- Email: [email protected]
The incidence of adenocarcinoma in Barrett's esophagus: A prospective study of 170, patients followed 4.8 years
144
INTERNATIONAL
induced diaphragmatic hernia at 90 days’ gestation, followed by delivery near term. These lambs were randomized to one of two groups. All animals underwent reduction of the diaphragmatic hernia at about 15 minutes of age and were gas-ventilated to 30 minutes. In one group, gas ventilation alone was continued; in the second group, PFC was instilled. Mechanical ventilation was continued for up to 3.5 hours. Gas exchange, pulmonary mechanics, and histology were analyzed at the end of the experiment. A morphometric analysis was performed, reporting proportions of parenchyma, bronchi, perivascular emphysema, etc. Pulmonary trauma was described using the perivascular compression index. In normal lungs, adequate gas exchange was achieved in all groups. No statistically significant differences were found with regard to the degree of lung trauma between the groups. In the hypoplastic lungs of the lambs with diaphragmatic hernias, gas ventilation with instillation of PFC improved survival, gas exchange, and pulmonary mechanics, compared with animals that had only gas ventilation. However, no difference was found in pulmonary trauma between the two groups. The authors conclude that partial liquid ventilation may be an alternative therapeutic method for severe congenital diaphragmatic hernia--P. Puvi Congenital Adenomatoid Disease of the Lung: nosis and Perinatal Management. E. Supin, Barget, et al. Pediatr Sing Int 12:126-129, (February),
Prenatal DiagK Lejeune, %I? 1997.
The aim of this study was to analyze the significance of ultrasonographic findings of congenital adenomatoid malformation (CAM) with respect to prognosis and to delineate a suggested plan for perinatal management. Eighteen patients diagnosed in the 17th to 36th gestational week were evaluated. Thirteen lesions were left-sided, four were right-sided, and one was bilateral. Using the Stocker classification, 12 patients had type I lesions (macrocystic lesions), 4 had type II (polymicrocystic lesion), and 2 type III lesions (homogenous solid lesions). The prenatal course was monitored in 13 cases. In eight babies the size of the lesion was stable; in 5 cases it decreased. Abortion was performed in one case. Six neonates needed surgery in the newborn period because of respiratory symptoms. Nine babies underwent delayed surgery. In two babies, there was spontaneous regression of the lesion. Of the surgical patients, eight underwent lobectomy; segmentectomy was sufficient in six cases. Twelve patients had uncomplicated postoperative courses. At follow-up, 15 patients were well. The authors conclude that one should not overestimate a poor prognosis in cases of prenatally detected CAM.-T. Wester
ABSTRACTS
had medical therapy, two of whom later underwent thymectomy because of failed medical therapy. Overall, two patients died and one was lost to follow-up. Among the surgical cases there was no operative mortality or morbidity. In 10 cases, thymic hyperplasia was found; in two cases the thymus was normal. At follow-up (1 to 10 years after surgery), 50% of the patients were in remission and 33% were much improved. One patient remained unchanged, and one patient deteriorated and died. All patients in remission underwent surgery before 6 years of age and had thymic hyperplasia. The authors conclude that thymectomy may provide a better chance of remission than medical therapy, particularly when it is performed in young children who have a hyperplastic thymus-R Puri
ALIMENTARY
TRACT
Gastric Transposition for Esophageal Replacement dren-An Indian Experience. D.K. Gupta, R. K&aria, Bajpai. Em-J Pediatr Surg 7:143-146, (June), 1997.
in Chiland M.
Most pediatric surgeons are wary of gastric transposition as a means of esophageal replacement in children, especially during infancy. The authors present their initial experience with this technique in five children with follow-up averaging 1.7 years postoperatively. Four were infants (5 to 10 months) with long gap esophageal atresia; one was operated on for an extended corrosive esophageal stricture at 4 years. The stomach was placed tmnshiatally in three patients and retrostemally in two. A gastric outlet drainage procedure was performed in all cases. Three of the four infants required postoperative ventilation (mean, 40 hours), their average hospital stay was 24 days. The first transposition resulted in death (20%), owing to ventilation problems. Other complications included anastomotic leakage and subsequent stricture, adhesive obstruction, transient Homer’s syndrome, recurrent laryngeal nerve palsy, and poor weight gain. No duodenogasuic reflux was observed. The authors recommend their method as a safe, relatively simple, and physiological procedure for esopageal replacement.--Thomas A. Angerpointner The Incidence of Adenocarcinoma in Barrett’s Esophagus: A Prospective Study of 170 Patients Followed 4.8 Years. D.J. Drewitz, R.E. Samplinel; and H.S. Garewal. Am J Gastroenterol92:212215 (February), 1997.
The authors report on 32 cases of early decortication for postpneumanic empyema. Twenty were male and 12 were female. Decortication was reserved for patients in whom antibiotic therapy and closed-tube drainage had failed, and was performed on the 10 to 15 days after diagnosis had been established. Indications for decortication were persistent fever (9), pulmonary air leakage (7), localized effusion (7), persistent respiratory distress (5), and pleural thickening without resolution (28). Decortication was achieved via standard posterolateral thoracotomy. The patients were discharged on the 8th postoperative day, and morbidity was minimal. There were no deaths. Low morbidity, short hospitalization period, quick improvement of respiratory function, and return to a normal and healthy life in a short time are the most important advantages of this technique.--Thornus A. Angevpointner
Although the patients in this study are adults and the study was conducted in a VA hospital, the results are at such variance with other studies that the reviewer felt it was appropriate to include them here. The significance of Barrett’s esophagus lies in its potential to develop adenocarcinoma. Virtually all cases of adenocarcinoma of the esophagus occur in the background of Barrett’s esophagus. Adenocarcinoma of the esophagus and of the esophagogastric junction had had the most rapidly increasing incidence of all tumors in the United States over the past two decades. The aim of this study was to prospectively determine the incidence of adenocarcinoma in patients with Barrett’s esophagus. One hundred seventy-four males and three females with a mean age at diagnosis of 62 years (range, 30 to 85 years), had follow-up for a mean of 4.8 years (range, 6 to 156 months) for a total of 834 patient-years. The prevalence of adenocarcinoma in this patient population was 4%. Adenocarcinoma developed in an additional four patients, for an incidence of 1 per 208 patient-years of follow-up. Therefore, the study demonstrates a lower incidence of adenocarcinoma associated with Barrett’s esophagus than had been reported previously, and it supports surveillance of patients with Barrett’s esophagus as an appropriate clinical practice.-Richard R. Rickeffs
Thymectomy in Black Children Gravis. K. Lakhoo, J. De Fonseca, 12:113-115, (February), 1997.
Experience With Gastrojejunal Feeding Tubes in Children. J.M. Peters, f! Simpsott, and R Tolia. Am J Gastroenterol 92:476-480 (March), 1997.
Postpneumonic Empyema in Children Treated by Early Decortication. R. Rizalal; S. Somuncu, R Bemay, et al. Eur J Pediatr Surg 7:135-137, (June), 1997.
With Juvenile Myasthenia J. Rodda, et al. Pediatr Surg Int
The authors report on 15 black children gravis, 12 of whom underwent thymectomy.
with juvenile myasthenia Five of the fifteen initially
The main indications for use of a jejunal feeding tube include aspiration, reflux esophagitis, or gastroparesis. Use of jejunal
tracheal feeding
INTERNATIONAL
induced diaphragmatic hernia at 90 days’ gestation, followed by delivery near term. These lambs were randomized to one of two groups. All animals underwent reduction of the diaphragmatic hernia at about 15 minutes of age and were gas-ventilated to 30 minutes. In one group, gas ventilation alone was continued; in the second group, PFC was instilled. Mechanical ventilation was continued for up to 3.5 hours. Gas exchange, pulmonary mechanics, and histology were analyzed at the end of the experiment. A morphometric analysis was performed, reporting proportions of parenchyma, bronchi, perivascular emphysema, etc. Pulmonary trauma was described using the perivascular compression index. In normal lungs, adequate gas exchange was achieved in all groups. No statistically significant differences were found with regard to the degree of lung trauma between the groups. In the hypoplastic lungs of the lambs with diaphragmatic hernias, gas ventilation with instillation of PFC improved survival, gas exchange, and pulmonary mechanics, compared with animals that had only gas ventilation. However, no difference was found in pulmonary trauma between the two groups. The authors conclude that partial liquid ventilation may be an alternative therapeutic method for severe congenital diaphragmatic hernia--P. Puvi Congenital Adenomatoid Disease of the Lung: nosis and Perinatal Management. E. Supin, Barget, et al. Pediatr Sing Int 12:126-129, (February),
Prenatal DiagK Lejeune, %I? 1997.
The aim of this study was to analyze the significance of ultrasonographic findings of congenital adenomatoid malformation (CAM) with respect to prognosis and to delineate a suggested plan for perinatal management. Eighteen patients diagnosed in the 17th to 36th gestational week were evaluated. Thirteen lesions were left-sided, four were right-sided, and one was bilateral. Using the Stocker classification, 12 patients had type I lesions (macrocystic lesions), 4 had type II (polymicrocystic lesion), and 2 type III lesions (homogenous solid lesions). The prenatal course was monitored in 13 cases. In eight babies the size of the lesion was stable; in 5 cases it decreased. Abortion was performed in one case. Six neonates needed surgery in the newborn period because of respiratory symptoms. Nine babies underwent delayed surgery. In two babies, there was spontaneous regression of the lesion. Of the surgical patients, eight underwent lobectomy; segmentectomy was sufficient in six cases. Twelve patients had uncomplicated postoperative courses. At follow-up, 15 patients were well. The authors conclude that one should not overestimate a poor prognosis in cases of prenatally detected CAM.-T. Wester
ABSTRACTS
had medical therapy, two of whom later underwent thymectomy because of failed medical therapy. Overall, two patients died and one was lost to follow-up. Among the surgical cases there was no operative mortality or morbidity. In 10 cases, thymic hyperplasia was found; in two cases the thymus was normal. At follow-up (1 to 10 years after surgery), 50% of the patients were in remission and 33% were much improved. One patient remained unchanged, and one patient deteriorated and died. All patients in remission underwent surgery before 6 years of age and had thymic hyperplasia. The authors conclude that thymectomy may provide a better chance of remission than medical therapy, particularly when it is performed in young children who have a hyperplastic thymus-R Puri
ALIMENTARY
TRACT
Gastric Transposition for Esophageal Replacement dren-An Indian Experience. D.K. Gupta, R. K&aria, Bajpai. Em-J Pediatr Surg 7:143-146, (June), 1997.
in Chiland M.
Most pediatric surgeons are wary of gastric transposition as a means of esophageal replacement in children, especially during infancy. The authors present their initial experience with this technique in five children with follow-up averaging 1.7 years postoperatively. Four were infants (5 to 10 months) with long gap esophageal atresia; one was operated on for an extended corrosive esophageal stricture at 4 years. The stomach was placed tmnshiatally in three patients and retrostemally in two. A gastric outlet drainage procedure was performed in all cases. Three of the four infants required postoperative ventilation (mean, 40 hours), their average hospital stay was 24 days. The first transposition resulted in death (20%), owing to ventilation problems. Other complications included anastomotic leakage and subsequent stricture, adhesive obstruction, transient Homer’s syndrome, recurrent laryngeal nerve palsy, and poor weight gain. No duodenogasuic reflux was observed. The authors recommend their method as a safe, relatively simple, and physiological procedure for esopageal replacement.--Thomas A. Angerpointner The Incidence of Adenocarcinoma in Barrett’s Esophagus: A Prospective Study of 170 Patients Followed 4.8 Years. D.J. Drewitz, R.E. Samplinel; and H.S. Garewal. Am J Gastroenterol92:212215 (February), 1997.
The authors report on 32 cases of early decortication for postpneumanic empyema. Twenty were male and 12 were female. Decortication was reserved for patients in whom antibiotic therapy and closed-tube drainage had failed, and was performed on the 10 to 15 days after diagnosis had been established. Indications for decortication were persistent fever (9), pulmonary air leakage (7), localized effusion (7), persistent respiratory distress (5), and pleural thickening without resolution (28). Decortication was achieved via standard posterolateral thoracotomy. The patients were discharged on the 8th postoperative day, and morbidity was minimal. There were no deaths. Low morbidity, short hospitalization period, quick improvement of respiratory function, and return to a normal and healthy life in a short time are the most important advantages of this technique.--Thornus A. Angevpointner
Although the patients in this study are adults and the study was conducted in a VA hospital, the results are at such variance with other studies that the reviewer felt it was appropriate to include them here. The significance of Barrett’s esophagus lies in its potential to develop adenocarcinoma. Virtually all cases of adenocarcinoma of the esophagus occur in the background of Barrett’s esophagus. Adenocarcinoma of the esophagus and of the esophagogastric junction had had the most rapidly increasing incidence of all tumors in the United States over the past two decades. The aim of this study was to prospectively determine the incidence of adenocarcinoma in patients with Barrett’s esophagus. One hundred seventy-four males and three females with a mean age at diagnosis of 62 years (range, 30 to 85 years), had follow-up for a mean of 4.8 years (range, 6 to 156 months) for a total of 834 patient-years. The prevalence of adenocarcinoma in this patient population was 4%. Adenocarcinoma developed in an additional four patients, for an incidence of 1 per 208 patient-years of follow-up. Therefore, the study demonstrates a lower incidence of adenocarcinoma associated with Barrett’s esophagus than had been reported previously, and it supports surveillance of patients with Barrett’s esophagus as an appropriate clinical practice.-Richard R. Rickeffs
Thymectomy in Black Children Gravis. K. Lakhoo, J. De Fonseca, 12:113-115, (February), 1997.
Experience With Gastrojejunal Feeding Tubes in Children. J.M. Peters, f! Simpsott, and R Tolia. Am J Gastroenterol 92:476-480 (March), 1997.
Postpneumonic Empyema in Children Treated by Early Decortication. R. Rizalal; S. Somuncu, R Bemay, et al. Eur J Pediatr Surg 7:135-137, (June), 1997.
With Juvenile Myasthenia J. Rodda, et al. Pediatr Surg Int
The authors report on 15 black children gravis, 12 of whom underwent thymectomy.
with juvenile myasthenia Five of the fifteen initially
The main indications for use of a jejunal feeding tube include aspiration, reflux esophagitis, or gastroparesis. Use of jejunal
tracheal feeding