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The experimental treatment of esophageal strictures by intralesional steroid injections
485
ABSTRACTS
DEVELOPMENT OF A MEMBRANE OXYGENATOR:OVERCOMINGBLOODDIFFUSION LIMITATION.R. H. Bartlett, D. Kittredge, B. S. Noyes, Jr., R. W. Willard, HI and P. A. Drinker. J. Thorac. Cardiovasc. Surg. 58:795-800 (December), 1969.
The authors report further experiences with an oscillating helix of 0.25 inch internal diameter, 5 mils thick silicone membrane tubing as an oxygenator. Fifty-one determinations of oxygen transport capabilities of this system were made on 8 dogs during venovenous bypass of several hours (after which the membrane failed). With a tube wall velocity of 220 cm./sec., the oxygenator was capable of transporting approximately 175 ml. of oxygen per minute per square meter, which approached the limit of the 5 mil membrane. It appears that the oscillating membrane solves the problem of diffusion block through the plasma boundary layer, which has plagued investigators of the membrane oxygenator. The authors claim an absence of adverse mechanical trauma to the blood elements, but present no evidence to support this contention. In short, it appears that a usable efficient membrane oxygenator for prolonged respiratory support is within reach. -J. G. Rosenkrantz.
ies showed minimal effects of trauma. The presence of fetal cells seemed to allow more complete organization of the fibrin layer inside the pump.-J. G. Rosenkrantz. RELATIONOF PULSATILEFLOW TO OXYGEN CONSUMPTION AND OTHER VARIABLES DURING CARDIOPULMONARY BYPASS.R. B. Shepard and .l. W. Kirklin. J. Thorac.
Cardiovasc. ber). 1969.
Surg.
58: 694-702
( Novem-
IMPROVED ORGAN FUNCTION DURING CARDIACBYPASS WITH A ROLLER PUMP MODIFIEDTO DELIVER PULSATILEFLOW. L. A. Jacobs, E. H. Klopp, W. Seamone, S. R. Topaz und V. L. Gott. J. Thorac.
Cardiovasc. ber), 1969.
Surg.
58:703-712
(Novem-
These two papers, the first describing experiments on calves on total cardiopulmonary bypass and the second presenting work on dogs during left heart bypass, have several things in common. Each has been done by careful investigators and attempts to answer the question of whether pulsatile or nonpulsatile flow is preferable during extracorporeal circulation, with careful control of variables other than the pulse contour. Both used fairly simple roller pumps to deliver pulsatile flow, the second group of investigators with a triangular wave-form AN APPRAISALOF BLOODTRAUMA AND THE electrical generator to drive the pump motor BLOOD-MATERIALINTERFACEFOLLOWING in such a fashion that the pulse wave form in the aorta could be made amazingly simiPROLONGED ASSISTEDCIRCULATION.W. F. lar to that occuring in the intact animal. Bernhard. M. Husain, T. Robinson, L. Neither study conclusively answered the Buttor!, S. Frieze and G. W. Curtis. J. question of superiority of one type of pumpThorac. Cardiovasc. Surg. 58:801-810 ing over the other, but the papers did pre(December), 1969. sent data which showed less alteration in The authors developed a pneumatic peripheral vascular resistance, arterial pH double-valved implantable pump, the lining and buffer base, lactic acid, creatinine clearof which was composed of flocked dacron ance and urine flow after pulsatile flow than fibrils in a polyurethane substrate. This after nonpulsatile flow. surface was then seeded with bovine fetal These papers both supply indirect evifibroblasts, grown in tissue culture. Imdence that, if the pressure-pulse and flowplanted in 20 calves for partial left venpulse contours can be made to approximate tricular bypass. this apparatus was evaluated those in the intact animal, pulsatile pumpover 30-120 days (only six of these experiing is less damaging to the organism than ments included the use of fetal fibroblasts). nonpulsatile pumping during extracorporeal Two calves developed empyema, two showed circulation.-J. G. Rosenkrarltz. clotting of the prosthesis and in four the pump failed mechanically. Three animals ALIMENTARY TRACT remained well 34-86 days postoperatively and nine were sacrificed postoperatively. THE EXPERIMENTAL TREATMENTOF ESOPHAFlow rates were 1.5 L./min. during the time GEAL STRICTURES BY INTRALESIONAL of implantation. Detailed hematologic stud-
486
ABSTRACTS
STEROIDINJECTIONS. K. W. Ashcraft and T. M. Holder. J. Thorac. Cardiovasc. Surg. 58:685-691 (November), 1969. Fifteen mongrel dogs were given short circumferential esophageal burn with 10 per cent NaOH. Three weeks later the resulting strictures were managed according to three methods: 1-3 injections of the strictured site with 20-40 mg. triamcinolone 6-23 weeks after burn, injection of equivalent amounts of saline at equivalent times and no therapy. No dilatations were done. The animals were evaluated by cine-esophagogram and at autopsy. Seven of the nine animals given triamcinolone showed significant improvement in the stricture, the two “failures” being in 23-week-old strictures. No improvement was noted in the three animals given saline or in the three animals with no therapy. Four patients were treated with triamcinolone injections in addition to esophageal dilatations. Three of these patients had previously been undergoing repeated dilatations after lye burns; and the fourth patient, with an acid burn, required only one injection and dilatation. Clinical details of these cases are not provided in this paper.-J. G. Rosenkrantz.
OESOPHAGEAL RECONSTRUCTION USING
A GASTRIC TUBE: A PRELIMINARY REPORT. D. Cohen. Aust. Paediat. J. 6~22-24
(March),
1970.
Three children are presented who had an esophageal reconstruction for atresia performed using a tube fashioned from the greater curvature of the stomach. The technique is dissimilar to that of Burrington and Stephens in that the tube takes the shortest route by crossing the thoracic cavity, and the spleen is preserved. Preliminary experience with this procedure has been encouraging. Sufficient length is obtained in the tube to reach the neck easily, and the vascular supply is less likely to cause problems than the colon or smaI1 bowel. The tube serves as a relatively inert conduit, but retains its tone and empties quicker than a colonic prosthesis. Reflux has not caused any problems and the patients do not regurgitate and can lie down after a meal. Two of the children have had difficulty with lumpy solids, though there has been no
interference
with nutritional
development.-
J. R. Solomon.
SURGICAL MANAGEMENT OF BLEEDING GASTROESOPHAGEALVARICES IN CHILDREN. E. S. Tank, W. Wallin, J. G. Turcotte and C. G. Child. Arch. Surg. 98:451-456
(April),
1969.
During the past eight years 23 children had 29 operations at the University of Michigan Medical Center to control bleeding from esophageal varicies. The portal hypertension was secondary to portal vein obstruction in 13 cases and the cause was intrahepatic in 10. In the latter group, the largest single cause was congenital hepatic fibrosis. In this group, intravenous pyelography demonstrated a solitary renal cyst in one patient and multiple renal cysts in the second. In 12 children with extrahepatic portal hypertension, a mesocaval shunt was successful, while portal decompression was achieved with a portocaval shunt in 7 of 8 children with intrahepatic disease. It is noteworthy that all children with extrahepatic portal obstruction or congenital hepatic fibrosis are alive. It is concluded that a mesocaval shunt is technically feasible in small children and is preferred for portal decompression in children with extrahepatic block. Splenorenal shunt is reliable only when the splenic vein is large, and should be reserved for cases in which it is not possible to fashion either a portocaval or mesocaval shunt.-A. M. Salzberg. EXPERIENCE WITH “DISSECTION-LIGATION” ACCORDING TO VOSSCHULTE FOR PORTAL HYPERTENSION IN CHILDREN. .I. G. Kundert. Helv. Chirurg. Acta 37: 12%
125, 1970. “Dissection-ligation” is an en bloc ligation of the lower esophagus over a metallic cylinder introduced into the lumen through gastrostomy. The cylinder itself is divided into three pieces, which are tied together with a catgut string. After a few days the three metallic pieces fall apart and are either eliminated by normal gastrointestinal transit or they can be pulled out via the gastrostomy. Of 9 children the late results (1 to 9 years) were good in sevenM. Bettex.
ABSTRACTS
DEVELOPMENT OF A MEMBRANE OXYGENATOR:OVERCOMINGBLOODDIFFUSION LIMITATION.R. H. Bartlett, D. Kittredge, B. S. Noyes, Jr., R. W. Willard, HI and P. A. Drinker. J. Thorac. Cardiovasc. Surg. 58:795-800 (December), 1969.
The authors report further experiences with an oscillating helix of 0.25 inch internal diameter, 5 mils thick silicone membrane tubing as an oxygenator. Fifty-one determinations of oxygen transport capabilities of this system were made on 8 dogs during venovenous bypass of several hours (after which the membrane failed). With a tube wall velocity of 220 cm./sec., the oxygenator was capable of transporting approximately 175 ml. of oxygen per minute per square meter, which approached the limit of the 5 mil membrane. It appears that the oscillating membrane solves the problem of diffusion block through the plasma boundary layer, which has plagued investigators of the membrane oxygenator. The authors claim an absence of adverse mechanical trauma to the blood elements, but present no evidence to support this contention. In short, it appears that a usable efficient membrane oxygenator for prolonged respiratory support is within reach. -J. G. Rosenkrantz.
ies showed minimal effects of trauma. The presence of fetal cells seemed to allow more complete organization of the fibrin layer inside the pump.-J. G. Rosenkrantz. RELATIONOF PULSATILEFLOW TO OXYGEN CONSUMPTION AND OTHER VARIABLES DURING CARDIOPULMONARY BYPASS.R. B. Shepard and .l. W. Kirklin. J. Thorac.
Cardiovasc. ber). 1969.
Surg.
58: 694-702
( Novem-
IMPROVED ORGAN FUNCTION DURING CARDIACBYPASS WITH A ROLLER PUMP MODIFIEDTO DELIVER PULSATILEFLOW. L. A. Jacobs, E. H. Klopp, W. Seamone, S. R. Topaz und V. L. Gott. J. Thorac.
Cardiovasc. ber), 1969.
Surg.
58:703-712
(Novem-
These two papers, the first describing experiments on calves on total cardiopulmonary bypass and the second presenting work on dogs during left heart bypass, have several things in common. Each has been done by careful investigators and attempts to answer the question of whether pulsatile or nonpulsatile flow is preferable during extracorporeal circulation, with careful control of variables other than the pulse contour. Both used fairly simple roller pumps to deliver pulsatile flow, the second group of investigators with a triangular wave-form AN APPRAISALOF BLOODTRAUMA AND THE electrical generator to drive the pump motor BLOOD-MATERIALINTERFACEFOLLOWING in such a fashion that the pulse wave form in the aorta could be made amazingly simiPROLONGED ASSISTEDCIRCULATION.W. F. lar to that occuring in the intact animal. Bernhard. M. Husain, T. Robinson, L. Neither study conclusively answered the Buttor!, S. Frieze and G. W. Curtis. J. question of superiority of one type of pumpThorac. Cardiovasc. Surg. 58:801-810 ing over the other, but the papers did pre(December), 1969. sent data which showed less alteration in The authors developed a pneumatic peripheral vascular resistance, arterial pH double-valved implantable pump, the lining and buffer base, lactic acid, creatinine clearof which was composed of flocked dacron ance and urine flow after pulsatile flow than fibrils in a polyurethane substrate. This after nonpulsatile flow. surface was then seeded with bovine fetal These papers both supply indirect evifibroblasts, grown in tissue culture. Imdence that, if the pressure-pulse and flowplanted in 20 calves for partial left venpulse contours can be made to approximate tricular bypass. this apparatus was evaluated those in the intact animal, pulsatile pumpover 30-120 days (only six of these experiing is less damaging to the organism than ments included the use of fetal fibroblasts). nonpulsatile pumping during extracorporeal Two calves developed empyema, two showed circulation.-J. G. Rosenkrarltz. clotting of the prosthesis and in four the pump failed mechanically. Three animals ALIMENTARY TRACT remained well 34-86 days postoperatively and nine were sacrificed postoperatively. THE EXPERIMENTAL TREATMENTOF ESOPHAFlow rates were 1.5 L./min. during the time GEAL STRICTURES BY INTRALESIONAL of implantation. Detailed hematologic stud-
486
ABSTRACTS
STEROIDINJECTIONS. K. W. Ashcraft and T. M. Holder. J. Thorac. Cardiovasc. Surg. 58:685-691 (November), 1969. Fifteen mongrel dogs were given short circumferential esophageal burn with 10 per cent NaOH. Three weeks later the resulting strictures were managed according to three methods: 1-3 injections of the strictured site with 20-40 mg. triamcinolone 6-23 weeks after burn, injection of equivalent amounts of saline at equivalent times and no therapy. No dilatations were done. The animals were evaluated by cine-esophagogram and at autopsy. Seven of the nine animals given triamcinolone showed significant improvement in the stricture, the two “failures” being in 23-week-old strictures. No improvement was noted in the three animals given saline or in the three animals with no therapy. Four patients were treated with triamcinolone injections in addition to esophageal dilatations. Three of these patients had previously been undergoing repeated dilatations after lye burns; and the fourth patient, with an acid burn, required only one injection and dilatation. Clinical details of these cases are not provided in this paper.-J. G. Rosenkrantz.
OESOPHAGEAL RECONSTRUCTION USING
A GASTRIC TUBE: A PRELIMINARY REPORT. D. Cohen. Aust. Paediat. J. 6~22-24
(March),
1970.
Three children are presented who had an esophageal reconstruction for atresia performed using a tube fashioned from the greater curvature of the stomach. The technique is dissimilar to that of Burrington and Stephens in that the tube takes the shortest route by crossing the thoracic cavity, and the spleen is preserved. Preliminary experience with this procedure has been encouraging. Sufficient length is obtained in the tube to reach the neck easily, and the vascular supply is less likely to cause problems than the colon or smaI1 bowel. The tube serves as a relatively inert conduit, but retains its tone and empties quicker than a colonic prosthesis. Reflux has not caused any problems and the patients do not regurgitate and can lie down after a meal. Two of the children have had difficulty with lumpy solids, though there has been no
interference
with nutritional
development.-
J. R. Solomon.
SURGICAL MANAGEMENT OF BLEEDING GASTROESOPHAGEALVARICES IN CHILDREN. E. S. Tank, W. Wallin, J. G. Turcotte and C. G. Child. Arch. Surg. 98:451-456
(April),
1969.
During the past eight years 23 children had 29 operations at the University of Michigan Medical Center to control bleeding from esophageal varicies. The portal hypertension was secondary to portal vein obstruction in 13 cases and the cause was intrahepatic in 10. In the latter group, the largest single cause was congenital hepatic fibrosis. In this group, intravenous pyelography demonstrated a solitary renal cyst in one patient and multiple renal cysts in the second. In 12 children with extrahepatic portal hypertension, a mesocaval shunt was successful, while portal decompression was achieved with a portocaval shunt in 7 of 8 children with intrahepatic disease. It is noteworthy that all children with extrahepatic portal obstruction or congenital hepatic fibrosis are alive. It is concluded that a mesocaval shunt is technically feasible in small children and is preferred for portal decompression in children with extrahepatic block. Splenorenal shunt is reliable only when the splenic vein is large, and should be reserved for cases in which it is not possible to fashion either a portocaval or mesocaval shunt.-A. M. Salzberg. EXPERIENCE WITH “DISSECTION-LIGATION” ACCORDING TO VOSSCHULTE FOR PORTAL HYPERTENSION IN CHILDREN. .I. G. Kundert. Helv. Chirurg. Acta 37: 12%
125, 1970. “Dissection-ligation” is an en bloc ligation of the lower esophagus over a metallic cylinder introduced into the lumen through gastrostomy. The cylinder itself is divided into three pieces, which are tied together with a catgut string. After a few days the three metallic pieces fall apart and are either eliminated by normal gastrointestinal transit or they can be pulled out via the gastrostomy. Of 9 children the late results (1 to 9 years) were good in sevenM. Bettex.