The management of the congenital esophageal stenosis is not well established. The authors present an infant with critical esophageal stenosis owing to tracheo bronchial remnant. This lesion was managed successfully by...The management of the congenital esophageal stenosis is not well established. The authors present an infant with critical esophageal stenosis owing to tracheo bronchial remnant. This lesion was managed successfully by circular myectomy of the esophageal wall without resection. An 1-year-old girl was referred for rec urrent vomiting and dysphagia. An esophagogram showed an abrupt stenosis, and en doscopic ultrasonography showed cartilaginous tracheo bronchial remnants within the esophageal wall. The extirpation of muscular lay er, which contained cartilage, was attempted. Circular muscular layer was resect ed in 1 cm width leaving mucosal layer intact. Muscular layer was closed horizon tally with absorbable sutures. The patient is free from the symptoms and eats no rmally 1 year after surgery. In case of short segmental stenosis owing to trache obronchial remnant, this may be the preferred approach.展开更多
A 52- year-old man underwent colonoscopy following preparation with polyethylene glycol- electrolyte lavage solution (PEG- ELS), which revealed a flat elevated lesion with an irregular depression in the rectum. Three ...A 52- year-old man underwent colonoscopy following preparation with polyethylene glycol- electrolyte lavage solution (PEG- ELS), which revealed a flat elevated lesion with an irregular depression in the rectum. Three days after this colonoscopy, flexible sigmoidoscopy was performed after preparation with a glycerin enema and this examination demonstrated an irregular depressed lesion which was not associated with a surrounding elevated lesion. Seven days after the flexible sigmoidoscopy, colonoscopy following preparation with PEG- ELS revealed an elevated lesion surrounding the depressed lesion. Fourteen days after this second colonoscopy, flexible sigmoidoscopy following preparation with a glycerin enema showed a depressed lesion and an endoscopic mucosal resection was performed: histological examination revealed the tumor to be a well- differentiated adenocarcinoma. We report a patient in whom PEG- ELS led to the reversible appearance of an elevated lesion around a minute rectal cancer and believe that this reactive elevated lesion might prove to be a useful clue in the detection of minute rectal cancers.展开更多
PURPOSE: Rectal stump washout has been recommended to prevent implantation of exfoliated malignant cells in the anastomosis after anterior resection for rectal cancer. The aim of this study was to investigate its effi...PURPOSE: Rectal stump washout has been recommended to prevent implantation of exfoliated malignant cells in the anastomosis after anterior resection for rectal cancer. The aim of this study was to investigate its efficacy, particularly the extent to which the volume of irrigation fluid might influence the efficacy of tumor cell elimination and whether tumor characteristics might influence the result. METHODS: The study comprised 30 consecutive patients operated on by anterior resection for rectal cancer. After cross clamping the rectum below the tumor, a washout sample was collected for examination after every incremental 500 ml of saline irrigation up to 2 liters. The presence of shed cancer cells was correlated with the washout volume and tumor characteristics. RESULTS: Cancer cells were found in 29 of 30 patients (97 percent) in the first sample of irrigation fluid and decreased gradually in frequency and number with increasing irrigation volumes. No cancer cells were demonstrated after 1.5 liters of irrigation in patients with tumor below the peritoneal reflection, whereas cancer cells were still present in one fourth of the patients with tumor located above the peritoneal reflection. Finally, only a small number of cancer cells was confirmed in one patient after 2 liters of irrigation. CONCLUSIONS: The irrigation volume determined the efficacy of rectal washout. With our method, 1 1/2 liters of saline irrigation appears to clear contents from cancer cells in patients with tumors below the peritoneal reflection whereas at least 2 liters is recommended for patients with tumor above the peritoneal reflection.展开更多
文摘The management of the congenital esophageal stenosis is not well established. The authors present an infant with critical esophageal stenosis owing to tracheo bronchial remnant. This lesion was managed successfully by circular myectomy of the esophageal wall without resection. An 1-year-old girl was referred for rec urrent vomiting and dysphagia. An esophagogram showed an abrupt stenosis, and en doscopic ultrasonography showed cartilaginous tracheo bronchial remnants within the esophageal wall. The extirpation of muscular lay er, which contained cartilage, was attempted. Circular muscular layer was resect ed in 1 cm width leaving mucosal layer intact. Muscular layer was closed horizon tally with absorbable sutures. The patient is free from the symptoms and eats no rmally 1 year after surgery. In case of short segmental stenosis owing to trache obronchial remnant, this may be the preferred approach.
文摘A 52- year-old man underwent colonoscopy following preparation with polyethylene glycol- electrolyte lavage solution (PEG- ELS), which revealed a flat elevated lesion with an irregular depression in the rectum. Three days after this colonoscopy, flexible sigmoidoscopy was performed after preparation with a glycerin enema and this examination demonstrated an irregular depressed lesion which was not associated with a surrounding elevated lesion. Seven days after the flexible sigmoidoscopy, colonoscopy following preparation with PEG- ELS revealed an elevated lesion surrounding the depressed lesion. Fourteen days after this second colonoscopy, flexible sigmoidoscopy following preparation with a glycerin enema showed a depressed lesion and an endoscopic mucosal resection was performed: histological examination revealed the tumor to be a well- differentiated adenocarcinoma. We report a patient in whom PEG- ELS led to the reversible appearance of an elevated lesion around a minute rectal cancer and believe that this reactive elevated lesion might prove to be a useful clue in the detection of minute rectal cancers.
文摘PURPOSE: Rectal stump washout has been recommended to prevent implantation of exfoliated malignant cells in the anastomosis after anterior resection for rectal cancer. The aim of this study was to investigate its efficacy, particularly the extent to which the volume of irrigation fluid might influence the efficacy of tumor cell elimination and whether tumor characteristics might influence the result. METHODS: The study comprised 30 consecutive patients operated on by anterior resection for rectal cancer. After cross clamping the rectum below the tumor, a washout sample was collected for examination after every incremental 500 ml of saline irrigation up to 2 liters. The presence of shed cancer cells was correlated with the washout volume and tumor characteristics. RESULTS: Cancer cells were found in 29 of 30 patients (97 percent) in the first sample of irrigation fluid and decreased gradually in frequency and number with increasing irrigation volumes. No cancer cells were demonstrated after 1.5 liters of irrigation in patients with tumor below the peritoneal reflection, whereas cancer cells were still present in one fourth of the patients with tumor located above the peritoneal reflection. Finally, only a small number of cancer cells was confirmed in one patient after 2 liters of irrigation. CONCLUSIONS: The irrigation volume determined the efficacy of rectal washout. With our method, 1 1/2 liters of saline irrigation appears to clear contents from cancer cells in patients with tumors below the peritoneal reflection whereas at least 2 liters is recommended for patients with tumor above the peritoneal reflection.
