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Biomedical subjects

J Imre

Publications and source records attributed to J Imre.

At least 19 recordsLinked to original sources
PubMed1987

Bypass with transdiaphragmatic Roux loop in nonresectable malignant stricture of the lower oesophagus.

Bypass with a Roux-en-Y loop is proposed for palliation of nonresectable malignant obstruction in the distal oesophagus and cardia without peritoneal dissemination. Over a 15-year period, 51 transdiaphragmatic Roux-en-Y procedures with side-to-end oesophagojejunal anastomosis were performed. The 11.8% mortality was unrelated to anastomotic leakage. Gastrostomy should be avoided because of its nutritional and psychologic disadvantages. Other methods for surgical bypass are discussed and comparison is made with intubation. Wider indications for the Roux loop bypass are mentioned.

Cardia↗
PubMed1985

Late malignant transformation of chronic corrosive oesophageal strictures.

The number of patients with scar carcinoma of the oesophagus developing on the basis of a corrosive stricture seems to have been rising in the past two decades. 36 patients of this kind were treated surgically between 1965 and 1984; this is the second largest series in the literature. The patients with scar cancer comprised 7.2% of the overall oesophageal carcinoma cases; this ratio is currently the highest of all in the literature. The interval between the caustic burn and the diagnosis of scar carcinoma was found to be 46.1 years; this is higher than the 30-35 years generally accepted so far. It was 50.9 years in those patients who drank lye before the age of 12, but 14 years less when it happened in adulthood. The long-term survival time proved to be excellent: 45.6% of the resected cases were alive after 5 years and 14.4% after 10 years. The explanation of the good prognosis lies in the fact that carcinoma developing in a lye stricture is at first surrounded by a rigid scar which allows only its intraluminal growth, and it causes early dysphagia through luminal obstruction. Early dissemination is prevented for the same reason. One-stage resection and replacement is suggested in the radically operable cases. In patients with oesophageal corrosive stricture which needs operation, both a by-pass procedure and resection can be adopted, but it should be pointed out that malignancy may develop even years after the operation in the remaining part of the gullet. Total oesophagectomy is therefore suggested instead of bypass.

Burns, Chemical↗
PubMed1983

Complications of oesophagoplasty with isoperistaltic transverse colon.

An analysis is presented of late results in 144 reconstructions of oesophagus with transplants (137 isoperistaltic, 7 anisoperistaltic) from transverse colon for correction of stricture, mainly after corrosive trauma. The grafts were interposed retrosternally in 126 cases and intrathoracically in 18. Delayed passage due to excessive size of the colon segment was managed in four cases by plication of the intra-abdominal part of the graft or by jejunal by-pass. 'Pseudo-diverticulum' at the proximal anastomosis occurred in five cases as a complication of the standard by-pass procedure. Correction was made by closure of the pouching oesophagus below the cervical anastomosis. Transformation to end-to-end anastomosis is also recommended. The incidence of gastrocolic reflux was low. In two of the four observed cases the cause was late pyloric stenosis. There was no case of peptic ulceration. For good late results of colo-oesophageal reconstruction, appropriate length and type of colon segment, suitable site of gastric implantation and isoperistalsis are of primary importance.

Colon↗
PubMed1983

Mechanical capacity of esophagogastric anastomosis at early postoperative stage.

The tensile strength of esophagogastric anastomosis was measured in 20 dogs. In case of 32 other animals the preparations were histologically examined, too. Mechanical tolerance was found significant from the 7th postoperative day on, reaching its maximum on the 15th day with no later change. An explanation is sought in the prevalence of the elastic elements growing in direct proportion to the time elapsing after operation. This role of the elastic fibres has not yet been reported in the available literature.

Animals↗
PubMed1982

Ischemic stricture of the intrathoracic roux loop used for esophagoplasty.

Three cases of stenosis of a Roux loop are presented, following the replacement of the lower third of the esophagus resected for cancer. In each case fibrotic stenosis developed 6 weeks after reconstruction, which was attributed to ischemia: in one case it was due to reduced blood flow during digitalization and in the other two cases to the vascular compression of the supplying vessels because of unsatisfactory dilatation of the hiatus.

Adult↗
PubMed1981

[Premalignant and malignant changes in the epithelium in an antethoracic skin tube after esophagus replacement surgery].

Seven clinical cases are described of plastic repair of the stenosed oesophagus by means of a skin tube in which premalignant changes have developed after the lapse of several decades. The authors assume that these changes have been caused by chronic inflammation due to chemical irritation of the skin tube by stagnant food, saliva, and the gastro-"neo-oesophageal" reflux. On the basis of data from the literature and personal experience, the authors suggest that use of a skin tube in the repair of the oesophagus should be reserved for the small group of patients with oesophageal malignancy not amenable to other methods of reconstruction.

Adult↗