Postoperative functional result and quality of life after oesophageal reconstruction based on the type of cervical anastomosis.

INTRODUCTION: The keystone of the rate of postoperative complications and functional outcome in oesophageal reconstruction is the technique method of performing cervical anastomosis.Despite new technologies and improved technique in specialized centres, post-anastomosis complications have not significantly improved. PURPOSE: The goal of our study is to analyse the causes that make anastomosis with the oesophagus hypopharynx a particular case. If anatomical and morphological aspects cannot be adjusted (poor histological structure and vascularity etc.), some important elements for performing a good anastomosis can be identified and corrected. MATERIAL AND METHOD: Between 1981-2014, 195 oesophageal reconstructions were performed in our clinic. Our study involved an analysis of 72 cases (2000-2014), based on a statistical evaluation by Kaplan-Meier method that considered as eries of factors (oesophagus hypopharynx as anastomotic partner, stomach, jejuno-ileum, colon as visceral partner,pharyngotomy type, T-L, T-T, L-L, L-T type anastomosis,number of anastomotic layers). RESULTS were compared with those obtained by standard clinical and laboratory investigation,analysing the post-therapeutic outcome using three criteria (clinical aspects of swallowing, barium swallow and endoscopy) and by subjective assessment by each patient of his her state and complaints, with effects on long-term functional outcome (dysphagia, reflux, pain, asthenia, weight loss, hoarseness). RESULTS: Statistical analysis determined that only some of the analysed factors proved to be valuable. The higher the level of the anastomosis, the more intense the impairment of the digestive function. The jejunum and left colon proved to bemost effective anastomotic partners. The best method for implantation seems to be T-T or T-L and the number of anastomosis layers has no influence on postoperative outcome. CONCLUSIONS: Acquired data can influence to some extent the operatory technique, with a lower complication rate.Unfortunately, laborious technical aspects and specific anatomical limitations make this goal difficult to achieve.

Motor criteria evaluation of iso-anisoperistaltic graft in oesophageal reconstruction -- an experimental study of isolated colic graft motility pattern in dogs.

In the medical literature there are more than one opinion in favour of the isoperistaltic interposed loop, considering it to render a higher propulsive activity and thus with much better functionality, with less intense symptoms of regurgitation,reflux or aspiration. Technically, however, due to anatomical relationships, anisoperistaltic graft interposition is more convenient. Is this detrimental to functionality? What is the best peristaltic model? At first sight, it seems that due to the local anatomy and surgical technique involved, we compromise at the expense of better functionality. To find the answer to these questions, starting from the typical pattern of colonic motility in the transverse and left colon, we need to identify new motor behaviour of the isolated colic segment. Because motor activity is generated by electric waves discharged from the area control centre, their electromyographic registration would allow finding the contractile pattern of a transplanted loop.

The vascularization pattern of the colon and surgical decision in esophageal reconstruction with colon. A selective SMA and IMA arteriographic study.

INTRODUCTION: No matter the reconstructive technique, the fundamental concepts in visceral reconstruction have as main grounds the mandatory vascular support for the graft replacement. Individual vascular particularities can influence or even oblige the surgeon to choose a certain procedure. This is why the vascularization is beyond doubt the dominant factor in mobilizing the colon for reconstruction. MATERIAL AND METHOD: Our arteriographic study entails an investigation upon the vascularization pattern of the two main sources that participate in the arterial irrigation of the colon via the emerging vessels: superior mesenteric artery (SMA) and inferior mesenteric artery (IMA). We did not consider certain patients upon a specific criterion; also, we did not exclude any patients due to various reasons. We took into account 49 patients as study group, all of them having registered into the clinic for a reconstructive technique, throughout the years from 2000 to 2010. From 1981 to 2012 there have been 187 reconstructive techniques performed due to post caustic pathology. From a total of 49 patients, 11 had suffered major abdominal surgeries, 5 of which had had unsuccessful reconstructive attempts. RESULTS: Out of the 49 patients on whom we have performed the exploration, arteriography showed a favorable situation for reconstruction in 31 of them. In the other 18 patients anomalies or atypical distributions were identified, in 5 of the SMA and in 13 of the IMA, respectively. Operative decision was modified in 22 patients. One important thing to note from the point of view of the segment to be moved: we had no graft necrosis in patients with preoperative arteriographic examination. CONCLUSIONS: Due to the need for good mobilization, arterial ligations should be adjusted and modified depending on the particular vascular distribution, to maintain a sufficient blood flow in the marginal artery, in order to reach the colic sections and the straight arteries near them.

[Some respiratory viruses in the etiology of acute upper respiratory infections]. / Unele virusuri respiratorii în etiologia afectiunilor respiratorii acute superioare

The viral etiology of acute respiratory diseases, determined in 107 children admitted to hospital during the 1966-1969 period, was confirmed in 36% of the cases by isolation of the viral agent and in 59% by serologic reactions. Parainfluenza viruses, especially of type 1 and 3, were encountered more often in the etiology of acute or obstructive laryngitis, and the syncytial respiratory virus in tracheobronchitis.