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Although the stomach is the first choice for esophageal reconstruction following esophagectomy, the colon interposition would be the best one when stomach removed or diseased. The colon reconstruction for esophagus, therefore, is the inevitable procedure in esophageal surgery. This paper focused on the colon interposition in terms of history, anatomy point, critical skills, and future prospect.
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Humans , Colon , General Surgery , Esophageal Neoplasms , General Surgery , Esophagectomy , Methods , Plastic Surgery Procedures , Stomach , General SurgeryABSTRACT
Objective To investigate the expression of CD14/CD16 by monocytes and the anti-inflammatory effects of hypertonic saline plus dextran (HSD) in adult blunt trauma patients in hemonhagic shock. Method A total of 30 adult patients were eligible for inclusion in the study if they sustained blunt trauma from March to October 2007 and had at least one recorded episode of hypotension (systolic blood pressure ≤ 90 mm Hg) with clear evidence of blood loss (external or internal including the thorax, abdomen or retroperitoneum). Patients were excluded if they refused to participate, were admitted ≥ 6 hours after injury, were pregnant, or had chronic disease. The enrolled patients were randomly divided in a double-blinded manner into an HSD group which was administered 7.5% Nad plus 6% dextran - 70, and a control group which was administered 0.9% NaCl. A single 250 ml dose of either HSD or NaO was immediately administered to the patients in each of the two groups while they were in the emergency room. The primary outcomes were to measure the changes in CD4/CD16 expression by monocytes and the levels of anti-inflammatory cytokines, including tumor necrosis factor-alpha (TNF-α), interleukin (IL)-lra and IL-10. Patient demographics, fluid requirements, organ dysfunction, infection and death were recorded. Results A total of 28 patients were enrolled with no significant differences in their clinical measurements. Hyperosmolarity was modest and transient. HSD altered the shock-induced monocyte redistribution pattern by reducing the drop in the "classic" CD14 ++ subset and remarkably affecting the expansion of the "pro-inflammatory" CD14+CD16+ subsets. In parallel, HSD significamly reduced pro-inflammatory TNF-α production while increasing anti-inflammatory IL-lra and IL-10 production. Conclusions This human trial demonstrates that HSD has anti-inflammatory and immunologic properties for trauma patients in hemorrhagic shock. HSD exerts profound immunomodulatory effects, promoting more balanced pro-/anti-inflammatory responses and reducing post-traumatic complications. Therefore, it could be useful in attenuating post-trauma multiorgan dysfunction (MOD).
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Objectives To evaluate the effects of hypertonic-hyperoncotic solution (HHS) on cardiac function and extravascular lung water in children after open-heart surgery for congenital cardiac disease. Methods 50 children with congenital cardiac disease were randomly assigned to 2 groups. The HHS group received HHS (7.5% sodium chloride with 6% hydroxyethyl-stareh 200 kDa). The ISS group received isotonic saline solution (ISS 0.9% sodium chloride). Cardiac index (CI), extravascular lung water index (ELWI), stroke volume index (SVI), mean arterial pressure (MAP), and systemic vascular resistance index (SVRI) were measured. Immediately after sur-gery, patients were loaded either with HHS or with ISS (4 ml/kg). Sodium concentration, osmolality, thrombocyte count(TC), fibrinogen, and arterial blood gases were detected before operation, immediately after loading, 15 minutes, 1,4, 12, and 24 hours after the end of vol-ume loading. Hemodynamic parameters were recorded at the same time. The total amount of dobutamine required was documented. Results In HHS group, MAP, SVI and CI increased, and SVRI decreased significantly after the administration of HHS, compared with ISS group and before administration(P<0.01 or 0.05). Both CVP and HR were unchanged in both groups. In HHS group, ELWI decreased signifi-cantly, compared with before volume administration. But ELWI increased directly and remained elevated for 60 minutes after the administra-tion of ISS. Sodium concentration increased immediately after infusion of HHS. The postoperative need for infused dobutamine in the patients in HHS group was decreased, compared with ISS group (P<0.05). All patients left the hospital in a clinically sufficient state. Condu-sions A single infusion of HHS after cardiac surgery is safe. After cardiopuimonary bypass surgery, the administration of HHS increased CI by elevating SVI in combination with a decreased SVRI. ELWI significantly decreased, which suggest that HHS effectively counteracts, the capillary leakage.
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Objective To test the role of a bioartificial kidney which consisted of a continuous vein-vein hemofiltration (CVVH) system and renal proximal tubule cells (PTCs)device, also called the renal tubule assist device (RAD),in endotoxin shock.Methods Female crossbred pigs 25 to 30 kg received with 3×1011 bacteria / kg body weight of E.coli intraperitoneally followed by treatment with a sham RAD without cells (n=7) or a RAD with cells (n=7). Data on blood pressure, cardiac output, renal blood flow and systemic marker of inflammation (IL-6) were measured.Results Cardiac outputs and renal blood flows were higher in the RAD group with cells than in the sham RAD group after E.coli infusion (P＜0.05). Plasma IL-6 levels were lower in the cell RAD group than in the sham RAD group after bacterial administration (P＜0.05). A significant difference on survival time was also observed between the two groups,with(9.07 ± 0.88) h in the cell RAD group vs. (5.10 ± 0.46)h in the sham RAD group, P＜ 0.01.Conclusion The bioartificial kidney containing PTCs can improve cardiovascular function,reduce cytokine levels,and prolong survival time.
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Objective The aim of this study was to evaluate the individual and combined diagnostic value of five tumor markers in the elderly patients with pleural effusion. Methods Serum and pleural levels of cytokeratin fragment19(CYFRA21 1), neuron specific enalase(NSE), carbohydrate antigen15 3(CA15 3), carbohydrate antigen19 9(CA19 9) and carbohydrate antigen 125(CA125) were assayed in 32 elderly patients with malignant pleural effusions resulting from advanced lung cancer and in 30 elderly patients with benign pleural effusions by ELISA. Results Serum levels of CYFRA21 1, NSE, CA15 3, CA19 9 and CA125 in patients with malignant pleural effusions were (12 84?6 48) ?g/L, (22 07?11 25) ?g/L, (65 74?30 26) kU/L, (56 32?25 67)kU/L and (71 86?31 45) kU/L, respectively and were significantly higher than those patients with benign pleural effusions (P
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0. 05). However, the serum CYFRA21-1 level was related to the histologic classification (P
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Objective: To review the experience of the esophageal replacement with colon. Methods: The data from 548 patients were summarized and analyzed, including the diseases type, operations type, selection of the colon segment, colon blood supply and pathway for pulling-up of transplanted colon. Results: Postoperative complications occurred in 86 cases (15。69%), with 10 deaths (mortality rate 1。82%). The 1,3,5 years survival rate were 85。6%, 60。8% and 32。4%, respectively. All the patients in the group of benign esophageal diseases survived well with normal lives and activities, after 2～25 years of follow-up. Conclusion: There are several keys to ameliorate the results and reduce the complications rate to 15。69% and mortality rate to 1。82%. The keys are choosing of isoperistaltic transposition, ascending branch of left colica artery, retrosternal tunnel, a single-row suturing by cervical esphagocolostomy and prevention of complications (injury of recurrent laryngeal nerve, thoracic colon syndrome and esophageal pouch syndrome).
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Objective: To investigate the etiological factors and treatment for a rare evacuation disturbance and severe dilatation syndrome of transplanted colon for esophagus diseases. Methods: From 1962 to 1999, 548 patients with colon replacement for esophagus were studied. 425 patients were followed-up for 0 5 to 10 years. 9 patients with thoracic colon syndrome were operated on from 1970 to 1980. The clinical sign, experiment test, etiological factor and method of treatment were reviewed. Results: 5 patients had large anastomotic stoma of colon-stomach, 2 had angulation of abdominal part colon, and 2 had mechanical obstruction. 7 patients were cured after reoperation. Clinical symptoms of other 2 patients were remission after drug treatment. No thoracic colon syndrome occurred after 1980. Conclusion: The etiological factors of thoracic colon syndrome were too large colon-stomach anastomotic stoma, angulation of long-winded colon in abdomen part colon and mechanical obstruction. Colon-stomach stoma should be 1/2 to 2/3 of intestinal luminal diameter and anti-reflux operation should be done at the same time. The pyloroplasty is essential when truncal vagotomy has been done during the operation.
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Objective To investigate the etiological factors and treatment of thoraco-gastric perforation (TGP) after esophagogastrostomy. Methods Retrospective analysis was carried out in 16 patients with thoraco-gastric perforation after esophagogastrostomy in our department from March 1974 to March 2004. The etiological factor, clinical feature, experiment test and the method of treatment were compared between TGP and patients of thoracic esophageal anastomosis leak (TEAL). Results Thoraco-gastric perforation occurs within 2～5 days postoperatively. Among these 16 cases, in 8, local necrosis of gastric wall was found which was caused by severe contusion and massive ligature. In 5, were penetrative injury of gastric wall caused by suture needle. In 3,unsuitable purse-string suturing of corner of greater or lisser gastric curvature. Hydropneumothorax occurred after thoraco-gastric perforation. Chest fluid was brown and turbid with putrefactive odor. With medium examination, anastomosis was normal, but medium and air bubbles were found outside of the stomach. Perforation were repaired and covered by pedicle tissue-flap in all cases. 15 cases were cured with no sequence. Conclusion TGP after esophagectomy were correlated with technique of surgery. TGP often occurs early after esophagogastrostomy. Transthoracic repairing of TGP should be done as soon as possible. The healing ratio of reparation was about 93.8%.
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Objective To probe the effects of hypothermia and St Thomas Hospital Ⅱ cardioplegia on immature myocardium.Methods To observe the change of hemodynamics,myocardial enzyme in the coronary effluent and myocardial biochemistry of the perfused immature rabbit heart in vitro after two or four hours ischemia at 14 degrees centigrade.Results There were no significant differences in post ischemic hemodynamics,myocardial enzyme in the coronary effluent and myocardial biochemical parameters of the perfused immature heart The myocardial protective effect provided by St.Thomas Hospital Ⅱ cardioplegia was worsen than that of hypothermia alone,marked by the elevated myocardial enzyme leakage and the decreased hemodynamics.Single dose perfusion was better than multi dose perfusion by characteristics of decreased enzyme leakege and good post ischemic hemodynamics.Conclusions Hypothermia alone can provide immature heart with satisfactory myocardial protection.St.Thomas Hospital Ⅱ cardioplegia can not afford good myocardial protection to immature heart and enhance the myocardial protective effect provided by hypothermia.The myocardial protection effect is better provided by single dose perfusion than by multi dose perfusion