Additional microvascular anastomosis in reconstruction after total esophagectomy for cervical esophageal carcinoma.

BACKGROUND: Maintaining sufficient blood flow to the substitute organ after total esophagectomy is essential for decreasing the risk of anastomotic leakage. Additional venous, or arterial and venous, anastomoses between the vessels of the gastric tube and the vessels in the neck after total esophagectomy are described for 11 patients with cervical esophageal carcinoma. METHODS: The tissue blood flow was measured by laser Doppler flowmetry before and after anastomosis. Venous anastomosis was performed for all 11 patients, and arterial anastomosis was added for 7 patients. RESULTS: A significant increase in tissue blood flow was observed after venous anastomosis alone (mean, 19%; P < 0.05) and after arterial and venous anastomoses (mean 43%; P < 0.01). There was no anastomotic leakage or hospital death. CONCLUSIONS: This procedure may reduce the risk of anastomotic leakage especially in the case of pharyngogastrostomy following total esophagectomy.

A modified stapling technique for esophagojejunostomy after total or proximal gastrectomy.

BACKGROUND: Stapling devices reduce the leakage rate of digestive tract anastomoses, but they increase the risk of strictures. We investigated a newly modified technique of end-to-end anastomosis stapling in esophagojejunostomy after total or proximal gastrectomy. STUDY DESIGN: A modified stapling technique (using a stapled anastomosis between esophageal mucosal and intact jejunal layers, with hand-sewn seromuscular sutures between the esophagus and jejunum) was used in 21 patients (modified group), while a conventionally stapled anastomosis was performed in 17 patients (conventional group). The incidence and severity of dysphagia and the size of the anastomosis as determined from x ray films were compared in the two groups. RESULTS: The modified technique provided significantly better results for dysphagia severity than the conventional method (p = 0.0025). Most of the patients in the modified group had mild dysphagia, and most patients in the conventional group complained of moderate or severe dysphagia. In the modified group, the inner diameter of the anastomosis was 12.1 +/- 2.5 mm, significantly larger than that in the conventional group (10.0 +/- 1.8 mm; p = 0.009). CONCLUSIONS: The use of our modified stapling technique can minimize the risk of anastomotic stricture and the feeling of dysphagia after esophagojejunostomy.

Dynamic MR imaging in the head and neck.

PURPOSE: To determine the utility of dynamic magnetic resonance (MR) imaging in evaluation of head and neck lesions. MATERIALS AND METHODS: Dynamic MR imaging was performed in 79 head and neck lesions. Five types of time versus signal intensity curves were obtained: type A, curve peaks 0-30 seconds after administration of contrast material; type B, curve peaks at 30-60 seconds; type C, curve peaks at 60-210 seconds; type D, gradual upward slope; and type E, flat. RESULTS: Use of dynamic imaging did not improve the sensitivity of nondynamic imaging for malignancy. Although malignancies had type B, C, or D curves, 39 (68%) of 57 benign lesions had the same patterns. Lesions with type A or E curves and lesions with type D curves and with marked hyperintensity on T2-weighted images were all benign. CONCLUSION: Although use of dynamic MR imaging contributes little in predicting malignancy in head and neck lesions, it can limit the differential diagnosis and has potential in predicting vascularity and recurrence.

Endoscopic examination of the upper gastrointestinal tract for the presence of second primary cancers in head and neck cancer patients.

Endoscopic examination of the upper gastro-intestinal tract with Lugol's solution staining was performed on 150 patients with head and neck cancer treated at the Departments of Otolaryngology and Radiology, Osaka University Hospital, between June 1987 and December 1991. Thirteen second primary cancers (11 esophageal and 2 gastric cancers) were found endoscopically, although prior fluoroscopy had found only 4 (3 esophageal and one gastric cancer). All of the 9 second primary cancers which were not detected by fluoroscopy were in the early stage. Both Brinkman's and Alcohol indices of double primary cancer cases were significantly higher than those of single head and neck cancer cases. These results indicate that head and neck cancer patients who smoke and/or drink heavily require thorough examination of their upper gastro-intestinal tract with endoscopy, using Lugol's solution staining, as well as with fluoroscopy.

Repeated dose toxicity studies on catena-(S)-[mu-[N alpha-(3-aminopropionyl) histidinato(2-)-N1,N2,O:N tau]-zinc] in rats.

Thirteen- and 52-week oral toxicity studies of Z-103 (catena-(S)-[mu- [N alpha-(3-aminopropionyl) histidinato (2-)-N1,N2,O:N tau]-zinc], CAS 107667-60-7) were carried out in rats. In a 13-week repeated dose toxicity study (37.5, 75, 150, 300, 600 or 1200 mg/kg/d), deterioration of the general condition was observed at 300 mg/kg/d or more, a decrease in body weight gain at 600 mg/kg/d or more. Approximately 40% of the animals were found dead or sacrificed in a moribund state at 1200 mg/kg/d. Furthermore, in the 600 mg/kg group changes in urine volume, blood urea nitrogen and weight of kidneys were observed, suggesting that Z-103 may have had adverse effects on the kidney. No sex difference was noted. From these results the no-effect dose level was estimated to be 150 mg/kg/d under the conditions of this experiment. In a 52-week repeated dose toxicity study (18.75, 37.5, 75 or 150 mg/kg/d), proliferation of small duct and atrophy of acinar cells in the pancreas were observed in both sexes of the 150 mg/kg/d group. No other dose-related changes were observed throughout the administration period. Therefore, the no-effect dose level was estimated to be 75 mg/kg/d under this condition.