Current knowledge on esophageal atresia.

Esophageal atresia (EA) with or without tracheoesophageal fistula (TEF) is the most common congenital anomaly of the esophagus. The improvement of survival observed over the previous two decades is multifactorial and largely attributable to advances in neonatal intensive care, neonatal anesthesia, ventilatory and nutritional support, antibiotics, early surgical intervention, surgical materials and techniques. Indeed, mortality is currently limited to those cases with coexisting severe life-threatening anomalies. The diagnosis of EA is most commonly made during the first 24 h of life but may occur either antenatally or may be delayed. The primary surgical correction for EA and TEF is the best option in the absence of severe malformations. There is no ideal replacement for the esophagus and the optimal surgical treatment for patients with long-gap EA is still controversial. The primary complications during the postoperative period are leak and stenosis of the anastomosis, gastro-esophageal reflux, esophageal dysmotility, fistula recurrence, respiratory disorders and deformities of the thoracic wall. Data regarding long-term outcomes and follow-ups are limited for patients following EA/TEF repair. The determination of the risk factors for the complicated evolution following EA/TEF repair may positively impact long-term prognoses. Much remains to be studied regarding this condition. This manuscript provides a literature review of the current knowledge regarding EA.

Immunohistochemical evidence of Muc1 expression during rat embryonic development.

During embryonic development, studies on mouse and human embryos have established that Muc1/MUC1 expression coincides with the onset of epithelial sheet and glandular formation. This study aimed therefore at evaluating the temporal and spatial expression of Muc1 at different stages of rat development. In this experiment, 80 animals were included: 64 rat foetuses at 13, 14, 15, 16, 17, 18, 19 and 20 days of gestation from pregnant females (WKAH/Hok), 8 embryos each stage. Standard immunohistochemistry was performed using anti-MUC1 cytoplasmic tail polyclonal antibody (CT33). The reaction was considered positive when more than 5% of the cells were stained; reaction patterns were: L = linear, membrane, C = cytoplasmic and M = mixed; nuclear staining was also recorded. Intensity was graded as negative (-), low (+), moderate (++) and strong (+++). Muc1 expression was observed with a low intensity on 13th day (13 d) in the stomach, lung and kidney; at 14 d, small intestine and pancreas were also reactive; at 16 d, liver and esophagus and at 18 d, trachea and salivary glands. During the development, intensity increased while the pattern of expression changed: at the first days of gestation, it was predominantly linear and apical while during further development an increase in cytoplasmic expression was observed. Trachea, stomach, kidney and lung epithelia were the more reactive tissues. In specimens belonging to neonates and adults, all tissues analyzed showed similar Muc1 expression. The findings of this study assess that Muc1 is highly expressed in the epithelial rat embryonic development.

The lung primordium an outpouching from the foregut! Evidence-based dogma or myth?

BACKGROUND/PURPOSE: This study examines and challenges the "evidence-based legitimacy" of the theory, "the lung primordium is an outpouching from the foregut." METHOD: A literature review was undertaken using computer database, journals, and relevant anatomical and embryological texts. RESULTS: The independent path of development taken by the tracheobronchial system and the oesophagus once identified as separate entities; the lack of morphologic, molecular, biological, and genetic supportive evidence for the "common-origin" theory; the distinct longitudinal line of demarcation between the nonsegmented muscles of the esophagus and the highly segmented cartilaginous structure of the tracheobronchial tree; the absence of a tracheoesophageal septum in the process of separation; the differences in epithelial lining; and the diametrically opposed mucociliary cascade of the upper airway vs the mucociliary escalator of the tracheobronchial tree all seriously challenge the authenticity of a common origin to these 2 entities. CONCLUSION: To the extent that the foregut is seen as consisting of 2 separate semitubular splanchnopleuric entities ventrodorsally juxtaposed, it is true that the lung primordium as an outpouching of, and not from, the foregut. This must never be confused with the notion that the esophagus and tracheobronchial tree have a common origin. In fact, they develop from 2 completely separate segments of the trilaminar germ disk, but because of head fold development are brought together to create a common tracheoesophageal chamber that is later separated, facilitated by the prochordal membrane diverticulum.

Determinación de volumen y pH gástricos en pacientes premedicados con cisaprida y famotidina durante la inducción de anestesia general en colecistectomías electivas / Determination of gastric volume and ph in patients premedicados with cisaprida and famotidina during the general anesthesia induction in elective colecistectomías

El objetivo fundamental de cualquier procedimiento aanestésico es mantener la homeostasia del paciente, frente a la posibilidad de que ocurr a durante la anestesia general regurgitación y broncoaspiración, complicaciones no frecuentes pero que ponen en peligro la vida del paciente. En el presente estudio se comparó la eficacia de la cisaprida y famotidina, administradas 2 horas antes de la inducción anestésica para disminuir el volumen y aumentar el pH gástrico. Para ello se tomó una muestra aleatoria simple de 90 pacientes procedentes del Hospital General de las Fuerzas Armadas, mayores de 18 años, sin patología gastrointestinal previa, ASA I-II, de ambos sexos, que fueron sometidos a colecistectomías electivas. Los pacientes se dividieron en 3 grupos: A) 30 que recibieron cisaprida 10 mg VO. B) 30 que recibieron famotidina 40 mg VO y grupo C) 30 control. Es un estudio descriptivo, controlado y experimental. Se analizaron las siguientes variables: pH y volumen gástrico, tensión arterial, frecuencia cardíaca y respiratoria, temperatura, y efectos secundarios de las drogas. La distribución de la muestra según el sexo fue: para el grupo control 80 por ciento varones y 20 por ciento mujeres, para los grupos cisaprida y famotidina fue de 72 por ciento varones y 28 por ciento mujeres; la distribución de la muestra según edad y peso fue de: grupo control 46.4 18.1 años y 59.8 8 kg, grupo cisaprida 42.1 16.6 años y 62 10.3 kg, grupo famotidina 45.3 17.4 años y 58.2 11.9 kg. Se encontró que la famotidina aumentó el pH gástrico con significancia estadística 0.05 y disminuyó el volumen gástrico en comparación con la cisaprida. No existieron efectos indeseables ni alteraciones hemodinámicas en ningún grupo. Recomendamos la famotidina como profilaxis de neumonítis por aspiración...