirteen children with intramural hematoma of the alimentary tract were treated in Chulalongkorn University Hospital during an 8-year period (1978 to 1986). A history of trauma was obtained in 11 cases. One case presented as a result of a coagulation defect secondary to a hematotoxic snake bite, and no causative factor was apparent in another patient. Profound vomiting with abdominal pain is the typical presentation. An upper gastrointestinal contrast study is usually characteristic and diagnostic. Conservative treatment was successful in 12 of the patients, with no morbidity or mortality.-Lewis Spitz Duplications of the Alimentary Tract. Clinical Characteristics, Preferred Treatment, and Associated Malformations. S.T. Ildstad,
D.J. Tollerud, R.G. Weiss, e/al. Ann Surg 208:184-189, (August), 1988. A single institution's 20-year experience of 17 patients with 20 enteric duplications is reviewed. The patient's age range was one day to 11 years (6% were <2 years of age at the time of diagnosis). Sixty percent were male. Thirty-nine percent of the duplications involved foregut structures, and 61% were midgut or hindgut, Foregut duplications were found predominantly in females and were of esophageal origin. Sixty-seven percent presented with moderate to severe acute respiratory distress, and all had masses identified on a chest radiograph. Two of six were extensive and tubular. Both were in communication with the native esophagus, and excision with preservation of seromuscular layers was successful. Four of six cystic esophageal duplications were easily and completely resected. Two patients had second noncontiguous alimentary tract duplications below the diaphragm; one involved the greater curvature of the stomach and the other the proximal ileum. Eleven patients had 13 duplications of midgut or hindgut derivation. Seventy-eight percent were found in boys. Sixty-two percent involved the ileocecal area,
fewer reflux episodes, both total and those lasting more than five minutes, and less time at pH <4 in the non-Barrett's group. The authors' conclusion is that the increased duodenogastric reflux of bile acids is an important pathogenic factor in the development of complications in Barrett's esophagus.--R.R. Turnock Perioperative Considerations in Esophageal Replacement for Epidermolysis Bullosa: Report of Two Cases Successfully Treated by Colon Interposition. R.J. Touloukian, S.M. Schonholz, ,I.D. Gry-
boski, et al. Am J Gastroenterol 83:857-861, (August), 1988. Patients with epidermolysis bullosa frequently develop esophageal strictures. Esophageal replacement is often considered a high risk procedure because of limited exposure of the airway, malnutrition, and postoperative skin bullae, which can easily become infected. Two patients, a 26-year-old man and a 19-year-old woman underwent successful substernal ileocolonic interposition for esophageal strictures secondary to epidermolysis bullosa. The key factors in the operative, intraoperative, and postoperative management of these patients leading to a successful outcome are detailed in this report. The multidisciplinary management by a surgeon, gastroenterologist, anesthesiologist, and dermatologist is stressed.--Richard R. Ricketts Trial of Sclerosing Agents in Patients With Oesophageal Verices.
S. Kitano, Y. lso, H. Yamaga, et al. Br J Surg 75:751-753, (August), 1988. Forty-five cirrhotic patients with esophageal varices underwent endoscopic injection sclerotherapy in a prospective randomized trial designed to compare two sclerosing agents (5% ethanolamine oleate and 2% sodium tetradecyl sulphate [STD]) with respect to safety, efficacy, and complications. Twenty-three patients were allocated to the ethanolamine group and 22 to the STD group. The rate of control of acute bleeding was 100% (6/6) in the ethanolamine group and 75% (3/4) in the STD group. There was a significantly lower rate ( P < .01) of postinjection bleeding after the overtube was removed at the initial session of sclerotherapy when ethanolamine was injected (0/23), as compared with 32% in the STD group (7/22). At the second session, there was a significantly higher rate ( P < .01) of jet-like bleeding from injection sites in the STD group (6/21) than in the ethanolamine group (0/22). The disappearance rate of red color signs 1 week after the initial session of sclerotherapy in the ethanolamine group was 100% and 62% in the STD group. Early esophageal ulcers developed less frequently in the ethanolamine group (0 and 9%) than in the STD group (24%), both after the initial ( P < .05) and the second session ( P < .01) of sclerotherapy. Early bleeding from an esophageal ulcer occurred only in the STD group (5/12) before the third session of sclerotherapy ( P < .05). The early mortality rate did not differ between the two groups. The authors conclude that ethanolamine seems to be safer and more efficacious than STD for sclerosing esophageal varices.--Lewis Spitz Development of Squamous Cell Carcinoma of the Esophagus After Endoscopic Varicesl Scierotherapy. G.S. Bochna, R.F. Harry, R.K.
Harned, et al. Am J Gastroenterol 83:564-568, (May), 1988. A 45-year-old man with portal hypertension and cirrhosis was treated for hematemesis by endoscopic sclerotherapy with sodium morrhuate. At the time of the initial endoscopy, there was no evidence of esophageal ulceration of tumor. Over the course of 3 months, at least four courses of sclerotherapy were performed. Eight months later, the patient presented with dysphagia, and at endoscopy, he was found to have squamous cell carcinoma of the esophagus. Although this report did not establish a causal relationship between sclerotherapy and the subsequent development of
INTERNATIONAL ABSTRACTS
squamous cell carcinoma of the esophagus, it emphasizes that carcinoma of the esophagus should be considered in the differential diagnosis of postsclerotherapy dysphagia. Many children now receive sclerotherapy for treatment of variceal bleeding due to portal hypertension. Careful endoscopic evaluation of the esophagus should he done in any of these patients who develop dysphagia.--Richard R. Ricketts Dieulafoy's Lesion Associated With Truncus Arteriosus Type IV: An Unusual Cause of Upper Gastrointestinal Hemorrhage. C. de
Virgilio, T.J. Dubrow, J.M. Robertson, et al. Am J Gastroenterol 83:865-867, (August), 1988. A 17-year-old boy with a history of type IV truncus arteriosus presented with massive upper gastrointestinal bleeding. A celiac and left gastric artery angiography showed extravasation from the left gastric artery into the area of the gastric fundus. Embolization of the left gastric artery was successfully performed. However, the patient continued to bleed, and during emergency surgery, a bleeding arterial vessel high on the lesser curvature of the stomach was ligated. There was no visible abnormality of the surrounding mucosa or stomach wall. In type IV truncus arteriosus, the pulmonary arteries are atretic, and pulmonary circulation is via bronchial branches of the descending aorta. The abnormal submucosal artery in the stomach (Dieulafoy's lesion) may have derived from a left gastric artery that was hypertrophic as a result of its anastomosis to an enlarged bronchial artery supplying the left lower lobe of the lung.--Richard R. Ricketts Intramural Haematoma of the Alimentary Tract in Children. S.
Chittmittrapap, B. Chandrakamol, and S. Chomdej. Br J Surg 75:754-757, (August), 1988. Thirteen children with intramural hematoma of the alimentary tract were treated in Chulalongkorn University Hospital during an 8-year period (1978 to 1986). A history of trauma was obtained in 11 cases. One case presented as a result of a coagulation defect secondary to a hematotoxic snake bite, and no causative factor was apparent in another patient. Profound vomiting with abdominal pain is the typical presentation. An upper gastrointestinal contrast study is usually characteristic and diagnostic. Conservative treatment was successful in 12 of the patients, with no morbidity or mortality.-Lewis Spitz Duplications of the Alimentary Tract. Clinical Characteristics, Preferred Treatment, and Associated Malformations. S.T. Ildstad,
D.J. Tollerud, R.G. Weiss, e/al. Ann Surg 208:184-189, (August), 1988. A single institution's 20-year experience of 17 patients with 20 enteric duplications is reviewed. The patient's age range was one day to 11 years (6% were <2 years of age at the time of diagnosis). Sixty percent were male. Thirty-nine percent of the duplications involved foregut structures, and 61% were midgut or hindgut, Foregut duplications were found predominantly in females and were of esophageal origin. Sixty-seven percent presented with moderate to severe acute respiratory distress, and all had masses identified on a chest radiograph. Two of six were extensive and tubular. Both were in communication with the native esophagus, and excision with preservation of seromuscular layers was successful. Four of six cystic esophageal duplications were easily and completely resected. Two patients had second noncontiguous alimentary tract duplications below the diaphragm; one involved the greater curvature of the stomach and the other the proximal ileum. Eleven patients had 13 duplications of midgut or hindgut derivation. Seventy-eight percent were found in boys. Sixty-two percent involved the ileocecal area,