[Colon interposition for esophageal reconstruction].

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.

Effect of CXCL12/CXCR4 on increasing the metastatic potential of non-small cell lung cancer in vitro is inhibited through the downregulation of CXCR4 chemokine receptor expression.

Lung cancer ranks as the most common type of cancer in males worldwide. Although great advances have been achieved in chemotherapy and radiotherapy, the long-term survival rate of lung cancer patients has not improved significantly. Dissemination of lung cancer in the thoracic cavity and metastatic spread to the liver, bone and brain are characteristic of non-small cell lung cancer (NSCLC), constituting the primary source of morbidity and mortality in lung cancer. Increasing evidence also indicates that the CXC chemokine receptor 4 (CXCR4)/chemokine CXC motif ligand 12 (CXCL12) chemokine axis is important for the cell invasion and migration of lung cancer. CXCR4 is a G protein-coupled receptor with a major role in lymphocyte homing. Its ligand, CXCL12, is secreted by target organs and functions as a highly efficient chemotactic factor for T cells, monocytes, pre-B cells, dendritic cells and myeloid bone marrow-derived cells. In the current study, recombinant CXCR4-specific small interfering RNA-pBSilence1.1 plasmids were constructed and transfected into the A549 NSCLC cell line in vitro. Reverse transcription polymerase chain reaction and western blotting revealed that CXCR4 was downregulated in transfected cells compared with control cells. The results of MTT and Transwell migration assays indicated that the specific downregulation of CXCR4 inhibited cell growth, invasiveness and migration. Thus, siRNA targeting of CXCR4 may effectively inhibit the effect of CXCL12/CXCR4 on increasing the metastatic potential of NSCLC.

Esophageal reconstruction with remnant stomach: a case report and review of literature.

The number of patients developing esophageal cancer after gastrectomy has increased. However, gastric remnant is very rarely used for reconstruction in esophageal cancer surgery because of the risk of anastomotic leakage resulting from insufficient blood flow. We present a case of esophageal cancer using gastric remnant for esophageal substitution after distal gastrectomy in a 57-year-old man who presented with a 1-month history of mild dysphagia and a background history of alcohol abuse. Gastroscopy showed a 1.2 cm × 1.0 cm bulge tumor of the lower third esophagus with the upper margin located 39 cm from the dental arcade. Computed tomography of the chest showed lower third esophageal wall thickening. The patient underwent en bloc radical esophagectomy with a two-field lymph node dissection of the upper abdomen and mediastinum via a left-sided posterolateral thoracotomy through the seventh intercostal space. The upper end of the esophagus was resected 5 cm above the tumor. The gastric remnant was used for reconstruction of the esophago-gastrostomy and placed in the left thoracic cavity. The patient started a liquid diet on postoperative day 8 and was discharged on the 10(th) postoperative day without complications. In this report, we demonstrate that the gastric remnant may be used for reconstruction in patients with esophageal cancer as a substitute organ after distal gastrectomy.

Propofol inhibits inflammation and lipid peroxidation following cerebral ischemia/reperfusion in rabbits.

The present study established a rabbit model of global cerebral ischemia using the 'six-vessel' method, which was reperfused after 30 minutes of ischemia. Rabbits received intravenous injection of propofol at 5 mg/kg prior to ischemia and 20 mg/kg per hour after ischemia until samples were prepared. Results revealed that propofol inhibited serum interleukin-8, endothelin-1 and malondialdehyde increases and promoted plasma superoxide dismutase activity after cerebral ischemia/reperfusion. In addition, cerebral cortex edema was attenuated with little neuronal nuclear degeneration and pyknosis with propofol treatment. The cross-sectional area of neuronal nuclei was, however, increased following propofol treatment. These findings suggested that propofol could improve anti-oxidant activity and inhibit synthesis of inflammatory factors to exert a protective effect on cerebral ischemia/reperfusion injury.

[Surgical treatment of traumatic intrathoracic esophageal perforations by foreign bone].

OBJECTIVE: To evaluate the staging criteria and surgical treatment strategy of traumatic intrathoracic esophageal perforations by foreign bone. METHODS: Fifty-seven patients with intrathoracic esophageal perforations caused by foreign bone in our department from January 1980 to June 2006 were studied. Patients were divided into 4 grades: grade I was esophageal perforation without mediastinitis (n=17), grade II was esophageal perforation with severe mediastinitis (n=13), grade III was esophageal perforation with severe empyema (n=21), grade IV was esophageal perforation with tracheal or aorto-esophageal fistula (n=6). Based on the stage of esophageal perforation, operative procedures were selected including esophagotomy, esophageal repair, esophagectomy, mediastinal drainage, and esophagus reconstruction with colon. RESULTS: In grade I, II and III, all but one patient experienced satisfactory healing of the esophagus. One patient died of multi-organ failure from septic complication. No leakage was observed. Normal swallowing function and improved weight gain was achieved in all the patients. There were 2 deaths in grade IV (2/6). CONCLUSIONS: Grading of esophageal perforation caused by foreign bone is helpful to the decision of surgical treatment strategy.

Laryngotracheal canal for hypopharyngoesophageal stricture after corrosive injury.

AIM: To evaluate the application of the laryngotracheal canal on the reconstruction of the hypopharyngoesophageal defect resulting from resection of stricture with corrosive injury. METHOD: Ten patients with the hypopharyngoesophageal stricture after corrosive injury due to ingestion of strong alkali in two cases and strong acid in eight treated surgically from January 2005 to December 2007 were studied. Lipiodol esophagography revealed almost complete obliteration of both sides of sinus piriformis in seven patients and stricture of the lower hypopharynx in two cases, and laryngofiberscopy revealed injury of vocal cord in one case. All patients received the operation of the laryngotracheal canal. As an isoperistaltic conduit in eight and an antiperistaltic in two, the colon was placed retrosternally anastomosed with lower margin of larynx for esophageal substitution. RESULT: All patients healed well. No anastomotic leakage was observed. Normal deglutition and weight gain were achieved in all the patients. Postoperative follow-up endoscopy showed no stricture recurrence of anastomosis. Functional results of nine patients (90%) were categorized as good result; only one (10%) faired. CONCLUSION: The application of the laryngotracheal canal therefore can be advocated as the method for reconstruction of the hypopharyngoesophageal defect after resection of stricture due to corrosive injury.

[Prevention and treatment of anastomotic leakage and intestinal ischemia after esophageal replacement with colon].

OBJECTIVE: To explore the effective management to prevent anastomotic leakage and intestinal ischemia after esophageal replacement with colon(ERC). METHODS: Clinical data of 572 cases received ERC from March 1966 to March 2006 were analyzed retrospectively. RESULTS: Most of patients received ERC were diagnosed as esophageal cancer and esophageal stenosis(92.5%). 55.6% of cases underwent esophageal reconstruction and 44.4% of cases underwent esophageal bypass. During ERC procedure, the colon interposition graft length should be 3-4 cm longer than expectation; good blood supply was maintained; the lifted passage was unobstructed, and the physiological peristalsis direction was kept. The incidence of anastomotic leakage was analyzed among different periods, which were 14.2%, 13.5%, and 5.6% during 1966-1975, 1976-1995 and 1996-2006 respectively(P<0.05). No intestinal ischemia was observed in all the patients. CONCLUSIONS: When performing ERC, the main preventional managements of anastomotic leakage and intestinal ischemia are fully blood supply maintenance and intercepting enough length of the colon graft. Ensuring unobstructed passage is good for survival of the colon graft. Correct physiological peristalsis direction of colon interposition is beneficial to the healing of the anastomosis.

[Etiology and treatment of non-thoracotraumatic pneumomediastinum].

OBJECTIVE: To investigate the etiological factors, pathogenesis, and treatment of pneumomediastinum not caused by thoracic injury and chest operation. METHODS: 56 patients with non-thoracotraumatic pneumomediastinum were divided into 3 groups according to etiology: idiopathic pneumomediastinum (n = 37), descending pneumomediastinum (n = 11) and ascending pneumomediastinum (n = 8). All of 56 patients received symptomatic treatment by mediastinotomy and etiological treatment on the basis of different primary affection of mouth, throat, neck, bronchus, colon etc. RESULTS: Complete recovery was observed in 45 patients and partial recovery was found in 5 patients. The causes of death in 6 patients were serious pulmonary infection with respiratory failure, descending necrotizing mediastinitis with multi-organ failure and colonic perforation with septicopyemia. CONCLUSION: Most non-thoracotraumatic pneumomediastinum are secondary to the underlying diseases, the mechanisms of its pathogenesis include lung interstitium path (idiopathic), oropharyngeal and cervical interspace path (descending), and extraperitoneal space path (ascending). The treatment should be focused on dealing with primary diseases as well as symptomatic treatment by mediastinotomy.

[Clinicopathological analysis of esophageal carcinosarcoma:a report of 22 cases].

OBJECTIVE: To evaluate the clinicopathological characteristics and surgical treatment of esophageal carcinosarcoma. METHODS: The patients with esophageal carcinosarcoma were divided into two types according to barium swallow: intraluminal carcinosarcoma (n=20) and fungating carcinosarcoma (n=2). Only one esophageal carcinosarcoma case was diagnosed by esophagoscopic biopsy preoperatively. Twenty patients underwent left thoracic approach esophagectomy and esophagogastrostomy above aortic arch, and two patients underwent esophagectomy and esophagogastrostomy below aortic arch. RESULTS: All the cases survived during operation and had no severe complication. Post-operative biopsy revealed that 21 cases had definite boundary between the carcinoma and the sarcoma. Only one case showed the invasion of carcinomatous tissues into sarcomatous tissues and mixed growth. Four cases had lymph node metastases (18.2%). The 1-, 3- and 5-year survival rates were 90.9% (20/22), 77.3% (17/22) and 68.2% (15/22) respectively. CONCLUSIONS: Esophageal carcinosarcoma is a rare malignant tumor with little invasiveness, low lymph node metastasis, early clinical symptom occurrence, low preoperative accurate diagnostic rate and good prognosis. Surgical resection is the main treatment for esophageal carcinosarcoma.

Migration and distribution of bone marrow stromal cells in injured spinal cord with different transplantation techniques.

OBJECTIVE: To study the regularity of migration and distribution of bone marrow stromal cells (BMSCs) in injured spinal cord with intradural space transplantation. METHODS: Forty Wistar rats were randomly assigned into 4 groups. The spinal cord injury model was prepared according to the modified Allen method. BMSCs were labeled by CM-Dil. And 5.0 multiply 10(6) cells were transplanted by different channels including intraventricular injection (Group A),injured spinal cord intrathecally injection (Group B), remote intrathecally injection at the L(3)-L(4) level (Group C), and intravenous injection (Group D). Spinal cord was dissected at 24 hours, 1, 2, 3 and 4 weeks after transplantation. Sections of 4 micromolar were cut on a cryostat and observed under fluorescence microscopy. RESULTS: No fluorescence was observed 24 hours after transplantation in spinal cord injury parenchyma except Group B. One week later, BMSCs in Groups A and C began to migrate to the injured parenchyma; 2-4 weeks later, BMSCs penetrated into the injured parenchyma except Group D. The number of BMSCs decreased at 3-4 weeks after transplantation. The number of cells in Group B decreased faster than that of Groups A and C. CONCLUSIONS: BMSCs transplanted through intraventricular injection, injured spinal cord intrathecally injection and remote intrathecal injection could migrate to the injured parenchyma of spinal cord effectively. The number of BMSCs migrated into injured spinal cord parenchyma is rare by intravenous injection.

[Cardioprotective effects of propofol and midazolam in children with congenital heart diseases undergoing open heart surgery].

OBJECTIVE: To observe the cardioprotective effects of propofol and midazolam in children with congenital heart diseases undergoing open heart surgery. METHODS: Thirty-two children with cyanotic congenital heart diseases of ASA classes I - II were randomly divided into 2 equal groups: propofol combined with low dose fentanyl group (Group PF) and midazolam combined with low dose fentanyl group (Group MF). The changes of hemodynaics, ECG, SpO2, nasopharyngeal and rectal temperatures were monitored continuously. The time of tracheal extubation and ICU staying time were recorded. Venous blood samples were collected when the venous channel was opened (T(0)), 2 h after declamping of the aorta (T(4)), and 24 h after operation (T(5)) to detect the plasma cardiac troponin I (cTnI). Myocardium samples were collected 10 - 20 min after aorta cross-clamp (T(2)), and 10 - 20 min after declamping of the aorta (T(3)) to undergo immunohistochemistry to observe the expression of heme oxygenase-1 (HO-1). RESULTS: The tracheal time of Group GF was 14.17 h, significantly shorter than that of Group MF (23.65 h, P < 0.05), and the ICU staying time of Group GF was 30.17 h, significantly shorter than that of Group MF (49.47 h, P < 0.05). The plasma cTnI level at T(4) of Group GF was 97 ng/ml +/- 33 ng/ml, significantly higher than those at T(0) (0.17 ng/ml +/- 0.10 ng/ml, P < 0.01) and T(5) (23 ng/ml +/- 13 ng/ml, P < 0.01). The plasma cTnI level at T(4) of Group MF was138 ng/ml +/- 56 ng/ml, significantly higher than those at T(0) (0.62 ng/ml +/- 0.96 ng/ml, P < 0.01) and T(5) (24 ng/ml +/- 6 ng/ml, P < 0.01). And the plasma cTnI levels at T(5) of these 2 groups were both significantly higher than those at T(0) (both P < 0.01), however, there was no significant difference in the plasma cTnI level at any time point between these 2 groups. The grey values of HO-1 in cardiac muscle cells at T(2) of Groups GF and MF were 182.2 +/- 0.8 and 193.5 +/- 1.4, both significantly higher than those at T(3) (125.6 +/- 2.1 and 145.5 +/- 7.4 respectively, both P < 0.01), and the grey values of HO-1 in cardiac muscle cells at T(2) and T(3) of Group MF were both significantly higher than those of Group GF (both P < 0.05). CONCLUSION: Both propofol and midazolam have protective effects for the children with congenital heart diseases undergoing open heart surgery, and propofol is superior to midazolam in the cardioprotection.

[Observation on the long-term complications after esophageal replacement with colon].

OBJECTIVE: To study the etiology and preventive measures of the long-term postoperative complication after esophageal replacement with colon for esophageal benign disease. METHODS: To review the clinical data of 577 patients with esophageal replacement with colon our department, including 123 cases of esophageal benign disease. Of all, there were 25 cases-time for 11 cases following with severe complication: redundancy and dilated colon 12 cases-time, severe stricture of stoma 4, macrocyst esophagus 2, colon-stomach stoma expansion 4, mechanical obstruction of colon 3. The etiology included iatrogenic and functionality. The therapy included stricture form or resection, redundancy segment resection, obstructed segment solution and stoma resection and form. RESULTS: Eight cases underwent once operation, 2 case twice, 1 case three times. After operation, 9 cases took food normally, 2 improved symptoms obviously. CONCLUSIONS: The iatrogenic and functionality factor contributed to severe complication after esophageal replacement with colon for esophageal benign disease. The preventive measure is followed during operation: cervical esophageal-colon anastomosis exceed 2.5 centimeter, abdominal colon-stomach anastomosis reflux, channel width of colon passage, intestinal canal lay up straight. Re-operation is best choice to for local stricture, colon expansion, redundancy and dilated colon.

Study on the relationship of APACHE III and levels of cytokines in patients with systemic inflammatory response syndrome after coronary artery bypass grafting.

The aim of this study was to explore the relationship and interpret the clinical importance of acute physiology and chronic health evaluation III (APACHE III) and levels of cytokines in patients with systemic inflammatory response syndrome (SIRS) after coronary artery bypass grafting (CABG) with or without cardio-pulmonary bypass (CPB) to see if they are beneficial for evaluating the seriousness of SIRS. The data suggested that the APACHE III score and levels of interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), interleukin-1 beta (IL-1beta), and soluble interleukin-2 receptor (sIL-2R) were significantly higher after conventional CABG (CCABG) than after off-pump coronary artery bypass grafting (OPCAB) (p<0.05). With an increase in the APACHE III score, the levels of IL6, IL8, TNF-alpha, IL-1beta, and sIL-2R and the morbidity of multiple organ dysfunction syndrome (MODS) increased gradually (p<0.01), while the level of IL2 decreased (p<0.01). Stepwise regression analysis showed that IL-1beta, IL6, IL8, and sIL-2R levels had significant influences on the APACHE III score (p<0.05). The APACHE III score and levels of IL6, IL8, TNF-alpha, IL-1beta, and sIL-2R were significantly higher in the MODS group than in the non-MODS group (p<0.05), but the level of IL2 was significantly lower in the MODS group (p = 0.04). In conclusion, despite comparable surgical trauma, we believe that CPB is one of the most important factors responsible for stimulating an inflammatory response. SIRS after OPCAB was clearly mitigated compared with CCABG. Determination of the APACHE III score and plasma IL-1beta, IL6, IL8 and sIL-2R concentrations might be helpful for evaluating the severity of SIRS following CABG and making a prognosis.

Estrogen accelerates G1 to S phase transition and induces a G2/M phase-predominant apoptosis in synthetic vascular smooth muscle cells.

OBJECTIVE: To investigate the mechanisms underlying the vascular-protective effects of estrogen. METHODS: The synthetic (subcultured for 3-4 passages) rat vascular smooth muscle cells were exposed to gradient concentrations (10(-10)-10(-5) M) of 17beta-estradiol. The growth, cell cycle progression and apoptosis of the cells, and the related proteins including Cyclin D1, Cdk4, p38, Bax and Bcl-2 were analyzed in MTT, flow cytometry, ELISA or Western blot. RESULTS: 17beta-estradiol in the physiological concentrations (10(-10)-10(-8) M) promoted the smooth muscle cell growth in a concentration-dependent manner, accelerated transition of the cells from G1 to S phases, and up-regulated expressions of Cyclin D1 and Cdk4. Meanwhile, the hormone (10(-9)-10(-7) M) triggered a G2/M phase-predominant apoptosis of the cells in a concentration- and time-dependent manner, which was accompanied by increased phosphorylation of p38 and expression of Bax. CONCLUSIONS: The effect of estrogen on the synthetic vascular smooth muscle cell is dual. It promotes proliferation of the cells by accelerating their G1/S phase transition via up-regulating Cyclin D1 and Cdk4; and on the other hand, it induces apoptosis of the proliferating cells by up-regulating Bax through p38-MAPK pathway.

Effect of radix paeoniae rubra on expression of p38 MAPK/iNOS/HO-1 in rats with lipopolysaccharide-induced acute lung injury / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To investigate the effect of radix paeoniae rubra (RPR) on expression of p38 mitogen activated protein kinase (MAPK)/iNOS/HO-1 in rats with lipopolysaccharide-induced acute lung injury and explore the molecular mechanism.</p><p><b>METHODS</b>Forty healthy male Wistar rats, weighing 200-250 g, aged 6-8 weeks (mean equal to 7 weeks), provided by the Experimental Center, Medical College, Wuhan University, Wuhan, China, were employed in this study. Under anesthesia with 7% chloraldurat (5 ml/kg body weight) through intraperitoneal injection, the trachea of the rat was exposed and an arterial puncture needle pricked into the trachea via cricothyroid membrane. Then they were randomly divided into five groups: 8 rats receiving 1 ml normal saline through the puncture needle (Group A), 8 receiving 1 ml lipopolysaccharide (LPS, 2.5 mg/kg, Group B), 8 receiving LPS and RPR (30 mg/kg, pumped through the femoral vein for 2 hours, Group C), 8 receiving RPR 2 hours before dripping LPS (Group D), and 8 receiving hemin (75 micromol/L through intraperitoneal injection) 18 hours before dripping LPS (Group E). After 6 hours of LPS dripping, blood samples were obtained through the carotid artery to perform blood gas analysis, then all the rats were exsanguinated to death and specimens of lung tissues were obtained. The pathomorphological changes of the lung tissues were observed. The expression of p38 MAPK/iNOS/HO-1, the neutrophil ratio, protein content in alveolar irrigating solution and malonaldehyde (MDA) content in the lung tissues were also detected.</p><p><b>RESULTS</b>Compared with Group A, the expression of p38 MAPK, iNOS and HO-1 markedly increased in Groups B, C, D, and E (P < 0.01). But in Groups C, D and E the expression of p38 MAPK and iNOS were significantly lower than that of Group B, while expression of HO-1 was obviously higher than that of Group B (P < 0.05). The protein content, the ratio of neutrophils in bronchoalveolar lavage fluid (BALF), the content of MDA and the activities of serum NO in Group B were significantly higher than those of Group A (P < 0.01). There was a significant decrease in the level of arterial bicarbonate and partial pressure of oxygen in Group B (P < 0.01). Compared with Group B, these indexes of lung injury were significantly lower while the levels of arterial bicarbonate and partial pressure of oxygen increased significantly in Groups C, D and E (P < 0.05 or P < 0.01). Under light microscope, the pathological changes induced by LPS were significantly attenuated by RPR and hemin.</p><p><b>CONCLUSIONS</b>The high expression of MAPK plays an important role in lipopolysaccharide-induced acute lung injury. Protective effect of RPR on lipopolysaccharide-induced acute lung injury may be related to the inhibition of the abnormal high expression of p38 MAPK/iNOS/HO-1.</p>

[The clinical study on the surgical treatment of thoracic aortic aneurysm associated with coronary artery disease].

OBJECTIVE: To analyze the factors which influence the safety and prognosis of aorta replacement combined with coronary artery bypass grafting (CABG) for thoracic aortic aneurysm associated with coronary artery disease. METHODS: From May 1982 to October 2002, 67 patients with thoracic aortic aneurysm were admitted, and 24 of them combined with CABG. Of the 24 patients, 9 received descending aorta replacement combined with CABG, and the other 15 received the ascending aorta replacement combined with CABG. The treatment results were compared with the other 43 patients only undergoing the thoracic aortic replacement. RESULTS: The mortality rate of the patients with aorta replacement combined with CABG was 13% (3/24). Though the descending aorta replacement combined with CABG could make the cardiopulmonary bypass time and selective cerebral perfusion time longer, (278 +/- 54) min and (188 +/- 59) min respectively, no significant difference was observed in postoperative complications, 3-year survival rate, 3-year-cardiac-event-free rate compared with the patients only undergoing the thoracic aortic replacement (P > 0.05). CONCLUSIONS: The aorta replacement combined with CABG can be performed safely, and the revascularization for coronary artery disease is useful for preventing occurrence of cardiac events.

[Surgical anatomy of the colic vessels in Chinese and its influence on the operation of esophageal replacement with colon].

OBJECTIVE: To investigate the configuration of colic vessels in Chinese and its influence on the operation of esophageal replacement with colon (ERC). METHODS: The origin, trend, branching, configuration, and distribution of the colic vessels, the intensity of the colic arterial impulse, the integrity of the marginal artery at the splenic flexure and hepatic flexure of colon were observed during the operation of ERC among 582 patients undergoing ERC, 402 males mad 180 females, aged 2 approximately 74, from 22 provinces, municipality, and autonomous regions. RESULTS: The left colic artery (LCA) stemmed from the inferior mesenteric artery (IMA) in 97.3% of the patients, with an absence rate of 0.7%. The middle colic artery (MCA) stemmed from the superior mesenteric artery (SMA) in 77.8% of the patients with an absence rate of 8.2%. Accessory middle colic artery (acMCA), originating from the right colic artery, could be seen in 6.2% of the patients 39.7% of the right colic artery (RCA) stemmed from the SMA by itself, 23.0% of the RMA stemmed together with MCA, and 28.0% of the RCA stemmed together with the ileocolic artery. The absence rate of RCA was 9.8%. The intactness rate of marginal artery was 96.8% at the splenic flexure of colon, and was 88.7% at the hepatic flexure. The Rolan arch was seen in only 7.6% of the patients. CONCLUSION: The configuration of colic vessels in Chinese was basically similar to those of the results of autopsies carried out abroad. The optimal supply artery of colic segment during ERC is LCA, followed by LCA. Attention should be paid to the integrity of marginal arteries and veins in the patients with history of epigastric operation.

[Classification and surgical treatment of intrathoracic esophageal injury caused by foreign body].

OBJECTIVE: To investigate the classification criterion and surgical treatment strategy of intrathoracic esophageal injury caused by foreign body. METHODS: Eighty-four patients with intrathoracic esophageal injury caused by foreign body in our department from January 1980 to April 2004 were divided into 4 grade: grade I was non-penetrated injury of esophagus (18 cases); grade II was esophageal perforation with mild mediastinitis (39 cases); grade III was esophageal perforation with severe intrathoracic infection (17 cases); grade IV was aortoesophageal fistula (10 cases). Based on the degree of esophageal injury and the extension of inflammation, operative procedures were selected including esophagotomy, esophageal reparation, esophagectomy, mediastinal drainage, reparation of fistula and replacement of aorta. RESULTS: Patients in grade I and II were all cured . One death occurred in grade III (1/17), the same in Grade IV was 9 (9/10). CONCLUSIONS: Classification of esophageal injury caused by foreign body is helpful to the decision of surgical treatment strategy. The prevention of aortoesophageal fistula is the key point of reducing of mortality.

Effect of four crystalloid cardioplegias on immature rabbit hearts during global ischaemia.

OBJECTIVE: Controversy surrounds the reported beneficial effects of crystalloid cardioplegic solutions in the immature myocardium. In the present study, we investigated the efficacy of four clinical cardioplegic solutions in the immature myocardium to determine if cardioplegic protection could be demonstrated and, if yes, the relative efficacy of the four solutions. METHODS: Isolated, working hearts (n=6 per group) from neonatal rabbits (age, 7-14 days) were perfused aerobically (37 C) for 15 minutes in the Langendorff mode and 30 minutes in the working mode before a 2-minute infusion of one of four cardioplegic solutions: the modified St. Thomas' Hospital no. 1 cardioplegic solution, Tyers solution, Bretschneider solution or Roe solution. Hearts were then rendered globally ischaemic for 120 minutes at 14C before reperfusion for 15 minutes in the Langendorff mode and 30 minutes in the working mode. The post-ischaemic recovery of cardiac function and leakage of myocardial enzymes (GOT, CK, CK-MB, LDH, LDH1) were compared with results in non-cardioplegic control hearts. RESULTS: Good protection was observed with modified St. Thomas' Hospital and Tyers solutions: postischaemic recovery of cardiac output was increased from 80.43+/-3.62% in the non-cardioplegic group to 85.19+/-3.12% and 70.66+/-3.48% in the St. Thomas' Hospital and Tyers groups (p<0.05), respectively. In contrast, no obvious protection was observed with either the Bretschneider or Roe solutions: cardiac output recovered to 45.08+/-3.16% and 30.06+/-2.59%, respectively. Post-ischaemic CK leakage was 19.83+/-2.14 IU/mL and 21.17+/-2.32 IU/mL in the St. Thomas' Hospital and Tyers groups (p>0.05). In the Bretschneider group, CK leakage increased to 30.00+/-3.16 IU/mL (p<0.01 vs. non-cardioplegic control hearts), and in the Roe group, CK leakage was 31.00+/-5.10 IU/mL (p<0.05 vs. cardioplegic-free hearts). Post-ischaemic ATP was 1.98+/-0.54 micromol/g*dry weight and 1.35+/-0.39 micromol/g*dry weight in the St. Thomas' Hospital and Tyers groups (p<0.01 vs. non-cardioplegic control group), respectively. In the Bretschneider group, ATP decreased to 0.91+/-0.16 micromol/g*dry weight (p<0.05 vs. non-cardioplegic control hearts), and in the Roe group to 0.88+/-0.10 micromol/g*dry weight (p<0.01 vs.cardioplegic-free hearts). CONCLUSION: In conclusion, cardioplegic protection can be achieved in the immature rabbit myocardium with both St. Thomas' Hospital and Tyers solutions, but acalcaemic solutions such as Bretschneider and Roe solutions increased damage. The reported lack of cardioplegic efficacy in the immature myocardium may, therefore, reflect the choice of cardioplegic solution rather than a greater vulnerability to injury in the neonatal heart.

[The ultrastructure change of cardiomyocyte in Athlete's Heart].

OBJECTIVE: This study is to see the pathologic change of cardiac myocyte in Athlete's Heart, and explore the mechanism of the pathologic change. METHODS: Fifteen male SD rats were separated randomly into control group (without any exercise), aerobic exercise group (Ae group, swimming for 75 min every day), and overloading exercise group (Oe group, swimming for 180 min with a loading of 5 percent of body weight every day). After 5 days per week for 12 weeks, swimming stopped, the rat hearts were prepared to specimens and examined under Transmission Electron Microscope. RESULTS: The Ae group, the number and volume of mitochondria increased, and the membrane of mitochondria remained entire. Few of dense bodies were found in cytoplasm. The nucleus envelopes of expansion nucleus appear as dentition. These changes were considered as the adaptation to exercises. At the same time, some pathologic changes of the cardiac myocytes similar to senescence also appeared, such as mitochondria expanse, the crista disorder or disappearance, unclear mitochondria membrane, many dense bodies in cytoplasm, nucleus disfiguration and chromatin collection at edge. CONCLUSION: After exercise training, some pathologic changes of cardiac myocyte also occur with physiological changes. With the raise of exercise intension, the pathologic changes become more obvious, even appearance of cardiac myocyte death.