Epithelial bone marrow cells in patients with advanced esophageal squamous cell carcinoma.

The aim of the current study was to examine epithelial cells in the bone marrow and peripheral blood of patients with various stages of esophageal squamous cell cancer prior to surgical treatment and to analyze the prognostic significance of these carcinoma cells deposits to the stage of the disease and applied surgical therapy. Thirty-two patients (25 men and 7 women), and 5 healthy bone marrow donors serving as controls were studied. Bone marrow samples were evaluated by light microscopy and examined by flow cytofluorometry. Cells were phenotypically analyzed for the antigens CD45- and CD18+ and/or EMA+. Results are presented as the number of cells revealing the investigated phenotype per 10 (5)analyzed cells. CD18 was expressed in the bone marrow cells of 15 of the 32 (47%) patients and EMA in 20/32 (62%), but not in peripheral blood. In 13 of the 32 pts (41%), co-expression of CD18 and EMA was observed. Patients with the proportion of marrow erythroblasts below 15% had higher numbers of CD18+ and EMA+ cells and there was a negative correlation between the number of erythroblasts and EMA+ cells (r=0.54, p=0.01). In patients with esophageal cancer and anemia, the number of EMA+ cells was higher (p=0.05) and the percentage of erythropoietic cells in the bone marrow was lower (p=0.01). In conclusion, flow cytofluorometry using anti-cytokeratin and anti-EMA antibodies may be useful in evaluating microdeposits of esophageal squamous cells in bone marrow. A dysfunctioning erythropoietic system causing anemia can be a first signal for the presence of malignant cell microdeposits in the marrow of patients with esophageal carcinoma.

[Esophageal substitute corrective operations]. / Operacje naprawcze schorzen przelyków wytworzonych z uszypulowanych odcinków jelit.

In the Clinic of Gastrointestinal Surgery at the Medical University in Wroclaw in 402 cases substernal oesophageal reconstruction was performed using different pedunculated oesophageal substitutes. 63 patients had to be operated on for the second time because of disorders in the oesophageal substitute. In 13 cases stenosis in the upper anastomosis and in 3 patients stenosis in the anastomosis with stomach were corrected. In 7 cases oesophageal ulcer was excised. 6 patients were operated because of substitute herniation into pleural cavity. In 3 cases huge diverticula in the neck were removed. 5 patients were operated because of stomach outlet stenosis. In 15 cases operation was necessary to correct the sequel of reflux oesophagitis. In 8 cases the surgery was performed to remove stenosis of the substitute. In 2 cases there was torsion of substitute and in the other 2 cases postoperative stenosis was caused by adhesions. One patient was operated because of the dumping syndrome. In 2 patients with the colon substitute polyps from the segment used for the oesophagus were removed endoscopically. The mortality after corrective surgery on the oesophageal substitute was less than 10% (6/63).

[Tumor in Vater's ampulla--local excision or Whipple's resection]. / Rak brodawki Vatera--miejscowe wyciecie czy operacja Whipple'a.

Results of the operative treatment of Vater's papilla carcinoma in fifteen cases were analysed. Eleven patients had pancreatoduodenectomy according to Whipple, four had only local excision of Vater's papilla along with the tumour. All four had early recurrence and were re-operated by Whipple method. In our experience only radical pancreatoduodenectomy with regional lymphadenectomy, preferably Whipple type, gives chance of achieving the radical cure.