[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).

[The second reconstructive operation of the esophagus]. / Ponowne operacje wytwórcze przelyków z uszypulowanych przeszczepów jelitowych.

What we need in order to obtain good results in oesophageal reconstructive surgery is long enough segment of intestine with sufficient blood supply. Evaluation of the blood flow is very difficult and often only after completion of the mobilization and transposition of the intestine into the neck final evaluation can be made. In the cases with poor blood flow one must resign from the already mobilized intestine. In such situation the second operation with the use of different alimentary tract segment must be performed. In our practice we encountered 7 cases where it was necessary to mobilize the second intestinal segment in order to achieve success in the reconstruction of the oesophagus. In 3 cases during the first operation jejunum was used. In 3 cases the necrosis of mobilized jejunal segment forced us to perform the second operation. In two patients during the second operation right colon segment along with terminal ileum was used. The third was operated with the use of right colon. In 2 others right colon was used in the first operation. One of them was operated for the second time with the use of left colon. The other were operated with the use of ileum. 2 patients with the substitute from right colon along with the terminal ileum when operated for the second time had the jejunum and left colon segment used to bridge the gap. Mortality in our reconstructive operations was 28.57% (2/7).

[Comparative evaluation of postoperative complication in the reconstructive surgery of the esophagus]. / Porównawcza ocena wczesnych powiklan pooperacyjnych po zabiegach wytwórczych przelyku.

The paper presents 78 patients with stenosis of the middle thoracic segment of the esophagus. The substitute, being pedunculated intestinal graft, was brought to the neck through the retrosternal space. Early post-operative complications occurred in 8.9% of patients. Post-operative mortality rate was 7.6%. The most dangerous complication after esophageal plastic surgery is blood supply insufficiency. It was observed in 2 cases. Other complications included anastomotic leaks and respiratory distress syndrome. The authors emphasize that frequency of post-operative complications and mortality are related with the patient general condition and extent of the surgery.

Early oesophageal cancer. Does it exist? Why we cannot find it?

Results of surgery in oesophageal cancer are still disappointing. The only possible solution is to search actively for early cancer in nonsymptomatic person. The group of patients with Barrett's oesophagus or after lye ingestion was included in the endoscopical screening programme. In order to improve our results and increase sensitivity we have employed the Lugol solution for mucous membrane staining. During five years follow-up period four cases of early cancer were found. All cases were treated surgically showing cancer confined only to the mucous membrane in two patients. Endoscopic ultrasonography is currently the best technique for the staging of oesophageal cancer. Our preliminary data are encouraging shown that its possible to use population screening programme in some well-defined group of patients.

Helicobacter pylori in kidney allograft recipients: high prevalence of colonization and low incidence of active inflammatory lesions.

Since kidney transplant recipients are at enhanced risk for developing severe upper gastrointestinal disease and Helicobacter pylori (Hp) is an important pathogen in active gastritis and peptic ulcer, we performed gastroduodenoscopic examination, coupled with assessment of Hp colonization in 29 renal allograft recipients complaining of recurrent dyspepsia. Results were compared with those of 25 chronically hemodialyzed patients and 16 subjects free from renal disease, also suffering from upper gastrointestinal symptoms of similar severity. We found that while transplant recipients have had a high prevalence of Hp infection (62 vs. 34.6% in dialysis and 43.6% in control dyspeptic patients), active gastritis was clearly less frequently seen in these patients than in control subjects (transplant group: 6.9%, dialysis 3.8%, control 31.3%) and peptic ulceration was totally absent. Prevalence of Hp colonization was even higher in renal graft recipients on triple posttransplant immunosuppression (82%). In dyspeptic transplant and dialysis patients, colonization with Hp did not account for development of active inflammatory lesions, an association frequently seen in subjects free from renal disease and immunosuppressive therapy.

[Pleural hernia of an esophageal graft--late postoperative complication]. / Przepukliny oplucnowe sztucznych przelyków--odlegle powiklania pooperacyjne.

Pleural hernia of the oesophageal substitute from pedicled intestinal segment is one of the late postoperative complications. 13 cases of patients with oesophagus reconstructed because of lye ingestion stenosis are presented. Problems concerning diagnosis and treatment of pleural hernia are analysed. Eight patients with minor symptoms were treated conservatively. Five patients were operated, two of them from acute necrosis of the substitute. Necrosis was caused by incarceration of the bowel and torsion of the mesentery. Elective operative treatment consisted of reduction of hernia sac contents, closing of the hernia orifice, chest drainage and temporary gastronomy. In patient operated as an emergency cases necrotic part of substitute was removed. This resulted in oesophageal exclusion in the neck, creating gastronomy. Chest drainage was also performed.

[Endoscopic bouginage of benign esophageal and cardial strictures]. / Endoskopowe poszerzanie lagodnych zwezen przelyku i wpustu.

Endoscopic bouginage of benign esophageal and cardial strictures was compared with surgical treatment. Bouginage was performed by Celestin or Eder-Puestow bougies. Results obtained suggest usefulness of bouginage in many patients with benign stenosis of the upper gastrointestinal tract.

[Circadian rhythm of cortisol in patients after reconstruction surgery of the esophagus using various intestinal segments for transplantation]. / Dobowy rytm kortyzolemii u chorych po operacjach wytwórczych przelyku wykonanych z uszypulowanych przeszczepów jelitowych.

The authors determined the circadian rhythm of cortisol expressed as blood 11-hydroxycorticosteroid level (11 OHCS) in group of healthy subjects and in 3 groups of patients after the formation of an artificial oesophagus from the jejunum, large intestine and ileum and caecum. In all examined patients the normal circadian rhythm of 11 OHCS was maintained. In patients with oesophagus made up of jejunum and large intestine mean level 11 OHCS in blood was insignificantly higher in comparison with a group healthy subjects. In group patients with the oesophagus made up of ileum and caecum the 11 OHCS level in blood was significantly lower in comparison to the group of healthy subjects and to patients with oesophagus made up of jejunum and large intestine.

[Multiorgan trauma complicated by purulent processes and occlusion of the digestive tract]. / Uraz wielonarzadowy powiklany procesami ropnymi i niedroznoscia przewodu pokarmowego.

Authors presented a case of multiorgan trauma complicated, during a treatment by purulent course and occlusion of digestive tract. They punctuate an important rate of intensive care and postoperative care, which enabled a diagnose of early dangerous complications and effective treatment.

Operative procedure in early carcinoma of the thoracic part of the esophagus.

The authors present four patients with early carcinoma of the thoracic part of the esophagus. In all patients, "blind" esophagectomy was performed without thoractomy. Simultaneously salivary fistula on the neck and gastrostomy was formed. During the second stage of the procedure a retrosternal esophagus was formed out of pedunculated intestinal grafts. No serious postoperative complications were noted. According to the authors, the above-mentioned procedure should be limited to early cases of carcinoma of the thoracic part of the esophagus. The post-operative follow up of the cases was up to four years.

[Benign esophageal tumors]. / Lagodne guzy przelyku.

The authors present seven cases of benign oesophageal tumours treated in hospital in the years 1972-1990. Among the treated patients were six men and one woman, aged from 30 to 70 years. In four patients the tumour was situated in the middle part of the thoracic segment, and in three cases in the lower part of the supradiaphragmatic segment of the oesophagus. The diagnosis od benign oesophageal tumour was made on the basis of X-ray examination, oesophagoscopy, and histopathological examination. Five patients were treated surgically. In two patients the access to the tumour was from the right pleural cavity, and in three other cases--from the abdominal cavity. The result of histopathological examination of the removed tumours was as follows: in two patients--benign polyps, in one patient--mature teratoma, in one female patient--myxofibroma, and in one case--fibromyoma. In all patients operated on complete cure was achieved.

Occurrence of ABO group antigens in bladder carcinoma.

Biopsies of bladder carcinoma obtained from 46 patients were tested for the presence of the group antigens, A, B and H. Lack of the antigens was confirmed in 69.6% of the samples examined. On the basis of histopathologic studies the patients were divided into three groups. The lack of the group antigens was reported in 86.4% bladder carcinoma patients; the lowest (45.5%) in the group of patients with papilloma of bladder. In cases of tumors with intermediate differentiation of tissue, the number of patients showing lack of group antigens amounted to 61.5%. Clinical observations carried out for five years suggest that the lack of group antigens is related to a recurrence of bladder carcinoma.

[Colon or ileum for reconstruction of the total esophagus with reference to vascularization]. / Kolon oder Ileum für die Rekonstruktion des gesamten Osophagus je nach dem Gefässverlauf.

Depending on the type of vascularisation of the transplant the authors present 7 different methods of using the most suited transplant (ileum, right and left sited colon in iso- and anisoperistaltic position) for reconstructing oesophagus. The authors performed 220 operations of this kind.