Livaditis' circular myotomy does not decrease anastomotic leak rates and induces deleterious changes in anastomotic healing.

Considering that Livaditis' myotomy is still accepted as a good method for lengthening the esophagus to allow primary repair of long-gap esophageal atresia, the aim of this experimental study was to verify if this procedure decreases the incidence of leaks in anastomoses performed under severe tension. In addition, it was verified whether the myotomy promotes any morphological or biochemical change in the healing esophageal anastomosis. Sixty small dogs were submitted to a cervicotomy and resection of an esophageal segment (8.0 - 10.0 cm) resulting in an anastomosis under severe tension. The animals were divided into two groups (control group: only anastomosis; experimental group: anastomosis plus circular myotomy in the proximal esophageal segment). The animals were sacrificed on the 14th postoperative day, submitted to autopsy, and were evaluated as to the presence of leaks. Twelve scars of each group were collected for histological, histomorphometric (evaluation of scar thickness), electrophoretic and immunoblotting studies of collagen (total collagen and types of collagen determinations). Leak rates were the same in both groups. Histologic examination showed that the scar at the anastomosis was formed by fibrous tissue, without mucosa or muscular tissue. In the myotomy animals, a decreased number of newly formed small vessels was noted in comparison to control animals, and morphometric analysis showed that in the myotomy animals the anastomotic scar was thinner than in the control animals. Biochemical analysis of scars demonstrated that myotomy promoted a decrease in the soluble collagen content in comparison with the control animals and no alteration in the content of insoluble collagen. The electrophoretic separation of the types of collagen and characterization by immunoblotting demonstrated the presence of collagen types I, III, and V, and the quantification by densitometry of the bands showed a reduction in collagen type V (present in the blood vessels) in the myotomy animals in comparison to controls. This result is in accordance with the histological observation of a decrease in newly formed blood vessels. Circular myotomy does not decrease the possibility of anastomotic leaks, in addition to promoting deleterious changes in anastomotic healing.

Extramedullary myeloid cell tumours localised to the mediastinum: a rare clinicopathological entity with unique karyotypic features.

Extramedullary myeloid cell tumour (EMMT) localised to the mediastinum is a rare manifestation of acute myeloid leukaemia, forming less than 4% of all cases of EMMT. In contrast to other types of EMMT, cytogenetic characteristics of this rare entity are relatively unknown. This report describes a patient with EMMT who had evidence of superior vena cava syndrome and normal peripheral blood counts at diagnosis. The results from an initial biopsy specimen were consistent with a diagnosis of mediastinal large B cell lymphoma. A diagnosis of acute myeloid leukaemia was made three months after initial diagnosis by bone marrow examination. Review of the initial biopsy specimen showed strong positivity for myeloperoxidase, revealing that the patient had been initially misdiagnosed as having large B cell lymphoma. Cytogenetic studies revealed a near triploid and near tetraploid karyotype with structural abnormalities in 12 and three metaphases, respectively. Review of the literature showed that a near tetraploid or triploid karyotype is found in most of the reported cases of mediastinal EMMT. Thus, the presence of a near triploid/tetraploid karyotype and mediastinal EMMT may represent a specific subset of EMMT. The biological relevance of this observation is discussed.

Spontaneous cervical epidural hematoma: case report.

Spontaneous spinal epidural hematoma (SSEH) is an uncommon cause of acute nontraumatic myelopathy. We report a 14 year-old boy who had tetraplegia on awakening. Diagnosis of spinal epidural hematoma was made by magnetic resonance imaging. Despite spinal cord decompression within 9 h from onset, he remained tetraplegic. No cause for the bleeding was found. The pathogenic hypotheses of SSEH are discussed and the importance of rapid diagnosis and treatment is emphasized.

Angiographic patterns of carotid ischemic cerebrovascular disease in Saudi Arabia.

The angiographic findings in 100 Saudi patients with carotid ischemic cerebrovascular disease (CVD) (transient ischemic attacks (TIA) or strokes) were retrospectively reviewed. These patients were representative of all patients with similar disorders in the terms of sex, frequency of diabetes mellitus and ischemic heart disease. They were, however, significantly younger, smoked more, had more cervical bruits and less atrial fibrillation. Analysis of the data showed that a significant stenosis (> 70%) of the carotid artery origin was found only in 12% of TIA cases, 4% in the lacunar infarction cases and 6% of the large infarction cases on the symptomatic side and only in one case of TIA in the asymptomatic side. These frequencies were significantly lower than those found in similar studies performed in western countries. This study suggests that stenoses and occlusions of extracranial carotid artery plays a smaller role in the pathogenesis of ischemic CVD in Saudis than in Caucasians. The low consumption of cigarettes among elderly and females may be one of the explanations.

Brain magnetic resonance imaging in non-alcoholic cirrhosis.

Twenty-six patients with stable non-alcoholic cirrhosis and normal neurological examination were investigated by brain MRI (inversion recovery sequences) and compared with 16 controls. Brain MRI findings were correlated with the clinical and metabolic status of the patients and analysis of variance and, when necessary, co-variance was performed. Five of the patients (19%) and all 16 controls showed no MRI changes. Twelve patients (46%) showed moderately high signal in the globus pallidus (score 1), and nine (35%) very high signal (score 2). Analysis of variance showed that age was the only significant variable (P = 0.038). Analysis of co-variance after adjustment for age showed that high pallidal signal was correlated only to ammonia level (P = 0.02) but not to any other clinical or biological parameter. We conclude that T1 high intensity pallidal signal is common in non-alcoholic cirrhosis even when neurological examination is normal, but its significance remains unclear.