[Severe caustic burn of the esophagus after unknown corrosive ingestion].
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Burns, Chemical↗
Biomedical subjects
J Isolauri
Publications and source records attributed to J Isolauri.
Pharyngo-oesophageal reconstruction with free jejunal transplants. New design of the upper anastomosis to improve monitoring of viability of transfer.
Since 1987, 13 free microsurgical jejunal transplants for large pharyngo-oesophageal tumors have been done in 12 patients at Tampere University Hospital. The conventional technique was used for the end to end upper anastomosis in seven patients, and our new end to side anastomotic technique in six. Five patients were alive at the time of writing, the mean survival being 22 months (range 1-48). Five patients developed orocutaneous fistulas, three of which healed spontaneously. In the remaining two the fistulas were caused by rapid recurrence of the tumour. There was no significant difference in ability to feed orally or swallow among the patients operated upon by the end to end or the end to side anastomotic technique. Our results show that the free microvascular jejunal transfer is a safe procedure for repair of the hypopharynx. Our new end to side hypopharyngojejunal anastomosis makes it possible to monitor the transplanted bowel reliably by direct vision.
Aged↗
Primary undifferentiated small cell carcinoma of the esophagus: clinicopathological and flow cytometric evaluation of eight cases.
We present a clinicopathological and flow cytometric evaluation of eight primary small cell carcinomas of the esophagus representing 1.5% of all esophageal malignancies diagnosed during a 22-year period (1965-1987) in the Tampere University Central Hospital. The mean age of the patients (four male and four female) was 67 years (range 55-75 years). Five cases had distant metastases at the time of diagnosis. Three patients were treated by esophageal resection, one by laser vaporisation, and four by chemotherapy. The median survival time was 4 months (range 9 days to 8 months). A complete local response to chemotherapy in serial esophagogramms was detected in one patient. All four patients given chemotherapy survived longer than those treated with esophageal resection only. Four (67%) of the six carcinomas analyzed by DNA flow cytometry contained DNA-aneuploid stemlines. The median S-phase fraction of these small cell carcinomas was high (16.3%), reflecting rapid cell proliferation rate, which may be related to their responsiveness to chemotherapy.
Aged↗
Colon interposition for esophageal disease: histologic finding of colonic mucosa after a follow-up of 5 months to 15 years.
Thirty-six patients, subjected to colon interposition for benign esophageal disease or carcinoma of the esophagus or gastric cardia, were studied by endoscopy for signs of mucosal disease in the interposed colon. Five months to 15 yr (mean 57 months) after the operation, endoscopic finding of the interposed colon was macroscopically normal in 28 patients. Signs of inflammation, including hyperemia or hyperemia and friability, were observed in seven patients. Histologic specimens obtained at endoscopy were examined microscopically, and the findings were compared with those seen in the preoperative graft. In two patients, chronic inflammatory changes were observed in the graft mucosa, consisting of mononuclear cell infiltration of the lamina propria accompanied by crypt dilatation and deformation. In one of these patients, the inflammation was in the proximal third of the graft, and it was also seen at the endoscopy. In the remaining 34 patients, the graft mucosa was microscopically comparable to normal. The alterations were unexpectedly few and mild considering the marked change in the location and function of the colonic segment.
Adult↗
Hypopharyngeal reconstruction with free microvascular jejunal transfer after total laryngopharyngectomy.
One-stage laryngopharyngeal free microvascular jejunal transfer after total laryngopharyngectomy was performed in 8 patients with advanced laryngopharyngeal cancer. The study showed that this was a relatively safe and time-saving method for hypopharyngeal reconstruction after radical cancer surgery. It improved the quality of life of the patients, allowing normal alimentation, though in some cases only temporarily due to the highly malignant nature of the disease.
Aged↗
Surgery for reflux stricture of the oesophagus.
Reflux stricture of the oesophagus was surgically treated in 27 patients. Oesophageal resection and colon interposition were performed in 18 cases, and peroperative fiberoptic endoscopic dilatation with Nissen fundoplication in nine. There was one perioperative death (resection group). Postoperative complications arose in four of that group and one of the dilatation-fundoplication group. At follow-up averaging 86 months after resection and colon interposition, no patient was dysphagic; 44% experienced regurgitation, but most could avoid this by modifying living habits. Further dilatations were required by four of nine patients during follow-up averaging 30 months after dilatation-fundoplication. Fiberoptic endoscopic dilatation with fundoplication is well tolerated by fitter patients with reflux stricture of the oesophagus. In poor-risk patients the treatment should be dilatation and medical antireflux control. Due to higher complication rates oesophageal resection and colon interposition are warranted when other treatment has failed.
Adolescent↗
Influence of pancreatic resection on systemic complications in acute necrotizing pancreatitis.
The influence of pancreatic resection on early systemic complications of acute necrotizing pancreatitis was evaluated in 84 patients. The aetiology of pancreatitis was alcohol 71 per cent, gallstones 13 per cent, alcohol plus gallstones 2 per cent, trauma 1 per cent and idiopathic 12 per cent. A total of 26 of 81 patients (32 percent) had greater than 50 per cent pancreatic necrosis and 9 patients (11 per cent) considered to have parenchymal necrosis at operation had none shown histologically. The overall mortality was 38/84 (45 per cent) and mortality during the first postoperative week was 15/84 (18 per cent). The outcome after early and delayed operation did not differ significantly. Pancreatic resection had no beneficial effect on shock or respiratory or renal failure (respective pre-operative incidence 12 per cent, 11 per cent and 14 per cent).
Acute Disease↗
Colonic interposition for benign esophageal disease. Long-term clinical and endoscopic results.
Replacement of the esophagus for benign disease requires familiarity with the long-term results of various esophageal substitutes. In the present study, 60 esophageal reconstructions for benign disease using colonic interposition have been presented. The operations were performed mainly without thoracotomy, using both antiperistaltic and isoperistaltic colonic segments. There were no differences in swallowing ability between patients with antiperistaltic and patients with isoperistaltic interpositions. Regurgitation symptoms, however, seemed to be somewhat more common and more difficult in patients with antiperistaltic colonic transpositions. Endoscopic signs of colitis were common, but they did not correlate with regurgitation symptoms. Bacterial cultures from the transplanted colon mainly revealed the usual mouth organisms. Candida albicans was frequently found in the fungal samples. There were no differences in the results between patients with follow-up periods of more and less than 2 years. The clinical results were good or fair in a great majority of the patients.
Adolescent↗
ERCP in evaluating the mode of therapy in pancreatic pseudocyst.
Twenty patients with ultrasonographic or computed tomographic diagnosis of pancreatic pseudocyst were referred for endoscopic retrograde cholangiopancreatography (ERCP). Two of these were found at laparotomy not to have pseudocysts and were excluded. Pancreatography was successful in 15 out of 18 cases (83%) and cholangiography in 12 out of 18 cases (67%). Three types of pseudocysts were noticed according to the communication of the pseudocyst to the main pancreatic duct and the presence of pancreatic duct stenosis. Successful treatment included two spontaneous resolutions, two internal drainages and three left pancreatic resections. In the eight percutaneous external drainages four recurrences (50%) occurred, one after closure of temporary pancreatocutaneous fistula. All the recurrences occurred in Type III pseudocysts with communication of the pseudocysts to stenotic main pancreatic duct. In these cases internal drainage would have been the preferable treatment method. We believe that by ERCP one can identify pseudocysts not suitable for external drainage.
Adult↗
Duodenogastrocolic reflux after colonic interposition measurement using scintigraphic method.
Enterogastric reflux was studied using the scintigraphic method in 20 patients with colonic interposition for benign esophageal disease. The state of the transplanted colonic mucosa was evaluated by endoscopy. In 16 patients, reflux of the duodenal contents into the stomach could be seen. In eight, reflux of the duodenal contents into the interposed colon could be demonstrated. There were no differences in the occurrence of reflux into the colonic graft between the isoperistaltic and antiperistaltic interpositions. In three patients, signs of colitis on the mucosa on the lower part of the graft were observed by endoscopy. Each of these patients had a reflux of the duodenal contents into the colonic graft. In monitoring the 24 hour pH of these three patients, one patient had marked acid reflux. Alkaline reflux was not observed. It is concluded that enterogastric reflux is frequent in patients with colonic interposition. Its role in the development of lower colonic graft colitis changes is discussed.
Adolescent↗
Nutritional state after colon interposition for benign oesophageal disease.
The nutritional state of 32 patients after (mean 66 months) colon interposition due to benign oesophageal disease was examined. Forty-four per cent of the patients had depleted iron stores (low serum ferritin concentration). Serum iron and blood haemoglobin concentrations were lower (P less than 0.001) in those with low than in those with normal serum ferritin concentration (115 +/- 12 g/l and 15 +/- 5 mumol/l vs 135 +/- 12 g/l and 23 +/- 9 mumol/l). Most very low blood haemoglobin concentrations (less than 110 g/l) were found in patients with depleted iron stores. Eighteen patients had serum albumin concentrations slightly below (35-39 g/l) the normal range, and two other patients had values less than 35 g/l. The patients had less dietary iron (13 +/- 6 mg/d) than age- and sex-matched controls (19 +/- 7 mg/d), but the intake of patients with depleted iron stores (12 +/- 5 mg/d) was similar to that of patients with normal iron stores (14 +/- 6 mg/d). Symptoms and/or the replacement of colon graft anti- or isoperistaltically did not have any significant association with the nutritional status, only slightly reduced blood haemoglobin and serum albumin concentration were found among the symptomatic patients and the patients with an antiperistaltic graft. Iron therapy and protein supplements, eg, from milk, egg, soy and meat, are recommended as the dietary treatment. To improve the nutritional status a short intra-abdominal colon graft loop anastomosed to the proximal stomach instead of long loop with an antral anastomosis of the present patients is suggested.
Adolescent↗
Dietary habits of patients with regurgitation after colon interposition.
The dietary habits after colon interposition following oesophagectomy in patients without symptoms (n = 8), with regurgitation (n = 22) and in sex- and age-matched healthy controls (n = 20) were studied by a 7-day diary method. The patients ate smaller meals (1080 +/- 90 kJ versus 1810 +/- 151 for the controls, P less than 0.01), more frequently during the day (eight versus five in the controls). Solid and sour foods were preferred, especially by those with regurgitation, compared with controls. The asymptomatic patients consumed more milk and coffee and less cheese, sour milk, meat, fish, eggs, tea and orange juice than the patients with regurgitation. Vegetable fats and medium chain triglycerides were consumed in negligible amounts. The patients with regurgitation had more fluids separately from meals than the asymptomatic patients. The results suggest that intake of vitamin supplements and replacement of animal fats by vegetable fats may be useful in these patients. Much of the dietary difficulties after colon interposition might be the result of the intra-abdominal colon graft loop anastomosed to the antrum; a short graft with a more proximal anastomosis to the lesser curvature merits study in this context.
Body Weight↗
Recurrent ulceration and colopericardial fistula as late complications of colon interposition.
Recurrent ulceration and colopericardial fistula as late complications of colon interposition occurred in a 48-year-old man who had undergone left colon antiperistaltic interposition for esophageal stricture caused by lye corrosion. To our knowledge, this complication has not been reported previously. Although its etiological process remains to be elucidated, this rare entity should be kept in mind after colonic interposition.
Colon↗
Colon interposition in the treatment of carcinoma of the esophagus and gastric cardia.
The stomach is the organ most used for restoring esophageal continuity after esophageal resection for malignancy. In the present series, we report our experience over a 20-year period (1965 through 1984) with an alternative method, colon interposition. Two hundred forty-eight patients (124 men and 124 women) underwent colon interposition. Seventy-one percent (175) of the tumors were squamous cell carcinomas, and 23% (58) were adenocarcinomas in the gastric cardia and lower esophagus. The left colon was the substitute of first choice and was used in 54% of the patients. Of the interpositions, 59% were antiperistaltic. Esophagectomy without thoracotomy was the method in 146 patients. The operative mortality was 16% (40 patients), and 3% (8 patients) sustained colon graft necrosis. Leakage in the upper anastomosis occurred in 4% (10). No dysphagia was experienced by 85%, 80%, and 76% of the patients during reexaminations 3, 6, and 12 months, respectively, after operation. The 1-year and 5-year survival for patients with squamous cell carcinoma was 40% and 10%, respectively, and for patients with adenocarcinoma, 50% and 12%, respectively. The data from this study suggest that colon interposition offers a good alternative for long-term relief of dysphagia in patients with carcinoma of the esophagus. The rate of complications is acceptable.
Adenocarcinoma↗
Colon interposition. Long-term radiographic results.
Colon interposition was carried out in 12 patients with oesophageal carcinoma and on 38 patients with benign oesophageal disease an average of 71 months before the radiographic examination. Various ischaemic changes including "jejunization", loss of haustration and stricture formation were observed in 15 cases. In 12 patients one or several diverticula were seen in the colon graft. Reflux was observed in 17 cases in supine position. Double contrast technique in the examination of interposed colon is recommended.
Adolescent↗
Functional evaluation of interposed colon in esophagus. Manometric and 24-hour pH observations.
Colon interposition was performed on 22 patients for benign esophageal disease which had not responded to medical or other surgical treatment. Left colon was used as the interposed segment in 17 cases, transverse colon in two and right colon in three cases. All left colon grafts were positioned antiperistaltically. Manometric studies showed no basal or stimulated motor activity in any of the 22 grafts. The peristaltic activity in the esophageal remnant could be demonstrated in four patients. Thirteen patients were studied with 24-hour pH measurements. Distinct acid reflux to the lower colon graft was observed in only one case. Interposed colon thus was confirmed to function as a passive conduit without motor response to swallowing stimuli. The rarity of acid reflux after colon replacement of esophagus probably is due to the vagotomy usually performed during the operation and to the alkalinity of colon mucus.
Adult↗
Radionuclide transit in patients with colon interposition.
To assess radionuclide transit in interposed segments of the colon, we examined 25 patients with colon interposition for benign esophageal disease. No such assessment has been reported previously. The most common indications for operation were esophageal strictures that developed after lye ingestion and reflux strictures not responding to other treatment. The operations were performed without thoracotomy by blunt esophageal dissection in 80% of the patients. There were 18 antiperistaltic and seven isoperistaltic colon grafts. A large-field gamma camera and computer system were used. Data were collected at time intervals of 0.5 second during the first 30 seconds and at intervals of 30 seconds up to 20 minutes. The 5% and 90% stomach filling times, times to 50% and 25% activity levels, and residual activity levels as a percentage of the maxima were calculated in the upper, middle, and lower thirds of the colon grafts and of the normal esophagus of 10 healthy control subjects. The examinations were performed with the subject in a sitting position. All parameters showed that emptying of the colon graft was markedly slower than that of the normal esophagus. The intra-abdominal third of the graft had a residual activity of 50.5% +/- 15.7% after 20 minutes' observation. No differences between antiperistaltic and isoperistaltic grafts were observed. Reconstruction with proximal cologastric anastomosis and a short intra-abdominal colon graft segments is suggested.
Adult↗
Copper sulfate corrosion and necrosis of the esophagus and stomach. Case report.
A case of corrosion and necrosis of the esophagus and stomach after ingestion of fluid containing copper sulfate, ethylene glycol and methanol is presented. Esophagectomy and gastrectomy were performed in a primary stage. Four months later reconstruction was carried out, using a right-sided isoperistaltic segment of colon. The mechanism of caustic chemical ingestion injuries and their treatment are discussed.
Adult↗